A review of the surgical conversion rate and independent management of spinal extended scope practitioners in a secondary care setting

INTRODUCTION Spinal orthopaedic triage aims to reduce unnecessary referrals to surgical consultants, thereby reducing waiting times to be seen by a surgeon and to surgical intervention. This paper presents an evaluation of a spinal orthopaedic triage service in the third largest spinal unit in the UK. METHODS A retrospective service evaluation spanning 2012 to 2014 was undertaken by members of the extended scope practitioner (ESP) team to evaluate the ESPs’ ability to manage patient care independently and triage surgical referrals appropriately. Data collected included rates of independent management, referral rates for surgical consideration and conversion to surgery. Patient satisfaction rates were evaluated retrospectively from questionnaires given to 5% of discharged patients. RESULTS A total of 2,651 patients were seen. The vast majority (92%) of all referrals seen by ESPs were managed independently. Only 8% required either a discussion with a surgeon to confirm management or for surgical review. Of the latter, 81% were considered to be suitable surgical referrals. A 99% satisfaction rate was reported by discharged patients. CONCLUSIONS ESP services in a specialist spinal service are effective in managing spinal conditions conservatively and identifying surgical candidates appropriately. Further research is needed to confirm ESPs’ diagnostic accuracy, patient outcomes and cost effectiveness

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

The causal role of breakfast in energy balance and health: a randomized controlled trial in lean adults. ISRCTN31521726

Background: Popular beliefs that ‘breakfast is the most important meal of the day’ are grounded in cross-sectional observations linking breakfast to health, the causal nature of which remains to be explored under real-life conditions. Objective: To conduct a randomized controlled trial examining causal links between breakfast habits and all components of energy balance in free-living humans. Design: The Bath Breakfast Project is a randomized controlled trial with repeated-measures at baseline and follow-up amongst a cohort in South-West England aged 21-60 y with Dual-Energy X-Ray Absorptiometry (DXA)-derived fat mass indices ≤11 kg·m-2 (women; n=21) and ≤7.5 kg·m-2 (men; n=12). Components of energy balance (resting metabolic rate, physical activity thermogenesis, energy intake) and 24-h glycemic responses were measured under free-living conditions with random allocation to daily breakfast (≥700 kcal before 1100 h) or extended fasting (0 kcal until 1200 h) for 6 weeks, with baseline and follow-up measures of health markers (e.g. hematology/biopsies). Results: Contrary to popular belief, there was no metabolic adaptation to breakfast (e.g. resting metabolic rate stable within 11 kcal·d-1), with limited subsequent suppression of appetite (energy intake remained 539 kcal·d-1 greater than fasting; 95%CI=157, 920). Rather, physical activity thermogenesis was markedly higher with breakfast than fasting (442 kcal·d-1; 95%CI=34, 851). Body mass and adiposity did not differ between treatments at baseline or follow-up and neither did adipose tissue glucose uptake or systemic indices of cardiovascular health. Twenty-four hour glycemia was more variable during the afternoon/evening with fasting than with breakfast by the final week of intervention (2%; 95%CI=0.1, 8). Conclusions: Daily breakfast is causally linked to higher physical activity thermogenesis in lean adults, with greater overall dietary energy intake but no change in resting metabolism. Cardiovascular health indices were unaffected by either treatment but breakfast maintained more stable afternoon/evening glycemia than fasting

The role of protective clothing in healthcare and its decontamination

Healthcare-associated infections (HAIs) are a significant cause of morbidity and mortality and pose a major economic burden. Infection control is therefore important in healthcare environments to minimize the transmission of microorganisms. Personal Protective Equipment (PPE) is used to provide protection to both wearer and patient from contaminants in a healthcare setting. Reusable PPE such as healthcare worker uniforms are common; however microorganisms are able to survive on textiles for days, indicating that insufficient decontamination of reusable clothing could transmit HAIs. Adequate laundering of reusable items is therefore a necessary infection control measure. Antimicrobial coatings offer a potential solution to the contamination of reusable textile items. However, research is needed to validate their efficacy in healthcare settings and assurances of their durability are needed to support their use for infection control purposes

Additional file 1: of Current management strategies for patellofemoral pain: an online survey of 99 practising UK physiotherapists

Survey Content. (DOCX 14 kb

The causal role of breakfast in energy balance and health: a randomized controlled trial in lean adults. ISRCTN31521726

Background: Popular beliefs that ‘breakfast is the most important meal of the day’ are grounded in cross-sectional observations linking breakfast to health, the causal nature of which remains to be explored under real-life conditions. Objective: To conduct a randomized controlled trial examining causal links between breakfast habits and all components of energy balance in free-living humans. Design: The Bath Breakfast Project is a randomized controlled trial with repeated-measures at baseline and follow-up amongst a cohort in South-West England aged 21-60 y with Dual-Energy X-Ray Absorptiometry (DXA)-derived fat mass indices ≤11 kg·m-2 (women; n=21) and ≤7.5 kg·m-2 (men; n=12). Components of energy balance (resting metabolic rate, physical activity thermogenesis, energy intake) and 24-h glycemic responses were measured under free-living conditions with random allocation to daily breakfast (≥700 kcal before 1100 h) or extended fasting (0 kcal until 1200 h) for 6 weeks, with baseline and follow-up measures of health markers (e.g. hematology/biopsies). Results: Contrary to popular belief, there was no metabolic adaptation to breakfast (e.g. resting metabolic rate stable within 11 kcal·d-1), with limited subsequent suppression of appetite (energy intake remained 539 kcal·d-1 greater than fasting; 95%CI=157, 920). Rather, physical activity thermogenesis was markedly higher with breakfast than fasting (442 kcal·d-1; 95%CI=34, 851). Body mass and adiposity did not differ between treatments at baseline or follow-up and neither did adipose tissue glucose uptake or systemic indices of cardiovascular health. Twenty-four hour glycemia was more variable during the afternoon/evening with fasting than with breakfast by the final week of intervention (2%; 95%CI=0.1, 8). Conclusions: Daily breakfast is causally linked to higher physical activity thermogenesis in lean adults, with greater overall dietary energy intake but no change in resting metabolism. Cardiovascular health indices were unaffected by either treatment but breakfast maintained more stable afternoon/evening glycemia than fasting

Additional file 1 of Development of a multivariable prognostic PREdiction model for 1-year risk of FALLing in a cohort of community-dwelling older adults aged 75 years and above (PREFALL)

Additional file 1. Data supplements. The data supplement provides appendices 1–4 as referenced in the manuscript text

Development of a multivariable prognostic PREdiction model for 1-year risk of FALLing in a cohort of community-dwelling older adults aged 75 years and above (PREFALL)

Abstract Background Falls are the leading cause of fatal and non-fatal injuries in older adults, and attention to falls prevention is imperative. Prognostic models identifying high-risk individuals could guide fall-preventive interventions in the rapidly growing older population. We aimed to develop a prognostic prediction model on falls rate in community-dwelling older adults. Methods Design: prospective cohort study with 12 months follow-up and participants recruited from June 14, 2018, to July 18, 2019. Setting: general population. Subjects: community-dwelling older adults aged 75+ years, without dementia or acute illness, and able to stand unsupported for one minute. Outcome: fall rate for 12 months. Statistical methods: candidate predictors were physical and cognitive tests along with self-report questionnaires. We developed a Poisson model using least absolute shrinkage and selection operator penalization, leave-one-out cross-validation, and bootstrap resampling with 1000 iterations. Results Sample size at study start and end was 241 and 198 (82%), respectively. The number of fallers was 87 (36%), and the fall rate was 0.94 falls per person-year. Predictors included in the final model were educational level, dizziness, alcohol consumption, prior falls, self-perceived falls risk, disability, and depressive symptoms. Mean absolute error (95% CI) was 0.88 falls (0.71–1.16). Conclusion We developed a falls prediction model for community-dwelling older adults in a general population setting. The model was developed by selecting predictors from among physical and cognitive tests along with self-report questionnaires. The final model included only the questionnaire-based predictors, and its predictions had an average imprecision of less than one fall, thereby making it appropriate for clinical practice. Future external validation is needed. Trial registration Clinicaltrials.gov ( NCT03608709 )

Development of a multivariable prognostic PREdiction model for 1-year risk of FALLing in a cohort of community-dwelling older adults aged 75 years and above (PREFALL)

Abstract Background Falls are the leading cause of fatal and non-fatal injuries in older adults, and attention to falls prevention is imperative. Prognostic models identifying high-risk individuals could guide fall-preventive interventions in the rapidly growing older population. We aimed to develop a prognostic prediction model on falls rate in community-dwelling older adults. Methods Design: prospective cohort study with 12 months follow-up and participants recruited from June 14, 2018, to July 18, 2019. Setting: general population. Subjects: community-dwelling older adults aged 75+ years, without dementia or acute illness, and able to stand unsupported for one minute. Outcome: fall rate for 12 months. Statistical methods: candidate predictors were physical and cognitive tests along with self-report questionnaires. We developed a Poisson model using least absolute shrinkage and selection operator penalization, leave-one-out cross-validation, and bootstrap resampling with 1000 iterations. Results Sample size at study start and end was 241 and 198 (82%), respectively. The number of fallers was 87 (36%), and the fall rate was 0.94 falls per person-year. Predictors included in the final model were educational level, dizziness, alcohol consumption, prior falls, self-perceived falls risk, disability, and depressive symptoms. Mean absolute error (95% CI) was 0.88 falls (0.71–1.16). Conclusion We developed a falls prediction model for community-dwelling older adults in a general population setting. The model was developed by selecting predictors from among physical and cognitive tests along with self-report questionnaires. The final model included only the questionnaire-based predictors, and its predictions had an average imprecision of less than one fall, thereby making it appropriate for clinical practice. Future external validation is needed. Trial registration Clinicaltrials.gov ( NCT03608709 )