Vasovagal reactions in ultrasound guided musculoskeletal injections: A study of 2,462 procedures

OBJECTIVE

to determine the rate of the vasovagal reaction (VVR) in ultrasound guided musculoskeletal injections (USGIs) and to investigate effect of injection site, age, and gender on this rate.

MATERIAL AND METHODS

Retrospective analysis of all USGIs performed from the 1st of January 2019 to the 31st of December 2019 in single tertiary orthopaedic hospital. Two thousand four hundred and sixty two consecutive subjects undergoing USGIs were included. Statistical analysis used to determine the rate of the overall VVR in USGIs and to determine if site of the injection or joint injected has an effect on this rate as well as age and gender effect.

RESULTS

Overall rate of VVR was 2.3% with shoulder and small joints of the hands and feet are more commonly affected than other sites. Females and patients aged younger than 65 years may be subjected to higher rate of VVR.

CONCLUSIONS

VVR has an overall low occurrence in USGI. The higher rate of VVR for shoulder and small joints of hands and feet procedures. Care should be taken when positioning a patient prior to the procedure to allow for a VVR in case it happens. VVR are more likely to occur in females and less likely in age more than 65 years.

35 Enhanced Service Through An Integrated New Model of Care in A Buckinghamshire Care Home

Introduction

Care home residents often have multiple, chronic conditions and are receiving complex treatment regimes. Polypharmacy and medication errors are common. The frequency and quality of medication reviews is variable with limited general practice (GP) capacity to carry out comprehensive reviews.

The initiative used a care home pharmacist, technician, geriatrician and GPs to tackle these issues on an individual and care home level. The objective being to ensure the safe and effective use of medicines for all care home residents. NICE guideline [NG56] recommends reducing pharmacological treatment burden for adults with multimorbidity at risk of adverse drug events such as unplanned hospital admissions. A study by Dilles et al1 found adverse drug reactions in 60% of residents.

Methods

A new interdisciplinary model of care was delivered in a 120 bedded Buckinghamshire care home. Clinical Commissioning Group pharmacist, general practitioners and pharmacy technician reviewed medication for all residents. The most complex individuals were reviewed by the geriatrician and if needed by other multidisciplinary team members specialist.

Results

Overall 115 medications were stopped for 109 residents, with 31 interventions to reduce falls risk and 19 interventions on medication at high risk2 of causing admission. Total cost savings on medicines optimisation, medicines waste and non-elective admission prevented was £35,211. Residents’ care plans were updated to reflect best practice standards.

Conclusions

Future direction of this project focuses on system wide improvements to promote interdisciplinary healthcare professionals work in care homes. The success of this integrated model of care has enabled recurrent funding of pharmacist by the local county council and an additional 42 geriatrician sessions into Buckinghamshire care homes.

References

1. Dilles T, Vander Stichele R, Van Bortel L, Elseviers M. Journal of American Medical Directors Association 2013; 14: 371–6.

2. Pirmohamed M, et al. Br Med J 2004; 329: 15–9 61.

A flexible pressure sensitive colour changing device using plasmonic nanoparticles

We report on the fabrication of a flexible pressure sensitive device based on near-field coupling between silver nanoparticles and an underlying conductor. Visually apparent colour changes can be realized with minimal change in separation owing to the high fields localized to the particle's surface. The use of soft and compliant materials enables actuation of the device at low strain.

Continuous electrocardiographic recording during exercise in young male diabetics. A computer study

Forty selected young patients with diabetes of medium to long duration and 26 control subjects without clinical evidence of ischaemic heart disease were studied using a new and sensitive technique of electrocardiographic recording during exercise with continuous computation of the time course of the ST-T segment changes to detect possible early ST depression indicative of ischaemia. Although no such evidence was found, significant differences in the diabetics were observed in the heart rate and ST-T segment, the latter changes having not been previously reported but which may be attributed to ischaemia or alternatively to autonomic neuropathy in the "presymptomatic" phase.