Revolutionising rapid recovery: a quality improvement project in hip and knee replacement.

With increasing bed pressures and an ageing population, there is a need to increase throughput and reduce the bed burden of joint replacements. These issues were recognised in North Devon and an enhanced recovery pathway was established. Enhanced recovery, which aims to optimise the patient journey and shorten the inpatient admission, was first adopted for hip and knee replacements in North Devon District hospital in 2011.

Is virtual clinic follow-up of hip and knee joint replacement acceptable to patients and clinicians? A sequential mixed methods evaluation.

Objective: To evaluate the acceptability to key stake holders of a newly introduced virtual clinic follow-up pathway for hip and knee joint replacement.

Design: A service evaluation comprising a questionnaire sent electronically to 115 patients and interviews with 10 individuals.

Setting: A newly introduced virtual clinic follow-up pathway for hip and knee replacement patients in a district general hospital.

Non-operative management, supported by self-monitoring using web-based patient reported outcome measures (PROMs), in knee osteoarthritis.

Despite being straightforward to collect and key to providing patient-centred, individualised care, the routine use of patient reported outcome measures (PROMs) remains limited in the National Health Service. Herein is described the case of a 69-year-old woman who presented to secondary care with osteoarthritis. Web-based PROMs were used to track the patient's symptoms and function.

A systematic review of cost-effectiveness, comparing traction to intramedullary nailing of femoral shaft fractures, in the less economically developed context.

Introduction: Femoral shaft fractures carry considerable morbidity and are increasingly common in less economically developed countries (LEDCs). Treatment options include traction and intramedullary (IM) nailing but in a limited-resource environment; cost-effectiveness is fundamental to policy development. The objective herein was to evaluate the cost-effectiveness of moving from traction to IM nailing for femoral shaft fractures, in adults, in LEDCs.

Slipping with the waste (a wheelie bin hand injury).

A right hand dominant man in his 60s was moving his wheelie bin when he tripped and landed still holding on to the handle. His hand was trapped between the handle and the ground. He sustained lacerations at the level of the proximal interphalangeal joints of all the fingers of his right hand.