A survey of upper and lower limb tourniquet use among Irish orthopaedic surgeons

Background

Tourniquet use in orthopaedic surgery is common practice. However, the technique varies among Irish orthopaedic surgeons and there are no standard guidelines.

Aim

To analyse trends in tourniquet use among Irish orthopaedic surgeons.

Methods

Ninety-two Irish orthopaedic consultants were sent a 15-survey question about tourniquet use by post.

Results

Sixty respondents returned a completed survey, of which 49 (81 % of respondents) used both upper arm and thigh tourniquets. A variation in tourniquet pressure settings and techniques used was reported. Thirty-nine surgeons (65 % of respondents) use a tourniquet pressure range of 201–250 mmHg for the upper arm and 30 surgeons (50 % of respondents) use a range of 251–300 mmHg for the thigh. Thirty-six surgeons (60 % of respondents) experienced a complication secondary to tourniquet use, the most common complications being nerve and skin injury.

Conclusions

Based on published studies of limb occlusion pressures, this study suggests that some of the tourniquet cuff inflation pressures used may be higher than necessary. Guidelines for optimising cuff pressure and technique should be established to minimise the risk of complications. This study may help determine direction for future research on tourniquet use.     

An analysis of Malawi's publication productivity

Background

Publications productivity, the number of scientific articles published, is a measure of a country''s scientific output. If measured carefully it can be a useful indicator that describes a countries'' research activity. Our objective was to analyze trends in publications originating from Malawi between 1996 – 2006.

Methods

The MEDLINE/PubMed database, a registry of articles from over 5,000 scientific journals was searched for articles originating from Malawi between 1996 – 2006 by typing Malawi in the author affiliation search field. A review of abstracts was performed to determine health field and origin of first author — Malawian vs foreign.

Results

506 articles were retrieved of which 489 were on health. 15.5% on TB, 14.5% on HIV and AIDS, 11.2% on infectious disease, 7.2% on TB and HIV, 7.2% on Malaria. 20.9% of the authors were of Malawian origin and Tropical Doctor was the journal that had the most articles originating from Malawi. The number of articles published from Malawi has grown by 106% in the past ten years.

Conclusions

Our results suggest there is growth in scientific publishing in Malawi but the main contribution is from foreign researchers residing in Malawi. More needs to be done to promote publishing by Malawian authors.     

Ethanol ingestion in children. A five-year review.

A five-year review at ethanol ingestions in children at Charity Hospital of Louisiana at New Orleans, revealed nine cases with blood ethanol levels in excess of 21.7 mmole/L (100 mg/dL); none resulted in death. We describe four patients in whom the blood ethanol levels were potentially life-threatening. In one case, we were able to follow the affected child's blood ethanol level serially; the rate of decrease was about twice that reported for an adult.     

A five-year review of patients admitted with the diagnosis of bacterial endophthalmitis

We conducted a retrospective, hospital-based study of patients who were diagnosed with bacterial endophthalmitis on admission to the Department of Ophthalmology, Hiroshima University Hospital, between January 1999 and December 2003. Thirty eyes of 30 patients were identified. Of these patients, 19 eyes had postoperative endophthalmitis, 8 eyes had penetrating trauma and 3 eyes were infected from an endogenous source. All of the patients underwent immediate three-port pars plana vitrectomy. Vitreous specimens of diabetic patients demonstrated a significantly higher incidence of positive bacterial culture. Diabetic vitreous appeared to be a good medium for culture. Visual acuity of hand motion or less at the latest follow-up visit was associated with the presence of diabetes. Prompt treatment with vitrectomy and intra-vitreal antibiotics is crucial for patients with bacterial endophthalmitis, especially if they are diabetic.     

A model to determine staff levels,cost, and productivity of hospital units

A methodology is presented with examples of the productivity, the staffing required, the resultant productivity, and costs that can be obtained for hospital units that are subject to random work demands such as laboratory, radiology, physical therapy, and nuclear medicine. The methodology assumes that the hospital has a labor productivity system that produces the RVUs or earned hours of work accomplished daily by shift. Factors considered are the distribution of the capabilities of the work force, the fatigue and delay allowances of the work standards, the quality of the work standards, the maximum amount of overtime that people will be asked to work, staffing policies such as constant or different staffing levels for each day of the week, and worker selection processes. Predicted results are compared with present practice, which indicates that substantial cost reductions can occur with the use of the methodology.     

From presentation to publication: the natural history of orthopaedic abstracts in the United Kingdom

Background

Up to 63% of the chapters in major orthopaedic textbooks use the results from abstracts that have been presented at international orthopaedic meetings.

Methods

Orthopaedic abstracts were reviewed that were presented at the 1997 and 1998 meetings of the British Orthopaedic Association and other specialist orthopaedic meetings. The number of abstracts that had gone on to a full text publication was assessed and changes in study design or outcome were determined.

Results

Of the 415 abstracts 137 (33.0%) went on to full text publication. Abstracts presented at the British Orthopaedic Association were significantly more likely to go on to full text publication than abstracts from the other meetings studied. The mean time to publication was 15.6 months. Sample sizes in unpublished studies were smaller (mean 129.8 subjects compared with a mean of 191.4 subjects for published studies). Of full text papers, 19.0% differed regarding study design from the abstract presented at the initial meeting and 10.9% had published different results. Randomised controlled trials had the highest rate of later full text publication (53.6%) followed by observational studies (32.8%), basic science studies (31.4%), and case reports (6.7%).

Conclusions

In comparison with a study from North America, similar numbers of abstracts presented at meetings finally became published as full text articles, the abstracts had fewer authors, more often included randomised controlled trials and follow up data, and had fewer changes to the results. It is questionable whether the inclusion of such results from abstracts presented at international meetings by major orthopaedic textbooks should be undertaken before full text publication.     

Establishing a children's orthopaedic hospital for Malawi: A review after 10 years

Background

BEIT CURE International Hospital (BCIH) opened in 2002 providing orthopaedic surgical services to children in Malawi. This study reviews the hospital''s progress 10 years after establishment of operational services. In addition we assess the impact of the hospital''s Malawi national clubfoot programme (MNCP) and influence on orthopaedic training.

Methods

All operative paediatric procedures performed by BCIH services in the 10th operative year were included. Data on clubfoot clinic locations and number of patients treated were obtained from the MNCP. BCIH records were reviewed to identify the number of healthcare professionals who have received training at the BCIH.

Results

609 new patients were operated on in the 10th year of hospital service. Patients were treated from all regions; however 60% came from Southern regions compared with the 48% in the 5th year. Clubfoot, burn contracture and angular lower limb deformities were the three most common pathologies treated surgically. In total BCIH managed 9,842 patients surgically over a 10-year period. BCIH helped to establish and co-ordinate the MNCP since 2007. At present the program has a total of 29 clinics, which have treated 5748 patients. Furthermore, BCIH has overseen the full or partial training of 5 orthopaedic surgeons and 82 orthopaedic clinical officers in Malawi.

Conclusion

The BCIH has improved the care of paediatric patients in a country that prior to its establishment had no dedicated paediatric orthopaedic service, treating almost 10,000 patients surgically and 6,000 patients in the MNCP. This service has remained consistent over a 10-year period despite times of global austerity. Whilst the type of training placement offered at BCIH has changed in the last 10 years, the priority placed on training has remained paramount. The strategic impact of long-term training commitments are now being realised, in particular by the addition of Orthopaedic surgeons serving the nation.     

科技期刊稿件的初审

结合《中华医学图书情报杂志》编辑部的初审工作,阐述了科技期刊稿件初审的重要性及原则要求,提出了必须从稿件的政治性和原创性、科学性和先进性、特色性和适用性三方面对稿件进行初审。     

Colonoscopic polypectomy and management of malignant colorectal polyps — A review in an Irish population

A RETROSPECTIVE analysis of 2124 colonoscopies was carried out. Most were performed as day cases under sedation. Abnormalities were detected in 59% of the colons examined; polyps were detected in 24% and almost half of these had more than one polyp. The detection rate was higher in males than females. Most polyps were left sided. Increasing size of polyp was associated with a higher proportion of villous elements and more frequent malignant change. The pattern of histological types was comparable to other large published series. Carcinoma was detected in 5% of adenomatous polyps, mainly in larger villous lesions. Twenty-nine polyps were malignant; these were also predominantly left sided. Applying the St. Mark’s criteria, no polyp with malignant change which was considered completely excised by endoscopic polypectomy has recurred or metastasized at follow up. In contrast, those polyps considered incompletely excised had a high (80%) incidence of residual tumour. The current controversies in the management of malignant colorectal polyps are discussed.     

A review of tuberculosis-related referrals among children in Ireland

Background  

Immigration has been shown to have an increasingly important effect on the epidemiology of tuberculosis (TB) in developed countries.     

A survey of Irish palliative care services

There has been no national policy directing the development of palliative care services in Ireland. Over the last 25 years different palliative care services have been established around the country, due largely to a strong and concerted effort on the part of voluntary groups. A study was carried out to determine the structure and process of all adult palliative care services in Ireland, to determine, where possible, the costs of providing these services and to assess the need for palliative care services in Ireland. All adult palliative care services (24 home care services, three inpatient services and one acute hospital service) in existence at the end of 1993 were circulated and 26 returns received (response rate 93 per cent). Twenty-five counties were covered by palliative care services, serving approximately threequarters of the national population. Less than 10 per cent of patients had noncancer diagnoses. Wide variation in staffing levels, workload, travelling, assessment of need and finance arrangements was reported. There is a need for further debate on the breadth and scope of palliative care services that should ideally be provided in Ireland, and how they should be funded in the future.     

Spinal tuberculosis: a five-year review of cases at the National Tuberculosis Centre.

We reviewed 31 cases (19 males and 12 females) of spinal tuberculosis seen at the National Tuberculosis Centre from 1985 to 1989. The mean age was 35.4 years. The predominant clinical feature was backache (90.3%), while neurological features were found in 30.9%. An elevated erythrocyte sedimentation rate (in 80.0%) and a positive Mantoux test (in 70.9%) served as useful investigations. Spinal x-ray was abnormal in all cases, the lumbar spine being most commonly involved. Bacteriological or histopathological confirmation was obtained in only 29.0% of cases. The mainstay of treatment was anti-tuberculous chemotherapy with surgery being performed in 41.9% of patients.