Central fractures of the acetabulum.

A series of 26 patients with central fractures of the acetabulum is presented with a follow-up of 3-13 years. Three patients had undisplaced fractures. In the remaining 23, long-term results of treatment by traction in 15 and by primary open reduction in 8 have been compared. A numerical grading system has been used for assessment. Results in the non-operative group were generally poor, only 2 being satisfactory. Some of the poorest scores in this group were associated with initial roof damage. Three patients required secondary salvage procedures because of severe pain and disability approximately 2 years after injury. Of the open reduction patients, all with roof damage, 4 had satisfactory results. Reasons for failure is the remaining 4 patients are discussed. Galloping degeneration due presumably to irreversible intra-articular cartilage damage at the initial injury, developed in 2 patients in the non-operative group and in one in the operative group.     

Incidence of incisional hernia after dehiscence of the abdominal wound

The records of 103 patients whose abdominal wounds burst were studied in an attempt to assess the subsequent incidence of incisional hernia. Sufficient information about seventy patients was obtained. Forty-nine patients (47.6 per cent) had a hernia whereas twenty-one patients (20.4 per cent) definitely did not have a hernia. The incidence of hernia was associated with the age of the patient, the site of the wound, the day of resuture, an original diagnosis of malignancy, and the postoperative blood urea level but not with the technic employed in the resuture nor with infection.It is suggested that a blood-stained serous discharge and the “dip sign” should enable an early diagnosis of dehiscence to be made before the small bowel appears in the wound; after diagnosis, the wound should either be explored electively or the skin sutures left for at least three weeks until the skin heals.     

The use of Kiton Fast Green to measure the viability of the head of the femur after fractures of the neck of the femur

An intravital staining method was used to predict the viability of the femoral head at operation in 36 patients with fractures of the neck of the femur. Life was predicted in 18 heads, death in 16 and in 2 there was some doubt.In the group which was predicted to be live, 15 fractures united uneventfully, 1 developed late collapse and 2 became infected and died. Of the heads predicted to be dead, 3 united without evidence of necrosis, four had radiological changes suggesting that necrosis had been followed by revascularization and 10 required further operations. Histological evidence was later obtained in 19 cases. Of 6 heads predicted to be live, 4 had united without evidence of necrosis, 1 showed necrosis and collapse and 1 was infected and dead. Of the heads predicted to be dead, 8 were dead, 4 showed revascularization taking place and 1 showed no evidence of bone necrosis. Intravital staining is a relatively easy technique but has limitations as a means of predicting the clinical outcome.     

Are expensive and elaborate burns units always necessary? a review of the bangour burns unit over the first 10 years of use

The Bangour Burns Unit was opened in 1968. It was built on a limited budget and great care was taken in the design and discipline. The unit was not airconditioned and strict isolation of the patients was only necessary on occasions.In an attempt to see whether or not the design and system was satisfactory, bacteriological analyses of the patients and staff were made in 1969, 1974 and 1978, which were the years before the unit was electively closed for painting. During these periods, the burn population remained similar and no major change in policy was made. The results confirm that there were no more infections in 1974 or in 1978 compared with 1969.It is suggested that, while the management of burns is generally best done in a burns unit, expensive, elaborate designs and complicated equipment may not be essential in every area. Possibly of greater importance is the application of a code of discipline as suggested by MacMillan (1975) in the Shriners Institute, particularly if the burn population contains a high percentage of severe burns.     

Modification of penile erectile response

A biofeedback method for modification of penile erectile response was used on six patients with psychogenic impotence. The procedure employed either the patient's own erotic fantasies or erotic pictures each with or without feedback. All six pateints showed improvement in erectile performance during the sixteen sessions. The effects significantly different from those obtained in six noemal subjects. The results suggeste that patients with psychogenic impotence can learn ti initiate and maintain penile tumescence of a significant degree.     

The role of the Consultant Radiographer in facilitating rapid access to palliative radiotherapy

IntroductionThe fast track pathway for palliative radiotherapy was created to facilitate rapid access to radiotherapy for symptom relief and improved quality of life. The fast track pathway has a target of 5 days from the decision to treat to starting treatment.MethodsThis study is a quantitative analysis of all patients referred and treated with palliative radiotherapy between the 1st September 2018 and 30th September 2019. The number of working days overall from referral to treatment and at each stage of the radiotherapy pathway was recorded and evaluated. The electronic referral system was amended to include the treatment priority option of ‘fast track’ for all patients with the selected treatment intent of ‘palliative’. The data was acquired using the electronic referral system reporting tool.ResultsResults demonstrate a reduction in average pathway timing from 14 days to 3 days for volume planned patients, and 13 days to 2 days for virtual simulation patients referred into the fast track pathway. The routine priority palliative pathway also demonstrated a decrease in time from decision to treat to treatment, despite this not being an initial objective.ConclusionReducing pathway time from referral to treatment is achievable through the introduction of a fast track treatment priority pathway. Rapid access to treatment was facilitated through the electronic referral system fast track option, the creation of a separate fast track care path in Aria, the use of fast track alerts in Aria, and reserved planning scan and treatment appointments.Implications for practiceRapid access to palliative radiotherapy facilitates alleviation of symptoms and improved quality of life. To improve the efficiency of the palliative radiotherapy service, a streamlined pathway and the commitment of the radiotherapy team is required.     

Current Products and Practice

Abstract

Objective: To collect information on the current consent practices of consultant orthodontists for orthodontic and joint orthognathic treatment.

Design: Postal questionnaire.

Subjects and Methods: The questionnaire was sent to all 222 consultant orthodontists held on the database of the British Orthodontic Society. The questionnaire consisted of five multi-part questions requiring tick-box responses.

Outcome: A total of 199 questionnaires were returned.

Results: Written information on orthodontic treatment was provided by 56 per cent of respondents whilst 41 per cent obtained written consent. Written information on joint orthognathic treatment was provided by 47.5 per cent of respondents, whilst 20 per cent obtained joint written consent. Most who obtained written consent for orthodontics and joint orthognathic treatment used 16 years as an appropriate age for patients to provide their own consent.

Conclusions: Consent practice amongst consultant orthodontists varies, with 35 per cent providing neither written information nor seeking written consent prior to orthodontic or joint orthognathic treatment.     

Leadership and the everyday practice of Consultant Radiographers in the UK: Transformational ideals and the generation of self-efficacy

IntroductionThis paper outlines findings from a broader, two-year project investigating the role of Consultant Radiographers (CRs) in the UK, focussing specifically on the leadership aspect of that role.MethodsUsing a qualitative-thematic approach, the leadership-related experiences of a purposive sample of six participating CRs are explored, alongside the systems through which they evaluated how successful they had been as leaders.ResultsIt is evidenced that many of the ways in which participants describe their own leadership practice, particularly in the intra-team domain, is consistent with the precepts of the Transformational Leadership Model. For example, they highlight how they have asserted positive influence and encouraged collective action and decision-making. However, the experiential focus of the analysis reveals that in specific examples of practice, the transformational approach was not always seen as the most useful route to a productive outcome given constrictions on time and other resources within real professional environments. More ‘direct’ managerial approaches were sometimes deemed necessary, and at others leadership was reduced to simply ‘solving other people's problems'. It was also found that the manner in which participants evaluated their own success as leaders was a practical concern, based in part upon having satisfied ‘hard’ institutional goals, but also on the more personal business of having affirmatively ‘surprised’ oneself, or a general sense of feeling trusted by colleagues.ConclusionThese findings may help support CRs in the business of real leadership, not least through better understanding how even apparently mundane outcomes can have significant impacts on professional self-efficacy.     

An investigation into the perceived value of the College of Radiographers voluntary accreditation scheme for advanced and consultant practitioners in breast imaging

IntroductionA voluntary accreditation scheme has been introduced, requiring advanced (AdP) and consultant practitioners (CP) to submit several pieces of work to the College of Radiographers (CoR). However, few individuals have opted to become voluntary accredited. This study investigated the reasons behind becoming voluntary accredited, the value that was gained and why there appears to be a lack of support for the scheme.MethodsAn online electronic survey was conducted using a mixed methods approach. Open questions enabled individual opinions and thoughts to be expressed, Likert scale style questions allowed further understanding of the level of agreement and closed questions identified the support for and against the scheme.ResultsA total of 55 respondents participated, including 18 AdPs, 25 CPs, 1 consultant trainee practitioner, 5 practitioners and 6 listed as ‘other’. Forty-four participants were non-accredited, citing too much clinical work; no recognition from employers and too much effort for little reward. Motivations for joining the scheme were to improve the profession; help create a new consultant post and protect the non-clinical element of the consultant role.ConclusionThe CoR voluntary accreditation scheme has a small perceived value but overall, the majority of respondents believed the scheme did not warrant the work needed to apply. Concern was raised about the risk of creating a two-tier profession by the scheme's instigation. The results of this study suggest that the CoR's voluntary accreditation scheme would need to address these barriers before more practitioners would apply.     

Reflections on leadership in advanced and consultant radiographic practice within the UK

IntroductionThis Educational Perspective provides an overview of how leadership fits into advanced and consultant radiographic roles within the UK setting. It draws on research in the area as well as reviewing some of the wider healthcare literature beyond the medical radiation sciences. The reflections outlined suggest how leadership at these levels may look and differ in practice.DiscussionLeadership should be seen as fundamental to practice and not necessarily a discreet element to either role, but one that supports all other areas. The proportion of the role that leadership takes up, along with the degree of influence, increases from advanced to consultant practice. Consideration over conflict with management and leadership within roles is also important. Ultimately leadership is about relationships with people, for which interpersonal skills are required, along with establishing networks, supported by training and development to maximise effectiveness.ConclusionA clearer understanding of leadership is needed to help conceptualise and measure its impact at advanced and consultant levels of practice. The content is intended to provide an opportunity for reflection and discussion around the topic, serving as a development tool in practice.