How reconfiguration of a minor injuries unit has affected service delivery during the COVID-19 pandemic: a retrospective analysis

INTRODUCTION

Redeployment of orthopaedic consultants to a minor injuries unit (MIU) during the COVID-19 pandemic provided a unique opportunity to assess the impact of early senior specialist input on patient management.

METHODS

Patient demographics, diagnosis, location of injury and disposal method were compared between three 7-day periods: during the April 2020 COVID-19 lockdown (period A), one month prior to period A (period B) and one year prior to period A (period C). Orthopaedic consultants staffed the MIU during period A, and emergency nurse practitioners staffed the MIU during periods B and C.

RESULTS

Period A witnessed higher injury severity either due to modified activities or altered healthcare-seeking behaviour during lockdown. For fractures, compared with periods B and C, period A saw a lower rate of referral to fracture clinic (41% vs 100% vs 86%, p<0.001) and higher rate of discharge (38% vs 0% vs 9%, p<0.001). The median time to fracture clinic was also longer (15 days vs 6 days vs 10 days, p<0.001), indicating earlier institution of definitive care. There were no other significant differences between periods with radiology alerts and complaints received remaining largely unchanged.

CONCLUSION

Early senior orthopaedic input in the patient journey from MIU had clear benefits, this being most true for fracture diagnoses. Earlier definitive management planning was observed as lower rates of fracture clinic referral, higher rates of discharge and deferred first fracture clinic reviews. This study highlights the benefits of greater partnership between MIU and orthopaedics. As the pandemic subsides and redeployed staff return to normal duties, a modification of this model could be utilised to ensure this partnership is sustainable.

The use of an asynchronous learning network for senior house officers in emergency medicine

Full-shift working by senior house officers (SHOs) is well recognised as a definite constraint to effective group learning, as it is practically impossible to gather all team members together for teaching sessions at any given time. Provision of a robust weekly teaching programme is further compromised in units where relatively few doctors participate in the rota in any case. Although practical skills tuition will always demand an intensive, hands-on learning environment, teaching in relation to case-based discussion, clinical problem solving and other group activities may well be suited to more innovative methods.

Associations of PKC isoforms with the cytoskeleton of B16F10 melanoma cells

Although PKC plays a major role in regulating the morphology and function of the cytoskeleton, little is known about in situ associations of specific isoforms with the cytoskeleton. We demonstrate that seven PKC isoforms are expressed in B16F10 melanoma cells and show different levels of induction by serum. Using cell cytoskeleton preparations (CSKs), confocal microscopy, and immunocytochemistry, all isoforms show specific patterns of localization to focal contact-like structures (alpha, delta), very small cytoplasmic granules/vesicles (all isoforms), dense ordered arrays of small granules in the perinuclear region (alpha, delta), granules/vesicles associated with a homogeneous framework in the cytoplasm adjacent to the nucleus (gamma), or irregular-shaped patches of granules at or near the nuclear perimeter (eta, theta). In addition, several isoforms are present as cytoplasmic granules/ vesicles in linear or curvilinear arrays (alpha, delta, epsilon, theta). When isoform localization is examined using 3.7% formaldehyde or methanol:acetone, the patterns of localization in CSKs are often difficult or impossible to detect, and many are described here for the first time. Double-labeling experiments with CSK demonstrate that PKC actin co-localizes with punctate alpha-rich particles above the nucleus, granules of epsilon throughout the cytoplasm, and with theta in irregular-shaped aggregates associated with the nucleus. Vimentin co-localizes with perinuclear granules of delta and beta(2), and alpha-tubulin co-localizes with theta in structures at or near the nuclear surface and in microtubules associated with the microtubule organizing center (MTOC). In summary, the present study demonstrates that seven PKC isoforms are endogenously expressed in B16F10 melanoma cells. These isoforms show various levels of induction by serum and specific patterns of association with various components of the detergent-resistant cell cytoskeleton.

From somatic variation to variant plants: mechanisms and applications

Plants from cell cultures show a high incidence of mutation. The causes of somaclonal variation are unknown, but the genetic consequences have been analysed. A range of genetic events are responsible, including single base changes; altered gene copy number; altered expression of multigene families; chromosome fragment interchanges; and mobilisation of transposable elements. Recent applications of these phenomena are discussed in this paper, for example, in vitro selection, somaclonal variation for agronomic traits, and limited gene transfer from cultured sexual and somatic hybrids. Research is outlined attempting to use high frequency chromosomal interchanges in wheat cell cultures to introgress genes from alien chromosomes. Two examples are cereal cyst nematode resistance on a rye chromosome and barley yellow dwarf resistance on a Thinopyrum chromosome. Some presumptive introgressed lines show selfed and backcross segregations, suggesting that the resistance, but not other alien markers, is now on a wheat chromosome.Key words: somaclonal variation, introgression, somatic hybridization, chromosome rearrangement, in vitro selection.