Stories From Children's Nurses in Flight: Exploring Experiences of Air Medical Transfers.

OBJECTIVE: Nurses are immersed in stories, and nurses who participate in flight transfers have stories to tell that may hold interest and offer insight for air medical professionals around the world. METHODS: Using a narrative inquiry methodology, 5 nurses working for a children's transport service in England were invited to tell stories from their experiences of air medical transfers. The aim of this article was to describe the meanings the nurses assigned to their experiences of flight transfers and to develop an interpretation of the narrative accounts, investigating the implications of the stories. RESULTS: This study provides a record of nurses' flight experiences within a predominately road-based children's transport service. The analysis considered the following topics: humor, parental presence on transport, and the joy and fear associated with the work. Implications for the training of nurses who fly were identified; it is recommended that the design of training should place the technical challenges of the work in the context of the emotional challenges. CONCLUSION: This article is a timely reflection on the social context of this new nursing experience for any situation around the world, which is seeing expansion of children's air medical transport provision.

Construct validity and responsiveness of commonly used patient reported outcome instruments in decompression for lumbar spinal stenosis.

BACKGROUND: Validity and responsiveness of Oswestry disability index (ODI), Roland Morris disability questionnaires (RMDQ), Short Form-12 Physical Component Score (SF-12 PCS) and Short Form-12 Mental Component Score (SF-12 MCS) in patients undergoing open decompression for lumbar canal stenosis has not been previously reported. METHODS: Outcome assessment was prospectively evaluated using the ODI, RMDQ, SF-12 PCS and SF-12 MCS pre-intervention and at average follow-up of three months post-intervention. Pearson correlation coefficient was used to evaluate the association between change in values of ODI, RMDQ, SF-12 PCS and SF-12 MCS. Distribution based methods (Effect size [ES], standardised response mean [SRM]) and anchor based method (Area under the curve [AUC] of receiver operating curve [ROC]) were used to determine responsiveness. AUC value ≥ 0.70 is considered as adequate level of responsiveness and the outcome instrument with the largest AUC is considered to be the most responsive outcome instrument. RESULTS: This study included 77 participants. Responsiveness was assessed at a mean follow-up of 12 weeks postoperatively. There was significant strong correlation between ODI and RMDQ (r = 0.65, p < 0.0001). The ES of ODI, RMDQ, SF-12 PCS and SF-12 MCS were 1.54, 1.48, 1.85 and 0.51 respectively. The SRM of RMDQ, ODI, SF-12 PCS and SF-12 MCS were 1.22, 1.17, 1.0 and 0.47 respectively. AUC of ODI, RMDQ, SF-12 PCS and SF-12 MCS were 0.83-0.88, 0.82 to 0.86, 0.78 to 0.81 and 0.69 to 0.70 respectively. CONCLUSION: It is recommended to use either ODI or RMDQ as region specific patient reported outcome instrument and SF-12 PCS as a health related quality of life outcome instrument to evaluate outcome after decompressive laminectomy for lumbar canal stenosis.

"Flight Nurses," or "Nurses Who Fly"? An International Perspective on the Role of Flight Nurses.

OBJECTIVE: Discovering how transport nurses around the world are prepared and supported for a flight role may illuminate areas of best practice. This article reviews the flight nursing research, exploring what the international literature tells us about the role of flight nurses and discovering lessons from their experiences that may have particular relevance for the UK context. METHODS: The results of a literature search and thematic synthesis for flight nursing research are described. RESULTS: Thirteen research articles were obtained covering a broad range of countries. The scope of practice encompasses primary and secondary transport services and both civilian and military personnel. In an attempt to distill the role, work, and purpose of a flight nurse, a list of all the themes and categories that could be identified within the literature was assembled. These were inductively refined into 8 cluster themes, seeking to capture a broad description of the role of a nurse who flies. The definition of a "flight nurse" in the international context is debated. Thoughts related to training and education and, in particular, the nontechnical challenges of the role are discussed. CONCLUSION: This reflection provides insights that will influence the ongoing conversation around future air medical service development.

Responsiveness of Commonly Used Patient- Reported Outcome Instruments in Lumbar Microdiscectomy.

Study Design: Prospective observational cohort study. Purpose: To evaluate the comparative responsiveness of Oswestry Disability Index (ODI, version 2.0), 24-item Roland-Morris Disability Questionnaire (RMDQ), 12-item Short-Form Health Survey (SF-12) physical component score (PCS), and SF-12 mental component score (MCS) in patients that underwent micro-discectomy for lumbar disc herniation. Overview of Literature: Responsiveness is a context specific term and no study has reported the responsiveness of ODI version 2.0, RMDQ, SF-12 PCS, or SF-12 MCS in discectomy patients. Methods: Responsiveness was assessed using distribution-based methods (effect size [ES], standardized response means [SRM ], SRM difference between patients who improved and those who did not show improvement [SRM difference]), and the anchor-based method (area under the curve [AUC] of receiver operating characteristic curves). Values of ES and SRM higher than 0.8, and AUC value higher than 0.7 suggest adequate responsiveness. Outcome instrument demonstrating the highest value of SRM difference and AUC was considered the most responsive. Results: Responsiveness was assessed in 98 participants at a mean follow-up time of 12 weeks postoperatively. The overall ES of RMDQ, ODI, SF-12 PCS, and SF-12 MCS was 2.15, 2.11, 2.08, and 0.86, respectively. The overall SRM of ODI, RMDQ, SF-12 PCS, and SF-12 MCS was 1.36, 1.43, 1.24, and 0.65, respectively. The SRM difference in RMDQ, ODI, SF-12 PCS, and SF-12 MCS was 2.64, 2.26, 1.32, and 1.29, respectively. The AUC of ODI, RMDQ, SF-12 PCS, and SF-12 MCS was 0.96, 0.96, 0.83, and 0.83, respectively. Conclusions: ODI, RMDQ, SF-12 PCS, and SF-12 MCS demonstrated adequate responsiveness in a homogenous cohort of patients who underwent lumbar micro-discectomy. ODI and RMDQ are equally responsive and, thus, are interchangeable instruments for region specific outcomes. Both the SF-12 PCS and SF-12 MCS can assess the quality of life following lumbar micro-discectomy.

Comparative responsiveness of four visual analogue scales in microdiscectomy for lumbar disc herniation.

INTRODUCTION: There is a paucity of studies reporting responsiveness of visual analogue scale (VAS) measures in patients treated by discectomy for symptomatic lumbar disc herniation. The aim of this study was to evaluate the responsiveness of different types of VAS. METHODS: VAS score was measured separately for constant leg pain (VAS-LP-constant), severe episode of leg pain (VAS-LP-severe), constant backache (VAS-BP-constant) and severe episode of backache (VAS-BP-severe) in a cohort of patients undergoing discectomy surgery for sciatica. VAS was evaluated preoperatively and postoperatively at final follow-up. Responsiveness was determined using standardised response mean (SRM), effect size (ES) and the area under the curve (AUC) analysis using receiver operating characteristic curves. For AUC analysis, the success of discectomy from the patient's perspective was chosen as the external anchor. RESULTS: Ninety-eight patients were included in this prospective study. Outcome was assessed at a mean follow-up of 12 weeks postoperatively. The SRM of VAS-LP-severe, VAS-LP-constant, VAS-BP-severe and VAS-BP-constant was 2.16, 2.16, 0.87 and 0.53, respectively. The ES of VAS-LP-severe, VAS-LP-constant, VAS-BP-severe and VAS-BP-constant was 3.53, 2.70, 0.89 and 0.53, respectively. The AUC of VAS-LP-severe, VAS-LP-constant, VAS-BP-severe and VAS-BP-constant was 0.88, 0.75, 0.74 and 0.59, respectively. CONCLUSION: We recommend the use of VAS-LP-Severe as the most responsive VAS measure when evaluating the results of discectomy surgery for sciatica.

Understanding of intra-operative tourniquets amongst orthopaedic surgeons and theatre staff--a questionnaire study.

INTRODUCTION: Pneumatic tourniquets are used frequently in orthopaedic theatres to provide a bloodless field whilst operating on the extremities. Their use has given rise to complications and preventable damage due to over-pressurisation and prolonged application. We designed a questionnaire to assess the knowledge on tourniquet use among operating department assistants (ODAs) and specialist registrars (SpRs) in orthopaedic surgery. SUBJECTS AND METHODS: A questionnaire was constructed using set guidelines from the Association of periOperative Registered Nurses (AORN) for recommended practice of tourniquet application. This was distributed to orthopaedic registrars with varying levels of experience and ODAs from five different NHS hospitals. The unpaired, two tailed t-test was used to test for statistical significance of results. RESULTS: A total of 54 completed questionnaires were collected for analysis. The study population included 29 orthopaedic SpRs and 25 ODAs. The mean score for the orthopaedic SpRs as a group was 41.3% (SD 6.85; range, 29.0-54.8%). The mean score for the ODAs was 46.7% (SD 9.64; range, 23.3-62.9%) with a P-value of 0.024. CONCLUSIONS: Most surgeons are taught how to use pneumatic tourniquets by their senior colleagues as no formal teaching is given. Most of the complications are infrequent and preventable. However, their consequences can be devastating to the patient with medicolegal implications. Our results show suboptimal knowledge of tourniquets and their use among SpRs and ODAs. This study highlights the need for amendments in training to improve the knowledge and awareness of medical practitioners on the application and use of tourniquets to prevent adverse events and improve patient safety.

Exposure of the thyroid to radiation during routine orthopaedic procedures.

The availability and usage of portable image intensifiers has revolutionised routine orthopaedic practice. Extensive use of fluoroscopy however may result into significant radiation exposure to operating staff. An accumulated dose of 65 microSv per procedure over long exposure has been reported to increase the risk of thyroid cancer. The present prospective study aimed at measuring the scattered dose to the thyroid using an Unfors EDD dosimeter during DHS/IMHS for fractures of the neck of the femur and IM nailing for long bone fractures. In 32 procedures, the dose of 65 microSv was exceeded 13 times; 8 times during DHS/IMHS and 5 times during IMN. The average thyroid dose was 142 microSv during IMN and 55 microSv during DHS. Only 9 of the total 223 (4%) theatre personnel were using a thyroid shield in spite of its availability. These results suggest that the thyroid is frequently exposed to potentially harmful radiation during these procedures. Strict inclusion of a thyroid shield as a part of routine radiation protection is recommended.

Clavicular hook plate for lateral end fractures:- a prospective study.

AIM: A prospective study was undertaken over a period of 4 years to evaluate the clinical and radiological outcomes following fixation with a clavicular hook plate for Neer types II and III fractures of lateral end clavicle. MATERIALS: Thirty-one patients (M:F; 24:7) with a mean age of 49 years (range 25-86 years) were recruited for the study. The mean follow-up duration was 40 months (range 18-68 months). Twenty-three patients were treated primarily and eight patients were treated for symptomatic delayed union. RESULTS: All the patients achieved clinical and radiological union over a mean of 12 weeks (range 6-18 weeks). Mean constant score at and after 3 months was 94 (range 82-100). Mean ASES score at and after 3 months was 26 out of a maximum of 30. CONCLUSION: The clinical result of fracture fixation of lateral end clavicle using hook plate appeared good in terms of fracture union and function. The principal advantages of this method were anatomical reduction of the fracture and early rehabilitation which lead to good shoulder girdle function.

Musculoskeletal recovery 5 years after severe injury: long term problems are common.

Five years after severe injury (ISS>15), usually involving several body regions, 158 patients were assessed regarding their musculo-skeletal recovery. An earlier paper in this journal about this study 'Injury 29 (1998) 55' showed that when considering the main body regions causing long term disability, 45% were due to bony injuries to the extremities, pelvis and shoulder girdle. We analysed these body areas regarding the degrees of disability and pain and also for problems with activities of daily living, work, sport and mobility. All patients with unstable pelvic fractures had moderate or severe persisting disability and chronic pain. Functional problems with activities of daily living, work, sport and mobility were reported in 28, 86, 100 and 100% of patients, respectively. Patients with stable pelvic fractures had persisting disability in 54% of cases, which was mild in 42% and moderate or severe in 12% of patients. In patients with stable pelvic fractures 54% had chronic pain, which was mild in 24% of patients and moderate or severe in 30% of patients. Functional problems with mobility, work and sport were reported in 38, 19 and 19% of patients, respectively. Patients with shoulder girdle injuries had persisting disability in 48% of cases which was mild in 24% and moderate or severe in 24% of patients. In patients with shoulder girdle injuries 45% had chronic pain, which was mild in 14% and moderate or severe in 31% of patients. Functional problems with activities of daily living, work, sport and mobility were reported in 38, 28, 38 and 38% of patients respectively. Patients with upper limb fractures had persisting disability in 66% of cases which was mild in 34% of patients and moderate or severe in 32% of patients. Chronic pain was present in 62% of these cases, which was mild in 32% and moderate or severe in 34% of patients. Functional problems with activities of daily living, work, sport and mobility were reported in 31, 45, 48 and 66% of patients, respectively. Patients with lower limb fractures had persisting disability in 84% of cases, which was mild in 16% and moderate or severe in 68% of patients. Chronic pain was present in 80% of these cases, which was mild in 24% and moderate or severe in 56% of patients. Functional problems with activities of daily living, work, sport and mobility were reported in 40, 56, 64 and 76% of patients, respectively. Patients with multiple extremity injuries or combinations of pelvic and lower extremity or shoulder girdle and upper extremity injuries were much more likely to have continuing disability compared with those sustaining single bone injuries of that limb. This high disability rate reflecting treatment in 1989-1990, raises the question of whether our present policy of earlier and better fixation and rehabilitation of fractures in severely injured patients (ISS>15) can improve these results.