Musgrove Park Hospital Taunton

Somerset, United Kingdom

Musgrove Park Hospital Taunton

Somerset, United Kingdom
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Miller C.,University of Birmingham | Peek A.L.,Musgrove Park Hospital Taunton | Power D.,University of Birmingham | Heneghan N.R.,University of Birmingham
Hand Therapy | Year: 2017

Introduction: Traumatic upper limb peripheral nerve injuries significantly impact individuals’ function and ability to return to work. Patients with peripheral nerve injury experience ongoing psychological impairments for which they are not routinely treated. The aim of this review was to investigate the psychological consequences of traumatic upper limb peripheral nerve injury. Methods: A systematic review of MEDLINE, Embase, PsycINFO, CINAHL, AMED, BNI, the Cochrane libraries and grey literature up to October 2015 was undertaken. Two reviewers independently assessed methodological quality in accordance with Cochrane Collaboration recommendations. Eligibility criteria comprised: adults or adolescents with traumatic upper limb peripheral nerve injury using any measurement of psychological well-being. Results: Six studies (n = 245) met the inclusion criteria. Methodological quality varied widely. Evidence of post-traumatic stress disorder at one month, which decreased over time, was reported in three studies. Two studies found a statistically significant correlation between the early presence of post-traumatic stress disorder and reduction in function at 12 or more months. Limited information was available on anxiety, depression and mental quality of life. Combined nerve injuries (in two studies) had significantly higher levels of post-traumatic stress disorder, at one month, compared to those with an isolated nerve injury. Conclusion: There is some evidence of early post-traumatic stress disorder following traumatic upper limb peripheral nerve injury, which may have an impact on functional outcome. However, high-quality studies using prospective cohorts are required to further evaluate the psychological aspects associated with this traumatic injury. © The author(s) 2016.


Goldsworthy S.G.S.,Musgrove Park Hospital Taunton | Goldsworthy S.G.S.,Royal Sussex County Hospital | Sinclair N.S.N.,London South Bank University | Tremlett J.T.J.,Royal Sussex County Hospital | And 3 more authors.
Journal of Radiotherapy in Practice | Year: 2011

Background: A randomised study to investigate whether bilateral arm abduction is superior to unilateral abduction with respect to stability using shifts on treatment as the main outcome measure. Material and Methods: 50 consecutive female patients were randomised to ipsilateral or bilateral arm abduction. Central lung depth (CLD) and cranial caudal depth (CCD) on the simulator image was compared with that featured on three Electronic Portal Images (EPI) captured during treatment for each patient. Systematic and random errors were analysed with respect to the average translational displacement and standard deviation per patient and per population between the planning image and the EPI. Results: The CLD average translational displacement in the test group was -1.7 mm (95% CI = -5 to 1.6 mm) ∑ pop = 2.3 mm, σ pop = 1.6 mm, and in the control group -1.9 mm (95% CI = -6 to 3 mm) ∑ pop = 4 mm, σ pop = 2.1 mm. The average translational displacement of CCD in test group was 0 mm (95% CI = - 5.3 to 5.1 mm) ∑ pop = 2.2 mm, σ pop = 2.6 mm. CCD translational displacement was greater in the unilateral arm abduction group at - 1.6 mm (95% CI = -6.7 to 3.4 mm) ∑ pop = 3.6 mm, σ pop = 2.4mm. Conclusion: The reduction in systematic error and inter-patient variability observed in the test group is evidence that bilateral arm abduction is a more stable and reproducible position than unilateral arm abduction. The CCD translational data indicates that patients treated with unilateral arm abduction were moving inferiorly on the breast board. These results support the adoption of bilateral arm abduction as a standard technique. © Cambridge University Press 2010.

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