A helping hand: Applying behavioural science and co-design methodology to improve hand hygiene compliance in the hospital setting.

Compliance with hand hygiene is an effective way of reducing the incidence of healthcare acquired infections (HCAI). At one London National Health Service (NHS) Trust, improving hand hygiene compliance (HHC) was a patient safety priority in response to non-compliance and ongoing occurrences of HCAI. The objective of this study was to co-design a behavioural science informed intervention to improve HHC.

The effect of socioeconomic status and training programmes on burnout in postgraduate trainees in the United Kingdom: a cross-sectional analysis.

Purpose: Burnout is described as a state of mental exhaustion caused by one's professional life and is characterised by three domains: emotional exhaustion, depersonalisation, and a reduced sense of accomplishment. The prevalence of stress is high amongst doctors and varies by specialty, gender, trainee level, and socioeconomic status. The authors set out to examine the scale of the problem, as well as to determine the influence of both socioeconomic status and chosen training programme on burnout amongst postgraduate trainees.

Long-Term Follow-up (14 to 25 Years) Following Closed Reduction and Early Movement for Simple Dislocation of the Elbow.

Background: We have previously reported on the midterm outcomes after a nonoperative protocol to treat simple dislocations of the elbow that included a short period of splinting followed by early movement. We have now performed extended follow-up of the original patient group from the prior study to determine whether the excellent results that previously had been reported were maintained in the long term and also to determine the rate of and need for any late surgical intervention.

Methods: We attempted to contact all of the patients from the original study group.

Acute Carpal Tunnel Syndrome: Early Nerve Decompression and Surgical Stabilization for Bony Wrist Trauma.

Unlabelled: We undertook this study to investigate the outcomes of surgical treatment for acute carpal tunnel syndrome following our protocol for concurrent nerve decompression and skeletal stabilization for bony wrist trauma to be undertaken within 48 hours.

Methods: We identified all patients treated at our trauma center following this protocol between January 1, 2014 and December 31, 2019. All patients were clinically reviewed at least 12 months after surgery and assessed using the Brief Michigan Hand Outcomes Questionnaire, the Boston Carpal Tunnel Questionnaire, and sensory assessment with Semmes-Weinstein monofilament testing.

Case Report - Short-term Bisphosphonate Use Associated Stress Fractures.

Introduction: Long-term bisphosphonate use has been linked to an increased risk of pathological neck of femur fractures.

Case Report: We write concerning a patient who presented with the left hip pain following a low impact fall, which was diagnosed as a pathological left neck of femur fracture. This was a subtrochanteric stress fracture most frequently seen in patients who take bisphosphonate medications.

Patterns of injury and treatment for distal radius fractures at a major trauma centre.

Aims: Fractures of the distal radius are common, and form a considerable proportion of the trauma workload. We conducted a study to examine the patterns of injury and treatment for adult patients presenting with distal radius fractures to a major trauma centre serving an urban population.

Methods: We undertook a retrospective cohort study to identify all patients treated at our major trauma centre for a distal radius fracture between 1 June 2018 and 1 May 2021.

Comparing shared decision making using a paper and digital consent process. A multi-site, single centre study in a trauma and orthopaedic department.

Introduction: The importance of shared decision making (SDM) for informed consent has been emphasised in the updated regulatory guidelines. Errors of completion, legibility and omission have been associated with paper-based consent forms. We introduced a digital consent process and compared it against a paper-based process for quality and patient reported involvement in shared decision making.

Patients presenting to an acute general hospital with acute mental health needs: a retrospective observational cohort study.

Objectives: To examine the numbers and patterns of patients presenting to an urban acute general hospital with acute mental health presentations and to further investigate any variation related to the COVID-19 pandemic.

Design: Retrospective observational cohort study.

Setting: An urban acute general hospital in London, UK, comprising of five sites and two emergency departments.

The Perceptions and Experience of Surgical Trainees Related to Patient Safety Improvement and Incident Reporting: Structured Interviews With 612 Surgical Trainees.

Background We undertook a prospective qualitative study to ascertain the perceptions and experience of trainee doctors in the first two years of formal core surgical training related to patient safety improvement and incident reporting. We sought to explore the beliefs, knowledge and opinions of core surgical trainees related to patient safety improvement, their understanding of existing patient safety initiatives and their experience and attitudes to incident reporting. Methods We identified 1133 doctors in formal core surgical training posts in the United Kingdom at this time, and we contacted these doctors to invite them to participate in our study.

Embracing virtual outpatient clinics in the era of COVID-19.

The response to the COVID-19 pandemic has raised the profile and level of interest in the use, acceptability, safety, and effectiveness of virtual outpatient consultations and telemedicine. These models of care are not new but a number of challenges have so far hindered widespread take-up and endorsement of these ways of working. With the response to the COVID-19 pandemic, remote and virtual working and consultation have become the default.

Repeat limited fasciectomy is a safe and effective treatment for recurrence of Dupuytren's disease.

Aims: The results of surgery for Dupuytren's disease can be compromised by the potential for disease recurrence and loss of function. Selecting which patients will benefit from repeat surgery, when to operate, and what procedure to undertake requires judgement and an understanding of patient expectations and functional needs. We undertook this study to investigate patient outcomes and satisfaction following repeat limited fasciectomy for recurrent Dupuytren's disease.

The perception of patient safety in an alternate site of care for elective surgery during the first wave of the novel coronavirus pandemic in the United Kingdom: a survey of 158 patients.

Background: We undertook a prospective qualitative survey to ascertain the perceptions and experience of National Health Service patients in the United Kingdom who underwent planned or elective procedures and surgery at alternate 'clean' hospital sites during the coronavirus disease 2019 (COVID-19) pandemic. These alternate 'clean' hospital sites were independent hospitals running active staff and patient testing programmes for COVID-19 and which did not admit or treat patients suffering with COVID-19.

Methods: A prospective survey was undertaken to include patients at least 30 days after a planned surgery or procedure conducted at a 'clean' alternate hospital site during the COVID-19 pandemic.

Surgery with the Motec total wrist replacement: learning from earlier designs.

The design of and applications for wrist arthroplasty continue to evolve but lag behind the results for hip and knee arthroplasty with respect to demonstrable durability and effectiveness. As we develop our knowledge, experience and the indications for wrist replacement surgery, it is important that we learn from past design and surgical experience. We report the case of a female patient treated with a Motec cementless metal-on-metal wrist replacement (Swemac Orthopaedics AB, Linköping, Sweden) for post-traumatic arthritis of the radiocarpal joint.

Surgical training in the UK: is cost a barrier to entry?

Background: There is good quality evidence linking socioeconomic background and the likelihood of a surgical career. Additionally, training in surgery is more expensive than in other specialties. Our aim was to assess the awareness and perceptions of trainees and medical students of the relative costs of surgical training and to determine whether perceptions of cost deter potential surgical trainees.

Acute calcific periarthritis secondary to calcium hydroxyapatite crystal deposition in the wrist: a case report.

Acute calcific periarthritis (ACP) is an unusual cause of monoarticular pain characterised by the deposition of calcium hydroxyapatite in the peri-articular and intra-articular tissues. Although the most commonly affected joint is the shoulder, other joints may be involved, including the wrist. This case report describes a 57-year-old female presenting with wrist pain and swelling associated with amorphous calcification overlying the lunate.

Waiting lists for symptomatic joint arthritis are not benign: prioritizing patients for surgery in the setting of COVID-19.

Aim: Restarting elective services presents a challenge to restore and improve many of the planned patient care pathways which have been suspended during the response to the COVID-19 pandemic. A significant backlog of planned elective work has built up representing a considerable volume of patient need. We aimed to investigate the health status, quality of life, and the impact of delay for patients whose referrals and treatment for symptomatic joint arthritis had been delayed as a result of the response to COVID-19.

Day case locked anterior plating for distal radial fractures is safe with uninterrupted antithrombotic therapy.

We undertook a matched prospective cohort study over a 4-year period to examine the safety of continuing the administration of regular antithrombotic treatment with warfarin, clopidogrel or aspirin during day case surgical fixation of distal radial fractures. One hundred and one patients were identified and consented to participate in this study. There was only one reported complication: a superficial wound infection treated with antibiotics.

Joystick reduction and percutaneous Kirschner wire stabilisation for dislocation of the pisiform.

We report the case of a sportsman who fell injuring his left non-dominant wrist. He suffered an unusual injury, a fracture dislocation of the pisotriquetral joint which left him with a painful restriction of wrist movement. We describe his presentation and treatment with a novel 'joystick' technique following failed manipulation.

Surgical fixation of fractures of the distal radius within 2 weeks reduces postoperative finger stiffness.

Locked anterior plating remains the most common form of surgical fixation for displaced fractures of the distal radius. We hypothesized that delayed surgical fixation later than 2 weeks after injury contributes to poorer patient outcomes for patients with displaced or intra-articular fractures of the distal radius. We conducted a retrospective cohort study of 158 patients who underwent locked anterior plating for an intra-articular or displaced fracture of the distal radius using multiple regression analysis to identify any relationship between patient, injury or treatment factors with the patient-rated wrist and hand evaluation score or finger and wrist stiffness.

The virtual fracture clinic improves quality of care for patients with hand and wrist injuries: an assessment of 3709 patients.

Fracture clinic services are under significant pressures to meet patients' expectations of a high-quality service. The virtual fracture clinic has shown early promise in helping to reduce such pressures. We used the virtual fracture clinic for hand and wrist injuries treated in the orthopaedic fracture clinic and used key quality indicators to measure improvement.

Medium-term patient-reported outcomes after total hip replacement for displaced hip fractures.

Introduction: The aim of the present study was to define the medium-term outcomes following total hip replacement (THR) for hip fracture.

Methods: We prospectively followed up 92 patients who underwent THR for a displaced hip fracture over a 3-year period between 2007 and 2010. These patients were followed up at 5 years using the Oxford Hip Score, Short-Form 12 (SF-12) questionnaire and satisfaction questionnaire.

Open Finger Fractures: Incidence, Patterns of Injury and the Influence of Social Deprivation.

Background: This study investigates the patterns and epidemiology of open finger fractures. There is little good data about these injuries.

Methods: Data were collected prospectively in a single trauma unit serving a well-defined population.

Factors associated with one-year outcome after distal radial fracture treatment.

Purpose: To identify factors that affect functional outcome one year after distal radial fracture treatment.

Methods: 521 women and 121 men aged 16 to 92 (mean, 59) years with distal radial fractures underwent external fixation (n=123), open reduction and internal fixation (n=63), a combination of both (n=10), distal radial osteotomy for symptomatic malunion (n=90), or casting with (n=194) or without (n=162) prior closed manipulation under regional anaesthesia. The indication for surgery (rather than casting) was metaphyseal instability.