1
|
White B, Ng SM, Agwu JC, Barrett TG, Birchmore N, Kershaw M, Drew J, Kavvoura F, Law J, Moudiotis C, Procter E, Paul P, Regan F, Reilly P, Sachdev P, Sakremath R, Semple C, Sharples K, Skae M, Timmis A, Williams E, Wright N, Soni A. A practical evidence-based approach to management of type 2 diabetes in children and young people (CYP): UK consensus. BMC Med 2024; 22:144. [PMID: 38561783 PMCID: PMC10986054 DOI: 10.1186/s12916-024-03349-4] [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] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 03/11/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Type 2 diabetes in young people is an aggressive disease with a greater risk of complications leading to increased morbidity and mortality during the most productive years of life. Prevalence in the UK and globally is rising yet experience in managing this condition is limited. There are no consensus guidelines in the UK for the assessment and management of paediatric type 2 diabetes. METHODS Multidisciplinary professionals from The Association of Children's Diabetes Clinicians (ACDC) and the National Type 2 Diabetes Working Group reviewed the evidence base and made recommendations using the Grading Of Recommendations, Assessment, Development and Evaluation (GRADE) methodology. RESULTS AND DISCUSSION Young people with type 2 diabetes should be managed within a paediatric diabetes team with close working with adult diabetes specialists, primary care and other paediatric specialties. Diagnosis of diabetes type can be challenging with many overlapping features. Diabetes antibodies may be needed to aid diagnosis. Co-morbidities and complications are frequently present at diagnosis and should be managed holistically. Lifestyle change and metformin are the mainstay of early treatment, with some needing additional basal insulin. GLP1 agonists should be used as second-line agents once early ketosis and symptoms are controlled. Glycaemic control improves microvascular but not cardiovascular risk. Reduction in excess adiposity, smoking prevention, increased physical activity and reduction of hypertension and dyslipidaemia are essential to reduce major adverse cardiovascular events. CONCLUSIONS This evidence-based guideline aims to provide a practical approach in managing this condition in the UK.
Collapse
Affiliation(s)
- Billy White
- University College London Hospitals NHS Foundation Trust, London, UK
| | - S M Ng
- Mersey And West Lancashire Teaching Hospitals NHS Trust, Ormskirk, UK
| | - J C Agwu
- Wye Valley NHS Trust, Hereford, UK
| | - T G Barrett
- Birmingham Women's And Children NHS Foundation Trust, Birmingham, UK
| | - N Birchmore
- Great Ormond Street Hospital For Children, NHS Foundation Trust, London, UK
| | - M Kershaw
- Birmingham Women's And Children NHS Foundation Trust, Birmingham, UK
| | - J Drew
- Nottingham University Hospitals NHS Foundation Trust, Nottingham, UK
| | - F Kavvoura
- Royal Berkshire NHS Foundation Trust, Reading, UK
| | - J Law
- Nottingham University Hospitals NHS Foundation Trust, Nottingham, UK
| | - C Moudiotis
- Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - E Procter
- Nottingham University Hospitals NHS Foundation Trust, Nottingham, UK
| | - P Paul
- Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - F Regan
- Guy's and St Thomas's NHS Foundation Trust, London, UK
| | - P Reilly
- Torbay and South Devon NHS Foundation Trust, Torquay, UK
| | - P Sachdev
- Nottingham University Hospitals NHS Foundation Trust, Nottingham, UK
| | - R Sakremath
- Shrewsbury and Telford Hospital NHS Trust, Shrewsbury, UK
| | - C Semple
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | | | - M Skae
- Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - A Timmis
- Countess of Chester Hospital NHS Foundation Trust, Chester, UK
| | - E Williams
- Hampshire Hospitals NHS Foundation Trust, Winchester, UK
| | - N Wright
- Sheffield Children's Hospital NHS Foundation Trust, Sheffield, S102TH, UK
| | - A Soni
- Sheffield Children's Hospital NHS Foundation Trust, Sheffield, S102TH, UK.
| |
Collapse
|
2
|
Davies A, Lloyd T, Sabharwal S, Liddle AD, Reilly P. Anatomical shoulder replacements in young patients: A systematic review and meta-analysis. Shoulder Elbow 2023; 15:4-14. [PMID: 37692879 PMCID: PMC10492528 DOI: 10.1177/17585732221075037] [Citation(s) in RCA: 1] [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: 10/14/2021] [Revised: 12/13/2021] [Accepted: 12/14/2021] [Indexed: 09/12/2023]
Abstract
Introduction Increasing numbers of young patients receive shoulder replacements. Greater information on outcomes is needed to inform implant choice. The aim of this study was to investigate the survivorship and clinical effectiveness of hemiarthroplasty and anatomical total shoulder arthroplasty (TSA) in patients younger than 65 years. Method A systematic review was performed of MEDLINE, EMBASE, CENTRAL, The Cochrane Database of Systematic Reviews and National Joint Registry reports. The primary outcomes were implant survival and change in perioperative shoulder scores. Results Meta-analysis of implant survivorship was performed of six studies reporting on 416 patients. Implant survival was 86.1% (72.1,100) at 10 years for hemiarthroplasty and 82.3% (64.6,100) for TSA. 20 year survival was 80.0% for hemiarthroplasty (72.5,87.4) and 75.0% (56.9,93.1) for TSA. Ten studies were included in the meta-analysis of shoulder scores, multiple instruments were used. The standardised mean difference between pre-operative and post-operative shoulder scores was 2.15 (1.95, 2.35) for TSA at 4.2-4.9 years, and 2.72 (1.98,3.47) for hemiarthroplasty at 3.8-6 years. Conclusion Over 80% of shoulder replacements last more than 10 years, and 75% last more than 20 years. Significant improvements in shoulder scores are shown at all time points.
Collapse
Affiliation(s)
- A Davies
- Department of Bioengineering, Imperial College London, London, UK
| | - T Lloyd
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - S Sabharwal
- Department of Trauma and Orthopaedics, Imperial College Healthcare NHS Trust, London, UK
| | - AD Liddle
- Department of Trauma and Orthopaedics, Imperial College Healthcare NHS Trust, London, UK
| | - P Reilly
- Department of Bioengineering, Imperial College London, London, UK
| |
Collapse
|
3
|
Tempany M, Leonard A, Prior AR, Boran G, Reilly P, Murray C, O'Brien M, Maguire G, Ennis D, Rakovac A, Reid A. The potential impact of post-COVID symptoms in the healthcare sector. Occup Med (Lond) 2021; 71:284-289. [PMID: 34415352 DOI: 10.1093/occmed/kqab109] [Citation(s) in RCA: 6] [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] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND The phenomenon of post-COVID syndrome (PCS) is evolving from an abstract array of non-specific symptoms to an identifiable clinical entity of variable severity. Its frequency and persistence have implications for service delivery and workforce planning. AIMS This study was aimed to assess the prevalence of symptoms consistent with PCS and the subjective degree of recovery in a cohort of healthcare workers, focusing on those who have returned to work. METHODS A study population of 1176 was surveyed when attending for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibody testing. Two sub-groups were identified: those with known (i.e. diagnosed on PCR testing) and assumed (i.e. antibody evidence of previous infection) SARs-CoV-2 infection, at least 12 weeks prior to the study. Each group was asked about their subjective degree of recovery and the nature of their persistent symptoms. Results were analysed via excel and SPSS. RESULTS In total, 144 employees showed PCR evidence of previous infection, with 139 of these being infected at least 12 weeks prior to the study. Of these 139, only 19% (n = 26) reported feeling 100% recovered, and 71% reported persistent symptoms. Of those with assumed SARS-CoV-2 infection (n = 78), 32 (41%) were truly asymptomatic since the commencement of the pandemic, while 46 (59%) described symptoms suggestive of possible infection at least 12 weeks prior to the study. Of this latter group, 23% (n = 18) also reported residual symptoms. CONCLUSIONS PCS is prevalent among this group, including those not previously diagnosed with COVID-19. Its' frequency and duration present challenges to employers with regards to the management of work availability and performance.
Collapse
Affiliation(s)
- M Tempany
- Department of Occupational Health and Wellbeing, Tallaght University Hospital, Dublin, Ireland
| | - A Leonard
- Department of Clinical Chemistry and Laboratory Medicine, Tallaght University Hospital, Dublin, Ireland.,School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - A R Prior
- Department of Clinical Microbiology, Tallaght University Hospital, Dublin, Ireland
| | - G Boran
- Department of Clinical Chemistry and Laboratory Medicine, Tallaght University Hospital, Dublin, Ireland.,School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - P Reilly
- Department of Clinical Chemistry and Laboratory Medicine, Tallaght University Hospital, Dublin, Ireland.,School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - C Murray
- Department of Clinical Chemistry and Laboratory Medicine, Tallaght University Hospital, Dublin, Ireland.,School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - M O'Brien
- Department of Clinical Chemistry and Laboratory Medicine, Tallaght University Hospital, Dublin, Ireland.,School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - G Maguire
- Department of Clinical Chemistry and Laboratory Medicine, Tallaght University Hospital, Dublin, Ireland.,School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - D Ennis
- Department of Clinical Chemistry and Laboratory Medicine, Tallaght University Hospital, Dublin, Ireland.,School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - A Rakovac
- Department of Clinical Chemistry and Laboratory Medicine, Tallaght University Hospital, Dublin, Ireland.,School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - A Reid
- Department of Occupational Health and Wellbeing, Tallaght University Hospital, Dublin, Ireland
| |
Collapse
|
4
|
Walker J, Davies A, Heaton T, Sabharwal S, Fertleman M, Dani M, Reilly P. P36 Consent for Orthopaedic Trauma Surgery during the COVID-19 Pandemic. BJS Open 2021. [PMCID: PMC8030248 DOI: 10.1093/bjsopen/zrab032.035] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Surgical services have been hugely disrupted by COVID-19 and have had to evolve rapidly in response. The best practice for consent mandates that risks associated with surgical treatment during a pandemic be discussed. This study aimed to assess whether patients undergoing orthopaedic operations were being consented for the risk of contacting COVID-19 and ITU care.
All orthopaedic consent forms from four-week periods in March, June and July were reviewed. Measures such as staff education were implemented after the second cycle.
Of consent forms for 37 operations performed in March, only 1 mentioned the risk of contracting COVID-19 and zero mentioned ITU. During June, 89 consent forms were reviewed, 32 mentioned COVID-19 and 10 discussed ITU admission. Following educational measures, the third cycle showed a significant improvement as of 100 consent form records available for review, 73 included risk of COVID-19 whilst 26 mentioned ITU.
The results show that earlier in the pandemic, surgeons at our centre were not counselling patients regarding COVID-19. This improved slightly between the first and second cycles, likely reflecting increased awareness of the nosocomial transmission of COVID-19. Educational measures contributed to a significant improvement in the third cycle. Planned interventions include use of electronic consent forms which incorporate COVID-19 infection and associated risks.
Collapse
Affiliation(s)
- J Walker
- St Mary's Hospital, Imperial College Healthcare NHS Trust, London
| | - A Davies
- St Mary's Hospital, Imperial College Healthcare NHS Trust, London
| | - T Heaton
- St Mary's Hospital, Imperial College Healthcare NHS Trust, London
| | - S Sabharwal
- St Mary's Hospital, Imperial College Healthcare NHS Trust, London
| | - M Fertleman
- St Mary's Hospital, Imperial College Healthcare NHS Trust, London
| | - M Dani
- St Mary's Hospital, Imperial College Healthcare NHS Trust, London
| | - P Reilly
- St Mary's Hospital, Imperial College Healthcare NHS Trust, London
| |
Collapse
|
5
|
Balai E, Sabharwal S, Griffiths D, Reilly P. A type VI acromioclavicular joint injury: subcoracoid dislocation in a patient with polytrauma. Ann R Coll Surg Engl 2020; 102:e1-e3. [PMID: 32735136 DOI: 10.1308/rcsann.2020.0157] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The Rockwood type VI acromioclavicular joint injury describes subcoracoid dislocation of the distal end of the clavicle. This injury pattern is exceedingly rare, with only 12 cases described in the literature. Diagnosis can be challenging; it is often the result of a high-energy mechanism and patients frequently have other severe distracting injuries. We report the case of a 23-year-old man who presented to our department after falling from a fifth-floor balcony. Alongside multiple intra-abdominal and musculoskeletal injuries, the patient sustained a type VI acromioclavicular joint dislocation. This injury was not picked up on the initial clinical assessment or described in the initial radiology report, with the diagnosis only made upon subsequent repeat review of the imaging by the admitting team. Fortunately, this delay did not increase the time to the patient receiving appropriate treatment. Despite its rarity, awareness of this injury pattern and its association with polytrauma is essential to reduce the risk of the diagnosis being overlooked in the acute setting.
Collapse
Affiliation(s)
- E Balai
- St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - S Sabharwal
- St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - D Griffiths
- St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - P Reilly
- St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
| |
Collapse
|
6
|
McMonagle MP, Kilduff CL, Reilly P, Sims C. The 'Philadelphia Technique' for abdominal closure. Ann R Coll Surg Engl 2020; 102:638-640. [PMID: 32538125 DOI: 10.1308/rcsann.2020.0142] [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: 11/22/2022] Open
Affiliation(s)
| | | | - P Reilly
- Penn Presbyterian Medical Center, Philadelphia, US
| | - C Sims
- Penn Presbyterian Medical Center, Philadelphia, US
| |
Collapse
|
7
|
Abstract
Following open reduction and internal fixation for a proximal humerus fracture a 71-year-old man re-presented with wound changes consistent with infection and elevated inflammatory markers. No significant improvement was seen with concomitant intravenous antibiotics and multiple debridement procedures. This case was further complicated by soft tissue breakdown at the site of a left thigh haematoma also requiring debridement. Surgical site infections represent the most common cause of morbidity postoperatively. This case highlights the importance of considering a number of differential diagnoses. A diagnosis of pyoderma gangrenosum prompted systemic corticosteroid therapy giving rapid clinical improvement.
Collapse
Affiliation(s)
- S Franklin
- Imperial College Healthcare NHS Trust, London, UK
| | - S Sabharwal
- Imperial College Healthcare NHS Trust, London, UK
| | | | - P Reilly
- Imperial College Healthcare NHS Trust, London, UK
| |
Collapse
|
8
|
Sugand K, Malik HH, Newman S, Spicer D, Reilly P, Gupte CM. Does using anatomical models improve patient satisfaction in orthopaedic consenting? Single-blinded randomised controlled trial. Surgeon 2019; 17:146-155. [PMID: 30944078 DOI: 10.1016/j.surge.2019.02.002] [Citation(s) in RCA: 4] [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] [Received: 11/01/2018] [Revised: 02/09/2019] [Accepted: 02/23/2019] [Indexed: 12/01/2022]
Abstract
BACKGROUND Patient satisfaction in consenting is a major pillar of clinical governance and healthcare quality assessment. The purpose was to observe the effect of using 3D anatomical models of knee and shoulder joints on patient satisfaction during informed consent in the largest single-blinded randomised controlled trial in this field. METHODS 52 patients undergoing elective knee or shoulder surgery were randomised into two groups when being consented. The intervention group (n = 26) was shown an anatomical model of the knee/shoulder joint while the control group (n = 26) was given only a verbal explanation without a model. Patients rated their satisfaction on the validated Medical Interview Satisfaction Scale (MISS-26) questionnaire. Semi-structured interviews were analysed for specific themes to determine key factors that influenced patient satisfaction. The mean score ±SD were calculated with significance set at p < 0.05. RESULTS There was a significant difference in the overall satisfaction between the control and intervention cohorts (MISS-26 score 4.33 [86.6%] ± 0.646 vs 4.70 [94.0%] ± 0.335 respectively, 7.4% improvement, 8.5% difference, p = 0.01). Behavioural criteria showed a 13% increase in satisfaction (p = 0.02). Semi-structured interviews determined that the factors influencing satisfaction included the surgeon's interpersonal manner, the use of the visual aid and seeing the consultant surgeon in clinic. All patients in the intervention cohort identified factors contributing to their satisfaction, whereas a fifth of the control cohort claimed nothing at all made them feel satisfied. CONCLUSION Anatomical models as visual aids significantly increased patient satisfaction during the consenting process and played an integral part of the surgeon's explanation. Patients exposed to anatomical models also claimed to be more satisfied with the surgeon's inter-personal skills. This study recommends the use of anatomical models, which are both cost-effective and easily implementable, during explanation and consent for orthopaedic procedures.
Collapse
Affiliation(s)
- K Sugand
- MSk Lab, Charing Cross Hospital, Level 7 East, London, UK.
| | - H H Malik
- MSk Lab, Charing Cross Hospital, Level 7 East, London, UK.
| | - S Newman
- MSk Lab, Charing Cross Hospital, Level 7 East, London, UK; Dept. of Trauma & Orthopaedics, St Mary's Hospital, London, UK.
| | - D Spicer
- Dept. of Trauma & Orthopaedics, St Mary's Hospital, London, UK.
| | - P Reilly
- Dept. of Trauma & Orthopaedics, St Mary's Hospital, London, UK.
| | - C M Gupte
- MSk Lab, Charing Cross Hospital, Level 7 East, London, UK; Dept. of Trauma & Orthopaedics, St Mary's Hospital, London, UK.
| |
Collapse
|
9
|
Klemt C, Toderita D, Nolte D, Di Federico E, Reilly P, Bull AMJ. The critical size of a defect in the glenoid causing anterior instability of the shoulder after a Bankart repair, under physiological joint loading. Bone Joint J 2019; 101-B:68-74. [DOI: 10.1302/0301-620x.101b1.bjj-2018-0974.r1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Aims Patients with recurrent anterior dislocation of the shoulder commonly have an anterior osseous defect of the glenoid. Once the defect reaches a critical size, stability may be restored by bone grafting. The critical size of this defect under non-physiological loading conditions has previously been identified as 20% of the length of the glenoid. As the stability of the shoulder is load-dependent, with higher joint forces leading to a loss of stability, the aim of this study was to determine the critical size of an osseous defect that leads to further anterior instability of the shoulder under physiological loading despite a Bankart repair. Patients and Methods Two finite element (FE) models were used to determine the risk of dislocation of the shoulder during 30 activities of daily living (ADLs) for the intact glenoid and after creating anterior osseous defects of increasing magnitudes. A Bankart repair was simulated for each size of defect, and the shoulder was tested under loading conditions that replicate in vivo forces during these ADLs. The critical size of a defect was defined as the smallest osseous defect that leads to dislocation. Results The FE models showed a high risk of dislocation during ADLs after a Bankart repair for anterior defects corresponding to 16% of the length of the glenoid. Conclusion This computational study suggests that bone grafting should be undertaken for an anterior osseous defect in the glenoid of more than 16% of its length rather than a solely soft-tissue procedure, in order to optimize stability by restoring the concavity of the glenoid.
Collapse
Affiliation(s)
- C. Klemt
- Department of Bioengineering, Imperial College London, London, UK
| | - D. Toderita
- Department of Bioengineering, Imperial College London, London, UK
| | - D. Nolte
- Department of Bioengineering, Imperial College London, London, UK
| | - E. Di Federico
- Department of Bioengineering, Imperial College London, London, UK
| | - P. Reilly
- Department of Trauma and Orthopaedics, Imperial College Healthcare NHS Trust, London, UK
| | - A. M. J. Bull
- Department of Bioengineering, Imperial College London, London, UK
| |
Collapse
|
10
|
Affiliation(s)
- C Pollack
- Thomas Jefferson University, Emergency Medicine, Philadelphia, PA, United States of America
| | - J Van Ryn
- Boehringer Ingelheim, Biberach, Germany
| | - P Reilly
- Boehringer Ingelheim, Ridgefield, CT, United States of America
| | - J Levy
- Duke University School of Medicine, Durham, NC, United States of America
| | - R Bernstein
- Northwestern University, Chicago, United States of America
| | - J L Weitz
- McMaster University and Henderson Centre, Hamilton, Canada
| |
Collapse
|
11
|
Sabharwal S, Patel NK, Griffiths D, Athanasiou T, Gupte CM, Reilly P. Trials based on specific fracture configuration and surgical procedures likely to be more relevant for decision making in the management of fractures of the proximal humerus: Findings of a meta-analysis. Bone Joint Res 2016; 5:470-480. [PMID: 27756738 PMCID: PMC5086838 DOI: 10.1302/2046-3758.510.2000638] [Citation(s) in RCA: 21] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 08/08/2016] [Indexed: 01/16/2023] Open
Abstract
Objectives The objective of this study was to perform a meta-analysis of all randomised controlled trials (RCTs) comparing surgical and non-surgical management of fractures of the proximal humerus, and to determine whether further analyses based on complexity of fracture, or the type of surgical intervention, produced disparate findings on patient outcomes. Methods A systematic review of the literature was performed identifying all RCTs that compared surgical and non-surgical management of fractures of the proximal humerus. Meta-analysis of clinical outcomes was performed where possible. Subgroup analysis based on the type of fracture, and a sensitivity analysis based on the type of surgical intervention, were also performed. Results Seven studies including 528 patients were included. The overall meta-analysis found that there was no difference in clinical outcomes. However, subgroup and sensitivity analyses found improved patient outcomes for more complex fractures managed surgically. Four-part fractures that underwent surgery had improved long-term health utility scores (mean difference, MD 95% CI 0.04 to 0.28; p = 0.007). They were also less likely to result in osteoarthritis, osteonecrosis and non/malunion (OR 7.38, 95% CI 1.97 to 27.60; p = 0.003). Another significant subgroup finding was that secondary surgery was more common for patients that underwent internal fixation compared with conservative management within the studies with predominantly three-part fractures (OR 0.15, 95% CI 0.04 to 0.63; p = 0.009). Conclusion This meta-analysis has demonstrated that differences in the type of fracture and surgical treatment result in outcomes that are distinct from those generated from analysis of all types of fracture and surgical treatments grouped together. This has important implications for clinical decision making and should highlight the need for future trials to adopt more specific inclusion criteria. Cite this article: S. Sabharwal, N. K. Patel, D. Griffiths, T. Athanasiou, C. M. Gupte, P. Reilly. Trials based on specific fracture configuration and surgical procedures likely to be more relevant for decision making in the management of fractures of the proximal humerus: Findings of a meta-analysisBone Joint Res 2016;5:470–480. DOI: 10.1302/2046-3758.510.2000638.
Collapse
Affiliation(s)
- S Sabharwal
- Virginia Commonwealth University Medical Centre, Richmond, Virginia, USA
| | - N K Patel
- Virginia Commonwealth University Medical Centre, Richmond, Virginia, USA
| | - D Griffiths
- Imperial College London, 1022, Queen Elizabeth the Queen Mother Wing (QEQM), St Mary's Campus, London, UK
| | - T Athanasiou
- Imperial College London, 1022, Queen Elizabeth the Queen Mother Wing (QEQM), St Mary's Campus, London, UK
| | - C M Gupte
- Department of Trauma and Orthopaedics, St Mary's Hospital, Ground Floor Salton House, South Wharf Road, London, W2 1NY, UK
| | - P Reilly
- Department of Trauma and Orthopaedics, St Mary's Hospital, Ground Floor Salton House, South Wharf Road, London, W2 1NY, UK
| |
Collapse
|
12
|
Fanous R, Sabharwal S, Altaie A, Gupte CM, Reilly P. Hip fracture litigation: A 10-year review of NHS Litigation Authority data and the effect of national guidelines. Ann R Coll Surg Engl 2016; 99:17-21. [PMID: 27659364 DOI: 10.1308/rcsann.2016.0277] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
We present a review evaluating all litigation claims relating to hip fractures made in a 10-year period between 2005 and 2015. Data was obtained from the NHS Litigation Authority through a freedom of information request. All claims relating to hip fractures were reviewed. During the period analysed, 216 claims were made, of which 148 were successful (69%). The total cost of settling these claims was in excess of £5 million. The introduction of a best-practice tariff by the Department of Health in 2010 was designed to improve the quality of care for hip fracture patients. This was followed by guidance from the National Institute for Health and Clinical Excellence in 2011 and the British Orthopaedic Association in 2012. We analysed claims submitted before and after these guidelines were introduced and no significant difference in the number of claims was noted. The most common cause for litigation was a delay in diagnosis, which accounted for 86 claims in total (40%). Despite the presence of these guidelines and targets, there has not been a significant reduction in the number of claims or an improvement in diagnostic accuracy. This may be due to an increasing level of litigation in the UK but we must also question whether we are indeed providing best-practice care to our hip fracture patients and whether these guidelines need further review.
Collapse
Affiliation(s)
- R Fanous
- Department of Trauma Orthopaedics, St Mary's Hospital, Imperial College Healthcare NHS Trust , London, W2 1NY , UK
| | - S Sabharwal
- Department of Trauma Orthopaedics, St Mary's Hospital, Imperial College Healthcare NHS Trust , London, W2 1NY , UK
| | - A Altaie
- Department of Trauma Orthopaedics, St Mary's Hospital, Imperial College Healthcare NHS Trust , London, W2 1NY , UK
| | - C M Gupte
- Department of Trauma Orthopaedics, St Mary's Hospital, Imperial College Healthcare NHS Trust , London, W2 1NY , UK
| | - P Reilly
- Department of Trauma Orthopaedics, St Mary's Hospital, Imperial College Healthcare NHS Trust , London, W2 1NY , UK
| |
Collapse
|
13
|
|
14
|
Abstract
Aims The aims of this study were to estimate the cost of surgical treatment of fractures of the proximal humerus using a micro-costing methodology, contrast this cost with the national reimbursement tariff and establish the major determinants of cost. Methods A detailed inpatient treatment pathway was constructed using semi-structured interviews with 32 members of hospital staff. Its content validity was established through a Delphi panel evaluation. Costs were calculated using time-driven activity-based costing (TDABC) and sensitivity analysis was performed to evaluate the determinants of cost Results The mean cost of the different surgical treatments was estimated to be £3282. Although this represented a profit of £1138 against the national tariff, hemiarthroplasty as a treatment choice resulted in a net loss of £952. Choice of implant and theatre staffing were the largest cost drivers. Operating theatre delays of more than one hour resulted in a loss of income Discussion Our findings indicate that the national tariff does not accurately represent the cost of treatment for this condition. Effective use of the operating theatre and implant discounting are likely to be more effective cost containment approaches than control of bed-day costs. Take home message: This cost analysis of fractures of the proximal humerus reinforces the limitations of the national tariff within the English National Health Service, and underlines the importance of effective use of the operating theatre, as well as appropriate implant procurement where controlling costs of treatment is concerned. Cite this article: Bone Joint J 2016;98-B:249–59.
Collapse
Affiliation(s)
- S. Sabharwal
- Imperial College NHS Trust, Ground
Floor Salton House, South Wharf Road, St
Mary's Hospital, London, W2
1NY, UK
| | | | - A. Rashid
- Addenbrookes’ Hospital, Cambridge, UK
| | - A. Darzi
- Imperial College, London
SW7 2AZ, UK
| | - P. Reilly
- Imperial College, London
SW7 2AZ, UK
| | | |
Collapse
|
15
|
Pollack C, Eikelboom J, Weitz J, Reilly P, Glund S, Dubiel R, Kreuzer J, Stangier J, Wang B, Gagg J, Verhamme P, Bernstein R, Huisman M, Hylek E, Kamphuisen P, Levy J, Selke F, Steiner T, Kam C. INITIAL RESULTS OF THE RE-VERSE AD TRIAL: IDARUCIZUMAB REVERSES THE ANTICOAGULANT EFFECTS OF DABIGATRAN IN PATIENTS IN AN EMERGENCY SETTING OF MAJOR BLEEDING, URGENT SURGERY OR INTERVENTIONS. Emerg Med J 2015. [DOI: 10.1136/emermed-2015-205372.9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
16
|
Pollack C, Gruenenfelder F, Eikelboom J, Hylek E, Mills M, Huisman M, Levy J, Reilly P, Kreuzer J, Weitz J. 4 Initial Experience With Idarucizumab in Dabigatran-Treated Patients Presenting With Acute Gastrointestinal Hemorrhage: Interim Results from the RE-VERSE AD Study. Ann Emerg Med 2015. [DOI: 10.1016/j.annemergmed.2015.07.033] [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: 10/23/2022]
|
17
|
Pollack C, Gruenenfelder F, Eikelboom J, Hylek E, Mills M, Sellke F, Kamphuisen P, Reilly P, Kreuzer J, Weitz J. 262 Initial Experience With Idarucizumab in Dabigatran-Treated Patients Presenting With Acute Traumatic Injuries: Interim Results From the RE-VERSE AD Study. Ann Emerg Med 2015. [DOI: 10.1016/j.annemergmed.2015.07.296] [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: 10/23/2022]
|
18
|
Shah M, Gburcik V, Reilly P, Sankey RA, Emery RJ, Clarkin CE, Pitsillides AA. Local origins impart conserved bone type-related differences in human osteoblast behaviour. Eur Cell Mater 2015; 29:155-75; discussion 175-6. [PMID: 25738584 DOI: 10.22203/ecm.v029a12] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Osteogenic behaviour of osteoblasts from trabecular, cortical and subchondral bone were examined to determine any bone type-selective differences in samples from both osteoarthritic (OA) and osteoporotic (OP) patients. Cell growth, differentiation; alkaline phosphatase (TNAP) mRNA and activity, Runt-related transcription factor-2 (RUNX2), SP7-transcription factor (SP7), bone sialoprotein-II (BSP-II), osteocalcin/bone gamma-carboxyglutamate (BGLAP), osteoprotegerin (OPG, TNFRSF11B), receptor activator of nuclear factor-κβ ligand (RANKL, TNFSF11) mRNA levels and proangiogenic vascular endothelial growth factor-A (VEGF-A) mRNA and protein release were assessed in osteoblasts from paired humeral head samples from age-matched, human OA/OP (n = 5/4) patients. Initial outgrowth and increase in cell number were significantly faster (p < 0.01) in subchondral and cortical than trabecular osteoblasts, in OA and OP, and this bone type-related differences were conserved despite consistently faster growth in OA. RUNX2/SP7 levels and TNAP mRNA and protein activity were, however, greater in trabecular than subchondral and cortical osteoblasts in OA and OP. BSP-II levels were significantly greater in trabecular and lowest in cortical osteoblasts in both OA and OP. In contrast, BGLAP levels showed divergent bone type-selective behaviour; highest in osteoblasts from subchondral origins in OA and trabecular origins in OP. We found virtually identical bone type-related differences, however, in TNFRSF11B:TNFSF11 in OA and OP, consistent with greater potential for paracrine effects on osteoclasts in trabecular osteoblasts. Subchondral osteoblasts (OA) exhibited highest VEGF-A mRNA levels and release. Our data indicate that human osteoblasts in trabecular, subchondral and cortical bone have inherent, programmed diversity, with specific bone type-related differences in growth, differentiation and pro-angiogenic potential in vitro.
Collapse
Affiliation(s)
- M Shah
- Department of Comparative Biomedical Science, Royal Veterinary College, London, NW1 0TU,
| | | | | | | | | | | | | |
Collapse
|
19
|
Allen SR, Scantling DR, Delgado MK, Mancini J, Holena DN, Kim P, Pascual JL, Reilly P. Penetrating torso injuries in older adults: increased mortality likely due to "failure to rescue". Eur J Trauma Emerg Surg 2015; 41:657-63. [PMID: 26038012 DOI: 10.1007/s00068-014-0491-7] [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] [Received: 11/18/2014] [Accepted: 12/22/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE Approximately 8 % of injuries in the elderly are from penetrating mechanisms. The natural history of potentially survivable penetrating torso wounds in the elderly is not well studied. Older adults with penetrating injuries to the torso may have worse outcomes than matched, younger patients due to a failure to rescue after complications. METHODS A retrospective chart review of all patients ≥55 (older) with a penetrating injury (GSW or SW) to the torso over 20 years was performed. All patients with a maximum AIS chest or abdomen >1 and <6 were included. A matched cohort (mechanism, AIS chest and abdomen, ISS and sex) of patients between the ages of 20-40 years (young) was created (3 young, 1 older). Differences in hemodynamics, complications, length of stay and mortality were analyzed. RESULTS 105 older met inclusion criteria were compared to 315 young patients. Hemodynamic status was similar between the groups. Older patients required ICU care more often than younger patients, p < 0.05. Older patients required longer ICU stays, p < 0.001 and longer hospitalizations, p = 0.0012. More older patients (41.0 %) suffered post-injury complications compared to the young (26.4 %), p = 0.005. Older patients who suffered a complication had a higher mortality (30.2 %) than the young after a complication (10.8 %), p = 0.007. CONCLUSIONS While uncommon, penetrating injuries to older adults are associated with higher rates of post-injury complications and increased mortality. This may represent a "failure to rescue" and represent an opportunity for improved post-injury care in older adults who suffer potentially survivable penetrating torso injuries.
Collapse
Affiliation(s)
- S R Allen
- Division of Traumatology, Critical Care and Emergency Surgery, The Hospital of the University of Pennsylvania, 5th Floor Maloney Building, 3400 Spruce Street, Philadelphia, PA, 19104, USA.
| | - D R Scantling
- Department of Surgery, Drexel University, Philadelphia, PA, USA
| | - M K Delgado
- Division of Traumatology, Critical Care and Emergency Surgery, The Hospital of the University of Pennsylvania, 5th Floor Maloney Building, 3400 Spruce Street, Philadelphia, PA, 19104, USA
| | - J Mancini
- Division of Traumatology, Critical Care and Emergency Surgery, The Hospital of the University of Pennsylvania, 5th Floor Maloney Building, 3400 Spruce Street, Philadelphia, PA, 19104, USA
| | - D N Holena
- Division of Traumatology, Critical Care and Emergency Surgery, The Hospital of the University of Pennsylvania, 5th Floor Maloney Building, 3400 Spruce Street, Philadelphia, PA, 19104, USA
| | - P Kim
- Division of Traumatology, Critical Care and Emergency Surgery, The Hospital of the University of Pennsylvania, 5th Floor Maloney Building, 3400 Spruce Street, Philadelphia, PA, 19104, USA
| | - J L Pascual
- Division of Traumatology, Critical Care and Emergency Surgery, The Hospital of the University of Pennsylvania, 5th Floor Maloney Building, 3400 Spruce Street, Philadelphia, PA, 19104, USA
| | - P Reilly
- Division of Traumatology, Critical Care and Emergency Surgery, The Hospital of the University of Pennsylvania, 5th Floor Maloney Building, 3400 Spruce Street, Philadelphia, PA, 19104, USA
| |
Collapse
|
20
|
Scantling D, Holena D, Pascual J, Kim P, Schwab C, Reilly P, Allen S. Penetrating Injuries In Older Adults: An Urban Trauma Center's Experience. J Surg Res 2014. [DOI: 10.1016/j.jss.2013.11.1012] [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: 11/28/2022]
|
21
|
Nieuwlaat R, Healey JS, Ezekowitz M, Reilly P, Formella S, Wallentin L, Yusuf S, Connolly S. Management of dyspepsia symptoms on dabigatran during RELY-ABLE: long-term follow up study after RE-LY. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht307.p549] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
22
|
Yalakki Jagadeesh L, Hepburn A, Hughes R, Bourke B, Garood T, Horwood N, Ewence A, Lloyd M, Makanjuola D, Reilly P, Moss K, Hajela V, Higgens C, Sandhu V, Stuart B, Kiely P. AB0461 The burden of behçet’s disease in the south thames and, se coast regions – a regional review. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.2783] [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: 11/03/2022]
|
23
|
Sant V, Cheney R, Holena D, Braslow B, Pascual J, Reilly P, Allen S. Trauma Recidivism: Short Time to Reinjury Calls for Early and Aggressive Violence Prevention and Intervention. J Surg Res 2013. [DOI: 10.1016/j.jss.2012.10.874] [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: 11/15/2022]
|
24
|
Sweeney T, Collins CB, Reilly P, Pierce KM, Ryan M, O'Doherty JV. Effect of purified β-glucans derived from Laminaria digitata, Laminaria hyperborea and Saccharomyces cerevisiae on piglet performance, selected bacterial populations, volatile fatty acids and pro-inflammatory cytokines in the gastrointestinal tract of pigs. Br J Nutr 2012; 108:1226-34. [PMID: 22313684 DOI: 10.1017/s0007114511006751] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
β-Glucans have been identified as natural biomolecules with immunomodulatory activity. The first objective of the present study was to compare the effects of purified β-glucans derived from Laminaria digitata, L. hyperborea and Saccharomyces cerevisiae on piglet performance, selected bacterial populations and intestinal volatile fatty acid (VFA) production. The second aim was to compare the gene expression profiles of the markers of pro- and anti-inflammation in both unchallenged and lipopolysaccharide (LPS)-challenged ileal and colonic tissues. β-Glucans were included at 250 mg/kg in the diets. The β-glucans derived from L. hyperborea, L. digitata and S. cerevisiae all reduced the Enterobacteriaceae population (P<0·05) without influencing the lactobacilli and bifidobacteria populations (P>0·05) in the ileum and colon. There was a significant interaction between gastrointestinal region and β-glucan source in the expression of cytokine markers, IL-1α (<0·001), IL-10 (P<0·05), TNF-α (P<0·05) and IL-17A (P<0·001). β-Glucans did not stimulate any pro- or anti-inflammatory cytokine markers in the ileal epithelial cells. In contrast, the expression of a panel of pro- and anti-inflammatory cytokines (IL-1α, IL-10, TNF-α and IL-17A) was down-regulated in the colon following exposure to β-glucans from all the three sources. However, the data suggest that the soluble β-glucans derived from L. digitata may be acting via a different mechanism from the insoluble β-glucans derived from L. hyperborea and S. cerevisiae, as the VFA profile was different in the L. digitata-treated animals. There was an increase in IL-8 gene expression (P<0·05) in the gastrointestinal tract from the animals exposed to L. digitata following an LPS ex vivo challenge that was not evident in the other two treatment groups. In conclusion, β-glucans from both seaweed and yeast sources reduce Enterobacteriaceae counts and pro-inflammatory markers in the colon, though the mechanisms of action may be different between the soluble and insoluble fibre sources.
Collapse
Affiliation(s)
- T Sweeney
- School of Agriculture, Food Science and Veterinary Medicine, College of Life Sciences, University College Dublin, Belfield, Dublin 4, Republic of Ireland
| | | | | | | | | | | |
Collapse
|
25
|
Abstract
AIM To explore the feasibility and acceptability of implementing a personalised care planning approach for diabetes care in general practice. METHODS A four-stage care planning process was introduced for diabetes annual review, involving patients (1) being made aware of the new process, (2) attending an appointment to gather clinical data, (3) receiving and reviewing their results and (4) attending a care planning consultation. The latter is a collaborative discussion with the health professional about their response to their results, their goals and desired action plan. Health professionals received specialist training in personalised care planning, including practice observations and feedback. RESULTS Sixty-six per cent of patients eligible to participate in the project attended both appointments and received an annual review. Of these, 89% also agreed a personalised care plan. Staff reported greater engagement among patients who had read and understood their results. Fourteen per cent of patients reported that they had not agreed a care plan but would have liked one. Patients reported increased confidence in managing their condition with 75% feeling that their ideas and goals were discussed completely. CONCLUSIONS Introducing personalised care planning to general practice diabetes care is possible and well received. Our model for implementation of personalised care planning, which includes specialist training for practice teams and ongoing support from local colleagues and health organizations, can help to meet national recommendations for the provision of personalised care plans for people with long-term conditions. When implementing personalised care planning, efficient administration is vital and behaviour change is necessary for both staff and patients.
Collapse
Affiliation(s)
- R Walker
- Successful Diabetes, Northampton, UK.
| | | | | | | | | | | |
Collapse
|
26
|
Smith AG, O'Doherty JV, Reilly P, Ryan MT, Bahar B, Sweeney T. The effects of laminarin derived from Laminaria digitata on measurements of gut health: selected bacterial populations, intestinal fermentation, mucin gene expression and cytokine gene expression in the pig. Br J Nutr 2011; 105:669-77. [PMID: 21251335 DOI: 10.1017/s0007114510004277] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The aim of the present study was to establish the optimum inclusion level of laminarin derived from Laminaria digitata on selected microbial populations, intestinal fermentation, cytokine and mucin gene expression in the porcine ileum and colon. A total of twenty-one pigs (mean body weight 17·9 kg) were randomly assigned to one of three dietary treatments: T1 - basal (control) diet, T2 and T3 - basal diets supplemented with laminarin included at 300 and 600 parts per million (ppm), respectively. Selected intestinal bacterial populations and volatile fatty acid (VFA) concentrations were measured in the ileum and colon. Relative gene expression levels for specific cytokine and mucin genes were investigated in ileal and colonic tissue in the absence and presence of a lipopolysaccharide (LPS) challenge. There was an up-regulation of MUC2 gene expression at the 300 ppm inclusion level in the ileum. In the colon, there was a significant reduction in the enterobacteriaceae population at the 300 ppm inclusion level (P = 0·0421). Dietary supplementation of 600 ppm laminarin led to a significant increase in MUC2 (P = 0·0365) and MUC4 (P = 0·0401) expression in the colon, and in the total VFA concentration in the caecum (P = 0·0489). A significant increase was also recorded in IL-6 (P = 0·0289) and IL-8 gene expression (P = 0·0245) in LPS-challenged colonic tissue at both laminarin inclusion levels. In conclusion, dietary inclusion of 300 ppm laminarin appears to be the optimum dose in the present study due to the reduction in the enterobacteriaceae populations and enhanced IL-6 and IL-8 cytokine expression in response to an ex vivo LPS challenge.
Collapse
Affiliation(s)
- A G Smith
- School of Agriculture, Food Science and Veterinary Medicine, University College, Dublin, Republic of Ireland
| | | | | | | | | | | |
Collapse
|
27
|
Murray LJ, Cooper D, Rosenfeld JV, Arabi Y, Davies A, D'urso P, Kossmann T, Ponsford J, Reilly P, Seppelt I, Wolfe R. Optimising the consent process in severe traumatic brain injury trials. Crit Care 2011. [PMCID: PMC3066989 DOI: 10.1186/cc9735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
|
28
|
Safavi S, Chua FJK, Reilly P, Russell GK. P246 Suspicion-prompted testing reveals missed opportunities for diagnosing new HIV cases among patients with community-acquired pneumonia. Thorax 2010. [DOI: 10.1136/thx.2010.151068.47] [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: 11/03/2022]
|
29
|
Reilly P, Sweeney T, Smith A, Pierce K, Gahan D, Callan J, O'Doherty J. The effects of cereal-derived β-glucans and enzyme supplementation on intestinal microbiota, nutrient digestibility and mineral metabolism in pigs. Livest Sci 2010. [DOI: 10.1016/j.livsci.2010.06.048] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
30
|
Smith A, Ryan M, O'Doherty J, Reilly P, Bahar B, Sweeney T. Effects of dietary supplementation with laminarin derived from Laminaria hyperborea and Laminaria digitata on colonic mucin gene expression in pigs. Livest Sci 2010. [DOI: 10.1016/j.livsci.2010.06.064] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
|
31
|
Smith A, Reilly P, Sweeney T, Pierce K, Gahan D, Callan J, O'Doherty J. The effect of cereal type and exogenous enzyme supplementation on intestinal microbiota and nutrient digestibility in finisher pigs. Livest Sci 2010. [DOI: 10.1016/j.livsci.2010.06.049] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
32
|
Ryan M, Smith A, O'Doherty J, Bahar B, Reilly P, Sweeney T. Effects of nutrient supplementation with laminarin derived from Laminaria hyperborea and Laminaria digitata on mucin gene expression in the porcine ileum. Livest Sci 2010. [DOI: 10.1016/j.livsci.2010.06.074] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
33
|
Foley P, Reilly P, Coulson A, O’Riordan JI. Routine interferon-neutralising antibody testing in patients with relapsing-remitting multiple sclerosis. J R Coll Physicians Edinb 2010; 40:105-10. [DOI: 10.4997/jrcpe.2010.203] [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: 11/19/2022] Open
|
34
|
Lejeune A, Monahan FJ, Moloney AP, Earley B, Black AD, Campion DP, Englishby T, Reilly P, O'Doherty J, Sweeney T. Peripheral and gastrointestinal immune systems of healthy cattle raised outdoors at pasture or indoors on a concentrate-based ration. BMC Vet Res 2010; 6:19. [PMID: 20356390 PMCID: PMC2864234 DOI: 10.1186/1746-6148-6-19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2009] [Accepted: 03/31/2010] [Indexed: 01/21/2023] Open
Abstract
Background Despite an increasing preference of consumers for beef produced from more extensive pasture-based production systems and potential human health benefits from the consumption of such beef, data regarding the health status of animals raised on pasture are limited. The objective of this study was to characterise specific aspects of the bovine peripheral and the gastrointestinal muscosal immune systems of cattle raised on an outdoor pasture system in comparison to animals raised on a conventional intensive indoor concentrate-based system. Results A number of in vitro functional tests of immune cells suggested subtle differences between the animals on the outdoor versus indoor production systems. There was a decrease in the number of neutrophils and monocytes engaged in phagocytosis in outdoor cattle (P < 0.01 and P < 0.05, respectively) in comparison to those indoors. Following mitogen stimulation, a lower level of interferon-γ was produced in leukocytes from the outdoor animals (P < 0.05). There was evidence of a gastrointestinal nematode infection in the outdoor animals with elevated levels of serum pepsinogen (P < 0.001), a higher number of eosinophils (P < 0.05) and a higher level of interleukin-4 and stem cell factor mRNA expression (P < 0.05) in the outdoor animals in comparison to the indoor animals. Lower levels of copper and iodine were measured in the outdoor animals in comparison to indoor animals (P < 0.001). Conclusion Despite distinctly contrasting production systems, only subtle differences were identified in the peripheral immune parameters measured between cattle raised at pasture in comparison to animals raised on a conventional intensive indoor concentrate-based production system.
Collapse
Affiliation(s)
- Alexandre Lejeune
- UCD School of Agriculture, Food Science and Veterinary Medicine, University College Dublin, Belfield, Dublin 4, Ireland.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
35
|
Cashman PMM, Baring T, Reilly P, Emery RJH, Amis AA. Measurement of migration of soft tissue by modified Roentgen stereophotogrammetric analysis (RSA): validation of a new technique to monitor rotator cuff tears. J Med Eng Technol 2010; 34:159-65. [DOI: 10.3109/03091900903174428] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
|
36
|
Platonov PG, Nault I, Stridh M, Haissaguerre M, Sztajzel J, Jackson Y, Getaz L, Tardin A, Gaspoz J, Chappuis F, Arsenos P, Gatzoulis K, Dilaveris P, Gialernios T, Manis G, Papaioannou T, Sideris S, Stefanadis C, Stoica E, Coriu D, Chioncel O, Macarie C, Szydlo K, Wita K, Trusz-Gluza M, Tabor Z, Filipecki A, Apiyasawat S, Ngarmukos T, Chandanamattha P, Likittanasombat K, Caselli L, Galanti G, Nieri M, Vignini S, Michelucci A, Castilla San Jose ML, Almendral Garrote J, Atienza Fernandez F, Rojo Alvarez JL, Everss, Gonzalez-Torrecilla E, Arenal Maiz A, Fernandez-Aviles F, Senga M, Fujii E, Sugiura S, Yamazato S, Nakamura M, Ito M, Zorio Grima E, Cano Perez O, Navarro Manchon J, Osca Asensi J, Arnau Vives MA, Gonzalez Llopis F, Olague De Ros J, Salvador Sanz A, Nagahori W, Suzuki M, Ohno M, Matsumura A, Hashimoto Y, Forclaz A, Narayan S, Jadidi A, Nault I, Miyazaki S, Wright M, Hocini M, Haissaguerre M, Arsenos P, Gatzoulis K, Dilaveris P, Gialernios T, Archontakis S, Tatsis I, Tsiliki G, Stefanadis C, Brembilla-Perrot B, Luporsi JD, Sadoul N, Kaminsky P, Letsas K, Weber R, Astheimer K, Kalusche D, Arentz T, Brembilla-Perrot B, Luporsi JD, Sadoul N, Kaminsky P, Hatzinikolaou-Kotsakou E, Kotsakou M, Moschos G, Reppas E, Beleveslis TH, Tsakiridis K, Platonov PG, Christensen AH, Carlson J, Holmqvist F, Haunso S, Svendsen JH, Scopinaro A, Rollando D, Modonesi E, Bezante GP, Brunelli C, Barsotti A, Bertero G, Garcia Quintana A, Arbelo Lainez E, Serrano Arriezu L, Serrano Aguilar P, Caballero Dorta E, Led S, Garcia Perez L, Medina Fernandez-Aceytuno A, Saravanan P, Gatley M, O'neill S, Davidson N, Sanchez-Munoz JJ, Garcia-Alberola A, Martinez-Sanchez J, Penafiel-Verdu P, Giner-Caro JA, Pastor-Perez FJ, Valdes-Chavarri M, Donoiu I, Giuca A, Militaru C, Moise B, Ionescu DD, Al-Shawabkeh NN, Van Der Zwaag P, Jongbloed JDH, Van Den Berg MP, Hofstra RMW, Van Tintelen JP, Pap R, Bencsik G, Klausz G, Makai A, Forster T, Saghy L, Haman L, Parizek P, Dostalova H, Fragakis N, Antoniadis A, Bikias A, Delithanasis I, Tsaritsaniotis E, Katsaris G, Londono Sanchez O, Terrades S, Paredes L, Santeladze V, Ezekowitz M, Connolly S, Parekh A, Reilly P, Oldgren J, Themeles E, Wallentin L, Yusuf S. Poster Session 4: ECG. Europace 2009. [DOI: 10.1093/europace/euq237] [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: 11/14/2022] Open
|
37
|
Leong JJH, Leff DR, Das A, Aggarwal R, Reilly P, Atkinson HDE, Emery RJ, Darzi AW. Validation of orthopaedic bench models for trauma surgery. ACTA ACUST UNITED AC 2008; 90:958-65. [PMID: PMID: 18591610 DOI: 10.1302/0301-620x.90b7.20230] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The aim of this study was to validate the use of three models of fracture fixation in the assessment of technical skills. We recruited 21 subjects (six experts, seven intermediates, and eight novices) to perform three procedures: application of a dynamic compression plate on a cadaver porcine model, insertion of an unreamed tibial intramedullary nail, and application of a forearm external fixator, both on synthetic bone models. The primary outcome measures were the Objective Structural Assessment of technical skills global rating scale on video recordings of the procedures which were scored by two independent expert observers, and the hand movements of the surgeons which were analysed using the Imperial College Surgical Assessment Device. The video scores were significantly different for the three groups in all three procedures (p < 0.05), with excellent inter-rater reliability (alpha = 0.88). The novice and intermediate groups specifically were significantly different in their performance with dynamic compression plate and intramedullary nails (p < 0.05). Movement analysis distinguished between the three groups in the dynamic compression plate model, but a ceiling effect was demonstrated in the intramedullary nail and external fixator procedures, where intermediates and experts performed to comparable standards (p > 0.6). A total of 85% (18 of 21) of the subjects found the dynamic compression model and 57% (12 of 21) found all the models acceptable tools of assessment. This study has validated a low-cost, high-fidelity porcine dynamic compression plate model using video rating scores for skills assessment and movement analysis. It has also demonstrated that Synbone models for the application of and intramedullary nail and an external fixator are less sensitive and should be improved for further assessment of surgical skills in trauma. The availability of valid objective tools of assessment of surgical skills allows further studies into improving methods of training.
Collapse
|
38
|
Hill A, Bull A, Richardson J, McGregor A, Smith C, Barrett C, Reilly P, Wallace A. The clinical assessment and classification of shoulder instability. ACTA ACUST UNITED AC 2008. [DOI: 10.1016/j.cuor.2008.02.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
39
|
Leek A, Callan J, Reilly P, Beattie V, O’Doherty J. Apparent component digestibility and manure ammonia emission in finishing pigs fed diets based on barley, maize or wheat prepared without or with exogenous non-starch polysaccharide enzymes. Anim Feed Sci Technol 2007. [DOI: 10.1016/j.anifeedsci.2006.03.024] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
40
|
Gilchrist NL, Frampton CM, Acland RH, Nicholls MG, March RL, Maguire P, Heard A, Reilly P, Marshall K. Alendronate prevents bone loss in patients with acute spinal cord injury: a randomized, double-blind, placebo-controlled study. J Clin Endocrinol Metab 2007; 92:1385-90. [PMID: 17227802 DOI: 10.1210/jc.2006-2013] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
CONTEXT Patients who sustain an acute spinal cord injury (SCI) experience rapid dramatic reductions in bone mineral density (BMD), especially marked in sublesional areas and sometimes leading to hypercalcemia and hypercalciuria, as well as increased fracture risk. OBJECTIVE In this prospective, double-blind, randomized, placebo-controlled study, we evaluated the hypothesis that oral alendronate administration would preserve BMD when administered soon after acute SCI. PATIENTS AND INTERVENTION Thirty-one patients with acute SCI were randomly allocated to receive oral alendronate 70 mg/wk or placebo, within 10 d of acute SCI, for 12 months. MAIN OUTCOME MEASUREMENTS At entry and at 3, 6, 12, and 18 months, total body bone density, lumbar and hip BMD, ultrasound of the calcaneus, 24-h urinary calcium, and serum C-telopeptide (betaCTX) were measured. RESULTS At study entry, patients in the two groups were well matched for age, gender, severity of neurological deficit, BMD, urinary calcium, and betaCTX. BMD indices declined steadily in the placebo group, and this effect was attenuated significantly by alendronate. After 12 months, there was a 5.3% difference (P<0.001) in total body BMD and a 17.6% difference (P<0.001) in the total hip BMD between the two groups. Alendronate compared with placebo induced significant (P<0.001) reductions in urinary calcium excretion and serum betaCTX. No treatment-related side effects were noted. CONCLUSIONS We conclude that alendronate therapy, 70 mg/wk, initiated soon after acute SCI, prevents bone loss and is not associated with side effects.
Collapse
Affiliation(s)
- N L Gilchrist
- Canterbury Geriatric Medical Research Trust, The Princess Margaret Hospital, and Department of Medicine, Christchurch School of Medicine and Health Sciences, New Zealand.
| | | | | | | | | | | | | | | | | |
Collapse
|
41
|
Affiliation(s)
- P Reilly
- Nuffield Department of Orthopaedic Surgery, Nuffield Orthopaedic Centre, Oxford, UK.
| | | | | |
Collapse
|
42
|
Affiliation(s)
- P Reilly
- Nuffield Department of Orthopaedic Surgery, Nuffield Orthopaedic Centre Oxford, UK
| | - J Rees
- Nuffield Department of Orthopaedic Surgery, Nuffield Orthopaedic Centre Oxford, UK
| | - AJ Carr
- Nuffield Department of Orthopaedic Surgery, Nuffield Orthopaedic Centre Oxford, UK
| |
Collapse
|
43
|
Reilly P, Macleod I, Macfarlane R, Windley J, Emery RJH. Dead men and radiologists don't lie: a review of cadaveric and radiological studies of rotator cuff tear prevalence. Ann R Coll Surg Engl 2006; 88:116-21. [PMID: 16551396 PMCID: PMC1964063 DOI: 10.1308/003588406x94968] [Citation(s) in RCA: 205] [Impact Index Per Article: 11.4] [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] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Rotator cuff tears are a common pathology, with a varied prevalence reported. PATIENTS AND METHODS A literature review was undertaken to determine the cadaveric and radiological (ultrasonography and magnetic resonance imaging [MRI]) prevalence of rotator cuff tear. The radiological studies were subdivided into symptomatic and asymptomatic subjects. RESULTS Cadaveric rotator cuff tears were found in 4629 shoulders of which only 2553 met the inclusion criteria. The prevalence of full-thickness tears was 11.75% and partial thickness 18.49% (total tears 30.24%). The total tear rate in ultrasound asymptomatic was 38.9% and ultrasound symptomatic 41.4%. The total rate in MRI asymptomatic was 26.2% whilst MRI symptomatic was 49.4%. DISCUSSION The unselected cadaveric population should contain both symptomatic and asymptomatic subjects. A prevalence of tears between the symptomatic and asymptomatic radiological groups would be expected. However, apart from the MRI asymptomatic group, the radiological prevalence of rotator cuff tears exceeds the cadaveric. CONCLUSIONS Rotator cuff tears are frequently asymptomatic. Tears demonstrated during radiological investigation of the shoulder may be asymptomatic. It is important to correlate radiological and clinical findings in the shoulder.
Collapse
Affiliation(s)
- P Reilly
- Department Orthopaedic Surgery, St Mary's Hospital, London, UK
| | | | | | | | | |
Collapse
|
44
|
FitzPatrick MK, Frankel HL, McMaster J, Heliger LA, Auerbach S, Reilly P, Schwab CW. Integration of concurrent trauma registry and performance improvement programs. J Trauma Nurs 2006; 7:92-7. [PMID: 16422385 DOI: 10.1097/00043860-200010000-00006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Health information management systems have had a tremendous impact on the delivery of healthcare. The implementation of an integrated, concurrent trauma registry and performance improvement system has had a remarkable impact on the University of Pennsylvania's trauma program. Having both the registry and performance improvement programs concurrent and integrated has allowed better utilization of staff and has produced more accurate, relevant and timely data.
Collapse
Affiliation(s)
- M K FitzPatrick
- University of Pennsylvania Medical Center, Division of Trauma and Surgical Critical Care, Philadelphia, PA, USA
| | | | | | | | | | | | | |
Collapse
|
45
|
MacLurg K, Reilly P, Hawkins S, Gray O, Evason E, Whittington D. A primary care-based needs assessment of people with multiple sclerosis. Br J Gen Pract 2005; 55:378-83. [PMID: 15904557 PMCID: PMC1463161] [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] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023] Open
Abstract
BACKGROUND Multiple sclerosis (MS) is a common cause of chronic progressive neurological disability where reduction in quality of life is an important feature. Many GPs have MS patients with a range of disabilities. Little is known about the supply of medical and community services and how this compares with demand. AIM We aim to describe a community based sample of MS patients and investigate how disease characteristics, benefits, services accessed and perceived needs relate to sense of wellbeing. DESIGN Cross-sectional survey. SETTING Participants were recruited from a representative network of 30 GP practices across Northern Ireland. METHOD MS patients answered a professionally administered questionnaire and agreed to their medical records being examined. Information was collected about their medical condition, sociodemographic characteristics, receipt of benefits and services, perceived needs and sense of wellbeing. RESULTS Of the 149 participants, 23% were mildly affected (Kurtzke's Expanded Disability Status Scale [EDSS] 0-4.5), 41% were moderately disabled (EDSS 5.0-6.5) and 36% were severely disabled (EDSS 7.0-9.5). Disability was related to employment, receipt of benefits and services. Physiotherapy was a commonly perceived need. Other perceived needs differed between the moderately and severely disabled groups. Scores relating to wellbeing were related to disability and perceived needs. CONCLUSIONS The relationship between use of medical and community services and disability is important for planning service provision. We have shown that perceived needs are related to wellbeing. In a progressive illness these developing needs could be anticipated.
Collapse
Affiliation(s)
- K MacLurg
- Department of General Practice, Queens University Belfast.
| | | | | | | | | | | |
Collapse
|
46
|
Eriksson BI, Dahl OE, Büller HR, Hettiarachchi R, Rosencher N, Bravo ML, Ahnfelt L, Piovella F, Stangier J, Kälebo P, Reilly P. A new oral direct thrombin inhibitor, dabigatran etexilate, compared with enoxaparin for prevention of thromboembolic events following total hip or knee replacement: the BISTRO II randomized trial. J Thromb Haemost 2005; 3:103-11. [PMID: 15634273 DOI: 10.1111/j.1538-7836.2004.01100.x] [Citation(s) in RCA: 328] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Dabigatran etexilate is an oral direct thrombin inhibitor undergoing evaluation for the prevention of venous thromboembolism (VTE) following orthopedic surgery. METHODS In a multicenter, parallel-group, double-blind study, 1973 patients undergoing total hip or knee replacement were randomized to 6-10 days of oral dabigatran etexilate (50, 150 mg twice daily, 300 mg once daily, 225 mg twice daily), starting 1-4 h after surgery, or subcutaneous enoxaparin (40 mg once daily) starting 12 h prior to surgery. The primary efficacy outcome was the incidence of VTE (detected by bilateral venography or symptomatic events) during treatment. RESULTS Of the 1949 treated patients, 1464 (75%) patients were evaluable for the efficacy analysis. VTE occurred in 28.5%, 17.4%, 16.6%, 13.1% and 24% of patients assigned to dabigatran etexilate 50, 150 mg twice daily, 300 mg once daily, 225 mg twice daily and enoxaparin, respectively. A significant dose-dependent decrease in VTE occurred with increasing doses of dabigatran etexilate (P < 0.0001). Compared with enoxaparin, VTE was significantly lower in patients receiving 150 mg twice daily [odds ratio (OR) 0.65, P = 0.04], 300 mg once daily (OR 0.61, P = 0.02) and 225 mg twice daily (OR 0.47, P = 0.0007). Compared with enoxaparin, major bleeding was significantly lower with 50 mg twice daily (0.3% vs. 2.0%, P = 0.047) but elevated with higher doses, nearly reaching statistical significance with the 300 mg once-daily dose (4.7%, P = 0.051). CONCLUSIONS Oral administration of dabigatran etexilate, commenced early in the postoperative period, was effective and safe across a range of doses. Further optimization of the efficacy/safety balance will be addressed in future studies.
Collapse
Affiliation(s)
- B I Eriksson
- Sahlgrenska University Hospital/Ostra, Göteborg, Sweden.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
47
|
Abstract
Tension in the coracoacromial (CA) ligament has been postulated as the mechanism of acromial spur formation. Five patients (mean age, 58 years) undergoing open rotator cuff repair were recruited. A differential variable reluctance transducer (DVRT) was inserted into the CA ligament parallel to the fiber orientation. The DVRT measured linear displacement as the glenohumeral joint was moved through 90 degrees of abduction and full internal/external rotation. The CA ligament was then removed with the DVRT in situ. The specimen was mounted on a material-testing machine. Load was applied in the line of the CA ligament fibers, and the DVRT output recorded. The CA ligament was found to be under tension, which was lowest with the arm adducted (mean, 8.9 N; range, 3.7-22 N) and highest in abduction (mean, 15.7 N; range, 6.5-38 N). This study confirms CA ligament tension in vivo as a possible stimulus for acromial spur formation.
Collapse
Affiliation(s)
- A F W Chambler
- Department of Orthopaedics, St Mary's Hospital, London, UK.
| | | | | | | | | |
Collapse
|
48
|
Reilly P, Amis AA, Wallace AL, Emery RJH. Mechanical factors in the initiation and propagation of tears of the rotator cuff. Quantification of strains of the supraspinatus tendon in vitro. J Bone Joint Surg Br 2003; 85:594-9. [PMID: 12793570 DOI: 10.1302/0301-620x.85b4.12062] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Differential strain has been proposed to be a causative factor in failure of the supraspinatus tendon. We quantified the strains on the joint and bursal sides of the supraspinatus tendon with increasing load (20 to 200 N) and during 120 degrees of glenohumeral abduction with a constant tensile load (20 to 100 N). We tested ten fresh frozen cadaver shoulders on a purpose-built rig. Differential variable reluctance extensometers allowed calculation of the strain. Static loading to 100 N or more increased strains on the joint side significantly more than on the bursal side. During glenohumeral abduction an increasing and significant difference in strain was measured between the joint and bursal sides of the supraspinatus tendon, which reached a maximum of 10.6% at abduction of 120 degrees. The joint side strain of 7.5% reached values which were previously reported to cause failure. Differential strain causes shearing between the layers of the supraspinatus tendon, which may contribute to the propagation of intratendinous defects that are initiated by high joint side strains.
Collapse
Affiliation(s)
- P Reilly
- Department of Mechanical Engineering, Imperial College of Science, Technology and Medicine, London, England, UK
| | | | | | | |
Collapse
|
49
|
Smith GD, Gunthorpe MJ, Kelsell RE, Hayes PD, Reilly P, Facer P, Wright JE, Jerman JC, Walhin JP, Ooi L, Egerton J, Charles KJ, Smart D, Randall AD, Anand P, Davis JB. TRPV3 is a temperature-sensitive vanilloid receptor-like protein. Nature 2002; 418:186-90. [PMID: 12077606 DOI: 10.1038/nature00894] [Citation(s) in RCA: 601] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Vanilloid receptor-1 (VR1, also known as TRPV1) is a thermosensitive, nonselective cation channel that is expressed by capsaicin-sensitive sensory afferents and is activated by noxious heat, acidic pH and the alkaloid irritant capsaicin. Although VR1 gene disruption results in a loss of capsaicin responses, it has minimal effects on thermal nociception. This and other experiments--such as those showing the existence of capsaicin-insensitive heat sensors in sensory neurons--suggest the existence of thermosensitive receptors distinct from VR1. Here we identify a member of the vanilloid receptor/TRP gene family, vanilloid receptor-like protein 3 (VRL3, also known as TRPV3), which is heat-sensitive but capsaicin-insensitive. VRL3 is coded for by a 2,370-base-pair open reading frame, transcribed from a gene adjacent to VR1, and is structurally homologous to VR1. VRL3 responds to noxious heat with a threshold of about 39 degrees C and is co-expressed in dorsal root ganglion neurons with VR1. Furthermore, when heterologously expressed, VRL3 is able to associate with VR1 and may modulate its responses. Hence, not only is VRL3 a thermosensitive ion channel but it may represent an additional vanilloid receptor subunit involved in the formation of heteromeric vanilloid receptor channels.
Collapse
Affiliation(s)
- G D Smith
- Neurology-CEDD, GlaxoSmithKline, Third Avenue, Harlow CM19 5AW, UK
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
50
|
Abstract
Since the 1980s, when DNA markers for identifying biological samples were first developed, the use of DNA evidence to convict defendants and to exonerate the wrongfully accused and wrongfully imprisoned has greatly increased. But the increase in databanks for storing DNA information on individuals convicted of certain crimes raises important legal and ethical issues on the use, collection and storage of DNA evidence. These issues have been the subject of a recent US National Commission, which will, hopefully, broaden public discourse about the future uses of DNA forensic technology.
Collapse
Affiliation(s)
- P Reilly
- Interleukin Genetics, 135 Beaver Street, Waltham, Massachusetts 02452, USA.
| |
Collapse
|