Parallel K-Wire Placement Leads to Fusion and Midcarpal Settling in Scaphoid Excision Four-Corner Fusion

Background: Scaphoid excision 4-corner fusion is a motion-sparing procedure in patients with advanced radioscaphoid arthritis. This study introduces an alternate technique for scaphoid excision 4-corner fusion using a parallel Kirschner wire (K-wire) construct across the midcarpal joints that leads to reliable fusion rates, and good patient outcomes. Methods: This is a single-surgeon, retrospective study of patients who underwent scaphoid excision 4-corner fusion, using a parallel K-wire construct across the midcarpal joints. Once fusion was achieved, K-wires were removed. Radiographic union rate, time to union, capitolunate angle, capitolunate coverage, and amount of midcarpal settling are measured. Patient-reported outcome measures and descriptive statistics are presented. Results: Sixty-five wrists were included in this study with a mean age of 50.1 years. One patient was lost to follow-up. All 64 wrists (100%) fused at an average of 2.6 months. The mean capitolunate angle was 7°, and capitolunate coverage was 99.2%. Fifty-two patients (81%) had adequate radiographs for measurement. Average midcarpal settling was 1.1 mm. Thirty-two patients (51%) were available for long-term follow-up at an average of 5.3 years (0.7-10.2 years), and participated in patient reported outcomes (PRO) surveys. The mean Quick Disabilities of the Arm, Shoulder, and Hand score was 16.6, and numeric pain rating scale score was 1.8. Conclusions: Parallel K-wire placement across the midcarpal joints with scaphoid leads to a high rate of fusion with good patient outcomes long term. Midcarpal settling that occurs through dynamic compression around the K-wires may have contributed to bony fusion. This technique may provide an alternative approach to achieving reliable fusion across the midcarpal joints.

Adverse event reviews in healthcare: What matters to patients and their family? A qualitative study exploring the perspective of patients and family

ObjectivesExplore what ‘good’ patient and family involvement in healthcare adverse event reviews may involve.DesignData was collected using semi-structured telephone interviews. Interview transcripts were analysed using an inductive thematic approach.SettingNHS Scotland.Participants19 interviews were conducted with patients who had experienced an adverse event during the provision of their healthcare, or their family member.ResultsFour key themes were derived from these interviews: trauma, communication, learning and litigation.ConclusionsFindings suggest there are many advantages of actively involving patients and their families in adverse event reviews. An open, collaborative, person-centred approach which listens to, and involves, patients and their families is perceived to lead to improved outcomes for all. For the patient and their family, it can help with reconciliation following a traumatic event and help restore their faith in the healthcare system. For the health service, listening and involving people will likely enhance learning with subsequent improvements in healthcare provision with reduction in risk of similar events occurring for other patients. Communicating in a compassionate manner could also decrease litigation claims following an adverse event. Overall, having personalised conversations and a streamlined review process, with open engagement to enhance learning, was important to most participants in this study.

Challenges and impact of COVID-19 on teledermatology practice in providing continued care to patients in a time of disarray

Background: The coronavirus disease 2019 (COVID-19) pandemic has significantly affected all areas of life in most countries. Telehealth has gained importance during this era of social distancing, including teledermatology (TD). The purpose of this survey was to determine the challenges and impact of COVID-19 on TD practice in providing continued care to patients by dermatologists in Pakistan. Methods: A questionnaire comprised of fifteen questions was created with Google Forms and distributed to dermatologists practicing in various cities of Pakistan via WhatsApp or e-mail, then the data was collected. Results: A total of 81 dermatologists from various cities of Pakistan responded to the survey, among whom about two thirds reported a positive experience with TD, yet some had issues in communication gaps and breaches of confidentiality, and the majority considered it unequal to in-person visits. Conclusion: TD plays an important role during the COVID-19 pandemic as a simple, time-saving procedure allowing social distancing with good patient satisfaction.

Achieving effective patient outcomes with PolyMem® Silicone Border

Clinicians are under increasing pressure to provide high-quality patient outcomes at a reduced cost. Increasingly, community staff must acquire knowledge on advanced wound care products to cope with the growing caseload demands. This article describes the use of PolyMem® dressings to reduce pain, inflammation, oedema and bruising and their ability to debride and absorb exudate while providing an optimum healing environment. The PolyMem range includes multifunctional dressings for various painful chronic wounds. This article also presents five case studies with particularly good patient outcomes where PolyMem dressings were the primary dressing. All five patients were holistically assessed to enable consistent evidence-based treatment decisions. In four cases, the new PolyMem Silicone Border dressing was used. The patients found the PolyMem Silicone Border dressing comfortable and gentle on removal even when the skin was extremely fragile. The right dressing used at the right time on the right patient can improve patient outcomes.

Nurse Managers’ Responsive Coaching To Facilitate Staff Nurses’ Clinical Skills Development in Public Tertiary Hospital

Background: Mentoring helps cultivate nurse leaders, retain nurses, and diversify the nursing workforce. By strengthening the nursing workforce, nursing mentorship improves the quality of patient care and outcomes. Widespread uses of nurse mentoring programs have been employed to produce positive outcomes and decrease turnover and assess job satisfaction.Purpose: The purpose of the study is to assess head nurse mentoring competency in relation to staff nurses’ career advancement in selected government hospitals to broaden the array of perspective among public hospitalsMethods: The researchers employed descriptive-correlational that glanced into the relationship of certain levels in the mentoring competency of head nurses in relation to staff nurses career advancement.Results: Majority of the nurse-respondents have indicated good remarks on the components of relationship building in public hospitals; and very good competency on the components of identifying areas for improvement; responsive coaching; advocating for an environment conducive to good patient care; and documentation/record keeping. Conclusion: Nurse manager-mentors in public hospitals are very good on mentoring in identifying areas for improvement, responsive coaching, advocating for an environment conducive to good patient care, and documentation/record keeping, but, good about relationship building.

Outcomes of Pediatric Posterior Cruciate Ligament Reconstruction: A Systematic Review

Background: Little has been reported in the literature regarding surgical treatment of posterior cruciate ligament (PCL) injuries in pediatric patients. Purpose/Hypothesis: The purpose was to evaluate presentation, injury pattern, outcomes, and complications of surgically managed PCL injuries in pediatric patients. It was hypothesized that pediatric patients would have good patient-reported outcomes and no significant radiographic changes or complications. Study Design: Systematic review; Level of evidence, 4. Methods: A literature search was performed using PubMed, Medline, EMBASE, Scopus, and Cochrane databases between 1975 and December 16, 2019. Search terms included “posterior cruciate ligament,” “peel-off injury,” “avulsion,” “PCL,” “pediatric,” “skeletally immature,” and “adolescent.” Included were studies on pediatric patients with PCL injuries managed operatively. Exclusion criteria included case reports, studies not reporting clinical results, reviews, abstract or conference papers, or papers not in the English language. Quality assessment was performed on all included studies using the MINORS (Methodological Index for Non-Randomized Studies) criteria. Results: Four articles comprising 43 knees in 42 patients met the criteria and were included. Motor vehicle accidents were the most common mechanism of injury (39.5%; n = 17/43), followed by sports-related injuries (35%; n = 15/43). All studies commented on tear pattern, with the following distribution: 42% (n = 18/43) midsubstance tears, 37% (n = 16/43) tibial avulsions, and 21% (n = 9/43) femoral avulsions. Overall, good patient-reported outcomes (Knee injury and Osteoarthritis Outcome Score and Pediatric International Knee Documentation Committee, Tegner, and Lysholm scores) and return to activity, as well as satisfactory posterior stability (KT-1000 arthrometer, posterior drawer test, and kneeling radiographs) and range of motion, were reported. There was no significant leg-length discrepancy or angular deformity reported. Arthrofibrosis was reported in 7% of postoperative knees and was the most commonly reported complication. Osteoarthritis was reported in 21% (n = 9/43) of knees. The average MINORS score was 7 (range, 6-8) for noncomparative studies and 10 for comparative studies. Conclusion: Good patient-reported outcomes and return to activity can be obtained using repair or reconstruction. This evidence was limited by the quality of the included studies and overall small sample size; however, this review serves as a baseline for futures studies on PCL repair/reconstruction in pediatric patients.

RIGHTS AND DUTIES OF PHYSICIAN ACCORDING TO AYURVEDA AND MODERN PERSPECTIVE

Ethics is a collection of principles that govern proper behaviour. In Ayurveda, the concept of ethics is strongly related to the concept of Dharma. Many instructions on appropriate medical practice can be found in Ayurveda textbooks. Chatushpada describes the qualities of a good patient and a good physician. The Adhyayana Vidhi clarifies the process of medical education as well as the rules for establishing future practises. Other milestones include Sadvritta and Vaidya Vrutti, which are extensive sets of standards for professional ethical conduct. Ayur- vedic Acharyas also instruct physicians on how to communicate with patients. As Ayurveda is the oldest medical science, ethical codes in medicine have existed since the beginning. In the numerous Ayurvedic Samhitas, refer- ences to medical ethics were described, including the responsibility of a physician, ideal qualities of a physician, surgeon qualities, medicinal dose (according to nature of individuals) and medicinal dosage for children, as well as specifics of post-mortem and anaesthetic. This paper enlightens the duties of a physician with Ayurvedic and modern perspectives. Keywords: Ayurveda, Duties, Physician

Life-Threatening Abdominal Bleed after DGHAL – A Case Report

Doppler guided haemorrhoidal artery ligation with recto-anal repair (DGHAL RAR) has been reported to be an effective, reliable and safe procedure for symptomatic haemorrhoidal disease with less postoperative pain and hence, good patient acceptance [1]. The reported complications are minor and include recurrence of anal bleed, prolapse, anal fissure, tenesmus to name few [2]. We report a case of life threatening intra-abdominal bleed following DGHAL RAR.