Clinically relevant markers of proficiency including error reduction, understanding of surgical strategy, and surgical quality are significantly improved with structured coaching. Path length and number of movements representing merely manual skills are developed with task repetition rather than influenced by coaching. Structured coaching may represent a key component in the acquisition of procedural skills.

Background & aim: Utilization of augmented reality (AR) and heads-up displays (HUD) to aid orthopaedic surgery has the potential to benefit surgeons and patients alike through improved accuracy, safety, and educational benefits. With the COVID-19 pandemic, the opportunity for adoption of novel technology is more relevant. The aims are to assess the technology available, to understand the current evidence regarding the benefit and to consider challenges to implementation in clinical practice. Methods & results: PRISMA guidelines were used to filter the literature. Of 1004 articles returned the following exclusion criteria were applied: 1) reviews/commentaries 2) unrelated to orthopaedic surgery 3) use of other AR wearables beyond visual aids leaving 42 papers for review. This review illustrates benefits including enhanced accuracy and reduced time of surgery, reduced radiation exposure and educational benefits. Conclusion: Whilst there are obstacles to overcome, there are already reports of technology being used. As with all novel technologies, a greater understanding of the learning curve is crucial, in addition to shielding our patients from this learning curve. Improvements in usability and implementing surgeons' specific needs should increase uptake.

Smart glasses can provide a heads-up display of advanced imaging intraoperatively. In recent years, growing attention has been drawn to the use of smart glasses as an assistive technology to improve both efficiency and ergonomics in a surgical setting. Previous studies have reported improved surgical accuracy, efficiency, and ergonomics with its usage, but its effectiveness as a form of intraoperative heads-up display remains elusive in the context of orthopaedics. This study provides a novel account of a wireless set-up of the Moverio BT-35E Smart Glasses (Suwa, Japan: Epson Inc.), incorporated in a complex orthopaedic procedure.Hind-foot nailing was performed on a patient with a complex open ankle fracture and multiple comorbidities. Smart glasses were worn by the primary surgeon throughout the procedure to provide heads-up visualisation of the intraoperative fluoroscopy.In our surgical case, the surgeon experienced improved ergonomics and reduced disruption to focus with the use of smart glasses. The wireless set-up provided excellent signal transmission throughout the duration of the procedure.The wireless set-up of smart glasses is a potential solution for common occupational risks imposed on orthopaedic surgeons. Smart glasses minimise musculoskeletal strain from switching of vision from monitor to patient, whilst the wireless set-up allows for efficient use of space in an operating theatre and may potentially limit radiation exposure. Lastly, ergonomic benefits may increase the efficiency of movement for the surgeon, decreasing operative duration, and in turn minimising the risk of surgical complications for patients.

Recent growth in the mental healthcare market has led to traditional service providers havingto rethink their conventional approach. The rate at which the current market is changing, as well as the impact of the financial downturn, call for an urgent review of the status quo. This article seeks to highlight the opportunities offered by an integration of the services currently supplied by multiple providers. It is proposed that this will lead to a more efficient mental healthcare service.

With mental health being a prominent issue for the NHS, it is necessary to consider improvements for patient care packages. Having conducted research into the mental health sector and the external providers of care, an analysis must be undertaken of the various external providers. In this article, we look at key questions that have arisen from our research regarding threats and opportunities in the mental health sector for foundation trusts. In order to answer these questions, it is necessary to choose relevant documents to analyse. Criteria were drawn up, and a methodology is outlined. Thematic analysis is used to understand the relevant data from organisations in the private, voluntary and social service sectors. This is then related back to foundation trusts, to recognise where there is room for improvement. Significant areas of interest are services developments, understanding the environment within which one operates and understanding theuser of such services. By analysing various organisations, we will go on to draw substantial conclusions regarding improvements that can be made for foundation trusts within the mental healthsector.