bluuebunny/crossref_metadata_2025 huggingface dataset:
Male partner voluntary counselling and testing associated with the antenatal services in Kinshasa, Democratic Republic of Congo: a randomized controlled trial
Authors: Ditekemena J , Matendo R , Koole O , Colebunders R , Kashamuka M , Tshefu A , Kilese N , Nanlele D , Ryder R
Published: April 2011

Low male participation in voluntary counselling and testing (VCT) services at antenatal clinics (ANCs) represents a lost HIV-prevention opportunity. A three-arm randomized controlled trial (RCT) was conducted that offered VCT at a neighbourhood health centre, bar or church to the male partners of pregnant women attending a maternity unit in Kinshasa, Democratic Republic of Congo (DRC). The primary outcome was the proportion of male participation at VCT; secondary outcomes were uptake of couple counselling and determinants of male and couple participation. From a total of 2706 women included in the study, 591 male partners (22%) attended one of the three venues. Male participation was significantly higher in bars (26%, P < 0.001), and higher but not statistically significant in church-based VCT (21%, P = 0.163) compared with health centre VCT (18%). Male participation in VCT associated with ANCs was higher in non-health service settings, particularly in bars. A combination of different strategies rather than single targeted interventions will be needed to increase VCT uptake in male partners of women seeking VCT at ANCs.
Presenting patient data in the electronic care record: the role of timelines
Authors: Gill Jasdeep , Chearman Tim , Carey Mike , Nijjer Sukhjinder , Cross Frank
Published: April 2011

Objective

To establish the current level of awareness and investigate the use of timelines within clinical computing systems as an organized display of the electronic patient record (EPR).

Design

Multicentre survey conducted using questionnaires and interview.

Setting

Seven UK hospitals and several general practice surgeries.

Participants

A total of 120 healthcare professionals completed a questionnaire which directed structured interviews. Participants fell into two cohorts according to whether or not they had used clinical timelines, which gave 60 ‘timeline users’ and 60 ‘prospective timeline users’.

Main outcome measures

To investigate the awareness of timelines, and the potential benefits of timelines within clinical computing systems.

Results

Fifty-eight percent of participants had not heard of the specific term ‘timelines’ despite 75% of users utilizing a form of timeline on a daily basis. The potential benefits of future timelines were clinical audit (95%CI 77.6-91.6), increased time efficiency (95%CI 77.7-91.6%), reduced clinical error (95%CI 71.0-86.7) and improved patient safety (95%CI 70.0-85.9). One continuous timeline view between primary and secondary care was considered to be of great potential benefit in allowing communication via a unified patient record.

Conclusions

The concept of timelines has enjoyed proven success in healthcare in the USA and in other sectors worldwide. Clinicians are supportive of timelines in healthcare. Formal input from clinicians should be sought when designing and implementing computer systems in healthcare. Timelines in healthcare support clinicians’ cognitive processes by improving the amount of data available and improving the way in which data are presented.
How do the information needs of cancer patients differ at different stages of the cancer journey? A cross-sectional survey
Authors: Mistry A , Wilson S , Priestman T , Damery S , Haque Ms
Published: April 2011

Objectives

Providing information to cancer patients can have significant benefits to their psychological wellbeing. The aim of this study was to investigate whether and how information needs may differ for patients at different stages of the cancer journey.

Design

Cross-sectional, self-completed survey using convenience sampling.

Setting

Oncology outpatients in Wolverhampton, West Midlands.

Participants

Cancer patients aged 18 years and over.

Main outcome measures

The survey used Likert scales to determine whether patients wished to know more about 35 items of information categorized under seven domains: cancer (diagnosis); prognosis; treatment; rehabilitation; psychological/spiritual; social/family; and body image/sexuality. Each domain was scored, with higher scores indicating a greater wish for information.

Results

There were 187 participants (50% response rate). Patients tended to want more information, particularly related to prognosis. Post-treatment patients continued to have information needs comparable to patients undergoing treatment or at the pre-treatment stage, except with reference to treatment-related information (p = <0.01), although as time from diagnosis increased, information needs reduced. Educational attainment, age, treatment status, gender and ethnicity were all significant predictors of scores in various domains.

Conclusion

This study indicates that the time since diagnosis may interact with various demographic and disease-related factors in contributing to the information needs of cancer patients. The majority of cancer patients wish to know more about a wide range of factors, and such information seeking preferences are present regardless of an individual's stage following diagnosis.
Can a bronchoscopist reliably assess a patient's experience of bronchoscopy?
Authors: Hadzri Hm , Azarisman Sms , Fauzi Arm , Roslan H , Roslina Am , Adina Atn , Fauzi Ma
Published: April 2011

Objectives

Bronchoscopy is an essential investigative tool in many respiratory complaints. The procedure can be unpleasant for both bronchoscopists and patients. To the best of our knowledge, there are only a few studies that correlate the bronchoscopist's satisfaction with that of the patient's during bronchoscopy. The aim of our study is to assess whether or not a bronchoscopist could reliably assess a patient's satisfaction during bronchoscopy.

Design

Cross-sectional, observational study with convenience sampling.

Setting

Patients attending flexible fibreoptic bronchoscopy appointments at the bronchoscopy suite, Respiratory Unit, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Cheras, Kuala Lumpur, Malaysia between March and September 2006.

Participants

Sixty patients undergoing bronchoscopy over a 6-month period completed a questionnaire after the procedure. All patients received standard pre-medication with intravenous midazolam.

Main outcome measures

Bronchoscopists and patients rated the level of satisfaction of the procedure using a 10 cm visual analogue scale (VAS). Lower scores indicated better satisfaction or less discomfort. Patients and bronchoscopists also rated coughing, choking and vomiting perception using the same 10 cm VAS. Reliability analysis (intra-class correlation coefficient [ICC]) was used to analyse the correlation between patients’ and bronchoscopists’ VAS scores.

Results

All 60 patients answered the questionnaire. The median overall satisfaction scored by bronchoscopists was 2.2 (2.0) with a non-significant (p = 0.880) trend to a better median overall satisfaction of 1.9 (2.3) scored by patients. The VAS scores for cough sensation were 1.9 (2.7) and 1.5 (5.0), respectively. There was positive correlation between bronchoscopists’ and patients’ VAS scores for coughing sensation (p = 0.047, ICC = 0.233). No significant correlation for overall satisfaction, vomiting sensation and choking sensation was found.

Conclusion

Positive correlation for cough perception suggested that the bronchoscopist could reliably assess the degree of cough discomfort patients experience during bronchoscopy.
Do patients wish to ‘listen in’ when doctors dictate letters to colleagues?
Authors: De Silva Rajith , Misbahuddin Anjum , Mikhail Salwa , Grayson Kate
Published: April 2011

Summary

Objectives

To evaluate the effects on clinical outcome of dictating correspondence in front of patients and sending them copies of letters.

Design

Observational study of the practices of two consultants, one of whom (RDS) routinely dictated letters in front of his patients and almost always sent them a copy while the other (AM) did neither. Questionnaires were completed anonymously by patients at the end of their consultation.

Setting

Neurology department of a teaching hospital.

Participants

Patients attending neurology outpatient clinics.

Results

Seventy-two percent and 62% of the two consultants’ patients were audited, and the demographic features of the two groups were similar. Eighty-six percent and 25% of RDS's and AM's patients, respectively, said that they wished to be present during dictation (p< 0.001). Within AM's group, those who had had some experience of the practice (with other consultants) were more likely to express a desire to be present during dictation (p = 0.023). Ninety-two percent and 77% of RDS's and AM's patients, respectively, felt that having a copy of their letter would be ‘very useful’ or ‘useful’ (p < 0.001). The perceived usefulness of receiving a copy letter and the desire to be present during dictation were associated for the total group and for RDS's patients. The two groups of patients were asked to express their degree of understanding at the end of the consultation, and 81% and 93% of RDS's and AM's patients, respectively, thought that their understanding was ‘excellent’ or ‘good’. No trends emerged with regard to patients’ preferences (to be present or absent during dictation and to receive or not receive a copy of their letter) and their level of understanding.

Conclusions

Patients appear to like being present when their letters are dictated, and appreciate receiving copies of these, but their overall understanding is seemingly independent of these variables. The success of the clinical consultation is probably influenced by numerous factors, and the elevation of patients’ presence during dictation of correspondence and receipt of copy letters above all others seems unjustified.
Key components of anaphylaxis management plans: consensus findings from a national electronic Delphi study
Authors: Worth Allison , Nurmatov Ulugbek , Sheikh Aziz
Published: April 2011

Summary

Objectives

There is no international consensus on the components of anaphylaxis management plans and responsibility for their design and delivery is contested. We set out to establish consensus among relevant specialist and generalist clinicians on this issue to inform future randomized controlled trials.

Design

A two-round electronic Delphi study completed by a 25-person, multidisciplinary expert panel. Participants scored the importance of a range of statements on anaphylaxis management, identified from a systematic review of the literature, on a five-point scale ranging from ‘very important’ to ‘irrelevant’. Consensus was defined a priori as being achieved if 80% or more of panel members rated a statement as ‘important’ or ‘very important’ after Round 2.

Setting

Primary and secondary care and academic settings in the UK and Ireland.

Participants

Twenty-five medical, nursing and allied health professionals.

Main outcome measures

Consensus on the key components of anaphylaxis management plans.

Results

The response rate was 84% ( n = 21) for Round 1 and 96% ( n = 24) for Round 2. The key components of emergency care on which consensus was achieved included: awareness of trigger factors (100%); recognition and emergency management of reactions of different severity (100%); and clear information on adrenaline (epinephrine) use (100%). Consensus on longer-term management issues included: clear written guidelines on anaphylaxis management (96%); annual review of plans (87%); and plans that were tailored to individual needs (82%).

Conclusions

This national consensus-building exercise generated widespread agreement that emergency plans need to be simple, clear and generic, making them easy to implement in a crisis. In contrast, long-term plans need to be negotiated between patient/carers and professionals, and tailored to individual needs. The effectiveness of this expert-agreed long-term plan now needs to be evaluated rigorously.
An evaluation of an enhanced fracture liaison service as the optimal model for secondary prevention of osteoporosis
Authors: Wallace IR , Callachand F , Elliott J , Gardiner PV
Published: April 2011

Summary

Objective

To assess secondary preventative therapy among postmenopausal female inpatients (aged 75 years and over) receiving surgical management for a fractured neck of femur using two service delivery models.

Design

Practice in two fracture units was audited and compared using the NICE guidelines (TA 87) as an audit standard.

Setting

Two fracture units: one with a fracture liaison service and one without.

Participants

Postmenopausal female inpatients (aged 75 years and over) receiving surgical management for a fractured neck of femur.

Main outcome measures

Rate of anti-resorptive treatment and rate of enquiry into risk factors.

Results

There was a significantly higher rate of anti-resorptive treatment (90.5% compared to 60.9% with a difference of 29.6%, p < 0.001) and enquiry into risk factors (83% compared to 7%) in the unit with a fracture liaison service.

Conclusions

We propose that a hospital-based enhanced fracture liaison service may result in higher osteoporosis treatment rates among postmenopausal hospitalized hip fracture patients aged 75 years and over.
The correlation of anxiety and depression levels with response to neoadjuvant chemotherapy in patients with breast cancer
Authors: Chintamani  , Gogne Anupriya , Khandelwal Rohan , Tandon Megha , Jain Sidharth , Kumar Yashwant , Narayan Nikhil , Bamal Rahul , Srinivas S , Saxena Sunita
Published: April 2011

Background

The aim was to evaluate and correlate anxiety and depression levels with response to neoadjuvant chemotherapy in patients with breast cancer. The study also assessed the effects of family support on distress levels.

Design

It was a prospective study in a cohort of 84 patients with locally advanced breast cancer. These assessments were done using the Hospital Anxiety and Depression Scale (HADS).

Setting

A prospective study in a developing world setting.

Participants

Eighty-four patients with locally advanced breast cancer receiving neoadjuvant chemotherapy were included after taking an informed consent and ethical committee clearance.

Main outcome measures

A significant correlation was observed between response to neoadjuvant chemotherapy and depression levels in breast cancer patients. Joint family and literacy levels also had an impact on the levels of depression observed.

Results

A total of 84 patients receiving neoadjuvant chemotherapy for breast cancer were evaluated using HADS. The effect of family support, literacy levels and employment on the psychological status of these patients were also assessed.

Conclusions

The response to neoadjuvant chemotherapy had a direct correlation with the levels of depression, the distress levels being lower in responders. This was found to be the most important variable determining the psychological status of the patients. It was also observed that Indian patients in comparison to their Western counterparts react differently to cancer-related stress.
Qigong for healthcare: an overview of systematic reviews
Authors: Lee Myeong Soo , Oh Byeongsang , Ernst Edzard
Published: April 2011

Summary

Objectives

Qigong has been recommended to improve health and prevent disease but the evidence is inconclusive. The aim of this overview was to critically evaluate all systematic reviews (SRs) of qigong for the treatment of any condition or symptom.

Design

Literature searches were carried out in 11 electronic databases for all systematic reviews of the effectiveness of qigong in any indication. Reviews were defined as systematic if they included an explicit and repeatable methods section describing the search strategy and explicit inclusion/exclusion criteria.

Setting

Retrospective review of medical database.

Participants

Participants with any type of medical conditions of any severity were included.

Main outcome measures

Evidence from each systematic review.

Results

Ten systematic reviews were included. They related to a wide range of conditions. The primary studies and several of the reviews were associated with a high risk of bias. Five reviews concluded that qigong is effective and five reviews were inconclusive.

Conclusion

The effectiveness of qigong is based mostly on poor quality research. Therefore, it would be unwise to draw firm conclusions at this stage.
Improving transitions in inpatient and outpatient care using a paper or web-based journal
Authors: Singh Ranjit , Roberts Alan C , Singh Ashok , Heider Arvela R , Norris Todd , Porreca Dan , Singh Gurdev
Published: April 2011

Objective

To develop a ‘Transitions Journal’ for inter-unit and inter-setting communication for improving quality and safety of care and patient satisfaction with timely, reliable and meaningful information for all stakeholders.

Design

Front-line staff were targeted in a series of four team meetings through which this ‘Journal’ was developed iteratively; initially as a paper-based and subsequently as an IT-based tool. Goals were to: (1) develop a standardized tool based on SBAR format (Situation, Background, Assessment, Recommendation); (2) facilitate improved communication at the points of care; (3) use a bottom-up approach; (4) create situational awareness and facilitate team formation; and (5) create visual workflow models to help inculcate a culture of safety.

Setting

A 183-bed community-hospital and its Primary Care Center, in an urban area in western New York State.

Participants

Ten nurses and 12 physicians representing both the hospital and primary care center participated voluntarily.

Main outcome measures

(1) Successful development of the ‘Transitions Journal’; and (2) identification of its potential uses.

Results

(1) Development: the journal was successfully developed in both paper and web-based formats; (2) identification of uses: participants recommended using the tool as a checklist to verify appropriate communication at both the sending and receiving ends; as an audit tool for retrospective review of handoffs; and as a teaching tool.

Conclusions

A journal developed by and for front-line staff has the potential to provide opportunities for improvement, instill a systems approach, improve care continuity, improve compliance with safety goals, improve patient and staff satisfaction, reduce duplication and costs, inculcate teamwork, and provide mutual emotional and intellectual support. Further work to evaluate and disseminate this tool is in progress.
The role of cranial CT in the investigation of meningitis
Authors: Nagra Inderjeet , Wee Bernard , Short Jennifer , Banerjee Arpan K
Published: April 2011

Summary

Objective

To assess the usage of cranial computed tomography (CT) in patients admitted with meningitis.

Design

Retrospective study.

Setting

Heart of England NHS foundation trust, a teaching hospital in the West Midlands.

Participants

Two groups of adult patients admitted with meningitis between April 2001 and September 2004 and from September 2006 until September 2009. Main outcome measures The numbers of patients having cranial CT and lumbar puncture and whether any complications had arisen following lumbar puncture. The appropriateness of the CT request according to local criteria.

Results

A total of 111 patients were admitted in the initial time period and 47 patients in the second time period. In the first group, 67 patients underwent CT (61%), compared with 36 patients (80%) in the second group. There were eight abnormal scans (12%) in the initial group including three patients with radiological features of cerebral oedema. Of these patients, one underwent lumbar puncture and had no neurological sequelae. In the second group, there were five abnormal scans (14%) with one presenting a contraindication for lumbar puncture due to mild ventricular dilatation. A lumbar puncture was performed in this patient without complication. All patients with abnormal scans had clinical features to suggest raised intracranial pressure. CT scan requests were considered inappropriate in 26% of patients in the initial study period and 56% of patients in the second study period.

Conclusion

More patients with meningitis are undergoing CT and the number of inappropriate requests are increasing. There are few abnormal CT scans presenting a contraindication for lumbar puncture and the majority of these patients usually have clinical signs to suggest raised intracranial pressure.
Evidence that central sensitisation is present in patients with shoulder impingement syndrome and influences the outcome after surgery
Authors: Gwilym S. E. , Oag H. C. L. , Tracey I. , Carr A. J.
Published: April 2011

Impingement syndrome in the shoulder has generally been considered to be a clinical condition of mechanical origin. However, anomalies exist between the pathology in the subacromial space and the degree of pain experienced. These may be explained by variations in the processing of nociceptive inputs between different patients. We investigated the evidence for augmented pain transmission (central sensitisation) in patients with impingement, and the relationship between pre-operative central sensitisation and the outcomes following arthroscopic subacromial decompression.

We recruited 17 patients with unilateral impingement of the shoulder and 17 age- and gender-matched controls, all of whom underwent quantitative sensory testing to detect thresholds for mechanical stimuli, distinctions between sharp and blunt punctate stimuli, and heat pain. Additionally Oxford shoulder scores to assess pain and function, and PainDETECT questionnaires to identify ‘neuropathic’ and referred symptoms were completed. Patients completed these questionnaires pre-operatively and three months post-operatively.

A significant proportion of patients awaiting subacromial decompression had referred pain radiating down the arm and had significant hyperalgesia to punctate stimulus of the skin compared with controls (unpaired t-test, p < 0.0001). These are felt to represent peripheral manifestations of augmented central pain processing (central sensitisation).

The presence of either hyperalgesia or referred pain pre-operatively resulted in a significantly worse outcome from decompression three months after surgery (unpaired t-test, p = 0.04 and p = 0.005, respectively).

These observations confirm the presence of central sensitisation in a proportion of patients with shoulder pain associated with impingement. Also, if patients had relatively high levels of central sensitisation pre-operatively, as indicated by higher levels of punctate hyperalgesia and/or referred pain, the outcome three months after subacromial decompression was significantly worse.
Exploring the application of mesenchymal stem cells in bone repair and regeneration
Authors: Griffin M. , Iqbal S. A. , Bayat A.
Published: April 2011

Failure of bone repair is a challenging problem in the management of fractures. There is a limited supply of autologous bone grafts for treating nonunions, with associated morbidity after harvesting. There is need for a better source of cells for repair. Mesenchymal stem cells (MSCs) hold promise for healing of bone because of their capacity to differentiate into osteoblasts and their availability from a wide variety of sources. Our review aims to evaluate the available clinical evidence and recent progress in strategies which attempt to use autologous and heterologous MSCs in clinical practice, including genetically-modified MSCs and those grown on scaffolds. We have compared various procedures for isolating and expanding a sufficient number of MSCs for use in a clinical setting.

There are now a number of clinical studies which have shown that implantation of MSCs is an effective, safe and durable method for aiding the repair and regeneration of bone.
Impaired bone healing in rabbits with steroid-induced osteonecrosis
Authors: Xie X.-H. , Wang X.-L. , Zhang G. , Liu Z. , Yao D. , Hung L.-K. , Hung V. W.-Y. , Qin L.
Published: April 2011

Corticosteroids are prescribed for the treatment of many medical conditions and their adverse effects on bone, including steroid-associated osteoporosis and osteonecrosis, are well documented. Core decompression is performed to treat osteonecrosis, but the results are variable. As steroids may affect bone turnover, this study was designed to investigate bone healing within a bone tunnel after core decompression in an experimental model of steroid-associated osteonecrosis. A total of five 28-week-old New Zealand rabbits were used to establish a model of steroid-induced osteonecrosis and another five rabbits served as controls. Two weeks after the induction of osteonecrosis, core decompression was performed by creating a bone tunnel 3 mm in diameter in both distal femora of each rabbit in both the experimental osteonecrosis and control groups. An in vivo micro-CT scanner was used to monitor healing within the bone tunnel at four, eight and 12 weeks postoperatively. At week 12, the animals were killed for histological and biomechanical analysis.

In the osteonecrosis group all measurements of bone healing and maturation were lower compared with the control group. Impaired osteogenesis and remodelling within the bone tunnel was demonstrated in the steroid-induced osteonecrosis, accompanied by inferior mechanical properties of the bone.

We have confirmed impaired bone healing in a model of bone defects in rabbits with pulsed administration of corticosteroids. This finding may be important in the development of strategies for treatment to improve the prognosis of fracture healing or the repair of bone defects in patients receiving steroid treatment.
Effect of low-intensity pulsed ultrasound stimulation on callus remodelling in a gap-healing model
Authors: Tobita K. , Ohnishi I. , Matsumoto T. , Ohashi S. , Bessho M. , Kaneko M. , Matsuyama J. , Nakamura K.
Published: April 2011

We evaluated the effect of low-intensity pulsed ultrasound stimulation (LIPUS) on the remodelling of callus in a rabbit gap-healing model by bone morphometric analyses using three-dimensional quantitative micro-CT. A tibial osteotomy with a 2 mm gap was immobilised by rigid external fixation and LIPUS was applied using active translucent devices. A control group had sham inactive transducers applied. A region of interest of micro-CT was set at the centre of the osteotomy gap with a width of 1 mm. The morphometric parameters used for evaluation were the volume of mineralised callus (BV) and the volumetric bone mineral density of mineralised tissue (mBMD). The whole region of interest was measured and subdivided into three zones as follows: the periosteal callus zone (external), the medullary callus zone (endosteal) and the cortical gap zone (intercortical). The BV and mBMD were measured for each zone.

In the endosteal area, there was a significant increase in the density of newly formed callus which was subsequently diminished by bone resorption that overwhelmed bone formation in this area as the intramedullary canal was restored. In the intercortical area, LIPUS was considered to enhance bone formation throughout the period of observation. These findings indicate that LIPUS could shorten the time required for remodelling and enhance the mineralisation of callus.
The use of the reamer-irrigator-aspirator to harvest mesenchymal stem cells
Authors: Cox G. , McGonagle D. , Boxall S. A. , Buckley C. T. , Jones E. , Giannoudis P. V.
Published: April 2011

The scarcity of mesenchymal stem cells (MSCs) in iliac crest bone marrow aspirate (ICBMA), and the expense and time in culturing cells, has led to the search for alternative harvest sites. The reamer-irrigation-aspirator (RIA) provides continuous irrigation and suction during reaming of long bones. The aspirated contents pass via a filter, trapping bony fragments, before moving into a ‘waste’ bag from which MSCs have been previously isolated. We examined the liquid and solid phases, performed a novel digestion of the solid phase, and made a comparative assessment in terms of number, phenotype and differentiation capacity with matched ICBMA.

The solid fraction from the filtrate was digested for 60 minutes at 37°C with collagenase. Enumeration was performed via the colony-forming unit fibroblast (CFU-F) assay. Passage (P2) cells were differentiated towards osteogenic, adipogenic and chondrogenic lineages, and their phenotypes assessed using flow cytometry (CD33, CD34, CD45, CD73, CD90, and CD105).

MSCs from the RIA phases were able to differentiate at least as well as those from ICBMA, and all fractions had phenotypes consistent with other established sources. The median number of colonies for the three groups was: ICBMA = 8.5 (2 to 86), RIA-liquid = 19.5 (4 to 90), RIA-solid = 109 (67 to 200) per 200 μl. The mean total yield of cells for the three groups was: ICBMA = 920 (0 to 4275), RIA-liquid = 114 983 (16 500 to 477 750), RIA-solid = 12 785 (7210 to 28 475).

The RIA filtrate contains large numbers of MSCs that could potentially be extracted without enzymatic digestion and used for bone repair without prior cell expansion.
Pre-operative patellofemoral degenerative changes do not affect the outcome after medial Oxford unicompartmental knee replacement
Authors: Kang S.-N. , Smith T. O. , De Rover W. B. Sprenger , Walton N. P.
Published: April 2011

There has been debate about the role of unicompartmental knee replacement in the presence of radiologically identifiable degenerative changes of the patellofemoral joint. We studied 195 knees in 163 patients in whom an Oxford unicompartmental knee replacement had been performed for medial osteoarthritis between January 2004 and July 2007. The mean age of the patients was 66 years (51 to 93). The degree of degenerative change of the patellofemoral joint was assessed using Jones’ criteria. Functional outcome was assessed at a mean of 3.4 years (2 to 7) post-operatively, using the Oxford knee score and the Short-form 12 score.

Degenerative changes of the patellofemoral joint were seen pre-operatively in 125 knees (64%) on the skyline radiographs. There was no statistically significant difference in the Oxford knee or Short-form 12 scores between those patients who had patellofemoral osteoarthritis pre-operatively and those who did not (p = 0.22 and 0.54, respectively).

These results support the opinion expressed at the designer’s hospital that degenerative changes of the patellofemoral joint in isolation should not be considered to be a contraindication to medial Oxford unicompartmental knee replacement.
The role of patient factors and implant position in squeaking of ceramic-on-ceramic total hip replacements
Authors: Sexton S. A. , Yeung E. , Jackson M. P. , Rajaratnam S. , Martell J. M. , Walter W. L. , Zicat B. A. , Walter W. K.
Published: April 2011

We investigated factors that were thought to be associated with an increased incidence of squeaking of ceramic-on-ceramic total hip replacements. Between June 1997 and December 2008 the three senior authors implanted 2406 primary total hip replacements with a ceramic-on-ceramic bearing surface. The mean follow-up was 10.6 years. The diagnosis was primary osteoarthritis in each case, and no patient had undergone previous surgery to the hip. We identified 74 squeaking hips (73 patients) giving an incidence of 3.1% at a mean follow-up of 9.5 years (4.1 to 13.3).

Taller, heavier and younger patients were significantly more likely to have hips that squeaked. Squeaking hips had a significantly higher range of post-operative internal (p = 0.001) and external rotation (p = 0.003) compared with silent hips. Patients with squeaking hips had significantly higher activity levels (p = 0.009). A squeaking hip was not associated with a significant difference in patient satisfaction (p = 0.24) or Harris hip score (p = 0.34). Four implant position factors enabled good prediction of squeaking. These were high acetabular component inclination, high femoral offset, lateralisation of the hip centre and either high or low acetabular component anteversion.

This is the largest study to date to examine patient factors and implant position factors that predispose to squeaking of a ceramic-on-ceramic hip. The results suggest that factors which increase the mechanical forces across the hip joint and factors which increase the risk of neck-to-rim impingement, and therefore edge-loading, are those that predispose to squeaking.
Traumatic amputations in children and adolescents
Authors: Roche A. J. , Selvarajah K.
Published: April 2011

There is no published literature detailing the demographics of paediatric amputations in the United Kingdom. We performed this review of children and adolescents referred to a regional limb-fitting centre from the 1930s to the current decade who suffered amputation as a result of trauma, and compared our data with similar cohorts from other units. Of the 93 patients included, only 11 were injured in the last 20 years. Road traffic accidents accounted for 63% of traumatic amputations. Of all amputations, 81% were in the lower limb and 19% in the upper limb.

Our figures are similar to those from a United Kingdom national statistical database of amputees which showed on average four traumatic amputee referrals to each regional limb-fitting centre in the United Kingdom per ten-year period. Compared with the United States, the incidence of paediatric traumatic amputations in the United Kingdom is low.
Venous thromboembolic events following foot and ankle surgery in the English National Health Service
Authors: Jameson S. S. , Augustine A. , James P. , Serrano-Pedraza I. , Oliver K. , Townshend D. , Reed M. R.
Published: April 2011

Diagnostic and operative codes are routinely collected for every patient admitted to hospital in the English NHS. Data on post-operative complications following foot and ankle surgery have not previously been available in large numbers. Data on symptomatic venous thromboembolism events and mortality within 90 days were extracted for patients undergoing fixation of an ankle fracture, first metatarsal osteotomy, hindfoot fusions and total ankle replacement over a period of 42 months. For ankle fracture surgery (45 949 patients), the rates of deep-vein thrombosis (DVT), pulmonary embolism and mortality were 0.12%, 0.17% and 0.37%, respectively. For first metatarsal osteotomy (33 626 patients), DVT, pulmonary embolism and mortality rates were 0.01%, 0.02% and 0.04%, and for hindfoot fusions (7033 patients) the rates were 0.03%, 0.11% and 0.11%, respectively. The rate of pulmonary embolism in 1633 total ankle replacement patients was 0.06%, and there were no recorded DVTs and no deaths. Statistical analysis could only identify risk factors for venous thromboembolic events of increasing age and multiple comorbidities following fracture surgery.

Venous thromboembolism following foot and ankle surgery is extremely rare, but this subset of fracture patients is at a higher risk. However, there is no evidence that thromboprophylaxis reduces this risk, and these national data suggest that prophylaxis is not required in most of these patients.
Physeal-sparing reconstruction of anterior cruciate ligament tears in children
Authors: Bonnard C. , Fournier J. , Babusiaux D. , Planchenault M. , Bergerault F. , de Courtivron B.
Published: April 2011

This study evaluated the results of a physeal-sparing technique of intra-articular anterior cruciate ligament (ACL) reconstruction in skeletally immature patients, with particular reference to growth disturbance. Between 1992 and 2007, 57 children with a mean age of 12.2 years (6.8 to 14.5) underwent ACL reconstruction using the same technique. At a mean of 5.5 years (2 to 14) after surgery, 56 patients underwent clinical and radiological evaluation. At that time, 49 patients (87.5%) had reached bony maturity and 53 (95%) achieved A or B according to the IKDC 2000 classification. Four patients had stopped participation in sports because of knee symptoms, and three patients (5.4%) had a subsequent recurrent ACL injury. There was no clinical or radiological evidence of growth disturbance after a mean growth in stature of 20.0 cm (3 to 38).

This study demonstrates that ACL reconstruction sparing the physes in children is a safe technique protecting against meniscal tears and giving better results than reconstruction in adults, without causing significant growth disturbance.
Early resection of congenital pseudarthrosis of the tibia and successful reconstruction using the Masquelet technique
Authors: Gouron R. , Deroussen F. , Juvet M. , Ursu C. , Plancq M.-C. , Collet L.-M.
Published: April 2011

Congenital pseudarthrosis of the tibia remains one of the most difficult orthopaedic problems. We describe early excision and the use of the Masquelet technique to reconstruct the bone defect in a child aged 14 months. Consolidation sufficient for complete weight-bearing was achieved by seven weeks. After two and a half years, the child was asymptomatic with a fully reconstructed tibia and no leg-length discrepancy.
Early mechanical complications of a multidirectional mobile-bearing total knee replacement
Authors: Chang C.-W. , Lai K.-A. , Yang C.-Y. , Lan S.-M.
Published: April 2011

Between April 2004 and July 2007, we performed 241 primary total knee replacements in 204 patients using the e.motion posterior cruciate-retaining, multidirectional mobile-bearing prosthesis. Of these, 100 were carried out using an image-free navigation system, and the remaining 141 with the conventional technique. We conducted a retrospective study from the prospectively collected data of these patients to assess the early results of this new mobile-bearing design.

At a mean follow-up of 49 months (32 to 71), 18 knees (7.5%) had mechanical complications of which 13 required revision. Three of these had a peri-prosthetic fracture, and were removed from the study. The indication for revision in the remaining ten was loosening of the femoral component in two, tibiofemoral dislocation in three, disassociation of the polyethylene liner in four, and a broken polyethyene liner in one. There were eight further mechanically unstable knees which presented with recurrent disassociation of the polyethylene liner. There was no significant difference in the incidence of mechanical instability between the navigation-assisted procedures (8 of 99, 8.1%) and the conventionally implanted knees (10 of 139, 7.2%).

In our view, the relatively high rate of mechanical complications and revision within 30 months precludes the further use of new design of knee replacement.
The long-term outcome of hip replacement in adults with juvenile idiopathic arthritis
Authors: Malviya A. , Walker L. C. , Avery P. , Osborne S. , Weir D. J. , Foster H. E. , Deehan D. J.
Published: April 2011

Juvenile idiopathic arthritis (JIA) is a chronic disease of childhood; it causes joint damage which may require surgical intervention, often in the young adult. The aim of this study was to describe the long-term outcome and survival of hip replacement in a group of adult patients with JIA and to determine predictors of survival for the prosthesis. In this retrospective comparative study patients were identified from the database of a regional specialist adult JIA clinic. This documented a series of 47 hip replacements performed in 25 adult patients with JIA. Surgery was performed at a mean age of 27 years (11 to 47), with a mean follow-up of 19 years (2 to 36). The mean Western Ontario and McMaster Universities osteoarthritis index questionnaire (WOMAC) score at the last follow-up was 53 (19 to 96) and the mean Health Assessment Questionnaire score was 2.25 (0 to 3). The mean pain component of the WOMAC score (60 (20 to 100)) was significantly higher than the mean functional component score (46 (0 to 97)) (p = 0.02). Kaplan-Meier survival analysis revealed a survival probability of 46.6% (95% confidence interval 37.5 to 55.7) at 19 years, with a trend towards enhanced survival with the use of a cemented acetabular component and a cementless femoral component. This was not, however, statistically significant (acetabular component, p = 0.76, femoral component, p = 0.45). Cox’s proportional hazards regression analysis showed an implant survival rate of 54.9% at 19 years at the mean of covariates.

Survival of the prosthesis was significantly poorer (p = 0.001) in patients who had been taking long-term corticosteroids and significantly better (p = 0.02) in patients on methotrexate.
Acalculous gallbladder disease: the outcomes of treatment by laparoscopic cholecystectomy
Authors: Ahmed M , Diggory R
Published: April 2011

INTRODUCTION

The treatment of symptomatic patients with the presence of gallstones is well established, with laparoscopic cholecystectomy being the treatment of choice for symptomatic cholelithiasis. The results of surgery in symptomatic patients without gallstones are highly variable. These patients are often referred to as having acalculous gallbladder disease and represent between 5% and 30% of laparoscopic cholecystectomies performed annually. We retrospectively reviewed the outcomes of patients who underwent laparoscopic cholecystectomy for acalculous gallbladder disease in our institution.

PATIENTS AND METHODS

We retrospectively analysed the period from February 2005 to January 2006 where 20 laparoscopic cholecystectomies had been performed specifically for a preoperative diagnosis of acalculous gallbladder disease. The histology of all laparoscopic cholecystectomies performed during this year was analysed and it was found that a further 46 patients had histological specimens that demonstrated the absence of gallstones in the presence of an intact gallbladder specimen. These patients were therefore included in the study group for acalculous gallbladder disease. All patients were sent a questionnaire comparing their state of health before and after surgery.

RESULTS

After laparoscopic cholecystectomy, 66% of patients were completely pain free. The remainder, however, experienced infrequent, moderate pain with occasional pain on eating. Following surgery, all patients were able to conduct their activities of daily living without any limitation.

CONCLUSIONS

We therefore conclude that laparoscopic surgery for patients with acalculous gallbladder disease is effective in symptom control and allowing patients to return to their normal lifestyle.
Ankle arthroscopy in children
Authors: Val Vasukutty Nijil , Akrawi Hawar , Theruvil Bipin , Uglow Mike
Published: April 2011

INTRODUCTION

Arthroscopy of the ankle has gained acceptance as a procedure for diagnosing and treating chronic and post-traumatic ankle problems. The senior author's perception is that magnetic resonance imaging (MRI) under-diagnoses anterior soft tissue impingement lesions in children. The purpose of this study was retrospectively to analyse the outcome of ankle arthroscopy in the paediatric age group.

PATIENTS AND METHODS

Between March 2005 and September 2007, 23 children underwent ankle arthroscopy for post-traumatic pathology. The indications for arthroscopy were failure of non-operative treatment for at least 12 weeks or a grade 3 or 4 osteochondral defect (OCD) on imaging.

RESULTS

At arthroscopy, OCDs were visualised in 12 cases and impingement lesions were seen in 17 ankles. MRI was performed in 8 of these 12 cases and only 1 suggested the possibility of an impingement lesion. Of the 17 cases of impingement seen on arthroscopy, 12 reported mechanical symptoms preoperatively and 4 were unstable on examination under anaesthetic. Eighteen of the twenty-three patients had complete relief of symptoms at 3 months. Eighteen children who were evaluated at one-year follow up had a mean American Orthopaedic Foot and Ankle Society score of 87. 5 (range: 49-100).

CONCLUSIONS

Ankle arthroscopy has a successful outcome in paediatric patients and the results are comparable with those reported in adult series. MRI was found to be insensitive for the diagnosis of soft tissue impingement of the ankle.
The Effects of a Heavy Snowfall on Emergency Services in a District General Hospital: What we can Learn
Authors: Kosuge Dennis , Rai Praveen , Williams William
Published: April 2011

In early February 2009, most of the UK experienced the heaviest snowfall in 18 years. This was preceded by the coldest winter since 1995–1996, with an average temperature of 2.9°C. South-east England, where our hospital is located, experienced snow depths of 15–30cm on 1–2 February followed by windy, icy and snowy conditions that continued until the second half of the month. The effect of the weather was compounded by the nation's salt shortage for gritting, which meant that suburban streets and quiet rural roads were often neglected in favour of major roads.
Dental revalidation: developing the College's role
Authors: Ladwa Russ , Willmot Derrick
Published: April 2011

Doctors and dentists in the UK will be well aware of discussions concerning revalidation over the last ten years. The development of the system is not yet complete, though an element in progress to date has been the mandatory involvement of the medical royal colleges.
Thy3 cytology: what to do next?
Authors: Lakhani Raj , Rourke Thomas , Jefferis Anthony , Perry Louise , Ghiacy Sabour , Wood Stephen
Published: April 2011

INTRODUCTION

Cytological analysis of thyroid fine needle aspiration (FNA) is aided by the ‘Thy’ classification. However, there is often confusion surrounding the management of patients with a Thy3 classification. A subdivision of Thy3 has been created to help reduce this dilemma but its use within the UK appears to by infrequent. This paper analyses the management of patients with Thy3 cytology from FNA of a thyroid nodule in a UK case series and reviews the relevant literature. It also describes the results of a survey of selected UK ENT departments on the use of the Thy3 classification and its subdivisions.

PATIENTS AND METHODS

A retrospective analysis of a case series of patients was undertaken. In addition, a telephone survey of local/regional pathology departments was conducted to assess the utilisation of the Thy classification and to assess the awareness and usage of the Thy3 subdivisions.

RESULTS

A total of 39 Thy3 results (11 males, 28 females) were identified from 2007 to 2009. Of these, 24 patients went on to have surgery, 8 had a further FNA, 2 had a Tru-cut biopsy and 5 were lost to follow-up. Eleven (28.2%) patients were subsequently diagnosed with a thyroid malignancy. The survey identified that none of the departments had adopted the Thy3 subclassifications and only 40% were aware of them.

CONCLUSIONS

Thy3 results from thyroid FNA have a significant risk of malignancy but there remains confusion surrounding their management. This district general hospital has adopted and recommends the use of the Thy3 (i) and Thy3 (ii) subdivisions in order to assist decision-making and avoid delays in treatment or unnecessary surgery.