Poole Hospital (also known as Poole General Hospital) is an acute general hospital in Poole, Dorset, England. Built in 1907, it has expanded from a basic 14-bed facility into a 789-bed hospital. It is the trauma centre for east Dorset and provides specialist services such as cancer treatment for the entire county. It is managed by the University Hospitals Dorset NHS Foundation Trust. The hospital was managed by Poole Hospital NHS Foundation Trust until the merger with The Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust on 1 October 2020.
Multiple sclerosis care is judged not only by diagnosis and access to disease-modifying therapy, but by how well services work together across the whole care pathway.
Background Deconditioning is a common and preventable cause of functional decline among hospitalized elderly patients, contributing to prolonged recovery, increased dependence, and hospital-associated complications. Despite this, early mobilization is often limited by ward routines, invasive devices, and competing clinical priorities. Objectives This two-cycle audit aimed to evaluate whether low-cost, multidisciplinary interventions could improve early mobilization among elderly inpatients and reduce the risk of deconditioning. Methods A baseline audit was conducted on an elderly inpatient ward to assess the proportion of eligible patients mobilizing out of bed by 11:00 a.m. daily. Findings informed two sequential Plan-Do-Study-Act (PDSA) cycles. Cycle 1 focused on promoting early mobilization during morning handovers and minimizing unnecessary barriers such as intravenous lines and urinary catheters. Cycle 2 introduced sit-out charts and educational posters to improve documentation and sustain engagement. Data were collected daily at a fixed time point, excluding patients receiving end-of-life care or those who were permanently bedbound. Results At baseline, a mean of 7.73 patients (30%) were mobilizing out of bed daily. Following PDSA Cycle 1, this increased to a mean of 14.71 patients (57%). During Cycle 2, improvement was sustained, with a mean of 13.14 patients (51%) mobilizing daily. Staff feedback indicated improved awareness and shared responsibility for patient mobility. Conclusion This two-cycle audit demonstrates that simple, low-cost, multidisciplinary interventions embedded into routine ward practice can sustainably improve early mobilization among elderly inpatients. Early mobilization should be considered a core marker of quality inpatient care and a key strategy in reducing the risk of hospital-associated deconditioning.
Aims:This audit aimed to assess compliance with British Orthopaedic Association Standards for Trauma (BOAST) for paediatric forearm and wrist fractures across UK NHS hospitals and identify targets for improvement locally and nationally. Methods:This was a prospective, multicentre observational audit of BOAST standards for the Early Management of the Paediatric Forearm Fracture guideline. Consecutive patients aged under 16 years presenting with a forearm or distal radius fracture over a two-month period were included with follow-up to eight weeks post injury. Data were collected to assess each of the BOAST standards for practice. Percentage compliance with all standards was calculated for each hospital. Results:Data from 1,699 patients across 53 hospitals were included. The mean age was 9.7 years (SD 3.6), and 37% (n = 636) were female. Overall, 60% of fractures (n = 1,023) were metaphyseal distal radius fractures. A total of 577 patients (34%) underwent manipulation with the majority initially reduced in the Emergency Department (ED) (n = 423, 73%); 89 (21%) required subsequent theatre manipulation. The median time to first manipulation in the ED was two hours 43 minutes (IQR 1 hr 43 mins to 4 hrs 4 mins) and 18 hours 47 minutes (IQR 13 hrs 48 mins to 24 hrs 2 mins) when first manipulation was performed in theatre. Overall compliance with BOAST standards was 63%, with 20% of patients (n = 85) having pain scores documented, 51% (n = 217) having a complete neurovascular assessment, and 23% (n = 95) receiving analgesia and a patient information leaflet on discharge. Conclusion:This study highlights variability in managing paediatric fractures despite established standards. In line with recommendations, a high proportion of reductions are now being performed in EDs. Particular areas requiring improvement are the management of paediatric pain, documented assessment of neurovascular status, and the provision of patient information. We recommend that hospitals review their current practice and ensure that local protocols are in place to promote the provision of optimal care for this patient group, and to minimize the impact on operating theatre capacity.
Total knee replacement (TKR) is widely performed for advanced osteoarthritis, and the choice between regional anaesthesia (RA) and general anaesthesia (GA) may influence perioperative outcomes. This systematic review and meta-analysis aimed to compare the impact of RA versus GA on outcomes following TKR. A comprehensive search of PubMed, Embase, Scopus, Web of Science, and the Cochrane Library was conducted for comparative studies published between January 2010 and May 2025. Nine retrospective cohort studies encompassing 522,080 TKR procedures were included. RA was associated with significantly lower odds of blood transfusion (odds ratio (OR): 0.58; 95% confidence interval (CI): 0.44-0.77; p<0.001), fewer 30-day postoperative complications (OR: 0.59; 95% CI: 0.39-0.88; p=0.01), and a shorter hospital stay (standardised mean difference (SMD): -0.09; 95% CI: -0.14 to -0.04; p<0.001). Despite moderate-to-high heterogeneity, the direction of effect consistently favoured RA. These findings suggest that RA provides superior short-term outcomes compared with GA in TKR, supporting its preferential use, particularly in high-risk or elderly patients, while reinforcing the importance of individualised anaesthetic planning.
Tibial plateau fractures are complex injuries affecting the knee's load-bearing surface and often require surgical fixation. Traditional rehabilitation protocols favor delayed weight-bearing (DWB) to minimize complications, while emerging evidence suggests early weight-bearing (EWB) may improve functional recovery without increasing risk. This systematic review and meta-analysis evaluated outcomes of EWB versus DWB following surgical treatment of tibial plateau fractures. A comprehensive search identified 10 studies including 940 adult patients. Data on postoperative pain, time to union, delayed union, non-union, and functional outcomes were extracted, and meta-analyses were performed using RevMan 5.4; methodological quality was assessed using the Downs and Black checklist. Early weight-bearing was not associated with increased pain, delayed union, or non-union. Meta-analysis showed no significant differences in Visual Analogue Scale (VAS) pain scores (SMD = 0.06; p = 0.89), time to union (SMD = -0.45; p = 0.32), delayed union (OR = 0.40; p = 0.25), or non-union (OR = 0.14; p = 0.10). Studies reported earlier functional recovery, improved range of motion, and similar complication rates in EWB groups. Overall, early weight-bearing after tibial plateau fracture fixation appears safe and may accelerate functional recovery, though heterogeneity in fracture types and rehabilitation protocols underscores the need for individualized strategies and further high-quality research.
