Pre-Employment physical capacity testing as a predictor of musculoskeletal injury in Victorian paramedics

Work ◽  
2021 ◽  
Vol 70 (1) ◽  
pp. 263-270
Author(s):  
Natasha Jenkins ◽  
Gavin Smith ◽  
Scott Stewart ◽  
Catherine Kamphuis
Keyword(s):  
Musculoskeletal Injury ◽  
Physical Capacity ◽  
Data Sets ◽  
Case Review ◽  
Workplace Injury ◽  
Retrospective Case ◽  
Sample Mean ◽  
The Mean ◽  
Manual Handling ◽  
Mean Time

BACKGROUND: Paramedic work has periods of intermittent high physical demand, a risk of workplace injury, may be confounded by inherent fitness of the paramedic. OBJECTIVE: This study aimed to identify the nature of workplace musculoskeletal injury, and determine if there was a relationship between pre-employment physical capacity testing (PEPCT) scores and risk of workplace musculoskeletal injury within the paramedic industry. METHODS: A retrospective case review using PEPCT scores and workplace injury (WI) manual handling data collected from 2008 to 2015 by an Australian pre-hospital emergency care provider (Ambulance Victoria), enabled comparison and analysis of two distinct data sets. RESULTS: A total of 538 paramedics were included for analysis with 34 paramedics reporting a workplace musculoskeletal injury from manual handling. The mean time to injury from commencement of employment was 395.4 days (SD 516.2). Female paramedics represented 53.0%and male paramedics represented 47%of the sample. Mean total PEPCT score for the entire sample was 19.1 (SD 2.9) with a range from 16.2–22, while for those reporting injuries it was 18.3 (SD 2.6) with a range from 15.7–20.9. CONCLUSIONS: Musculoskeletal injury amongst Victorian paramedics is more prevalent where the paramedic is female, and/or within three years of commencement of employment. The PEPCT score did not differentiate those at risk of subsequent injury.

scholarly journals Navigation with laparoscopic ultrasound during fundus-first laparoscopic cholecystectomy-a single-centre retrospective case control study

2020 ◽  
Author(s):  
Maciej Sebastian ◽  
Agata Sebastian ◽  
Jerzy Rudnicki
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Statistical Significance ◽  
Laparoscopic Ultrasound ◽  
Retrospective Case ◽  
Exact Test ◽  
Critical View ◽  
Critical View Of Safety ◽  
The Mean ◽  
Mean Time ◽  
Bail Out

Abstract Background Laparoscopic cholecystectomy is considered as the gold standard treatment for cholecystolithiasis. The critical view of safety is a generally accepted technique of intraoperative visualization but during inflammation and fibrosis in the region of Calot’s triangle it may fail. Fundus-first laparoscopic cholecystectomy with laparoscopic ultrasound navigation may be an attractive bail-out option when the intraoperative conditions are difficult. Methods The study group consisted of 900 patients with symptomatic cholecystolithiasis which was divided into two subgroups. The first subgroup where the only method of intraoperative identification was the critical view of safety consisted of 402 patients, the second subgroup where the critical view of safety and laparoscopic ultrasound were used consisted of 498 patients. In the first subgroup fundus-first laparoscopic cholecystectomy was performed in 13 patients, in the second subgroup in 42 patients. Statistical analysis included the Mann-Whitney U test for continuous and Fisher’s exact test for binary variables. The level of statistical significance was set at 95% (p < 0.05). Results Fundus-first technique was significantly more often in the subgroup with laparoscopic ultrasound and the hospitalization time of fundus-first laparoscopic cholecystectomies was significantly shorter than in converted cases. The mean time of laparoscopic cholecystectomy and the mean time to obtain the transection level between the gallbladder and the hepatoduodenal ligament were significantly shorter and the conversion rate was significantly lower in the fundus-first and laparoscopic ultrasound group. Conclusions Fundus-first technique with laparoscopic ultrasound navigation may be a very efficient bail-out option during laparoscopic cholecystectomy due to a more precisely and significantly faster defined plane of dissection what enables safe performance of laparoscopic cholecystectomy with significantly lower rate of conversions.

A ten-year retrospective study investigating the rate of venous thromboembolism in patients who require immobilization in a total contact lower limb cast

2019 ◽  
Vol 101-B (6) ◽  
pp. 691-694 ◽  
Author(s):  
X. N. Tonge ◽  
J. C. Widnall ◽  
G. Jackson ◽  
S. Platt
Keyword(s):  
Venous Thromboembolism ◽  
General Population ◽  
Lower Limb ◽  
Case Series ◽  
Individual Case ◽  
Plaster Cast ◽  
Retrospective Case ◽  
Increased Risk ◽  
The Mean ◽  
Mean Time

Aims To our knowledge, there is currently no information available about the rate of venous thromboembolism (VTE) or recommendations regarding chemoprophylaxis for patients whose lower limb is immobilized in a plaster cast. We report a retrospective case series assessing the rate of symptomatic VTE in patients treated with a lower limb cast. Given the complex, heterogeneous nature of this group of patients, with many risk factors for VTE, we hypothesized that the rate of VTE would be higher than in the general population. Patients and Methods Patients treated with a lower limb cast between 2006 and 2018 were identified using plaster room records. Their electronic records and radiological reports were reviewed for details about their cast, past medical history, and any VTE recorded in our hospital within a year of casting. Results There were 136 episodes of casting in 100 patients. The mean age was 55 years (22 to 91). The mean time in a cast was 45 days (five days to eight months). A total of 76 patients had neuropathy secondary to diabetes. No patient received chemical thromboprophylaxis while in a cast. One VTE (0.7% of casting episodes) was documented. This was confirmed by Doppler scan nine days after removing the cast. Conclusion The frequency of VTE was higher than that of the general population (0.05%); this is most likely attributable to our patients’ apparent increase in VTE risk as suggested by The National Institute for Health and Care Excellence (NICE). These findings suggest that thromboprophylaxis is not routinely indicated in patients who undergo immobilization of the lower limb in a cast, although the risks of VTE should be assessed. While the cast itself does not pose an increased risk, other pathologies, such as active cancer, mean that each individual case needs to be considered on their merit. Cite this article: Bone Joint J 2019;101-B:691–694.

scholarly journals Deep infection following reconstruction of pelvic fractures: prevalence, characteristics, and predisposing risk factors

2021 ◽  
Author(s):  
Nikolaos Konstantinou Kanakaris ◽  
Vincenzo Ciriello ◽  
Petros Zoi Stavrou ◽  
Robert Michael West ◽  
Peter Vasiliou Giannoudis
Keyword(s):  
Risk Factors ◽  
Median Number ◽  
Deep Infection ◽  
Pelvic Fractures ◽  
Control Group ◽  
Pelvic Reconstruction ◽  
Retrospective Case ◽  
Related Factors ◽  
The Mean ◽  
Mean Time

Abstract Purpose To identify the incidence, risk factors, and treatment course of patients who developed deep infection following fixation of pelvic fractures. Methods Over a period of 8 years patients who underwent pelvic reconstruction in our institution and developed postoperative infection were included. Exclusion criteria were pathological fractures and infections that were not secondary to post-traumatic reconstruction. The mean time of follow-up was 43.6 months (33–144). For comparison purposes, we randomly selected patients that underwent pelvic fracture fixation from our database (control group). A logistic regression was fitted to patient characteristics including age, sex, ISS, and diabetic status. Results Out of 858 patients, 18 (2.1%) (12 males), with a mean age of 41 (18–73) met the inclusion criteria. The control group consisted of 82 patients with a mean age of 41 years (18–72). The mean ISS was 27.7 and 17.6 in the infection and control group, respectively. The mean time from pelvic reconstruction to the diagnosis of infection was 20 days (7–80). The median number of trips to theatre was 3 (1–16). Methicillin-resistant Staphylococcus aureus (MRSA) was the most frequently isolated organism in the years prior to 2012. Eradication was achieved in 93% of the patients. The most important risk factors for deep infection were ISS (OR 1.08, 1.03–1.13), posterior sacral approach (OR 17.03, 1.49–194.40), and diabetes (OR 36.85, 3.54–383.70). Conclusion In this retrospective case–control study, deep infection following pelvic trauma was rare. A number of patient-, injury- and surgery-related factors have shown strong correlation with this serious complication.

scholarly journals Trauma Rapid Review Process: Efficient Out-Patient Fracture Management

2006 ◽  
Vol 88 (4) ◽  
pp. 408-411 ◽  
Author(s):  
A Beiri ◽  
A Alani ◽  
T Ibrahim ◽  
GJS Taylor
Keyword(s):  
Review Process ◽  
Clinical Decision Making ◽  
Musculoskeletal Injury ◽  
Rapid Review ◽  
X Rays ◽  
Fracture Clinic ◽  
Number Of Patients ◽  
Fracture Management ◽  
The Mean ◽  
Mean Time

INTRODUCTION Our hospital operates a consultant-led, rapid review process of X-rays and case notes of all musculoskeletal injury patients on a daily basis. This compares with other centres where patients are reviewed in out-patient fracture clinics soon after injury. The aim of this study was to evaluate the effectiveness of this consultant-led, rapid review process compared to standard consultant fracture clinics. PATIENTS AND METHODS A prospective study of the rapid review process over 4 weeks of all musculoskeletal injury patients was conducted. The total number of patients referred per day, time taken to review these patients X-rays and case notes, number of recalls and reason for recall were documented. This was compared to consultant-led fracture clinics, which included time taken to review patients. RESULTS A total of 797 patients were processed through the rapid review over 4 weeks: 53 (6%) patients were recalled, 32 (4%) for a change of management and 21 (2.6%) because of lack of information. The mean number of patients referred per day was 28 taking a mean of 28 min; thus the mean time to review one patient was 1.0 min. The mean number of patients recalled per day was two. The mean time taken to review a patient in a standard fracture clinic was 11 min. Therefore, the total time that would have taken to review 28 patients in a standard fracture clinic would be 308 min. CONCLUSIONS A consultant-led, rapid review process of all patients with musculoskeletal injury is a very efficient process. The rapid review process saves clinic time and resources, minimises delays in clinical decision-making and saves the patient an unnecessary visit to the outpatient department.

Combined Posteromedial and Posterolateral Approaches for 2-Part Posterior Malleolar Fracture Fixation

2020 ◽  
Vol 41 (10) ◽  
pp. 1234-1239 ◽  
Author(s):  
Yunfeng Yang ◽  
Wenbao He ◽  
Haichao Zhou ◽  
Jiang Xia ◽  
Bing Li ◽  
...  
Keyword(s):  
Case Series ◽  
Good Alternative ◽  
Retrospective Case ◽  
Malleolar Fracture ◽  
Level Of Evidence ◽  
Malleolar Fractures ◽  
Posterior Malleolar Fracture ◽  
The Mean ◽  
Mean Time

Background: This study investigated the clinical efficacy of combined posteromedial and posterolateral approaches for repair of 2-part posterior malleolar fractures associated with medial and lateral malleolar fractures. Methods: This case series report included 27 Weber B with Haraguchi type II patients with medial and lateral malleolar fractures combined with 2-part posterior malleolar fractures. Patients were treated with open reduction and internal fixation through a combination of posteromedial and posterolateral approaches from January 2015 to January 2018. There were 11 males and 16 females, with an average age of 61.5 years (range, 53-67 years). The procedures were performed on prone patients under spinal anesthesia. The medial, lateral, and posterior malleolar fractures were exposed through posteromedial and posterolateral approaches performed at the same time. The lateral malleolar fracture was fixed using a plate, the medial malleolar fracture was fixed using screws, and the posterior malleolar fracture was fixed using a plate or cannulated screws according to the size of the fragments. We performed follow-up on 22 patients for an average of 30 months (range, 18-48 months). Results: Primary healing of the incisions was achieved in all cases, and no infection was found. The mean time of bone union was 12.5 weeks (range, 10-15 weeks). The mean time from the operation to full weightbearing was 13 weeks (range, 11-16 weeks). We used the American Orthopaedic Foot & Ankle Society (AOFAS) Ankle-Hindfoot Scale to score patient outcomes; the mean score was 85.4 (range, 80-92) at the final follow-up. No significant pain was found at the final follow-up. Conclusion: This study showed that satisfactory outcomes were achieved with combined posteromedial and posterolateral approaches. Therefore, we believe this approach was a good alternative strategy to repair 2-part posterior malleolar fractures associated with medial and lateral malleolar fractures. Level of Evidence: Level IV, retrospective case series.

Microscopic vs Endoscopic Ear Surgery for Congenital Ossicular Anomaly

2020 ◽  
Vol 162 (4) ◽  
pp. 548-553 ◽  
Author(s):  
Jaein Chung ◽  
Jae-Yoon Kang ◽  
Min-Su Kim ◽  
Bongjik Kim ◽  
Jin Woong Choi
Keyword(s):  
Operation Time ◽  
Complication Rates ◽  
Endoscopic Ear Surgery ◽  
Case Review ◽  
Retrospective Case ◽  
Ear Surgery ◽  
Microscopic Surgery ◽  
Academic Center ◽  
Significant Difference ◽  
The Mean

Objective To compare surgical outcomes of transcanal endoscopic ear surgery (TEES) for congenital ossicular anomalies with those of conventional microscopic surgery. Study Design Retrospective case review. Setting Tertiary referral academic center. Subjects and Methods From March 2012 to November 2018, 42 consecutive ears in 40 patients with congenital ossicular anomaly who underwent ossiculoplasty or stapes surgery using either ear endoscopes (TEES group) or an operating microscope (microscopic group) were included. Postoperative audiometric results, operation time, switch of approach, and complications were compared between the 2 groups. Results Twenty-four ears (66.1%) were in the microscopic group and 18 ears (33.9%) were in the TEES group. The mean (SD) preoperative air-bone gap was 31.8 (10.0) dB in the microscopic group and 35.2 (11.1) dB in the TEES group. The mean (SD) postoperative air-bone gap was 7.4 (6.5) dB in the microscopic group and 5.6 (5.0) dB in the TEES group. The differences in the preoperative and postoperative air-bone gaps between the 2 groups were not statistically significant ( P = .316 and P = .412, respectively). Average operation time in the TEES group was 24.6 minutes shorter than that in the microscopic group, which was statistically significant ( P = .019). None of patients in the TEES group did require a switch of approach. There was no significant difference in complication incidence between the 2 groups. Conclusions TEES for congenital ossicular anomaly has comparable audiometric results and complication rates to conventional microscopic surgery. TEES appears to have the advantages of shorter operation times.

scholarly journals EP.FRI.700 NCEPOD Acute Bowel Obstruction Report 2019:  A pilot study for review of quality of care provided to patients with acute bowel obstruction in a Surgical Emergency Unit

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Abhishek Dey ◽  
Antons Rudzats ◽  
Jeffrey Gilmour
Keyword(s):  
Bowel Obstruction ◽  
Retrospective Case ◽  
X Ray ◽  
Surgical Emergencies ◽  
The Mean ◽  
Pathway Of Care ◽  
In Transit ◽  
Mean Time ◽  
Larger Sample

Abstract Aims Acute bowel obstruction is one of the commonest surgical emergencies posing various diagnostic and therapeutic challenges. A review of care titled ‘Delay in Transit’ by NCEPOD delineated inadequacies in the pathway of care for patients with acute bowel obstruction nationwide, highlighting areas of improvement. This audit aims to assess key elements of management pathway in our centre and compare it to national statistics.  Methods A retrospective case note analysis was conducted for 24 randomly selected patients, aged above 15 years, admitted with a clinical diagnosis of acute bowel obstruction between December, 2018-December, 2019. Results Summary of some of NCEPOD recommendations, national and local performance The mean time to diagnosis was 8.5±6.6 hours, which was delayed if abdominal X-ray preceded the CT. Poor consultant review times may reflect failure to capture on records. Conclusion The management pathway, although faring well in some criteria, has scope for further improvement. Plans for an audit with a larger sample size will be implemented along with an enhanced pathway.

Predicting Daily Maintenance Dose of Fluindione, an Oral Anticoagulant Drug

1996 ◽  
Vol 75 (05) ◽  
pp. 731-733 ◽  
Author(s):  
V Cazaux ◽  
B Gauthier ◽  
A Elias ◽  
D Lefebvre ◽  
J Tredez ◽  
...  
Keyword(s):  
Effective Dose ◽  
Maintenance Dose ◽  
Successive Approximations ◽  
Hemorrhagic Complication ◽  
Simple Method ◽  
Individual Variations ◽  
Anticoagulant Drug ◽  
The Mean ◽  
Mean Time ◽  
Daily Maintenance Dose

SummaryDue to large inter-individual variations, the dose of vitamin K antagonist required to target the desired hypocoagulability is hardly predictible for a given patient, and the time needed to reach therapeutic equilibrium may be excessively long. This work reports on a simple method for predicting the daily maintenance dose of fluindione after the third intake. In a first step, 37 patients were delivered 20 mg of fluindione once a day, at 6 p.m. for 3 consecutive days. On the morning of the 4th day an INR was performed. During the following days the dose was adjusted to target an INR between 2 and 3. There was a good correlation (r = 0.83, p<0.001) between the INR performed on the morning of day 4 and the daily maintenance dose determined later by successive approximations. This allowed us to write a decisional algorithm to predict the effective maintenance dose of fluindione from the INR performed on day 4. The usefulness and the safety of this approach was tested in a second prospective study on 46 patients receiving fluindione according to the same initial scheme. The predicted dose was compared to the effective dose soon after having reached the equilibrium, then 30 and 90 days after. To within 5 mg (one quarter of a tablet), the predicted dose was the effective dose in 98%, 86% and 81% of the patients at the 3 times respectively. The mean time needed to reach the therapeutic equilibrium was reduced from 13 days in the first study to 6 days in the second study. No hemorrhagic complication occurred. Thus the strategy formerly developed to predict the daily maintenance dose of warfarin from the prothrombin time ratio or the thrombotest performed 3 days after starting the treatment may also be applied to fluindione and the INR measurement.

Retrospective analysis of mortality within 30 days of systemic anticancer therapy and comparison with a previous audit at an Australian Regional Cancer Centre

2021 ◽  
pp. 107815522110160
Author(s):  
Bernadatte Zimbwa ◽  
Peter J Gilbar ◽  
Mark R Davis ◽  
Srinivas Kondalsamy-Chennakesavan
Keyword(s):  
Checkpoint Inhibitors ◽  
Anticancer Therapy ◽  
Mortality Rates ◽  
Feedback Process ◽  
Time To Death ◽  
Cancer Centre ◽  
Haematology Patients ◽  
The Mean ◽  
Regional Cancer Centre ◽  
Mean Time

Purpose To retrospectively determine the rate of death occurring within 14 and 30 days of systemic anticancer therapy (SACT), compare this against a previous audit and benchmark results against other cancer centres. Secondly, to determine if the introduction of immune checkpoint inhibitors (ICI), not available at the time of the initial audit, impacted mortality rates. Method All adult solid tumour and haematology patients receiving SACT at an Australian Regional Cancer Centre (RCC) between January 2016 and July 2020 were included. Results Over a 55-month period, 1709 patients received SACT. Patients dying within 14 and 30 days of SACT were 3.3% and 7.0% respectively and is slightly higher than our previous study which was 1.89% and 5.6%. Mean time to death was 15.5 days. Males accounted for 63.9% of patients and the mean age was 66.8 years. 46.2% of the 119 patients dying in the 30 days post SACT started a new line of treatment during that time. Of 98 patients receiving ICI, 22.5% died within 30 days of commencement. Disease progression was the most common cause of death (79%). The most common place of death was the RCC (38.7%). Conclusion The rate of death observed in our re-audit compares favourably with our previous audit and is still at the lower end of that seen in published studies in Australia and internationally. Cases of patients dying within 30 days of SACT should be regularly reviewed to maintain awareness of this benchmark of quality assurance and provide a feedback process for clinicians.

Vitamin D Level Stability in Dystrophinopathy Patients on Vitamin D Supplementation

2021 ◽  
pp. 1-7
Author(s):  
Naomi Vather-Wu ◽  
Matthew D. Krasowski ◽  
Katherine D. Mathews ◽  
Amal Shibli-Rahhal
Keyword(s):  
Vitamin D ◽  
Retrospective Cohort ◽  
Vitamin D Supplementation ◽  
Hydroxyvitamin D ◽  
Frequent Monitoring ◽  
25 Hydroxyvitamin D ◽  
The Mean ◽  
Stable Maintenance ◽  
Mean Time

Background: Expert guidelines recommend annual monitoring of 25-hydroxyvitamin D (25-OHD) and maintaining 25-OHD ≥30 ng/ml in patients with dystrophinopathies. Objective: We hypothesized that 25-OHD remains stable and requires less frequent monitoring in patients taking stable maintenance doses of vitamin D. Methods: We performed a retrospective cohort study, using the electronic health record to identify 26 patients with dystrophinopathies with a baseline 25-OHD ≥30 ng/mL and at least one additional 25-OHD measurement. These patients had received a stable dose of vitamin D for ≥3 months prior to their baseline 25-OHD measurement and throughout follow-up. The main outcome measured was the mean duration time the subjects spent with a 25-OHD ≥30 ng/mL. Results: Only 19% of patients dropped their 25-OHD to <  30 ng/ml, with a mean time to drop of 33 months and a median nadir 25-OHD of 28 ng/mL. Conclusions: These results suggest that measurement of 25-OHD every 2–2.5 years may be sufficient in patients with a baseline 25-OHD ≥30 ng/mL and who are on a stable maintenance dose of vitamin D. Other patients may require more frequent assessments.

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