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Hodgetts T.J.,Defence Medical Services | Porter K.M.,University of Birmingham | Mahoney P.F.,Defence Medical Services | Thurgood A.,Pre hospital Care | McKinnie C.,Pre hospital Care
Trauma (United Kingdom) | Year: 2017

Events in Europe in the last year have shown there is a realistic threat to public safety in the UK from shooting, stabbing and bombing incidents. In an interview with BBC on 31 July 2016, the Metropolitan Police Commissioner stated that an attack within UK was a case of 'when not if'. citizenAID empowers the public to take action to save lives and thereby enhance national resilience. © The Author(s) 2016.


Hunt L.,Save the Children International | Gupta-Wright A.,London School of Hygiene and Tropical Medicine | Simms V.,London School of Hygiene and Tropical Medicine | Tamba F.,Ministry of Health and Sanitation | And 12 more authors.
The Lancet Infectious Diseases | Year: 2015

Background: Clinical management of Ebola virus disease remains challenging. Routine laboratory analytics are often unavailable in the outbreak setting, and few data exist for the associated haematological and biochemical abnormalities. We aimed to assess laboratory and clinical data from patients with Ebola virus disease to better inform clinical management algorithms, improve understanding of key variables associated with outcome, and provide insight into the pathophysiology of Ebola virus disease. Methods: We recruited all patients, alive on arrival, with confirmed Ebola virus disease who were admitted to the Kerry Town Ebola treatment centre in Sierra Leone. At admission, all patients had clinical presentation recorded and blood taken for Ebola confirmation using reverse-transcriptase-PCR (RT-PCR) and for haematological and biochemical analysis. We studied the association between these and clinical outcome. The primary outcome was discharge from the Ebola treatment centre. Findings: 150 patients were admitted to the treatment centre between Dec 8, 2014, and Jan 9, 2015. The mean age of patients was 26 years (SD 14·7). Case fatality rate was 37% (55/150). Most patients presented with stage 2 (gastrointestinal involvement, 72/118 [61%]) and stage 3 (severe or complicated, 12/118 [10%]) disease. Acute kidney injury was common (52/104 [50%]), as were abnormal serum potassium (32/97 [33%]), severe hepatitis (54/92 [59%]), and raised C-reactive protein (21/100 [21%]). Haematological abnormalities were common, including raised haematocrit (15/100 [15%]), thrombocytopenia (47/104 [45%]), and granulocytosis (44/104 [42%]). Severe acute kidney injury, low RT-PCR cycle threshold (<20 cycles), and severe hepatitis were independently associated with mortality. Interpretation: Ebola virus disease is associated with a high prevalence of haematological and biochemical abnormalities, even in mild disease and in the absence of gastrointestinal symptoms. Clinical care that targets hypovolaemia, electrolyte disturbance, and acute kidney injury is likely to reduce historically high case fatality rates. Funding: None. © 2015 Elsevier Ltd.


PubMed | Ministry of Health and Sanitation, Defence Medical Services, Save the Children International, London School of Hygiene and Tropical Medicine and Public Health England
Type: Journal Article | Journal: The Lancet. Infectious diseases | Year: 2015

Clinical management of Ebola virus disease remains challenging. Routine laboratory analytics are often unavailable in the outbreak setting, and few data exist for the associated haematological and biochemical abnormalities. We aimed to assess laboratory and clinical data from patients with Ebola virus disease to better inform clinical management algorithms, improve understanding of key variables associated with outcome, and provide insight into the pathophysiology of Ebola virus disease.We recruited all patients, alive on arrival, with confirmed Ebola virus disease who were admitted to the Kerry Town Ebola treatment centre in Sierra Leone. At admission, all patients had clinical presentation recorded and blood taken for Ebola confirmation using reverse-transcriptase-PCR (RT-PCR) and for haematological and biochemical analysis. We studied the association between these and clinical outcome. The primary outcome was discharge from the Ebola treatment centre.150 patients were admitted to the treatment centre between Dec 8, 2014, and Jan 9, 2015. The mean age of patients was 26 years (SD 147). Case fatality rate was 37% (55/150). Most patients presented with stage 2 (gastrointestinal involvement, 72/118 [61%]) and stage 3 (severe or complicated, 12/118 [10%]) disease. Acute kidney injury was common (52/104 [50%]), as were abnormal serum potassium (32/97 [33%]), severe hepatitis (54/92 [59%]), and raised C-reactive protein (21/100 [21%]). Haematological abnormalities were common, including raised haematocrit (15/100 [15%]), thrombocytopenia (47/104 [45%]), and granulocytosis (44/104 [42%]). Severe acute kidney injury, low RT-PCR cycle threshold (<20 cycles), and severe hepatitis were independently associated with mortality.Ebola virus disease is associated with a high prevalence of haematological and biochemical abnormalities, even in mild disease and in the absence of gastrointestinal symptoms. Clinical care that targets hypovolaemia, electrolyte disturbance, and acute kidney injury is likely to reduce historically high case fatality rates.None.


PubMed | Imperial College London, University of Oxford, Birmingham Business Park, University College London and Harvard University
Type: | Journal: Tissue engineering. Part B, Reviews | Year: 2016

Traumatic soft tissue wounds present a significant reconstructive challenge. The adoption of closed-circuit negative pressure wound therapy (NPWT) has enabled surgeons to temporize these wounds before reconstruction. Such systems use porous synthetic foam scaffolds as wound fillers at the interface between the negative pressure system and the wound bed. The idea of using a bespoke porous biomaterial that enhances wound healing, as filler for an NPWT system, is attractive as it circumvents concerns regarding reconstructive delay and the need for dressing changes that are features of the current systems. Porous foam biomaterials are mechanically robust and able to synthesize in situ. Hence, they exhibit potential to fulfill the niche for such a functionalized injectable material. Injectable scaffolds are currently in use for minimally invasive surgery, but the design parameters for large-volume expansive foams remain unclear. Potential platforms include hydrogel systems, (particularly superabsorbent, superporous, and nanocomposite systems), polyurethane-based moisture-cured foams, and high internal phase emulsion polymer systems. The aim of this review is to discuss the design parameters for such future biomaterials and review potential candidate materials for further research into this up and coming field.


Nimenko W.,Rear Operations Group Civilian Medical Practitioner | Simpson R.G.,Defence Medical Services
Journal of the Royal Army Medical Corps | Year: 2014

Objectives To investigate group activity psychological decompression (GAPD) in a Rear Operations Group.Methods Provision of military archaeological exercises for a Rear Operations Group’s medical centre patients during Op HERRICK 14 with analysis of before and after Patient Health Questionnaires (PHQ), Work and Social Adjustment Scales, generalised anxiety disorder (GAD) 7 Anxiety, Audit Questionnaire and Impact of Events Scale Revised and analysis of interviews with supervisors and soldiers.Results Soldiers reported a mean of 13%–38% improvement across the self-reported domains. The civilian archaeologists reported improvements in self-esteem, morale and team-working. 10 out of 24 soldiers have expressed an interest to pursue archaeology further; eight soldiers disclosed mental health issues for the first time, four of whom required mental health referral.Conclusions GAPD can help early-returned soldiers in reducing symptoms of anxiety, depression, isolation and psychological traumatic symptoms. It also helps to increase perception of their ability to work and socialise as a team and help them to an early return to work. It can provide soldiers with the opportunity to approach their supervisors in an informal manner and help in early detection of mental health problems. © 2014, Royal Army Medical College. All rights reserved.


PubMed | Rear Operations Group Civilian Medical Practitioner and Defence Medical Services
Type: Journal Article | Journal: Journal of the Royal Army Medical Corps | Year: 2014

To investigate group activity psychological decompression (GAPD) in a Rear Operations Group.Provision of military archaeological exercises for a Rear Operations Groups medical centre patients during Op HERRICK 14 with analysis of before and after Patient Health Questionnaires (PHQ), Work and Social Adjustment Scales, generalised anxiety disorder (GAD) 7 Anxiety, Audit Questionnaire and Impact of Events Scale Revised and analysis of interviews with supervisors and soldiers.Soldiers reported a mean of 13%-38% improvement across the self-reported domains. The civilian archaeologists reported improvements in self-esteem, morale and team-working. 10 out of 24 soldiers have expressed an interest to pursue archaeology further; eight soldiers disclosed mental health issues for the first time, four of whom required mental health referral.GAPD can help early-returned soldiers in reducing symptoms of anxiety, depression, isolation and psychological traumatic symptoms. It also helps to increase perception of their ability to work and socialise as a team and help them to an early return to work. It can provide soldiers with the opportunity to approach their supervisors in an informal manner and help in early detection of mental health problems.


PubMed | Eastman Dental Institute and Defence Medical Services
Type: | Journal: The British journal of oral & maxillofacial surgery | Year: 2016

We studied the dental records of British military personnel who were less than 20 years old on enlistment, and had at least five years service with at least five recorded dental inspections, at three military dental centres in the UK. The median (IQR) period from first to last inspection in 720 subjects was 15 (10-19) years, and the median frequency of inspection was every 14 (13-16) months. A total of 288/1250 mandibular third molars were extracted (23%). There were significant increases in the proportion of extractions stating caries in the mandibular third molar or multi-episode pericoronitis as indications (n=13, 14%, p <0.001) (n=15, 19%, p <0.001) post-introduction of NICE guidance. The number of extractions with no documented indication was reduced by 50 (26%, p<0.001) and that for a single episode of pericoronitis by 20 (9%, p =0.02). Extractions of mandibular third molars because of caries in the adjacent second molar increased by 4 (4%, p=0.045). The median age at the time of extraction before introduction of the guidelines was 23 years compared with 25 years afterwards (p<0.001). Twenty-five of 114 (22%) extractions of mandibular third molars were in patients over the age of 30 after the introduction of guidelines compared with 1/174 (<1%) before. The introduction of the NICE guidelines on the management of third molars has significantly changed our practice. Whether or not these changes have resulted in a net benefit to patients is still a matter for debate.


Pope L.,University of Glasgow | Hawkridge A.,Stonehill Medical Center | Simpson R.,Defence Medical Services
Education for Primary Care | Year: 2014

Background and aims Differences in performance between male and female candidates in the CSA exam have been reported. This study aimed to consider this in more detail, looking at gender performance overall, and to check if there are particular task domains or curriculum topic areas where male and female doctors score differently.Method Routinely collected data were analysed, enabling detailed comparison of gender performance across 92 989 consecutive encounters, which were examined for any overall impact of candidate gender, and sub-analysed by assessment domain, and by curriculum area. Significance of differences was calculated by analysis of variance.Results Female GP trainees outperform their male peers in the CSA overall, in each assessment domain and in every curriculum area. The difference in performance is most marked in the areas of women's health and sexual health and least marked in cardiovascular problems and rheumatology and musculoskeletal.Conclusions These findings have implications for GP trainees and trainers when planning educational activities and opportunities. As well as prioritising the development of consultation skills, consideration needs to be given to the case mix presented to trainees, especially in light of the changing role of the doctor within practices and the composition of training programmes. © 2014 Radcliffe Publishing Limited.


PubMed | Poole Hospital NHS Foundation trust, Leeds Beckett University and Defence Medical Services
Type: Comparative Study | Journal: PloS one | Year: 2016

There has been considerable debate as to whether different modalities of simulated hypoxia induce similar cardiac responses.This was a prospective observational study of 14 healthy subjects aged 22-35 years. Echocardiography was performed at rest and at 15 and 120 minutes following two hours exercise under normobaric normoxia (NN) and under similar PiO2 following genuine high altitude (GHA) at 3,375 m, normobaric hypoxia (NH) and hypobaric hypoxia (HH) to simulate the equivalent hypoxic stimulus to GHA.All 14 subjects completed the experiment at GHA, 11 at NN, 12 under NH, and 6 under HH. The four groups were similar in age, sex and baseline demographics. At baseline rest right ventricular (RV) systolic pressure (RVSP, p = 0.0002), pulmonary vascular resistance (p = 0.0002) and acute mountain sickness (AMS) scores were higher and the SpO2 lower (p<0.0001) among all three hypoxic groups (GHA, NH and HH) compared with NN. At both 15 minutes and 120 minutes post exercise, AMS scores, Cardiac output, septal S, lateral S, tricuspid S and A velocities and RVSP were higher and SpO2 lower with all forms of hypoxia compared with NN. On post-test analysis, among the three hypoxia groups, SpO2 was lower at baseline and 15 minutes post exercise with GHA (89.33.4% and 89.32.2%) and HH (89.03.1 and (89.85.0) compared with NH (92.91.7 and 93.62.5%). The RV Myocardial Performance (Tei) Index and RVSP were significantly higher with HH than NH at 15 and 120 minutes post exercise respectively and tricuspid A was higher with GHA compared with NH at 15 minutes post exercise.GHA, NH and HH produce similar cardiac adaptations over short duration rest despite lower SpO2 levels with GHA and HH compared with NH. Notable differences emerge following exercise in SpO2, RVSP and RV cardiac function.


PubMed | Defence Medical Services
Type: | Journal: The British journal of oral & maxillofacial surgery | Year: 2016

Mandibular third molars are commonly removed because of distal caries in the adjacent tooth. To find out the prevalence of distal caries in mandibular second molars we retrospectively studied the primary care dental records of 720 British military personnel (653 men and 67 women) from various centres. These records are standardised and personnel are required to attend for inspection regularly. Those who had been under 20 years of age at enlistment, who had served for at least five years, and had five recorded dental inspections, were included. The median (IQR) period from the first to last inspection was 15 (9.7 - 19.2) years, and inspections were a median (IQR) of 14.1 (12.8 - 15.8) months apart. A total of 59/1414 (4.2%) mandibular second molars developed caries in their distal surfaces. This was 4% higher when they were associated with a partially-erupted mandibular third molar than when associated with one that was fully erupted or absent (29/414 (7%) compared with 30/1000 (3%); p=0.001). Carious lesions developed in the distal aspect of 22/133 mandibular second molars (16.5%) that were adjacent to a mesioangularly impacted third molar. Of these, 19/22 were successfully restored. Four mesioangularly impacted mandibular third molars would have to be extracted to prevent one case of distal caries in a second molar (number needed to treat=3.25). Second molars that are associated with a partially-erupted mesioangular mandibular third molar have a higher risk of caries, and this can be reduced by removal of the third molar. However, distal caries in second molars seems to be a treatable and slowly-developing phenomenon and we recommend that the merits and risks of the prophylactic removal of third molars should be discussed with the patient, who should have long-term clinical and radiographic checks if the tooth is retained.

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