Yim, Annie P. Y. MPhil; YEUNG, Hiu-Yan PhD; HUNG, Vivian W. Y. MPhil; LEE, Kwong-Man PhD; LAM, Tsz-Ping FRCS; NG, Bobby K. W. FRCS; QIU, Yong MD; CHENG, Jack C. Y. MD
Abstract
Study Design. A cross-sectional and prospective longitudinal study on the anthropometric parameters and growth pattern of adolescent idiopathic scoliosis (AIS) girls.
Objective. To investigate the growth pattern of AIS girls with different severities using cross-sectional and prospective longitudinal data set in comparison with age-matched healthy controls.
Summary of Background Data. AIS occurs in children during their pubertal growth spurt. Although there is no clear consensus on the difference in body height between AIS girls and healthy controls, it is generally believed that the development and curve progression in AIS girls is closely associated with their growth rate. There is no concrete prospective longitudinal study to document clearly the growth pattern and growth rate of AIS subjects.
Methods. 611 AIS girls and 296 healthy age-matched controls were included in the study and among them, 194 AIS girls and 116 healthy controls were followed up until skeletal maturity. The AIS girls were grouped into moderate (AIS20) and severe curve (AIS40) groups based on maximum curve magnitude at skeletal maturity. Clinical data and detailed anthropometric parameters were recorded. In the cross-sectional analysis, the groups of subjects were compared within different age groups (from age 12 to 16). In the longitudinal study, linear mixed modeling with respect to age or years since menarche was employed to formulate the growth trajectory of different anthropometric parameters.
Results. In the cross-sectional analysis, the AIS girls were generally taller, with longer arm span, and lower BMI than the healthy controls. The AIS40 girls were found to be significantly shorter in height (p = 0.006) and arm span (p = 0.025) at age 12 but caught up and overtook the control group at age 14 to 16. In the longitudinal study, the average growth rate of arm span in AIS40 girls were significantly higher than AIS20 girls (>30%) (p = 0.004) and controls (>70%) (p = 0.0004). The age of menarche of AIS40 girls was significantly delayed by 5.9 months and 3.8 months when compared with the control group and AIS20 girls respectively (p<0.05).
Conclusion. The growth patterns of AIS girls with confirmed curve severities were significantly different from healthy age-matched controls. Severe AIS girls had delayed menarche with faster skeletal growth rate during age 12-16. Monitoring the rate of change of arm span of AIS girls could be an important additional clinical parameter in helping to predict curve severity in AIS girls.
http://journals.lww.com/spinejournal/Abstract/publishahead/Abnormal_Skeletal_Growth_Patterns_in_Adolescent.98282.aspx
The British Association of Prosthetists and Orthotists (BAPO) was established to encourage high standards of prosthetic and orthotic practice. It is committed to Continued Professional Development and education to enhance standards of prosthetic and orthotic care. BAPO is the only UK body that represents the interests of prosthetic and orthotic professionals and associate members to their employers, BAPO enjoys the support of a high majority of the profession as members.
Sunday 29 July 2012
Saturday 28 July 2012
NHS strategic clinical networks
The NHS Commissioning Board Authority has set out its plans for a small number of national networks to improve health services for specific patient groups or conditions.
Called strategic clinical networks these organisations will build on the success of network activity in the NHS which, over the last 10 years, has led to significant improvements in the delivery of patient care.
The conditions or patient groups chosen for the first strategic clinical networks are:
Cancer
Cardiovascular disease (including cardiac, stroke, diabetes and renal disease) Maternity and children's services
Mental health, dementia and neurological conditions
These networks will exist for up to five years and will be managed by 12 locally based support teams. These teams will build and oversee effective network arrangements for their area and help networks develop an annual programme of quality improvement in local services. The support teams, funded by the NHS CB, will be located in local area teams' offices.
Read full details of the new strategic clinical networks in the document called The Way Forward, along with answers to frequently asked questions. You can find these published documents on the NHS Commissioning Board Authority website.
Tuesday 24 July 2012
Improved NHS Services Through New Perspectives – A Toolkit
Improved NHS Services Through New Perspectives – a toolkit for Doctors and Managers to improve quality for patients
Where doctors are engaged in management, quality improves for patients. Moreover, it is the partnership between doctors and managers that makes the difference – where they have a productive working relationship. The Centre for Innovation in Health Management (CIHM) at Leeds University Business School has devised an online toolkit to help implement positive change in NHS Trusts.
The toolkit is laid out in a simple, well thought out manner utilising a workshop sessions guide. It offers a way of improving productive working between doctors and managers in a series of steps that requires conversations between all parties and identifies any development required. There are a series of questions for people to answer in the Trust. The process of answering the questions will develop a better shared agenda, a better understanding of how to work together and a better working relationship between doctors and managers.
The National Inquiry into Management and Medicine, conducted by CIHM, found that doctors and managers work best together when the following conditions exist:
A clear focus on the clinical businessspace is created for local innovation by managing upwards decisions are devolved to the right levelthere is continuity over time complacency is avoided by seeking internal and external challengeinterests are aligned through rewards, information, and performance management.doctors and managers make sense of the external environment together there is frequent dialogue to build a shared purposedifferences are seen as an asset – conflict is used positively managers and doctors understand each otherthere is investment in organisational change, doctors and managers learn together, and locally relevant performance management systems are developed.
The Toolkit is free to use and is available once you have registered. Your registration gives you access to more detailed information on each stage of the process and also enables us to provide you with additional support should you require it.
To find out more about how this could work for you and your Trust please follow www.cihm.leeds.ac.uk/drmgrtoolkit
For a copy of the National Inquiry into Management and Medicine please visit: http://www.cihm.leeds.ac.uk/document_downloads/CIHM_NIMM_short_report.pdf
Monday 23 July 2012
FallSafe project
The FallSafe project involved educating, inspiring and supporting acute, rehabilitation and mental health nurses to deliver multifactorial assessments and interventions through a care bundle approach. The care bundle, the FallSafe project final report, and How to… guides for implementation comprise the Falls Prevention Resource pack.
Access the Falls Prevention Resource.
Over 280,000 patient falls are reported from hospitals and mental health units annually, costing approximately £15 million per annum. Most hospital fallers are aged over 75 years and have multiple long term and acute illnesses. Although in purely financial terms the healthcare costs of falls are only a small fraction of a percentage of trust income and expenditure, the costs to a trusts' reputation, patient and carer confidence, and social care costs can be significant.
The FallSafe project was delivered by the Royal College of Physicians (RCP) as part of the Health Foundation's Closing the Gap Programme, which aimed to reduce the gap between best practice and routine delivery of care. Although all falls cannot be prevented without unacceptable restrictions to patients' independence, dignity and privacy, research has shown that falls can be reduced by 20-30% through multifactorial assessments and interventions.
The main mechanism of improvement was supporting a designated nurse – a FallSafe lead - to lead local improvement on their own wards, influencing not only the ward nurses and healthcare support workers but also their physiotherapist, occupational therapist, pharmacist, and medical colleagues.
Dr Frances Healey, a registered nurse who was clinical co-lead of the fallsafe project, and associate director, RCP's Clinical Effectiveness and Evaluation Unit, said:
'The FallSafe project is a great illustration of how quality improvement can empower and inspire nurses to lead and drive change on their wards, influence a multidisciplinary team, and deliver better patient care.
'The 16 nurses, who rose to the challenge of FallSafe lead within their wards, demonstrated that they can be effective change agents. This is an important finding given more senior staff may not have the capacity to lead quality improvements in the areas where it is needed. The FallSafe leads grew in confidence, knowledge and skills and, by the end of the project, felt that attitudes to falls prevention on their wards had been 'transformed' from passive acceptance to active engagement in falls prevention.'
Dr Adam Darowski, consultant geriatrician, and clinical co-lead for FallSafe said:
'Avoiding medication that can increase the risk of falling is a vital part of falls prevention. FallSafe proved how much nursing staff can influence doctors' prescribing practice – the FallSafe leads provided educational materials to the doctors on their wards, requested medication reviews for hundreds of patients, and by the end of the project the number of patients being given night sedation had reduced by 41%.'
Jill Phipps, clinical specialist physiotherapist & falls prevention coordinator at Southern Health NHS Foundation Trust said:
'Many hospitals don't have a process for issuing mobility aids to new patients except on weekdays when physiotherapists are on duty; but by the end of the project most of the FallSafe wards had arranged for mobility aids to be provided by trained nursing staff on a temporary basis as soon as they were needed. This was a great example of how nurses and physiotherapists can work together on sharing skills and experience to improve patient's mobility and reduce the risk of falls.'
The report indicates FallSafe wards and their hospitals have benefited through substantial improvements in the proportion of patients receiving multifactorial assessments, changes to policy, attitude to and awareness of falls, and better team working. FallSafe delivered a 25% reduction in falls for the South Central area and it is anticipated there will be further reductions as the project is rolled out to other hospitals. The costs of delivering the FallSafe project were kept low enough for its replication on a wide scale to be feasible, and the mix of ward types involved demonstrate that it could be replicated in most hospital settings.
Access the Falls Prevention Resource.
FallSafe
FallSafe is a two year multidisciplinary quality improvement project funded by The Health Foundation's Closing the Gap Programme. It has been delivered by the Royal College of Physicians' (RCP) Clinical Effectiveness and Evaluation Unit and was overseen by a stakeholder steering group including the Royal College of Nursing, the National Patient Safety Agency and Action against Medical Accidents.
FallSafe is promoted by 'Harm free' care, the national roll out of the pilot Safety Express Quality, Innovation, Productivity and Prevention (QIPP) programme implemented by the national QIPP Safe Care work stream.
A care bundle is a structured way of improving of care. It a specific measureable set of multifactorial assessments and interventions.
Multifactorial assessment
Multifactorial assessment refers to a process of assessing patients for a range of risk factors that can lead to falls, such as impaired mobility, cognitive impairment, medication with sedating effects, cardiovascular problems, etc. Interventions are changes made to care or treatment that can modify the risk factor or manage it in such a way as to reduce the risk of it leading to falls.
Access the Falls Prevention Resource.
Sunday 22 July 2012
Friday 20 July 2012
Project Manager - Prosthetics & Orthotics Workforce and Education Project
The Department of Health is looking to recruit a Project manager for their Prosthetics and Orthotics Workforce and Education Project. This position will be key in working with key stakeholders and delivering a workforce and education strategy for Prosthetics and Orthotics to meet current and future service priorities. This job position has been advertised across the AHPs. As our professions are very specialised, BAPO would prefer that a person with significant knowledge of our services is selected for this role. The person specification is attached.
Further information and application can be be made here.
Thursday 19 July 2012
Superhuman: are we the greatest design project of the century?
Should medical aids discretely simulate normality – perhaps for society's comfort rather than the wearer's – or should they accentuate difference and express the wearer's identity? For Mullins, the discussion is no longer about compensating for a deficiency, but about augmenting the body. The same might be true of theSouth African Paralympian sprinter Oscar Pistorius. His carbon-fibre Cheetah running blades have made him such a threat that he was initially banned from competing against full-bodied athletes in the Beijing Olympics – he was allowed to compete in London, though, and has qualified for the 400m relay.
Improving life … i-Limb ultra prosthetic hand. Photograph: Wellcome Images/Wellcome LibraryIf being human means being defined by our limits as much as by our abilities, we are reaching the stage where prosthetics and technological gizmos will challenge what we think should be possible. Professor Kevin Warwick tested that boundary when he implanted an RFID transmitter – basically a microchip that could switch on lights and open doors – into his body and called himself the first cyborg. Yet some would argue that anyone who carries a smartphone is effectively using a prosthesis – a pocket backup brain, an iLimb (there is actually something called an i-Limb in the show but it's a bionic hand, not a PDA). Presumably, when such technologies become more invasive we'll have reached what futurists call "the singularity", or the dissolving of the distinction between human and machine.
What the Superhuman exhibition does well is demonstrate how design and technology challenge our ethics and our attitudes to the body. But it's also one of those shows where the objects are merely illustrations of the issues, and the issues become broad indeed. In one of the video displays, the bioethicist Julian Savulescu argues that humans don't just need physical enhancement but moral supports too. He argues that the reason we can't rally together and tackle climate change – the biggest threat to the survival of the species – is that we evolved to look after our own tribes of about 150 people. Instead of sugar water, what we need is altruism in a can.
Source: http://gu.com/p/3948a
Wednesday 18 July 2012
Never Again? The story of the Health and Social Care Act 2012
Never Again? The story of the Health and Social Care Act 2012 explains why and how the Act became law; from the legislation's origins 20 years ago, through the development of the 2010 White Paper Liberating the NHS to the passage of the controversial Bill through both Houses of Parliament.
The book, published jointly by the Institute for Government and The King's Fund, focuses on what Andrew Lansley, Secretary of State for Health, is trying to achieve through the NHS reforms and considers the role the Liberal Democrats played in introducing amendments to the legislation and passing the Bill.
Written by ex-Financial Times public policy editor Nicholas Timmins, the book discusses:
- the fact that details of the NHS reforms remained unclear before the May 2010 election
- how 'the pause' to the legislation came about
- the appointment of Sir David Nicholson as chief executive designate of the NHS Commissioning Board
- Andy Burnham, Shadow Health Secretary, reviving opposition to the Bill
- how the coalition government helped the passage of the legislation through the House of Lords.
Never Again? draws some early lessons from the process of legislation and change surrounding the reforms and explains why the Secretary of State for Health believes that the NHS will 'never again' need to undergo such a huge structural change. It also raises the possibility that Andrew Lansley could emerge as a hero of public sector reform.
source: http://www.kingsfund.org.uk/publications/never_again.html
Tuesday 17 July 2012
Saturday 14 July 2012
A new risk classification rule for curve progression in adolescent idiopathic scoliosis
C.F. Lee, Daniel Y.T. Fong, Kenneth M.C. Cheung, Jack C.Y. Cheng, Bobby K.W. Ng, T.P. Lam, Paul S.F. Yip, Keith D.K. Luk,A new risk classification rule for curve progression in adolescent idiopathic scoliosis, The Spine Journal, Available online 21 June 2012, ISSN 1529-9430, 10.1016/j.spinee.2012.05.009. (http://www.sciencedirect.com/science/article/pii/S1529943012003300)Abstract: Background context Prognostic factors for curve progression of adolescent idiopathic scoliosis (AIS) have been reported previously. There is only one existing rule that classifies AIS patients into two groups by a curvature of 25°.Purpose This study aimed to develop a more refined risk classification rule for AIS. Study design This was a retrospective cohort study. Patient sample We examined 2,308 untreated AIS patients, aged 10 years and older, who had a Risser sign of 2 and lesser and a curvature less than 30° at presentation. Outcome measures Outcome was taken as the time to progression to 30°.Methods Patients' clinical parameters were analyzed by Classification and Regression Tree analysis.Results The new classification rule identified four risk groups of curve progression. Patients with a curvature of 26° and more and less than 18° constituted the highest and lowest risk groups, respectively. The two intermediate groups were identified by the age (11.3 years), menarcheal status, and body height (154 cm).Conclusions The risk classification rule only uses information at the first presentation and can aid physicians in deriving an efficient management. Keywords: Adolescent idiopathic scoliosis; Classification and regression tree; Classification rule; Curve progression; Prognostic factors
Friday 13 July 2012
Characteristics of foot structure and footwear associated with hallux valgus: a systematic review
S.E. Nix, B.T. Vicenzino, N.J. Collins, M.D. Smith
Abstract
Objective
Factors associated with the development of hallux valgus (HV) are multifactorial and remain unclear. The objective of this systematic review and meta-analysis was to investigate characteristics of foot structure and footwear associated with HV.
Design
Electronic databases (Medline, Embase, and CINAHL) were searched to December 2010. Cross-sectional studies with a valid definition of HV and a non-HV comparison group were included. Two independent investigators quality rated all included papers. Effect sizes and 95% confidence intervals (CI) were calculated (standardized mean differences (SMD) for continuous data and risk ratios (RR) for dichotomous data). Where studies were homogeneous, pooling of SMDs was conducted using random effects models.
Results
A total of 37 papers (34 unique studies) were quality rated. After exclusion of studies without reported measurement reliability for associated factors, data were extracted and analysed from 16 studies reporting results for 45 different factors. Significant factors included: greater first intermetatarsal angle (pooled SMD = 1.5, CI: 0.88 to 2.1), longer first metatarsal (pooled SMD = 1.0, CI: 0.48 to 1.6), round first metatarsal head (RR: 3.1 to 5.4), and lateral sesamoid displacement (RR: 5.1 to 5.5). Results for clinical factors (e.g. first ray mobility, pes planus, footwear) were less conclusive regarding their association with HV.
Conclusions
Although conclusions regarding causality cannot be made from cross-sectional studies, this systematic review highlights important factors to monitor in HV assessment and management. Further studies with rigorous methodology are warranted to investigate clinical factors associated with HV.
Full text can be found here: http://www.sciencedirect.com/science/article/pii/S106345841200862X?v=s5
Thursday 12 July 2012
BAPOmag 2012 Issue 2 now available
Please log in to find the latest edition of the BAPOmag that is available to download from the Downloads section at www.bapo.com
Wednesday 11 July 2012
Funding via SHAs for organisation to offer research internships for AHP clinical staff
The Department of Health has agreed to fund an intern programme to widen access to research awareness and capability for AHPs, nurses and midwives.
Final details are not yet available yet but we have some provisional information which should be useful to anyone who may be able to offer one or more intern placements in their organisation.
The need for an intern programme was identified in the recently published strategy ' Developing the role of the Clinical Academic Researcher in Nursing, Midwifery and AHPs' http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_133094.pdf
The purpose of the scheme is to help clinical staff understand what is involved in a research career and gain research experience prior to undertaking MRes study. The intern placement should be part time for 4 – 6 months, for example, it could be involvement with data collection for a research study for one day a week and should provide mentorship support.
Potential applicants for internships will be graduates with limited research experience. Individuals who already have an MRes would not be eligible but those with an MSc may be eligible depending on how much research experience they have.
The DH are transferring the funding to the SHA clusters to distribute. They are currently discussing final details of the scheme and how it will operate but it is likely that each SHA will have some flexibility to use the funding in ways that suit them locally.
There will be £10K per internship which will go to the organisation offering the scheme not the individual interns but the money should be used to support individuals (salary etc).
There will be 150 internships throughout England.
The funding has been agreed at very short notice and has to be allocated and utilised (internships completed) before March 2013.
'Caring for our future: reforming care and support’ White Paper Published
The Department has published the 'Caring for our future: reforming care and support' White Paper, which sets out the vision for a reformed care and support system. The new system will:
focus on people's wellbeing and support them to stay independent for as long as possible
introduce greater national consistency in access to care and support
provide better information to help people make choices about their care
give people more control over their care
improve support for carers
improve the quality of care and support
improve integration of different services
You can find out more about the White Paper and the draft Care and Support Bill on the Caring for our future site.
Further Documents relating to this reform can be found here: http://www.dh.gov.uk/health/2012/07/careandsupportwhitepaper/
Government announces care and support reforms
The government has announced the biggest reform of the care and support system since 1948. The White Paper, 'Caring for our future: reforming care and support' and the draft Care and Support Bill, also published today, set out how the social care system will be transformed from a service that reacts to crises to one that focuses on prevention and is built around the needs and goals of people.
Key elements of the government's plans include:
People will be confident about the quality of care.
People will be treated with dignity and respect.
Everyone will know what they are entitled to.
Everyone will have control over their care.
Carers will have new rights to public support.
Secretary of State for Health Andrew Lansley said:
"Too often people who need care don't know who or where to go to, don't know what care they will get and don't know how it will be paid for. Our plans will bring the most comprehensive overhaul of social care since 1948 and will mean that people get the care and support that they need to be safe and to live well so they don't reach a crisis point."
The government has also published a progress report on social care funding. The report sets out that government agrees the principles of the Dilnot Commission's model – financial protection through capped costs and an extended means test – would be the right basis for any new funding model.
Find out more about the:
A small integrated lateral wedge does not alter knee joint does not alter knee joint moments during walking moments during walking
Claudiane Fukuchi, Jay Worobets , John William Wannop Wannop & Darren Stefanyshyn et al
Footwear Science
ABSTRACT
Knee osteoarthritis (OA) is one of the most Knee osteoarthritis (OA) is one of the most common degenerative disorders. Recently, it common degenerative disorders. Recently, it has been proposed that lateral wedged has been proposed that lateral wedged footwear could play a preventative role by footwear could play a preventative role by reducing the frontal plane knee joint moments reducing the frontal plane knee joint moments during walking. However, these interventions during walking. However, these interventions can be uncomfortable, so it is important to can be uncomfortable, so it is important to determine whether minimal wedging can still determine whether minimal wedging can still have a positive influence. The aim of this study have a positive influence. The aim of this study was to test the influence of a 2° full-length was to test the influence of a 2° full-length lateral wedge on frontal plane knee joint lateral wedge on frontal plane knee joint internal moments during walking. It was internal moments during walking. It was hypothesized that the lateral wedge would shift hypothesized that the lateral wedge would shift the centre of pressure (COP) laterally and the centre of pressure (COP) laterally and decrease the knee abduction moment. Joint decrease the knee abduction moment. Joint kinematics, joint kinetics and the COP kinematics, joint kinetics and the COP trajectory of 15 healthy subjects (seven males trajectory of 15 healthy subjects (seven males and eight females) were obtained when the and eight females) were obtained when the
subjects walked at 1.4 m s subjects walked at 1.4 m s −1 −1 with a Control with a Control shoe and a Lateral Wedge shoe (2° wedge). shoe and a Lateral Wedge shoe (2° wedge). The results of this study showed no difference The results of this study showed no difference between the Lateral Wedge and the Control between the Lateral Wedge and the Control shoe condition in the internal peak knee shoe condition in the internal peak knee abduction moment and the position of the abduction moment and the position of the COP. This suggests that a 2° wedge is not COP. This suggests that a 2° wedge is not sufficient to influence the position of the COP sufficient to influence the position of the COP nor to decrease the internal knee abduction nor to decrease the internal knee abduction moment.
http://www.tandfonline.com/doi/abs/10.1080/19424280.2012.683044
Tuesday 10 July 2012
The Allied Health Professional’s Continuing Personal and Professional Development (CPPD) Toolkit
As a set of professions we have many common functions that need to be supported through development. This document illustrates how CPPD processes may be maximised to enhance
clinical delivery.
This piece of work comes out of a project undertaken by NHS London that investigated how AHPs interact with the CPPD mechanisms available. Often it was reported that AHPs did not
make the most of flexibilities or felt held back from participating. A toolkit has been designed to ensure that clinicians and managers are enabled to make best use
of the opportunities presented to them. There is great benefit to be gained in working directly with education providers and in collaborating with colleagues to increase the quality and range
of educational experiences that AHPs can use.
Monday 9 July 2012
A Cohort-Controlled Trial of Customized Foot Orthotics in Trochanteric Bursitis
JPO Journal of Prosthetics & Orthotics:
July 2012 - Volume 24 - Issue 3 - p 107–110
doi: 10.1097/JPO.0b013e3182627659
Original Research Article
A Cohort-Controlled Trial of Customized Foot Orthotics in Trochanteric Bursitis
Ferrari, Robert MD, MSc (Med) FRCPC, FACP
ABSTRACT: Customized foot orthotics are widely prescribed for patients with lower limb pain from a variety of disorders, but there are few trials demonstrating effectiveness and none for trochanteric bursitis. Sixty-eight consecutive patients presenting with symptoms and findings compatible with a case definition for acute or subacute trochanteric bursitis (pain <3 months, point tenderness along the femoral greater trochanter, and pain on resisted hip abduction) were included in the study. A total of 34 subjects were prescribed a local corticosteroid injection under fluoroscopic guidance (control group), and 34 subjects were prescribed a local corticosteroid injection with the addition of customized foot orthotics (orthotics group). All subjects completed the Oswestry Disability Index at baseline, and the number of subjects using prescribed analgesics for their hip pain was recorded at baseline and at follow-ups of 8 weeks and 4 months. Subjects were asked at each follow-up if they felt they had recovered from their "hip and thigh region pain," with recovery arbitrarily being defined as having pain or symptoms in this region for 1 day per week or less. All subjects who failed to report recovery at 8 weeks underwent a repeat corticosteroid injection. A total of 32 subjects in each group completed the study at 8 weeks, and 30 subjects in each group completed the 4-month follow-up. The 2 groups were well matched in terms of age, sex distribution, duration of pain, unilateral or bilateral nature of bursal involvement, and baseline Oswestry Disability Index score. At 8 weeks, 50% reported recovery in the control group and 75% reported recovery in the orthotics group. The number of subjects who reported recovery at 4 months, however, was markedly different between groups, with only 40% reporting recovery in the control group and 90% reporting recovery in the orthotics group. The control group thus reported a high rate of recurrence of trochanteric bursitis. In a cohort-controlled trial of primary care patients with acute or subacute trochanteric bursitis, the addition of custom-made foot orthotics to local corticosteroid injection appears to improve the short- and long-term outcome, with fewer recurrences.
Developing our NHS care objectives: A consultation on the draft mandate to the NHS Commissioning Board
New objectives for the improvement of health and healthcare have been set out for public consultation.
'Our NHS care objectives: a draft mandate to the NHS Commissioning Board', sets out Health Secretary Andrew Lansley's expectations for the health service and marks the move to a more patient-centred, independent, transparent and outcomes focused NHS.
Consultation documents
Our NHS care objectives: A draft mandate to the NHS Commissioning Board
Our NHS care objectives: A draft mandate to the NHS Commissioning Board – Annexes
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