Value-based healthcare analysis of shoulder surgery for patients with symptomatic rotator cuff tears - Calculating the impact of arthroscopic cuff repair.

Background: Surgical repair of full-thickness rotator cuff tears in symptomatic patients is known to offer significant benefits. Despite this there remains a lack of universal appreciation that such surgery offers high clinical value, with some commissioners even limiting access to it. The value-based healthcare agenda provides a means to design, deliver and measure the impact of healthcare to a defined segment of patients. The aim of this study was to measure the value of surgically repairing primary symptomatic full-thickness rotator cuff tears when outcomes and costs were assessed over an entire care pathway. Methods: A prospective study of patients undergoing rotator cuff tears repair was undertaken. Patients were managed using a standardised integrated care pathway. Subsequent outcomes and costs were measured over the whole care pathway. Outcomes were assessed from both traditional and patient centric re-formatted prisms. Results: Significant improvement in clinical outcomes where recognised when assessed from either the traditional or re-formatted prisms. Economic review of this approach revealed the pathway generated a sustainable and notable positive margin. Discussion: This study evidences how a well-designed value-based healthcare shoulder approach can be delivered and measured. It demonstrates rotator cuff surgery to be a high value treatment for patients with symptomatic rotator cuff tears.

Impact of intravenous tranexamic acid on patients undergoing shoulder arthroplasty surgery.

Background: Shoulder arthroplasty surgery carries the risk of blood loss. The antifibrinolytic tranexamic acid (TXA) is effective in reducing blood loss in lower limb arthroplasty. The purpose of this study was to assess blood loss and associated complications following shoulder arthroplasty performed with and without TXA for both elective and trauma indications. Methods: A cohort study was performed to assess blood loss, transfusion requirements and post-operative venous thromboembolic events (VTE) following shoulder arthroplasty undertaken with and without the use of intravenous TXA. Results: The study consisted of 67 patients (n = 36 with TXA; n = 31 without TXA). Type of arthroplasty included reverse-shoulder arthroplasty, total-shoulder arthroplasty and hemiarthroplasty. There was no significant difference between TXA and non-TXA groups regarding blood loss (TXA group haemoglobin drop 20.6 mg/dL; non-TXA group haemoglobin drop 20.5 mg/dL; p = 0.978). There was no significant difference in measured outcomes with or without TXA use for elective or trauma indications, nor regarding type of arthroplasty. Discussion: The use of intravenous TXA in shoulder arthroplasty was not associated with a significant reduction in blood loss or post-operative transfusion rates, nor did it impact on VTE. This result was not affected by the indication being elective or trauma nor the type of arthroplasty surgery performed.

The 2021 Magnonics Roadmap.

Magnonics is a budding research field in nanomagnetism and nanoscience that addresses the use of spin waves (magnons) to transmit, store, and process information. The rapid advancements of this field during last one decade in terms of upsurge in research papers, review articles, citations, proposals of devices as well as introduction of new sub-topics prompted us to present the first roadmap on magnonics. This is a collection of 22 sections written by leading experts in this field who review and discuss the current status besides presenting their vision of future perspectives. Today, the principal challenges in applied magnonics are the excitation of sub-100 nm wavelength magnons, their manipulation on the nanoscale and the creation of sub-micrometre devices using low-Gilbert damping magnetic materials and its interconnections to standard electronics. To this end, magnonics offers lower energy consumption, easier integrability and compatibility with CMOS structure, reprogrammability, shorter wavelength, smaller device features, anisotropic properties, negative group velocity, non-reciprocity and efficient tunability by various external stimuli to name a few. Hence, despite being a young research field, magnonics has come a long way since its early inception. This roadmap asserts a milestone for future emerging research directions in magnonics, and hopefully, it will inspire a series of exciting new articles on the same topic in the coming years.

The effect of the COVID-19 pandemic on mental health associated trauma, admissions and fractures at a London major trauma centre.

INTRODUCTION: Non-injury-related factors have been extensively studied in major trauma and have been shown to have a significant impact on patient outcomes. Mental illness and associated medication use has been proven to have a negative effect on bone health and fracture healing. MATERIALS AND METHODS: We collated data retrospectively from the records of orthopaedic inpatients in a non-COVID and COVID period. We analysed demographic data, referral and admission numbers, orthopaedic injuries, surgery performed and patient comorbidities, including psychiatric history. RESULTS: There were 824 orthopaedic referrals and 358 admissions (six/day) in the non-COVID period, with 38/358 (10.6%) admissions having a psychiatric diagnosis and 30/358 (8.4%) also having a fracture. This was compared with 473 referrals and 195 admissions (three/day) in the COVID period, with 73/195 (37.4%) admissions having a documented psychiatric diagnosis and 47/195 (24.1%) having a fracture. DISCUSSION: There was a reduction in the number of admissions and referrals during the pandemic, but a simultaneous three-fold rise in admissions with a psychiatric diagnosis. The proportion of patients with both a fracture and a psychiatric diagnosis more than doubled and the number of patients presenting due to a traumatic suicide attempt almost tripled. CONCLUSION: While total numbers using the orthopaedic service decreased, the impact of the pandemic and lockdown disproportionately affects those with mental health problems, a group already at higher risk of poorer functional outcomes and non-union. It is imperative that adequate support is in place for patients with vulnerable mental health during these periods, particularly as we look towards a potential 'second wave' of COVID-19.

Synthesis and biological evaluation of imidazoline derivatives as potential CNS and CVS agents.

A series of substituted imidazoline derivatives were synthesized and characterized. Compounds were tested in-vivo for their antihypertensive, analgesic, antiaggressive, depressant, antidepressant, and ALD50 activities. The compounds 3a, 3c, 4c, 5a, and 6c showed cardiovascular as well as central nervous system activities and are potential candidate as drug among all fifteen compounds tested. All these compounds have shown better activity for antihypertensive, analgesic, antiaggressive, and depressant-antidepressant, properties than reference compounds clonidine, morphine, diazepam, and imipramine respectively. Most of the compounds have shown ALD50 > 500 mg/kg with maximum in 4a and 5a (>1000 mg/kg).

All-optical detection of interfacial spin transparency from spin pumping in ß-Ta/CoFeB thin films.

Generation and utilization of pure spin current have revolutionized energy-efficient spintronic devices. Spin pumping effect generates pure spin current, and for its increased efficiency, spin-mixing conductance and interfacial spin transparency are imperative. The plethora of reports available on generation of spin current with giant magnitude overlook the interfacial spin transparency. Here, we investigate spin pumping in ß-Ta/CoFeB thin films by an all-optical time-resolved magneto-optical Kerr effect technique. From variation of Gilbert damping with Ta and CoFeB thicknesses, we extract the spin diffusion length of ß-Ta and spin-mixing conductances. Consequently, interfacial spin transparency is derived as 0.50 ± 0.03 from the spin Hall magnetoresistance model for the ß-Ta/CoFeB interface. Furthermore, invariance of Gilbert damping with Cu spacer layer thickness inserted between ß-Ta and CoFeB layers confirms the absence of other interface effects including spin memory loss. This demonstrates a reliable and noninvasive way to determine interfacial spin transparency and signifies its role in generation of pure spin current by spin pumping effect.

Dental Restorative Materials Based on Thiol-Michael Photopolymerization.

Step-growth thiol-Michael photopolymerizable resins, constituting an alternative chemistry to the current methacrylate-based chain-growth polymerizations, were developed and evaluated for use as dental restorative materials. The beneficial features inherent to anion-mediated thiol-Michael polymerizations were explored, such as rapid photocuring, low stress generation, ester content tunability, and improved mechanical performance in a moist environment. An ester-free tetrafunctional thiol and a ultraviolet-sensitive photobase generator were implemented to facilitate thiol-Michael photopolymerization. Thiol-Michael resins of varied ester content were fabricated under suitable light activation. Polymerization kinetics and shrinkage stress were determined with Fourier-transform infrared spectroscopy coupled with tensometery measurements. Thermomechanical properties of new materials were evaluated by dynamic mechanical analysis and in 3-point bending stress-strain experiments. Photopolymerization kinetics, polymerization shrinkage stress, glass transition temperature, flexural modulus, flexural toughness, and water sorption/solubility were compared between different thiol-Michael systems and the BisGMA/TEGDMA control. Furthermore, the mechanical performance of 2 thiol-Michael composites and a control composite were compared before and after extensive conditioning in water. All photobase-catalyzed thiol-Michael polymerization matrices achieved >90% conversion with a dramatic reduction in shrinkage stress as compared with the unfilled dimethacrylate control. One prototype of ester-free thiol-Michael formulations had significantly better water uptake properties than the BisGMA/TEGDMA control system. Although exhibiting relatively lower Young's modulus and glass transition temperatures, highly uniform thiol-Michael materials achieved much higher toughness than the BisGMA/TEGDMA control. Moreover, low-ester thiol-Michael composite systems show stable mechanical performance even after extensive water treatment. Although further resin/curing methodology optimization is required, the photopolymerized thiol-Michael prototype resins can now be recognized as promising candidates for implementation in composite dental restorative materials.

Robotic surgery in trauma and orthopaedics: a systematic review.

The use of robots in orthopaedic surgery is an emerging field that is gaining momentum. It has the potential for significant improvements in surgical planning, accuracy of component implantation and patient safety. Advocates of robot-assisted systems describe better patient outcomes through improved pre-operative planning and enhanced execution of surgery. However, costs, limited availability, a lack of evidence regarding the efficiency and safety of such systems and an absence of long-term high-impact studies have restricted the widespread implementation of these systems. We have reviewed the literature on the efficacy, safety and current understanding of the use of robotics in orthopaedics.

Lipid profile of population of central region of Nepal.

This study was conducted to know the status of Lipid profile in people of central region of Nepal. This study was conducted in College of Medical Sciences & Teaching Hospital, Bharatpur, Nepal from February 2009 to March 2010 which is situated in central region of Nepal. A total of 870 cases, out of which 512(58.85%) male and 358(41.14%) female were included and study was carried out using data retrieved from the register maintained in the Department of Biochemistry. The variables collected were age, sex, lipid profile which includes total cholesterol (TC), triglycerides (TG), high density lipoprotein-cholesterol (HDL-C) & low density lipoprotein-cholesterol (LDL-C). The data was analyzed using excel 2007 and Statistical Package for the Social Sciences (SPSS) 16.0. The total mean±SD of TC, TG, HDL-C, LDL-C were found to be 164.87±49.49, 157.56±79.78, 33.59±11.10, 97.79±40.68 respectively. Total Cholesterol, HDL-C & LDL-C were found to be statistically significant whereas TG was statistically insignificant between male and female. In both male and female, TG & LDL-C were higher in the age group of 21-40 years whereas HDL-C was higher in the age group of >61 years in both the group. Total cholesterol (TC) level was higher in the age group of 21-40 years in male while in female in the age group of 41-60 years. Desirable level of TC was observed in 78.50% of the total subjects while the normal TG, LDL-C were observed in 56.55%, 81.49%, respectively. Very high levels of TC, TG, LDL-C were observed in 4.94%, 0.34% & 1.6% of the total population studied, respectively. More percentage of female (27.65%) had higher HDL-C level than in male (15.62%). High triglycerides (TG) level is the commonest lipid abnormality in our study. HDL-C level was increase with increasing in age. Clinical evaluation can be made according to this study.

Increased macromolecular damage due to oxidative stress in the neocortex and hippocampus of WNIN/Ob, a novel rat model of premature aging.

Wistar of the National Institute of Nutrition obese (WNIN/Ob) is a unique rat strain isolated and established at NIN, Hyderabad, India, in 1996, from its existing stock of Wistar rat colony (WNIN). This animal model exhibits all traits of metabolic syndrome and has a remarkably reduced lifespan (1.5 years as compared to 3 years in parental WNIN rats), albeit, the factors associated with premature aging are not well understood. Considering that oxidative stress and DNA damage are crucial players associated with senescence, we analyzed oxidative stress markers like lipid peroxidation and protein oxidation; DNA damage in terms of both single-stranded and double-stranded breaks and the activity of antioxidant enzymes: superoxide dismutase and catalase in brain regions of these animals. Our study revealed that the magnitude of oxidative stress and DNA damage in the neocortex and hippocampus of 3-month-old WNIN/Ob obese rats is as high as that seen in 15-month-old parental WNIN control rats. Concurrently, the antioxidant enzyme activity was significantly decreased. From these results, it can be concluded that increased oxidative stress-induced damage of macromolecules, probably due to reduced activity of antioxidant enzymes, is associated with premature aging in WNIN/Ob obese rats.

Implementing self sustained quality control procedures in a clinical laboratory.

INTRODUCTION: Quality control is an essential component in every clinical laboratory which maintains the excellence of laboratory standards, supplementing to proper disease diagnosis, patient care and resulting in overall strengthening of health care system. Numerous quality control schemes are available, with combinations of procedures, most of which are tedious, time consuming and can be "too technical" whereas commercially available quality control materials can be expensive especially for laboratories in developing nations like Nepal. Here, we present a procedure performed at our centre with self prepared control serum and use of simple statistical tools for quality assurance. METHODS: The pooled serum was prepared as per guidelines for preparation of stabilized liquid quality control serum from human sera. Internal Quality Assessment was performed on this sample, on a daily basis which included measurement of 12 routine biochemical parameters. The results were plotted on Levey-Jennings charts and analysed with quality control rules, for a period of one month. RESULTS: The mean levels of biochemical analytes in self prepared control serum were within normal physiological range. This serum was evaluated every day along with patients' samples. The results obtained were plotted on control charts and analysed using common quality control rules to identify possible systematic and random errors. Immediate mitigation measures were taken and the dispatch of erroneous reports was avoided. CONCLUSIONS: In this study we try to highlight on a simple internal quality control procedure which can be performed by laboratories, with minimum technology, expenditure, and expertise and improve reliability and validity of the test reports.

Meticillin-resistant Staphylococcus aureus screening in Wales: survey of practices in adult critical care units in Welsh hospitals.

Screening for meticillin-resistant Staphylococcus aureus (MRSA) carriage in critical care units remains a controversial issue. This cross-sectional study reviewed the MRSA screening policies in adult critical care units in Welsh hospitals. Data were collected by structured questionnaires. The study showed a degree of variability in practice from universal screening to no screening at all. It is recommended that local MRSA policies should be reviewed, bearing in mind the local prevalence of colonization and infection; and compliance with basic infection control strategies should not only be directed at MRSA infection, but also at other healthcare-associated infections.

The value of ultrasound in assessing displacement of a medial clavicular physeal separation in an adolescent.

We describe a case of medial clavicular physeal separation with posterior displacement of the metaphysis in a 13-year-old girl, focusing on the role played by ultrasound in the diagnosis, planning of treatment and post-reduction follow-up. On clinical examination and conventional radiography, the injury is essentially indistinguishable from a sternoclavicular dislocation or a fracture of the medial aspect of the clavicle; however, the pathogenesis is different, consisting in medial physeal separation and 'degloving' of the inner cancellous bone of the metaphysis from the surrounding periosteal collar with posterior metaphyseal dislocation. In our case, attempted closed reduction failed, and the injury required open reduction with relocation of the clavicle into the periosteal sleeve followed by suturing of the periosteal tear.

Audit of trauma case load suitable for a day surgery trauma list and cost analysis.

BACKGROUND: Day surgery trauma lists are becoming an increasingly popular and widespread approach to address the inpatient trauma demand on NHS services. A 'Rapid Access' list initiative was set-up to book patients from an emergency pathway who require surgery and also fulfilled the standard day case patient criteria but for whom it was safe to wait for over 24 h before going to theatre. MATERIALS & METHODS: We performed a prospective audit of the cases undertaken on the day surgery trauma list over a 12-month period and analysed the number of cases, spectrum of procedures, complications and the cost benefits. RESULTS: A total of 119 day surgery trauma cases were performed (42 lists; average of 3 cases per list; upper limb procedures accounted for 60%.). The overall cost benefit for day surgery was calculated as the difference between the tariff and the costs for day surgery and inpatient procedures. A cost benefit of £617 per case for day surgery over inpatient surgery was noted with a total saving of £67,450 for the performed procedures. DISCUSSION: We demonstrate day trauma surgery to be a safe and cost effective method of optimising the management of the appropriate trauma case workload. Further it reduces demand for inpatient beds, provides significant cost savings for the trust and improves patient satisfaction.

Enhancing solar cells with localized plasmons in nanovoids.

Localized plasmon resonances of spherical nanovoid arrays strongly enhance solar cell performance by a factor of 3.5 in external quantum efficiency at plasmonic resonances, and a four-fold enhancement in overall power conversion efficiency. Large area substrates of silver nanovoids are electrochemically templated through self-assembled colloidal spheres and organic solar cells fabricated on top. Our design represents a new class of plasmonic photovoltaic enhancement: that of localized plasmon-enhanced absorption within nanovoid structures. Angularly-resolved spectra demonstrate strong localized Mie plasmon modes within the nanovoids. Theoretical modelling shows varied spatial dependence of light intensity within the void region suggesting a first possible route towards Third Generation plasmonic photovoltaics.

Superdominant right coronary artery with absent left circumflex artery.

Noninvasive imaging of coronary artery disease is rapidly replacing angiography as the first line of investigation. Multislice CT is the non-invasive modality of choice for imaging coronary artery disease and provides high speed with good spatial resolution. CT coronary angiography in addition to detecting and characterising atherosclerotic coronary artery disease is also a good imaging tool for evaluating anomalies of coronary arteries. Superdominant right coronary artery with absent left circumflex artery is one such rare coronary artery anomaly which is well evaluated with multislice CT angiography. The authors report one such case of superdominant right coronary artery with absent left circumflex artery imaged with 64-slice MDCT.

Classification of the morphology of the acromioclavicular joint using cadaveric and radiological analysis.

The aim of this study was to establish a classification system for the acromioclavicular joint using cadaveric dissection and radiological analyses of both reformatted computed tomographic scans and conventional radiographs centred on the joint. This classification should be useful for planning arthroscopic procedures or introducing a needle and in prospective studies of biomechanical stresses across the joint which may be associated with the development of joint pathology. We have demonstrated three main three-dimensional morphological groups namely flat, oblique and curved, on both cadaveric examination and radiological assessment. These groups were recognised in both the coronal and axial planes and were independent of age.

Outcome analysis of surgery for disorders of the rotator cuff: a comparison of subjective and objective scoring tools.

A consecutive series of 372 patients who underwent surgery for disorders of the rotator cuff involving arthroscopic subacromial decompression and open or arthroscopic repairs of the cuff were prospectively investigated as to the comparability of subjective and objective assessment scores of shoulder function. Assessments were made before operation and at 3, 6, 12, 18 and 24 months after surgery using the Disabilities of the Arm, Shoulder, and Hand score, the Oxford shoulder score and the Constant-Murley score, which was used as a reference. All scores were standardised to a scale of 0 to 100 for comparison. Statistical analysis compared the post-operative course and the mean score for the subjective Disabilities to the Arm, Shoulder and Hand score and Oxford shoulder score, with the objective Constant score at each interval. A strong correlation was evident between both subjective scores and the Constant score. We concluded that both the subjective scores would be useful substitutes for the Constant score, obviating the need for a trained investigator and the specialist equipment required to perform the Constant score.

Gender-specific Constant score correction for age.

To investigate the relationship between age, gender and the Constant score. Two hundred and seventy Healthy volunteers (527 normal shoulders) from our local population with no previous history of shoulder disease were assessed using the Constant score. The mean age was 43.9 years (16-86) and the mean Constant score 85.9 (56-100). The mean score was 88.1 (range 56-100) for men and 83.7 (range 60-100) for women. A mixed regression model estimated that, for the male population, the Constant score falls by 0.15 points per annum between the ages of 50 and 70 and by 1.3 points per year after the age of 70. Similarly, for the female population, the fall is of 0.25 per year between 60 and 70 and 0.35 after the age of 70. The changes are statistically significant (P < 0.01) and clinically important when comparing patients of different age groups.

An analysis of outcome of arthroscopic versus mini-open rotator cuff repair using subjective and objective scoring tools.

The purpose is to perform a comparative analysis of mini-open and arthroscopic rotator cuff repairs through the use of subjective and objective scoring tools. We conducted a prospective comparative cohort study that evaluated 123 consecutive patients who underwent rotator cuff repairs (arthroscopic and 31 mini-open repair). Subjective and objective functional assessment was performed preoperatively and postoperatively at 3, 6, 12, 18 and 24 months using the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, the Oxford Shoulder Score (OSS) and the Constant-Murley score. Statistical analysis was performed on the datasets assessing the Pearson correlation coefficients and any significant differences present at each respective time point. At every time point the arthroscopic group scored better than the mini-open group, regardless of the assessment tool employed. The percentage recovery from the baseline measured at 1 year was similar with either treatment option. A significant difference was found between the arthroscopic and mini-open groups for the Constant-Murley, DASH and OSS scoring systems preoperatively (P < 0.05), reflecting a difference in tear severity. Arthroscopic rotator cuff repair is comparable with the mini-open technique with well correlated postoperative rates recovery. Subjective scoring provides an accurate and potentially easier method of postoperative assessment for long-term follow-up of rotator cuff repairs.