Mater Dei Hospital Research Articles

Traumatic Soft Tissue Finger Injuries at Mater Dei Hospital, Malta: Epidemiology, Complications and Functional Outcomes

Traumatic Soft Tissue Finger Injuries at Mater Dei Hospital, Malta: Epidemiology, Complications and Functional Outcomes

686 National Audit Assessing the Imaging of Acute Pancreatitis at Mater Dei Hospital, Malta

686 National Audit Assessing the Imaging of Acute Pancreatitis at Mater Dei Hospital, Malta

Perceived authority gradients among anaesthetic teams in Malta.

Over the decades, cases like those of Elaine Bromiley, who passed away after a 'cannot intubate, cannot ventilate' scenario, have prompted deeper analyses of team dynamics and authority gradients. It is thought that a steep authority gradient may have impeded lifesaving communication between members of the anaesthetic team, leading to her death. Using an online questionnaire, we carried out a cross-sectional observational study exploring the perceived authority gradients within anaesthetic teams in the main operating theatres at Mater Dei Hospital, Malta. Nurses were found to experience a steeper authority gradient than anaesthetists. They were less comfortable making suggestions too and also felt like the suggestions they made were less listened to by lead anaesthetists. To a lesser extent, females also experienced a steeper authority gradient. Increasing age and grade were associated with a flatter authority gradient. Further research needs to be carried out to identify the underlying reasons behind the steeper perceived authority gradient affecting nurses. Interventions are being planned to attempt to decrease the perceived authority gradient.

Return to Sport, Re-injury and Performance After the Anterior Cruciate Ligament Reconstruction: Evaluating the Role of International Knee Documentation Committee (IKDC) and Knee Injury and Osteoarthritis Outcome Score (KOOS) Scoring Systems.

Introduction Anterior cruciate ligament (ACL) tears are common injuries that can considerably impact an individual's quality of life and athletic performance. In these cases, surgical reconstruction of the ligament can be considered to restore stability to the knee. This study aims to investigate the time taken for individuals to return to sport post-ACL reconstruction, assess the rate of re-injuryand evaluate the reliability of the International Knee Documentation Committee (IKDC) and Knee Injury and Osteoarthritis Outcome Score (KOOS) scoring systems in predicting a return to sport at the pre-injury level. Methods In this retrospective study, a total of 104 patients who underwent ACL reconstruction between January 2016 and December 2022 by one surgical team at Mater Dei Hospital, Malta were evaluated using a self-administered questionnaire. The questionnaire was based on different components including the sport practised at the time of injury, sport engagement classification, return to sport, the ability to return to pre-injury levels of performanceand re-injury. The participants then had to fill in IKDC and KOOS evaluation forms. Results In this study, 73% (n=76) of individuals successfully returned to sport after ACL reconstruction, with no significant difference being found between professional and recreational athletes (Chi-squared=0.00455, p=0.95). After reconstruction, 31.7% (n=33) of participants experienced an ipsilateral or contralateral ACL tear, with those returning to sport within six months showing a fivefold increase in re-injury risk compared to individuals who returned at eight or 12 months, suggesting a significant association between return duration and re-injury. The relationship between scoring systems and return to sport at the pre-injury level of performance was analysed using binary logistic regression, revealing that achieving scores of 85.6 or higher in IKDC or 89 or higher in KOOS meant having a 95% probability of returning to sport at the pre-injury level. Conclusions By considering these scoring systems with other post-operative criteria, clinicians can offer a more customised rehabilitation plan tailored to each patient who undergoes ACL reconstruction.

Audit of referrals to the colposcopy clinic at mater dei hospital in Malta

Audit of referrals to the colposcopy clinic at mater dei hospital in Malta

Induction of labour at mater dei hospital, Malta (re-audit)

Induction of labour at mater dei hospital, Malta (re-audit)

Audit on Management of Reduced Fetal Movements, Mater Dei Hospital (Malta)

Audit on Management of Reduced Fetal Movements, Mater Dei Hospital (Malta)

Inconsistency in the Application of Glasgow Coma Scale in Pediatric Patients

Objective: The Glasgow Coma Scale (GCS) is widely used to objectively describe the extent of patients’ impaired consciousness. However, there are known variations in scoring GCS both in adults and children which may impact patient management. The aim of this audit was to assess the application of GCS by medical and nursing staff in pediatric medical patients. Subject and Methods: An online questionnaire was distributed amongst doctors and nurses working in the Department of Child and Adolescent Health at Mater Dei Hospital in Malta. The participants assigned GCS for 8 case scenarios involving children of different ages with varying levels of consciousness. Results were analyzed by calculating percentage agreement and by Cronbach’s alpha. Results: Sixty-six participants were studied, with a response rate of 52%. Performance was poor overall, with Cronbach alpha 0.53. Correlation was better at the upper and lower ends of the scale and the worst performance was for verbal response. Only respondents with 5–10 years of experience achieved acceptable consistency in the application of the GCS (Cronbach alpha 0.78). Conclusion: There is considerable variation in application of GCS in pediatric patients, highlighting the need for education and training to improve consistency for this commonly used neurological assessment tool.

Evolutionary and spatiotemporal analyses reveal multiple introductions and cryptic transmission of SARS-CoV-2 VOC/VOI in Malta.

Genomic surveillance and epidemiology have shed light on the viral diversity driving coronavirus disease 2019 (COVID-19) outbreaks and are important during waves of highly transmissible and immune-escaping variants of interest or of concern (VOCs). We analyzed the epidemiological data of the understudied country of Malta and related the patterns observed with viral genetic sequences obtained through the surveillance system headed by the Mater Dei Hospital and the University of Malta. We reconstructed the evolutionary history and spatiotemporal dynamics of Maltese severe acute respiratory syndrome coronavirus 2 viruses using a phylodynamics framework. Our findings suggest that the number of cases associated with B.1.1.7/Alpha, B.1.617.2.X/Delta, and B.1.1.529.X/Omicron VOCs was nine times higher than those associated with wild-type variants. The positivity rates in Malta remained low to moderate (<10%). A combination of public health interventions appeared to have allowed Malta to mitigate the impact of COVID-19. Our phylodynamic reconstruction traced most of the 173 viral introductions inferred to countries in Northern Europe, which is consistent with flight connectivity patterns. We also observed prolonged periods of cryptic transmission (median = 102 days) until expansion into larger outbreaks. These larger outbreaks were more easily detected by the intermittent genomic surveillance in Malta, characterized by periods of sequencing hiatus. Our study demonstrates that integrating epidemiological and genomic data are crucial for uncovering the COVID-19 dynamics of understudied locations, particularly when genomic surveillance is suboptimal. Accordingly, strengthening the genomic surveillance system in Malta should help in the earlier detection of introductions and minimize viral expansion in the country while informing public health interventions.IMPORTANCEOur study provides insights into the evolution of the coronavirus disease 2019 (COVID-19) pandemic in Malta, a highly connected and understudied country. We combined epidemiological and phylodynamic analyses to analyze trends in the number of new cases, deaths, tests, positivity rates, and evolutionary and dispersal patterns from August 2020 to January 2022. Our reconstructions inferred 173 independent severe acute respiratory syndrome coronavirus 2 introductions into Malta from various global regions. Our study demonstrates that characterizing epidemiological trends coupled with phylodynamic modeling can inform the implementation of public health interventions to help control COVID-19 transmission in the community.

#4893 THE INCIDENCE, RISK FACTORS AND OUTCOMES OF ACUTE KIDNEY INJURY AFTER MINOR LOWER LIMB AMPUTATIONS

Abstract Background and Aims Minor lower limb amputations (toe amputations and/or amputations distal to or through the tarsometatarsal joint), are limb and potentially lifesaving procedures. However, they are associated with serious adverse events including acute kidney injury (AKI). The aim of this study was to determine the incidence of AKI after such interventions, identify potential risk factors and assess impact on patient survival. Method This was a single centre retrospective study involving patients who underwent minor lower limb amputations at Mater Dei Hospital Malta between January and December 2019. Patient and procedure details were obtained from hospital records. Estimated glomerular filtration rate (eGFR) was calculated using the Modification of Diet in Renal Disease formula. Chronic kidney disease (CKD) was defined as per Kidney Disease: Improving Global Outcomes (KDIGO) criteria. AKI was defined using Acute Kidney Injury Network (AKIN) criteria or KDIGO criteria if day 7 serum creatinine was available. Statistical analysis was performed using SPSS Statistics for Windows v21.0 (IBM Corp.). Results A total of 201 patients were included; males 69.7%, mean age 70.4 ±11.5 years, 87.1% had diabetes mellitus, 71.1% hypertension and 26.4% had ischemic heart disease. Pre-existing CKD was identified in 35.8%; 16.4% CKD stage 3a, 13.4% CKD stage 3b, 5.5% CKD 4 and 1 patient CKD 5. The majority (76.1%) underwent single toe amputations. Surgery was performed under loco-regional anaesthesia in 90% of patients, mostly in view of lower limb ulcers (64.7%) or gangrene (29.4%). A cohort of 54 (26.9%) patients received iodine based contrast within 7 days of procedure, including those who underwent bypass surgery (8%) and endarterectomy (4%). The incidence of AKI after minor lower limb amputations using AKIN criteria was 18.9%. An additional 12 patients were identified using KDIGO criteria (24.9%), however KDIGO criteria could only be applied for 123 patients as the rest did not have a day 7 serum creatinine. Most developed stage 1 AKI (18.4%), one patient developed stage 2 AKI and none developed stage 3 AKI using AKIN criteria. Only 1 patient needed temporary haemodialysis having developed AKI after day 3 post-operatively fulfilling KDIGO but not AKIN criteria. Recovery of kidney function occurred in all patients. All-cause mortality at 30 days, 60 days and 18 months (end of follow-up) was 2.0%, 5.5% and 19.9% respectively. None of the deaths were directly related to the AKI-amputation event. Patients who developed AKI, compared to those who did not, were more likely to have an eGFR &amp;lt;45ml/min/1.73 m2 at the time of procedure (39.5% vs. 14.7%, p = 0.001). They were significantly older (73.0 ±10.4 vs. 68.5 ±11.8 years, p = 0.033), and more likely to have underlying chronic obstructive pulmonary disease (COPD) (28.9% vs. 13.5% p = 0.028). Use of loop and/or thiazide diuretics (68.4% vs. 49.1%, p = 0.049), fluoroquinolones (71.1% vs. 52.8% p = 0.047) and/or carbapenems (10.5% vs. 2.5%, p = 0.043) was also more frequent in this group. Use of iodine based contrast within 7 days of procedure did not effect incidence of AKI. Hospital length of stay and all-cause mortality were not significantly higher in patients with AKI. An eGFR &amp;lt;45ml/min/1.73 m2 was established as a strong independent predictor for the development of AKI (odds ratio [OR] 3.24, confidence interval [CI]: 1.40–7.52, p = 0.006), as were use of fluoroquinolones (OR: 3.19, CI: 1.30–7.82, p = 0.012) and day 1 C-reactive protein (CRP) (OR: 1.01, CI: 1.00–1.01, p = 0.009). Cumulative survival censored at the end of follow-up was not significantly lower in patients who developed AKI (log rank: 0.45, p = 0.50). Conclusion In our study, 18.9% of patients developed AKI after minor lower limb amputations using AKIN criteria. One patient required acute haemodialysis. Age, COPD, diuretics, fluoroquinolones and carbapenems were associated with increased incidence of AKI. An eGFR &amp;lt;45ml/min/1.73 m2, day 1 CRP and fluoroquinolone use were independent risk factors for the development of AKI. In this small patient cohort, AKI was not associated with higher all-cause mortality, and none of the deaths were directly related to the AKI-amputation event.

The impact of unplanned 30-day readmission as a quality indicator in pediatric surgery.

Hospital readmission is one of the indicators used to assess quality of service provided in healthcare. Based on accumulated knowledge, risk management teams assess data related to readmissions to find curative solutions for underlying factors. The current article's aim is investigating readmission routes within the workplace in paediatric surgery service during the first 30 days post discharge from Mater Dei Hospital (MDH). A retrospective study of children's hospital readmissions between October 2017 and November 2019 was performed, strictly before COVID-19 pandemic. Demographics and clinical records including age, gender, pre-existing comorbidities, diagnosis during primary admission and readmission, procedure carried out, ASA grade, length of stay, and outcomes were collected. All children re-admitted under a single paediatric surgical department within 30 days from initial admission to tertiary referral hospital were included. Patients undergoing emergency visitation without subsequent admissions were excluded. Readmissions were classified into cohorts: elective and emergency, depending on the nature of primary admission. Contributing factors and outcomes were compared. 935 surgical admissions (221 elective and 714 emergencies) were registered at MDH over the given period, with an average hospital stay of 3.62 days. Total readmission rate was 1.7% (n = 16). 25% (n = 4) of readmissions were post elective, 75% (n = 12) post emergency admission, with an average stay of 4.37 days and no mortalities. 43.7% (n = 7) were re-admissions post-surgical intervention. Further surgical interventions were necessary in 25% (n = 4) of readmitted patients, the remainder (n = 12) treated conservatively. Published reports concerning paediatric surgical readmission rates are limited, challenging healthcare systems. Most readmissions area voidable; therefore, healthcare workers must provide adequate strategies tailored to their resources, efficient multidisciplinary approaches with improved communication to decrease morbidity and prevent readmissions.

The effect of tooth borne versus skeletally anchored Alt-RAMEC protocol in early treatment of Class III malocclusion: a single-centre randomized clinical trial.

This was a randomized, controlled trial designed to compare outcomes between the use of dental and skeletal anchorage, using the Face mask/Alternate Rapid Maxillary Expansion and Contraction (FM/Alt-RAMEC) protocol. The study was carried out at Mater Dei Hospital, Malta and included prepubertal skeletal Class III malocclusion patients where the aetiology was primarily maxillary hypoplasia. Two groups were assigned. Group I was treated with FM/Alt-RAMEC and group II was treated with skeletally anchored FM/Alt-RAMEC. Wear-time (WT) of the FM was monitored using TheraMon microsensors. Patients were instructed to wear the FM for 12-14 hours/day for 9 months. Changes were evaluated with lateral cephalograms and analysed with Wilcoxon and Mann-Whitney U tests. ANOVA was used to analyse the effect of gender on compliance parameters. Spearman's correlation coefficient was used to assess the correlation between compliance and skeletal changes. To compare the skeletal and dentoalveolar changes in patients treated with these two protocols. The primary outcome was to assess skeletal and dentoalveolar outcomes in patients treated with skeletally anchored FM/RME and tooth-borne FM/RME; utilizing Alt-RAMEC protocol. The secondary outcome was compliance rate and adherence to FM wear among patients. Randomizer software and the sealed envelope technique were used to randomly allocate patients 1:1 into either group I (tooth-borne FM/Alt-RAMEC) or group II (skeletally anchored FM/Alt-RAMEC). It was not possible to blind to treatment allocation, but blinding was used when assessing the outcomes. Numbers randomized and analysed. Thirty-five patients were allocated. Group I consisted of 18 subjects and group II consisted of 17 subjects. One patient in group I dropped out due to illness, so 17 subjects in each group completed the study. Post-treatment changes in group I showed significant increases in SNA (2.10°), ANB (3.90°), Wits (4.70 mm), and overjet (5.40 mm). Group II showed significant increases in ANB (3.10°), Wits (3.20 mm), and overjet (4.50 mm). Wearing time for group I patients was 7.87 ± 2.88 hours/day and for group II was 6.98 ± 2.68 hours/day, with no significant difference between the groups. Lack of long-term follow-up post-treatment, making the conclusion applicable only in the short term. No harm was observed in both groups. Despite the large difference between the measured and the patient-reported daily WT, both tooth-borne and skeletally anchored FM/Alt-RAMEC showed positive, similar, skeletal and dental effects. ISRCTN12197405.

The Management of Obese Women in Pregnancy &amp; Neonatal Outcome in Malta

Background: Over the past few years, the rise of obesity in pregnancy has been associated with a rise in pregnancy complications. The aim of this audit was to analyze the current management of obese women in pregnancy at Mater Dei Hospital (MDH). The Royal College of Obstetricians and Gynaecologists (RCOG) green-top guideline: Care of Women with Obesity in Pregnancy which was published in 2018 was used as a standard for this audit. Method: Data was collected from inpatient medical notes of obese mothers who presented at MDH between July 2020 and October 2020. There was no patient contact during data collection and all data was kept anonymous. Results: 53 mothers were recorded as obese between July and October 2020. The average maternal age was 31 years and the average maternal weight was 94kgs at antenatal booking visit. 47% of obese mothers were classified as Class 1 obese. Only 38% of obese mothers had an oral glucose test performed, and 70% of these mothers had a positive test.54.7% delivered via a caesarean section. 12% of neonates required NPICU admission. Conclusion: Pregnancy in women with obesity is an important public health problem with short- and long-term implications for maternal and child health. This audit demonstrates that the management of obese women in pregnancy currently in use at MDH does not follow all the RCOG recommendations. We suggest the need for local guidelines together with the use of patient information leaflets to help improve the care of women with obesity in pregnancy.

Screening and Management of Smoking in Pregnancy

Smoking in is harmful to both the mother and baby in pregnancy. Smoking cessation is strongly encouraged and needs to be approached in a sensitive manner employing patient centred care. Women should be provided with information about the risks of smoking and referred to smoking cessation services. Referral applies to smokers and ex-smokers who quit in the prior two weeks. Data was collected from smoker or ex-smoker post-natal mothers who delivered at Mater Dei Hospital and was analysed against NICE Public Health guideline (PH26) ‘Smoking: stopping in pregnancy and after childbirth’ published in 2010 and Green-top guideline no.31 ‘The Investigation and Management of the Small-for-Gestational-Age Fetus’ published in 2013. The audit included 50 post-natal smokers or ex-smokers with the majority being either smokers or ex-smokers who stopped as soon as they found out they were pregnant. There was not a single documented referral to smoking cessation services. Only 75% of smokers who smoke 11+ cigarettes daily had serial ultrasounds to monitor for SGA. Foetal outcomes were overall satisfactory with only 12% being admitted to NPICU, 10% of which belonged to mothers still smoking in pregnancy. It is essential that mothers understand the risks of smoking in pregnancy and these should be provided with the necessary information and assistance in smoking cessation. It is not enough to recommend smoking cessation but referrals and constant support should be offered.

Preventing healthcare-associated MRSA bacteremia: getting to the root of the problem.

Bloodstream infections caused by methicillin-resistant Staphylococcus aureus (MRSA) remain a major challenge in most countries worldwide. We describe a quasi-experimental sequential intervention at Mater Dei Hospital, Malta, to reduce hyper-prevalence of healthcare-associated MRSA bacteremia (HA-MRSA-B). The hospital initiated a hand hygiene (HH) campaign in 2008 to improve alcohol hand rub (AHR) use. In 2011, this was followed by root cause analysis (RCA) of all HA-MRSA-B cases and finally universal MRSA admission screening in 2014. Change-point analysis was used to evaluate the impact of the interventions. The effect of the HH campaign became evident when AHR consumption reached 40L/1000 occupied bed days (BD). RCAs identified intravascular devices as the likely risk factor in 83% of all HA-MRSA-B; specifically non-tunneled double-lumen hemodialysis catheters (36%), peripheral venous cannulas (25%), and central venous catheters (22%). Interventions to improve their management resulted in the greatest reduction of HA-MRSA-B rates. They were informed by the RCA findings and targeted behavior change through education, motivation, and system change. Universal MRSA admission screening provided the final decline in incidence. Each intervention affected HA-MRSA-B rates after a lag period of approximately 18-24 months. Overall, HA-MRSA-B incidence decreased from 1.72 cases/10000BD in 2008 to 0.18/10000BD in 2019; a reduction of almost 90%. Intravenous device interventions were also associated with a reduction of methicillin-sensitive Staphylococcus aureus (MSSA) bacteremia rates. Significant improvement in HA-MRSA-B is possible, even in highly endemic regions. It requires well-planned behavior change interventions which are compatible with local context and culture.

The Impact that the Necessary Changes due to COVID-19 had on the Motivation of Allied Health Professionals within a Public Hospital

The objective of this research focuses on the impact that the necessary changes due to the COVID-19 pandemic had on the motivation of a specific cohort of healthcare workers within a public hospital in Malta (Mater Dei Hospital). The changes introduced by the local public healthcare system, which were necessary to cope with the increased stress caused by the pandemic, were: staff relocations, changes in work practices, and changes in working hours. The study explored in depth the impact of these changes on allied health professionals (AHP) motivation, acknowledging the importance of the self-determination theory. During analysis, autonomy, relatedness, and competence were the three domains of motivations explored.The hypothesis focuses on the effect of the specified changes on these three domains of motivation. The study will therefore validate whether there was an impact, or not, on each of these motivational aspect of allied health professionals by the necessary changes due to the COVID-19 pandemic within a public hospital. The ultimate purpose is to discover relations and variableswhich are scientifically measuredbetween these implemented changes and affected motivation aspects. The aim is that healthcare management takes preventive measures in future pandemic recurrences to reduce negative impacts on motivation.

11.G. Round table: Resilient health systems: harnessing health information to improve population health

Abstract Health systems are built to improve the health of the population. When the COVID-19 crisis hit Europe, the sustained performance of these health systems was challenged. The resilience of these health systems, defined as the ability to absorb, adapt, and transform to cope with shocks (Observatory, 2021), was found to be different in the many European countries, leaving some important lessons to be learned and best practices to be showcased to help countries assess their own response to the COVID-19 pandemic and support efforts to strengthen health systems in Europe. A common denominator is health information; the data and information that is needed to monitor the health of patients as well as the general population. Especially in times of crisis, the availability and trustworthiness of these data is of utmost importance. The COVID-19 pandemic showed that within a substantial number of European countries, health information systems were not always equipped to accommodate the data and information flows that were needed in order for researchers to provide the best available evidence to underpin health policy decisions. Ad-hoc surveillance and monitoring systems were set up (under emergency legislation) and clear governance of health information was lacking. In addition, sharing data and information across European borders and ensuring comparability of data and indicators proved to be difficult in a timely manner during the COVID-19 crisis. This resulted in a European landscape with different national and federal health policies, based on sometimes poor scientific findings. However, when the crisis progressed, numerous national and international initiatives were set up aiming to harmonize the available health information and as of now, many of these initiatives are forming a solid foundation of the health systems, rendering their performance sustainable for the future. In this workshop, which is organized as a round table discussion, we will discuss the resilience of health information systems in European countries, with regards to lessons learned from the COVID-19 crisis, barriers to sharing health information within and across borders, best practices and future perspectives. The topic will be highlighted from multiple perspectives, bringing together experts from different backgrounds, including the European level (European Commission and European Observatory on Health Systems and Policies), the country level, and the perspective of European projects. The audience will be able to provide their view on the different topics through an interactive voting poll during the session. Throughout the session, the exchange of knowledge, experiences and opinions with the audience will be facilitated by the chairs. Key messages • Population health information plays a key role in times of crisis, with trustworthy information flows facilitating evidence-informed policies and decision-making. • Sharing and harmonising health information is key to building resilient healthcare systems that are prepared for the future. Speakers/Panellists Ebba Barany European Commission, Luxembourg, Luxembourg Cianrán Nicholl European Commission, JRC, Ispra, Italy Kenneth Grech Public Health Medicine, Mater Dei Hospital, L-Imsida, Malta Miriam Saso Sciensano, Brussels, Belgium Anna Sagan European Observatory on Health Systems and Policies, London, UK

Gestational Trophoblastic Disease in Malta

Background: Gestational trophoblastic disease (GTD) is a group of uncommon conditions associated with pregnancy and includes a spectrum of premalignant to malignant disorders. The aim of this study is to determine the local incidence of GTD and to analyses the management that is being offered to patients with GTD in Mater Dei Hospital. Methodology: All patients diagnosed with GTD from 1st January 2015 till 31st December 2020 were studied. The list of patients with GTD was obtained from the Pathology Department and data was collected from medical records, iSOFT and electronic discharge summaries. Results: In this 6-year study period, 83 cases of GTD were identified. 79.5% of patients had partial hydatidiform mole and 16.9% had complete mole. 3.6% were cases of gestational trophoblastic neoplasia. 55.4% of patients received medical treatment with vaginal misoprostol and 27.7% had immediately surgical management. Their follow-up was studied; 21.7% had 3 out-patients visits or less, 33.7% had between 4 to 6 visits and 19.3% had 7 to 15 outpatients visits. 7.2% had extra oncology out-patients visits. 40% of patients had a follow-up that lasted for 7 months or more. Conclusion: GTD in Mater Dei Hospital appears to be an uncommon disease, but the local incidence was noted to be as high as 1 per 319 living births. This study demonstrated that a large number of patients were medically treated and the follow-up received was noted to be inconsistent. The care of these patients can be highly optimized by the set-up of a small dedicated clinic

The Impact of the COVID-19 Pandemic on Injury Patterns in Inpatient and Outpatient Orthopaedic Trauma.

The effect of banning of nonessential services during the novel coronavirus disease 2019 (COVID-19) pandemic led to a perceived change in the volume of trauma cases and injury patterns. Literature indicates trends toward less trauma overall, with a decrease in outdoor, sporting, and motor vehicle injuries. However, studies focusing on outpatient orthopaedic trauma are less common. The main aim of this study was to assess the effect of COVID-19 pandemic on differences in inpatient and outpatient injury patterns and mechanisms. Patients requiring orthopaedic inpatient admission to Mater Dei Hospital, Malta, were analyzed between March 15 and June 17 between 2019 and 2021. For outpatients, all newly referred patients seen at the fresh trauma clinic (FTC) on the first 5 clinic days of each month from April to June between 2019 and 2021 were assessed. There were a total of 503, 362, and 603 hospital admissions during the data collection period from 2019, 2020 and 2021, respectively. There was a decrease in elbow ( p = 0.015) and pelvis ( p = 0.038) pathology since COVID-19 pandemic. In contrast, there was an increase in shoulder injuries ( p = 0.036) and lacerated wounds ( p = 0.012) in 2021. The most frequent mechanisms of injury for inpatients were low impact falls, and fall from heights greater than 1 m. Machine-related injuries ( p = 0.002), blunt trauma ( p = 0.004), and twisting injuries ( p = 0.029) increased in 2021. In the outpatient setting, there were a total of 367, 232, and 299 new referrals in 2019, 2020, and 2021, respectively. Injury patterns in this cohort were similar throughout, except for a significant increase in shoulder injuries during 2020 ( p = 0.009). There appears to be some minor variation in injury mechanisms due to lifestyle changes; however, most injury patterns have remained fairly constant. Further research should focus on the use of public awareness campaigns to decrease home-related trauma during enforced periods of lockdown.

Selective Serotonin Reuptake Inhibitors for Stroke Recovery

HomeStrokeVol. 53, No. 9Selective Serotonin Reuptake Inhibitors for Stroke Recovery No AccessArticle CommentaryRequest AccessFull TextAboutView Full TextView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toNo AccessArticle CommentaryRequest AccessFull TextSelective Serotonin Reuptake Inhibitors for Stroke Recovery Xing Hua, MBBS, Simiao Wu, PhD, Lynn A. Legg, PhD, Ann-Sofie Rudberg, PhD, Maree L. Hackett, PhD, Russel Tilney, PhD, Linnea Lindgren, MSc, Mansur A. Kutlubaev, PhD, Cheng-Fang Hsieh, MD, Amanda J. Barugh, PhD, Graeme J. Hankey, MD, Erik Lundström, PhD, Martin Dennis, MD and Gillian E. Mead, PhD Xing HuaXing Hua https://orcid.org/0000-0003-0204-8289 Department of Neurology, West China Hospital, Sichuan University, Chengdu, China (X.H., S.W.). Search for more papers by this author , Simiao WuSimiao Wu https://orcid.org/0000-0002-4557-7386 Department of Neurology, West China Hospital, Sichuan University, Chengdu, China (X.H., S.W.). Search for more papers by this author , Lynn A. LeggLynn A. Legg https://orcid.org/0000-0003-0625-5971 NHS Greater Glasgow and Clyde Health Board, Paisley, United Kingdom (L.A.L.). Search for more papers by this author , Ann-Sofie RudbergAnn-Sofie Rudberg https://orcid.org/0000-0003-3616-9943 Division of Neurology, Department of Clinical Sciences, Karolinska Institutet Danderyd Hospital, Stockholm, Sweden (A.-S.R.). Search for more papers by this author , Maree L. HackettMaree L. Hackett https://orcid.org/0000-0003-1211-9087 Mental Health, The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia (M.L.H.). Search for more papers by this author , Russel TilneyRussel Tilney Department of Medicine, Mater Dei Hospital, Msida, Malta (R.T.). Search for more papers by this author , Linnea LindgrenLinnea Lindgren https://orcid.org/0000-0002-9379-7965 Department of Medical Sciences, Neurology, Uppsala University, Sweden (L.L., E.L.). Search for more papers by this author , Mansur A. KutlubaevMansur A. Kutlubaev https://orcid.org/0000-0003-1001-2024 Department of Neurology, Bashkir State Medical University, Ufa, Russian Federation (M.A.K.). Search for more papers by this author , Cheng-Fang HsiehCheng-Fang Hsieh https://orcid.org/0000-0002-9101-0233 Division of Geriatrics and Gerontology, Departments of Internal Medicine and Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Taiwan (C.-F.H.). Search for more papers by this author , Amanda J. BarughAmanda J. Barugh Department of Geriatric Medicine (A.J.B.), University of Edinburgh, United Kingdom. Search for more papers by this author , Graeme J. HankeyGraeme J. Hankey https://orcid.org/0000-0002-6044-7328 Medical School, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Australia (G.J.H.). Search for more papers by this author , Erik LundströmErik Lundström https://orcid.org/0000-0002-5313-9052 Department of Medical Sciences, Neurology, Uppsala University, Sweden (L.L., E.L.). Search for more papers by this author , Martin DennisMartin Dennis https://orcid.org/0000-0003-1148-8972 Centre for Clinical Brain Sciences (M.D., G.E.M.), University of Edinburgh, United Kingdom. Search for more papers by this author and Gillian E. MeadGillian E. Mead Correspondence to: Gillian E. Mead, PhD, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom. Email E-mail Address: [email protected] https://orcid.org/0000-0001-7494-2023 Centre for Clinical Brain Sciences (M.D., G.E.M.), University of Edinburgh, United Kingdom. Search for more papers by this author Originally published22 Aug 2022https://doi.org/10.1161/STROKEAHA.121.038149Stroke. 2022;53:e426–e428FootnotesFor Sources of Funding and Disclosures, see page e427–e428.Correspondence to: Gillian E. Mead, PhD, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom. Email gillian.e.[email protected]ac.ukReference1. Legg LA, Rudberg A-S, Hua X, Wu S, Hackett ML, Tilney R, Lindgren L, Kutlubaev MA, Hsieh C-F, Barugh AJ, et al. Selective serotonin reuptake inhibitors (SSRIs) for stroke recovery.Cochrane Database Syst Rev. 2021;11:CD009286. doi: 10.1002/14651858.CD009286.pub4Google Scholar Previous Back to top Next FiguresReferencesRelatedDetails September 2022Vol 53, Issue 9 Advertisement Article InformationMetrics © 2022 American Heart Association, Inc.https://doi.org/10.1161/STROKEAHA.121.038149 Originally publishedAugust 22, 2022 Keywordsrecovery of functionstrokemeta-analysisserotonin uptake inhibitorsdepressionPDF download Advertisement SubjectsCerebrovascular Disease/Stroke