2024

Buprenorphine (Butrans) 5microgram patches on discharge from Sheldon Ward (RJAH) over the last 12 months (2024)

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Type of publication:

Service improvement case study

Author(s):

Dr *Haroon Razmandeh; Dr *Abdullah Safdar

Citation:

SaTH Improvement Hub, November 2024

Abstract:

The aim is to increase the percentage of review of Butrans patches on discharge TTO medications from 44% to 75% over the following 12 months (November 2024 until November 2025).

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Functional Outcomes in the Distal End of Radius Fracture: A Prospective Study in a Tertiary Care Center (2024)

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Type of publication:

Journal article

Author(s):

*Thusoo, Varun; Chakrapani, Arjun S; Nehru, Ashish; Kudyar, Sachin; Nagpal, Brahmpreet; Kv, Alok; S, Ebin; Jose, Akhil.

Citation:

Cureus. 16(11):e74226, 2024 Nov.

Abstract:

OBJECTIVES: The objectives of this study are to determine the functional outcomes and compare them between conservative and surgical management in patients managed for closed-type intra-articular distal end of radius fractures.

METHODS: A prospective observational study was done on 150 patients who underwent treatment for closed-type intra-articular distal end of radius fractures. As per Frykman Classification, they were type III. patients were either managed conservatively, i.e. 100 patients out of 150 and surgical management was done in 50 cases. For surgical management, implants used were K-wires, Schanz pins, and Ellis Plate. The functional outcomes were noted in terms of pain and range of motion, in the follow up of six months. Union was noted clinically and radiologically.

RESULTS: The mean age of the study patients was 42.32 +/- 15.77 years. Out of 150 patients, there were 100 (66.67%) male patients. Compared to conservative management, surgical management had significantly lesser time of union (12 vs. 20 weeks, P<0.0001); significantly more excellent results (44% vs. 30%), more good results (32% vs. 15%) (P=0.003); comparable pain score (P=0.236); and comparable functional score (P=0.661). Regarding radiological outcomes, surgical management had significantly more volar tilt (9.6+/-2.5degree vs. 8+/-5degree, P=0.035); lesser Ulnar variance (3+/-2 vs. 4+/-2 mm, P=0.004), lesser grip strength <50% (26% vs. 65%, P<0.0001); comparable radial inclination (21+/-4degree vs. 20+/-5degree, P=0.661); and comparable radial height (11+/-3 vs. 10+/-5 mm, P=0.195)

CONCLUSION: To conclude, surgery for distal radius fractures promotes faster healing, lesser pain, lesser malunion, and better functional outcomes. However, it is not without potential risks. Non-surgical treatment is still a suitable option, for patients with contraindications to surgery or having lower need for functional improvement.

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Functional Outcomes and Complications After Open Reduction and Internal Fixation of Mid-shaft Clavicle Fractures: A Retrospective Study (2024)

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Type of publication:

Journal article

Author(s):

Hamid, Muhammad A; *Younis, Zubair; Mannan, Muhammad; Shrivastava, Nayan; Prabhu, Rudra M.

Citation:

Cureus. 16(11):e74302, 2024 Nov.

Abstract:

INTRODUCTION: Clavicle fractures are routinely encountered in orthopedic clinical practice and have often been the subject of debate when it comes to optimal treatment. Clavicle fracture surgery has come a long way with excellent pre-contoured superior locking plates available for fixation. This study aimed to evaluate a cohort of patients operated for displaced mid-shaft clavicle fractures by open reduction and internal fixation using superior clavicle locking plates.

MATERIALS AND METHODS: This is a retrospective cohort study of mid-shaft clavicle fracture patients who were operated on and had their fractures fixed using superior clavicle locking plates. We identified a total of 29 patients to be included in this study. The primary outcome measure was the quickDASH score at the time of discharge (12 weeks from surgery). Secondary outcome measures were the pattern and frequency of complications, and the need for metalwork removal.

RESULTS: Our study had a male preponderance, with 19 (65.5%) patients being male. The most common mode of trauma was fracture secondary to a road traffic accident in 12 (41.4%) patients. All but one fracture united uneventfully. The mean quickDASH score was 0.94 at 12-week follow-up. Complications were noted in 12 (41.4%) patients, and the most common complication was hardware irritation in seven (24.1%) patients, followed by dysesthesia around the surgical scar in five (17.2%) patients.

CONCLUSION: Open reduction and internal fixation of the clavicle give a high likelihood of fracture union along with good shoulder function. In a particular cohort of patients, this offers a quick recovery and earlier return to activity. However, this must be balanced with the risk of complications in a considerable proportion of operated patients, some of which might necessitate a second surgery.

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VEST: The UK vedolizumab real life experience study in Inflammatory Bowel Disease (2024)

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Type of publication:

Conference abstract

Author(s):

Bodger K.; Booker C.; Kok K.; Lobo A.; Ahmad T.; Bloom S.; *Butterworth J.; Irving P.; Cummings F.

Citation:

Journal of Crohn's and Colitis. Conference: 19th Congress of the European Crohn's and Colitis Organisation, ECCO 2024. Stockholm Sweden. 18(Supplement 1) (pp i1775-i1777), 2024. Date of Publication: January 2024.

Abstract:

Background: The characteristics and outcomes of patients treated with vedolizumab in routine healthcare settings have not been widely evaluated in the UK. Method(s): Prospective, multicentre observational study of 364 patients started on vedolizumab in UK practice from January 2017 until February 2019 using the UK IBD Registry clinical web-based tool. For the present analysis, the primary outcome was drug survival (persistence) at 1-year, defined as attendance for infusion >=48 weeks after the first dose. Secondary outcomes were: Clinical remission (CR, based on partial Mayo score [<=1] or Harvey Bradshaw index [<=4]), physician global assessment (PGA), IBD-Control Questionnaire (IBD-Control-8, IBD-Control-VAS and individual item scores), laboratory parameters and adverse events. Result(s): Age (mean): 44 yrs; Males: 48%; IBD duration (mean): 6 yrs; Prev. resection: 18%; Steroids at baseline: 39%; Outcomes are summarized in Table 1. 37% of CD patients were assessed as being in clinical remission at baseline. Overall, 210 (58%) continued treatment beyond 48 weeks. At 1 year, 67.1% and 52.3% of CD and UC patients were in clinical remission with a clear improvement in QoL as assessed by IBD-Control -8. There were significant improvements across each IBD-Control-8 domain, including fatigue, with few patients considering switching treatment at that point (Figure 1). Conclusion(s): Vedolizumab was effective in clinical practice with 58% of patients remaining on treatment at one-year. Baseline status differed significantly from those recruited into RCTs. Patient reported outcomes demonstrated significant and meaningful improvements across physical, psychological, social and treatment domains.

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Widespread non-adherence to guidelines in the operative management of diabetes-related foot disease complications (2024)

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Type of publication:

Journal article

Author(s):

Renwick B.; Gannon M.; Kerr S.; Melvin R.; Ingram A.; Bosanquet D.; Fabre I.; Yew S.; Moreau J.; Dewi M.; Lowry D.; Clothier A.; Hutchings T.; Boyle J.; Wijewardena C.; Chowdhury M.; Torre G.L.; Grewal H.; Ansaripour A.; Lawson D.; Nandhra S.; Ugwumba L.; El-Sayed T.; Altahir A.; Elkashef H.; *Jones S.; Arkle J.; Khalil R.; Ramsay J.; Nesbitt C.; Paravastu S.; Jayaprakash V.V.; Flumignan R.L.G.; Flumignan C.D.Q.; Nakano L.C.U.; Schippers P.; Pereira F.A.; Pegas N.C.; Hitchman L.; Walshaw J.; Ravindhran B.; Lathan R.; Smith G.; Shalhoub J.; Ahmad M.; Shea J.; Howard T.; Elsanhoury K.; Eskandar G.; Mekhaeil K.; Scott K.; Enc M.; Mannan F.; Chowdhury S.; Abdelmageed A.E.; Russell D.; Jones A.; Dattani N.; El-Nakhal T.; Katsogridakis E.; Duncan A.; Musto L.; Proctor D.; Parsapour S.; Lewis S.; Hassan A.; Abdelal A.; Elzefzaf N.; Yasser N.; Antoniou G.A.; Singh A.; Alhoussan L.; Venkateswaran V.; Feil F.; Dindyal S.; Lyons O.; Benson R.; Lim E.; Sze M.; Khashram M.; Hart O.; Vincent Z.; Xue N.; Pottier M.; Gormley S.; Tong C.; Pang D.; Patil A.; Ngam L.; Macleod C.; Aziz I.; Stather P.; Abuduruk A.; Manson J.; Howard D.; Hussain S.; Glatzel H.; James N.; Rafil M.; Marlow N.; Meldrum A.; Hussey K.; Jones C.; Shepherd E.; Fitridge R.; Hon K.; Kour K.; Ng S.; Hardy T.; Muse S.; Ching D.; Donoghue S.; Thompson D.; Forsythe R.; Chan S.; Powezka K.; Wu D.; Kuronen-Stewart C.; Winarski A.; Lapolla P.; Cirillo B.; *Al-Saadi N.; *Dowdeswell M.; *Mcdonald S.; *Al-Hashimi K.; *Merriman K.; Hassouneh A.; Sadia U.; Jaipersad A.; Moulakakis K.G.; Papageorgopoulou C.; Kakkos S.; Tsimpoukis A.; Papadoulas S.; Kouri N.; Nikolakopoulos K.; D'oria M.; Lepidi S.; Grando B.; Nickinson A.; Gamtkitsulashvili G.; Enemosah I.; Storer N.; Gabab K.; Dingwell M.; Premadasan Y.; Karkos C.; Mitka M.; Soteriou A.; Asaloumidis N.; Papazoglou K.; Condie N.; Abdullahi H.; Shafeek F.; Lyons T.; Ambler G.; Benson R.A.; Birmpili P.; Blair R.H.J.; Bosanquet D.C.; Gwilym B.L.; Machin M.; Onida S.; Saratzis A.; Singh A.A.; Shelmerdine L.;

Citation:

British Journal of Surgery. 111(10) (no pagination), 2024. Article Number: znae231. Date of Publication: 01 Oct 2024.

Abstract:

The incidence of diabetes is increasing. One of the most common complications is diabetes-related foot disease (DFD), which include ulcers and gangrene. If not managed appropriately, DFD can rapidly deteriorate resulting in limb loss and death.The International Working Group on the Diabetic Foot (IWGDF) and the Global Vascular Guidelines (GVG) provide recommendations on the assessment and management of DFD and chronic limb-threatening ischaemia (CLTI). It has been hypothesized that adherence to these guidelines varies and could be contributing to poor outcomes.This study aimed to capture practices of diabetic foot debridement and minor amputation in theatre, to compare practice with the IWGDF and GVG recommendations, and to report the outcomes of patients undergoing debridement or minor amputation for a DFD complication.

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Evaluation of Patient-Initiated Follow-Up (PIFU) Service in a Fracture Clinic: A Comprehensive Service Evaluation and Patient Satisfaction Audit (2024)

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Type of publication:

Journal article

Author(s):

*Younis, Zubair; Hamid, Muhammad A; *Khan, Muhammad Murtaza; Sapra, Rahul; *Gurukiran, Gurukiran; *Singh, Rohit.

Citation:

Cureus. 16(11):e73461, 2024 Nov.

Abstract:

Background Outpatient clinics are increasingly challenged by high patient volumes and rising "did not attend" (DNA) rates, leading to extended wait times and declines in patient satisfaction. Traditional follow-up (FU) models with routinely scheduled appointments contribute to inefficiencies, as stable patients may attend unnecessary visits, thus straining clinic resources. The patient-initiated follow-up (PIFU) model offers an alternative where patients schedule appointments only when necessary. This study evaluates PIFU's efficacy in improving outpatient services and patient satisfaction by reducing routine appointments and prioritizing patient-driven follow-up. Methods This service evaluation and patient satisfaction audit was conducted at the fracture clinic of Royal Shrewsbury Hospital over three months (December 2023-March 2024). Out of 3828 patients seen, 203 were assigned to PIFU based on criteria indicating stable conditions with minimal follow-up requirements. The remaining patients were either scheduled for routine follow-ups or discharged. Data were collected retrospectively from clinic records, and a structured
questionnaire assessed patient satisfaction with the PIFU service. Results Among the 203 patients assigned to PIFU, 183 (90.15%) patients received an informational leaflet, with all respondents finding it easy to understand. However, only 41 (20.2%) of patients utilized the PIFU service, primarily for concerns about pain, healing, or complications. Satisfaction among PIFU users was high, with 163 (80.3%) patients rating the service 5/5. Non-users mostly cited no perceived need for follow-up. Demographic analysis indicated that patients aged 40-60 were predominant (n=132; 65.02%) among the PIFU cohort. Conclusion The PIFU model demonstrated the potential to alleviate clinic workload by reducing routine follow-ups while maintaining high patient satisfaction. Although utilization rates were low, those who engaged found the service beneficial, suggesting PIFU's value for patients comfortable with self-management. Improved patient education may enhance engagement, supporting the broader implementation of PIFU in outpatient settings. Further research is warranted to explore barriers to patient-initiated follow-up and refine eligibility criteria for optimal outcomes.

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