Sustained virological response is durable in patients treated for hepatitis C virus. Recurrence rates are generally low but increase in patient populations with risk factors for reinfection. The evidence supports the notion that risk of recurrence is driven by reinfection.

The results of this meta-analysis suggest that there is a significant survival benefit of achieving an sustained virologic response compared with unsuccessful treatment in the general hepatitis C virus-infected population. This benefit is held in patients with cirrhosis and those coinfected with human immunodeficiency virus.

Background Despite advancements in primary correction of hallux valgus (HV), significant rates of reoperation remain across common techniques, with complications following primary correction up to 50% according to some studies.1 This study explored different methods of surgery currently used in treating HV recurrence specifically (for which literature on the subject has been limited), evaluating open and adapted minimally invasive surgical (MIS) primary techniques used for revision. Methods In December 2020, literature search for both open and MIS surgical techniques in HV revision was conducted using PubMed, EMBASE, and MEDLINE library databases. Results and Conclusion Of initial 143 publications, 10 were finally included for data synthesis including 273 patients and 301 feet. Out of 301 feet, 80 (26.6%) underwent revision with MIS techniques (involving distal metatarsal osteotomies). Those undergoing grouped MIS revisions had an average improvement of 38.3 in their American Orthopaedic Foot and Ankle Society score, compared to 26.8 in those using open techniques. Revision approaches using grouped MIS techniques showed a postoperative reduction in intermetatarsal angle and HV angle of 5.6 and 18.4 degrees, respectively, compared to 15.5 and 4.4 degrees, respectively, for open techniques. There are, however, limitations in the current literature on MIS techniques in revision HV surgery specifically. MIS techniques grouped did not show worse outcomes or safety concerns compared to open techniques.

Introduction Numerous minimally invasive techniques have been developed for Hallux Valgus in recent years. Third-generation Minimally Invasive Chevron Akin (MICA) osteotomy has shown promising early results, but longer-term follow-up is required to assess whether patient clinical and radiological improvement is sustained. This cohort study presents three-year follow-up outcomes for patients of a single surgeon case series. Methods Thirty-three patients underwent third-generation MICA surgery between 2017 and 2018. Patient clinical-reported outcome measures included American Orthopaedic Foot & Ankle Society (AOFAS), Manchester-Oxford Foot Questionnaire (MOXFQ) scores, and Coughlin satisfaction. Radiographic outcomes were evaluated after a period of three years using hallux valgus angle (HVA) and inter-metatarsal angle (IMA), and compared to pre- and early post-operative outcomes. Results At 36 months, mean AOFAS scores improved from 48.2 to 95.6, mean MOXFQ scores improved from 57.6 to 6.7. Using the Coughlin scale, 81.8% of patients rated their outcome as ‘Excellent’ and 18.2% as ‘Good’. Radiographic outcomes showed HVA and mean IMA decreased from 34.6 degrees to 16.0 degrees and from 13.1 to 6.1, respectively at 36 months. Conclusion Third-generation MICA demonstrates promising patient satisfaction scores post-operatively, and we have shown these improvements are sustained over a minimum three-year follow-up period. Level of Evidence Level IV, case series.

ObjectivesInpatient falls are the most commonly reported safety incidents and are associated with serious injuries. This study aimed to use multifactorial interventions to reduce the delays to the diagnosis of serious injury in a time series analysis after serious incidents relating to falls within a central London Trust.MethodsA multiprofessional project team undertook process mapping to identify opportunities for improvement at different stages in the management of a fall. The interventions included an educational teaching session aimed at doctors, a lanyard card designed by doctors using the plan-do-study-act methodology, a falls-specific pager for radiographers, and a new system to refer to portering. Quantitative data were obtained using an serious incident database where serious injury occurred (SI data; n = 65) and routinely collected incident reporting database on falls regardless of injury (IR data; n = 178). Qualitative questionnaire data (n = 70) were also used to evaluate doctors’ confidence in falls assessment before and after interventions.ResultsResults in the IR data demonstrated a significant reduction in the median (interquartile range) minutes delay in the time to review a patient after a fall from 81 (43–180) to 51 (26–112; P = 0.003) and the time to order imaging from 102 (45–370) to 50 (33–96; P = 0.04). Analysis of the SI database demonstrated a nonstatistically significant reduction in the overall time taken to detect serious injury after a fall from 348 (126–756) to 192 (108–384) minutes (P = 0.070). Furthermore, analysis using statistical process control charts showed evidence of special cause variation and a shift in the process in detecting serious harm after a fall. Junior doctors’ confidence in investigations improved from 53% to 76% (P = 0.04) after the intervention.ConclusionsThe cumulative application of multiple interventions with small individual effects resulted in a substantial positive effect on delays and variability in diagnosis of serious harm. Given a similar institutional context, the more effective interventions in our study could be adopted elsewhere.