Accuracy of one-dimensional templating on linear EOS radiography allows template-directed instrumentation in total knee arthroplasty.

BACKGROUND: Templating for total knee arthroplasty (TKA) is routinely performed on two-dimensional standard X-ray images and allows template-directed instrumentation. To date, there is no report on one-dimensional (1D) anteroposterior (AP) templating not requiring specific templating software. We aim to describe a novel technique and explore its reliability, accuracy and potential cost-savings. METHODS: We investigated a consecutive series of TKAs at one institution between January and July 2019. Patients with preoperative low-dose linear AP EOS radiography images were included. Implant component sizes were retrospectively templated on the AP view with the hospitals imaging viewing software by two observers who were blinded to the definitive implant size. Planning accuracy as well as inter- and intra-observer reliability was calculated. Cost-savings were estimated based on the reduction of trays indicated by the 1D templating size estimations. RESULTS: A total of 141 consecutive TKAs in 113 patients were included. Accuracy of 1D templating was as follows: exact match in 53% femoral and 63% tibial components, within one size in 96% femoral and 98% tibial components. Overall 58% of TKA components were planned correctly and 97% within one size. Inter- and intra-rater reliability was good (κ = 0.66) and very good (κ = 0.82), respectively. This templating process can reduce instrumentation from six to three trays per case and therefore halve sterilisation costs. CONCLUSIONS: The new 1D templating method using EOS AP imaging predicts component sizes in TKA within one size 97% of the time and can halve the number of instrumentation trays and sterilisation costs.

Healthcare Professionals' Perceptions of the Benefits and Challenges of a Teleconsultation Service in the Amansie-West District of Ghana.

OBJECTIVES: A teleconsultation service was introduced in the Amansie-West District, Ghana, in 2010 linking health center-based community health nurses (CHNs) with a teleconsultation center (TCC) at the district hospital. This study aimed to assess healthcare professionals' perceptions of the benefits and challenges of this service and to identify possible areas for improvement. MATERIALS AND METHODS: Qualitative semistructured interviews were conducted with eight CHNs and three TCC healthcare professionals to find their views on the benefits, challenges, and recommendations for improving the service. The data were analyzed using qualitative content analysis. RESULTS: Interviewees were generally positive when describing the use of the teleconsultation service. They were of the opinion that the service had improved the quality of care at health centers, thus reducing the need to refer patients to the district hospital. Practical problems, such as inadequate information provided over the phone, delays in responding to calls, and the additional workload for teleconsultation staff, were viewed as important challenges to the success of the project. Interviewees identified several possible options for improving the service through extension to other levels of the healthcare system or by adding additional functionalities to their phones. CONCLUSIONS: Teleconsultation services have the potential to improve quality of care in rural communities. However, practical problems in the operation of the service have to be taken seriously as they threaten sustainability of the intervention. Adequate training in phone-based clinical reporting appears to be essential. Teleconsultation staff should be compensated for additional workload through a reduction of other work-related tasks.

Lay beliefs and the management of disease amongst West Indians with diabetes.

This paper presents the findings of an exploratory study into lay beliefs and management of the chronic disease diabetes mellitus as well as the service use experiences of West Indians with the disease. In the United Kingdom, there is a higher prevalence of diabetes and higher mortality rates from this disease amongst West Indians when compared with their white counterparts. The project fieldwork was conducted in four sites; in general practice and out-patient diabetic clinics in London and Cambridge. In-depth interviews were held with 12 Caucasian and 12 West Indian diabetic patients and key informant interviews were held with a total of 13 health professionals on the diabetic care team. The study showed important differences between West Indians and Caucasians regarding knowledge and beliefs about diabetes as well its management. With the exception of two Pentecostal Christian women in the West Indian subsample, there was no evidence that these beliefs or practices conflicted with medical advice. However, the West Indian interviewees stated that the dietary advice provided did not take into account their traditional foods or cooking methods and as a result they experienced difficulties in following this advice. West Indians also expressed a general distrust of doctors and the majority had developed a range of strategies which they used to negotiate consultations with doctors and the heath service.

Plexiform neurofibroma: a rare cause of obstructive jaundice

A case of obstructive jaundice secondary to a neurofibroma in the common hepatic duct is presented. The histological appearance was that of a plexiform neurofibroma. The clinicopathological features are discussed

Plexiform neurofibroma: a rare cause of obstructive jaundice

A case of obstructive jaundice secondary to a neurofibroma in the common hepatic duct is presented. The histological appearance was that of a plexiform neurofibroma. The clinicopathological features are discussed (AU)

Helicobacter pylori in patients undergoing upper endoscopy in Jamaica

One hundred and two consecutive patients undergoing upper gastrointestinal endoscopy were tested for H. pylori by a rapid urease test, using antral biopsy specimens. There were 60 men (mean age 54 yrs) and 42 women (mean age 49 yrs). Fifty-six patients (55//) were positive for H. pylori. Of male patients, 36 (60//) and of female patients, 20 (48//) tested positive. Sixty-eight per cent of patients with antral gastritis, 65//with duodenal ulcer and 60//with gastric ulcer had H. pylori. Thirty-nine patients (70//) positive for H. pylori were from major urban areas, and 17 (30//) were from rural areas of Jamaica. In patients without H. pylori, 61//and 39//were from urban and rural areas respectively. Forty-four patients (79//) with H. pylori and 40 (87//) without H. pylori had piped water in their homes. Ninety-three per cent of all patients had electricity and 88//had refrigeration. There was no difference between patients positive or negative for H. pylori with regard to the use of alcohol, marijuana or tobacco. There was also no difference between both groups in exposure to domestic animals in the home environment. H. pylori is associated with antral gastritis and peptic ulcer disease in Jamaican patients. There are no specific environmental or social factors that seem to predispose to infection.

Helicobacter pylori in patients undergoing upper endoscopy in Jamaica

One hundred and two consecutive patients undergoing upper gastrointestinal endoscopy were tested for H. pylori by a rapid urease test, using antral biopsy specimens. There were 60 men (mean age 54 yrs) and 42 women (mean age 49 yrs). Fifty-six patients (55 percent) were positive for H. pylori. Of male patients, 36 (60 percent) and of female patients, 20 (48 percent) tested positive. Sixty-eight per cent of patients with antral gastritis, 65 percent with duodenal ulcer and 60 percent with gastric ulcer had H. pylori. Thirty-nine patients (70 percent) positive for H. pylori were from major urban areas, and 17 (30 percent) were from rural areas of Jamaica. In patients without H. pylori, 61 percent and 39 percent were from urban and rural areas respectively. Forty-four patients (79 percent) with H. pylori and 40 (87 percent) without H. pylori had piped water in their homes. Ninety-three per cent of all patients had electricity and 88 percent had refrigeration. There was no difference between patients positive or negative for H. pylori with regard to the use of alcohol, marijuana or tobacco. There was also no difference between both groups in exposure to domestic animals in the home environment. H. pylori is associated with antral gastritis and peptic ulcer disease in Jamaican patients. There are no specific environmental or social factors that seem to predispose to infection (AU)

The Jamaican childhood cardiovascular risk status study; blood pressure in Jamaican school children, relationship to body size and composition - abstract

Hypertension is one of the most prevalent chronic cardiovascular diseases and is the leading cause of death in the Caribbean as well as in the developed countries. Childhood blood pressure is predictive of hypertension in adulthood. Risk factors for hypertension, including body composition, are often present in childhood when they may be modified in order to contribute to primary prevention of hypertension. As part of a study of risk factors for cardiovascular disease, we measured blood pressure (BP) and anthropometry in Jamaican schoolchildren. Anthropometric and demographic variables were analysed to explain the variance of blood pressure in the children. A total of 2332 children (1046 males; 1286 females) were studied. Their ages ranged from 6 to 16 years. Boys and girls were similar in age. Mean diastolic and systolic blood pressures were similar in boys and girls' pulse rate was significantly higher than in boys. Boys had significantly greater Waist-Hip Ratio (0.82 vs 0.76; p<0.0001) and Lean Body Mass (34.2 vs 33.20 kg; p=0.006). Girls had significantly greater weight (42.3 vs 39.5; p<0.0001); Height (150.6 vs 148.9; p=0.005); BMI (18.2 vs 17.3; p<0.0001); MUAC (21.5 vs 20.8; p<0.0001); Hip Circumference (79.5 vs 73.9; p<0.0001); Triceps Skinfold (11.6 vs 8.3; p<0.0001); Per cent Body Fat (19.5 vs 11.6; p<0.0001); Fat Weight (9.1 vs 5.2; p<0.0001). Systolic BP increased steadily with age from 101 ñ 9.9 mm Hg at 6 years to 112 ñ 8.5 mm Hg at 16 years. Systolic BP was significantly correlated with weight, height, BMI, MUAC, WH Ratio, fat mass and lean body mass on univariate analysis but only weight and lean body mass were independently correlated (p<0.0001 for both variables). There was a significant age-sex interaction on Systolic BP (p<0.0001) but only at age 15 years were the mean BPs significantly different (boys vs girls = 119 ñ 15.2 vs 107.8 ñ 10.8; p<0.001). Diastolic BP increased less steeply with age. Significant predictors were MUAC and hip circumference (p<0.0001 and p<0.002, respectively). The data reveal significant correlation between anthropometric variables and blood pressure. This could provide an opportunity for intervention and primary prevention of hypertension (AU)

The Jamaican childhood cardiovascular risk status study: serum total cholesterol concentration in Jamaican schoolchildren - abstract

The pathogenesis of atherosclerosis occurs over decades and begins in childhood. Hypertension, elevated serum cholesterol levels and obesity are major risk factors for the development of cardiovascular disease. In population-based studies, the presence of these two risk factors in childhood has been shown to be predictive of hypertension and hypercholesterolaemia in adulthood and ultimately of coronary heart disease mortality rates. There is evidence that much of the risk of developing hypercholesterolaemia is due to exposure to an unfavourable environment. Therefore it should be possible to reduce or eliminate this risk. In this study of 2337 Jamaican school children aged 6 to 16 years, girls were found to have higher cholesterol levels than boys (4.2ñ0.82vs4.1ñ0.83mM;p<0.003). At all ages (except 11), the cholesterol concentration in girls was higher than in boys, and girls had significantly more body fat. Cholesterol levels were found to be associated with socio-economic status (SES), 4.0mM in children from the lowest SES and 4.4mM in those from the highest (p<0.0000). Multiple regression analysis revealed signigicant correlation between cholesterol, weight, body fat and SES. This result for SES is different from studies in the developed world which report an inverse relationship between cholesterol and SES. In our population there was also correlation between SES and height and weight. Obesity and weight are important contributors to the risk of developing hypercholesterolaemia. Differences in dietary intake and levels of activity between the SES groups may contribute to this difference. The greater adiposity evident from the first decade of life is also worthy of note. Combined with the higher serum total of cholesterol levels, this may be an important indicator of the likelihood of future cardiovascular disease in this group (AU)