Implementation of a standardized protocol to manage elderly patients with low energy pelvic fractures: can service improvement be expected?

Purpose: The incidence of low energy pelvic fractures (FPFs) in the elderly is increasing. Comorbidities, decreased bone-quality, problematic fracture fixation and poor compliance represent some of their specific difficulties. In the absence of uniform management, a standard operating procedure (SOP) was introduced to our unit, aiming to improve the quality of services provided to these patients. Methods: A cohort study was contacted to test the impact of (1) using a specific clinical algorithm and (2) using different antiosteoporotic drugs. Multivariate regression analysis was used to determine prognostic factors. Study endpoints were the time-to-healing, length-of-stay, return to pre-injury mobility, union status, mortality and complications. Results: A total of 132 elderly patients (≥65 years) admitted during the period 2012–2014 with FPFs were enrolled. High-energy fractures, acetabular fractures, associated trauma affecting mobility, pathological pelvic lesions and operated FPFs were used as exclusion criteria. The majority of included patients were females (108/132; 81.8%), and the mean age was 85.8 years (range 67–108). Use of antiosteoporotics was associated with a shorter time of healing (p = 0.036). Patients treated according to the algorithm showed a significant protection against malunion (p < 0.001). Also, adherence to the algorithm allowed more patients to return to their pre-injury mobility status (p = 0.039). Conclusions: The use of antiosteoporotic medication in elderly patients with fragility pelvic fractures was associated with faster healing, whilst the adherence to a structured clinical pathway led to less malunions and non-unions and return to pre-injury mobility state

Comparative Analysis of Various Multicarrier Modulation Techniques for Different Multilevel Converters

The applications of Multilevel Converter (MLC) are increased because of the huge demand for clean power; especially these types of converters are compatible with the renewable energy sources. In addition, these new types of converters have the capability of high voltage and high power operation. A Nine-level converter in three modes of implementation; Diode Clamped-MLC (DC-MLC), Capacitor Clamped-MLC (CC-MLC), and the Modular Structured-MLC (MS-MLC) are analyzed and simulated in this paper. Various types of Multicarrier Modulation Techniques (MMTs) (Level shifted (LS), and Phase shifted (PS)) are used for operating the proposed Nine level - MLCs. Matlab/Simulink environment is used for the simulation, extracting, and analysis the results. Finally, a comparison is made between the results for all topologies that are implemented regarding to the criteria of the output voltage waveforms harmonic distortion factor, No. of the necessitated power components, and the complexity of each circuit. Based on simulation results, the MS-MLC is finer as compared to the other types of MLCs. It also observed that the MLCs (with three types) using Phase Opposition Disposition (POD) technique is performed better in terms of getting greater fundamental output voltage and lower THD% as compared to the other techniques

Understanding how human factors can cause errors in the operating theatre

Human error can be defined as the ‘failure of a planned action’ (Reason, 2005: 57). The study of human and team error in the operating theatre is slowly gathering momentum as we acquire further evidence that many patient iatrogenic injuries and adverse events have human fallibility at their root (Department of Health, 2009). Effective teamwork and communication in safety-critical environments such as operating theatres involve the cooperation of multiple practitioners with varying levels of expertise and seniority (Sasou and Reason, 1999). Despite innovative ideas such as the World Health Organization's (WHO) Safe Surgery Checklist, evidence suggests that shortfalls in communication, shared cognition and the presence of authority gradients—described as the failure of efficient and effective communication as a result of a perceived hierarchy within the team (Cosby and Croskerry, 2004)—continue to affect patient safety in the operating theatre. This paper explores some of the potential barriers to free flow of communication, as well as investigating how operating department practitioners' (ODPs) mastery of safety sciences including human factors could potentially increase safety and reduce avoidable harm