The presence of residents during orthopedic operation exerts no negative influence on outcome

Background Operative procedural training is a key component of orthopedic surgery residency. It is unclear how and whether residents participation in orthopedic surgical procedures impacts on post-operative outcomes. Sources of data A systematic search was performed to identify articles in which the presence of a resident in the operating room was certified, and was compared with interventions without the presence of residents. Areas of agreement There is a likely beneficial role of residents in the operating room, and there is only a weak association between the presence of a resident and a worse outcome for orthopedic surgical patients Areas of controversy Most of the studies were undertaken in USA, and this represents a limit from the point of view of comparison with other academic and clinical realities. Growing point The data provide support for continued and perhaps increased involvement of resident in orthopedic surgery. Areas of research To clarify the role of residents on clinically relevant outcomes in orthopedic patients, appropriately powered randomized control trials should be planned.

P008: Evaluation of outcomes after implementation of a provincial prehospital bypass standard for trauma patients – an Eastern Ontario experience

Introduction: Trauma and injury play a significant role in the population's burden of disease. Limited research exists evaluating the role of trauma bypass protocols. The objective of this study was to assess the impact and effectiveness of a newly introduced prehospital field trauma triage (FTT) standard, allowing paramedics to bypass a closer hospital and directly transport to a trauma centre (TC) provided transport times were within 30 minutes. Methods: We conducted a 12-month multi-centred health record review of paramedic call reports and emergency department health records following the implementation of the 4 step FTT standard (step 1: vital signs and level of consciousness, step 2: anatomical injury, step 3: mechanism and step 4: special considerations) in nine paramedic services across Eastern Ontario. We included adult trauma patients transported as an urgent transport to hospital, that met one of the 4 steps of the FTT standard and would allow for a bypass consideration. We developed and piloted a standardized data collection tool and obtained consensus on all data definitions. The primary outcome was the rate of appropriate triage to a TC, defined as any of the following: injury severity score ≥12, admitted to an intensive care unit, underwent non-orthopedic operation, or death. We report descriptive and univariate analysis where appropriate. Results: 570 adult patients were included with the following characteristics: mean age 48.8, male 68.9%, attended by Advanced Care Paramedic 71.8%, mechanisms of injury: MVC 20.2%, falls 29.6%, stab wounds 10.5%, median initial GCS 14, mean initial BP 132, prehospital fluid administered 26.8%, prehospital intubation 3.5%, transported to a TC 74.6%. Of those transported to a TC, 308 (72.5%) had bypassed a closer hospital prior to TC arrival. Of those that bypassed a closer hospital, 136 (44.2%) were determined to be “appropriate triage to TC”. Bypassed patients more often met the step 1 or step 2 of the standard (186, 66.9%) compared to the step 3 or step 4 (122, 39.6%). An appropriate triage to TC occurred in 104 (55.9%) patients who had met step 1 or 2 and 32 (26.2%) patients meeting step 3 or 4 of the FTT standard. Conclusion: The FTT standard can identify patients who should be bypassed and transported to a TC. However, this is at a cost of potentially burdening the system with poor sensitivity. More work is needed to develop a FTT standard that will assist paramedics in appropriately identifying patients who require a trauma centre.

Study on Psychological Influence of Nursing Intervention on Orthopedic Operation Patients during Perioperative Period

<p><strong>Objective</strong>: to discuss psychological influence of orthopedic operation patients with nursing intervention during perioperative period. <strong>Methods</strong>: 106 cases of orthopedic operation patients from August 2014 to March 2015 in our hospital were selected. According to the random number table, all cases were divided into two groups with principle of informed consent. The control group: 53 cases were treated with the conventional nursing; the intervention group: 53 cases were treated with the nursing intervention. Psychological reactions were compared in the two groups. <strong>Results</strong>: After nursing, the intervention group had the good rate of psychological reaction 86.8%, which was much higher than that in the control group (66.0%). Different results between the two groups were significant in Statistics (<em>p</em> &lt; 0.05); however, the intervention group had the rate of pain occurrence 54.7%, which was much lower than that in the control group (73.6%). Different results between the two groups were significant in Statistics (<em>p</em> &lt; 0.05). <strong>Conclusion</strong>: Nursing intervention could obviously improve psychological state of patients, reduce pain occurrence and accelerate recovery.</p>

The Analysis of the Preventive Nursing of Infection after Orthopedic Operation

<p><strong>Objective:</strong> To explore the preventive nursing methods of infection after orthopedic operation and provide some basis for clinical nursing. <strong>Method: </strong>1000 patients who have received orthopedic operations are selected randomly from our hospital from September 2009 to September 2014, then we make follow-up and survey, analyze the factors influencing infection and implement corresponding nursing measures. <strong>Result:</strong> Among the 1000 patients, 26 patients have incision infection of sterile operation and the infected positions are on spinal cord, upper limbs and lower limbs. Surveys find that after orthopedic operation, infection patients are mostly infected 3-4 weeks after being hospitalized with the earliest infection occurring after one week after being hospitalized. We can find that the longer patients are hospitalized for, the higher the occurrence of infection is. <strong>Conclusion: </strong>In the preventive nursing of infection after orthopedic operation, sterile operation and preoperative, intraoperative and postoperative nursing should be remembered. And the most important one is to adopt sterilization and isolation system after orthopedic operation to lower the occurrence of infection to the lowest.</p>

Postoperative cognitive dysfunction in geriatric patients after orthopedic surgery

The aim of our study was to find out the changes of cognitive functions of geriatric patients after orthopedic surgery and when these differen­ ces are marked. We also tried to find out factors, which have influence on the results of common mental activity, to estimate the dynamics of mental activity and to choose the most optimal intervals of estimation. The population of our investigation consisted of 25 consecutive adult patients, undergoing orthopedic operation, applying regional anesthesia. Neurophysiological assessment where all patients underwent neurophysiological tests consisted of the Mini-mental State Examination (MMSE), 6 Item Cognitive Impairment test (6CIT), Trail-making test – a neuropsychological test of visual attention and task switching. Patients were tested the day before the surgery (MMSE1, 6CIT1, TMT1), on the day of the surgery (MMSE2, 6CIT2, TMT2) and on the third day after the surgery (MMSE3, 6CIT3, TMT3). The day before the surgery reveals that results of MMSE1, 6CIT1 tests were better in a group of younger patients. We found that the results of the MMSE test were significantly worse 3 days after the surgery than those before the procedure in the A group, p = 0.016. The biggest digression was fixed in “copying” and “repeating” after the surgery intervention, p = 0.01, p = 0.04. The orientation in time significantly decreased in the group B after the surgery, p = 0.00. MMSE, 6CIT, TMT test results were significantlt worse in older patients rather than younger ones 3 days after the surgery. We set that the elderly have a significantly shorter duration of education. Younger patients and patients with a longer studying period achieved better results of tests. The results mean that age and lasting of education are significant predictors of POCD. Our pilot study confirmed that POCD develops for older patients, undergoing neuroaxial anesthesia for orthopedic surgery. It is very important to continue studies and reveal how to decrease POCD events, keep the quality of life.