Results
- Showing results for:
- Reset all filters
Search results
-
Journal articleClunie G, Roe J, Alexander C, et al., 2021, , The Laryngoscope, Vol: 131, Pages: 146-157, ISSN: 0023-852X
Objectives: Laryngotracheal stenosis is a rare condition characterized by upper airway narrowing. Reconstructive surgical treatment aims to manage the area of stenosis to improve dyspnea and can impact on voice and swallowing function. This article critically evaluates the literature about voice and swallowing outcomes in adults with laryngotracheal stenosis who undergo reconstructive surgery.Study Design: Systematic review.Methods: Six databases were searched for articles referring to voice and swallowing outcome measures following reconstruction procedures in adults with laryngotracheal stenosis. Screening was completed using predefined inclusion/exclusion criteria. Results: A total of 143 abstracts were reviewed, with 67 articles selected for full text review. 20 studies met the inclusion criteria. Data extraction was completed with The Strengthening Reporting of Observational Studies in Epidemiology checklist with Oxford Centre for Evidence-Based Medicine Level of Evidence used to indicate quality. Risk of bias was assessed using the Risk of Bias Assessment Tool for Non-Randomized Studies. All studies scored a high risk of bias in at least one of the domains. Selection and timing of outcome measures was heterogenous and there was limited information provided about rationale or reliability.Conclusion: The literature acknowledges the importance of voice and swallowing outcomes following airway reconstruction. Studies show correlation between reconstructive surgery and deterioration in vocal function; there is no consistent data about swallowing outcomes. The lack of a core outcome measures set for adults with laryngotracheal stenosis limits the findings of this review. Further research is needed to establish clear criteria for robust and clinically relevant outcome measurement.
-
Book chapterRodríguez-Merchán EC, Liddle AD, 2021, , Controversies in Orthopaedic Surgery of the Lower Limb, Pages: 151-159
20–25% of patients experiencing TKA acquire hypersensitivity to metals, but solely less than 1% present symptoms (dermatitis, continuous painful synovitis of the knee or aseptic loosening of the implant). Currently, skin patch test (SPT), leukocyte migration inhibition test (LMIT) and lymphocyte transformation tests (LTT) are being habitually utilized to evaluate metal hypersensitivity. However, these tests are not fully dependable and most patients are diagnosed on the basis of self-reported reactions. Most patients with metal allergy patients tolerate the conventional implants without complications. Given the current controversy over whether or not to use a conventional primary implant in patients who report having a metal allergy, the logical decision is to use a “hypoallergenic” primary prosthesis. There are two “hypoallergenic” options: (1) equivalent design but with different materials (oxidized zirconium, ceramic or titanium-based alloys); (2) equivalent designs but with coatings, normally titanium niobium or titanium nitride.
-
Journal articleAllen JE, Clunie GM, Slinger C, et al., 2021, , International Journal of Language & Communication Disorders, Vol: 56, Pages: 174-204, ISSN: 1368-2822
BackgroundUltrasound (US) is not widely used as part of the speech and language therapy (SLT) clinical toolkit. The COVID‐19 pandemic has intensified interest in US as an alternative to SLT instrumental tools such as the videofluoroscopic swallowing study (VFSS), fibreoptic endoscopic evaluation of swallowing (FEES) and endoscopic evaluation of the larynx (EEL) as a non‐invasive, non‐aerosol‐generating procedure that can be delivered at the bedside to assess swallowing and/or laryngeal function. To establish the appropriacy of routine US use, and in response to a national professional body request for a position statement, a group of expert SLTs conducted a rapid review of the literature.AimTo explore critically the clinical utility of US as an assessment tool for swallowing and laryngeal function in adults.Methods & ProceduresA rapid review of four databases was completed to identify articles using US to assess swallowing and/or laryngeal function in adults compared with reference tests (VFSS/FEES/EEL/validated outcome measure). Screening was completed according to predefined inclusion/exclusion criteria and 10% of abstracts were rescreened to assess reliability. Data were extracted from full texts using a predeveloped form. The QUADAS‐2 tool was used for quality ratings. Information from included studies was summarized using narrative synthesis and visual illustration.Outcomes & ResultsTen papers used US to assess swallowing, and 13 to assess laryngeal function. All were peer‐reviewed primary studies across a range of clinical populations and with a wide geographical spread. Four papers had an overall low risk of bias, but the remaining 19 had at least one domain where risk of bias was judged as high or unclear. Applicability concerns were identified in all papers. The papers that used US to assess swallowing varied widely in terms of the anatomical structures assessed and methodology employed. The papers assessing laryngeal function were more homogenous i
-
Journal articleMullington CJ, Malhotra S, 2021, , BJA Education, Vol: 21, Pages: 26-31, ISSN: 2058-5349
-
Journal articleCastro-Sanchez E, Alexander CM, Atchison C, et al., 2020, , Journal of Hospital Infection, Vol: 109, Pages: 68-7, ISSN: 0195-6701
BackgroundThe COVID-19 pandemic has presented one of the biggest challenges to healthcare providers worldwide. The appropriate use of Personal Protective Equipment (PPE) has been essential to ensuring staff and patient safety. To counteract sub-optimal PPE practice, a PPE helper programme was developed at a large London hospital group. Based on a behaviour change model of Capability, Opportunity and Motivation (COM-B), the programme provided PPE support, advice and education to ward staff.AimEvaluation of the PPE Helper Programme.MethodsClinical and non-clinical ward staff completed a questionnaire informed by the Theoretical Domains Framework and COM-B. The questionnaire was available in paper and electronic versions. Quantitative responses were analysed using descriptive and non-parametric statistics, free-text responses were analysed thematically.FindingsOver a six-week period, PPE helpers made 268 ward visits. Overall, 261 questionnaires were available for analysis. Across the Trust, 68% of respondents reported having had contact with a PPE helper. Staff who had encountered a PPE helper responded significantly more positively to a range of statements about using PPE than those who had not. Black and Minority Ethnic (BAME) staff were significantly more anxious in relation to the adequacy of PPE. Non-clinical and redeployed staff (e.g. domestic staff) were most positive about the impact of PPE helpers. Free-text comments showed that staff found the programme supportive and would have liked it earlier in the pandemic.ConclusionA PPE Helper programme is a feasible and beneficial intervention for providing support, advice and education to ward staff during infectious disease outbreaks.
-
Journal articlePapi E, Chiou S-Y, McGregor A, 2020, , BMJ Open, Vol: 10, ISSN: 2044-6055
Objectives This study aims to investigate the feasibilityand acceptability of using an app-based technology totrain balance in the older population.Design Prospective feasibility study.Setting The study was conducted in a university settingand participants’ homes.Participants Thirty-five volunteers ≥55 years old wererecruited.InterventionParticipants were asked to follow a balanceexercise programme 7 days a week for 3 weeks using aphone application. Seventeen participants trained for afurther 3 weeks.Outcome measuresPostural sway measures duringquiet standing with feet at shoulder width apart andfeet together, one leg standing and tandem stancewere measured at baseline, and at the end of the 3and 6 training weeks; the International Physical ActivityQuestionnaire (IPAQ) assessed participants’ physicalactivity level before training; and app acceptability wasrecorded using a user experience questionnaire.ResultsParticipants on the 3 and 6-week programmeon average completed 20 (±5) and 38 (±11) days oftraining, respectively, and all scored moderate to high onthe IPAQ. Between baseline and the 3-week assessments,statistically significant improvements were observedfor anteroposterior sway, mediolateral sway, sway areaduring tandem stance, for anteroposterior sway duringone leg standing and for sway area during feet togetherstance. Improvements were observed at 6 week comparedwith baseline but those between 3 and 6 weeks werenot significant. Based on the questionnaire, participantsreported that the app is an appropriate tool for balancetraining (77%), they reported benefits from the training(50%) and found it easy to fit it into daily routine (88%).Conclusion The high level of adherence andimprovements observed in the analysed measuresdemonstrate the feasibility of using an app to train balancein moderately to highly physically active older participants.This demonstrates that given appropriate tools the olderpopulation is positive towards and r
-
Journal articleAldera M, Alexander C, McGregor A, 2020, , Journal of Epidemiology and Global Health, Vol: 10, Pages: 269-275, ISSN: 2210-6006
Study Design: A systematic review.Objective: To identify published studies that assess the prevalence and incidence of Low Back Pain (LBP) in the Saudi Arabian population.Methods: Six electronic databases were searched for articles published between January 1995 and December 2018. Crosssectional or cohort studies were included if they were conducted in the KSA and focused on the prevalence or incidence of LBP in adults. Case–control and retrospective studies were excluded. Studies were also excluded if they did not meet the quality criteria set out by the Joanna Briggs Institute (JBI) assessment or had a high or medium risk of bias according to the criteria proposed by Hoy et al. One independent reviewer (MAA) verified that the studies met the inclusion criteria, and three independent reviewers (MAA, AHM, CMA) assessed the quality of the studies and extracted their relevant characteristics. All the studies were assessed for quality using the JBI assessment and were assessed for risk of bias according to the Hoy et al. approach.Results: The initial search identified 158 papers; five studies met the inclusion criteria. The nature of the findings meant no meta-analysis could be performed; therefore, a narrative summary was generated to discuss the findings. The prevalence of LBP in different professional groups within a working-age group ranged between 64% and 89%.Discussion: The prevalence of LBP in the KSA has only been examined within specific professional groups, which limits the ability to generalize the finding. The review clarifies the need for further quality epidemiological studies to identify the prevalence of LBP in the general population. Many of the issues identified are problems related to occupational risk of LBP. The implication therefore is that these occupational factors need to be assessed so that risk factors for LBP among employees in KSA can be modified.
-
Journal articleGoldsworthy S, Zheng CY, McNair H, et al., 2020, , Journal of Medical Imaging and Radiation Sciences, Vol: 51, Pages: S39-S43, ISSN: 0820-5930
Radiotherapy for cancer is an effective treatment but requires precise delivery. Patients are required to remain still in the same position during procedure which may be uncomfortable. This combined with high anxiety experienced by patients, and feelings of isolation, have indicated a need for comfort interventions. Care conveyed through empathetic touch promotes comfort, individual attention and presence and provides both psychological and physical comfort at the same time. Evidence in nursing and care literature showed that empathetic touch interventions have a significant role in promoting comfort, facilitating communication between care recipients and caregivers. However, the application of empathetic touch interventions may be challenging to administer due to the safety concern in the radiotherapy environment. The emergence of haptic technologies that enable the communication of touch remotely may have a potential to fill this gap. We take inspiration from both clinical empathetic touch in radiotherapy practice, as well as affective haptic technologies to envision the opportunities for haptic technologies as a complimentary comfort intervention to supplement human empathetic touch during radiotherapy.
-
Journal articleJaggard MKJ, Boulange CL, Graca G, et al., 2020, , CLINICAL RHEUMATOLOGY, Vol: 39, Pages: 3875-3882, ISSN: 0770-3198
- Cite
- Citations: 8
-
Journal articleYork T, Jenney H, Jones G, 2020, , BMJ Health & Care Informatics, Vol: 27, ISSN: 2632-1009
Background Up to half of all musculoskeletal injuries are investigated with plain radiographs. However, high rates of image interpretation error mean that novel solutions such as artificial intelligence (AI) are being explored.Objectives To determine patient confidence in clinician-led radiograph interpretation, the perception of AI-assisted interpretation and management, and to identify factors which might influence these views.Methods A novel questionnaire was distributed to patients attending fracture clinic in a large inner-city teaching hospital. Categorical and Likert scale questions were used to assess participant demographics, daily electronics use, pain score and perceptions towards AI used to assist in interpretation of their radiographs, and guide management.Results 216 questionnaires were included (M=126, F=90). Significantly higher confidence in clinician rather than AI-assisted interpretation was observed (clinician=9.20, SD=1.27 vs AI=7.06, SD=2.13), 95.4% reported favouring clinician over AI-performed interpretation in the event of disagreement.Small positive correlations were observed between younger age/educational achievement and confidence in AI-assistance. Students demonstrated similarly increased confidence (8.43, SD 1.80), and were over-represented in the minority who indicated a preference for AI-assessment over their clinicians (50%).Conclusions Participant’s held the clinician’s assessment in the highest regard and expressed a clear preference for it over the hypothetical AI assessment. However, robust confidence scores for the role of AI-assistance in interpreting skeletal imaging suggest patients view the technology favourably.Findings indicate that younger, more educated patients are potentially more comfortable with a role for AI-assistance however further research is needed to overcome the small number of responses on which these observations are based.
-
Journal articleAhmad K, Bhattacharyya R, Gupte C, 2020, , Ann Med Surg (Lond), Vol: 59, Pages: 131-137, ISSN: 2049-0801
BACKGROUND: Working time restraints; senior led care; and a reduction in 'out of hours' operating has resulted in less operating time for orthopaedic trainees in the United Kingdom. Therefore, there has been an attempt to overcome these challenges by implementing novel techniques. Cognitive Task Analysis (CTA) focuses on the mental steps required to complete complex procedures. It has been used in training athletes and in general surgery but is new to orthopaedic training. AIM: To undertake a systematic review to analyse if CTA is beneficial to train novice surgeons in common orthopaedic and trauma procedures. MATERIALS AND METHODS: A systematic review was performed evaluating CTA in trauma and orthopaedic surgery on MEDLINE and EMBASE. Search terms used were: 'Cognitive task', 'mental rehearsal' and 'Orthop*'']. 33 studies were originally identified. Duplicate studies were excluded (11). Articles not relating to Orthopaedic surgery were excluded (15). The CTA research ranking scale was used to evaluate the impact of the studies included. RESULTS: 7 studies were identified as appropriate for inclusion. 264 participants. 178 M, 86F. All studies showed objective or subjective benefits from CTA in orthopaedic training when compared to traditional methods. The majority of the participants highlighted high subjective satisfaction with the use of the CTA tools and reported that they proved to be excellent adjuncts to the traditional apprenticeship model. CONCLUSION: CTA learning tools have demonstrated significant objective and subjective benefits in trauma and orthopaedic training. It is cost effective, easily accessible and allows repeated practice which is key in simulation training.
-
Journal articleDeane JA, Papi E, Phillips A, et al., 2020, , BMC Research Notes, Vol: 13, ISSN: 1756-0500
ObjectivesAs a step towards the comprehensive evaluation of movement in patients with low back pain, the aim of this study is to design a marker set (three rigid segment spine, pelvic and lower limb model) and evaluate the reliability and minimal detectable change (MDC) of this marker set in healthy adults during gait and sit to stand (STS) tasks using three dimensional motion capture.ResultsThe ‘ԹϺ Spine’ marker set was used to assess relative peak angles during gait and STS tasks using the minimum recommended sample size (n = 10) for reliability studies with minimum Intraclass Correlation Coefficient (ICC) of 0.70, optimum ICC 0.90 and 9 trials replicated per subject per task. Intra- and inter-tester reliability between an experienced and inexperienced user was examined. ICC, mean, standard error (SEM), Bland Altman 95% limits of agreement (LOA) and MDC were computed.ICC values demonstrated excellent intra- and inter-tester reliability in both tasks, particularly in the sagittal plane (majority ICCs > 0.80). SEM measurements were lower in gait (0.8–5.5°) than STS tasks (1°-12.6°) as were MDC values. LOA demonstrated good agreement. The ‘ԹϺ Spine’ marker set is reliable for use in healthy adults during functional tasks. Future evaluation in patients is required.
-
Journal articleRudran B, Little C, Wiik A, et al., 2020, , BRITISH JOURNAL OF HOSPITAL MEDICINE, Vol: 81, ISSN: 1750-8460
- Cite
- Citations: 39
-
Journal articleWiik AV, Nathwani D, Akhtar A, et al., 2020, , Knee Surgery Sports Traumatology Arthroscopy, Vol: 28, Pages: 3193-3199, ISSN: 0942-2056
PurposeTo determine the preferred knee in patients with both one total and one unicompartmental knee arthroplasty.MethodPatients simply with a unicompartmental (UKA) and total knee arthroplasty (TKA) on contralateral sides were retrospectively screened from three senior knee surgeon’s logs over a 15 year period. Patients safe and free from other diseases to affect gait were approached. A total of 16 patients (mean age 70 ± 8) agreed to ground reaction force testing on an instrumented treadmill at a fair pace and incline. A gender-ratio identical group of 16 healthy control subjects (mean age 67 ± 10) and 16 patients with ipsilateral medial knee OA (mean age 66 ± 7) were analysed to compare.ResultsRadiographically the mode preoperative Kellgren–Lawrence knee grade for each side was 3. Postoperatively, the TKA side had a mean coronal femoral component alignment of 7° and a mean tibial coronal alignment of 89° with a mean posterior slope of 5° in the sagittal plane. The UKA side had a mean coronal femoral component alignment of 7° and a mean tibial coronal alignment of 86° with a mean posterior slope of 4° in the sagittal plane. In 7 patients, the TKA was the first procedure, while 6 for the UKA and 3 done simultaneously. Gait analysis demonstrated in both walking conditions the UKA limb was the preferred side through all phases of loading (p < 0.05) and nearer to normal than the TKA limb when compared to healthy controls and patients with knee OA. The greatest difference was observed between the transition of weight acceptance and midstance (p = 0.008), when 22% more load was taken by the UKA side.ConclusionBy using a dynamic metric of an everyday activity, a distinct gait difference between differing arthroplasty types were established. A more natural loading pattern can be achieved with unicompartmentals as compared to total knees.Level o
-
Journal articleLiddle AD, 2020, , CLINICAL ORTHOPAEDICS AND RELATED RESEARCH, Vol: 478, Pages: 2274-2276, ISSN: 0009-921X
-
Journal articlePatterson JM, Govender R, Roe J, et al., 2020, , International Journal of Language and Communication Disorders, Vol: 55, Pages: 806-817, ISSN: 1368-2822
BACKGROUND: The COVID-19 pandemic and the UK government's subsequent coronavirus action plan have fundamentally impacted on every aspect of healthcare. One area that is severely affected is ear, nose and throat (ENT)/laryngology where speech and language therapists (SLTs) engage in a diverse range of practice with patients with a range of conditions, including voice disorders, airway problems, and head and neck cancers (HNCs). A large majority of these patients are in high-risk categories, and many specialized clinical practices are vulnerable. In addition, workforce and research issues are challenged in both the immediate context and the future. AIMS: To discuss the threats and opportunities from the COVID-19 pandemic for SLTs in ENT/laryngology with specific reference to clinical practice, workforce and research leadership. METHODS & PROCEDURES: The relevant sections of the World Health Organisation's (WHO) health systems building blocks framework (2007) were used to structure the study. Expert agreement was determined by an iterative process of multiple-group discussions, the use of all recent relevant policy documentation, and other literature and shared documentation/writing. The final paper was verified and agreed by all authors. MAIN CONTRIBUTION: The main threats to ENT/laryngology SLT clinical services include increased patient complexity related to COVID-19 voice and airway problems, delayed HNC diagnosis, reduced access to instrumental procedures and inequitable care provision. The main clinical opportunities include the potential for new modes of service delivery and collaborations, and harnessing SLT expertise in non-instrumental assessment. There are several workforce issues, including redeployment (and impact on current services), training implications and psychological impact on staff. Workforce opportunities exist for service innovation and potential extended ENT/SLT practice roles. Research is threatened by a reduction in immediate funding call
-
Journal articleTurner S, McGregor A, 2020, , Archives of Rehabilitation Research and Clinical Translation, Vol: 2, Pages: 1-8, ISSN: 2590-1095
ObjectiveTo determine amputees’ and rehabilitation clinicians’ perspectives on the impact of socket fit and issues caused by ill-fitting sockets throughout lower limb prosthetic rehabilitation.DesignA survey was developed to identify rehabilitation factors and issues for prosthesis wearers and rehabilitation clinicians. Participants opted to participate in a further telephone interview.SettingOnline and across the United Kingdom.ParticipantsLower limb prosthetic wearers and clinicians that are part of a lower limb prosthetic rehabilitation team.InterventionsNot applicable.Main Outcome Measure(s)A survey and an interview to measure the perceived impact of socket fit on lower limb rehabilitation.Results48.0% of amputees and 65.7% of clinicians identified socket fit related issues as the biggest factor impacting rehabilitation. Amputee interviewees focused on the impact of fit on quality of life and the ability to complete daily tasks, whilst clinicians focused on the lack of widespread ability to adjust the socket and gait re-education.ConclusionsSocket fit has a large impact on and is a large source of frustration to amputees and their clinical teams throughout rehabilitation. From the interviews, it became clear that the interpretation of socket fit is different for each person; thus “socket fit” does not mean the same for all.
-
Journal articleEdwards TC, Logishetty K, Cobb JP, 2020, , JOURNAL OF ARTHROPLASTY, Vol: 35, Pages: 2686-2687, ISSN: 0883-5403
- Cite
- Citations: 2
-
Journal articleClark JN, Heyraud A, Tavana S, et al., 2020, , MATERIALS, Vol: 13
- Cite
- Citations: 9
-
Journal articleMa S, Goh EL, Tay T, et al., 2020, , Scientific Reports, Vol: 10, Pages: 1-14, ISSN: 2045-2322
Nanoscale mineralized collagen fibrils may be important determinants of whole-bone mechanical properties and contribute to the risk of age-related fractures. In a cross-sectional study nano-and tissue-level mechanics were compared across trabecular sections from the proximal femora of three groups(n=10 each): ageing non-fractured donors (Controls);untreated fracture patients (Fx-Untreated); bisphosphonate-treated fracture patients (Fx-BisTreated).Collagen fibril, mineral and tissue mechanics were measured using synchrotron X-Ray diffraction,of bone sections under load. Mechanical data were compared across groups, and tissue-level data were regressed against nano. Compared to controls fracture patients exhibited significantly lower critical strain, max strain and normalized strength, with lower peak collagen and mineral strain. Bisphosphonate-treated exhibited the lowest properties. In all three groups, peak mineral strain coincided with maximum tissue strength (i.e. ultimate stress), whilst peak fibril strain occurred afterwards(i.e. higher strain). Tissue strain and strength were positively and strongly correlated with peak fibril and mineral strains. Age-related fractures were associated with lower peak fibril and mineral strain irrespective of treatment. Indicating earlier mineral disengagement and the subsequent onset of fibril sliding is one of the key mechanisms leading to fracture. Treatments for fragility should target collagen-mineral interactions to restore nano-scale strain to that of healthy bone.
This data is extracted from the Web of Science and reproduced under a licence from Thomson Reuters. You may not copy or re-distribute this data in whole or in part without the written consent of the Science business of Thomson Reuters.