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Hoyos-Jaramillo A, Palomares R, Bittar J, Divers S, Chamorro M, Berghaus R, Kirks S, Rush J, Edmondson M, Rodriguez A, Gonzalez-Altamiranda E. Clinical status and endoscopy of the upper respiratory tract of dairy calves infected with Bovine viral diarrhea virus 2 and Bovine herpes virus 1 after vaccination and trace minerals injection. Res Vet Sci 2022; 152:582-595. [DOI: 10.1016/j.rvsc.2022.09.026] [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: 05/31/2022] [Revised: 09/19/2022] [Accepted: 09/23/2022] [Indexed: 11/24/2022]
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Ngo V, Chan G, Edmondson M. 470 Financial and Efficacy Analysis of a Centralised Neck of Femur Fracture Service. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.991] [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: 11/14/2022]
Abstract
Abstract
Aim
Osteoporotic fractures are rising in incidence, costing the National Health Service up to £1.1 billion for hospital care. The implementation of the Best Practice Tariff (BPT) of fragility fractures in 2010 created a financial incentive to achieve standards of best practice. In June 2015, a dedicated hip fracture unit (HFU) was set up at Princess Royal Hospital (PRH). The aim of this study is (A) to assess changes in performance to the BPT after the introduction of a dedicated HFU, and (B) whether the performance of a HFU is affected by direct/indirect presentation to the HFU.
Method
The performance of Brighton and Sussex University Hospitals (BSUH) to BPT pre and post HFU was assessed by a retrospective review of BPT performance data between 2015 and 2016. 870 patients who were treated for NOFF at BSUH were reviewed to assess whether the performance of the HFU was impacted by patients presenting either directly (PRH) to the HFU or indirectly (presentation to Royal Sussex County Hospital). Appropriate statistical tests were used to analyse the significant differences between these outcome measures.
Results
The comparison between pre and post HFU showed there was a significant increase in the time between A&E admission to ward, theatre or orthogeriatric (OG) assessment (P < 0.001) in patients presenting indirectly to HFU compared to direct presentations.
Conclusions
Having a HFU is cost neutral, and advantages of HFU include focusing NOFF care which improves in patient care. BPT achievements could be improved by increasing the direct admission of NOFF to the HFU.
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Affiliation(s)
- V Ngo
- Brighton and Sussex University Hospital, Brighton, United Kingdom
| | - G Chan
- Brighton and Sussex University Hospital, Brighton, United Kingdom
| | - M Edmondson
- Brighton and Sussex University Hospital, Brighton, United Kingdom
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Quayle J, Barakat A, Klasan A, Mittal A, Chan G, Gibbs J, Edmondson M, Stott P. Management of peri-prosthetic joint infection and severe bone loss after total hip arthroplasty using a long-stemmed cemented custom-made articulating spacer (CUMARS). BMC Musculoskelet Disord 2021; 22:358. [PMID: 33863329 PMCID: PMC8052787 DOI: 10.1186/s12891-021-04237-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 04/09/2021] [Indexed: 02/02/2023] Open
Abstract
Background There is little evidence on techniques for management of peri-prosthetic infection (PJI) in the context of severe proximal femoral bone loss. Custom-made articulating spacers (CUMARS) utilising cemented femoral stems as spacers was described providing better bone support and longer survival compared to conventional articulating spacers. We retrospectively report our experience managing PJI by adaptation of this technique using long cemented femoral stems where bone loss precludes use of standard stems. Methods Patients undergoing 1st stage revision for infected primary and revision THA using a cemented long stem (> 205 mm) and standard all-polyethylene acetabulum between 2011 and 2018 were identified. After excluding other causes of revision (fractures or aseptic loosening), Twenty-one patients remained out of total 721 revisions. Medical records were assessed for demographics, initial microbiological and operative treatment, complications, eradication of infection and subsequent operations. 2nd stage revision was undertaken in the presence of pain or subsidence. Results Twenty-one patients underwent 1st stage revision with a cemented long femoral stem. Mean follow up was 3.9 years (range 1.7–7.2). Infection was eradicated in 15 (71.4%) patients. Two patients (9.5%) required repeat 1st stage and subsequently cleared their infection. Three patients (14.3%) had chronic infection and are on long term suppressive antibiotics. One patient (4.8%) was lost to follow up before 2 years. Complications occurred in seven patients (33%) during or after 1st stage revision. Where infection was cleared, 2nd stage revision was undertaken in 12 patients (76.5%) at average of 9 months post 1st stage. Five (23.8%) CUMARS constructs remained in-situ at an average of 3.8 years post-op (range 2.6–5.1). Conclusions Our technique can be used in the most taxing of reconstructive scenarios allowing mobility, local antibiotic delivery, maintenance of leg length and preserves bone and soft tissue, factors not afforded by alternative spacer options.
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Affiliation(s)
- J Quayle
- Brighton and Sussex University Hospitals, Brighton, UK.
| | - A Barakat
- Brighton and Sussex University Hospitals, Brighton, UK
| | - A Klasan
- Department for Orthopaedics and Traumatology, Kepler University Hospital GmbH, Krankenhausstrasse 9, 4020, Linz, Austria.,Johannes Kepler University Linz, Altenberger Strasse 69, 4040, Linz, Austria
| | - A Mittal
- Brighton and Sussex University Hospitals, Brighton, UK
| | - G Chan
- Brighton and Sussex University Hospitals, Brighton, UK
| | - J Gibbs
- Brighton and Sussex University Hospitals, Brighton, UK
| | - M Edmondson
- Brighton and Sussex University Hospitals, Brighton, UK
| | - P Stott
- Brighton and Sussex University Hospitals, Brighton, UK
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Chase AP, Kramer SJ, Haëntjens N, Boss ES, Karp‐Boss L, Edmondson M, Graff JR. Evaluation of diagnostic pigments to estimate phytoplankton size classes. Limnol Oceanogr Methods 2020; 18:570-584. [PMID: 33132771 PMCID: PMC7589370 DOI: 10.1002/lom3.10385] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 06/01/2020] [Accepted: 07/11/2020] [Indexed: 05/19/2023]
Abstract
Phytoplankton accessory pigments are commonly used to estimate phytoplankton size classes, particularly during development and validation of biogeochemical models and satellite ocean color-based algorithms. The diagnostic pigment analysis (DPA) is based on bulk measurements of pigment concentrations and relies on assumptions regarding the presence of specific pigments in different phytoplankton taxonomic groups. Three size classes are defined by the DPA: picoplankton, nanoplankton, and microplankton. Until now, the DPA has not been evaluated against an independent approach that provides phytoplankton size calculated on a per-cell basis. Automated quantitative cell imagery of microplankton and some nanoplankton, used in combination with conventional flow cytometry for enumeration of picoplankton and nanoplankton, provide a novel opportunity to perform an independent evaluation of the DPA. Here, we use a data set from the North Atlantic Ocean that encompasses all seasons and a wide range of chlorophyll concentrations (0.18-5.14 mg m-3). Results show that the DPA overestimates microplankton and picoplankton when compared to cytometry data, and subsequently underestimates the contribution of nanoplankton to total biomass. In contrast to the assumption made by the DPA that the microplankton size class is largely made up of diatoms and dinoflagellates, imaging-in-flow cytometry shows significant presence of diatoms and dinoflagellates in the nanoplankton size class. Additionally, chlorophyll b is commonly attributed solely to picoplankton by the DPA, but Chl b-containing phytoplankton are observed with imaging in both nanoplankton and microplankton size classes. We suggest revisions to the DPA equations and application of uncertainties when calculating size classes from diagnostic pigments.
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Affiliation(s)
| | - Sasha J. Kramer
- Interdepartmental Graduate Program in Marine ScienceUniversity of California Santa BarbaraSanta BarbaraCaliforniaUSA
| | - Nils Haëntjens
- School of Marine SciencesUniversity of MaineOronoMaineUSA
| | | | - Lee Karp‐Boss
- School of Marine SciencesUniversity of MaineOronoMaineUSA
| | - Mimi Edmondson
- School of Marine SciencesUniversity of MaineOronoMaineUSA
| | - Jason R. Graff
- Department of Botany and Plant PathologyOregon State UniversityCorvallisOregonUSA
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Walton TJ, Bellringer SF, Edmondson M, Stott P, Rogers BA. Does a dedicated hip fracture unit improve clinical outcomes? A five-year case series. Ann R Coll Surg Engl 2019; 101:215-519. [PMID: 30602304 PMCID: PMC6400913 DOI: 10.1308/rcsann.2018.0220] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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] [Accepted: 11/04/2018] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The aim of the study was to establish whether a dedicated hip fracture unit, geographically separate from the local major trauma centre, could improve clinical outcomes for patients sustaining proximal femoral fragility fractures. MATERIALS AND METHODS This study was a retrospective case series, using data collected from Brighton and Sussex University Hospitals NHS Trust's submissions to the National Hip Fracture Database between 1 April 2011 and 16 September 2016. The outcomes measured were mortality, length of hospital stay, time from admission to surgical intervention and return to premorbid residence. Patients were compared before and after reconfiguration of services into a separate dedicated hip fracture unit geographically distinct from the major trauma centre. RESULTS A total of 2117 patients (2178 injuries) were managed before the existence of the hip fracture unit, while 660 patients (673 injuries) were treated within the hip fracture unit. During the five-year study period, the 30-day mortality rate (pre-hip fracture unit 5.47% vs hip fracture unit 3.13%, P = 0.014), variance in the length of hospital stay (P < 0.001), mean time to surgical intervention (P = 0.044) and return to premorbid residence were significantly improved. An immediate 12-month comparison demonstrated significantly improved variance in length of hospital stay (P = 0.020) and return to premorbid residence (P = 0.015). DISCUSSION The reconfiguration of services significantly reduced variance in length of stay, enabling accurate resource planning in future. Multiple incremental improvements in service provision, in addition to the hip fracture unit, may explain the lower mortality observed. CONCLUSION While further research is required, replication of the hip fracture unit service model may potentially afford significant clinical and financial gains.
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Affiliation(s)
- TJ Walton
- Trauma and Orthopaedics, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - SF Bellringer
- Trauma and Orthopaedics, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - M Edmondson
- Trauma and Orthopaedics, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - P Stott
- Trauma and Orthopaedics, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - BA Rogers
- Trauma and Orthopaedics, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
- Brighton and Sussex Medical School, Brighton, UK
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Morley R, Edmondson M, Dovell G, Blencowe N, Main B, Blazeby J, Hinchliffe R. #16 The introduction and evolution of an innovative endovascular device for venous arterialisation: A systematic analysis of current practice (poster presentation). Int J Surg 2018. [DOI: 10.1016/j.ijsu.2018.10.017] [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: 10/27/2022]
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7
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Edmondson M, Atrey A, East D, Ellens N, Miles K, Goddard R, Apthorp H, Butler-Manuel A. Survival analysis and functional outcome of the Oxford unicompartmental knee replacement up to 11 years follow up at a District General Hospital. J Orthop 2015; 12:S105-10. [PMID: 26719619 DOI: 10.1016/j.jor.2013.12.007] [Citation(s) in RCA: 9] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Accepted: 12/07/2013] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND There have been several large originator studies reporting excellent results with this prosthesis but far fewer large independent studies. We present, to our knowledge, the largest independent series documenting excellent survivorship rates and good functional outcomes at a mean follow up of 5.5 years post implantation of the Oxford unicompartmental knee replacement. METHODS Our prospective study looks at the survivorship and the functional outcome of 364 Oxford UKRs performed in a district general hospital at a mean follow up of 5.5 years (range 5-11 years). Post operatively knees were assessed in a research clinic using the Oxford knees score (as well as the American Knee Society Score and the Hospital for Special Surgery Score). Maximal flexion was also measured. RESULTS There were 26 revisions of 364 knees giving a survivorship, with revision as the end point, of 93% at a mean of 5.5 years post op (range 5-11 years). We achieved an Oxford score of 37.5, a mean AKSS of 161 (divided as American knee functional score 75.75/American knee objective score 85.4 (excellent)). The mean HSS score was 84.5. We achieved 'Excellent' Oxford knee scores in 137 knees (48%), 'Good' in 75 (26%), 'Moderate' in 51 (17%) and 'Poor' in only 27 (9%) of knees. Mean improvement in functional scores were: Oxford score (14.4), AKSS (71) and HSS (26.3). Mean maximal flexion was 123° range (110-140). CONCLUSIONS We have confirmed that good medium to long-term function and survival can be obtained following Oxford medial knee replacement for treating anteromedial osteoarthritis, in our large independent series.
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Affiliation(s)
| | - A Atrey
- Conquest Hospital, East Sussex TN37 7RD, UK
| | - D East
- Conquest Hospital, East Sussex TN37 7RD, UK
| | - N Ellens
- Conquest Hospital, East Sussex TN37 7RD, UK
| | - K Miles
- Conquest Hospital, East Sussex TN37 7RD, UK
| | - R Goddard
- Conquest Hospital, East Sussex TN37 7RD, UK
| | - H Apthorp
- Conquest Hospital, East Sussex TN37 7RD, UK
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Davey RJ, Hilton AM, Garside J, de la Fuente M, Edmondson M, Rainsford P. Crystallisation of oil-in-water emulsions. Amphiphile directed nucleation in aqueous emulsions of m-chloronitrobenzene. ACTA ACUST UNITED AC 1996. [DOI: 10.1039/ft9969201927] [Citation(s) in RCA: 19] [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] [Indexed: 11/21/2022]
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Abstract
The number of surgical procedures being performed as day cases is increasing. In an attempt to ensure that patients are given the chance to present their views of this developing service, one unit has set up an innovative project to allow patients to voice any dissatisfactions directly to the staff. The project has led to several changes being made and increased satisfaction for both staff and patients.
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Edmondson M. A short stopover. Nurs Times 1988; 84:31-2. [PMID: 3205788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Milam H, Evans JW, Elliott JP, Platt LO, Gordon JO, Brasfield D, Trapp J, Edmondson M. Percutaneous renal calculi removal. J Miss State Med Assoc 1984; 25:287-90. [PMID: 6502702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Edmondson M, Rambo M. Child restraints: the name of the game is saving children's lives. Ky Nurse 1984; 32:15-6. [PMID: 6565127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
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