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Journal articleMullington CJ, Low DA, Strutton PH, et al., 2018,
Body temperature, cutaneous heat loss and skin blood flow during epidural anaesthesia for emergency caesarean section
, Anaesthesia, Vol: 73, Pages: 1500-1506, ISSN: 0003-2409It is not clear how converting epidural analgesia for labour to epidural anaesthesia for emergency caesarean section affects either cutaneous vasomotor tone or mean body temperature. We hypothesised that topping up a labour epidural blocks active cutaneous vasodilation (cutaneous heat loss and skin blood flow decrease), and that as a result mean body temperature increases. Twenty women in established labour had body temperature, cutaneous heat loss and skin blood flow recorded before and after epidural top‐up for emergency caesarean section. Changes over time were analysed with repeated measures ANOVA. Mean (SD) mean body temperature was 36.8 (0.5)°C at epidural top‐up and 36.9 (0.6)°C at delivery. Between epidural top‐up and delivery, the mean (SD) rate of increase in mean body temperature was 0.5 (0.5) °C.h−1. Following epidural top‐up, chest (p < 0.001) and forearm (p = 0.004) heat loss decreased, but head (p = 0.05), thigh (p = 0.79) and calf (p = 1.00) heat loss did not change. The mean (SD) decrease in heat loss was 15 (19) % (p < 0.001). Neither arm (p = 0.06) nor thigh (p = 0.10) skin blood flow changed following epidural top‐up. Despite the lack of change in skin blood flow, the most plausible explanation for the reduction in heat loss and the increase in mean body temperature is blockade of active cutaneous vasodilation. It is possible that a similar mechanism is responsible for the hyperthermia associated with labour epidural analgesia.
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Journal articleCowell I, O'Sullivan P, O'Sullivan K, et al., 2018,
Perceptions of physiotherapists towards the management of non-specific chronic low back pain from a biopsychosocial perspective: a qualitative study
, Musculoskeletal Science and Practice, Vol: 38, Pages: 113-119, ISSN: 2468-8630BackgroundPhysiotherapists have been urged to embrace a patient-oriented biopsychosocial (BPS) framework for the management of non-specific chronic low back pain (NSCLBP). However, recent evidence suggests that providing broader BPS interventions demonstrates small differences in pain or disability compared to usual care. Little is known about how to integrate a BPS model into physiotherapy practice and the challenges it presents.ObjectiveTo explore the perceptions of physiotherapists' in primary care in England adopting a BPS approach to managing NSCLBP patients.MethodQualitative semi-structured interviews were conducted with ten physiotherapists working in primary care. A purposive sampling method was employed to seek the broadest perspectives. Thematic analysis was used to analyse the interview transcripts and capture the emergent themes.ResultsThree main themes emerged: (1) physiotherapists recognised the multi-dimensional nature of NSCLBP and the need to manage the condition from a BPS perspective, (2) addressing psychological factors was viewed as challenging due to a lack of training and guidance, (3) engaging patients to self-manage their NSCLBP was seen as a key objective.ConclusionAlthough employing a BPS approach is recognised by physiotherapists in the management of NSCLBP, this study highlights the problems of implementing evidence based guidelines recommending that psychological factors be addressed but providing limited support for this. It also supports the need to allocate more time to explore these domains in distressed individuals. Engaging patients to self-manage was seen as a key objective, which was not a straightforward process, requiring careful negotiation.
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Journal articleRudran B, Logishetty K, 2018,
Virtual reality simulation: a paradigm shift for therapy and medical education
, BRITISH JOURNAL OF HOSPITAL MEDICINE, Vol: 79, Pages: 666-667, ISSN: 1750-8460- Author Web Link
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Conference paperCourtney A, Harvey R, Abel R, et al., 2018,
CHANGES IN BONE TURNOVER MARKERS IN ADVANCED PROSTATE CANCER PATIENTS TREATED WITH LHRH AGONISTS AND TRANSDERMAL OESTRADIOL PATCHES
, Osteoporosis Conference, Publisher: SPRINGER LONDON LTD, Pages: 617-617, ISSN: 0937-941X -
Journal articleLogishetty K, Western L, Morgan R, et al., 2018,
Can an Augmented Reality Headset Improve Accuracy of Acetabular Cup Orientation in Simulated THA? A Randomized Trial.
, Clin Orthop Relat ResBACKGROUND: Accurate implant orientation reduces wear and increases stability in arthroplasty but is a technically demanding skill. Augmented reality (AR) headsets overlay digital information on top of the real world. We have developed an enhanced AR headset capable of tracking bony anatomy in relation to an implant, but it has not yet been assessed for its suitability as a training tool for implant orientation. QUESTIONS/PURPOSES: (1) In the setting of simulated THA performed by novices, does an AR headset improve the accuracy of acetabular component positioning compared with hands-on training by an expert surgeon? (2) What are trainees' perceptions of the AR headset in terms of realism of the task, acceptability of the technology, and its potential role for surgical training? METHODS: Twenty-four study participants (medical students in their final year of school, who were applying to surgery residency programs, and who had no prior arthroplasty experience) participated in a randomized simulation trial using an AR headset and a simulated THA. Participants were randomized to two groups completing four once-weekly sessions of baseline assessment, training, and reassessment. One group trained using AR (with live holographic orientation feedback) and the other received one-on-one training from a hip arthroplasty surgeon. Demographics and baseline performance in orienting an acetabular implant to six patient-specific values on the phantom pelvis were collected before training and were comparable. The orientation error in degrees between the planned and achieved orientations was measured and was not different between groups with the numbers available (surgeon group mean error ± SD 16° ± 7° versus AR 14° ± 7°; p = 0.22). Participants trained by AR also completed a validated posttraining questionnaire evaluating their experiences. RESULTS: During the four training sessions, participants using AR-guidance had smaller mean (± SD) e
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Journal articleHolman A, Clunie G, Roe J, et al., 2018,
Management of swallowing in adults undergoing laryngotracheal resection and reconstruction
, Perspectives of the ASHA Special Interest Groups, Vol: 3, Pages: 113-123, ISSN: 2381-4764Purpose: This article presents a detailed review of the etiology of laryngotracheal stenosis, common surgical procedures, and typical pathophysiological changes affecting swallowing function. We describe the redundancy in airway protection and the possibility of safe swallowing in suboptimal conditions.Conclusion: Comprehensive understanding of unique patient factors and swallowing physiology in this complex population facilitates targeted and patient-specific rehabilitation.
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Journal articleJones GG, Logishetty K, Clarke S, et al., 2018,
Do patient-specific instruments (PSI) for UKA allow non-expert surgeons to achieve the same saw cut accuracy as expert surgeons?
, Archives of Orthopaedic and Trauma Surgery, Vol: 138, Pages: 1601-1608, ISSN: 0936-8051INTRODUCTION: High-volume unicompartmental knee arthroplasty (UKA) surgeons have lower revision rates, in part due to improved intra-operative component alignment. This study set out to determine whether PSI might allow non-expert surgeons to achieve the same level of accuracy as expert surgeons. MATERIALS AND METHODS: Thirty-four surgical trainees with no prior experience of UKA, and four high-volume UKA surgeons were asked to perform the tibial saw cuts for a medial UKA in a sawbone model using both conventional and patient-specific instrumentation (PSI) with the aim of achieving a specified pre-operative plan. Half the participants in each group started with conventional instrumentation, and half with PSI. CT scans of the 76 cut sawbones were then segmented and reliably orientated in space, before saw cut position in the sagittal, coronal and axial planes was measured, and compared to the pre-operative plan. RESULTS: The compound error (absolute error in the coronal, sagittal and axial planes combined) for experts using conventional instruments was significantly less than that of the trainees (11.6°±4.0° v 7.7° ±2.3º, p = 0.029). PSI improved trainee accuracy to the same level as experts using conventional instruments (compound error 5.5° ±3.4º v 7.7° ±2.3º, p = 0.396) and patient-specific instruments (compound error 5.5° ±3.4º v 7.3° ±4.1º, p = 0.3). PSI did not improve the accuracy of high-volume surgeons (p = 0.3). CONCLUSIONS: In a sawbone model, PSI allowed inexperienced surgeons to achieve more accurate saw cuts, equivalent to expert surgeons, and thus has the potential to reduce revision rates. The next test will be to determine whether these results can be replicated in a clinical trial.
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Journal articleRivière C, Dhaif F, Shah H, et al., 2018,
Kinematic alignment of current TKA implants does not restore the native trochlear anatomy
, Revue de Chirurgie Orthopedique et Traumatologique, Vol: 104, Pages: 673-685, ISSN: 1877-0517 -
Conference paperMa S, Goh EL, Karunaratne A, et al., 2018,
The Effects of Bisphosphonate at the Nanoscale: Effects on Bone Collagen, Mineral Strain and Collagen-Mineral Interaction
, Annual Meeting of the American-Society-for-Bone-and-Mineral-Research, Publisher: WILEY, Pages: 410-411, ISSN: 0884-0431 -
Journal articleRivière C, Dhaif F, Shah H, et al., 2018,
Kinematic alignment of current TKA implants does not restore the native trochlear anatomy
, Orthopaedics and Traumatology: Surgery and Research, Vol: 104, Pages: 983-995, ISSN: 1877-0568INTRODUCTION: Preserving constitutional patellofemoral anatomy, and thus producing physiological patellofemoral kinematics, could prevent patellofemoral complications and improve clinical outcomes after kinematically aligned TKA (KA TKA). Our study aims 1) to compare the native and prosthetic trochleae (planned or implanted), and 2) to estimate the safety of implanting a larger Persona® femoral component size matching the proximal lateral trochlea facet height (flange area) in order to reduce the native articular surfaces understuffing generated by the prosthetic KA trochlea. METHODS: Persona® femoral component 3D model was virtually kinematically aligned on 3D bone-cartilage models of healthy knees by using a conventional KA technique (group 1, 36 models, planned KA TKA) or an alternative KA technique (AT KA TKA) aiming to match the proximal (flange area) lateral facet height (10 models, planned AT KA TKA). Also, 13 postoperative bone-implant (KA Persona®) models were co-registered to the same coordinate geometry as their preoperative bone-cartilage models (group 2 - implanted KA TKA). In-house analysis software was used to compare native and prosthetic trochlea articular surfaces and medio-lateral implant overhangs for every group. RESULTS: The planned and performed prosthetic trochleae were similar and valgus oriented (6.1° and 8.5°, respectively), substantially proximally understuffed compared to the native trochlea. The AT KA TKAs shows a high rate of native trochlea surface overstuffing (70%, 90%, and 100% for lateral facet, groove, medial facet) and mediolateral implant overhang (60%). There was no overstuffing with conventional KA TKAs having their anterior femoral cut flush. CONCLUSION: We found that with both the planned and implanted femoral components, the KA Persona® trochlea was more valgus oriented and understuffed compared to the native trochlear anatomy. In addition, restoring the lateral trochlea facet height by increasing t
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Journal articleAqil A, Patel S, Wiik A, et al., 2018,
Patient-specific guides improve hip arthroplasty surgical accuracy
, COMPUTER METHODS IN BIOMECHANICS AND BIOMEDICAL ENGINEERING, Vol: 21, Pages: 579-584, ISSN: 1025-5842 -
Journal articleWong JKL, McGregor AH, 2018,
Spatiotemporal gait changes in healthy pregnant women and women with pelvic girdle pain: a systematic review
, Journal of Back and Musculoskeletal Rehabilitation, Vol: 31, Pages: 821-838, ISSN: 1053-8127INTRODUCTION: Gait is affected in women with pelvic girdle pain (PGP), a musculoskeletal condition affecting 20% of pregnant women. Whilst there is evidence of spatiotemporal changes in gait during healthy pregnancy, less is known in relation to women with PGP. Appreciating gait characteristics during healthy pregnancy could inform our understanding of the role of gait in PGP. PURPOSE: The purpose of this review was to systematically analyse differences in the spatiotemporal parameters of gait in healthy pregnant women and those with PGP, and to make recommendations to improve research methods in investigating gait in PGP women. METHODS: The review was undertaken following the PRISMA guidelines. Three databases and pre-existing literature were electronically and manually searched. Study selection and data extraction were conducted by two reviewers. Quality assessment was performed using the NHLBI tool for Observational Cohort and Cross-sectional Studies. RESULTS: The search returned 2925 results. Fourteen studies were selected for data extraction. Twelve studies investigated gait in healthy pregnant women and two in PGP women. Studies employed either a cohort or cross-sectional design and used various methods to assess gait. Three, nine and two studies were high, medium and low in quality, respectively. Direct comparisons between studies were impeded due to incomparable gestational time-points investigated, in addition to variations in gait parameters and definitions used. CONCLUSION: Evidence from studies on healthy pregnant women could inform future research on PGP women, for which current evidence is scarce. We recommend the standardisation of critical factors to allow inter-study comparisons for a meta-analysis.
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Journal articleBhattacharyya R, Sugand K, Al-Obaidi B, et al., 2018,
Trauma simulation training: a randomized controlled trial -evaluating the effectiveness of the Imperial Femoral Intramedullary Nailing Cognitive Task Analysis (IFINCTA) tool
, Acta Orthopaedica, Vol: 89, Pages: 689-695, ISSN: 1745-3674Background and purpose - Cognitive task analysis (CTA) has been used extensively to train pilots and in other surgical specialties. However, the use of CTA within orthopedics is in its infancy. We evaluated the effectiveness of a novel CTA tool to improve understanding of the procedural steps in antegrade femoral intramedullary nailing. Material and methods - Design: A modified Delphi technique was used to generate a CTA from 3 expert orthopedic trauma surgeons for antegrade femoral intramedullary nailing. The written and audiovisual information was combined to describe the technical steps, decision points, and errors for each phase of this procedure Validation: A randomized double-blind controlled trial was undertaken with 22 medical students (novices) randomized into 2 equal groups. The intervention group were given the CTA tool and the control group were given a standard operative technique manual. They were assessed using the validated "Touch Surgery™" application assessment tool on femoral intramedullary nailing. Results - The pre-test scores between the two groups were similar. However, the post-test scores were statistically significantly better in the intervention group compared with the control group. The improvement (post-test median scores) in the intervention group compared with the control group was 20% for patient positioning and preparation, 21% for femoral preparation, 10% for proximal locking, and 19% for distal locking respectively (p < 0.001 for all comparisons). Interpretation - This is the first multimedia CTA tool in femoral intramedullary nailing that is easily accessible, user-friendly, and has demonstrated significant benefits in training novices over the traditional use of operative technique manuals.
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Conference paperFavier C, McGregor A, Phillips A, 2018,
Subject specific multiscale modelling of the lumbar spine
, 14th Annual Bath Biomechanics Symposium -
Journal articleJones G, Jaere M, Clarke S, et al., 2018,
A Clinical Trial Examining the Accuracy of High Tibial Osteotomy When Performed by Experts Using a Novel Patient Specific Instrument (PSI)
, SSRN -
Journal articleZhao S, Arnold M, Ma S, et al., 2018,
Standardising compression testing for measuring the stiffness of human bone: a systematic review
, Bone and Joint Research, Vol: 7, Pages: 524-538, ISSN: 2046-3758Objectives: The ability to determine human bone stiffness is of clinical relevance in many fields, including bone quality assessment and orthopaedic prosthesis design. Stiffness can be measured using compression testing; an experimental technique commonly used to test bone specimens in vitro. This systematic review aims to determine how best to perform compression testing of human bone. Methods: A keyword search of all English language articles up until December 2017 of compression testing of bone was undertaken in Medline, Embase, PubMed and Scopus databases. Studies using bulk tissue, animal tissue, whole bone or testing techniques other than compression testing were excluded. Results: 4712 abstracts were retrieved with a total of 177 papers included in the analysis. 20 studies directly analysed the compression testing technique to improve the accuracy of the testing technique. Several influencing factors should be considered when testing bone samples in compression. These include the method of data analysis, specimen storage, specimen preparation, testing configuration and loading protocol. Conclusions: Compression testing is a widely used technique for measuring the stiffness of bone but there is a great deal of inter-study variation in experimental techniques across the literature. Based on best evidence from the literature, suggestions for bone compression testing are made in this review, though further studies are needed to help establish standardised bone testing techniques to increase the comparability and reliability of bone stiffness studies.
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Journal articleZhao S, Arnold M, Ma S, et al., 2018,
Standardizing compression testing for measuring the stiffness of human bone
, BONE & JOINT RESEARCH, Vol: 7, Pages: 524-538, ISSN: 2046-3758 -
Journal articleWiik AV, Brevadt M, Johal H, et al., 2018,
The loading patterns of a short femoral stem in total hip arthroplasty: gait analysis at increasing walking speeds and inclines.
, Journal of Orthopaedics and Traumatology, Vol: 19, ISSN: 1590-9921BACKGROUND: The purpose of this study was to examine the gait pattern of total hip arthroplasty (THA) patients with a new short femoral stem at different speeds and inclinations. MATERIALS AND METHODS: A total of 40 unilateral THA patients were tested on an instrumented treadmill. They comprised two groups (shorter stemmed THA n = 20, longer stemmed THA n = 20), both which had the same surgical posterior approach. The shorter femoral stemmed patients were taken from an ongoing hip trial with minimum 12 months postop. The comparative longer THR group with similar disease and severity were taken from a gait database along with a demographically similar group of healthy controls (n = 35). All subjects were tested through their entire range of gait speeds and inclines with ground reaction forces collected. Body weight scaling was applied and a symmetry index to compare the implanted hip to the contralateral normal hip. An analysis of variance with significance set at α = 0.05 was used. RESULTS: The experimental groups were matched demographically and implant groups for patient reported outcome measures and radiological disease. Both THA groups walked slower than controls, but symmetry at all intervals for all groups were not significantly different. Push-off loading was less favourable for both the shorter and longer stemmed THR groups (p < 0.05) depending on speed. CONCLUSIONS: Irrespective of femoral stem length, symmetry for ground reaction forces for both THA groups were returned to a normal range when compared to controls. However individual implant performance showed inferior (p < 0.05) push-off forces and normalised step length in both THR groups when compared to controls. LEVEL OF EVIDENCE: III.
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Journal articleLord BR, Colaco HB, Gupte CM, et al., 2018,
ACL graft compression: a method to allow reduced tunnel sizes in ACL reconstruction
, Knee Surgery, Sports Traumatology, Arthroscopy, Vol: 26, Pages: 2430-2437, ISSN: 0942-2056PURPOSE: A common problem during ACL reconstruction is asymmetry of proximal-distal graft diameter leading to tunnel upsizing and graft-tunnel mismatch. Compression downsizing provides a graft of uniform size, allowing easy passage into a smaller tunnel. The purpose of this study was to quantify the graft compression technique and its effects on graft biomechanics and stability. It was hypothesised that compression downsizing would significantly reduce cross-sectional area (CSA); that no significant changes in graft biomechanics would occur; graft fixation stability would be improved. METHOD: Sixty-eight non-irradiated peroneus longus (PL) tendons were investigated. Twenty were halved and paired into ten four-strand grafts, 20 strands were compressed by 0.5-1 mm diameter and changes in CSA recorded using an alginate mould technique. The following properties were compared with 20 control strands: cyclic strain when loaded 70-220 N for 1000 cycles; stiffness; ultimate tensile load and stress; Young's modulus. 24 PL tendons were quadrupled into grafts, 12 were compressed and all 24 were submerged in Ringer's solution at 37 °C and the CSA recorded over 12 h. Twelve compressed and 12 control quadrupled grafts were mounted in porcine femurs, placed in Ringer's solution for 12 h at 37 °C and graft displacement at the bone tunnel aperture recorded under cyclic loading. RESULTS: Mean decreases in CSA of 31% under a stress of 471 kPa and 21% under a stress of 447 kPa were observed for doubled and quadrupled grafts, respectively. Compressed grafts re-expanded by 19% over 12 h compared to 2% for controls. No significant differences were observed between compressed and control grafts in the biomechanical properties and graft stability; mean cyclic displacements were 0.3 mm for both groups. CONCLUSIONS: No detrimental biomechanical effects of graft compression on allograft PL tendons were observed. Following compression, t
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Journal articleRawson T, Sivakumaran P, Lobo R, et al., 2018,
Development of a web-based tool for undergraduate engagement in medical research; the ProjectPal experience
, BMC Medical Education, Vol: 18, ISSN: 1472-6920BackgroundWe report the development and evaluation of a web-based tool designed to facilitate student extra-curricular engagement in medical research through project matching students with academic supervisors.UK based university students were surveyed to explore their perceptions of undergraduate research, barriers and facilitators to current engagement. Following this, an online web-based intervention (www.ProjectPal.org) was developed to support access of students to research projects and supervisors. A pilot intervention was undertaken across a London-based university in January 2013 to February 2016. In March 2016, anonymised data were extracted from the prospective data log for analysis of website engagement and usage. Supervisors were surveyed to evaluate the website and student outputs.ResultsFifty-one students responded to the electronic survey. Twenty-four (47%) reported frustration at a perceived lack of opportunities to carry out extra-curricular academic projects. Major barriers to engaging in undergraduate research reported were difficulties in identifying suitable supervisors (33/51; 65%) and time pressures (36/51; 71%) associated with this. Students reported being opportunistic in their engagement with undergraduate research. Following implementation of the website, 438 students signed up to ProjectPal and the website was accessed 1357 times. Access increased on a yearly basis. Overall, 70 projects were advertised by 35 supervisors. There were 86 applications made by students for these projects. By February 2016, the 70 projects had generated 5 peer-review publications with a further 7 manuscripts under peer-review, 14 national presentations, and 1 national prize.ConclusionThe use of an online platform to promote undergraduate engagement with extra-curricular research appears to facilitate extra-curricular engagement with research. Further work to understand the impact compared to normal opportunistic practices in enhancing student engagement is now
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