scholarly journals The TROJAN project: creating a customized international orthopedic training program for junior doctors

2015 ◽  
Vol 7 (1) ◽  
Author(s):  
Ashish Kalraiya ◽  
Pranai Buddhdev
Keyword(s):  
South Africa ◽  
Training Program ◽  
Daily Practice ◽  
Junior Doctors ◽  
Neck Of Femur ◽  
Femur Fractures ◽  
Reduction Techniques ◽  
Management Plans ◽  
Musculoskeletal Problems ◽  
The Uk

Musculoskeletal problems account for a vast proportion of presentations encountered by doctors globally, with figures ranging from 15-36%. However, the time medical schools allocate to learning orthopedics is by no means proportional to this. This study aims to bridge this gap by developing an international orthopedic teaching program tailored to the specific knowledge and skills required by junior doctors in different countries. This prospective study asked fifty junior doctors, who had recently completed an orthopedics job, what three orthopedic teaching topics taught retrospectively would have benefitted their clinical practice. The most requested topics were used to design educational workshops for junior doctors and these consequently comprised the TROJAN (Teaching Requested by Orthopaedic Juniors And Novices) training program. Data was collected from twenty-five junior doctors in KwaZulu-Natale State, South Africa, and twenty-five in London, UK. It is therefore in these two countries that the TROJAN program was subsequently made available. Participants who selected topics were within two years of graduating medical school and had worked an orthopedic or Accident and Emergency job within the last year. 49% of topics chosen by SA doctors were practical skills such as wrist and ankle fracture reduction techniques, and management of open fractures. The most requested topic by UK doctors (11 out of 25) was management of neck of femur fractures. This is rationalized by the fact South African doctors require more handson responsibility in their daily practice whereas in the UK greater emphasis is placed on optimizing patients for theatre and making sound management plans. TROJAN currently develops orthopedic skills and knowledge in junior doctors in South Africa and United Kingdom with teaching customized based upon location. Feedback has been exceptionally positive with every candidate thus far rating the usefulness of TROJAN as the highest option, <em>very useful.</em>

Does the Nottingham Hip Fracture Score Help Predict Which Patients Will Benefit From a Modern Modular Hemiarthroplasty for the Treatment of Intracapsular Proximal Femoral Fractures?

2021 ◽  
Author(s):  
Sush Ramakrishna Gowda
Keyword(s):  
Hip Fracture ◽  
Femoral Fractures ◽  
High Volume ◽  
Neck Of Femur ◽  
Residential Status ◽  
Orthopaedic Department ◽  
Femur Fractures ◽  
Modular Prostheses ◽  
The Uk ◽  
To Receive

Introduction: Hemiarthroplasty for the management of intracapsular neck of femur fractures is common but current practice in the UK still varies regionally and individually. Guided by the National Institute of Health and Care Excellence (NICE) we have observed a move towards modern, modular prostheses such as the Exeter V40 Stem but the use of older, monoblock prostheses such as the Thompsons Hemiarthroplasty remains controversial. Use of the Nottingham Hip Fracture Scores (NHFS) can help surgeons stratify patients according to risk and select the most appropriate prosthesis to meet their individual needs. Materials and Methods: 765 hip hemiarthroplasties were analysed over a 28-month period at a single, high-volume, orthopaedic department in the UK. We calculated the NHFS and recorded the choice of prosthesis. Patients were then followed up for at least a year. Outcomes were mortality and change in residential status. Results: Six hundred and forty-six (446) patients were treated with monoblock prostheses (mean age=85.6; range 62-105). 319 patients received modular prostheses (mean age=81.0; range 61-98). Patients who were selected to receive a monoblock prosthesis were over twice as likely to be dead at a year (32.87% vs. 13.65%) and over twice as likely to require increased assistance with living (50.12% vs. 23.81%). Amongst patients with equivocal NHFS, those who receive a monoblock stem suffered worse outcomes in all but the very highest risk group, who experienced lower mortality (OR=0.71, CI 0.52-0.96) and change in residential status (OR=0.76, CI 0.58-0.99). Conclusion: Nottingham Hip Fracture Score (NHFS) can confer predictable outcomes in hip fracture patients treated with modular stems. Modular stems should be the default choice when performing hemiarthroplasties for intracapsular neck of femur fractures. However, in keeping with other studies, we found that in very old, frail, or co-morbid patients, modular stems are not associated with better survival or return to pre-morbid function.

scholarly journals The impact of COVID-19 on acute Trauma and Orthopaedic referrals and surgery in the UK: the "golden peak weeks" of the first national multi-centre observational study. The COVid-Emergency Related Trauma and orthopaedics (COVERT) Collaborative

2020 ◽  
Author(s):  
Kapil Sugand ◽  
Keyword(s):  
Operative Intervention ◽  
National Study ◽  
Orthopaedic Trauma ◽  
Odds Ratios ◽  
Neck Of Femur ◽  
Acute Trauma ◽  
Clinical Encounters ◽  
Femur Fractures ◽  
The Uk ◽  
The Impact

Objectives: This is the first national study observing the impact of the COVID-19 pandemic on orthopaedic trauma with respect to referrals, operative caseload and mortality during the first six weeks (namely the "golden peak weeks") following the introduction of the national social distancing and lockdown measures from mid-March 2020. Design: A longitudinal, national, multi-centre, retrospective, observational, cohort study was conducted for the first six weeks from March 17, 2020 from start of the national social distancing and then lockdown compared to the same period in 2019 as a comparative baseline. Setting: Hospitals from seven major urban cities were recruited around the UK, including London, representing a comprehensive national picture of the impact of COVID-19 pandemic and its lockdown at its peak. Participants: A total of 4840 clinical encounters were initially recorded. Exclusion criterion consisted of spinal pathology only. Post-exclusion, 4668 clinical encounters were recorded and analysed within the two timeframes. Main outcome measures: Primary outcomes included the number of acute trauma referrals and those undergoing operative intervention, patient demographics, mortality rates, and the proportion of patients contracting COVID-19. Secondary outcomes consisted of the mechanism of injury, type of operative intervention and proportion of aerosolising-generating anaesthesia utilised. Demographics for each patient was recorded along with underlying medical co-morbidities. Sub-group analysis compared mortalities between both cohorts. Statistical analyses included mean (+/-SD), risk and odds ratios, as well as Fisher's exact test to calculate the statistical significance (p = 0.05). Results: During the COVID-19 period there was a 34% reduction in acute orthopaedic trauma referrals compared to 2019 (1792 down to 1183 referrals), and 29.5% less surgical interventions (993 down to 700 operations). The mortality rate significantly (both statistically and clinically) more than doubled for both risk and odds ratios during the COVID period in all referrals (1.3% vs 3.8%, p=0.0005) and in those undergoing operative intervention (2.2% vs 4.9%, p=0.004). Moreover, mortality due to COVID-related complications (versus non-COVID causes) had greater odds by a factor of at least 20 times. The odds ratios of road traffic accidents, sporting injuries, infection, and lower limb injuries were significantly less (by a third to a half) during the COVID period; albeit, the odds of sustaining neck of femur fractures and having falls <1.5m increased by more than 50%. For the operative cohorts, there was a greater odds of aerosolising-generating anaesthesia (including those with superimposed regional blocks) by three-quarters as well as doubling of the odds of a Consultant acting as the primary surgeon. Nevertheless, the odds of open reduction and internal fixation reduced by a quarter whereas removal of metalwork or foreign bodies reduced by three-quarters. Six-week Kaplan-Meier survival probability analysis confirmed those patients with neck of femur fracture and pre-existing cardiovascular and cerebrovascular disease were most at risk of mortality during the COVID-19 era. Conclusion: Although there was a reduction of acute trauma referrals and those undergoing operative intervention, the mortality rate still more than doubled in odds during the peak of the pandemic compared to the same time interval one year ago. Elderly patients with neck of femur fractures and existing cardiovascular and cerebrovascular comorbidities were at the highest risk stratification for mortality. This was the first national study to assess impact of COVID-19 pandemic on acute Orthopaedic trauma and it will aid clinicians in counselling trauma patients of the increased risk of mortality during the era of COVID-19 as well as acting as a risk-prediction tool influencing policymaking as the pandemic continues with potential subsequent waves. Further studies after the lifting of the lockdown are also required to observe for return of standard practice.

scholarly journals 1444 Is FBC Being Investigated Within 32 Hours of Surgery in Neck of Femur Fractures?

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
K Lammin ◽  
M Dhingra ◽  
P Mishra ◽  
P Narayan ◽  
L A H Tenang
Keyword(s):  
Emergency Department ◽  
Blood Loss ◽  
Blood Count ◽  
Full Blood Count ◽  
Neck Of Femur ◽  
Femur Fractures ◽  
Post Surgery ◽  
Number Of Patients ◽  
Audit Standard ◽  
The Uk

Abstract Introduction The UK treats approximately 76,000 neck of femur (NOF) fractures annually (NHFD 2018). These patients are known to be frail and dehydrated upon arrival to the emergency department. Surgery can expose patients to substantial blood loss both preoperatively and postoperatively (Foss et al). Furthermore, studies have shown that postoperative anaemia is detrimental in patients who have had hip surgery (Marval et al 2014). Thus, it is imperative to monitor patients’ haemoglobin (Hb) levels immediately after the operation so that optimum treatment can be assured. The current audit standard in our local trust states that all patients must have their full blood count (FBC) within 32 hours post-surgery. As Covid-19 has brought disruption to the NHS, It is important for us to highlight any issues that arise in the monitoring of Hb in the post-operative phase of these NOF patients. Method Using retrospective analysis, this study analysed the number of patients having the FBC within 32 hours post-surgery during the pandemic (n = 60) and was compared to a similar cohort pre-pandemic (n = 139). Results 91% of patients overall had their Hb checked within 32 hours. 92% in the pre-covid group had a Hb check within time compared to 81% in the covid group. The risk ratio calculated was 1.5. Conclusions Conclusively, patients in the covid group were 1.5 times more likely to have their FBC checked past 32 hours post-surgery. However, this finding was not significant. Overall, the audit standard was not met.

International Listening Post report summary: the world at the dawn of 2019

2019 ◽  
Vol 19 (1) ◽  
pp. 121-124
Author(s):  
Sandy Henderson ◽  
Ulrike Beland ◽  
Dimitrios Vonofakos
Keyword(s):  
South Africa ◽  
Faroe Islands ◽  
The South ◽  
The World ◽  
The Uk

On or around 9 January 2019, twenty-two Listening Posts were conducted in nineteen countries: Canada, Chile, Denmark, Faroe Islands, Finland, Germany (Frankfurt and Berlin), Hungary, India, Ireland, Israel, Italy (two in Milan and one in the South), Peru, Serbia, South Africa, Spain, Sweden, Taiwan, Turkey, and the UK. This report synthesises the reports of those Listening Posts and organises the data yielded by them into common themes and patterns.

scholarly journals Correction to: Hemiarthroplasty for neck of femur fractures: to cement or not? A systematic review of literature and meta-analysis

2019 ◽  
Vol 29 (8) ◽  
pp. 1835-1836
Author(s):  
Prasoon Kumar ◽  
Rajesh Kumar Rajnish ◽  
Deepak Neradi ◽  
Vishal Kumar ◽  
Saurabh Agarwal ◽  
...  
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Review Of Literature ◽  
Neck Of Femur ◽  
Femur Fractures

102 Peer Teaching in Hip Fracture: Responding to the Medical Needs of Surgical Patients and Educational Needs of Junior Doctors

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
N Jones ◽  
J Francis ◽  
R Parikh ◽  
M Shaath
Keyword(s):  
Metastatic Cancer ◽  
Vascular Complications ◽  
Educational Programme ◽  
Junior Doctors ◽  
Fractured Neck Of Femur ◽  
Neck Of Femur ◽  
Teaching Programme ◽  
Medical Needs ◽  
Strongly Agree ◽  
Case Based

Abstract Introduction Fractured Neck of Femur (FNOF) patients are complex. A mortality project identified topics for a peer-led teaching programme. Method Eight bite-sized case-based sessions were devised, to provide a framework to approach the following topics: Anaemia, delirium/dementia, ECG abnormalities, metastatic cancer, osteoporosis, renal disease, respiratory disease, and vascular complications. Attendees were asked to complete pre- and post- teaching programme questionnaires using a Likert Scale to indicate agreement with statements relating to the topic areas chosen (1=strongly disagree and 5=strongly agree). Result Pre-programme questionnaire: respondents were neutral (average 3.04) when asked whether topic areas were currently “well managed”. Attendees lacked confidence, indicating preparedness as neutral (average 3.35). Trainees agreed that they would benefit from teaching (average 4.56). Post-programme questionnaire: increased confidence was reported when considering preparedness (average 4.3). Attendees felt the teaching programme was “accessible” and the “topics well-chosen”. 100% of attendees regarded the teaching as ‘excellent’ or ‘very-good’. Conclusions Matching patient needs to an educational programme is important. The “bite-sized” nature of the programme paired with case-based learning increased confidence. A peer-led teaching programme is a positive response to themes emerging from morbidity and mortality reviews.

Digital Ophthalmology in the UK – Diabetic Retinopathy Screening and Virtual Glaucoma Clinics in the National Health Service

2020 ◽  
Vol 237 (12) ◽  
pp. 1400-1408
Author(s):  
Heinrich Heimann ◽  
Deborah Broadbent ◽  
Robert Cheeseman
Keyword(s):  
Diabetic Retinopathy ◽  
National Health Service ◽  
Health Service ◽  
National Health ◽  
Daily Practice ◽  
Diabetic Retinopathy Screening ◽  
Technological Advances ◽  
Imaging Results ◽  
The Uk ◽  
Retinopathy Screening

AbstractThe customary doctor and patient interactions are currently undergoing significant changes through technological advances in imaging and data processing and the need for reducing person-to person contacts during the COVID-19 crisis. There is a trend away from face-to-face examinations to virtual assessments and decision making. Ophthalmology is particularly amenable to such changes, as a high proportion of clinical decisions are based on routine tests and imaging results, which can be assessed remotely. The uptake of digital ophthalmology varies significantly between countries. Due to financial constraints within the National Health Service, specialized ophthalmology units in the UK have been early adopters of digital technology. For more than a decade, patients have been managed remotely in the diabetic retinopathy screening service and virtual glaucoma clinics. We describe the day-to-day running of such services and the doctor and patient experiences with digital ophthalmology in daily practice.

scholarly journals Drivers of Broad-Spectrum Antibiotic Overuse across Diverse Hospital Contexts—A Qualitative Study of Prescribers in the UK, Sri Lanka and South Africa

Antibiotics ◽  
2021 ◽  
Vol 10 (1) ◽  
pp. 94
Author(s):  
Carolyn Tarrant ◽  
Andrew M. Colman ◽  
David R. Jenkins ◽  
Edmund Chattoe-Brown ◽  
Nelun Perera ◽  
...  
Keyword(s):  
South Africa ◽  
Sri Lanka ◽  
Antimicrobial Stewardship ◽  
Broad Spectrum ◽  
Low Income ◽  
System Level ◽  
Comparative Approach ◽  
Structured Interviews ◽  
Public And Private ◽  
The Uk

Antimicrobial stewardship programs focus on reducing overuse of broad-spectrum antibiotics (BSAs), primarily through interventions to change prescribing behavior. This study aims to identify multi-level influences on BSA overuse across diverse high and low income, and public and private, healthcare contexts. Semi-structured interviews were conducted with 46 prescribers from hospitals in the UK, Sri Lanka, and South Africa, including public and private providers. Interviews explored decision making about prescribing BSAs, drivers of the use of BSAs, and benefits of BSAs to various stakeholders, and were analyzed using a constant comparative approach. Analysis identified drivers of BSA overuse at the individual, social and structural levels. Structural drivers of overuse varied significantly across contexts and included: system-level factors generating tensions with stewardship goals; limited material resources within hospitals; and patient poverty, lack of infrastructure and resources in local communities. Antimicrobial stewardship needs to encompass efforts to reduce the reliance on BSAs as a solution to context-specific structural conditions.

scholarly journals Shape-shifting and pushing against the odds: staff perceptions of the experiences of first generation students in South Africa and the UK

2021 ◽  
Author(s):  
Rachel Forsyth ◽  
Claire Hamshire ◽  
Danny Fontaine-Rainen ◽  
Leza Soldaat
Keyword(s):  
Higher Education ◽  
South Africa ◽  
First Generation ◽  
Teaching Practice ◽  
First Generation Students ◽  
Staff Perceptions ◽  
Staff Members ◽  
Diversity And Inclusion ◽  
University Life ◽  
The Uk

AbstractThe principles of diversity and inclusion are valued across the higher education sector, but the ways in which these principles are translated into pedagogic practice are not always evident. Students who are first in their family to attend university continue to report barriers to full participation in university life. They are more likely to leave their studies early, and to achieve lower grades in their final qualifications, than students whose families have previous experience of higher education. The purpose of this study was to explore whether a mismatch between staff perceptions and students’ experiences might be a possible contributor to these disparities. The study explored and compared staff discourses about the experiences of first generation students at two universities, one in the United Kingdom (UK), and the other in South Africa (SA). One-to-one interviews were carried out with 40 staff members (20 at each institution) to explore their views about first generation students. The results showed that staff were well aware of challenges faced by first generation students; however, they were unsure of their roles in relation to shaping an inclusive environment, and tended not to consider how to use the assets that they believed first generation students bring with them to higher education. This paper explores these staff discourses; and considers proposals for challenging commonly-voiced assumptions about students and university life in a broader context of diversity and inclusive teaching practice.

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