Prognostic level I. See Instructions for authors for a complete description of levels of evidence.

Prognostic study, Level 4.

Introduction:As the number of patients sustaining hip fractures increases, interventions aimed at improving patient comfort and reducing complication burden acquire increased importance. Frailty, cognitive impairment, and difficulty in assessing pain control characterize this population. In order to inform future care, a review of pain assessment and the use of preoperative intravenous paracetamol (IVP) is presented.Materials and Methods:Systematic review of preoperative IVP administration in patients presenting with a hip fracture.Results:Intravenous paracetamol is effective in the early management of pain control in the hip fracture population. There is a considerable decrease in use of breakthrough pain medications when compared with other pain relief modalities. Additionally, IVP reduces the incidence of opioid-induced complications, reduces length of stay, and lowers mean pain scores. Another significant finding of this study is the poor administration of all analgesics to patients with hip fracture with up to 72% receiving no prehospital analgesia.Discussion:The potential benefits of IVP as routine in the early management of hip fracture-related pain are clear. Studies of direct comparison between analgesia regimes to inform optimum bundles of analgesic care are sparse. This study highlights the need for properly constructed pathway-driven comparator studies of contemporary analgesia regimes, with IVP as a central feature to optimize pain control and minimize analgesia-related morbidity in this vulnerable population.

No abstract

The aims of this study were to identify the common components of the Minimum Data Set (MDS) of current national shoulder arthroplasty registries that could be pooled for analysis; and to determine whether further harmonisation of data collection across these registries would be feasible. Copies of primary shoulder arthroplasty MDS forms, annual reports, and other publications from national shoulder arthroplasty registries were identified using internet search engines up to November 2016. Data relating to local or regional registries was excluded. There were nine national shoulder arthroplasty registries reporting a total of 97,388 primary shoulder replacements. All minimum data sets included patient identifiers, date of surgery, implant identification, laterality of surgery, indication and mode of implant fixation. At least 6 registries had common options within the categories of indication, implant fixation and previous operations. Most discrepancies were seen in categories for additional interventions, outcome measures, and intraoperative complications. As numbers within individual registries are relatively small, international collaboration would harness the global strength of knowledge and experience in shoulder replacement. Several similarities were identified between the current national registries that could become unified with only minor changes by a few registries, highlighting the potential feasibility of MDS harmonisat.