Blue Book on the Management of Distal Radial Fractures

British Society for Surgery of the Hand publishes its Blue Book on the Management of Distal Radial Fractures


UHCW Consultant Orthopaedic Surgeon Helen Hedley and Electronic Systems & Resources Librarian Helga Perry contributed to this publication.


Obtain the full document at: http://www.bssh.ac.uk/_userfiles/pages/files/professionals/Radius/Blue%20Book%20DRF%20Final%20Document.pdf

NIHR Signal Physiotherapy education before major abdominal surgery reduces lung complications

NIHR Signal Physiotherapy education before major abdominal surgery reduces lung complications


Published on 3 April 2018


A physiotherapy session before planned abdominal surgery, explaining the importance of breathing exercises and sitting out of bed as soon after surgery as possible, halves the risk of pneumonia.


https://discover.dc.nihr.ac.uk/content/signal-00579/physiotherapy-before-abdominal-surgery-helps-prevent-pneumonia


From the NIHR Dissemination Centre

New NICE Interventional procedures guidance [IPG610] Nerve transfer to partially restore upper limb function in tetraplegia

New NICE Interventional procedures guidance [IPG610] Nerve transfer to partially restore upper limb function in tetraplegia


Published date: April 2018 Next review: April 2021




Evidence-based recommendations on nerve transfer to partially restore upper limb function in people with tetraplegia. This involves connecting an undamaged, functioning, but non-essential nerve near the injury to the damaged essential nerve.


For full guidance https://www.nice.org.uk/guidance/ipg610

Vascular surgery: GIRFT Programme National Specialty Report.

Vascular surgery: GIRFT Programme National Specialty Report.

This report provides a detailed picture of vascular procedures and how they are delivered. It is intended to enable clinicians and managers to consider how best to configure their vascular services as part of a 'hub and spoke' model for the benefit of their patients.

Get full details and the report at http://gettingitrightfirsttime.co.uk/vascular-surgery-report/

Hand surgery: Applications for Travelling Fellowship now open

Applications for Travelling Fellowship now open!
A new award has been created to facilitate trainee involvement in Global Hand Surgery and the work of the BSSH Overseas Committee. This will allow a trainee to accompany one of many BSSH overseas trips undertaken annually to observe and assist in clinics, theatre, and teaching delivery. Currently, there are ongoing projects in Malawi, Sierra Leone, Ethiopia, Sudan, Cambodia, Nepal, and Myanmar.
Find out more and get the expression of interest form at http://www.bssh.ac.uk/about/news/120/applications_for_travelling_fellowship_now_open

UHCW publication: pilot randomized trial of meniscal allograft transplantation versus personalized physiotherapy for patients with a symptomatic meniscal deficient knee compartment

A pilot randomized trial of meniscal allograft transplantation versus personalized physiotherapy for patients with a symptomatic meniscal deficient knee compartment.
Smith, N. A.; Parsons, N.; Wright, D.; Hutchinson, C.; Metcalfe, A.; Thompson, P.; Costa, M. L.; Spalding, T.
The Bone & Joint Journal 2018 January 100B(1):56–63
Abstract

Aims: Meniscal allograft transplantation is undertaken to improve pain and function in patients with a symptomatic meniscal deficient knee compartment. While case series have shown improvements in patient reported outcome measures (PROMs), its efficacy has not been rigorously evaluated. This study aimed to compare PROMs in patients having meniscal transplantation with those having personalized physiotherapy at 12 months.

Patients and Methods: A single-centre assessor-blinded, comprehensive cohort study, incorporating a pilot randomized controlled trial (RCT) was performed on patients with a symptomatic compartment of the knee in which a (sub)total meniscectomy had previously been performed. They were randomized to be treated either with a meniscal allograft transplantation or personalized physiotherapy, and stratified for malalignment of the limb. They entered the preference groups if they were not willing to be randomized. The Knee injury and Osteoarthritis Outcome Score (KOOS), International Knee Documentation Committee (IKDC) score and Lysholm score and complications were collected at baseline and at four, eight and 12 months following the interventions.

Results: A total of 36 patients entered the study; 21 were randomized and 15 chose their treatments. Their mean age was 28 years (range 17 to 46). The outcomes were similar in the randomized and preference groups, allowing pooling of data. At 12 months, the KOOS4 composite score (mean difference 12, p = 0.03) and KOOS subscales of pain (mean difference 15, p = 0.02) and activities of daily living (mean difference 18, p = 0.005) were significantly superior in the meniscal transplantation group. Other PROMs also favoured this group without reaching statistical significance. There were five complications in the meniscal transplantation and one in the physiotherapy groups.

Conclusion: This is the first study to compare meniscal allograft transplantation to non-operative treatment. The results provide the best quality evidence to date of the symptomatic benefits of meniscal allograft transplantation in the short term, but a multicentre RCT is required to investigate this question further. Full text PDF available at http://ovidsp.ovid.com/athens/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&AN=01714648-201801000-00010&D=ovft&PDF=y (UHCW Athens login required)

RSTN launches TRIGGER Trial

The Reconstructive Surgery Trials Network (RSTN) is leading the design of a trial of the treatment of trigger fingers in adults along with Dutch colleagues. We are looking for collaborators around the UK to coordinate a survey of practice as part of this.

We are also hosting a webinar to discuss the trial on 21st February, in conjunction with ICOPLAST.

To learn more, and to sign up for both, please visit: http://reconstructivesurgerytrials.net/trigger/

Intrabeam radiotherapy system for adjuvant treatment of early breast cancer [TA 501]

New: Technology appraisal guidance


The Intrabeam radiotherapy system (Carl Zeiss UK) is a mobile irradiation system. It is designed to deliver a single dose of targeted low-energy radiation (X‑rays) directly to the tumour bed, while limiting the exposure of healthy tissue to radiation. Because it delivers low energy radiation, it can be used in an ordinary operating theatre at the time of surgery. The Intrabeam radiotherapy system provides a source of 50 kV energy from a spherical applicator of between 1.5 cm and 5.0 cm diameter. The applicator is sutured to the tumour bed so that breast tissue at risk of local recurrence receives the prescribed dose while skin and deeper structures are protected. Radiation is delivered over 20 to 30 minutes.




The Intrabeam radiotherapy system was granted a CE (Conformité Européene) mark in 1999 for use in radiotherapy.
Intrabeam can be used as an intraoperative radiotherapy system given as the sole treatment or as a boost treatment followed by external beam radiotherapy (EBRT). When intraoperative radiotherapy is given as a boost treatment with Intrabeam and followed by EBRT, there is no need for further external boost treatment. Six NHS centres in the UK have used Intrabeam for adjuvant treatment of early breast cancer.

Interventional radiology leaders release guidance to help speed up rollout of vital life-changing stroke treatment

The Supplementary Guidance to Facilitate the Training of Interventional Radiology Consultants to Undertake Stroke Thrombectomy has been produced by The Royal College of Radiologists, the British Society of Interventional Radiology, the British Society of Neuroradiologists and the UK Neurointerventional Group, to help hospitals train more specialist radiologists to perform life-changing stroke thrombectomy treatment.

NIHR Signal A surgical procedure for shoulder pain is less effective than previously thought

An increasingly common surgical procedure for shoulder pain, subacromial decompression, was only slightly more effective than no treatment. In the first trial of this sort, improvements in pain and function following decompression or arthroscopy (a placebo surgery) did not reach a threshold of clinical importance compared with people allocated to no treatment at all.


This NIHR-funded study involved 313 people with shoulder pain that had not responded to physiotherapy and a steroid injection. The main intervention, decompression, involved removing any bony outgrowths that could have been causing the tendons around the shoulder to be “pinched”. This was compared with an arthroscopy used for investigation only; this did not include removing any bone or tissue. Those in the third “no treatment” arm did not receive any physiotherapy or advice.


From the NIHR Dissemination Centre

RCOT announces revised guidelines for occupational therapy and total hip replacement

The Royal College of Occupational Therapists (RCOT) is delighted to announce the publication of the second edition of the practice guidelines for working with people undergoing total hip replacement. Endorsed by the British Hip Society, the new guidelines recognise in particular the changes in length of recommended stay for patients as well as the fact that this surgery is increasingly being performed on younger patients.
https://www.rcot.co.uk/practice-resources/rcot-practice-guidelines/hip

Lateral percutaneous nephrolithotomy: A safe and effective surgical approach

Indian Journal of Urology (INDIAN J UROL), Jan-Mar 2018; 34(1): 45-50

Percutaneous nephrolithotomy (PCNL) is traditionally performed with the patient in the prone position for large renal calculi. However, anesthetic limitations exist with the prone position. Similarly, the supine position is associated with poorer ergonomics due to the awkward downward position of the renal tract, a smaller window for percutaneous puncture, and a higher risk of anterior calyx puncture. This study aimed to demonstrate the feasibility and safety of lateral-PCNL in managing large renal calculi without the disadvantages of prone and supine positions.
UHCW Research: Jonathan Jian Wei Gan

Subcutaneous implantable cardioverter defibrillator insertion for preventing sudden cardiac death [IPG603]

New interventional procedures guidance from NICE. This involves placing a device under the skin of the chest, which detects and treats fast heartbeats called tachyarrhythmias.
Recommendations:
Current evidence on the safety and efficacy of subcutaneous implantable cardioverter defibrillator insertion for preventing sudden cardiac death is adequate to support the use of this procedure provided that standard arrangements are in place for clinical governance, consent and audit.

Artificial heart implantation as a bridge to transplantation for end-stage refractory biventricular heart failure [IPG602]

New interventional procedures guidance from NICE.  This involves replacing the 2 lower chambers of the heart with a mechanical device to improve circulation until heart transplantation.

Current evidence on the safety and efficacy of total artificial heart implantation as a bridge to transplantation for end-stage refractory biventricular heart failure is limited in quality and quantity. Therefore, this procedure should only be used with special arrangements for clinical governance, consent and audit or research.

Clinicians wishing to do total artificial heart implantation as a bridge to transplantation for end-stage refractory biventricular heart failure should:

• Inform the clinical governance leads in their NHS trusts.
• Ensure that patients understand the uncertainty about the procedure's safety and provide them with clear written information. In addition, the use of NICE's information for the public is recommended.
• Audit and review clinical outcomes of all patients having total artificial heart implantation as a bridge to transplantation for end-stage refractory biventricular heart failure (see section 6.3).
• Clinicians should enter details about all patients having total artificial heart implantation as a bridge to transplantation for end-stage refractory biventricular heart failure onto an appropriate registry and review local clinical outcomes.
• Patient selection should be done by a multidisciplinary team experienced in managing end-stage refractory biventricular heart failure in patients needing a heart transplant, for whom a donor organ is not expected to be available before their own heart fails completely.
• This technically challenging procedure should only be done in centres specialising in heart transplantation. Only cardiothoracic surgeons with specific expertise and training in inserting the device should carry it out.

Endobronchial valve insertion to reduce lung volume in emphysema [IPG600]

New interventional procedures guidance from NICE. Endobronchial valve insertion to reduce lung volume in emphysema.

Current evidence on the safety and efficacy of endobronchial valve insertion to reduce lung volume in emphysema is adequate in quantity and quality to support the use of this procedure provided that standard arrangements are in place for clinical governance, consent and audit.

Patient selection should be done by a multidisciplinary team experienced in managing emphysema, which should typically include a chest physician, a radiologist, a thoracic surgeon and a respiratory nurse.

Patients selected for treatment should have had pulmonary rehabilitation. The procedure should only be done to occlude volumes of the lung where there is no collateral ventilation, by clinicians with specific training in doing the procedure.

Children best placed to explain facts of surgery to patients, say experts

Medical Devices & Surgical Technology Week; Atlanta [Atlanta]31 Dec 2017: 90.
Research shows that patients who are given clear information about their test, operation or care are less anxious and more satisfied with their care.

Patient information leaflets are a popular way to support verbal discussion with a health professional, particularly where consent is needed. However, the average reading age in the UK is 9 years, and some studies indicate that the average readability (a measure of how easy a piece of text is to read) needed for patient information leaflets is beyond 9 years.

So Dr Catrin Wigley at University Hospitals Coventry and Warwickshire NHS Trust and colleagues assessed the average readability of six NHS patient information leaflets for hip replacement surgery (total hip arthroplasty) and found an average readability score of 17 - well above a reading age of 9 years.

They then recruited 57 school children aged 8-10 at a local primary school to help revise the content.

Draft AAGBI guideline Cell salvage for peri-operative blood conservation

A draft guideline on cell salvage for peri-operative blood conservation is in its final draft stage and comments are invited from members. Please read the draft and submit any comments to workingparties@aagbi.org. All comments submitted will be considered before a final version is brought before the AAGBI Board for approval. The closing date for comment submission is 5pm on Friday 12 January 2018.

NIHR Signal Alternative drug may prevent atrial fibrillation following heart surgery

After heart surgery around a third of people have atrial fibrillation, an abnormal heart rhythm, which impedes their recovery and lengthens hospital stay. Colchicine treatment could reduce this complication by about a third.

About 11 people would need this treatment to prevent one of them developing atrial fibrillation. Using amiodarone, an alternative drug commonly used in this situation, other research shows that about seven people would be treated to prevent one person suffering fibrillation.

From the NIHR Dissemination Centre

Transvaginal mesh repair of anterior or posterior vaginal wall prolapse [IPG599]

New interventional procedures guidance from NICE:

Evidence-based recommendations on transvaginal mesh repair of anterior or posterior vaginal wall prolapse. This involves inserting a mesh to replace tissue that has weakened and caused the pelvic organs to drop down (prolapse) into the vagina.

Current evidence on the safety of transvaginal mesh repair of anterior or posterior vaginal wall prolapse shows there are serious but well-recognised safety concerns. Evidence of long-term efficacy is inadequate in quality and quantity. Therefore, this procedure should only be used in the context of research.nice

Culture and sensitivity reporting in odontogenic infections: do microbiology swabs change antibiotic prescribing practice?

British Journal of Oral and Maxillofacial Surgery , Volume 55 , Issue 10 , e94 - e95 

Odontogenic infections are commonly polymicrobial. Effective treatment depends on definitive drainage of abscesses and empirical antimicrobial therapy based on likely organisms.

UHCW Research: Jasdeep Singh Saggu, Jean Medard Croos, Ross Elledge and Gary Walton