scholarly journals Treating the boxer's fracture in Wales: a postal survey

2010 ◽  
Vol 92 (3) ◽  
pp. 236-239 ◽  
Author(s):  
Rhidian Jones ◽  
Sadie Burdett ◽  
Matthew Jefferies ◽  
Abhijit R Guha
Keyword(s):  
Best Practice ◽  
Current Practice ◽  
Response Rate ◽  
Plaster Cast ◽  
Postal Questionnaire ◽  
Postal Survey ◽  
Outcome Study ◽  
Best Practice Guidelines ◽  
Boxer’S Fracture

INTRODUCTION There is no standardised treatment for fifth metacarpal neck fractures. Treatment of this common fracture can vary from immediate mobilisation to immobilisation in a plaster cast for 3 weeks. There is no literature identifying current practice amongst surgeons. SUBJECTS AND METHODS This survey's aim was to reveal current practice in Wales by means of a postal questionnaire sent to all Welsh orthopaedic consultants. RESULTS The questionnaire had a 60% response rate. Results demonstrated varied opinion regarding the degree of displacement warranting reduction. Overall, 10% of surgeons reduce the fracture at 30° of displacement, 29% at 40°, 18% at 50° and 20% at 60° of displacement. The treatment was also very varied. Most surgeons preferred to treat these fractures with neighbour strapping (43%,) while others preferred plaster immobilisation (39%) or immediate mobilisation (10%.) Only 22% of surgeons discharge these patients back to the community after their first visit to out-patients while 13% offer two follow-up appointments. CONCLUSIONS The treatment being offered for this common fracture in Wales is inconsistent. There is a need to develop evidence- based best practice guidelines which should standardise the treatment of this common injury. Perhaps, a large multicentre outcome study may enable this to be drawn up in the future.

A health screening and promotion clinic to improve metabolic monitoring for patients prescribed antipsychotic medication

2013 ◽  
Vol 30 (2) ◽  
pp. 113-118 ◽  
Author(s):  
D. Gallagher ◽  
M. Buckley ◽  
C. Kenny ◽  
C. Onwudiwe ◽  
C. Young ◽  
...  
Keyword(s):  
Antipsychotic Medication ◽  
Practice Guidelines ◽  
Best Practice ◽  
Health Screening ◽  
Local Resource ◽  
Blood Tests ◽  
Best Practice Guidelines ◽  
Metabolic Monitoring

ObjectivesWe sought to determine whether the introduction of a health screening and promotion clinic might serve as a useful addition to existing services for patients prescribed antipsychotic medication. In particular, we wished to assess whether such a clinic might improve adherence to best practice guidelines. We also wished to determine the level of patient interest in such a clinic and how readily this service might be provided within the constraints of existing clinical resources.MethodsWe conducted an audit of outpatient records before and following the introduction of a health screening and promotion clinic.ResultsOf the eligible patients, 73% attended the clinic. The proportion of patients who had fasting blood tests within the previous 12 months increased from 45% at baseline to 85% at follow-up (χ2 = 14.1, p < 0.001). The proportion of patients with appropriate physical observations completed increased from 5% at baseline to 80% at follow-up (χ2 = 46.0, p < 0.001).ConclusionsWe found that the introduction of a health screening and promotion clinic improved adherence to best practice guidelines. This service was well received and readily provided within the constraints of existing resources. Ultimately, the structure of services to screen and advise patients prescribed antipsychotic medication will be determined by local resource considerations and configuration of services.

Service response to benzodiazepine use in opiate addicts: a national postal survey

2005 ◽  
Vol 22 (1) ◽  
pp. 15-18 ◽  
Author(s):  
Hugh Williams ◽  
Doug Handyside ◽  
Kirsty Bashford ◽  
Adenekan Oyefeso
Keyword(s):  
Current Practice ◽  
Postal Questionnaire ◽  
Postal Survey ◽  
Common Source ◽  
Prescribing Practices ◽  
Service Community ◽  
Treatment Services ◽  
Benzodiazepine Dependence ◽  
Benzodiazepine Use ◽  
Opiate Addicts

AbstractObjectives: The study reports on benzodiazepine use among opiate dependent patients attending National Health Service community prescribing services and examines current practice in the clinical management of benzodiazepine dependence.Method: A postal questionnaire survey of 174 NHS substance misuse services in England and Wales.Results: A 71% response rate was achieved. Services estimated the prevalence of benzodiazepine use to be 40% and the prevalence of benzodiazepine dependence to be less than 25% among opiate dependent patients in treatment. Illicit supplies (street) and general practitioners were regarded as the most common source of benzodiazepines. The most commonly reported reasons for benzodiazepine use were for the direct intoxicating effects and for the treatment of anxiety/insomnia. The majority of services (93,75%) reported prescribing benzodiazepines to patients for benzodiazepine detoxification while 43 (35%) reported prescribing for benzodiazepine maintenance treatment. The variations in benzodiazepine prescribing practices across services are described.Conclusions: Benzodiazepine use remains common among opiate addicts in contact with treatment services. The majority of services surveyed reported prescribing benzodiazepines but there was much variation in clinical practice nationally. There is need for further research to identify effective treatment approaches for comorbid benzodiazepine dependence in opiate misusers.

scholarly journals 84 Optimising The Assessment and Management of Acute Renal Colic in Secondary Care

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
T Fonseka ◽  
R Ellis ◽  
A Gowda ◽  
L Tuckwood ◽  
A Careless ◽  
...  
Keyword(s):  
Best Practice ◽  
Current Practice ◽  
Renal Colic ◽  
Electronic Patient Records ◽  
X Ray ◽  
Improved Outcomes ◽  
Acute Renal Colic ◽  
The Impact ◽  
First Time

Abstract Aim The latest guidance in acute renal colic states that patients should have serum calcium and urate (stone bloods) measured during inpatient admission. The guidance also states that follow-up imaging should be in the form of computed tomography (CT)-, ultrasound (USS)-, or X-ray- kidney, ureters and bladder (KUB). X-ray intravenous urogram (IVU) is now considered obsolete as it can result in over-exposing patients to radiation. Aims of this 2-cycle QIP were twofold; Method Data was extracted from electronic patient records on whether or not they had stone bloods measured during admission and also what follow-up imaging was requested. In the first cycle baseline data was extracted. A stone proforma was then created, incorporating the latest guidelines. In the second cycle the impact of the stone proforma was assessed. Results The study included 119 patients. After introducing the stone proforma we were successful in improving the rate of stone bloods being measured, increasing from 13% to 53%. We were also successful in reducing the rate of performing X-ray IVU, decreasing from 25% to 14% of patients. Conclusions This QIP demonstrates that management of acute renal colic can be optimised using a stone proforma and move current practice towards best practice. This is supported by the ‘Getting it Right First Time’ (GIRFT) Urology report 2018. The third cycle is currently underway, and we hope to see further improved outcomes.

scholarly journals Non-randomised evaluations of strategies to increase participant retention in randomised controlled trials: a systematic review

2020 ◽  
Vol 9 (1) ◽  
Author(s):  
Adel Elfeky ◽  
Katie Gillies ◽  
Heidi Gardner ◽  
Cynthia Fraser ◽  
Timothy Ishaku ◽  
...  
Keyword(s):  
Systematic Review ◽  
Clinical Trials ◽  
Response Rate ◽  
Postal Questionnaire ◽  
Risk Of Bias ◽  
Randomised Trials ◽  
Questionnaire Response ◽  
Retention Strategies ◽  
Participant Retention

Abstract Background Retention of participants is essential to ensure the statistical power and internal validity of clinical trials. Poor participant retention reduces power and can bias the estimates of intervention effect. There is sparse evidence from randomised comparisons of effective strategies to retain participants in randomised trials. Currently, non-randomised evaluations of trial retention interventions embedded in host clinical trials are rejected from the Cochrane review of strategies to improve retention because it only included randomised evaluations. However, the systematic assessment of non-randomised evaluations may inform trialists’ decision-making about retention methods that have been evaluated in a trial context.Therefore, we performed a systematic review to synthesise evidence from non-randomised evaluations of retention strategies in order to supplement existing randomised trial evidence. Methods We searched MEDLINE, EMBASE, and Cochrane CENTRAL from 2007 to October 2017. Two reviewers independently screened abstracts and full-text articles for non-randomised studies that compared two or more strategies to increase participant retention in randomised trials. The retention trials had to be nested in real ‘host’ trials ( including feasibility studies) but not hypothetical trials. Two investigators independently rated the risk of bias of included studies using the ROBINS-I tool and determined the certainty of evidence using GRADE (Grading of Recommendations Assessment, Development and Evaluation) framework. Results Fourteen non-randomised studies of retention were included in this review. Most retention strategies (in 10 studies) aimed to increase questionnaire response rate. Favourable strategies for increasing questionnaire response rate were telephone follow-up compared to postal questionnaire completion, online questionnaire follow-up compared to postal questionnaire, shortened version of questionnaires versus longer questionnaires, electronically transferred monetary incentives compared to cash incentives, cash compared with no incentive and reminders to non-responders (telephone or text messaging). However, each retention strategy was evaluated in a single observational study. This, together with risk of bias concerns, meant that the overall GRADE certainty was low or very low for all included studies. Conclusions This systematic review provides low or very low certainty evidence on the effectiveness of retention strategies evaluated in non-randomised studies. Some strategies need further evaluation to provide confidence around the size and direction of the underlying effect.

Current management of popliteal fossa incompetent superficial venous systems

2007 ◽  
Vol 22 (4) ◽  
pp. 179-185 ◽  
Author(s):  
A Kambal ◽  
C Bicknell ◽  
M Najem ◽  
S Renton ◽  
S T Hussain
Keyword(s):  
Current Practice ◽  
Varicose Veins ◽  
Postal Questionnaire ◽  
Popliteal Fossa ◽  
Duplex Scanning ◽  
Initial Assessment ◽  
Current Management ◽  
Skin Changes

Objectives: Controversy exists regarding the management of varicose veins at the level of the popliteal fossa. This questionnaire reviews the current practice of vascular surgeons. Methods: A postal questionnaire was sent to 440 consultant surgeon members of the Vascular Society of Great Britain and Ireland. Recipients were asked to indicate their current practice of investigation and management of small saphenous (SSV), gastrocnemius and Giacomini varicosities. Results: We have received 296 (67%) responses to the questionnaire. Duplex scanning is utilized by 275 (93%) for the initial assessment of patients. Preoperatively, 188 (64%) reuse duplex scanning to mark the saphenopopliteal junction (SPJ) site, 53 (18%) mark with handheld Doppler only and 24 (8%) do not mark the SPJ. At operation, 198 (67%) flush ligate the SPJ and 87 (29%) tie the SSV 2–3 cm from the junction. A total of 101 (34%) usually strip the SSV to various levels. In symptomatic patients, 158 (53%) ligate the SPJ when an incompetent segment of SSV with a competent SPJ exists. One hundred and sixty-nine (57%) disconnect incompetent gastrocnemius veins during SPJ surgery and 172 (58%) regularly look for the Giacomini vein. Routine follow-up after surgery is practised by 172 (58%), most commonly at six weeks. This is mostly (88%) by clinical examination, with 14 (8.1%) using duplex scanning and six (4.7%) using a nurse-run clinic for the follow-up. Conclusions: This review suggests marked variation in the management of popliteal fossa venous incompetence. There is a clear need for further research to clarify the role of ablation in the management of symptoms and skin changes.

scholarly journals Diagnosing chronic rhinosinusitis: comparing questionnaire-based and clinical-based diagnosis

2013 ◽  
Vol 51 (2) ◽  
pp. 128-136
Author(s):  
B. Lange ◽  
T. Thilsing ◽  
J. Baelum ◽  
R. Holst ◽  
A. Kjeldsen
Keyword(s):  
Chronic Rhinosinusitis ◽  
Regression Models ◽  
Epidemiological Studies ◽  
Postal Questionnaire ◽  
Postal Survey ◽  
Position Paper ◽  
Kappa Statistics ◽  
Logistic Regression Models ◽  
High Level

Background: The European Position Paper on Rhinosinusitis and Nasal Polyps (EP3OS) incorporates symptomatic and endo- scopic criteria in the clinical diagnosis of chronic rhinosinusitis (CRS), while in epidemiological studies the definition is based on symptoms only. The aim of this study was to evaluate the correlation between questionnaire-based and clinical-based CRS. Methods: Based on the GA2LEN postal survey data a total of 366 persons participated at the follow-up at the Danish centre and provided information on questionnaire-based CRS. At the same occasion the 366 participants underwent clinical inter- view and examination by an otorhinolaryngologist to provide information for a clinical-based CRS diagnosis. The association between questionnaire-based and clinical-based CRS diagnosis was determined using logistic regression models and kappa statistics. Results: Mean age of respondents to the postal questionnaire was 45.3 years and 52.9% were female. Persons with asthma were 8.4 % and 26.2 % were actual smokers. There was moderate agreement between questionnaire-based and clinical-based CRS. Sensitivity was [corrected] low comparing questionnaire-based CRS with clinical-based CRS. Incorporation of self reported CRS and medical history in diagnosing CRS by questionnaire increased increased [corrected] the agreement and sensitivity while specificity stayed at a high level. [corrected] Conclusion: Evaluating the correlation between questionnaire-based and clinical-based CRS showed only moderate agree- ment and questions whether they evaluate the same disease. It brings into consideration that adjustments are needed to justify correlation between questionnaire-based and clinical-based diagnosis of CRS.

Clinical management of acute low back pain in elite and subelite rowers: a Delphi study of experienced and expert clinicians

2021 ◽  
pp. bjsports-2020-102520
Author(s):  
Kellie Wilkie ◽  
Jane S Thornton ◽  
Anders Vinther ◽  
Larissa Trease ◽  
Sarah-Jane McDonnell ◽  
...  
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Delphi Study ◽  
Best Practice ◽  
Response Rate ◽  
Future Research ◽  
Original Research ◽  
Low Back ◽  
Acute Low Back Pain ◽  
Best Practice Guidelines

ObjectivesRowing-related low back pain (LBP) is common but published management research is lacking. This study aims to establish assessment and management behaviours and beliefs of experienced and expert clinicians when elite and subelite rowers present with an acute episode of LBP; second, to investigate how management differs for developing and masters rowers. This original research is intended to be used to develop rowing-related LBP management guidelines.MethodsA three-round Delphi survey was used. Experienced clinicians participated in an internet-based survey (round 1), answering open-ended questions about assessment and management of rowing-related LBP. Statements were generated from the survey for expert clinicians to rate (round 2) and rerate (round 3). Consensus was gained when agreement reached a mean of 7 out of 10 and disagreement was 2 SD or less.ResultsThirty-one experienced clinicians participated in round 1. Thirteen of 20 invited expert clinicians responded to round 2 (response rate 65%) and 12 of the 13 participated in round 3 (response rate 92%).One hundred and fifty-three of 215 statements (71%) relating to the management of LBP in elite and subelite rowers acquired consensus status. Four of six statements (67%) concerning developing rowers and two of four (50%) concerning masters rowers gained consensus.ConclusionIn the absence of established evidence, these consensus-derived statements are imperative to inform the development of guidelines for the assessment and management of rowing-related LBP. Findings broadly reflect adult LBP guidelines with specific differences. Future research is needed to strengthen specific recommendations and develop best practice guidelines in this athletic population.

scholarly journals Seismic retrofitting of Māori wharenui in Aotearoa New Zealand

2019 ◽  
Vol 377 (2155) ◽  
pp. 20190003 ◽  
Author(s):  
Ambrosia Crum ◽  
Deidre Brown ◽  
Tūmanako Fa'aui ◽  
Naomi Vallis ◽  
Jason M. Ingham
Keyword(s):  
Best Practice ◽  
Current Practice ◽  
Expert Knowledge ◽  
Knowledge Bases ◽  
Seismic Retrofitting ◽  
Theme Issue ◽  
Best Practice Guidelines ◽  
Aotearoa New Zealand ◽  
Dual Interpretation ◽  
Level Analysis

The design of Māori wharenui (meeting houses), refined over the last 180 years, has given rise to a distinctive typology that demonstrates an understanding of tectonic-narrative expression. It is a visual codex designed to be read. Set within the context of pre-disaster readiness, this current study investigated the resilience of Māori buildings and communities through a dual interpretation of seismic, regulatory and historical frameworks. The literature on Māori building technologies scarcely addresses matters of resilience and there is currently no formalized methodology to guide wharenui seismic retrofit practice. Through a macro level analysis of recently completed retrofit projects, this current study identified issues present in current practice. The resulting research presented a pathway for the future development of an approach (to inform methodologies) and strategy (to build capability) founded on the recognition of wharenui as a new category of building within building regulations. It is also recommended that research continues to develop alternative engineered solutions, expert knowledge bases and best practice guidelines. This article is part of the theme issue ‘Environmental loading of heritage structures’.

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