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1.
Ann R Coll Surg Engl ; 102(1): 3-8, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31858833

RESUMO

INTRODUCTION: Achieving a standard of clinical research at the pinnacle of the evidence pyramid is historically expensive and logistically challenging. Research collaboratives have delivered high-impact prospective multicentre audits and clinical trials by using trainee networks with a range of enabling technology. This review outlines such use of technology in the UK and provides a framework of recommended technologies for future studies. METHODS: A review of the literature identified technology used in collaborative projects. Additional technologies were identified through web searches. Technologies were grouped into themes including access (networking and engagement), collaboration and event organisation. The technologies available to support each theme were studied further to outline relative benefits and limitations. FINDINGS: Thirty-three articles from trainee research collaboratives were identified. The most frequently documented technologies were social media applications, website platforms and research databases. The Supportive Technologies in Collaborative Research framework is proposed, providing a structure for using the technologies available to support multicentre collaboration. Such technologies are often overlooked in the literature by established and start-up collaborative project groups. If used correctly, they might help to overcome the physical, logistical and financial barriers of multicentre clinical trials.


Assuntos
Pesquisa Biomédica/métodos , Tecnologia Biomédica/métodos , Comportamento Cooperativo , Relações Interprofissionais , Ensaios Clínicos como Assunto , Comunicação , Cirurgia Geral/educação , Humanos , Internet , Redes Sociais Online , Estudantes de Medicina
3.
Br J Surg ; 104(12): 1634-1639, 2017 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-29044488

RESUMO

BACKGROUND: Nail-bed injuries are the most common hand injury in children. Surgical dogma is to replace the nail plate after repairing the nail bed. Recent evidence suggests this might increase infection rates and returns to clinic. The aim of this feasibility trial was to inform the design and conduct of a definitive trial comparing replacing or discarding the nail plate after nail-bed repair. METHODS: This study recruited participants from four hand units in the UK between April and July 2015. Participants were children under the age of 16 years with a nail-bed injury requiring surgery. They were randomized to either having the nail plate replaced or discarded after nail-bed repair. The follow-up method was also allocated randomly (postal versus clinic). Information was collected on complications at 2 weeks and 30 days, and on nail-plate appearance at 4 months using the Zook classification. Two possible approaches to follow-up were also piloted and compared. RESULTS: During the recruitment phase, there were 156 potentially eligible children. Sixty were randomized in just over 3 months using remote web-based allocation. By 2 weeks, there were two infections, both in children with replaced nail plates. The nail-replaced group also experienced more complications. There was no evidence of a difference in return rates between postal and clinic follow-up. CONCLUSION: Recruitment was rapid and nail-bed repair appeared to have low complication and infection rates in this pilot trial. The findings have led to revision of the definitive trial protocol, including the mode and timing of follow-up, and modification of the Zook classification.


Assuntos
Unhas/lesões , Unhas/cirurgia , Procedimentos Cirúrgicos Reconstrutivos , Adolescente , Antibacterianos/uso terapêutico , Criança , Pré-Escolar , Estudos de Viabilidade , Feminino , Humanos , Lactente , Masculino , Dor/etiologia , Projetos Piloto , Complicações Pós-Operatórias , Estudos Prospectivos , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Infecção da Ferida Cirúrgica/tratamento farmacológico
4.
J Plast Reconstr Aesthet Surg ; 70(7): 901-907, 2017 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-28511813

RESUMO

INTRODUCTION: Mallet injuries are common and usually treated conservatively. Various systematic reviews have found a lack of evidence regarding the best management, and it is unclear whether this uncertainty is reflected in current UK practice. METHODS: An online survey was developed to determine the current practice for the conservative treatment of mallet injury among specialist hand clinicians in the UK, including physiotherapists, occupational therapists and surgeons. Clinician's views of study outcome selection were also explored to improve future trials. RESULTS: In total, 336 professionals completed the survey. Inconsistency in overall practice was observed in splint type choice, time to discharge to GP, and assessment of adherence. Greater consistency was observed for recommended duration of continuous immobilisation. Bony injuries were most commonly splinted for 6 weeks (n = 228, 78%) and soft tissue injuries for either 8 weeks (n = 172, 56%) or 6 weeks (n = 119, 39%). Post-immobilisation splinting was frequently recommended, but duration varied between 2 and 10 weeks. The outcome rated as most important by all clinicians was patient satisfaction. DISCUSSION: There is overall variation in the current UK conservative management of mallet injuries, and the development of a standardised, evidence-based protocol is required. Clinicians' opinions may be used to develop a core set of outcome measures, which will improve standardisation and comparability of future trials.


Assuntos
Tratamento Conservador , Traumatismos dos Dedos/terapia , Padrões de Prática Médica , Polegar/lesões , Humanos , Imobilização , Terapia Ocupacional/métodos , Ortopedia/métodos , Cooperação do Paciente , Alta do Paciente , Fisioterapia/métodos , Contenções , Cirurgia Plástica/métodos , Inquéritos e Questionários , Fatores de Tempo , Reino Unido
5.
Br J Surg ; 103(5): 487-92, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-26928808

RESUMO

BACKGROUND: Simple hand trauma is very common, accounting for 1·8 million emergency department visits annually in the USA alone. Antibiotics are used widely as postinjury prophylaxis, but their efficacy is unclear. This meta-analysis assessed the effect of antibiotic prophylaxis versus placebo or no treatment on wound infection rates in hand injuries managed surgically. METHODS: Embase, MEDLINE, PubMed, Cochrane Central, ClinicalTrials.gov and the World Health Organization International Clinical Trials Portal were searched for published and unpublished studies in any language from inception to September 2015. The primary outcome was the effect of antibiotic prophylaxis on wound infection rates. Open fractures, crush injuries and bite wounds were excluded. Study quality was assessed using the Cochrane risk-of-bias tool. Data were pooled using random-effects meta-analysis, and risk ratios (RRs) and 95 per cent c.i. obtained. RESULTS: Thirteen studies (2578 patients) were included, comprising five double-blind randomized clinical trials, five prospective trials and three cohort studies. There was no significant difference in infection rate between the antibiotic and placebo/no antibiotic groups (RR 0·89, 95 per cent c.i. 0·65 to 1·23; P = 0·49). Subgroup analysis of the five double-blind randomized clinical trials (864 patients) again found no difference in infection rates (RR 0·66, 0·36 to 1·21; P = 0·18). CONCLUSION: There was moderate-quality evidence that routine use of antibiotics does not reduce the infection rate in simple hand wounds that require surgery.


Assuntos
Antibacterianos/uso terapêutico , Antibioticoprofilaxia , Traumatismos da Mão/cirurgia , Infecção da Ferida Cirúrgica/prevenção & controle , Humanos , Modelos Estatísticos , Resultado do Tratamento
7.
Osteoarthritis Cartilage ; 23(4): 616-28, 2015 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-25545425

RESUMO

OBJECTIVE: Identify gene changes in articular cartilage of the medial tibial plateau (MTP) at 2, 4 and 8 weeks after destabilisation of the medial meniscus (DMM) in mice. Compare our data with previously published datasets to ascertain dysregulated pathways and genes in osteoarthritis (OA). DESIGN: RNA was extracted from the ipsilateral and contralateral MTP cartilage, amplified, labelled and hybridized on Illumina WGv2 microarrays. Results were confirmed by real-time polymerase chain reaction (PCR) for selected genes. RESULTS: Transcriptional analysis and network reconstruction revealed changes in extracellular matrix and cytoskeletal genes induced by DMM. TGFß signalling pathway and complement and coagulation cascade genes were regulated at 2 weeks. Fibronectin (Fn1) is a hub in a reconstructed network at 2 weeks. Regulated genes decrease over time. By 8 weeks fibromodulin (Fmod) and tenascin N (Tnn) are the only dysregulated genes present in the DMM operated knees. Comparison with human and rodent published gene sets identified genes overlapping between our array and eight other studies. CONCLUSIONS: Cartilage contributes a minute percentage to the RNA extracted from the whole joint (<0.2%), yet is sensitive to changes in gene expression post-DMM. The post-DMM transcriptional reprogramming wanes over time dissipating by 8 weeks. Common pathways between published gene sets include focal adhesion, regulation of actin cytoskeleton and TGFß. Common genes include Jagged 1 (Jag1), Tetraspanin 2 (Tspan2), neuroblastoma, suppression of tumourigenicity 1 (Nbl1) and N-myc downstream regulated gene 2 (Ndrg2). The concomitant genes and pathways we identify may warrant further investigation as biomarkers or modulators of OA.


Assuntos
Cartilagem Articular/metabolismo , Meniscos Tibiais/metabolismo , Análise em Microsséries/métodos , Osteoartrite do Joelho/etiologia , Osteoartrite do Joelho/metabolismo , Transdução de Sinais/fisiologia , Transcrição Genética/fisiologia , Ferimentos e Lesões/complicações , Proteínas Adaptadoras de Transdução de Sinal , Animais , Proteínas de Ligação ao Cálcio/metabolismo , Cartilagem Articular/patologia , Proteínas de Ciclo Celular , Modelos Animais de Doenças , Proteínas da Matriz Extracelular/metabolismo , Fibromodulina , Fibronectinas/metabolismo , Peptídeos e Proteínas de Sinalização Intercelular/metabolismo , Proteína Jagged-1 , Masculino , Proteínas de Membrana/metabolismo , Meniscos Tibiais/patologia , Camundongos , Camundongos Endogâmicos C57BL , Proteínas do Tecido Nervoso/metabolismo , Osteoartrite do Joelho/patologia , Proteínas/metabolismo , Proteoglicanas/metabolismo , Proteínas Serrate-Jagged , Transdução de Sinais/genética , Tenascina/metabolismo , Tetraspaninas/metabolismo , Fator de Crescimento Transformador beta/metabolismo
8.
J Plast Reconstr Aesthet Surg ; 63(9): e665-73, 2010 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-20615774

RESUMO

Free tissue transfer has revolutionised tissue reconstruction. Surgical technique is just one of many perioperative factors that determine the eventual outcome of the procedure. Many of these factors can be modified to ensure success. A search of the MEDLINE database using search terms related to perioperative management of free tissue transfer was performed. Further articles were identified by performing related-article searches in MEDLINE. The various perioperative factors that have been demonstrated to affect clinical outcome are discussed along with the current evidence for their optimisation. We present an algorithm for the management of patients undergoing free tissue transfer.


Assuntos
Sobrevivência de Enxerto , Microcirculação , Assistência Perioperatória/normas , Procedimentos Cirúrgicos Reconstrutivos/métodos , Retalhos Cirúrgicos/irrigação sanguínea , Algoritmos , Anestesia/métodos , Humanos , Monitorização Fisiológica , Complicações Pós-Operatórias/prevenção & controle , Terapia de Salvação
9.
Hip Int ; 17(2): 109-12, 2007.
Artigo em Inglês | MEDLINE | ID: mdl-19197855

RESUMO

We report the unfortunate case of a man who experienced stem failures of both his primary and revision hip arthroplasties. As far as we are aware this is the only reported case of a patient to suffer the misfortune of multiple femoral implant failures.

10.
J Bone Joint Surg Br ; 88(11): 1524-6, 2006 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-17075103

RESUMO

We describe a case of lumbosacral plexopathy caused by an isolated aneurysm of the common iliac artery. The patient presented with worsening low back pain, progressive numbness and weakness of the right leg in the L2-L4 distribution. This had previously been diagnosed as sciatica. A CT scan showed an aneurysm of the right common iliac artery which measured 8 cm in diameter. Despite being listed for emergency endovascular stenting, the aneurysm ruptured and the patient died. It is important to distinguish a lumbosacral plexopathy from sciatica and to bear in mind its treatable causes which include aneurysms of the common and internal iliac arteries.


Assuntos
Aneurisma Roto/complicações , Aneurisma Ilíaco/complicações , Plexo Lombossacral , Doenças do Sistema Nervoso Periférico/etiologia , Idoso , Aneurisma Roto/diagnóstico por imagem , Evolução Fatal , Humanos , Aneurisma Ilíaco/diagnóstico por imagem , Plexo Lombossacral/diagnóstico por imagem , Masculino , Doenças do Sistema Nervoso Periférico/diagnóstico por imagem , Radiografia
11.
Disabil Rehabil ; 24(4): 219-25, 2002 Mar 10.
Artigo em Inglês | MEDLINE | ID: mdl-11926262

RESUMO

PURPOSE: In an attempt to find a more clinically useful functional outcome measure specifically tailored for lower limb amputees undergoing inpatient prosthetic rehabilitation, a 6-month prospective assessment of inter-rater reliability for Harold Wood-Stanmore Mobility Scale Data, including two handicap scales, was undertaken. An analysis of the data is presented in this paper. METHODS: An inter-rater reliability study was undertaken using four observers to complete admission and discharge scores for the three disability/handicap scales on 14 consecutive patients over 6 months. RESULTS: The disability mobility scale demonstrated perfect observer agreement on admission and at discharge the inter-rater reliability for this measure was high (0.83). By contrast, reliability between observers for admission scores on the handicap mobility scale was poor at 0.49 but reasonably high on discharge (0.83). On admission, inter-rater reliability for handicap physical independence was very low (0.15). At discharge, reliability improved to 0.69 being more consistent with results achieved for the other axes. CONCLUSIONS: This study confirms the good inter-rater reliability demonstrated previously in the literature but reveals poor inter-rater reliability for the two handicap scales. The latter will require modification before they can be used with confidence in conjunction with the disability scale.


Assuntos
Amputados/reabilitação , Avaliação da Deficiência , Adulto , Idoso , Idoso de 80 Anos ou mais , Amputados/psicologia , Membros Artificiais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Reprodutibilidade dos Testes
12.
Br Med J (Clin Res Ed) ; 288(6428): 1405-8, 1984 May 12.
Artigo em Inglês | MEDLINE | ID: mdl-6426577

RESUMO

Some relations between metastatic bone disease and calcium homoeostasis were determined in a consecutive series of 81 patients with solid malignant tumours attending for radionuclide bone scans. Biochemical evaluation showed that bone resorption from metastatic disease was generally not enough to account for hypercalcaemia. While skeletal metastases were present in about half of the patients who developed hypercalcaemia, biochemical indices of bone resorption in these subjects were greatly increased and disproportionate to the extent of metastatic disease detected by the bone scans. Furthermore, a reduced renal phosphate threshold and increased tubular calcium reabsorption were generally observed in hypercalcaemic patients when compared with their normocalcaemic counterparts. These findings suggest that in most cases malignancy associated hypercalcaemia may be caused by the release of a humoral factor by tumour tissue which exhibits "parathyroid-hormone-like" activity with regard to bone resorption, renal phosphate threshold, and renal calcium handling. It may be postulated that this putative humoral mediator predisposes to hypercalcaemia both by stimulating generalised osteolysis and in most cases also by impairing the renal excretion of the resultant increase in filtered calcium load. While hypercalcaemia may arise as a result of metastatic bone disease alone, these data indicate that this may be the exception rather than the rule. Hence the term "metastatic hypercalcaemia" should probably be reserved for patients with extensive skeletal tumour disease in whom biochemical evaluation fails to yield evidence of an underlying humorally mediated cause.


Assuntos
Neoplasias Ósseas/secundário , Neoplasias da Mama , Carcinoma Broncogênico , Hipercalcemia/etiologia , Neoplasias Ósseas/diagnóstico por imagem , Neoplasias Ósseas/metabolismo , Reabsorção Óssea , Osso e Ossos/diagnóstico por imagem , Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/metabolismo , Cálcio/sangue , Cálcio/urina , Carcinoma Broncogênico/diagnóstico por imagem , Carcinoma Broncogênico/metabolismo , Creatinina/urina , Feminino , Humanos , Hidroxiprolina/urina , Masculino , Cintilografia
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