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Datyner E, Adeseye V, Porter K, Dryden I, Sarma A, Vu N, Patrick AE, Paueksakon P. Small vessel childhood primary angiitis of the central nervous system with positive anti-glial fibrillary acidic protein antibodies: a case report and review of literature. BMC Neurol 2023; 23:57. [PMID: 36737749 PMCID: PMC9895965 DOI: 10.1186/s12883-023-03093-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 01/25/2023] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Small vessel childhood primary angiitis of the central nervous system (SV-cPACNS) is a rare disease characterized by inflammation within small vessels such as arterioles or capillaries. CASE PRESENTATION We report a case of SV-cPACNS in an 8-year-old boy confirmed by brain biopsy. This patient was also incidentally found to have anti-glial fibrillary acidic protein (GFAP) antibodies in the cerebrospinal fluid (CSF) but had no evidence of antibody-mediated disease on brain biopsy. A literature review highlighted the rarity of SV-cPACNS and found no prior reports of CSF GFAP-associated SV-cPACNS in the pediatric age group. CONCLUSION We present the first case of biopsy proven SV-cPACNS vasculitis associated with an incidental finding of CSF GFAP antibodies. The GFAP antibodies are likely a clinically insignificant bystander in this case and possibly in other diseases with CNS inflammation. Further research is needed to determine the clinical significance of newer CSF autoantibodies such as anti-GFAP before they are used for medical decision-making in pediatrics.
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Affiliation(s)
- E Datyner
- grid.412807.80000 0004 1936 9916Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN USA
| | - V Adeseye
- grid.412807.80000 0004 1936 9916Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN USA
| | - K Porter
- grid.152326.10000 0001 2264 7217Vanderbilt University, Nashville, TN USA
| | - I Dryden
- grid.412807.80000 0004 1936 9916Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, 1161 21St Avenue South, Nashville, TN MCN C2318B37232-2561 USA
| | - A Sarma
- grid.412807.80000 0004 1936 9916Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN USA
| | - N Vu
- grid.412807.80000 0004 1936 9916Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN USA
| | - AE Patrick
- grid.412807.80000 0004 1936 9916Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN USA
| | - P Paueksakon
- grid.412807.80000 0004 1936 9916Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, 1161 21St Avenue South, Nashville, TN MCN C2318B37232-2561 USA
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Spencer B, Nelson J, Schuelke A, Porter K. Abstract No. 609 Quality of life metrics in a young population with nonthrombotic iliac vein compression following stenting of the iliac vein. J Vasc Interv Radiol 2022. [DOI: 10.1016/j.jvir.2022.03.591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Sobotka L, Mumtaz K, Hinton A, Porter K, Conteh L. National report on healthcare utilization and mortality in patients with hepatitis A infection in the United States. Public Health 2022; 207:113-118. [DOI: 10.1016/j.puhe.2022.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 02/14/2022] [Accepted: 04/06/2022] [Indexed: 10/18/2022]
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Little MA, Pebley K, Porter K, Talcott GW, Krukowski RA. 'I Think Smoking's the Same, but the Toys Have Changed.' Understanding Facilitators of E-Cigarette Use among Air Force Personnel. J Addict Prev 2020; 8:7. [PMID: 33204766 PMCID: PMC7668561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The military has stringent anti-tobacco regulations for new recruits. While most tobacco products have declined in recent years, e-cigarette use has tripled among this population. However, little is known about the factors facilitating this inverse relationship. OBJECTIVES Examine the facilitators of e-cigarette use during a high risk period following initial enlistment among young adults. METHODS Focus groups were conducted with Airmen, Military Training Leaders (MTLs) and Technical Training Instructors (TTIs) to qualitatively explore unique characteristics of e-cigarettes leading to use in Technical Training. RESULTS The most commonly used tobacco product across participants was cigarettes (42.7%), followed by e-cigarettes (28.0%) and smokeless tobacco (22.6%). Almost a third (28.7%) of participants reported using more than one tobacco product. E-cigarette use was much more common among Airmen (76.1%), compared to MTLs (10.9%) and TTIs (13.0%).Four main facilitators around e-cigarette use were identified including: 1) There is no reason not to use e-cigarettes; 2) Using e-cigarettes helps with emotion management; 3) Vaping is a way of fitting in; and 4) Existing tobacco control policies don't work for vaping. E-cigarettes were not perceived as harmful to self and others, which could explain why Airmen were much less likely to adhere to existing tobacco control regulations. Subversion was viewed as the healthy option compared to utilizing designated tobacco use areas due to the potential exposure to traditional tobacco smoke. This coupled with a lack of understanding about e-cigarette regulations and difficulties with enforcement, promoted use among this young adult population. CONCLUSION Findings suggest that e-cigarettes are used for similar reasons as traditional tobacco products, but their unique ability to be concealed promotes their widespread use and circumvents existing tobacco control policies. In order to see reductions in use, environmental policies may need to be paired with behavioral interventions at the personal and interpersonal level.
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Affiliation(s)
- MA Little
- University of Virginia, School of Medicine, Department of
Public Health Sciences, 560 Ray C. Hunt Drive, Charlottesville, VA, USA,Address for Correspondence Little MA,
University of Virginia, School of Medicine, Department of Public Health
Sciences, 560 Ray C. Hunt Drive, Rm 2119 Charlottesville, VA, USA, 22903;
| | - K Pebley
- University of Memphis, Department of Psychology, 400
Innovation Drive, Memphis, TN, USA, 38152
| | - K Porter
- University of Virginia, School of Medicine, Department of
Public Health Sciences, 560 Ray C. Hunt Drive, Charlottesville, VA, USA
| | - GW Talcott
- University of Virginia, School of Medicine, Department of
Public Health Sciences, 560 Ray C. Hunt Drive, Charlottesville, VA, USA,Wilford Hall Ambulatory Surgical Center, 59 MDW/ 59 SGOWMP,
1100 Wilford Hall Loop, Bldg 4554, Joint Base Lackland AFB, TX, USA 78236
| | - RA Krukowski
- Department of Preventive Medicine, University of Tennessee
Health Science Center, 66 North Pauline Street, Memphis, TN, USA 38163
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Geraghty L, Hoffman S, Schultz T, Porter K, Issa M, Rupert R, Bhateja P, Old M, Rocco J, Blakaj D, Bonomi M. Weekly Versus Tri-Weekly Paclitaxel and Carboplatin in Combination with Cetuximab in Recurrent/Metastatic Head and Neck Cancer Patients: a Toxicity Analysis. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2019.11.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Oosthuizen N, Fontes PLP, Porter K, Lamb GC. Presynchronization with prostaglandin F 2α and prolonged exposure to exogenous progesterone impacts estrus expression and fertility in beef heifers. Theriogenology 2020; 146:88-93. [PMID: 32062494 DOI: 10.1016/j.theriogenology.2020.02.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 01/20/2020] [Accepted: 02/06/2020] [Indexed: 11/25/2022]
Abstract
To determine the effects of two presynchronization strategies in conjunction with delayed fixed-time artificial insemination (TAI) on pregnancy rates to TAI (PR/AI), 1700 Angus beef heifers at three locations in South Dakota were enrolled in a completely randomized design with a 2 by 2 factorial arrangement of treatments. Within location, all heifers were randomly assigned to one of four treatments: 1) PG54 (n = 434), heifers were administered prostaglandin F2α (PGF; 25 mg im) 7 d prior [Day -14] to the initiation of the 7-d CO-Synch + controlled internal drug releasing (CIDR) protocol wherein they received gonadotropin-releasing hormone (GnRH; 100 μg im) and a CIDR insert on Day -7, PGF at CIDR removal on Day 0, and a second injection of GnRH concurrently with TAI 54 ± 2 h later; 2) PG72 (n = 426), heifers were exposed to the same treatment as PG54, however, TAI was performed 72 ± 2 h after CIDR removal; 3) PG-CIDR54 (n = 422), same as PG54 but heifers received a CIDR insert on Day -14 rather than Day -7, in addition to PGF administration; 4) PG-CIDR72 (n = 418), same as PG-CIDR54, however, TAI was performed 72 ± 2 h after CIDR removal. Estrus detection patches were applied to all heifers on Day 0 and were evaluated for activation at TAI. Pregnancy was diagnosed via transrectal ultrasonography between 30 and 47 d after TAI. The percentage of heifers exhibiting estrus between Day 0 and TAI was greater (P < 0.01) in the PG72, PG-CIDR54, and PG-CIDR72 treatments compared to the PG54 treatment (78.11, 86.59, and 91.09 vs. 31.05%, respectively). Furthermore, estrus response was greater (P < 0.01) in PG-CIDR72 heifers when compared to PG72. Pregnancy rates to TAI differed among treatments and were greater (P < 0.05) in the PG72 and PG-CIDR54 treatments when compared to PG-CIDR72 (48.8 and 50.4 vs. 38.4%, respectively), and were greater (P = 0.03) in PG-CIDR54 vs. PG54 (43.1%). Moreover, a tendency (P = 0.10) was determined on PR/AI between PG54 and PG72. In conclusion, presynchronization strategies and prolonged exposure to exogenous progesterone have the potential to alter estrus expression and improve fertility in replacement beef heifers.
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Affiliation(s)
- N Oosthuizen
- Department of Animal Science, Texas A&M University, College Station, TX, 77843-2471, USA
| | - P L P Fontes
- Department of Animal and Dairy Science, University of Georgia, Athens, GA, 30602, USA
| | - K Porter
- Kleinsasser-Porter Veterinary Service, Huron, SD, 57350, USA
| | - G C Lamb
- Department of Animal Science, Texas A&M University, College Station, TX, 77843-2471, USA.
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Serebriakoff P, Hartley F, Hall J, Porter K. An update on firearm police medical response. Trauma 2020. [DOI: 10.1177/1460408619885523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - Fiona Hartley
- Palliative Care Medicine, Woodlands Hospice, Liverpool, UK
| | - J Hall
- Royal College of Surgeons of Edinburgh, Edinburgh, UK
| | - K Porter
- Department of Clinical Traumatology, University Hospital Birmingham, Queen Elizabeth, Birmingham, UK
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Bronson A, Peay H, Porter K, Toth D. EP.73Pain interference in children and adults with Duchenne and Becker muscular dystrophy. Neuromuscul Disord 2019. [DOI: 10.1016/j.nmd.2019.06.479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Khatutsky G, Bercaw LE, Shah A, Porter K, Eng T, Ormond C, Zoromski PJ, Husick C. EVALUATING INITIATIVE TO REDUCE AVOIDABLE HOSPITALIZATIONS OF NURSING HOME RESIDENTS: FACILITY PERSPECTIVE. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- G Khatutsky
- RTI International, Waltham, Massachusetts, United States
| | | | - A Shah
- RTI International, Waltham, MA, USA
| | - K Porter
- RTI International, Research Triangle Park, NC, USA
| | - T Eng
- RTI International, Waltham, MA, USA
| | - C Ormond
- RTI International, Waltham, MA, USA
| | | | - C Husick
- RTI International, Research Triangle Park, NCUSA
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Bercaw LE, Shah A, Porter K, Eng T, Ormond C, Zoromski PJ, Husick C. EVALUATING INITIATIVE TO REDUCE AVOIDABLE HOSPITALIZATIONS OF NURSING HOME RESIDENTS: PRACTITIONER PERSPECTIVE. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- L E Bercaw
- RTI International, Waltham, Massachusetts, United States
| | - A Shah
- RTI International, Waltham, MA, USA
| | - K Porter
- RTI International, Research Triangle Park, NC, USA
| | - T Eng
- RTI International, Waltham, MA, USA
| | - C Ormond
- RTI International, Waltham, MA, USA
| | | | - C Husick
- RTI International, Research Triangle Park, NC, USA
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Ireland G, Delpech V, Kirwan P, Croxford S, Lattimore S, Sabin C, Porter K, Mandal S, Simmons R. Prevalence of diagnosed HIV infection among persons with hepatitis C virus infection: England, 2008-2014. HIV Med 2018; 19:708-715. [PMID: 30051565 DOI: 10.1111/hiv.12662] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2018] [Indexed: 01/28/2023]
Abstract
OBJECTIVES In persons with hepatitis C virus (HCV) infection, HIV coinfection leads to faster progression to advanced liver disease. The aim of our study was to estimate diagnosed HIV prevalence among people with evidence of current HCV infection (polymerase chain reaction positive) and examine predictors of coinfection. METHODS Adults (≥ 15 years old) with a current HCV infection reported to the Public Health England (PHE) sentinel surveillance of blood-borne viruses were linked to the PHE national HIV database using a deterministic methodology. Descriptive and multivariate analyses were conducted. RESULTS Between 2008 and 2014, 5.0% (999/20 088) of adults with a current HCV infection were diagnosed with HIV coinfection. The majority acquired HIV through sex between men (441; 64.9%), followed by injecting drug use (153; 22.5%) and heterosexual contact (84; 12.4%). Of persons who were coinfected, 65.5% had been diagnosed with HIV infection > 6 months before their HCV diagnosis, 41.4% of whom had a negative anti-HCV test between their HIV and HCV diagnoses. In a multivariable model among persons with current HCV infection, an HIV diagnosis was more likely among men [adjusted odds ratio (aOR) 3.29; 95% confidence interval (CI) 2.60-4.16] and persons of black ethnicity (aOR 3.19; 95% CI 1.36-7.46), and less likely among older adults (aOR 0.85 per 10-year increase; 95% CI 0.79-0.92) and persons of Asian ethnicity (aOR 0.59; 95% CI 0.41-0.86). CONCLUSIONS Our results indicate that the majority of diagnosed HIV and current HCV coinfections are among men who have sex with men. Safer sex campaigns should include awareness of transmission of HCV among MSM living with HIV.
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Affiliation(s)
- G Ireland
- National Infection Service, Public Health England, London, UK.,The National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections, University College London, London, UK
| | - V Delpech
- National Infection Service, Public Health England, London, UK.,The National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections, University College London, London, UK
| | - P Kirwan
- National Infection Service, Public Health England, London, UK
| | - S Croxford
- National Infection Service, Public Health England, London, UK
| | - S Lattimore
- National Infection Service, Public Health England, London, UK.,The National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections, University College London, London, UK
| | - C Sabin
- The National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections, University College London, London, UK.,Institute for Global Health for both Sabin and Porter, University College London, London, UK
| | - K Porter
- The National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections, University College London, London, UK.,Institute for Global Health for both Sabin and Porter, University College London, London, UK
| | - S Mandal
- National Infection Service, Public Health England, London, UK.,The National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections, University College London, London, UK
| | - R Simmons
- National Infection Service, Public Health England, London, UK.,The National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections, University College London, London, UK
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Van Dongen H, Gaddameedhi S, Chowdhury NR, Skornyakov E, Gajula RP, Middleton B, Satterfield BC, Porter K, Skene DJ. 0038 Separating Circadian- and Behavior-Driven Metabolite Rhythms in Simulated Shift Work. Sleep 2018. [DOI: 10.1093/sleep/zsy061.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- H Van Dongen
- Sleep and Performance Research Center, Washington State University, Spokane, WA
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA
| | - S Gaddameedhi
- Sleep and Performance Research Center, Washington State University, Spokane, WA
- College of Pharmacy, Washington State University, Spokane, WA
| | - N R Chowdhury
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, UNITED KINGDOM
| | - E Skornyakov
- Sleep and Performance Research Center, Washington State University, Spokane, WA
- Department of Physical Therapy, Eastern Washington University, Spokane, WA
| | - R P Gajula
- College of Pharmacy, Washington State University, Spokane, WA
| | - B Middleton
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, UNITED KINGDOM
| | - B C Satterfield
- Sleep and Performance Research Center, Washington State University, Spokane, WA
- Department of Psychiatry, College of Medicine, University of Arizona, Oro Valley, AZ
| | - K Porter
- College of Pharmacy, Washington State University, Spokane, WA
| | - D J Skene
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, UNITED KINGDOM
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Chilvers G, Porter K, Choudhary S. Cervical spine clearance in adults following blunt trauma: a national survey across major trauma centres in England. Clin Radiol 2018; 73:410.e1-410.e8. [DOI: 10.1016/j.crad.2017.11.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 11/02/2017] [Indexed: 10/18/2022]
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Sturm AS, Trinkley KE, Porter K, Nahata MC. Efficacy and safety of atypical antipsychotics for behavioral symptoms of dementia among patients residing in long-term care. Int J Clin Pharm 2017; 40:135-142. [PMID: 29189977 DOI: 10.1007/s11096-017-0555-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 10/26/2017] [Indexed: 11/28/2022]
Abstract
Background There are limited options for the treatment of behavioral and psychological symptoms of dementia (BPSD). Objective Evaluate the efficacy and safety of using atypical antipsychotics for BPSD among patients residing in long-term care. Setting Long term care community facility in the United States. Methods Retrospective observational study of patients residing in a long-term care facility with a diagnosis of dementia not trauma-induced with documented BPSD treated with an atypical antipsychotic for at least 2 weeks. Paper medical records were reviewed from January 1, 1990 until March 23, 2010. Main outcome measure Behavioral/psychological efficacy outcomes were documented beginning 2 weeks after atypical antipsychotic therapy was initiated and safety outcomes were documented from the time of atypical antipsychotic initiation, until the last documentation available. Efficacy and safety outcomes were documented as part of routine clinical practice based on the responsible clinician. Results A total of 85 distinct atypical antipsychotic treatment periods for 73 unique patients were included. Nearly 50% of patients continued atypical antipsychotic treatment for at least 1 year and 5.6% of treatments were discontinued due to an adverse event. Patients' behavioral/psychological outcomes improved for 52 (61%) treatments, remained stable for 17 (20%) treatments, and worsened for 16 (19%) treatments. Adverse events were reported by 57% of patients, with the most common adverse events being metabolic, fall related, and extrapyramidal symptoms. The odds ratio for an adverse event was 1.08 (p = 0.03) for every 90 day increase in duration of treatment. Conclusion In patients who reside in a long-term care setting, atypical antipsychotic treatment improved BPSD, but also increased the potential risk of adverse events.
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Affiliation(s)
- A S Sturm
- College of Pharmacy, Ohio State University, Columbus, OH, USA
| | - K E Trinkley
- Skaggs School of Pharmacy and Pharmaceutical Sciences and School of Medicine, University of Colorado, Denver, CO, USA
| | - K Porter
- Center for Biostatistics, Ohio State University, Columbus, OH, USA
| | - Milap C Nahata
- College of Pharmacy, Ohio State University, Columbus, OH, USA.
- Emeritus of Pharmacy, Pediatrics and Internal Medicine, Institute of Therapeutic Innovations and Outcomes, Ohio State University, 500 W. 12th Avenue, Columbus, OH, 43210, USA.
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Nabhan F, Porter K, Senter L, Ringel MD. Anti-thyroglobulin antibodies do not significantly increase the risk of finding iodine avid metastases on post-radioactive iodine ablation scan in low-risk thyroid cancer patients. J Endocrinol Invest 2017; 40:1015-1021. [PMID: 28510122 PMCID: PMC7102497 DOI: 10.1007/s40618-017-0685-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 05/03/2017] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Post-operative thyroglobulin (Tg) levels can predict the likelihood of residual cancer, including distant metastases, thereby influencing postsurgical treatment strategies even in patients with low-risk disease. Circulating anti-thyroglobulin antibodies (anti-Tg Abs) interfere with Tg measurement preventing this clinical use. It is not known if the presence of anti-Tg Abs predicts metastatic disease on post-therapy scan in patients with low-risk disease or if they should influence the use or dose of I-131 therapy. In the present study, we compare post-therapy scans in low-risk patients with and without anti-Tg Abs. METHODS This is a single-institution retrospective study. The study population (Group A) included all patients with low-risk differentiated thyroid cancer (DTC) who underwent total thyroidectomy and RAI between 1/1/2006 to 9/11/2015 with intrathyroidal T1-T2, Nx, N0 or N1a (≤5 nodes all measuring, when reported, <2 mm) that had anti-thyroglobulin antibodies. Patients were excluded if they had known distant metastases and/or extensive vascular invasion. A second group of patients (Group B) treated during the same period but without anti-Tg antibodies was selected to match group A by propensity core matching with a logistic regression model. RESULTS Each group included 37 patients. In group A: Median age was 40 years, 86% female and 76% PTC. Median tumor size was 2 cm (0.2-3.8), 32% had multifocal disease, 16% were N1a and 4% had vascular invasion. Parameters in group B were not statistically different from Group A, as expected based on the selection criteria, except being less likely to have Hashimoto's thyroiditis on pathology (p < 0.001). Post-therapy scan results were compared by Chi-square test with 86% negative post therapy scan frequency in group A and 92% in group B without evidence of a difference (p = 0.45). CONCLUSION In patients with low-risk DTC, anti-Tg Abs did not significantly predict metastatic disease on post-therapy scan. If confirmed, these data suggest that the presence of anti-Tg Abs alone should not influence initial therapy in patients with low-risk DTC.
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Affiliation(s)
- F Nabhan
- Division of Endocrinology, Diabetes, and Metabolism, The Ohio State University Medical Center, The Ohio State University and Arthur G. James Cancer Center, 575 McCampbell Hall, 1581 Dodd Dr, Columbus, OH, 43210, USA.
| | - K Porter
- Center for Biostatistics, Department of Biomedical Informatics, The Ohio State University College of Medicine, Columbus, OH, 43235, USA
| | - L Senter
- Division of Human Genetics, The Ohio State University and Arthur G. James Cancer Center, Columbus, OH, 43235, USA
| | - M D Ringel
- Division of Endocrinology, Diabetes, and Metabolism, The Ohio State University Medical Center, The Ohio State University and Arthur G. James Cancer Center, 575 McCampbell Hall, 1581 Dodd Dr, Columbus, OH, 43210, USA
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Soodla P, Simmons R, Huik K, Pauskar M, Jõgeda EL, Rajasaar H, Kallaste E, Maimets M, Avi R, Murphy G, Porter K, Lutsar I. HIV incidence in the Estonian population in 2013 determined using the HIV-1 limiting antigen avidity assay. HIV Med 2017; 19:33-41. [PMID: 28762652 DOI: 10.1111/hiv.12535] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2017] [Indexed: 01/30/2023]
Abstract
OBJECTIVES Estonia has one the highest number of new HIV diagnoses in the European Union, mainly among injecting drug users and heterosexuals. Little is known of HIV incidence, which is crucial for limiting the epidemic. Using a recent HIV infection testing algorithm (RITA) assay, we aimed to estimate HIV incidence in 2013. METHODS All individuals aged ≥18 years newly-diagnosed with HIV in Estonia January- December 2013, except blood donors and those undergoing antenatal screening, were included. Demographic and clinical data were obtained from the Estonian Health Board and the Estonian HIV-positive patient database. Serum samples were tested for recent infection using the LAg-avidity EIA assay. HIV incidence was estimated based on previously published methods. RESULTS Of 69,115 tested subjects, 286 (0.41%) were newly-diagnosed with HIV with median age of 33 years (IQR: 28-42) and 65% male. Self-reported routes of HIV transmission were mostly heterosexual contact (n = 157, 53%) and injecting drug use (n = 62, 21%); 64 (22%) were with unknown risk group. Eighty two (36%) were assigned recent, resulting in estimated HIV incidence of 0.06%, corresponding to 642 new infections in 2013 among the non-screened population. Incidence was highest (1.48%) among people who inject drugs. CONCLUSIONS These high HIV incidence estimates in Estonia call for urgent action of renewed targeted public health promotion and HIV testing campaigns.
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Affiliation(s)
- P Soodla
- Department of Microbiology, Faculty of Medicine, University of Tartu, Tartu, Estonia
| | - R Simmons
- University College London, London, UK
| | - K Huik
- Department of Microbiology, Faculty of Medicine, University of Tartu, Tartu, Estonia
| | - M Pauskar
- Department of Microbiology, Faculty of Medicine, University of Tartu, Tartu, Estonia
| | - E-L Jõgeda
- Department of Microbiology, Faculty of Medicine, University of Tartu, Tartu, Estonia
| | - H Rajasaar
- Department of Microbiology, Faculty of Medicine, University of Tartu, Tartu, Estonia
| | - E Kallaste
- Department of Microbiology, Faculty of Medicine, University of Tartu, Tartu, Estonia
| | - M Maimets
- Department of Infectious Diseases, Tartu University Hospital, Tartu, Estonia
| | - R Avi
- Department of Microbiology, Faculty of Medicine, University of Tartu, Tartu, Estonia
| | - G Murphy
- Public Health England, London, UK
| | - K Porter
- University College London, London, UK
| | - I Lutsar
- Department of Microbiology, Faculty of Medicine, University of Tartu, Tartu, Estonia
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Porter K, Lepore M, Scales K, Corazzini K, McConnell E, Thach T, Song Y, Anderson R. CARE PLANNING IN U.S. NURSING HOMES, A FRAMEWORK FOR PERSON-DIRECTED CARE PLANNING (PDCP). Innov Aging 2017. [DOI: 10.1093/geroni/igx004.3288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- K. Porter
- RTI International, Research Triangle Park, North Carolina,
| | - M. Lepore
- RTI International, Research Triangle Park, North Carolina,
| | - K. Scales
- Duke University School of Nursing,
Durham, North Carolina,
- Center for the Study of Aging and Human Development, Duke University, Durham, North Carolina,
| | - K.N. Corazzini
- Duke University School of Nursing,
Durham, North Carolina,
- Center for the Study of Aging and Human Development, Duke University, Durham, North Carolina,
| | - E.S. McConnell
- Duke University School of Nursing,
Durham, North Carolina,
- Center for the Study of Aging and Human Development, Duke University, Durham, North Carolina,
- Department of Veterans Affairs Medical Center, Durham, North Carolina,
| | - T. Thach
- RTI International, Research Triangle Park, North Carolina,
| | - Y. Song
- Duke University School of Nursing,
Durham, North Carolina,
| | - R.A. Anderson
- University of North Carolina School of Nursing,
Chapel Hill, North Carolina
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18
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Lepore M, Knowles M, Porter K, Wiener J. MEDICAID BENEFICIARIES’ ACCESS TO RESIDENTIAL CARE SETTINGS. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.1984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- M. Lepore
- RTI International, Washington, District of Columbia
| | - M. Knowles
- RTI International, Washington, District of Columbia
| | - K. Porter
- RTI International, Washington, District of Columbia
| | - J.M. Wiener
- RTI International, Washington, District of Columbia
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19
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Batehup L, Porter K, Gage H, Williams P, Simmonds P, Lowson E, Dodson L, Davies NJ, Wagland R, Winter JD, Richardson A, Turner A, Corner JL. Follow-up after curative treatment for colorectal cancer: longitudinal evaluation of patient initiated follow-up in the first 12 months. Support Care Cancer 2017; 25:2063-2073. [PMID: 28197848 PMCID: PMC5445145 DOI: 10.1007/s00520-017-3595-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 01/23/2017] [Indexed: 11/20/2022]
Abstract
PURPOSE To compare patient-triggered follow-up (PTFU) for curatively treated colorectal cancer against traditional outpatient follow-up (OPFU). METHODS Questionnaires were mailed at four time points over one-year post-treatment to two prospectively-recruited cohorts: A, patients entering follow-up and receiving OPFU pre-implementation of PTFU; B, patients entering follow-up (FU) and receiving either OPFU (B1) or PTFU (B2) post-implementation of PTFU. Bi-variate tests were used to compare patient characteristics and outcomes eight months after entering follow-up (generic and cancer-specific quality of life (QoL), satisfaction). Regression analysis explored associations between follow-up model and outcomes. Resource implications and costs of models were compared. RESULTS Patients in Cohort B1 were significantly more likely to have received chemotherapy (p < 0.001), radiotherapy (p < 0.05), and reported poorer QoL (p = 0.001). Having a longstanding co-morbid condition was the most important determinant of QoL (p < 0.001); model of care was not significant. Patients were satisfied with their follow-up care regardless of model. Health service costs were higher in PTFU over the first year CONCLUSIONS: PTFU is acceptable to patients with colorectal cancer and can be considered to be a realistic alternative to OPFU for clinically suitable patients. The initial costs are higher due to provision of a self-management (SM) programme and remote surveillance. Further research is needed to establish long-term outcomes and costs.
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Affiliation(s)
- L Batehup
- Health Sciences, Nightingale Building, University of Southampton, Highfield, Southampton, Hampshire, SO17 1BJ, UK.
| | - K Porter
- Health Sciences, Nightingale Building, University of Southampton, Highfield, Southampton, Hampshire, SO17 1BJ, UK
| | - H Gage
- School of Economics, University of Surrey, Guildford, Surrey, GU2 7XH, UK
| | - P Williams
- Department of Mathematics, University of Surrey, Guildford, Surrey, GU2 7XH, UK
| | - P Simmonds
- Cancer Research UK, Clinical Research Unit, University of Southampton, Tremona Road, Southampton, Hampshire, SO16 6YD, UK
| | - E Lowson
- Health Sciences, Nightingale Building, University of Southampton, Highfield, Southampton, Hampshire, SO17 1BJ, UK
| | - L Dodson
- Health Sciences, Nightingale Building, University of Southampton, Highfield, Southampton, Hampshire, SO17 1BJ, UK
| | - N J Davies
- Health Psychology Consultancy Ltd., Staffordshire, UK
| | - R Wagland
- Health Sciences, Nightingale Building, University of Southampton, Highfield, Southampton, Hampshire, SO17 1BJ, UK
| | - J D Winter
- University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, Hampshire, SO16 6YD, UK
| | - A Richardson
- Health Sciences, Nightingale Building, University of Southampton, Highfield, Southampton, Hampshire, SO17 1BJ, UK
- University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, Hampshire, SO16 6YD, UK
| | - A Turner
- Centre for Technology Enabled Health Research, Faculty of Health and Life Sciences, Coventry University, Priory Street, Coventry, CV1 5FB, UK
| | - J L Corner
- The University of Nottingham, Executive Office, Trent Building, University Park, Nottingham, NG7 2RD, UK
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Waller A, Lundberg J, Porter K, Hwang S, Hastings J, Haverkos B, Brammer J, Fabbro S, William B, Dotson E, Porcu P. GEMCITABINE PLUS LIPOSOMAL DOXORUBICIN FOR RELAPSED REFRACTORY T-CELL LYMPHOMAS. Hematol Oncol 2017. [DOI: 10.1002/hon.2439_166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- A. Waller
- Department of Pharmacy; The James Cancer Hospital and Solove Research Institute at The Ohio State University; Columbus USA
| | - J. Lundberg
- Department of Pharmacy; The James Cancer Hospital and Solove Research Institute at The Ohio State University; Columbus USA
| | - K. Porter
- Center for Biostatistics; The Ohio State University; Columbus USA
| | - S. Hwang
- Division of Hematology; The James Cancer Hospital and Solove Research Institute at The Ohio State University; Columbus USA
| | - J. Hastings
- Division of Dermatology; The James Cancer Hospital and Solove Research Institute at The Ohio State University; Columbus USA
| | - B. Haverkos
- Division of Hematology; University of Colorado School of Medicine; Aurora USA
| | - J. Brammer
- Division of Hematology; The James Cancer Hospital and Solove Research Institute at The Ohio State University; Columbus USA
| | - S. Fabbro
- Division of Dermatology; The James Cancer Hospital and Solove Research Institute at The Ohio State University; Columbus USA
| | - B.M. William
- Division of Hematology; The James Cancer Hospital and Solove Research Institute at The Ohio State University; Columbus USA
| | - E. Dotson
- Department of Pharmacy; The James Cancer Hospital and Solove Research Institute at The Ohio State University; Columbus USA
| | - P. Porcu
- Division of Hematologic Malignancies; Sidney Kimmel Cancer Center at Jefferson; Philadelphia USA
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21
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Fox N, Tuck J, Chandler J, Greenwood S, May P, Porter K, Sargeant S. 74ADVANCED NURSE PRACTITIONER-LED AMBULATORY CARE FOR OLDER PEOPLE: SAFE AND EFFECTIVE. Age Ageing 2017. [DOI: 10.1093/ageing/afx055.74] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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22
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Battaloglu E, Porter K. Management of pregnancy and obstetric complications in prehospital trauma care: faculty of prehospital care consensus guidelines. Emerg Med J 2017; 34:318-325. [PMID: 28264877 DOI: 10.1136/emermed-2016-205978] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 10/14/2016] [Accepted: 10/30/2016] [Indexed: 11/04/2022]
Abstract
This consensus statement seeks to provide clear guidance for the management of pregnant trauma patients in the prehospital setting. Pregnant patients sustaining trauma injuries have certain clinical management priorities beyond that of the non-pregnant trauma patients and that if overlooked may be detrimental to maternal and fetal outcomes.
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Affiliation(s)
- E Battaloglu
- Academic Department of Clinical Traumatology, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - K Porter
- Academic Department of Clinical Traumatology, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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23
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Abstract
A fracture through the pars interarticularis of the axis is colloquially known as the ‘hangman’s fracture’. The origin of the name is self-explanatory; however, in modern times the hangman’s fracture is rarely seen in suicide by hanging. This short article aimed at the non-spinal surgeon will take the reader through a brief timeline from the days of capital punishment to the modern day road traffic collision and the management of the hangman’s fracture.
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Affiliation(s)
| | | | - K Porter
- Major Trauma Service, Queen Elizabeth Hospital Birmingham, UK
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24
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Abstract
The acromioclavicular joint is involved in four out of ten shoulder injuries. The joint is prone to injury due to its anatomy and relative lack of soft tissue cover. Sportsmen involved in contact sports are likely to suffer damage to the joint during their professional careers. Most subluxations of the joint can be treated nonoperatively whilst dislocations are generally treated operatively except in those individuals at significant risk of re-injury, for example, rugby players. This article looks at the anatomy and physiology of the acromioclavicular joint, injury classification and presents the current evidence regarding treatment options for these injuries.
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Affiliation(s)
- J Rollo
- University Hospitals Birmingham NHS Trust, Birmingham, UK
| | - J Raghunath
- University College London NHS Trust, London, UK
| | - K Porter
- University Hospitals Birmingham NHS Trust, Birmingham, UK,
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25
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Martin G, Gossez M, Williams J, Stöhr W, Meyerowitz J, Leitman E, Ramjee G, Porter K, Fidler S, Frater J. 4 Post-treatment control or treated controllers? The impact of ART on time to viral rebound in recent seroconverters. J Virus Erad 2016. [DOI: 10.1016/s2055-6640(20)30949-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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26
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Abstract
In the abrupt vertical deceleration that occurs on impact after a free fall, tissue damage is caused by the absorption by the body of the energy accumulated during the free fall. Patients sustain a unique injury pattern that is predicatably different from that seen with other forms of blunt multiple trauma. The present paper reviews the pathophysiology and pattern of injury sustained following free fall.
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Affiliation(s)
- S Tan
- South Birmingham Trauma Unit, Selly Oak Hospital, Birmingham, UK,
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27
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Abstract
The nail is unique to primates as a specialized structure on the dorsum of the distal portion of each finger, thumb and toe. The nail allows for increased sensory perception on the volar pulp by compressing sensory organs against the unyielding nail. The nail is vital for increased prehension which is so unique in primate function. In addition it protects the fingertip and also serves as a temperature regulator.Fingertips are often our first contact with the environment, are one of the most common injuries presenting to a hand surgeon and may seriously impair the abilities of individuals if injured. The fingertip is the most sensitive part of the hand and has a large area of representation in the sensory cortex.The severity of injury to the nail bed is commonly underestimated because the nail conceals the true extent of injury. The consequences of mismanaged fingertip injuries is often manifest in the form of chronic nail and fingertip deformities, which are more difficult to treat than the original injury. It is therefore important for junior doctor to competently assess the patient, appreciate the potential disabilities and to arrange prompt referral to a hand unit. This article discusses the relevant anatomy, physiology and management of acute perionychial injuries.
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Affiliation(s)
- J Chakravarthy
- South Birmingham Trauma Unit, Selly Oak Hospital, Birmingham, UK,
| | - A Qureshi
- South Birmingham Trauma Unit, Selly Oak Hospital, Birmingham, UK
| | - M A Waldram
- South Birmingham Trauma Unit, Selly Oak Hospital, Birmingham, UK
| | - K Porter
- South Birmingham Trauma Unit, Selly Oak Hospital, Birmingham, UK
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28
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Abstract
Acute compartment syndrome of the limb is an orthopaedic surgical emergency. Delay in its recognition and treatment can result in serious morbidity. The aetiology, diagnosis and management of this condition are discussed in this review article.
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Affiliation(s)
- E. Shears
- SPR Trauma and Orthopaedics, University Hospital Birmingham Foundation NHS Trust, Birmingham, UK,
| | - K. Porter
- Clinical Traumatology, University Hospital Birmingham Foundation NHS Trust, Birmingham, UK
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29
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Abstract
Limb trauma is probably the commonest injury that a pre-hospital carer will encounter. In isolation it is rarely life threatening and it should be remembered that the care of the airway, breathing and circulation must taken precedence. Exceptionally a limb injury influences the care of the above, for example external blood loss from a injury that requires immediate haemorrhage control. Limb injuries may pose multiple problems to pre-hospital care personnel particularly with regard to immobilization, appropriate pain relief and subsequent safe painless extrication.
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Affiliation(s)
- M Green
- Selly Oak Hospital, Birmingham, UK
| | | | - K Porter
- Selly Oak Hospital, Birmingham, UK
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30
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Abstract
A review of the literature underpinning modern triage methodology is presented. The philosophy and history is described prior to a review of triage scoring methodology relevant to modern day practice. The importance of triage is most acute during major incidents and the triage process is highlighted within this framework. Triage has wide-ranging applications throughout medical practice and these are included as part of the discussion.
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Affiliation(s)
- M. O'Meara
- Porter K, O'Meara M. Academic department of traumatology, University of Birmingham, Vincent Drive, Birmingham
| | - K. Porter
- Porter K, O'Meara M. Academic department of traumatology, University of Birmingham, Vincent Drive, Birmingham,
| | - I. Greaves
- Greaves I, Department of Academic Emergency medicine, James Cook University Hospital, Middlesbrough
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31
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Abstract
Before attempting to treat ankle fractures it is vital to appreciate the normal functional anatomy of this complex joint. The objectives of treatment, as with all fracture management, are to restore the anatomy and return normal function to the injured joint. This article describes the functional anatomy of the ankle and the epidemiology, assessment and definitive management required for a routine ankle fracture.
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Affiliation(s)
- R.W. Westerman
- Department of Clinical Traumatology, Selly Oak Hospital, University Hospital Birmingham NHS Foundation Trust, Selly Oak, Birmingham, B29 6JD, UK,
| | - K. Porter
- Department of Clinical Traumatology, Selly Oak Hospital, University Hospital Birmingham NHS Foundation Trust, Selly Oak, Birmingham, B29 6JD, UK
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Simmons R, Kall M, Collins S, Cairns G, Taylor S, Nelson M, Fidler S, Porter K, Fox J. A global survey of HIV-positive people's attitudes towards cure research. HIV Med 2016; 18:73-79. [PMID: 27167600 DOI: 10.1111/hiv.12391] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Involvement of people living with HIV (PLHIV) in the design of HIV cure studies is important, given the potential risks to participants. We present results of an international survey of PLHIV to define these issues and inform cure research. METHODS PLHIV were recruited in June-November 2014 through HIV websites, advocacy forums, social media and 12 UK HIV clinics. The survey included questions concerning demographics, HIV disease history, the desirability of types of cure and the patient's willingness to accept potential toxicity and treatment interruption (TI). We examined factors associated with TI and willingness to accept substantial risks. RESULTS A total of 982 PLHIV completed the survey; 87% were male, 79% white and 81% men who have sex with men (MSM). Fifty-one per cent were aged 25-44 years and 69% were UK residents. The median time since diagnosis was 7 years [interquartile range (IQR) 2-17 years]. Eighty-eight per cent were receiving antiretrovirals (91% reported undetectable viral load). Health/wellbeing improvements (96%) and an inability to transmit HIV (90%) were more desirable cure characteristics than testing HIV-negative (69%). Ninety-five per cent were interested in participating in cure studies, and 59% were willing to accept substantial risks. PLHIV with a low CD4 count [201-350 cells/μL vs. ≥ 350 cells/μL; odds ratio (OR) 2.11; 95% confidence interval (CI) 1.11-4.00] were more likely to accept risks, whereas those with limited knowledge of HIV treatments vs. excellent/good knowledge and those aged ≥ 65 years vs. 45-64 years were less likely to accept risks [OR 0.58 (95% CI 0.37-0.90) and OR 0.18 (95% CI 0.07-0.45), respectively]. TI was acceptable for 62% of participants, with the main concerns being becoming unwell (82%), becoming infectious (76%) and HIV spreading through the body (76%). CONCLUSIONS Cure research was highly acceptable to the PLHIV surveyed. Most individuals would accept risks, including TI, even in the absence of personal benefit. An optimal cure would improve health and minimize onward transmission risk.
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Affiliation(s)
- R Simmons
- MRC, Clinical Trials Unit University College, London, UK
| | - M Kall
- Public Health England, London, UK
| | | | | | - S Taylor
- Birmingham Heartlands Hospital, Birmingham, UK
| | - M Nelson
- Chelsea and Westminster Hospital, London, UK
| | | | - K Porter
- MRC, Clinical Trials Unit University College, London, UK
| | - J Fox
- Guy's and St Thomas' Hospital, London, UK
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Penn-Barwell JG, Sargeant ID, Bennett P, Fries C, Kendrew J, Midwinter M, Bishop J, Rickard R, Sargeant I, Porter K, Rowlands T, Mountain A, Kay A, Mortiboy D, Stevenson T, Myatt R. Gun-shot injuries in UK military casualties - Features associated with wound severity. Injury 2016; 47:1067-71. [PMID: 26948689 DOI: 10.1016/j.injury.2016.02.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2015] [Accepted: 02/07/2016] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Surgical treatment of high-energy gun-shot wounds (GSWs) to the extremities is challenging. Recent surgical doctrine states that wound tracts from high-energy GSWs should be laid open, however the experience from previous conflicts suggests that some of these injuries can be managed more conservatively. The aim of this study is to firstly characterise the GSW injuries sustained by UK forces, and secondly test the hypothesis that the likely severity of GSWs can be predicted by features of the wound. METHODS The UK Military trauma registry was searched for cases injured by GSW in the five years between 01 January 2009 and 31 December 2013: only UK personnel were included. Clinical notes and radiographs were then reviewed. Features associated with energy transfer in extremity wounds in survivors were further examined with number of wound debridements used as a surrogate marker of wound severity. RESULTS There were 450 cases who met the inclusion criteria. 96 (21%) were fatally injured, with 354 (79%) surviving their injuries. Casualties in the fatality group had a median New Injury Severity Score (NISS) of 75 (IQR 75-75), while the median NISS of the survivors was 12 (IQR 4-48) with 10 survivors having a NISS of 75. In survivors the limbs were most commonly injured (56%). 'Through and through' wounds, where the bullet passes intact through the body, were strongly associated with less requirement for debridement (p<0.0001). When a bullet fragmented there was a significant association with a requirement for a greater number of wound debridements (p=0.0002), as there was if a bullet fractured a bone (p=0.0006). CONCLUSIONS More complex wounds, as indicated by the requirement for repeated debridements, are associated with injuries where the bullet does not pass straight through the body, or where a bone is fractured. Gunshot wounds should be assessed according to the likely energy transferred, extremity wounds without features of high energy transfer do not require extensive exploration.
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Affiliation(s)
- Jowan G Penn-Barwell
- Institute of Naval Medicine, Trauma and Orthopaedic Registrar Royal Navy, United Kingdom.
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34
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Abstract
The clay-shoveler’s fracture is a stable oblique fracture through the spinous process of a lower cervical vertebra, classically C6 or C7. Diagnosed on plain radiograph, computed tomography and occasionally magnetic resonance imaging, the injury is most commonly seen in road traffic collisions in the modern-day. A stable injury, the clay-shoveler’s fracture is managed non-operatively and requires symptomatic treatment only. This short article examines the history surrounding the injury and provides a comprehensive overview of the clay-shoveler’s fracture for the non-spinal surgeon.
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Affiliation(s)
- E Toman
- NIHR Surgical Reconstruction and Microbiology Research Centre, Birmingham, UK
| | - A Beaven
- NIHR Surgical Reconstruction and Microbiology Research Centre, Birmingham, UK
| | - S Harland
- Queen Elizabeth Hospital Birmingham, UK
| | - K Porter
- Major Trauma Service, Queen Elizabeth Hospital Birmingham, UK
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35
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Sinnott JD, Morris G, Medland PJ, Porter K. High-velocity facial gunshot wounds: multidisciplinary care from prehospital to discharge. BMJ Case Rep 2016; 2016:bcr-2015-213268. [PMID: 26823355 DOI: 10.1136/bcr-2015-213268] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A case is presented in which a high velocity rifle (shotgun) was fired into the inferior part of a patient's face in an attempted suicide causing widespread trauma to the inferior and left side of the patient's face. He presented to his general practitioner where an ambulance was called. The patient is followed from prehospital care (air ambulance) to resuscitation in accident and emergency and through the first stages of reconstructive surgery. The article focuses on the multidisciplinary approach to the patient's prehospital care and initial resuscitation at a major trauma centre. CT reconstruction images of the patient's skull allow visualisation of the extent of bone damage at presentation. Medical photography allows visualisation of the extent of the initial damage and shows how reconstructive surgery was undertaken early and in progressive stages. A literature review was performed allowing discussion of the current evidence and best practice in the management of facial gunshot wounds.
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Affiliation(s)
- J D Sinnott
- East Sussex Healthcare Trust, Eastbourne, UK
| | | | - P J Medland
- East Sussex Healthcare Trust, Eastbourne, UK
| | - K Porter
- University Hospital Birmingham, Birmingham, UK
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36
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Mussini C, Antinori A, Bhagani S, Branco T, Brostrom M, Dedes N, Bereczky T, Girardi E, Gökengin D, Horban A, Lacombe K, Lundgren JD, Mendao L, Mocroft A, Oprea C, Porter K, Podlekareva D, Battegay M, d'Arminio Monforte A. European AIDS Clinical Society Standard of Care meeting on HIV and related coinfections: The Rome Statements. HIV Med 2015; 17:445-52. [PMID: 26492497 DOI: 10.1111/hiv.12347] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2015] [Indexed: 11/27/2022]
Abstract
OBJECTIVES The objective of the 1st European AIDS Clinical Society meeting on Standard of Care in Europe was to raise awareness of the European scenario and come to an agreement on actions that could be taken in the future. METHODS Data-driven presentations were given on specific topics followed by interactive panel discussions. RESULTS In Eastern European countries, the epidemic is largely driven by injecting drug use, in contrast with Western Europe where the infection mainly occurs through heterosexual contact. A high proportion of people living with HIV remain unaware of their infection. Substantial differences exist in Eastern Europe and Central Asia with respect to treatment coverage, regimen availability and continuity of drug supply. In 2012, tuberculosis case notification rates were 5-10 times higher in Eastern Europe compared with Western Europe, with an alarming proportion of newly diagnosed multi-drug-resistant cases. Hepatitis C is widespread in selected geographical areas and risk groups. CONCLUSIONS The key conclusion from the meeting was that a high-priority group of actions could be identified, including: increasing HIV awareness and testing, improving training for health care providers, ensuring equitable patient access to treatments and diagnostics for HIV and comorbidities, and implementing best practices in infection control and treatment of HIV-infected patients coinfected with tuberculosis and hepatitis C virus, for whom direct acting antiviral treatment. should be considered.
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Affiliation(s)
- C Mussini
- University of Modena and Reggio Emilia, Modena, Italy
| | - A Antinori
- National Institute for Infectious Disease 'L. Spallanzani', Rome, Italy
| | - S Bhagani
- University College London, London, UK
| | - T Branco
- Department of Infectious Diseases, Hospital Center, Lisbon, Portugal
| | | | | | | | - E Girardi
- National Institute for Infectious Disease 'L. Spallanzani', Rome, Italy
| | | | - A Horban
- Warsaw Medical University and Hospital of Infectious Diseases, Warsaw, Poland
| | | | - J D Lundgren
- Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | | | - A Mocroft
- University College London, London, UK
| | - C Oprea
- Victor Babes Hospital, Bucharest, Romania
| | - K Porter
- University College London, London, UK
| | - D Podlekareva
- Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - M Battegay
- University Hospital of Basel, Basel, Switzerland
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Abstract
This paper outlines the emerging best practice when packaging a prehospital trauma patient while providing spinal immobilisation. The best practice described is based on the recommendations of a consensus meeting held by the Faculty of Pre-Hospital Care, Royal College of Surgeons of Edinburgh, in the West Midlands in April 2012, where the opinion of experienced practitioners from across the prehospital and emergency care community considered the currently available evidence and reviewed current clinical practice. Initial consensus points were then subject to further review and dialogue with stakeholders from the initial meeting. The recommendations drawn from the meeting and subsequent dialogue represent a 'general agreement' to the principles and practices described in the paper. The recommendations will provide guidance for clinical practice and governance alongside other consensus statements from the Faculty of Pre-Hospital Care that seek to address prehospital spinal immobilisation and pelvic immobilisation.
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Affiliation(s)
- R Moss
- Department of Anaesthetics, University Hospital of North Staffordshire, , Stoke on Trent, UK
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Affiliation(s)
- R Moss
- Department of Anaesthesia, University Hospital of North Staffordshire, , Stoke on Trent, UK
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Abstract
This paper reviews the current evidence available on the practice of spinal immobilisation in the prehospital environment. Following this, initial conclusions from a consensus meeting held by the Faculty of Pre-hospital Care, Royal College of Surgeons of Edinburgh in March 2012 are presented.
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Affiliation(s)
- D Connor
- Department of Emergency Medicine, Southampton General Hospital, , Southampton, UK
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Nassimizadeh A, Taki H, Nassimizadeh M, Senanayake EL, Graham T, Porter K. Occult pneumothoraces – red flag or red herring? Trauma 2015. [DOI: 10.1177/1460408614568828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Pneumothorax is a relatively common complication following blunt chest trauma; however, the investigation and management of these injuries remains a contentious issue. Occult pneumothoraces are those not diagnosed by conventional radiographic imaging, but by subsequent computed tomography. This review examines the current evidence base behind the investigation and management of this condition. An anteroposterior chest x-ray should not be underestimated in its ability to provide sufficient radiological information to instigate an initial management plan in the trauma setting. Ultrasound has a high diagnostic rate for pneumothoraces; however, it is subjected to influence from other injuries, whilst failing to address other important injuries in trauma patients requiring computed tomography imaging. It is therefore best used in situations where computed tomography is unavailable or contraindicated. In the management of occult pneumothoraces, there is little difference in patient outcome between those managed conservatively or with a prophylactic chest drain. Clinicians must be wary of recommendations which in this area are often based on inadequate study size and they should continue to provide the best individual care on a case-by-case basis. Observation alone in patients that are haemodynamically stable can be considered, with a view to drainage of the pneumothorax should the clinical status of the patient deteriorate.
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Affiliation(s)
| | - H Taki
- Department of Orthopaedics, Queen Elizabeth Hospital, Birmingham, UK
| | - M Nassimizadeh
- Department of Plastic Surgery, Queen Elizabeth Hospital, Birmingham, UK
| | - EL Senanayake
- Cardiothoracic Surgery, Queen Elizabeth Hospital, Birmingham, UK
| | - T Graham
- Cardiothoracic Surgery, Queen Elizabeth Hospital, Birmingham, UK
| | - K Porter
- Department of Traumatology, Queen Elizabeth Hospital, Birmingham, UK
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Scott I, Porter K, Laird C, Greaves I, Bloch M. The prehospital management of pelvic fractures: initial consensus statement. Trauma 2015. [DOI: 10.1177/1460408614556442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- I Scott
- Department of Anaesthesia, Aberdeen Royal Infirmary, Aberdeen, UK
| | - K Porter
- Department of Trauma, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - C Laird
- Faculty of Pre-Hospital Care, Royal College of Surgeons of Edinburgh, Edinburgh, UK
| | - I Greaves
- Department of Emergency Medicine, James Cook University Hospital, Middlesborough, UK
| | - M Bloch
- Department of Anaesthesia, Aberdeen Royal Infirmary, Aberdeen, UK
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Jarrett N, Porter K, Davis C, Lathlean J, Duke S, Corner J, Addington-Hall J. Palliative care patients' perceptions of the work involved in understanding and managing the network of care provision surrounding them. BMJ Support Palliat Care 2015; 7:133-139. [PMID: 25829381 DOI: 10.1136/bmjspcare-2014-000781] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Revised: 02/17/2015] [Accepted: 03/11/2015] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To explore the work carried out for cancer palliative care patients in understanding and dealing with the often large network of care provision surrounding them. METHOD Qualitative thematic analysis of interviews with 24 patients (aged 48-85 years) with 15 different types/sites of cancer and palliative care needs. RESULTS The main theme of 'patient work-their strategies and project management' is presented. Subthemes included: being organised and keeping records; planning ahead and coordinating care; information gathering; understanding the hierarchy and knowing who the key people are; strategies to remember names and roles; understanding and 'working the system'. Insights are given into the work carried out on patients' behalf by family, although it was unclear who would do this work if no family was available. Some of the challenges faced by patients and families are identified. These included limited information; uncertainty when care is transferred between different teams or locations; deciding who to contact and how; and negotiating through gatekeepers. CONCLUSIONS The number and variety of people contributing to the care of a cancer palliative care patient can be difficult for patients and family to comprehend. Work is required by patients or family on their behalf to achieve the level of understanding required to become accomplished at navigating the system and project managing their care organisation, and is probably influenced by role expectations and previous experience. Much of this additional, often hidden, workload for patients and family could probably be reduced with clear, timely information provision by health professionals.
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Affiliation(s)
- N Jarrett
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - K Porter
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - C Davis
- Countess Mountbatten House, Moorgreen Hospital and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - J Lathlean
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - S Duke
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - J Corner
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - J Addington-Hall
- Faculty of Health Sciences, University of Southampton, Southampton, UK
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Jarrett N, Porter K, Davis C, Addington-Hall J, Duke S, Corner J, Lathlean J. The networks of care surrounding cancer palliative care patients. BMJ Support Palliat Care 2015; 5:435-42. [PMID: 25812576 DOI: 10.1136/bmjspcare-2014-000782] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Accepted: 03/11/2015] [Indexed: 11/04/2022]
Affiliation(s)
- N Jarrett
- Faculty of Health Sciences, Centre for Innovation and Leadership in Health Sciences, University of Southampton, Southampton, Hants, UK
| | - K Porter
- Faculty of Health Sciences, Centre for Innovation and Leadership in Health Sciences, University of Southampton, Southampton, Hants, UK
| | - C Davis
- Countess Mountbatten House, Moorgreen Hospital and University Hospital Southampton NHS Foundation Trust, Southampton, Hants, UK
| | - J Addington-Hall
- Faculty of Health Sciences, Centre for Innovation and Leadership in Health Sciences, University of Southampton, Southampton, Hants, UK
| | - S Duke
- Faculty of Health Sciences, Centre for Innovation and Leadership in Health Sciences, University of Southampton, Southampton, Hants, UK
| | - J Corner
- Faculty of Health Sciences, Centre for Innovation and Leadership in Health Sciences, University of Southampton, Southampton, Hants, UK
| | - J Lathlean
- Faculty of Health Sciences, Centre for Innovation and Leadership in Health Sciences, University of Southampton, Southampton, Hants, UK
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Penn-Barwell JG, Myatt RW, Bennett PM, Sargeant ID, Bennett P, Fries C, Myatt R, Kendrew J, Midwinter M, Rickard R, Sargeant I, Porter K, Rowlands T, Mountain A, Foster M, Stapley S, Mortiboy D, Bishop J. Medium-term outcomes following limb salvage for severe open tibia fracture are similar to trans-tibial amputation. Injury 2015; 46:288-91. [PMID: 25548111 DOI: 10.1016/j.injury.2014.12.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2014] [Revised: 10/19/2014] [Accepted: 12/04/2014] [Indexed: 02/02/2023]
Abstract
Extremity injuries define the surgical burden of recent conflicts. Current literature is inconclusive when assessing the merits of limb salvage over amputation. The aim of this study was to determine medium term functional outcomes in military casualties undergoing limb salvage for severe open tibia fractures, and compare them to equivalent outcomes for unilateral trans-tibial amputees. Cases of severe open diaphyseal tibia fractures sustained in combat between 2006 and 2010, as described in a previously published series, were contacted. Consenting individuals conducted a brief telephone interview and were asked to complete a SF-36 questionnaire. These results were compared to a similar cohort of 18 military patients who sustained a unilateral trans-tibial amputation between 2004 and 2010. Forty-nine patients with 57 severe open tibia fractures met the inclusion criteria. Telephone follow-up and SF-36 questionnaire data was available for 30 patients (61%). The median follow-up was 4 years (49 months, IQR 39-63). Ten of the 30 patients required revision surgery, three of which involved conversion from initial fixation to a circular frame for non- or mal-union. Twenty-two of the 30 patients (73%) recovered sufficiently to complete an age-standardised basic military fitness test. The median physical component score of SF-36 in the limb salvage group was 46 (IQR 35-54) which was similar to the trans-tibial amputation cohort (p=0.3057, Mann-Whitney). Similarly there was no difference in mental component scores between the limb salvage and amputation groups (p=0.1595, Mann-Whitney). There was no significant difference in the proportion of patients in either the amputation or limb salvage group reporting pain (p=0.1157, Fisher's exact test) or with respect to SF-36 physical pain scores (p=0.5258, Mann-Whitney). This study demonstrates that medium term outcomes for military patients are similar following trans-tibial amputation or limb salvage following combat trauma.
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Affiliation(s)
- J G Penn-Barwell
- National Institute of Health Research, Surgical Reconstruction and Microbiology Research Centre (NIHR SRMRC), Birmingham, UK; Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine (RCDM), Birmingham, UK.
| | - R W Myatt
- Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine (RCDM), Birmingham, UK
| | - P M Bennett
- Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine (RCDM), Birmingham, UK
| | - I D Sargeant
- Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine (RCDM), Birmingham, UK; Queen Elizabeth's Hospital, Birmingham, UK
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Affiliation(s)
- R Moss
- Department of Anaesthetics, University Hospital of North Staffordshire, Stoke on Trent, UK
| | - K Porter
- Department of Trauma, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - I Greaves
- Department of Emergency Medicine, James Cook University Hospital Middlesborough, Middlesborough, UK
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Affiliation(s)
- R Moss
- Department of Anaesthesia, University Hospital of North Staffordshire, Stoke on Trent, UK
| | - K Porter
- Department of Trauma, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - I Greaves
- Department of Emergency Medicine, James Cook University Hospital Middlesbrough, Middlesbrough, UK
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Penn-Barwell JG, Bennett PM, Kay A, Sargeant ID, Bennett P, Fries C, Cooper J, Kendrew J, Midwinter M, Rickard R, Sargeant I, Porter K, Rowlands T, Mountain A, Kay A, Jeffrey S, Evirviades D, Cubison T. Acute bilateral leg amputation following combat injury in UK servicemen. Injury 2014; 45:1105-10. [PMID: 24598278 DOI: 10.1016/j.injury.2014.01.025] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Revised: 10/27/2013] [Accepted: 01/21/2014] [Indexed: 02/02/2023]
Abstract
BACKGROUND This study aims to characterise the injuries and surgical management of British servicemen sustaining bilateral lower limb amputations. METHODS The UK Military Trauma Registry was searched for all cases of primary bilateral lower limb amputation sustained between March 2004 and March 2010. Amputations were excluded if they occurred more than 7 days after injury or if they were at the ankle or more distal. RESULTS There were 1694 UK military patients injured or killed during this six-year study period. Forty-three of these (2.8%) were casualties with bilateral lower limb amputations. All casualties were men with a mean age of 25.1 years (SD 4.3): all were injured in Afghanistan by Improvised Explosive Devices (IEDs). Six casualties were in vehicles when they were injured with the remaining 37 (80%) patrolling on foot. The mean New Injury Severity Score (NISS) was 48.2 (SD 13.2): four patients had a maximum score of 75. The mean TRISS probability of survival was 60% (SD 39.4), with 18 having a survival probability of less than 50% i.e. unexpected survivors. The most common amputation pattern was bilateral trans-femoral (TF) amputations, which was seen in 25 patients (58%). Nine patients also lost an upper limb (triple amputation): no patients survived loss of all four limbs. In retained upper limbs extensive injuries to the hands and forearms were common, including loss of digits. Six patients (14%) sustained an open pelvic fracture. Perineal/genital injury was a feature in 19 (44%) patients, ranging from unilateral orchidectomy to loss of genitalia and permanent requirement for colostomy and urostomy. The mean requirement for blood products was 66 units (SD 41.7). The maximum transfusion was 12 units of platelets, 94 packed red cells, 8 cryoprecipitate, 76 units of fresh frozen plasma and 3 units of fresh whole blood, a total of 193 units of blood products. CONCLUSIONS Our findings detail the severe nature of these injuries together with the massive surgical and resuscitative efforts required to firstly keep patients alive and secondly reconstruct and prepare them for rehabilitation.
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Affiliation(s)
- J G Penn-Barwell
- Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine (RCDM), Birmingham, UK; Institute of Naval Medicine, Gosport, Hampshire, UK.
| | - P M Bennett
- Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine (RCDM), Birmingham, UK
| | - A Kay
- Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine (RCDM), Birmingham, UK
| | - I D Sargeant
- Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine (RCDM), Birmingham, UK
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Fries CA, Ayalew Y, Penn-Barwell JG, Porter K, Jeffery SLA, Midwinter MJ. Prospective randomised controlled trial of nanocrystalline silver dressing versus plain gauze as the initial post-debridement management of military wounds on wound microbiology and healing. Injury 2014; 45:1111-6. [PMID: 24485549 DOI: 10.1016/j.injury.2013.12.005] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Revised: 09/06/2013] [Accepted: 12/07/2013] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Recent conflicts have been characterised by the use of improvised explosive devices causing devastating injuries, including heavily contaminated wounds requiring meticulous surgical debridement. After being rendered surgical clean, these wounds are dressed and the patient transferred back to the UK for on-going treatment. A dressing that would prevent wounds from becoming colonised during transit would be desirable. The aim of this study was to establish whether using nanocrystalline silver dressings, as an adjunct to the initial debridement, would positively affect wound microbiology and wound healing compared to standard plain gauze dressings. METHODS Patients were prospectively randomised to receive either silver dressings, in a nanocrystalline preparation (Acticoat™), or standard of care dressings (plain gauze) following their initial debridement in the field hospital. On repatriation to the UK microbiological swabs were taken from the dressing and the wound, and an odour score recorded. Wounds were followed prospectively and time to wound healing was recorded. Additionally, patient demographic data were recorded, as well as the mechanism of injury and Injury Severity Score. RESULTS 76 patients were recruited to the trial between February 2010 and February 2012. 39 received current dressings and 37 received the trial dressings. Eleven patients were not swabbed. There was no difference (p=0.1384, Fishers) in the primary outcome measure of wound colonisation between the treatment arm (14/33) and the control arm (20/32). Similarly time to wound healing was not statistically different (p=0.5009, Mann-Whitney). Wounds in the control group were scored as being significantly more malodorous (p=0.002, Mann-Whitney) than those in the treatment arm. CONCLUSIONS This is the first randomised controlled trial to report results from an active theatre of war. Performing research under these conditions poses additional challenges to military clinicians. Meticulous debridement of wounds remains the critical determinant in wound healing and infection and this study did not demonstrate a benefit of nanocrystaline silver dressing in respect to preventing wound colonisation or promoting healing, these dressings do however seem to significantly reduce the unpleasant odour commonly associated with battlefield wounds.
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Affiliation(s)
- C A Fries
- The Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, ICT Centre & NIHR SRMRC, University of Birmingham, Vincent Drive, Birmingham B15 2SQ, UK.
| | - Y Ayalew
- The Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, ICT Centre & NIHR SRMRC, University of Birmingham, Vincent Drive, Birmingham B15 2SQ, UK
| | - J G Penn-Barwell
- The Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, ICT Centre & NIHR SRMRC, University of Birmingham, Vincent Drive, Birmingham B15 2SQ, UK
| | - K Porter
- The Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, ICT Centre & NIHR SRMRC, University of Birmingham, Vincent Drive, Birmingham B15 2SQ, UK; The Queen Elizabeth Hospital, Mindelsohn Way, Edgbaston, Birmingham B15 2TH, UK
| | - S L A Jeffery
- The Queen Elizabeth Hospital, Mindelsohn Way, Edgbaston, Birmingham B15 2TH, UK
| | - M J Midwinter
- The Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, ICT Centre & NIHR SRMRC, University of Birmingham, Vincent Drive, Birmingham B15 2SQ, UK
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Jennison T, Porter K, Rankin P. 71 * A PILOT STUDY OF PATIENTS EXPERIENCES OF HIP FRACTURES. Age Ageing 2014. [DOI: 10.1093/ageing/afu036.71] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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