The provision of a trauma bed in theatre recovery and its impact on trauma theatre efficiency: experience from a high-volume trauma unit.

INTRODUCTION: Inefficiencies in the trauma setting are well known and have been further exacerbated by the COVID-19 pandemic among other factors, resulting in national guidance to aid improvements in resource utilisation. This study introduced a novel surgeon-led intervention, a trauma bed in recovery, with the aim of improving trauma theatre efficiency. METHODS: This quality improvement project was conducted using a Plan Do Study Act (PDSA) methodology and comprised multiple cycles to assess theatre performance. A multidisciplinary team (MDT) approach with relevant stakeholder input enabled intervention implementation, aimed at facilitating 'golden patient' arrival in the anaesthetic room as early as possible. The primary outcome was the time at which the first patient entered the anaesthetic room, and the secondary outcome was the number of cases performed each day. RESULTS: The study period was 1 year and encompassed three PDSA cycles. The intervention achieved its primary outcome by PDSA cycle 1 and its secondary outcome by PDSA cycle 2, demonstrating statistically significantly improved results (p < 0.001). A subanalysis assessed the specific impact of the intervention, and demonstrated a significant improvement in both outcomes when the intervention was used as intended (p < 0.0005). CONCLUSIONS: A ringfenced trauma bed significantly improved theatre start times and thereby theatre efficiency. This is a simple, pragmatic intervention that benefitted the MDT trauma team while also demonstrating a sustained impact. Given that National Health Service efficiency is at the forefront of national healthcare discourse, we recommend that this intervention is implemented in other trauma units to help provide a solution to this longstanding issue.

The surgical treatment of anterior column and anterior wall acetabular fractures: short- to medium-term outcome.

Isolated fractures of the anterior column and anterior wall are a relatively rare subgroup of acetabular fractures. We report our experience of 30 consecutive cases treated over ten years. Open reduction and internal fixation through an ilioinguinal approach was performed for most of these cases (76.7%) and percutaneous techniques were used for the remainder. At a mean follow-up of four years (2 to 6), 26 were available for review. The radiological and functional outcomes were good or excellent in 23 of 30 patients (76.7%) and 22 of 26 patients (84.6%) according to Matta's radiological criteria and the modified Merlé d'Aubigné score, respectively. Complications of minor to moderate severity were seen in six of the 30 cases (20%) and none of the patients underwent secondary surgery or replacement of the hip.

Evolution of transdermal oxybutynin in the treatment of overactive bladder.

Overactive bladder (OAB) syndrome affects millions of people worldwide. In addition to adversely affecting quality of life, the direct and indirect costs in managing patients with OAB incur a substantial financial burden on health services. Among the approved anticholinergics for treating OAB, oxybutynin is the most extensively studied drug in clinical trials. The principle metabolite of oxybutynin has a higher affinity for muscarinic receptors in salivary glands which lead to significantly high dry mouth rates. This prompted the development of alternative formulations of oxybutynin aiming to achieve better tolerability whilst sustaining efficacy. This editorial examines the efficacy and tolerability of transdermal oxybutynin (OXY-TD) in treating OAB. Articles were retrieved from PubMed between 2000 to the present day relating to OXY-TD. Data is presented from phase I-IV trials. The results from placebo-controlled trials indicate that OXY-TD is efficacious in treating patients with OAB associated with urge urinary or mixed incontinence. Systemic side effects most notably dry mouth, appear to be less with this formulation compared with oral anticholinergics. However, further study is required in different OAB populations. The main limitation appears to be related to application site adverse events such as pruritus and erythema. OXY-TD is likely to find its place as first-line pharmacotherapy in the clinicians' armamentarium in treating OAB.

Dynamics of changes in operant reflexes in rats after transection of the corticospinal tract and removal of the sensorimotor region of the cerebral cortex.

Prior unilateral transection of the bulbar pyramid facilitated recovery of operant reflexes and compensatory processes occurring after removal of the ipsilateral sensorimotor cortex in rats. This increase in corticofugal plasticity was absent when only the sensorimotor cortex was removed. This phenomenon is explained by switching of descending influences to the corticorubrospinal system via the following loop: corticobulbar projection--red nucleus--lower olive--cerebellum--thalamus--cortex. A general property of this phenomenon is that prior lesioning of the peripheral part of the descending spinal projection acquires anticipatory signal value for mobilizing the compensatory abilities of the brain with the aim of recovering from the deficit of the central branch of the system.

[Effects of pyramidotomy on instrumental reflexes in rats depend on the duration of its execution]. / Effekty piramidotomii na instrumental'nye refleksy u krys v zavisimosti ot vremeni ee provedeniia

The effects of unilateral transection of bulbar pyramids on instrumental conditioned reflexes in rats were shown to be in direct relationship with the time of its execution. In rats with stable conditioned reflexes, pyramidotomy impaired conditioned performance, on the average, for 3.9 days. However, preliminary transection of the pyramid delayed operant conditioning and its stabilization, on the average, by 16.5 day. The findings are discussed in terms of the mechanisms of switching over descending influences of the cortico-spinal and cortico-rubrospinal systems.

Time-dependent effects of pyramidotomy in the operantly conditioned rats.

The effect of unilateral transection of bulbar pyramid on operantly conditioning in rats, have been shown to be in direct relationship with the time of its execution. Stable instrumental reflexes reappeared on average 3.9 days after the transection of the bulbar pyramid. However, preliminary transection of the pyramid led to the prolongation of stabilization of operant conditioning after an average of 16.5 days. These findings are considered to be in view of the mechanisms of switching of descending influences of corticospinal and cortico--rubrospinal systems.

[Dynamics of instrumental reflex changes following transection of the corticospinal tract and ablation of the cerebral cortex sensorimotor region in rats]. / Dinamika izmenenii instrumental'nykh refleksov u krys posle pererezki kortikospinal'nogo trakta i udaleniia sensomotornoi oblasti kory mozga.

Unilateral transection of bulbar pyramid performed prior to ablation of the ipsilateral sensomotor cortex was shown to facilitate recovery of operant conditioning and compensatory processes in rats. There was no such corticofugal plasticity in ablation of the sensomotor cortex alone. The phenomenon may be explained by switching of descending influences on the cortico-rubrospinal system through participation of the loop: corticorubral projection--red nucleus--inferior olive--cerebellum--thalamus--cerebral cortex.

Enhanced behavioral recovery from sensorimotor cortex lesions after pyramidotomy in adult rats.

Unilateral transection of the bulbar pyramid, performed before the ablation of the ipsilateral sensorimotor cortex, has been shown to facilitate the recovery of operantly conditioned reflexes and compensatory processes in rats. Such enhanced behavioral recovery was absent when only the sensorimotor cortex was ablated. This phenomenon is explained by the switching of motor activity under the control of the cortico-rubrospinal system. Switching of the descending influences is accomplished through the following loop: cortico-rubral projection-red nucleus-inferior olive-cerebellum-thalamus-cerebral cortex. This suggests that a preliminary lesion of the peripheral part of the system, represented by a descending spinal projection, facilitates the recovery processes to develop during the subsequent destruction of its central part.