Clinical efficacy of the virtual fracture clinic: analysis of 17,269 referrals by type of injury.

INTRODUCTION: Numerous studies have deemed the virtual fracture clinic (VFC) model to be both cost and clinically effective. However, very few of these studies have analysed the type of injuries seen in the VFC. The objectives of this study were to assess the clinical effectiveness of the VFC and analyse the types of injuries that lead to patients re-presenting in the face-to-face fracture clinic after being discharged virtually. METHODS: This is a retrospective study analysing 17,269 patients referred to the VFC between September 2017 and February 2020. Data regarding the type of presenting injury were collected to understand which injuries required further management after being discharged virtually. Patient clinic letters provided data regarding the purpose and outcomes of VFC referrals as well as face-to-face appointments. Theatre lists were cross-referenced to extract data regarding surgical management. RESULTS: In total, 57.37% (9,908) patients were discharged virtually. Of these patients, 92.52% were discharged successfully and 7.48% re-presented to the fracture clinic: 98.11% were managed conservatively and 1.88% required surgery. The highest number of failed discharges were for distal radius fractures (109, 14.69%). Face-to-face follow-up in fracture clinic was requested for 37.06% (6,400) of patients; 4.98% of them required surgical intervention. Some 5.56% (961) of referrals were removed from our analysis: 807 were inappropriate referrals and 154 were deemed suitable for multidisciplinary team discussion. The trust has saved an average of £702,205 annually since introduction of the VFC. CONCLUSIONS: The VFC model delivers as promised in terms of clinical efficacy and cost management. Injury types showing higher numbers of unsuccessful discharges could benefit from having modified management pathways.

The safety and efficacy of day-case total joint arthroplasty.

INTRODUCTION: The popularity of day-case arthroplasty has been fuelled by focus on its cost effectiveness for the healthcare system. Safety concerns still remain. The aim of this review was to compare readmission rates after total joint arthroplasty for patients undergoing day-case surgery and for inpatients. METHODS: A comprehensive online search of databases was performed for all published articles in the English language evaluating readmission rates after total hip arthroplasty (THA) and total knee arthroplasty (TKA). Seventeen studies were deemed eligible and included in the meta-analysis. RESULTS: All studies included in the meta-analysis described readmission rates following THA/TKA. The readmission rate for day-case patients was 1.9% (n=124) whereas for inpatients, it was 2.0% (n=12,399). Compared with inpatient arthroplasty, day-case arthroplasty was associated with lower total readmission rates (odds ratio [OR]: 0.77, 95% confidence interval [CI]: 0.63-0.94, p=0.01). Furthermore, day-case surgery conferred a decrease in readmission rates for both THA (1.3% vs 7.0%) and TKA (2.7% vs 4.3%). Moreover, day-case THA and TKA were both associated with a decreased chance of readmission (OR: 0.27, 95% CI: 0.17-0.42, p<0.00001; and OR: 0.55, 95% CI: 0.42-0.72, p<0.00001 respectively). CONCLUSIONS: This review emphasises that with a thoughtful, designated protocol and with careful patient selection, day-case arthroplasty is a safe and effective option.

Simple reversed-phase high-performance liquid chromatographic method for 13-cis-retinoic acid in serum.

An isocratic reversed-phase high-performance liquid chromatographic method for the analysis of 13-cis-retinoic acid in serum is developed. Sample preparation includes deproteination with acetonitrile-perchloric acid-acetic acid followed by centrifugation. 9-Methylanthracene is used as the internal standard. Chromatographic separation is achieved on a C18 column (Zorbax) using an acetonitrile-aqueous 0.5% acetic acid (85:15, v/v) eluent containing 0.05% (w/v) sodium hexanesulfonate. The limit of detection is 12 ng/ml in serum, using 0.5 ml samples. Quantitative recoveries and excellent intra-day and inter-day precision are reported.

High-performance liquid chromatographic analysis of chlorhexidine phosphanilate, a new antimicrobial agent.

Chlorhexidine phosphanilate (CHP) is analysed by two separate reversed-phase HPLC methods. CHP was found to be a non-stoichiometric compound with a phosphanilic acid to chlorhexidine ratio of 1.83. By careful choice of solvents, solution pH and HPLC columns, loss of sample due to incomplete dissolution and adsorption to surfaces is avoided. Both methods are shown to be stability-indicating and accurate.

Determination of tretinoin in creams by high-performance liquid chromatography.

A stability indicating reversed-phase high-performance liquid chromatographic method has been developed to quantify tretinoin (all-trans-retinoic acid) in cream formulations. Tretinoin cream samples were dissolved directly in tetrahydrofuran and diluted for injection. Separation was accomplished on a 15 cm Nova-Pak C18 column using a tetrahydrofuran-phosphate buffer solvent system (42:58, v/v) and 1.0 ml/min flow-rate. The method is able to separate tretinoin from its degradation products formed under stressing conditions. Excellent precision and accuracy were found for the assay of tretinoin in the cream formulations.

Purity determination by a combination of spectrophotometric and liquid chromatographic methods: application to 13-cis-retinoic acid.

A method is described to determine the purity of 13-cis-retinoic acid. Spectrophotometry is used to determine the non-UV-absorbing impurities, and HPLC is used to determine the UV-absorbing impurities. In combination, these methods permit determination of the purity. An authentic standard is used in developing this method, but it is not needed in the application of the method.

Analysis of anthralin in dermatological products by reversed-phase high-performance liquid chromatography.

A reversed-phase liquid chromatographic method is described for the determination of anthralin in topical products. The factors affecting the degradation of anthralin solid and solutions are discussed. Ultraviolet spectra of degradation products are presented. The assay method has been thoroughly optimized and is shown to be specific, precise, and accurate.

Determination of propylene carbonate in pharmaceutical formulations using liquid chromatography.

A stability-indicating reversed-phase high-performance liquid chromatographic method using a refractive index detector is described for the determination of propylene carbonate in pharmaceutical formulations. Good precision and accuracy of the method was demonstrated using an aqueous formulation. This method is also applicable to an anhydrous formulation.

High-pressure liquid chromatographic assay of benzoyl peroxide in dermatological gels and lotions.

A high-pressure liquid chromatographic method for the assay of benzoyl peroxide in dermatological preparations is described. Degradation products such as benzoic acid and perbenzoic acid do not interfere. The method is simple, precise, accurate, and stability indicating.