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Metcalf CD, Ostler C, Thor P, Kheng S, Srors S, Sann R, Worsley P, Gates L, Donnovan-Hall M, Harte C, Dickinson A. Engaging multisector stakeholders to identify priorities for global health innovation, change and research: an engagement methodology and application to prosthetics service delivery in Cambodia. Disabil Rehabil 2024; 46:685-696. [PMID: 36823949 DOI: 10.1080/09638288.2023.2173313] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 01/21/2023] [Indexed: 02/25/2023]
Abstract
PURPOSE While innovation is known to catalyse solutions to global sustainable development challenges, lack of engagement from stakeholders during conceptualisation and development may influence the degree of success of implementation. METHODS AND MATERIALS This paper presents a complete and novel engagement methodology, developed from value led business modelling approaches, for working with multi-sector stakeholders. The methodology can be used to determine barriers and facilitators to clinical practice innovations or translational research, within a country-specific context. The approach has then been applied in the Cambodian prosthetics and orthotics sector to provide a practice-based exemplar application of the framework. RESULTS This approach seeks to ensure the suitability and sustainability of clinical practice and research programmes being implemented within a complex ecosystem. A theoretical basis, drawn from academic and business innovation sectors, has been consolidated and adapted for practical application to design, direct, and inform initiatives in low resource settings. CONCLUSIONS The methods presented provide a way to both develop and articulate the mission, vision, and goals of any proposed change, and to effectively communicate these with stakeholders in a way that engages the personal and professional values that exist in their ecosystem. It provides a structured process through which meaningful conversations can happen, and a basis for relationship management with key stakeholders; intrinsic to enable a sustained legacy from research and development.
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Affiliation(s)
- C D Metcalf
- School of Health Sciences, University of Southampton, Southampton, UK
- Exceed Research Network, Lisburn, Northern Ireland
| | - C Ostler
- School of Health Sciences, University of Southampton, Southampton, UK
- Exceed Research Network, Lisburn, Northern Ireland
- Portsmouth NHS, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | - P Thor
- Department of Prosthetics & Orthotics, Phnom Penh, Cambodia
- Exceed Worldwide, Lisburn, Northern Ireland
| | - S Kheng
- Exceed Research Network, Lisburn, Northern Ireland
- Department of Prosthetics & Orthotics, Phnom Penh, Cambodia
- Exceed Worldwide, Lisburn, Northern Ireland
| | - S Srors
- Department of Prosthetics & Orthotics, Phnom Penh, Cambodia
- Exceed Worldwide, Lisburn, Northern Ireland
| | - R Sann
- National Institute of Social Affairs, Phnom Penh, Cambodia
- Elderly Welfare Department, Ministry of Social Affairs, Veterans and Youth Rehabilitation, National Elderly Care Center, Phnom Penh, Cambodia
| | - P Worsley
- School of Health Sciences, University of Southampton, Southampton, UK
| | - L Gates
- School of Health Sciences, University of Southampton, Southampton, UK
| | - M Donnovan-Hall
- School of Health Sciences, University of Southampton, Southampton, UK
- Exceed Research Network, Lisburn, Northern Ireland
| | - C Harte
- Exceed Research Network, Lisburn, Northern Ireland
- Exceed Worldwide, Lisburn, Northern Ireland
| | - A Dickinson
- Exceed Research Network, Lisburn, Northern Ireland
- School of Engineering, University of Southampton, Southampton, UK
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Clarkson P, Bader D, Schoonhoven L, Worsley P. A multidisciplinary approach to pressure ulcer prevention: exploring healthcare professionals’ knowledge and attitudes to pressure ulcer prevention in the community. Physiotherapy 2016. [DOI: 10.1016/j.physio.2016.10.322] [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: 11/15/2022]
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Warwick DJ, Graham D, Worsley P. New insights into the immediate outcome of collagenase injections for Dupuytren's contracture. J Hand Surg Eur Vol 2016; 41:583-8. [PMID: 26307140 DOI: 10.1177/1753193415600670] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [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: 01/12/2015] [Accepted: 05/27/2015] [Indexed: 02/03/2023]
Abstract
UNLABELLED Collagenase clostridium histolyticum is now established as an effective and safe option to treat patients with a single joint affected with Dupuytren's contracture. We have extended its use to natatory and combined cords. In a prospective consecutive series of 298 cords in 237 patients, the mean total extension loss improved in cords crossing the metacarpophalangeal joint from 46° to 1°, in cords crossing the proximal interphalangeal joint from 56° to 7°, in natatory cords from 130° to 25° and in combined cords from 102° to 16°. The immediate correction of combined cords and natatory cords was less reliable than that obtained in cords crossing the metacarpophalangeal joint or proximal interphalangeal joint. Less severe pre-intervention contractures tended to correct better. We found a high complication rate, which may cause alarm. A total of 21% developed skin splits, with the risk of skin splits generally increasing with more severe pre-injection deformity. Blood blisters were only encountered after manipulation of the more severe contractures. A total of 23 patients (8%) had a spontaneous rupture and 57 patients (19%) had a partial spontaneous rupture. Only 4.9% needed a second injection. We noticed a learning curve, with seven of the first 20 cords (35%) needing a second injection to achieve a satisfactory correction and then only seven (2.5%) in the rest. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- D J Warwick
- Hand Unit, University Hospital Southampton, Southampton, UK Musculoskeletal Research Unit, University Hospital Southampton and University of Southampton, Southampton, UK
| | - D Graham
- Hand Unit, University Hospital Southampton, Southampton, UK
| | - P Worsley
- Musculoskeletal Research Unit, University Hospital Southampton and University of Southampton, Southampton, UK
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Warwick DJ, Shaikh A, Worsley P, Bain D, Gadola S, Tucker A, Gadola S, Stokes M. Microcirculation in the foot is augmented by neuromuscular stimulation via the common peroneal nerve in different lower limb postures: a potential treatment for leg ulcers. INT ANGIOL 2015:R34Y9999N00A150049. [PMID: 26138236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVES To examine the effects of the geko™ device (a portable electical nerve stimulator) on microcirculatory flow on the dorsum of the foot, and whether this is influenced by lower limb postures and application of a plaster cast. STUDY DESIGN Cross-sectional, healthy cohort, open label, physiological response study. METHODS In 10 healthy volunteers, aged 19 to 24 years, Laser Doppler Fluxmetry measurements were made on the dorsum of the foot in four postures: standing (weight bearing and non-weight bearing) and supine lying (with the lower limb horizontal and then elevated). Measurements of flux were made both at rest and during stimulation with the geko™ device applied over the common peroneal nerve, at 1Hz for 5 minutes in each posture. Repeat measurement were made after the application of a below knee plaster cast. Measures of flux were compared to basal levels assumed to be in supine with limb horizontal, with no cast and an inactive Geko device. RESULTS The geko™ device was effective in increasing microcirculation on the dorsum of the foot in all four postures (Mean difference =141%, 95% CI 70%-212%, p=0.001). This effect was more pronounced than that of using a plaster alone (Mean increase in Flux of 73%, 95% CI 22%-125%, p=0.01) or variances due to the hydrostatic effects of different postures (Mean difference 17-27.6%, p>0.05). There was a 2 to 3 fold increase in flux when stimulation was delivered in combination with the plaster cast. CONCLUSIONS Stimulation using the geko™ device augments microcirculation in the foot. The response is greater in lying and non-weight bearing than weight bearing standing but the most striking effect is when stimulation is combined with a plaster cast. The geko™ offers a potential means of promoting conditions favourable for wound healing, where treatment using compression may be contraindicated, such as arterial/mixed aetiology ulcers.
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Affiliation(s)
- D J Warwick
- Faculty of Medicine and Musculoskeletal Research Unit, University of Southampton, Southampton, UK -
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Warwick D, Worsley P, Graham D. Re: Akhavani MA, McMurtrie A, Webb M, Muir L. A review of the classification of Dupuytren's Disease. J Hand Surg Eur. 2015, 40: 155-65 and Rodrigues JN, Zhang W, Scammell BE, Davis TRC. What patients want from the treatment of Dupuytren's Disease--is the Unité Rhumatologique des Affections de la Main (URAM) scale relevant? J Hand Surg Eur. 2015, 40: 150-4. J Hand Surg Eur Vol 2015; 40:544. [PMID: 26002706 DOI: 10.1177/1753193415583625] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- D Warwick
- University Hospital Southampton, University of Southampton, UK
| | - P Worsley
- University Hospital Southampton, University of Southampton, UK
| | - D Graham
- University Hospital Southampton, University of Southampton, UK
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Warwick D, Shaikh A, Worsley P, Gadola S, Bain D, Tucker A, Gadola SD, Stokes M. Microcirculation in the foot is augmented by neuromuscular stimulation via the common peroneal nerve in different lower limb postures: a potential treatment for leg ulcers. INT ANGIOL 2015; 34:158-165. [PMID: 25839841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
AIM Aim of the study was to examine the effects of the geko™ device (a portable electical nerve stimulator) on microcirculatory flow on the dorsum of the foot, and whether this is influenced by lower limb postures and application of a plaster cast. METHODS This was a cross-sectional, healthy cohort, open label, physiological response study. In 10 healthy volunteers, aged 19 to 24 years, laser Doppler fluxmetry measurements were made on the dorsum of the foot in four postures: standing (weight bearing and non-weight bearing) and supine lying (with the lower limb horizontal and then elevated). Measurements of flux were made both at rest and during stimulation with the geko™ device applied over the common peroneal nerve, at 1 Hz for 5 minutes in each posture. Repeat measurement were made after the application of a below knee plaster cast. Measures of flux were compared to basal levels assumed to be in supine with limb horizontal, with no cast and an inactive geko™ device. RESULTS The geko™ device was effective in increasing microcirculation on the dorsum of the foot in all four postures (mean difference =141%, 95% CI 70%-212%, P=0.001). This effect was more pronounced than that of using a plaster alone (Mean increase in flux of 73%, 95% CI 22%-125%, P=0.01) or variances due to the hydrostatic effects of different postures (mean difference 17-27.6%, P>0.05). There was a 2 to 3 fold increase in flux when stimulation was delivered in combination with the plaster cast. CONCLUSION Stimulation using the geko™ device augments microcirculation in the foot. The response is greater in lying and non-weight bearing than weight bearing standing but the most striking effect is when stimulation is combined with a plaster cast. The geko™ offers a potential means of promoting conditions favourable for wound healing, where treatment using compression may be contraindicated, such as arterial/mixed aetiology ulcers.
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Affiliation(s)
- D Warwick
- Musculoskeletal Research Unit, University of Southampton, University Hospital of Southampton, Southampton, UK -
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Warwick DJ, Shaikh A, Gadola S, Stokes M, Worsley P, Bain D, Tucker AT, Gadola SD. Neuromuscular electrostimulation viathe common peroneal nerve promotes lower limb blood flow in a below-kneecast: A potential for thromboprophylaxis. Bone Joint Res 2013; 2:179-85. [PMID: 23999610 PMCID: PMC3763477 DOI: 10.1302/2046-3758.29.2000176] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [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] [Indexed: 01/06/2023] Open
Abstract
Objectives We aimed to examine the characteristics of deep venous flow in
the leg in a cast and the effects of a wearable neuromuscular stimulator
(geko; FirstKind Ltd) and also to explore the participants’ tolerance
of the stimulator. Methods This is an open-label physiological study on ten healthy volunteers.
Duplex ultrasonography of the superficial femoral vein measured
normal flow and cross-sectional area in the standing and supine
positions (with the lower limb initially horizontal and then elevated).
Flow measurements were repeated during activation of the geko stimulator
placed over the peroneal nerve. The process was repeated after the
application of a below-knee cast. Participants evaluated discomfort
using a questionnaire (verbal rating score) and a scoring index
(visual analogue scale). Results The geko device was effective in significantly increasing venous
blood flow in the lower limb both with a plaster cast (mean difference
11.5 cm/sec-1; p = 0.001 to 0.13) and without a plaster
cast (mean difference 7.7 cm/sec-1; p = 0.001 to 0.75).
Posture also had a significant effect on peak venous blood flow
when the cast was on and the geko inactive (p = 0.003 to 0.69),
although these differences were less pronounced than the effect
of the geko (mean difference 3.1 cm/sec-1 (-6.5 to 10)).
The geko device was well tolerated, with participants generally
reporting only mild discomfort using the device. Conclusion The geko device increases venous blood flow in the lower limb,
offering a potential mechanical thromboprolylaxis for patients in
a cast. Cite this article: Bone Joint Res 2013;2:179–85.
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Affiliation(s)
- D J Warwick
- University Hospital Southampton, SouthamptonS16 6UY, UK
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Kedda MA, Worsley P, Shi J, Phelps S, Duffy D, Thompson PJ. Polymorphisms in the 5-lipoxygenase activating protein (ALOX5AP) gene are not associated with asthma in an Australian population. Clin Exp Allergy 2005; 35:332-8. [PMID: 15784112 DOI: 10.1111/j.1365-2222.2005.02188.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND The cysteinyl-leukotrienes (cys-LTs) are important pro-inflammatory mediators in asthma, and have been shown to have a role in specific disease subtypes, including asthma severity. Few studies have investigated the role of polymorphisms in the ALOX5AP gene, encoding 5-lipoxygenase activating protein (FLAP), and asthma. We hypothesized that polymorphisms in this gene are associated with asthma and in particular, with asthma severity, in an Australian population. OBJECTIVE To screen the coding region of the ALOX5AP gene for polymorphisms and to determine the association between previously described polymorphisms and asthma and asthma severity in an Australian population. METHODS We used PCR-SSCP and PCR-RFLP analysis to examine a previously described promoter polyA variable repeat polymorphism and two intronic polymorphisms (IVS2+12C>A, IVS2+105T>C), and to screen all five exons of the gene for new polymorphisms, in a large Australian population of randomly selected, non-asthmatic controls (n=457), mild asthmatics (n=274), moderate asthmatics (n=231) and severe asthmatics (n=79). RESULTS We confirmed the presence of two polymorphisms in intron 2 and found no association between these polymorphisms and asthma or asthma severity, nor between a promoter polymorphism in the ALOX5AP gene and asthma or asthma severity. Gene fragment analysis of the promoter polymorphism revealed novel, conserved repeat numbers in our population, and no new polymorphisms were found in the coding region of the gene. CONCLUSION These findings in a large, well characterized asthma population, reveal that, while FLAP is an important enzyme in cys-LTs biosynthesis, polymorphisms in the ALOX5AP gene are not likely to be functionally associated with the asthma phenotype.
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Affiliation(s)
- M-A Kedda
- The Co-operative Research Centre for Asthma, the Asthma and Allergy Research Institute (Inc.), Perth, Australia
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Kalaydjieva L, Gresham D, Gooding R, Heather L, Baas F, De Jonge R, Blechschmidt K, Angelicheva D, Chandler D, Worsley P, Rosenthal A, King RHM, Thomas P. N‐MYC Downstream‐Regulated Gene 1 Is Mutated In Hereditary Motor And Sensory Neuropathy‐LOM. J Peripher Nerv Syst 2001. [DOI: 10.1046/j.1529-8027.2001.01008-16.x] [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: 11/20/2022]
Affiliation(s)
- L Kalaydjieva
- American Journal of Human Genetics 67: 47–58, 2000. Reprinted with permission from University Chicago Press
| | - D Gresham
- American Journal of Human Genetics 67: 47–58, 2000. Reprinted with permission from University Chicago Press
| | - R Gooding
- American Journal of Human Genetics 67: 47–58, 2000. Reprinted with permission from University Chicago Press
| | - L Heather
- American Journal of Human Genetics 67: 47–58, 2000. Reprinted with permission from University Chicago Press
| | - F Baas
- American Journal of Human Genetics 67: 47–58, 2000. Reprinted with permission from University Chicago Press
| | - R De Jonge
- American Journal of Human Genetics 67: 47–58, 2000. Reprinted with permission from University Chicago Press
| | - K Blechschmidt
- American Journal of Human Genetics 67: 47–58, 2000. Reprinted with permission from University Chicago Press
| | - D Angelicheva
- American Journal of Human Genetics 67: 47–58, 2000. Reprinted with permission from University Chicago Press
| | - D Chandler
- American Journal of Human Genetics 67: 47–58, 2000. Reprinted with permission from University Chicago Press
| | - P Worsley
- American Journal of Human Genetics 67: 47–58, 2000. Reprinted with permission from University Chicago Press
| | - A Rosenthal
- American Journal of Human Genetics 67: 47–58, 2000. Reprinted with permission from University Chicago Press
| | - RHM King
- American Journal of Human Genetics 67: 47–58, 2000. Reprinted with permission from University Chicago Press
| | - Pk Thomas
- American Journal of Human Genetics 67: 47–58, 2000. Reprinted with permission from University Chicago Press
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Kalaydjieva L, Gresham D, Gooding R, Heather L, Baas F, de Jonge R, Blechschmidt K, Angelicheva D, Chandler D, Worsley P, Rosenthal A, King RH, Thomas PK. N-myc downstream-regulated gene 1 is mutated in hereditary motor and sensory neuropathy-Lom. Am J Hum Genet 2000; 67:47-58. [PMID: 10831399 PMCID: PMC1287101 DOI: 10.1086/302978] [Citation(s) in RCA: 257] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2000] [Accepted: 05/11/2000] [Indexed: 12/22/2022] Open
Abstract
Hereditary motor and sensory neuropathies, to which Charcot-Marie-Tooth (CMT) disease belongs, are a common cause of disability in adulthood. Growing awareness that axonal loss, rather than demyelination per se, is responsible for the neurological deficit in demyelinating CMT disease has focused research on the mechanisms of early development, cell differentiation, and cell-cell interactions in the peripheral nervous system. Autosomal recessive peripheral neuropathies are relatively rare but are clinically more severe than autosomal dominant forms of CMT, and understanding their molecular basis may provide a new perspective on these mechanisms. Here we report the identification of the gene responsible for hereditary motor and sensory neuropathy-Lom (HMSNL). HMSNL shows features of Schwann-cell dysfunction and a concomitant early axonal involvement, suggesting that impaired axon-glia interactions play a major role in its pathogenesis. The gene was previously mapped to 8q24.3, where conserved disease haplotypes suggested genetic homogeneity and a single founder mutation. We have reduced the HMSNL interval to 200 kb and have characterized it by means of large-scale genomic sequencing. Sequence analysis of two genes located in the critical region identified the founder HMSNL mutation: a premature-termination codon at position 148 of the N-myc downstream-regulated gene 1 (NDRG1). NDRG1 is ubiquitously expressed and has been proposed to play a role in growth arrest and cell differentiation, possibly as a signaling protein shuttling between the cytoplasm and the nucleus. We have studied expression in peripheral nerve and have detected particularly high levels in the Schwann cell. Taken together, these findings point to NDRG1 having a role in the peripheral nervous system, possibly in the Schwann-cell signaling necessary for axonal survival.
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Affiliation(s)
- L Kalaydjieva
- Centre for Human Genetics, Edith Cowan University, Perth, Australia.
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Worsley P, Clayton J. Creating computing: quiet revolution led by the other SAS. Health Soc Serv J 1983; 93:812. [PMID: 10263738] [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: 02/12/2023]
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