No abstract

Polymethyl methacrylate is commonly known as bone cement and is widely used for implant fixation in various orthopaedic arthroplasty and trauma surgery. The first bone cement use in orthopaedics is widely accredited to the famous English surgeon, John Charnley, who in 1958, used it for total hip arthroplasty. Since then, there have been many developments in cementing techniques in arthroplasty surgery. This overview aims to cover the perioperative considerations of bone cement, including cementing techniques, current outcomes and complications such as bone cement implantation syndrome. The overview will additionally consider future developments involving bone cement in orthopaedic arthroplasty.

Aim It was recognized that surgical wards often have a large number of patients outlied to them. Unfortunately, it was also noted that they often were not regularly seen and so had no daily medical plan. Evidence shows outliers have: The aim was to develop a means of increasing outlier reviews, plans and awareness of outlier parent speciality. Method Medical outliers and outliers from other surgical specialties were included looking at how often care plans were updated and if the nurses knew who and how to contact the patient's named consultant/team. Brightly coloured posters were created to highlight the importance of a patient plan and how to escalate a request. Stickers were created for the notes to highlight outliers and their last plan and their named consultant/team. The effect of the interventions was tracked for just under 6 weeks. Results Initial assessment showed care plans were only updated twice a week and nurses were largely unsure who to contact for an individual outlier. With the increased awareness the nurses achieved three reviews a week with patient plans. Importantly, during the review period there were no adverse events, and the nurses reported increased confidence in who to approach. Patients were also discharged earlier and not moved to another ward. Conclusions The nurses were empowered, and the patients benefitted from more regular reviews and up to date plans, importantly resulting in fewer adverse events and quicker discharges.

Aim Patients with learning disabilities (LD) are less satisfied because they do not fully understand their surgical management. Poor communication between doctors & LD patients leaves them unhappy & reluctant to seek further help. We aimed to improve satisfaction in 90% of patients. Method In one year in a midlands DGH 201 patients with an LD were admitted. Interviews were conducted which highlighted key problems. Multiple ideas were reviewed, and the simple but effective intervention was a brightly coloured prompt sheet with 4 questions placed in the patient notes: Have you explained: A simple scale tracked the patient & carer satisfaction over 8 weeks as the prompt sheets were introduced to patient notes by the learning disability nurses. Results A 90% increase in patient satisfaction was not achieved but considerable positive feedback was. Moreover, the LD nurses witnessed an increased use of hospital passports among doctors as well as improved patient-doctor communication. A small target population restricts the rapid collection of large amounts of data. The patient satisfaction measure was qualitative, and a 10-point scale would have detailed smaller changes. Lack of carer continuity also made it difficult to collect consistent data. Conclusions The role of learning disability nurses is key to improving patient understanding and satisfaction, but they can be assisted by channelling and maintaining initiatives to raise awareness of the needs of these patients.