Land-use effects on local biodiversity in tropical forests vary between continents

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Management of symptomatic knee osteoarthritis in obesity:a survey of orthopaedic surgeons’ opinions and practice

Introduction: The aim of this survey was to explore knee surgeons’ opinions and practices regarding the management of symptomatic knee osteoarthritis in obesity. Methods: Questionnaires were sent electronically to all consultant members of the British Association for Surgery of the Knee. Results: The response rate was 52%. The survey showed considerable practice variation and divided opinion on the evidence base. The majority stated that weight loss should be the first-line treatment. 53% (91/172) stated that such cases should ideally be assessed by a specialist multidisciplinary service; however, only 24% (41/169) would be interested in being the orthopaedic surgeon in such a service. Discussion: The optimal pathway of care for the obese patient with symptomatic knee osteoarthritis remains unclear. Given recent debate around the rationing of knee arthroplasty surgery in obesity, we felt it was timely to survey knee surgeons’ current practice. Conclusion: Our survey has shown considerable variation in the opinions and practice of surgeons on the management of symptomatic knee osteoarthritis in obesity, together with divided views on current literature.</p

Skin closure following fractured neck of femur surgery: a survey of orthopaedic surgeons’ practices

Introduction: Surgical intervention for patients presenting with a fractured neck of femur is common, however the best method of skin closure remains unclear. It has been suggested that the use of metallic skin clips in the closure of hip wounds may increase the rate of surgical site infections, however there are few high quality studies evaluating this. Methods: We designed a survey to assess surgeons preferred skin closure method and their reasons for choosing it. This was sent to 545 consultant orthopaedic surgeons. Results: The positive response rate to our survey was 68% (n = 370). The survey showed that 44% of surgeons used metallic skin clips, and this was the most common method of closure reported. Hip surgeons were less likely to use metallic skin clips when compared to surgeons with other principal subspecialty practices. Surgeons using clips were most likely to state the rationale for use as convenience, whereas those using non-clip skin closure methods were more likely to cite reduced rates of wound inflammation, discharge, and infection as the rationale for use. Only a small proportion of surgeons indicate that their decisions were evidence based. Conclusions: Skin closure following surgery for fractured neck of femur is not consistent amongst surgeons and is not driven by evidence. Greater levels of evidence in this field are required to improve outcomes in this patient group. </jats:sec

Interprofessional relationships between orthopaedic and podiatric surgeons in the UK.

INTRODUCTION: The first comprehensive report on the interprofessional relationships between foot and ankle surgeons in the UK is presented. MATERIALS AND METHODS: A questionnaire was sent to orthopaedic surgeons with membership of the British Foot and Ankle Surgery Society (BOFAS), orthopaedic surgeons not affiliated to the specialist BOFAS and podiatrists specialising in foot surgery. The questionnaire was returned by 77 (49%) of the BOFAS orthopaedic consultant surgeons, 66 (26%) of non-foot and ankle orthopaedic consultant surgeons and 99 (73%) of the podiatric surgeons. RESULTS: While most respondents have experience of surgeons working in the other specialty in close geographical proximity, the majority do not believe that this has adversely affected their referral base. The experience of podiatrists of the outcomes of orthopaedic surgery has been more positive than orthopaedic surgeons of podiatric interventions. Podiatrists are more welcoming of future orthopaedic involvement in future foot and ankle services than in reverse. However, there are a sizeable number of surgeons in both professions who would like to see closer professional liaisons. The study has identified clear divisions between the professions but has highlighted areas where there is a desire from many clinicians to work more harmoniously together, such as in education, training and research. CONCLUSIONS: While major concerns exist over issues such as surgery by non-registered medical practitioners and the suitable spectrum of surgery for each profession, many surgeons, in both professions, are willing to provide training for juniors in both specialties and there is a wish to have closer working relationships and common educational and research opportunities than exists at present

'Foot' and 'surgeon': a tale of two definitions

Recent events in the USA and UK have raised questions about the appropriate definition and application of the terms 'foot' and 'surgeon'. In this editorial, we explore these issues and clarify our use of these terms in the journa