BackgroundPatients post total hip arthroplasty (THA) remain at high risk of developing Deep Vein Thrombosis (DVT) during the recovery period following surgery despite the availability of effective pharmacological and mechanical prophylactic methods. The use of calf muscle neuromuscular electrical stimulation (NMES) during the hospitalised recovery period on this patient group may be effective at preventing DVT. However, the haemodynamic effectiveness and comfort characteristics of NMES in post-THA patients immediately following surgery have yet to be established.MethodsThe popliteal veins of 11 patients, who had undergone unilateral total hip replacement surgery on the day previous to the study, were measured using Doppler ultrasound during a 4 hour neuromuscular electrical stimulation (NMES) session of the calf muscles. The effect of calf muscle NMES on peak venous velocity, mean venous velocity and volume flow were compared to resting values. Comfort was assessed using a 100mm non-hatched visual analogue scale taken before application of NMES, once NMES was initiated and before NMES was withdrawn.ResultsIn the operated limb NMES produced increases in peak venous velocity of 99% compared to resting. Mean velocity increased by 178% compared to resting and volume flow increased by 159% compared to resting. In the un-operated limb, peak venous velocity increased by 288%, mean velocity increased by 354% and volume flow increased by 614% compared to basal flow (p<0.05 in all cases). There were no significant differences observed between the VAS scores taken before the application of NMES, once NMES was initiated and before NMES was withdrawn (p=.211).ConclusionsNMES produces a beneficial hemodynamic response in patients in the early post-operative period following orthopaedic surgery. This patient group found extended periods of calf-muscle NMES tolerable.Trial registrationClinicalTrials.gov NCT01785251
Virtual review of orthopaedic trauma patients results in satisfactory patient outcomes. Clinical outcomes were acceptable with minimal additional medical attention required following injury. Electronic transfer of information allows for the virtual service to operate from sites long distances from the primary orthopaedic centre. The NIMIS is a safe and confidential means of collaborating with other institutions and has huge potential in the areas of trauma care delivery, clinical conferencing and other image-based disciplines.
Background The use of virtual fracture clinics across the United Kingdom and Ireland is growing and have been shown in an increasing number of studies to be safe, cost-effective and associated with good functional outcomes and patient satisfaction rates for certain fracture types. Initially pioneered at Glasgow Royal Infirmary, many centres have adopted similar templates, or variations of, and the overall aim of this study was to assess functional outcomes and injury recovery satisfaction rates of patients discharged directly following review in a specific virtual fracture clinic model known as the Trauma Assessment Clinic (TAC). Methods A prospective observational study was carried out of paediatric (aged <17 years) and adult (aged >17 years) patients, with the five most commonly observed fracture types, who were discharged directly following review at the TAC in a single hospital centre over a 12 month period from January to December 2018. Primary and secondary outcomes were assessed via telephone administered questionnaires and patient reported outcome measures (PROMs). Results A total of 198 patients were included in the study (n = 98 paediatric and n = 100 adult). Overall, 192 (97%) patients or parents/guardians of patients stated that they either strongly agreed (n = 148, 74.9%) or agreed (n = 44, 22.1%) that they were satisfied with their own or their child's recovery from their injury at a median follow-up of 9 months post direct discharge from the TAC. Adult patients had an EQ-5D-5L index median value of 1 (range 0-1), an EQ-VAS median of 87 (range 0-100), a QuickDASH median score of 0 (range 0-100) and a median LEFS of 80 (range 0–80). Conclusion The virtual management of trauma patients via the TAC model is a safe and patient-centred approach to treating certain injuries and fracture patterns. This study reports excellent patient reported outcome measures and patient injury recovery satisfaction rates. The use of current available technology in tandem with up-to-date best clinical practice and guidelines play a central role in this novel care pathway.
Introduction Reporting of adverse events in medicine is an important concept. It is widely accepted that a key element of any healthcare service is the approach that is adopted towards reporting adverse events. Government legislation and the increased number of patient safety initiatives with widespread discussion within the medical literature marks adverse event reporting as an important topic for analysis. Methods The Clinical Indemnity Scheme (CIS) provides risk advisory services to state authorities in Ireland. This study will focus on 42,094 adverse events reported across all surgical specialties to the CIS via a confidential weblink (STARSWeb) since 2004. The most common features of each adverse event and closed medicolegal claims processed by the CIS were reviewed as part of this study. Results The majority of reported adverse events occur in orthopaedic and general surgery (73% of all cases). Slips/trips/falls are the most common adverse event reported. Doctors report only 4% of the total number of adverse events. The month of October records the highest number of adverse events with the highest frequency of adverse events taking place before 13:00 each day. The most common incident type which resulted in a claim being closed by the CIS was the perioperative/periprocedure incident (50% of all cases). Conclusions The CIS report a significant number of adverse events across a range of surgical specialties. A pattern of adverse events being reported during 'daylight' hours gives a clear indication that routine surgical operations and procedures carry with them a risk for injury to the patient. Particular months of the year and time of the day are more likely to be associated with reported adverse events. This pattern of events should be highlighted in an attempt to promote safer surgical practice within hospitals during particular times of the day, month or year.
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