McFarlane Toys, a subsidiary of Todd McFarlane Productions, Inc., is a company started by Todd McFarlane that makes highly detailed models of characters from movies, comics, popular music, video games and sporting genres. McFarlane has attracted both acclaim and criticism for offering a select range of action figurines that graphically depict torture, mutilation, bondage and murder. Wikipedia.
Lapner P.L.C.,Ottawa Hospital Research Institute |
Wood K.S.,University of Ottawa |
Zhang T.,Ottawa Hospital Research Institute |
Journal of Shoulder and Elbow Surgery | Year: 2015
Background: During shoulder arthroplasty, the subscapularis tendon is released and repaired. Whether subscapularis strength subsequently returns to normal is poorly understood. This study's purpose was to determine whether subscapularis strength returns to normal after shoulder replacement and whether any preoperative factors predict the return of strength postoperatively. Methods: Sixty-four patients underwent unilateral shoulder arthroplasty. Subscapularis strength was compared between the surgical and contralateral (normal) limbs at baseline (preoperatively) and follow-up. In addition, operative arm subscapularis strength recovery was compared with ipsilateral supraspinatus strength recovery. Independent variables were assessed for their effect on subscapularis strength, including sex, age, dominant-side surgery, preoperative strength, preoperative external rotation, subscapularis management technique, and fatty infiltration. Results: The mean subscapularis strength ratio at 24months from baseline was 1.19±2.23 (. P=.0007). The normal side was significantly stronger than the operative side at all time points (. P<.0001). The operative-side subscapularis mean strength ratio was 0.54±0.28 of normal at baseline and 0.70±0.24 at 24months. Defining normal strength as ±15%, 15% of patients were normal at baseline up to 22% at 24months. At 24months, the mean supraspinatus strength ratio from baseline (3.13±6.11) was significantly greater than the subscapularis mean strength ratio (. P=.0007). Multivariable regression analysis did not demonstrate any correlation (. P>.05) between the independent variables studied and final subscapularis strength. Discussion: Although significant strength improvement from baseline was observed at 2years after shoulder arthroplasty, subscapularis strength returned to normal in only a minority of patients. Potential prognostic variables associated with final subscapularis strength remain elusive. © 2015 Journal of Shoulder and Elbow Surgery Board of Trustees.
Calman L.,University of Manchester |
Beaver K.,University of Central Lancashire |
Hind D.,University of Sheffield |
Lorigan P.,Christie NHS Foundation Trust |
And 2 more authors.
Journal of Thoracic Oncology | Year: 2011
Introduction: The burden of lung cancer is high for patients and carers. Care after treatment may have the potential to impact on this. We reviewed the published literature on follow-up strategies intended to improve survival and quality of life. Methods: We systematically reviewed studies comparing follow-up regimes in lung cancer. Primary outcomes were overall survival (comparing more intensive versus less intensive follow-up) and survival comparing symptomatic with asymptomatic recurrence. Quality of life was identified as a secondary outcome measure. Hazard ratios (HRs) and 95% confidence intervals from eligible studies were synthesized. Results: Nine studies that examined the role of more intensive follow-up for patients with lung cancer were included (eight observational studies and one randomized controlled trial). The studies of curative resection included patients with non-small cell lung cancer Stages I to III disease, and studies of palliative treatment follow-up included limited and extensive stage patients with small cell lung cancer. A total of 1669 patients were included in the studies. Follow-up programs were heterogeneous and multifaceted. A nonsignificant trend for intensive follow-up to improve survival was identified, for the curative intent treatment subgroup (HR: 0.83; 95% confidence interval: 0.66-1.05). Asymptomatic recurrence was associated with increased survival, which was statistically significant HR: 0.61 (0.50-0.74) (p < 0.01); quality of life was only assessed in one study. Conclusions: This meta-analysis must be interpreted with caution due to the potential for bias in the included studies: observed benefit may be due to systematic differences in outcomes rather than intervention effects. Some benefit was noted from intensive follow-up strategies. More robust data, in the form of randomized controlled trials, are needed to confirm these findings as the review is based primarily on observational studies. Future research should also include patient-centered outcomes to investigate the impact of follow-up regimes on living with lung cancer and psychosocial well-being. Copyright © 2011 by the International Association for the Study of Lung Cancer.
Rothwell M.P.,Macclesfield Hospital |
Pearson D.,Acute Pain Service |
Hunter J.D.,Macclesfield Hospital |
Mitchell P.A.,Macclesfield Hospital |
And 3 more authors.
British Journal of Anaesthesia | Year: 2011
To determine if oral oxycodone (OOXY) could provide equivalent postoperative analgesia and a similar side-effect profile to i.v. patient-controlled morphine in patients undergoing elective primary total hip replacement (THR) under spinal anaesthesia. Methods. We studied 110 consecutive patients aged 6085 yr. After operation, patients were randomly allocated to receive either oral controlled- and immediate-release OOXY or i.v. patient-controlled analgesia (IVPCA) with morphine. Both groups received regular co-analgesia and antiemetics. The primary outcome measures were: (i) postoperative pain at rest and movement and (ii) nausea score recorded 12 hourly. The secondary outcome measures were: (i) time to first mobilization, (ii) total amount of opioid consumed, (iii) number of additional antiemetic doses, and (iv) time to analgesic discontinuation. Results. There were no statistically significant differences in the primary outcome measures of pain at rest and movement (P>0.05, 95 confidence intervals -0.41, 0.96) or nausea score (P>0.5). The secondary outcome measures showed no significant difference in the total amount of opioid consumed (102 vs 63 mg; P>0.05) or time to mobilization (24.45 vs 26.6 h, P0.2). The number of antiemetic doses required in the first 24 h was significantly lower in the OOXY group (1.1 vs 1.4, P<0.05). The time to analgesic discontinuation was significantly shorter in the OOXY group (50.5 vs 56.6 h, P<0.05). Oral analgesia with OOXY was approximately GBP 10 less expensive per patient than IVPCA. Conclusion. sOral analgesia with OOXY after THR offers non-inferior analgesia to IVPCA and may offer some logistical and cost advantages. © The Author .
Lapner M.,University of Alberta |
Willing R.,Binghamton University State University of New York |
Johnson J.A.,St Josephs Health Center |
Johnson J.A.,University of Western Ontario |
Clinical Biomechanics | Year: 2014
Background Hemiarthroplasty is a treatment option for selected distal humerus fractures. The purpose of this study was to determine the effect of distal humeral hemiarthroplasty and implant size on elbow articular contact. We hypothesized that implants of varying sizes produce different contact patterns compared with the native elbow. Methods Eight cadaveric arms were tested in an elbow simulator and the kinematics recorded. Three-dimensional reconstructions of bones and cartilage were generated from computed-tomography images to determine contact patterns. The native articulation was compared to optimal, oversized, and undersized implants (Latitude Anatomic Hemiarthroplasty). Changes in contact patterns relative to the native articulation were measured using total contact area and contact patch agreement scores, defined as the sum of distance between contact patches × area, indicating how well contact patches agree with the native contact pattern. Findings The native articulation had significantly lower ulnohumeral contact patch agreement scores compared to all tested implants (P < 0.05). Mean ulnohumeral and radiocapitellar contact area decreased an average 44% (P = 0.03) and 4% (P = 0.07) following placement of an optimally sized implant. There was no effect of implant size on contact area or contact patch agreement score (P > 0.05). Interpretation Shape differences of elbow implants relative to the native joint may be responsible for altered contact patterns and could be improved with design modifications. These changes may predispose the elbow to arthritis. The lack of influence of implant size suggests that implant shape and materials may be more important than implant sizing during surgery. © 2014 Elsevier Ltd. All rights reserved.
Kislov R.,University of Manchester |
Waterman H.,Mcfarlane |
Harvey G.,University of Adelaide |
Boaden R.,University of Manchester
Implementation Science | Year: 2014
Background: Knowledge mobilisation in healthcare organisations is often carried out through relatively short-term projects dependent on limited funding, which raises concerns about the long-term sustainability of implementation and improvement. It is becoming increasingly recognised that the translation of research evidence into practice has to be supported by developing the internal capacity of healthcare organisations to engage with and apply research. This process can be supported by external knowledge mobilisation initiatives represented, for instance, by professional associations, collaborative research partnerships and implementation networks. This conceptual paper uses empirical and theoretical literature on organisational learning and dynamic capabilities to enhance our understanding of intentional capacity building for knowledge mobilisation in healthcare organisations. Discussion: The discussion is structured around the following three themes: (1) defining and classifying capacity building for knowledge mobilisation; (2) mechanisms of capability development in organisational context; and (3) individual, group and organisational levels of capability development. Capacity building is presented as a practice-based process of developing multiple skills, or capabilities, belonging to different knowledge domains and levels of complexity. It requires an integration of acquisitive learning, through which healthcare organisations acquire knowledge and skills from knowledge mobilisation experts, and experience-based learning, through which healthcare organisations adapt, absorb and modify their knowledge and capabilities through repeated practice. Although the starting point for capability development may be individual-, team- or organisation-centred, facilitation of the transitions between individual, group and organisational levels of learning within healthcare organisations will be needed. Summary: Any initiative designed to build capacity for knowledge mobilisation should consider the subsequent trajectory of newly developed knowledge and skills within the recipient healthcare organisations. The analysis leads to four principles underpinning a practice-based approach to developing multilevel knowledge mobilisation capabilities: (1) moving from 'building' capacity from scratch towards 'developing' capacity of healthcare organisations; (2) moving from passive involvement in formal education and training towards active, continuous participation in knowledge mobilisation practices; (3) moving from lower-order, project-specific capabilities towards higher-order, generic capabilities allowing healthcare organisations to adapt to change, absorb new knowledge and innovate; and (4) moving from single-level to multilevel capability development involving transitions between individual, group and organisational learning.