Improving the quality of procedure-specific operation reports in orthopaedic surgery

INTRODUCTION

The objectives of this study were to: (i) assess whether handwritten operation reports for hip hemi-arthroplasties adhere to The Royal College of Surgeons of England (RCSE) guidelines on surgical documentation; (ii) improve adherence to these guidelines with procedure-specific computerised operation reports; and (iii) improve the quality of documentation in surgery.

PATIENTS AND METHODS

Thirty-three parameters based on RCSE guidelines were used to score hip hemi-arthroplasty operation reports. The first audit cycle was performed retrospectively to assess 50 handwritten operation reports, and the second cycle prospectively to assess 30 new computerised procedure-specific operation reports produced for hip hemi-arthroplasties. Eighty patients undergoing hip hemi-arthroplasty in a department of orthopaedic surgery within a UK hospital between September 2007 and August 2008 formed the study cohort.

RESULTS

The main outcome measure was the average scores attained by handwritten versus computerised operation reports. Handwritten reports scored an average of 58.7%, rising significantly (P < 0.01) to 92.8% following the introduction of detailed, computerised proformas for the operation note. Adherence to each RCSE parameter was improved.

CONCLUSIONS

Computerised proformas reduce variability between different operation reports for the same procedure and increase their content in line with RCSE recommendations. The proformas also constitute a more robust means of operative documentation.     

Changes in the vascular cell adhesion molecule-1, intercellular adhesion molecule-1 and c-reactive protein following administration of aqueous extract of <Emphasis Type="Italic">piper sarmentosum</Emphasis> on experimental rabbits fed with cholesterol diet

Background  

Inflammation process plays an important role in the development of atherosclerosis. Hypercholesterolemia is one of the major risk factors for atherosclerosis. The present study aimed to evaluate the effect of aqueous extract of Piper sarmentosum (P.s) on inflammatory markers like vascular cell adhesion molecule-1 (VCAM-1), intercellular adhesion molecule-1 (ICAM-1), and C-reactive protein (CRP).     

A probabilistic sampling method (PSM) for estimating geographic distance to health services when only the region of residence is known

Background  

The need to estimate the distance from an individual to a service provider is common in public health research. However, estimated distances are often imprecise and, we suspect, biased due to a lack of specific residential location data. In many cases, to protect subject confidentiality, data sets contain only a ZIP Code or a county.     

Lipoatrophy and lipohypertrophy are independently associated with hypertension*

Objective

Lipoatrophy and lipohypertrophy are associated with metabolic abnormalities, but little is known about their impact on hypertension. We conducted this study to determine the associations of lipoatrophy and lipohypertrophy with hypertension.

Methods

A cross‐sectional study of HIV‐infected patients who completed a self‐report body morphology assessment was performed. We defined hypertension as a clinical diagnosis, or a mean systolic blood pressure (BP)>140 mmHg or diastolic BP>90 mmHg in the previous 6 months. We used logistic regression to examine the association between hypertension and body morphology.

Results

Among 347 patients, there were 2278 BP readings in 6 months. In adjusted analyses, patients with moderate lipoatrophy [odds ratio (OR) 4.3; P=0.03] or moderate lipohypertrophy (OR 4.3; P=0.006) had four times the odds, and patients with mild lipohypertrophy (OR 2.3; P=0.03) had twice the odds of having hypertension compared with patients without changes. We hypothesized that the impact of lipohypertrophy on hypertension was mediated, in part, through body mass index (BMI). When BMI was included in the analysis, increased BMI was significantly associated with hypertension (OR=1.1; P<0.001 per kg/m²), and the association between lipohypertrophy and hypertension was no longer present. However, the association between moderate lipoatrophy and hypertension was strengthened (OR=5.5; P=0.01).

Conclusions

Lipoatrophy and lipohypertrophy are independently associated with hypertension and there is a dose–response effect with more severe lipoatrophy and lipohypertrophy. The association between lipohypertrophy (but not lipoatrophy) and hypertension appears to be mediated by BMI. Our results suggest that patient‐based body morphology assessments are related to hypertension and may have potential implications for cardiovascular disease.