scholarly journals The decline of elective operating at major trauma centres

2017 ◽  
Vol 99 (2) ◽  
pp. 166-168
Author(s):  
A Memarzadeh ◽  
H Taki ◽  
EK Tissingh ◽  
P Hull
Keyword(s):  
Lower Limb ◽  
Major Trauma ◽  
Statistical Significance ◽  
Future Research ◽  
Trauma Network ◽  
Trauma Centres ◽  
Joint Registry ◽  
District Hospitals ◽  
Before And After ◽  
Chi Squared

INTRODUCTION Major trauma is a leading cause of death in those aged under 40 years. In order to improve the care for multiply injured patients, the major trauma network was activated in April 2012 in England. Its goal was to link all district hospitals to major trauma centres (MTCs) and allow for rapid transfer of patients. Anecdotally, this has affected elective orthopaedic operating at MTCs. The aim of this study was to compare the number of lower limb arthroplasty procedures performed before and after the establishment of the trauma network. METHODS Data on hip and knee arthroplasties in England during the two years prior to and the two years following the introduction of the trauma network were obtained from the National Joint Registry. These were broken down by type of unit (MTCs vs non-MTCs). Differences between the number of hip and knee arthroplasties undertaken in the two time periods were analysed. The chi-squared test was used to assess statistical significance. RESULTS The total number of lower limb arthroplasties increased after the activation of the trauma network by 5.5% (from 211,453 to 223,119). When stratifying the data by type of unit, this increasing trend was present for non-MTCs; however, in MTCs, a reduction occurred: the number reduced by 13.6% (from 13,492 to 11,657). This reversal of trend was seen in both hip and knee procedures independently (both p<0.01). CONCLUSIONS The introduction of the trauma network has led to a reduction in the total number of lower limb arthroplasty procedures performed in MTCs. Various reasons have been postulated for this but its impact on surgical training and hospital finances must be scrutinised in future research.

scholarly journals Reinforced Feedback in Virtual Environment for Plantar Flexor Poststroke Spasticity Reduction and Gait Function Improvement

2019 ◽  
Vol 2019 ◽  
pp. 1-9
Author(s):  
Carlos Luque-Moreno ◽  
Fátima Cano-Bravo ◽  
Pawel Kiper ◽  
Ignacio Solís-Marcos ◽  
Jose A. Moral-Munoz ◽  
...  
Keyword(s):  
Virtual Environment ◽  
Statistical Significance ◽  
Combined Treatment ◽  
Functional Independence Measure ◽  
Functional Independence ◽  
Assessment Tools ◽  
Future Research ◽  
End Of Treatment ◽  
Before And After ◽  
Gait Function

Background. Ankle spasticity is a frequent phenomenon that limits functionality in poststroke patients. Objectives. Our aim was to determine if there was decreased spasticity in the ankle plantar flex (PF) muscles in the plegic lower extremity (LE) and improvement of gait function in stroke patients after traditional rehabilitation (TR) in combination with virtual reality with reinforced feedback, which is termed “reinforced feedback virtual environment” (RFVE). Methods. The evaluation, before and after treatment, of 10 hemiparetic patients was performed using the Modified Ashworth Scale (MAS), Functional Ambulatory Category (FAC), and Functional Independence Measure (FIM). The intervention consisted of 1 hour/day of TR plus 1 hour/day of RFVE (5 days/week for 3 weeks; 15 sessions in total). Results. The MAS and FAC reached statistical significance (P<0.05). The changes in the FIM did not reach statistical significance (P=0.066). The analysis between the ischemic and haemorrhagic patients showed significant differences in favour of the haemorrhagic group in the FIM scale. A significant correlation between the FAC and the months after the stroke was established (P=−0.711). Indeed, patients who most increased their score on the FAC at the end of treatment were those who started the treatment earliest after stroke. Conclusions. The combined treatment of TR and RFVE showed encouraging results regarding the reduction of spasticity and improvement of gait function. An early commencement of the treatment seems to be ideal, and future research should increase the sample size and assessment tools.

scholarly journals Experience of managing open fractures of the lower limb at a major trauma centre

2015 ◽  
Vol 97 (4) ◽  
pp. 287-290 ◽  
Author(s):  
AM Ali ◽  
JM McMaster ◽  
D Noyes ◽  
AJ Brent ◽  
LK Cogswell
Keyword(s):  
Soft Tissue ◽  
Median Time ◽  
Lower Limb ◽  
Major Trauma ◽  
Deep Infection ◽  
Trauma Centre ◽  
Open Fractures ◽  
Trauma Network ◽  
Soft Tissue Cover ◽  
Major Trauma Centre

Introduction In April 2012 the John Radcliffe Hospital in Oxford became a major trauma centre (MTC). The British Orthopaedic Association and British Association of Plastic, Reconstructive and Aesthetic Surgeons joint standards for the management of open fractures of the lower limb (BOAST 4) require system-wide changes in referral practice that may be facilitated by the MTC and its associated major trauma network. Methods From 2008 to 2013 a multistep audit of compliance with BOAST 4 was conducted to assess referral patterns, timing of surgery and outcomes (surgical site infection rates), to determine changes following local intervention and the establishment of the MTC. Results Over the study period, 50 patients had soft tissue cover for an open lower limb fracture and there was a significant increase in the proportion of patients receiving definitive fixation in our centre (p=0.036). The median time from injury to soft tissue cover fell from 6.0 days to 3.5 days (p=0.051) and the median time from definitive fixation to soft tissue cover fell from 5.0 days to 2.0 days (p=0.003). The deep infection rate fell from 27% to 8% (p=0.247). However, in 2013 many patients still experienced a delay of >72 hours between injury and soft tissue cover, primarily owing to a lack of capacity for providing soft tissue cover. Conclusions Our experience may be relevant to other MTCs seeking to identify barriers to optimising the management of patients with these injuries.

scholarly journals Efficacy of Different Concentrations of Chlorhexidine Mouthwash on Plaque Accumulation and Periodontal Parameters

2016 ◽  
Vol 8 (1) ◽  
pp. 8-11
Author(s):  
Ali Zarandi ◽  
Sina Salahaddin ◽  
Masoumeh Faramarzi
Keyword(s):  
Statistical Significance ◽  
Clinical Parameters ◽  
Chemical Agents ◽  
Probing Depth ◽  
Before And After ◽  
Chi Squared ◽  
Plaque Control ◽  
Group 2 ◽  
Antibacterial Potential ◽  
Group 1

Background and aims. Dental plaque and gingivitis were controlled by administration of chemical agents such as chlorhexidine (CHX) which is recognized as a gold standard of chemical agents. The aim of this study was to compare the effects of two mouthwashes (0.2% CHX and Kin Gingival) on clinical parameters. Materials and methods. A total of 88 subjects were included in this interventional‒experimental study. The subjects were divided into two groups of 44 (group 1: 0.2% CHX and group 2: Kin Gingival). The study involved no mechanical plaque control methods. Patients used the mouthwashes twice a day for two weeks. Clinical parameters included plaque index (PI), gingival index (GI), probing depth (PD) and bleeding on probing (BOP), which were measured before and after the use of mouthwashes. The results were analyzed by Man-Whitney U and chi-squared tests. Statistical significance was set at P < 0.05. Results. The results indicated that PI, GI and PD significantly decreased in group 2 (Kin Gingival) in comparison with group 1 (0.2% CHX) (P < 0.05). However, the two mouthwashes did not differ significantly from each other in relation to BOP (P > 0.05). Conclusion. Based on the results it can be concluded that Kin Gingival and 0.2% CHX mouthwashes decrease the clinical parameters in patients significantly. However, Kin Gingival is more effective than 0.2% CHX, which might be attributed to the synergic antibacterial potential of Kin Gingival ingredients like sodium fluoride.

Injured patients who would benefit from expedited major trauma centre care: a consensus-based definition for the United Kingdom

2021 ◽  
Vol 6 (3) ◽  
pp. 7-14
Author(s):  
Gordon Fuller ◽  
Samuel Keating ◽  
Janette Turner ◽  
Josh Miller ◽  
Chris Holt ◽  
...  
Keyword(s):  
United Kingdom ◽  
Major Trauma ◽  
Trauma Centre ◽  
Research Network ◽  
Future Research ◽  
Trauma Network ◽  
Reference Standard ◽  
The United Kingdom ◽  
Major Trauma Centre ◽  
The Right

Introduction: Despite the importance of treating the ‘right patient in the right place at the right time’, there is no gold standard for defining which patients should receive expedited major trauma centre (MTC) care. This study aimed to define a reference standard applicable to the United Kingdom (UK) National Health Service major trauma networks.Methods: A one-day facilitated roundtable expert consensus meeting was conducted at the University of Sheffield, UK, in September 2019. An expert panel of 17 clinicians was purposively sampled, representing all specialities relevant to major trauma management. A consultation process was subsequently held using focus groups with Public and Patient Involvement (PPI) representatives to review and confirm the proposed reference standard.Results: Four reference standard domains were identified, comprising: need for critical interventions; presence of significant individual anatomical injuries; burden of multiple minor injuries; and important patient attributes. Specific criteria were defined for each domain. PPI consultation confirmed all aspects of the reference standard. A coding algorithm to allow operationalisation in Trauma Audit and Research Network data was also formulated, allowing classification of any case submitted to their database for future research.Conclusions: This reference standard defines which patients would benefit from expedited MTC care. It could be used as the target for future pre-hospital injury triage tools, for setting best practice tariffs for trauma care reimbursement and to evaluate trauma network performance. Future research is recommended to compare patient characteristics, management and outcomes of the proposed definition with previously established reference standards.

scholarly journals Economic Crises and Returns to University Education in Middle-Income Countries: Stylized Facts and COVID-19 Projections

2021 ◽  
Vol 23 (1) ◽  
Author(s):  
Tazeen Fasih ◽  
Harry A. Patrinos ◽  
M. Najeeb Shafiq
Keyword(s):  
Statistical Significance ◽  
University Education ◽  
Future Research ◽  
Economic Crises ◽  
Stylized Facts ◽  
Rates Of Return ◽  
Middle Income ◽  
Middle Income Countries ◽  
Before And After ◽  
The Relationship

In this study, we develop a conceptual framework that explains the reasons behind a widening of the gaps in private rates of return to university education during an economic crisis such as COVID-19. Next, we report stylized facts on the private rates of return to university education before and after economic crises in Indonesia, Pakistan, and South Africa. We further conduct panel regression analysis to assess the statistical significance of the relationship between private returns and crises in the three countries. We conclude by speculating on COVID-19 implications and future research.

The impact of the introduction of the londonTrauma Network on a trauma and orthopaedic department within its catchment area

2013 ◽  
Vol 95 (6) ◽  
pp. 208-209 ◽  
Author(s):  
Tim Sinnett ◽  
Sheila Bacon ◽  
Naresh Somashaker
Keyword(s):  
Hospital Mortality ◽  
Catchment Area ◽  
Major Trauma ◽  
Trauma Network ◽  
National Audit ◽  
Trauma Systems ◽  
Orthopaedic Department ◽  
Trauma Centres ◽  
The Impact

Following the decision by the Joint Committee of Primary CareTrusts (JPCTs) in July 2009 to designate four major trauma centres (MTC) in London, each with its own trauma network, the final MTC went fully live in January 2011. The primary aim of the LondonTrauma System is to ensure that those patients who suffer major trauma are treated at specialist MTCs. The National Audit Office Report published in 2010 revealed the literature suggested that where trauma systems had been introduced, in-hospital mortality was reduced by 15 to 20 per cent.

STUDY CLINICAL FEATURE AND RESULT OF TREATMENT PHACOMORPHIC GLAUCOMA

2015 ◽  
pp. 71-75
Author(s):  
Van Nam Phan ◽  
Ba Ken Tran
Keyword(s):  
Visual Acuity ◽  
Intraocular Pressure ◽  
Statistical Significance ◽  
Corneal Edema ◽  
Clinical Feature ◽  
Anterior Chamber Angle ◽  
Male Population ◽  
Significant Difference ◽  
Operative Complications ◽  
Before And After

Purpose: Study clinical feature of phacomorphic glaucoma. To evaluate the result of treatment phacomorphic glaucoma. Method: The retrospective, interventional study on 36 cases with phacomorphic glaucoma who underwent treated at Hue Central Hospital from 6/2010 to 6/2011. Standard of research: visual, IOP, before and after surgery, accompanying lesions and post-operative complications. The surgery is considered successful when postoperative IOP less than 21 mmHg. Results: Age 50-59 presented 30.5 percent, ≥ 60 presented 91.7 percent. There was a slight female preponderance (66.7%) compared to the male population (33.3%) which implies a statistically marginally significant difference. However there was no statistical significance difference when compared by the two subgroups. Patient in country presented 61,1% and city presented 38,9%. The duration between the onset of pain and surgery from 0 to < 5 days (77.8%), from 6 to 10 (16.7%) and >10 days presented 5.5%. The preoperative intraocular pressure 35 to 45mmHg (47.2%), 46-55 (30.6%), 56-65 (13.9%) and more than 65 presented 8.3%. The visual acuity preoperation less than 1metre count finger (94.5%), less than 3 metre count finger presented 5.5%. Close anterior chamber angle presented 80.6% and shallow was presented 19.4%. Corneal edema presented 100%, iritis presented 94.4%, dilated pupil larger 5mm presented 83.3%, Synchynea iris and cataract presented 72.2%. ECCE, implantation IOL combined trabeculectomy presented 11.1%, Phaco, implantation IOL combined trabeculectomy presented 69,5%, ECCE implantation IOL presented 5.6%, Phaco, implantation IOL presented 13.8%. Postoperative visual acuity from 1/10 to 5/10 presented 72.2%, no case have VA larger than 5/10. Postoperative 3 months VA 1/10 to 5/10 presented 72.2%, larger VA 5/10 presented 8.3%. Postoperative 3 months intraocular pressure ≤ 21mmHg presented 91.7%, 22 to 24mmHg presented 8.3%, no case have IOP ≥25mmHg. Postoperative edema presented 58.3%, iritis presented 58.3%. Key words: phacomorphic Glaucoma

scholarly journals Treatment of HIV-associated facial lipoatrophy: impact on infection progression assessed by viral load and CD4 count

2013 ◽  
Vol 88 (4) ◽  
pp. 570-577 ◽  
Author(s):  
Flávia Machado Gonçalves Soares ◽  
Izelda Maria Carvalho Costa
Keyword(s):  
Viral Load ◽  
Disease Progression ◽  
Statistical Significance ◽  
Undetectable Viral Load ◽  
Fat Distribution ◽  
Cd4 Count ◽  
Before And After ◽  
Facial Lipoatrophy ◽  
A Prospective Study ◽  
The Impact

BACKGROUND: HIV/AIDS-Associated Lipodystrophy Syndrome includes changes in body fat distribution, with or without metabolic changes. The loss of fat from the face, called facial lipoatrophy, is one of the most stigmatizing signs of the syndrome.OBJECTIVES:To evaluate the effect of FL treatment using polymethylmethacrylate (PMMA) implants on disease progression, assessed by viral load and CD4 cell count.METHODS: This was a prospective study of 44 patients treated from July 2009 to December 2010. Male and female patients, aged over 18 years, with clinically detectable FL and who had never been treated were included in the study. PMMA implantation was done to fill atrophic areas. Laboratory tests were conducted to measure viral load and CD4 count before and after treatment.RESULTS: Of the 44 patients, 72.72% were male and 27.27% female, mean age of 44.38 years. Before treatment, 82% of patients had undetectable viral load, which increased to 88.6% after treatment, but without statistical significance (p = 0.67). CD4 count before treatment ranged from 209 to 1293, averaging 493.97. After treatment, the average increased to 548.61. The increase in CD4 count after treatment was statistically significant with p = 0.02.CONCLUSION: The treatment of FL with PMMA implants showed a statistically significant increase in CD4 count after treatment, revealing the impact of FL treatment on disease progression. Viral load before and after treatment did not vary significantly.

scholarly journals Parathyroid hormone Gene and Genes Involved in the Maintenance of Vitamin D Levels Association with Mandibular Retrognathism

2021 ◽  
Vol 11 (5) ◽  
pp. 369
Author(s):  
Erika Calvano Küchler ◽  
Caio Luiz Bitencourt Reis ◽  
Guido Marañón-Vásquez ◽  
Paulo Nelson-Filho ◽  
Mírian Aiko Nakane Matsumoto ◽  
...  
Keyword(s):  
Statistical Significance ◽  
Interaction Model ◽  
Distribution Analysis ◽  
Nucleotide Polymorphisms ◽  
Allele Distribution ◽  
Vitamin D Levels ◽  
Lateral Cephalograms ◽  
Genes Encoding ◽  
Chi Squared ◽  
Mandibular Retrognathism

In this study we evaluated whether single nucleotide polymorphisms (SNPs) in the genes encoding PTH, VDR, CYP24A1, and CYP27B1 were associated with mandibular retrognathism (MR). Samples from biologically-unrelated Brazilian patients receiving orthodontic treatment were included in this study. Pre-orthodontic lateral cephalograms were used to determine the phenotype. Patients with a retrognathic mandible were selected as cases and those with an orthognathic mandible were selected as controls. Genomic DNA was used for genotyping analysis of SNPs in PTH (rs694, rs6256, and rs307247), VDR (rs7975232), CYP24A1 (rs464653), and CYP27B1 (rs927650). Chi-squared or Fisher’s tests were used to compare genotype and allele distribution among groups. Haplotype analysis was performed for the SNPs in PTH. The established alpha was p < 0.05. Multifactor dimensionality reduction (MDR) was used to identify SNP–SNP interactions. A total of 48 (22 males and 26 females) MR and 43 (17 males and 26 females) controls were included. The linear mandibular and the angular measurements were statistically different between MR and controls (p < 0.05). In the genotype and allele distribution analysis, the SNPs rs694, rs307247, and rs464653 were associated with MR (p < 0.05). MDR analyses predicted the best interaction model for MR was rs694–rs927650, followed by rs307247–rs464653–rs927650. Some haplotypes in the PTH gene presented statistical significance. Our results suggest that SNPs in PTH, VDR, CYP24A1, and CYP27B1 genes are associated with the presence of mandibular retrognathism.

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