National databases, such as the Irish Hip Fracture Database (IHFD), are known to contain inaccuracies. The coordination of services, national funding and future research rely on the integrity of the IHFD so as to avoid policy and budget planning being based on misrepresentative data. An audit was performed to assess the accuracy of the 2016 IHFD data collected in our trauma unit. The Hospital In-Patient Enquiry (HIPE)-recorded fracture classification, IHFD-recorded fracture classification and IHFD-recorded operation performed for each hip fracture patient was identified. Each variable was compared with the classifications and procedures derived by the authors. Two hundred fifty-two cases were identified. The HIPE-recorded fracture classification was accurate in 29% of cases, and the IHFD-recorded fracture classification in 61% (p < 0.001). The IHFD-recorded operation performed was accurate in 76% of cases. Thirty-six cases (14%) were omitted by HIPE, and eight (3%) from the local IHFD (p < 0.001). Errors resulted from poor documentation, in determining the presence of fracture displacement, prosthesis coating and intramedullary nail length. Diagnoses and procedures were identified from ward and theatre logbooks that the data coordinator was unable to record. The data coordinator in our unit doubled the accuracy of the data, and reduced the rate of omitted cases by a factor of 4.5. Accuracy levels would be significantly improved with clear, thorough documentation by the medical team following education of junior surgical trainees on hip fracture classification and procedural coding. Inaccurate data has a negative effect on hospital reimbursement and compromises the integrity of the IHFD.
BackgroundLaparoscopy has revolutionized the surgical field with the advent of minimally invasive techniques leading to smaller surgical wounds, enhanced recovery, early discharge from the hospital and early return to work. Since the initiation of three‐dimensional (3D) systems, studies have failed to prove significant advantages over traditional two‐dimensional systems which could be attributed to suboptimal image quality, poor illumination and high cost of earlier systems. Recent advances in stereoscopy have led to the introduction of high‐definition (HD) systems with improvement in image quality in both two‐dimensional and 3D systems. With HD and new 4K imaging system, the previous data are now obsolete.MethodsWe devised a cross‐over study using the Olympus 4K camera imaging system compared with the HD 3D systems using 40 novice surgeons with no prior surgical skills to perform standardized surgical tasks and the groups were crossed over to assess any difference in the learning curve with the imaging systems.ResultsThe data showed a statistically significant difference in errors performed with the 3D imaging system with reduction in errors for passing needle through a ring, knot tying, cutting circle and touching circles with a needle. The time taken to perform those tasks was comparable except in knot tying where there was significant reduction in the time taken to tie knots with a P‐value of <0.001 in both groups.ConclusionThe study showed no significant difference in the time to perform tasks. The precision of the tasks was significantly improved with the 3D systems.
Segmental colonic volvulus involving the sigmoid or ileocaecal region is an important cause of large bowel obstruction and a well-established surgical emergency. Volvulus of the entire colon however is hazardously rare, in which case the diagnosis is likely to be made intraoperatively. The surgeon is then faced with the conundrum of the best surgical management, especially in the case of early intervention with viable bowel. To our knowledge this has never been reported.
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