Moral Legitimacy: The Struggle Of Homeopathy in the NHS.

This article deploys a well-established theoretical model from the accountability literature to the domain of bioethics. Specifically, homeopathy is identified as a controversial industry and the strategic action of advocates to secure moral legitimacy and attract public funding is explored. The Glasgow Homeopathic Hospital (GHH) is used as the location to examine legitimizing strategies, from gaining legitimacy as a National Health Service (NHS) hospital in 1948, followed by maintaining and repairing legitimacy in response to government enquires in 2000 and 2010. An analysis of legitimizing strategies leads to the conclusion that advocates have been unsuccessful in maintaining and repairing moral legitimacy for homeopathy, thus threatening continued public funding for this unscientific medical modality. This is an encouraging development towards open and transparent NHS accountability for targeting limited public resources in pursuit of maximizing society's health and well-being. Policy implications and areas for future research are suggested.

Medium-term results of arthroscopic debridement and capsulectomy for the treatment of elbow osteoarthritis.

BACKGROUND: We retrospectively reviewed 20 patients (21 elbows) after arthroscopic debridement and capsulectomy of the elbow for primary osteoarthritis. We aimed to see if there was an improvement in pain, function, and range of movement in the medium-term. MATERIALS AND METHODS: Outcomes of 20 patients (18 men, 2 women) with primary osteoarthritis of the elbow (21 elbows) operated on by the senior surgeon were reviewed at a mean of 5.5 years postoperatively. Inclusion criteria were patients with undergoing arthroscopic debridement and capsulectomy after failure of previous conservative treatment. Exclusion criteria were patients undergoing additional intra-articular procedures at surgery and patients with post-traumatic or inflammatory arthritis. Mean age was 42 years (range, 22-79 years). Preoperatively, osteoarthritis was classified based on plain x-ray images. Functional outcome was assessed using preoperative and postoperative Disabilities of the Arm, Shoulder and Hand (DASH) scores, Mayo scores, and range of movement. RESULTS: Radiographically, osteoarthritis was assessed as class I in 9 elbows, class II in 10 elbows, and class III in 3 elbows. There was a mean significant improvement in DASH score from 34.0 to 12.7 (P < .05). This was true for all grades of osteoarthritis and significant for classes II and III (P < .05). Mayo scores postoperatively were "excellent" in 11 elbows, "good" in 5, "fair" in 4, and "poor" in 1. Nineteen of the 20 patients said they would have had the surgery again. CONCLUSION: Arthroscopic debridement and capsulectomy is an effective procedure for patients with primary osteoarthritis of the elbow. We propose this may work as a partial neurectomy to denervate pain sensation in the joint.

The fixation strength of scaphoid bone screws: an in vitro investigation using polyurethane foam.

PURPOSE: To compare the compression strength and pull-apart resistance of 5 single-piece scaphoid bone compression screws (Acutrak, Asnis, Herbert, Herbert-Whipple, and Little Grafter), with those of 2 dual-component screws (Kompressor and TwinFix). METHODS: Two blocks of polyurethane foam were compressed with a screw while held in a tension test machine, with the force measured at full insertion of the screw. The 2 blocks were then pulled apart, and the maximum resistive force was measured. RESULTS: The dual-component screws (Kompressor and TwinFix) gave greater compression force than the single-component screws, with the Kompressor screw giving statistically significantly greater compression than the TwinFix. The pull-apart resistance forces did not show such clear differences. CONCLUSIONS: The Kompressor screw achieves the greatest compressive forces and has one of the highest pull-apart forces. CLINICAL RELEVANCE: When compression and pull-apart resistance are considered, the Kompressor screw has advantages over other methods of scaphoid fixation.

Comparison of bacteriologically proven septic arthritis of the hip and knee in children, a preliminary study.

The hip and knee are the commonest joints affected by septic arthritis in the pediatric age group. Both can present as a limping, unwell child and can be difficult to diagnose. The primary aim of this study is to review and compare characteristics of pediatric patients with culture positive septic arthritis of the hip to those with culture positive septic arthritis of the knee. We retrospectively reviewed all patients who were clinically diagnosed with acute septic arthritis of either hip or knee in a tertiary pediatric hospital for a period of 3 years. Twelve of 29 patients who underwent arthrotomy for presumed septic arthritis of the hip and 7 of 37 patients who underwent arthrotomy for presumed septic arthritis of the knee had positive joint cultures. Patients with septic arthritis of the knee were much younger than that with septic arthritis of the hip. Patients with presumed septic arthritis of the knee based on clinical picture were less likely to have a positive synovial fluid culture. Children with septic arthritis of the knee did not follow Kocher criteria in the same way that children with septic arthritis of the hip did.

Total ankle replacement for rheumatoid ankle arthritis.

This article reviews total ankle replacement for rheumatoid ankle arthritis. The benefits of preserving the mobility of the ankle joint for the patient who has rheumatoid arthritis are undisputed. Recent reports have consistently shown that patient satisfaction following ankle replacement is high and prosthetic survival is more than 90% at five years and in many instances more than 80% at 10 years. Ankle replacement is contraindicated when there is severe coronal plane deformity.

Acute coronary syndrome following repair of aortic dissection.

Cardiac complications associated with type A aortic dissections are relatively common before and during the surgical repair. A cardiac event occurring a few days after routine recovery is rare though. We describe a case of acute occlusion of the left anterior descending artery by thrombus, 4 days after surgical repair, salvaged by emergency angioplasty and stenting. A possible explanation for the thrombus includes embolisation of a fragment of glue.