My Orthopaedic Surgeon

Conservative management following closed reduction of traumatic anterior dislocation of the shoulder (Cochrane Review) Handoll HHG, Hanchard NCA, Goodchild L, Feary J The Cochrane Database of Systematic Reviews 2006, Issue 1. Art. No.: CD004962. Abstract Authors' conclusions: There is a lack of evidence from randomised controlled trials to inform the choices for conservative management following closed reduction of traumatic anterior dislocation of the shoulder.Sufficiently powered, good quality, well reported randomised controlled trials with long-term surveillance of conservative management are required. In particular, trials examining the type and duration of immobilisation would be useful.

Early Management of Patients with a Head Injury. SIGN Guideline
SIGN Publication No. 46 ISBN 1899893 27 X Published August 2000

The authors evaluated two hypothetical interventions to prevent hip fracture in the overall female population and in a high-risk female population. For one intervention the authors assumed treatment costs approximating treatment with bisphosphonates, and for the other intervention the authors assumed treatment costs approximating those of hormone replacement therapy (HRT).
Jonsson B, Kanis J, Dawson A, Oden A, Johnell O. Osteoporos Int. 1999;10(3):193-9. Abstract only + PPV

NICE - The National Institute for Clinical Excellence - was set up as a Special Health Authority for England and Wales on 1 April 1999. It is part of the National Health Service (NHS), and its role is to provide patients, health professionals and the public with authoritative, robust and reliable guidance on current “best practice”. The guidance will cover both individual health technologies (including medicines, medical devices, diagnostic techniques, and procedures) and the clinical management of specific conditions. NICE offers the NHS and its patients a new service, which we intend shall earn, and retain, the confidence and respect of the community as a whole.

The National Guideline Clearinghouse™ (NGC) is a comprehensive database of evidence-based clinical practice guidelines and related documents. NGC is an initiative of the Agency for Healthcare Research and Quality (AHRQ), U.S. Department of Health and Human Services. NGC was originally created by AHRQ in partnership with the American Medical Association and the American Association of Health Plans (now America's Health Insurance Plans [AHIP]). The NGC mission is to provide physicians, nurses, and other health professionals, health care providers, health plans, integrated delivery systems, purchasers and others an accessible mechanism for obtaining objective, detailed information on clinical practice guidelines and to further their dissemination, implementation and use.

'NHS Evidence - emergency and urgent care' is a unique resource aimed at supporting healthcare professionals by providing high quality information on all aspects of emergency and urgent healthcare including both clinical and organisational issues. We have recently expanded the scope of the collection to fully include early (the first 24 hours of) trauma care.

Respect for patient autonomy is an important ethical principle for medical practitioners; however, previous investigators have reported inconsistent attitudes amongst practitioners towards respect for patient autonomy. This study in empirical ethics used qualitative methods to investigate GPs' attitudes towards respect for patient autonomy in consultations for low back pain. Wendy A Rogers Department of General Practice, Flinders University of South Australia

Hip fracture is a common serious injury that occurs mainly in older people. For many previously fit patients it means loss of prior full mobility; for some frailer patients the permanent loss of the ability to live at home. And for the frailest of all it may bring pain, confusion and disruption to complicate an already distressing last illness. Mortality after hip fracture is high: around 30% at one year. Despite significant improvements in both surgery and rehabilitation in recent decades, hip fracture remains, for patients and their carers, a much-feared injury.

Meta-analysis of 27 papers on Regional Nerve Block in Fractured Neck of Femura. Conclusion: In patients with suspected fractured neck of femur, regional nerve block may be of benefit in reducing parenteral analgesic requirements.
Best BETs - Best Evidence Topics

The Scottish Intercollegiate Guidelines Network (SIGN) was formed in 1993. Our objective is to improve the quality of health care for patients in Scotland by reducing variation in practice and outcome, through the development and dissemination of national clinical guidelines containing recommendations for effective practice based on current evidence.

The Western Slope Study Group (WSSG) was founded in 1997 as a multidisciplinary not-for-profit corporation dedicated to musculoskeletal education and research. WSSG's activities have historically emphasized orthopaedics due to the fact that the founder and director, Michael Dohm, M.D. is an orthopaedic surgeon. The group’s educational offerings have attracted participation from physician interns, nurses, orthopaedic technicians, physical therapists, occupational therapists, chiropractors, family physicians, massage therapists, and orthopaedic surgeons, both M.D. and D.O., among others.

Clinical Trials in Spine Medicine lists industry-sponsored trials that are actively recruiting patients.

The metaRegister of Controlled Trials is a searchable, international database of ongoing randomised controlled trials in all areas of healthcare. At present, the mRCT also contains some completed trials. Offering access to more than 10,000 records, the mRCT is free

Stretching before or after exercising does not confer protection from muscle soreness

Archive Copy: 2004 Hi Quality website, launched in March 2002 and designed to raise standards in health information. Hi Quality should be used if you are: looking for health information and require guidance on how to check its quality; producing health information and require guidance on how to assure quality standards.