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Complications in primary anterior cruciate ligament reconstruction surgery: rates of occurrence, prevention, and management
Get PDFIn anterior cruciate ligament (ACL) reconstruction surgery a graft is used to replace the torn ligament. Understanding the complications of ACL reconstruction surgery is vital for the surgeon to help guide clinical practice.
This synoptic commentary presents eight articles the overall aim of which was to explore complications of ACL reconstruction surgery consider how their occurrence may be
minimised through preventive measures and how they can be managed once they occur.
The stage was set out by a narrative review which looked at the spectrum of intraoperative complications encountered in ACL reconstruction surgery as well as their causes and
management. Following this, an article presented a narrative over view of hamstring tendon harvesting and the substantial variability that exists in the anatomy of these tendons that are frequently used as ACL reconstruction grafts. Subsequently, a third article reported a clinical study on the rate of inadequate hamstring graft harvesting whilst a fourth article reported on a cadaveric study that showed that the hamstring tendon graft quality is related to the type of tendon harvester utilised to obtain the graft. Two systematic reviews and meta analyses were conducted to assess infection in ACL reconstruction surgery. One reported on the rate of infection in ACL reconstruction, its relation to graft type as well as its relation to vancomycin presoaking. This article demonstrated a higher risk of infection associated with hamstring grafts as compared to other graft types and showed that vancomycin graft presoaking minimise d this infection risk. The other article analysed the effectiveness of arthroscopic washout and antibiotic treatment with graft salvage and showed this to be a successful option in most cases of bacterial infection post ACL reconstruction. The seventh article of this commentary reported a systematic review of complications of femoral suture button fixation of the ACL graft It showed the potential for misplacement of the femoral suture button and the need to consider additional intraoperative measures such as radiological screening or arthroscopic inspection of the button to try and avoid this. The final article reported a study which used artificial bones and looked at the relation between the type of reamer used to create the tibial tunnel in ACL reconstruction and tunnel morphology. It showed that misdirection of the reamer may influence the morphology of the outer aperture of the tibial tunnel and that such change in aperture morphology is reamer type dependent.
In conclusion, the articles of this commentary provided knowledge to enhance the ability of the surgeon to obtain a graft of adequate dimensions, minimise the risk of infection and enhance the graft fixation to the femur and tibia. This knowledge may also improve the ability of the surgeon to manage postoperative infection once encountered. The commentary ’s articles also emphasise the need to recognise that surgical complications occur and that by discussing these and sharing experiences in a n open and transparent way, surgeons and other professionals can learn and develop further
Understanding and defining people’s body image experiences after a stroke
Get PDFWhen someone has a stroke, it can cause bodily changes which may lead to an altered body image experience. What this experience is like, and how it impacts wellbeing and
recovery, is not fully understood. We need to understand this to identify whether support for body image experience is required post-stroke. This thesis involves three studies which aimed to build the evidence base and allow deeper insight into poststroke body image experiences. If these experiences impacted wellbeing and recovery, the aim would also be to recommend how body image could be assessed and supported post-stroke.
A systematic review, which identified 61 relevant papers, enabled a summary of existing evidence. Findings showed that people experience a changed body image post-stroke, which impacted their everyday lives. Methods for assessing body image within these studies were not specifically validated for stroke. Semi-structured interviews with 22 people with stroke confirmed this changed experience, its impacts, and enhanced our understanding by providing additional nuanced detail. From this, a stroke-specific definition of body image to support patient, family, carer and clinician understanding was developed. Feedback from clinicians, participants, and public advisors described this as being clear, relevant and comprehensive.
An expert panel of clinicians reviewed my interpretation of the findings and found them to be clinically relevant. They recommended practical, and psychological, methods
whereby body image experience could be supported. They also considered how poststroke body image and any benefits of support could be assessed.
Recommendations for clinical practice and future research have been made. The stroke-specific summary and definition of body image will facilitate a more consistent understanding around, and identification of, people who might be struggling with their post-stroke body image experience. Initial recommendations for post-stroke body image support and methods of assessing any benefits of this support provide direction for future research
Towards Improving Stroke Services in Africa: Results from the Africa-UK Stroke Partnership [AUKSP] Surveys
Get PDFBackground
The African Stroke Organization (ASO) in partnership with the University of Central Lancashire's Stroke Research Team launched the Africa-UK Stroke Partnership (AUKSP). AUKSP undertook two (stroke expert and hospital Stroke Unit (SU)) on-line surveys mapping existing capacity and capability to deliver African stroke care.
Methods
An on-line expert survey tool was sent to 139 stroke experts in 54 African countries October 2021- March 2022 and the hospital SU survey to 120 hospital SUs (identified from the expert survey) June-October 2022. Both survey tools were prepared according to the World Stroke Organisation's Roadmap for Delivering Quality Stroke Care. Completed responses were exported from Qualtrics into Microsoft excel and were analysed descriptively.
Results
Forty-five expert responses and 62 hospital SU responses were analysed, representing 54(87%) public hospitals, 7(11%) private and 1(2%) charitable organization. In both surveys, three main priorities for improvement of stroke services were: a rapid and prompt stroke diagnosis; effective primary and secondary stroke prevention, and acute stroke management. Survey findings suggest that there is a low presence of national stroke surveillance systems and registries, and heterogeneity in availability of diagnostic services, SUs, endovascular treatments, and rehabilitation.
Conclusion
Significant gaps exist in Africa's capacity and capability to deliver essential elements of effective and quality stroke care. Tackling these challenges requires urgent and sustained multi-stakeholder action including: government, administrators, policy makers and other partners. Our survey findings highlight key priority areas for multi-stakeholder engagement and crafting of a pragmatic, prioritized and context-sensitive African Stroke Action Plan
Testing Behavioral Messages to Increase Recruitment to Health Research When Embedded Within Social Media Campaigns on Twitter: Web-Based Experimental Study
Get PDFBackground:
Social media is rapidly becoming the primary source to disseminate invitations to the public to consider taking part in research studies. There is, however, little information on how the contents of the advertisement can be communicated to facilitate engagement and subsequently promote intentions to participate in research.
Objective:
This paper describes an experimental study that tested different behavioral messages for recruiting study participants for a real-life observational case-control study.
Methods:
We included 1060 women in a web-based experiment and randomized them to 1 of 3 experimental conditions: standard advertisement (n=360), patient endorsement advertisement (n=345), and social norms advertisement (n=355). After seeing 1 of the 3 advertisements, participants were asked to state (1) their intention to take part in the advertised case-control study, (2) the ease of understanding the message and study aims, and (3) their willingness to be redirected to the website of the case-control study after completing the survey. Individuals were further asked to suggest ways to improve the messages. Intentions were compared between groups using ordinal logistic regression, reported in percentages, adjusted odds ratio (aOR), and 95% CIs.
Results:
Those who were in the patient endorsement and social norms–based advertisement groups had significantly lower intentions to take part in the advertised study compared with those in the standard advertisement group (aOR 0.73, 95% CI 0.55-0.97; P=.03 and aOR 0.69, 95% CI 0.52-0.92; P=.009, respectively). The patient endorsement advertisement was perceived to be more difficult to understand (aOR 0.65, 95% CI 0.48-0.87; P=.004) and to communicate the study aims less clearly (aOR 0.72, 95% CI 0.55-0.95; P=.01). While the patient endorsement advertisement had no impact on intention to visit the main study website, the social norms advertisement decreased willingness compared with the standard advertisement group (157/355, 44.2% vs 191/360, 53.1%; aOR 0.74, 95% CI 0.54-0.99; P=.02). The majority of participants (395/609, 64.8%) stated that the messages did not require changes, but some preferred clearer (75/609, 12.3%) and shorter (59/609, 9.7%) messages.
Conclusions:
The results of this study indicate that adding normative behavioral messages to simulated tweets decreased participant intention to take part in our web-based case-control study, as this made the tweet harder to understand. This suggests that simple messages should be used for participant recruitment through Twitter (subsequently rebranded X)
About scholarly publication and early-career LGBTQ+ scholars
No full textThis introductory chapter gives a rationale for exploring the publishing practices of novice LGBTQ+ researchers and those publishing research on LGBTQ+-related topics, and it explains the book’s frame of reference. The chapter begins by outlining some of the challenges facing early-career scholars in academic publishing and explains how many of these factors are exacerbated for those who also identify as LGBTQ+. The chapter provides an overview of key issues that LGBTQ+ scholars, particularly those at the early stages of their academic career, face when publishing for scholarly purposes. It explores the challenges early-career LGBTQ+ scholars experience in navigating heteronormative practices and accessing appropriate support for publishing and argues that LGBTQ+ early-career scholars’ experiences of academic publishing are under-researched and dominated by studies from Anglophone contexts and the Global North, making this volume, which takes an international and multidisciplinary perspective, a much-needed one. Finally, the chapter outlines the structural organisation of the book and provides an overview of the content of the constituent chapters
Increasing the number of midwives is necessary but not sufficient: using global data to support the case for investment in both midwife availability and the enabling work environment
Get PDFBackground
Most countries are off-track to achieve global maternal and newborn health goals. Global stakeholders agree that investment in midwifery is an important element of the solution. During a global shortage of health workers, strategic decisions must be made about how to configure services to achieve the best possible outcomes with the available resources. This paper aims to prompt policy dialogue and support this decision-making process.
Methods
Using the most recent available data from publicly available global databases for the period 2000–2020, we examined the association between the number of midwives per 10,000 population and: (i) maternal mortality, (ii) neonatal mortality, and (iii) caesarean birth rate in low- and middle-income countries (LMICs). We developed a composite measure of the strength of the midwifery profession, and examined its relationship with maternal mortality.
Results
In LMICs (especially low-income countries), higher availability of midwives is associated with lower maternal and neonatal mortality. In upper-middle-income countries, higher availability of midwives is associated with caesarean birth rates close to 10–15%. However, some countries achieved good outcomes without increasing midwife availability, and some have increased midwife availability and not achieved good outcomes. Similarly, while stronger midwifery service structures are associated with greater reductions in maternal mortality, this is not true in every country.
Conclusions
A complex web of health system factors and social determinants contribute to maternal and newborn health outcomes, but there is enough evidence from this and other studies to indicate that midwives can be a highly cost-effective element of national strategies to improve these outcomes
Anticancer drug delivery: Investigating the impacts of viscosity on lipid-based formulations for pulmonary targeting
Get PDFPulmonary drug delivery via aerosolization is a non-intrusive method for achieving localized and systemic effects. The aim of this study was to establish the impact of viscosity as a novel aspect (i.e., low, medium and high) using various lipid-based formulations (including liposomes (F1-F3), transfersomes (F4-F6), micelles (F7-F9) and nanostructured lipid carriers (NLCs; F10-F12)) as well as to investigate their impact on in-vitro nebulization performance using Trans-resveratrol (TRES) as a model anticancer drug. Based on the physicochemical properties, micelles (F7-F9) elicited the smallest particle size (12–174 nm); additionally, all formulations tested exhibited high entrapment efficiency (>89 %). Through measurement using capillary viscometers, NLC formulations exhibited the highest viscosity (3.35–10.04 m2/sec). Upon using a rotational rheometer, formulations exhibited shear-thinning (non-Newtonian) behaviour. Air jet and vibrating mesh nebulizers were subsequently employed to assess nebulization performance using an in-vitro model. Higher viscosity formulations elicited a prolonged nebulization time. The vibrating mesh nebulizer exhibited significantly higher emitted dose (ED), fine particle fraction (FPF) and fine particle dose (FPD) (up to 97 %, 90 % and 64 µg). Moreover, the in-vitro release of TRES was higher at pH 5, demonstrating an alignment of the release profile with the Korsmeyer-Peppas model. Thus, formulations with higher viscosity paired with a vibrating mesh nebulizer were an ideal combination for delivering and targeting peripheral lungs
The vulnerability of UK dentistry to dental tourists and dental tourism
Get PDFA growing trend in dental health tourism reflects growing pressures on dental services and risks to the NHS
Optimising Exercise Prescription in Patients with Intermittent Claudication: A United Kingdom Perspective
Get PDFThe National Institute for Health Care Excellence guidelines (NICE) recommend supervised exercise programmes (SEPs) as the first line of treatment for patients with intermittent claudication (IC). However, there are inconsistencies between guidelines regarding the optimal level of claudication pain prescribed. This thesis aimed to synthesis the current evidence in the literature and undertake a randomised control trial to understand which level of claudication pain was optimal in improving functional outcomes for patients with IC. In addition, it aimed to assess barriers, uptake and adherence to SEPs. Additional components of this thesis including a systematic review identifying how many studies had directly compared exercise prescription at differing levels of claudication pain on walking performance and a commentary highlighting the limitations of current guidance to clinicians and exercise professionals which could lead to variability in care.
Evidence from this thesis indicates that maximal claudication pain appears to elicit a larger benefit in treadmill related maximal walking distance compared to pain-free and moderate claudication pain, supporting the current NICE guidelines. However, at the time of submission we had not fully recruited and therefore results may be subject to change.
In addition, the evidence indicates that adherence to exercise in this clinical population is poor. Although, this was largely associated with non-PAD related health issues. Common barriers to attending the SEP included time and location of the class. Therefore, centres should engage with their patients to develop an effective accessible rehabilitation programme
Gaining exposure on perceptions of sunscreen: a national survey of patients with melanoma
Get PDFThe incidence of melanoma is increasing. We ascertained perceptions regarding sunscreen and factors influencing choice in patients with melanoma. A survey was distributed to all members of a support group for people with melanoma. In total, 571 responses were received across 6 weeks. Most respondents (n=452/571; 79.2%) indicated that they knew how much sunscreen to apply; the most popular frequency of application was once daily (n=180/571; 31.5%). The most popular cosmetic benefit respondents indicated was reduced redness on sun-exposed areas of the skin (n=418/571; 73.2%). Most respondents (n=552/571; 96.7%) agreed that more education is needed regarding the importance of wearing sunscreen. The three most popular factors influencing sunscreen choice were a sun protection factor (SPF)>50 (n=299/571; 52.4%), dermatologist recommendation (n=267/571; 46.8%) and price (n=262/571; 45.9). Sustainable packaging (n=45/571; 7.9%) and ethical sourcing of ingredients (n=65/571; 11.4%) were not ranked highly. Given that 42.0% (n=240/571) only applied sunscreen on sunny days, an education campaign is required. Industry should consider public education regarding sustainability. A further study ascertaining the views and perceptions of sunscreen in a cohort of people without melanoma is strongly encouraged