The good go to heaven and the bad go to hell: doing patienthood on the orthopaedic ward

2020 ◽  
pp. 113-125
Author(s):  
David C. Hyndman
Keyword(s):  
Orthopaedic Ward

When fever is more than infection: two cases of vancomycin-induced drug reaction with eosinophilia and systemic symptoms (DRESS)

2021 ◽  
Vol 14 (1) ◽  
pp. e238006
Author(s):  
Mitchell Cox ◽  
Sophie Paviour ◽  
Sophie Gregory ◽  
Rusheng Chew
Keyword(s):  
Drug Reaction ◽  
Cytomegalovirus Reactivation ◽  
First Case ◽  
Metropolitan Hospital ◽  
Orthopaedic Ward ◽  
Systemic Hypersensitivity ◽  
Systemic Symptoms ◽  
Inflammatory Syndrome ◽  
Intravenous Glucocorticoids

Drug reaction with eosinophilia and systemic symptoms (DRESS) is a rare, but serious systemic hypersensitivity reaction associated with a range of medications. We present two cases of vancomycin-induced DRESS, which occurred simultaneously in the orthopaedic ward in an outer metropolitan hospital. These cases demonstrate the complexity in the diagnosis and management of this inflammatory syndrome on the background of known infection as well as evidence for linezolid as an alternative to vancomycin. The first case was managed conservatively, but developed progressive renal and liver injury along with demonstrated cytomegalovirus reactivation and recurrent colitis, and was eventually palliated. The second was commenced on intravenous glucocorticoids and achieved remission, although had ongoing renal dysfunction at the time of discharge from outpatient follow-up.

The Role of Ehrs in Rapid Response Call Outs: A Case Study

2018 ◽  
Vol 62 (1) ◽  
pp. 494-498
Author(s):  
Anne Miller ◽  
Paul Hudson ◽  
Malcolm Green
Keyword(s):  
Design Research ◽  
Rapid Response Team ◽  
Clinical Work ◽  
Rapid Response ◽  
Research Approach ◽  
Contextual Design ◽  
Response Team ◽  
Orthopaedic Ward ◽  
Technological Constraints

This study aimed to determine the source of complaints about the poor usability and lack of fit between rapid response documentation screens and rapid response (RR) processes. A modified Contextual Design research approach was implemented to explore RR processes and the congruence between these and RR documentation screens. Participants were 15 consenting clinicians from an orthopaedic ward, a rapid response team and an Intensive Care Unit. Results show that RR team documentation screens do not support clinical work that is integrated, iterative and ongoing. The relaxation of conceptual and EHR technological constraints may facilitate more effective support for clinical work.

scholarly journals Drug-resistant coagulase-negative skin staphylococci: Evaluation of four marker systems and epidemiology in an orthopaedic ward

1990 ◽  
Vol 105 (1) ◽  
pp. 95-105 ◽  
Author(s):  
M. Thore ◽  
I. Kühn ◽  
S. Löfdahl ◽  
L. G. Burman
Keyword(s):  
Drug Resistant ◽  
Ward Staff ◽  
Coagulase Negative Staphylococci ◽  
Species Determination ◽  
Carriage Rate ◽  
Methicillin Resistant ◽  
Orthopaedic Patients ◽  
Orthopaedic Ward ◽  
Combined Data

SUMMARYDrug-resistant coagulase-negative staphylococci (DRCNS) in orthopaedic patients and ward staff were studied. A significant increase in the DRCNS carriage rate was observed among the 16 patients studied after 14 days of hospitalization with levels approaching that of the staff. Patients receiving dicloxacillin prophylaxis (n=9) were more likely to be colonized with methicillin-resistant CNS, while patients receiving no antibiotics (n= 7) became to a larger extent colonized with multiple DRCNS. The combined data from species determination, biochemical, plasmid, and antibiogram typing revealed a considerable diversity among DRCNS;64 types were distinguished among 112 DRCNS isolates selected for study after exclusion of apparently duplicate isolates. Plasmid plus antibiogram typing yielded almost as many types (61); whereas species determination plus antibiogram distinguished only 33 types. Although a novel computerized 96-reaction boityping method alone enabled differentiation of 17 biotypes, most DRCNS isolates belonged to one of three major biotypes limiting the usefulness of this method. Ten of the 64 (16%) DRCNS types identified comprised 50 of the 112 (45%) isolates. These were isolated from staff and from patients on day 14, suggesting a nosocomial origin.

Costs of an outbreak of wound infections in an orthopaedic ward

1992 ◽  
Vol 22 (1) ◽  
pp. 73-79 ◽  
Author(s):  
M.A.T. O'Donoghue ◽  
K.D. Allen
Keyword(s):  
Wound Infections ◽  
Orthopaedic Ward

Aetioepidemiological profile of spinal injury patients in Eastern Nepal

2005 ◽  
Vol 35 (4) ◽  
pp. 231-233 ◽  
Author(s):  
S Lakhey ◽  
N Jha ◽  
B P Shrestha ◽  
S Niraula
Keyword(s):  
Community Education ◽  
Spinal Injury ◽  
Case Series ◽  
Spinal Injuries ◽  
Retrospective Case ◽  
Target Groups ◽  
Retrospective Case Series ◽  
Adolescents And Adults ◽  
Orthopaedic Ward

This is a retrospective case series of 233 spinal injury patients admitted to the orthopaedic ward of BPKIHS from May 1997 to April 2001. The inpatient records were analysed. In all, 40.3% of spinal injuries resulted from falls from trees while cutting leaves for fodder, and 27.9% resulted from falls from first/second floors. More than 75% of total spinal injuries are largely preventable. Overall, 46.8% of our spinal injury patients had complete cord transection at the level of injury. All adolescents and adults, irrespective of age or sex, should be the target groups for community education and intervention programmes for prevention of spinal injury.

scholarly journals Introduction of day case hip and knee replacement programme at an inpatient ward is safe and may expedite shortening of hospital stays of traditional arthroplasties

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Gyorgy Lovasz ◽  
Attila Aros ◽  
Ferenc Toth ◽  
John Va Faye ◽  
Marco La Malfa
Keyword(s):  
Day Case ◽  
Urine Retention ◽  
Inpatient Ward ◽  
Same Day Discharge ◽  
Knee Replacements ◽  
Hip And Knee Arthroplasty ◽  
Orthopaedic Ward ◽  
Hospital Stays ◽  
Total Knee ◽  
Satisfaction Rates

Abstract Purpose We investigated the safety of primary hip and knee replacements with same day discharge (SDD) and their effect on length of stay (LOS) of traditional inpatient arthroplasties at our elective orthopaedic ward. Methods 200 patients underwent elective, unilateral primary day case total hip (THA, n = 94), total knee (TKA, n = 60) and unicondylar knee replacements (UKA, n = 46). SDD rates, reasons for failure to discharge, readmission, complication and satisfaction rates were recorded at 6-week follow up. Changes in LOS of inpatient arthroplasties (n = 6518) and rate of patients discharged with only one night stay treated at the same ward were tracked from 1 year prior to introduction of day case arthroplasty (DCA) program to the end of observation period. Results 166 patients (83%) had SDD while 34 (17%) needed overnight stay. Main reasons for failure to discharge were lack of confidence (4%) fainting due to single vasovagal episode (3.5%), urine retention (3%) and late resolution of spinal anaesthesia (3%). 5 patients (3%) had readmission within 6 weeks, including 1 (0.6%) with a partial and treated pulmonary embolism. 163 patients were satisfied with SDD (98%). After launching the DCA program, average LOS of inpatients was reduced from 2.3 days to 1.8 days and rate of discharge with only 1-night stay increased from 12% to around 60%. Conclusion Introduction of routine SDD hip and knee arthroplasty programme at an elective orthopaedic centre is safe and also may confer wider benefits leading to shorter inpatient hospital stays.

scholarly journals The Effect of Multiple Assessments on Delirium Detection: a Pilot Study*

2020 ◽  
Vol 23 (4) ◽  
pp. 277-282
Author(s):  
SA. De Freitas ◽  
EKC. Wong ◽  
JY. Lee ◽  
C. Reppas-Rindlisbacher ◽  
C. Gabor ◽  
...  
Keyword(s):  
Pilot Study ◽  
Hip Fractures ◽  
Detection Rate ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Diagnostic Interview ◽  
Academic Hospital ◽  
Confusion Assessment ◽  
High Prevalence ◽  
Orthopaedic Ward

Background Delirium is characterized by fluctuating attention or arousal, with high prevalence in the orthopaedic ward. Our aim was to: 1) establish the prevalence of delirium on an orthopaedic ward, and 2) compare delirium prevalence using a single geriatrician assessment vs. multiple 3D-CAM (3-Minute Diagnostic Interview for Confusion Assessment Method) assessments during the day. We hypothesized that multiple assessments would increase the detection rate due to the fluctuating nature of delirium. Methods Comparative study conducted at an academic hospital in Hamilton, Ontario. Participants included patients 65 years and older admitted to the orthopaedic ward (n=55). After a geriatrician made the first assessment of delirium by 3D-CAM on each patient, teams with specialized geriatrics training re-assessed participants up to four times. Delirium rates based on first assessment were compared to cumulative end-of-day rates to determine if detection increased with multiple assessments. Results The prevalence of delirium was 30.9% (17 participants) us­ing multiple assessments. Of these cases, 13 (76.4%) were detected in the initial geriatrician assessment. In patients with hip fractures, 70.6% (12 of 17) were identified as delirious by multiple assessments. Conclusion As symptoms fluctuate, multiple daily CAM assessments may increase the identification of delirium in orthopaedic inpatients.

scholarly journals The Burden of Orthopaedic Disease in Sub-Saharan Africa: A Focus on Tanzania

2021 ◽  
Author(s):  
William Mack Hardaker ◽  
Mubashir Jusabani ◽  
Honest Massawe ◽  
Anthony Pallangyo ◽  
Rogers Temu ◽  
...  
Keyword(s):  
Growth Rate ◽  
Developing World ◽  
Road Traffic ◽  
Medical Center ◽  
Sub Saharan Africa ◽  
System Level ◽  
Definitive Treatment ◽  
Femur Fractures ◽  
Orthopaedic Patients ◽  
Orthopaedic Ward

Abstract Background As road traffic crashes (RTCs) continue to rise in the developing world, the current growth rate and true burden of orthopaedic injuries are unknown. In 2015, we characterized the orthopaedic burden at Kilimanjaro Christian Medical Center (KCMC) in Tanzania. In this study, we re-evaluated the burden and growth-rate over three years in the absence of any system level changes. Additionally, we calculated the percentage of orthopaedic patients that received definitive fixation for their orthopaedic injury when surgery was indicated.Methods We prospectively collected data for 190 patients admitted to the orthopaedic ward at KCMC during June/July 2018. We also retrospectively reviewed available records for patients presenting to the KCMC emergency department, orthopaedic outpatient clinic and orthopaedic ward.Results Prospective data: RTC (48.6%) was the most common etiology and femur fractures (31.0%) the most common type of injury. Almost 96% of admitted patients were indicated for surgical fixation, but only 44.5% received definitive fracture treatment. Retrospective data: KCMC treated an average of 15,117 orthopaedic patients per year, representing a 35.3% growth in the orthopaedic burden compared to 2015.Conclusion The burden of orthopaedic surgical disease at KCMC continues to grow. Throughout the developing world, multiple system level constraints preclude delivery of definitive treatment for most patients. Without innovative strategies to address this situation, the discrepancy between the need for orthopaedic care and surgical care capacity in the developing world will continue to grow.

Sign in / Sign up

Export Citation Format

Share Document