Neil Cunningham

Techniques for reduction of anteroinferior shoulder dislocation

Dislocation of the shoulder joint is common. The shoulder is affected in up to 60% of all major joint dislocations, one study citing an incidence of 1.7% in the general population. The most common form is anteroinferior dislocation. A variety of techniques to reduce shoulder dislocation has been described. The key to successful relocation is a thorough understanding of the anatomy of both the enlocated and the dislocated shoulder joint.

Telephone referrals by junior doctors: a randomised controlled trial assessing the impact of SBAR in a simulated setting

Objective To determine whether exposing junior doctors to Situation, Background, Assessment, Recommendation (SBAR) improves their telephone referrals. SBAR is a standardised minimum information communication tool. Methods A randomised controlled trial with participants and rating clinicians both blinded to group allocation. Hospital interns from a 2-year period (2006–2007) participated in two simulated clinical scenarios which required them to make telephone referrals. The intervention group was educated in SBAR between scenarios. Pre and post intervention telephone referrals were recorded, scored and compared. Six-month follow-up and year group comparisons were also made. An objective rating score measured the presence of specific ‘critical data’ communication elements on a scale of 1–12. Qualitative measures of global rating scores and participant self-rated scoring of performance were recorded. Time to ‘first pitch’ (the interns initial speech) was also recorded. Results Data were available for 66 interns out of 91 eligible. SBAR exposure did not increase the number of communication elements presented; objective rating scores were 8.5 (IQ 7.0–9.0) for SBAR and 8.0 (IQ 6.5–8.0) for the control group (p=0.051). Median global rating scores, designed to measure ‘call impact’, were higher following SBAR exposure (SBAR: 3.0 (IQR 2.0–4.0); control: 2.0 (IQ 1.0–3.0); p=0.003)). Global rating scores improved as time to ‘first pitch’ duration decreased (p=0.001). SBAR exposure did not improve time to ‘first pitch’ duration. Conclusion In this simulated setting exposure to SBAR did not improve telephone referral performance by increasing the amount of critical information presented, despite the fact that it is a minimum data element tool. SBAR did improve the ‘call impact’ of the telephone referral as measured by qualitative global rating scores.

Use of a Checklist During Observation of a Simulated Cardiac Arrest Scenario Does Not Improve Time to CPR and Defibrillation Over Observation Alone for Subsequent Scenarios

Theory: Immersive simulation is a common mode of education for medical students. Observation of clinical simulations prior to participation is believed to be beneficial, though this is often a passive process. Active observation may be more beneficial. Hypotheses: The hypothesis tested in this study was that the active use of a simple checklist during observation of an immersive simulation would result in better participant performance in a subsequent scenario compared with passive observation alone. Methods: Medical students were randomized to either passive or active (with checklist) observation of an immersive simulation involving cardiac arrest prior to participating in their own simulation. Performance measures included time to cardiopulmonary resuscitation (CPR) and time to defibrillation and were compared between first and second scenarios as well as between passive and active observers. Results: Seventy-nine simulations involving 232 students were conducted. Mean time to CPR was 18 seconds (SD = 11.6) for those using the checklist and 24 seconds (SD = 15.8) for those who observed passively (M difference = 6 seconds), t(35) = 1.46, p =.153. Time to defibrillation was 94 seconds (SD = 26.4) for those using the checklist and 92 seconds (SD = 23.8) for those who observed passively (M difference = –2 seconds), t(38) =.21, p =.837. Time to CPR was 24 seconds (SD = 15.8) for passive observers and 31 seconds (SD = 21.0; M difference = 7 seconds), t(35) = 1.13, p =.265, for their first scenario counterparts. Time to CPR was 18 seconds (SD = 11.6) for active observers and 36 seconds (SD = 26.2; M difference = 18 seconds), t(24) = 2.81, p =.010, for their first scenario counterparts. Time to defibrillation was 92 seconds (SD = 23.8) for passive observers and 125 seconds (SD = 32.2; M difference = 33 seconds), t(33) = 3.63, p =.001, for their first scenario counterparts. Time to defibrillation was 94 seconds (SD = 26.4) for the active observers and 132 seconds (SD = 52.9; M difference = 38 seconds), t(28) =.46, p =.008, for their first scenario counterparts. Conclusions: Observation alone leads to improved performance in the management of a simulated cardiac arrest. The active use of a simple skills-based checklist during observation did not appear to improve performance over passive observation alone.

Response to ‘Beta-Blockers and The Cardiac Complications of Methamphetamines’

Heart, Lung and Circulation - In Press.Proof corrected by the author Available online since samedi 5 novembre 2016

Adherence to national exercise guidelines by patients attending emergency departments: A multi-site survey: EXERCISE GUIDELINE ADHERENCE IN AUSTRALIA

The proportion of adults in Australia meeting or exceeding the national guidelines for physical activity has remained relatively static over the past 10 years. The research objective was to measure self‐reported physical activity and sedentary behaviour among ED patients in accordance with Australias current physical activity and sedentary behaviour guidelines, revised in 2014.

Resuscitation skills for radiologists: A short paper

The radiologist is likely to be the first medical practitioner on the scene for contrast reactions, anaphylaxis and other common medical emergencies that occur in radiology departments and stand‐alone practices. Until 2007, the Royal Australian and New Zealand College of Radiologists (RANZCR) did not provide resuscitation training as a CPD service for fellows, and the need for such a service has not been gauged. In 2007, the authors ran the first RANZCR large‐group resuscitation refresher training workshop at the Melbourne 2007 annual scientific meeting. The workshop maximized audience participation and knowledge transfer in a constrained time, disseminated guidelines, and collected feedback on the need for further resuscitation training for radiologists. Of the 100 feedback forms, 82 were returned. All the 82 responses wanted the workshop repeated at future annual scientific meetings, and 71 wanted RANZCR to provide hands‐on refresher training. Sixty‐six responders indicated when they had their most recent resuscitation training: six in the past 12 months, 25 in the past 3 years and 35 longer than 3 years. Sixty‐nine responded on availability of resuscitation training at their workplace: 33 indicated ‘Yes’ and 36 ‘No’. There is a definite need to provide resuscitation training for radiologists in Australia. At the end of this article, we reproduce the currently applicable guidelines as a service to our readers.

Review article: Isolated proximal tibiofibular joint dislocation: PROXIMAL TIBIOFIBULAR JOINT DISLOCATION

Proximal tibiofibular joint (PTFJ) dislocations are relatively rare injuries and this paper provides an up‐to‐date review and practical management approach for the assessment and management of these cases. Isolated PTFJ dislocations are a rare injury, accounting for less than 1% of all knee injuries. Thus, there does not appear to be a clear consensus on definitive management and post‐reduction care in the literature. This paper provides a review of the literature, anatomical analysis of the PTFJ in the dislocated state, and a technique for reduction. In the majority of cases, PTFJ dislocations are an injury that can be identified with simple imaging modalities and treated in the ED with manipulation under procedural sedation.