Royal Bolton Hospital

Aims:In the Scaphoid Waist Internal Fixation for Fractures Trial (SWIFFT), surgical fixation was compared with cast immobilization, with the primary endpoint being the outcomes at one year. The aim of the current study was to assess the radiological outcomes (union and the development of osteoarthritis (OA)) of the two forms of treatment at five years. Methods:Patients who remained in the trial at five years after randomization were invited to have plain radiographs and a CT scan of the injured wrist, and a posterior-anterior radiograph of the contralateral wrist. This imaging was reviewed by three observers independently for union of the fracture and the distribution and severity of OA. This analysis followed a pre-specified statistical analysis plan. The relationship between OA and the Patient-Rated Wrist Evaluation (PRWE) scores at five years was assessed. Results:Of the 439 patients who were randomized, 267 (60.8%) provided imaging at five years. Their characteristics were similar to those of the original cohort. A total of 182 patients (68.2%) (n = 92 fixation, n = 90 cast) had complete union and seven had a nonunion (2.6%; n = 3 fixation, n = 4 cast). Fractures with a minimum of 20% union at one year consolidated with the passage of time without intervention. Progression of OA in the joints around the scaphoid was seen in both groups from baseline to five years. By five years, 140 patients (52.4% of those with imaging at five years) had OA in at least one joint with similar prevalences in both groups. The prevalence of OA, the number of arthritic joints and the maximum severity of OA, was similar in the two groups. A total of 344 of the initial cohort of 439 patients (78.4%) provided a valid PRWE score at five years and the mean score was higher in those with more severe OA, indicating worse pain and function. Conclusion:Between one and five years after randomization, union consolidated in those with > 20% bridging without intervention. The proportion of patients with full, almost full, partial, slight, and nonunion for the two forms of treatment remained similar at five years. The prevalence and severity of OA increased during the five years but was similar in both groups.

Purpose Intra-operative anterior cruciate ligament (ACL) graft contamination is a rare but recognised complication. There are no guidelines or consensus on the management of this occurrence. Our aim was to survey trauma and orthopaedic surgeons with a knee subspecialty interest in the United Kingdom (UK) who perform ACL reconstruction (ACLR) to explore the preferred strategy when there is intra-operative graft contamination. Methods An online questionnaire was sent to UK ACLR surgeons. The survey included the year of training completion, the average number of ACLs per year, whether they have experienced any intra-operative graft contamination, the strategies implemented, and whether they are aware of any literature and how it has influenced their strategies. Results Twenty-eight responses were received, with an average of 11 years of experience in ACLR, totalling an estimated of more than 15,000 ACLR. Three surgeons surveyed had experienced a single intra-operative ACL graft contamination, all of which were soaked in chlorhexidine gluconate (CG) solution. Of those surgeons who had not encountered a contaminated graft, 11 (44%) would use CG, 7 (28%) would soak in saline and vancomycin solution, and 7 (28%) would harvest a new graft. Conclusions There is significant variation in management strategy for an intra-operative contaminated graft in ACLR. This variation highlights the need for further work to develop a consensus for guidance for ACLR surgeons.

There is a recognised desire to teach amongst GP trainees yet limited formal opportunities to do this. There are known benefits of near-peer teaching to both teacher and learner, but minimal research investigating the role of GP trainees as teachers in a clinical setting. This study aims to evaluate the views of GP trainees participating in a teaching scheme piloted at the University of Manchester. This mixed-methods study was conducted over a three-year period. In years one and three, evaluation was undertaken using questionnaires comprising Likert scale items and free-text responses (n = 11). In the second year, qualitative data was collected via a focus group with GP trainees following their teaching experiences (n = 8). Subsequently, a thematic analysis was conducted. GP trainees reported benefits including improved clinical skills, job satisfaction and development of leadership skills. There was a noted impact on their teaching skills, as GP trainees demonstrated their ability to be adaptable to learners’ needs and develop interactive, structured teaching sessions. The main challenges identified were organisation and time management, balancing responsibilities and adapting to student needs. Trainees unanimously felt the scheme allowed them to meet their portfolio requirements, develop their teaching skills and made them more likely to consider pursuing medical education as part of their future careers. All participants expressed a desire to continue with teaching and reported improved job satisfaction. Participation in a near-peer teaching scheme can have significant positive impacts on GP trainees’ personal and professional development. Despite some challenges, trainees reported numerous benefits from undertaking the scheme. Formal teaching opportunities for GP trainees could contribute to the development of a skilled and motivated future workforce of clinician-educators in general practice.

INTRODUCTION:As infectious agents may be associated with neurodegenerative diseases, this systematic review and meta-analysis investigated whether prior influenza infection is associated with an increased odds of subsequent Parkinson's disease (PD) diagnosis. METHODS:We searched PubMed, Web of Science, and Scopus for observational studies examining influenza infection and later PD diagnosis. Seven studies (comprising eight cohorts) were analyzed using frequentist and Bayesian random-effects meta-analyses. Meta-regression and subgroup analyses were conducted to explore the moderating effect of the time interval between influenza exposure and subsequent PD diagnosis (i.e. exposure window). RESULTS:A significant association was observed in both approaches: pooled OR = 1.87 (95% CI: 1.24-2.81) under the frequentist model, and posterior median OR = 1.88 (95% CrI: 1.07-3.36) under the Bayesian model. Meta-regression and subgroup analyses identified the influenza exposure window as a moderator (R2 = 36.6%, p < 0.05), with studies reporting influenza exposure within five years before PD diagnosis showing the strongest associations. CONCLUSION:Our findings support a probable and temporally sensitive association between influenza infection and subsequent PD diagnosis. However, these findings should be interpreted cautiously, given the retrospective and heterogeneous nature of the available data.