Bretherton C.P.,Lister Hospital |
Parker M.J.,Peterborough City Hospital
The bone & joint journal | Year: 2015
There has been extensive discussion about the effect of delay to surgery on mortality in patients sustaining a fracture of the hip. Despite the low level of evidence provided by many studies, a consensus has been accepted that delay of > 48 hours is detrimental to survival. The aim of this prospective observational study was to determine if early surgery confers a survival benefit at 30 days. Between 1989 and 2013, data were prospectively collected on patients sustaining a fracture of the hip at Peterborough City Hospital. They were divided into groups according to the time interval between admission and surgery. These thresholds ranged from < 6 hours to between 49 and 72 hours. The outcome which was assessed was the 30-day mortality. Adjustment for confounders was performed using multivariate binary logistic regression analysis. In all, 6638 patients aged > 60 years were included. Worsening American Society of Anaesthesiologists grade (p < 0.001), increased age (p < 0.001) and extracapsular fracture (p < 0.019) increased the risk of 30-day mortality. Increasing mobility score (p = 0.014), mini mental test score (p < 0.001) and female gender (p = 0.014) improved survival. After adjusting for these confounders, surgery before 12 hours improved survival compared with surgery after 12 hours (p = 0.013). Beyond this the increasing delay to surgery did not significantly affect the 30-day mortality. ©2015 The British Editorial Society of Bone & Joint Surgery.
Lakhani R.,Peterborough City Hospital
Cochrane database of systematic reviews (Online) | Year: 2012
Patients with unilateral vocal fold paralysis (UVFP) usually present with dysphonia, but can also be breathless and have problems with their swallowing. Speech and language therapy forms the initial mainstay of management in cases of UVFP, since up to 60% of cases will resolve spontaneously. If vocal fold paralysis persists surgery, in the form of injection medialisation, has been shown to be an effective intervention. What is currently unclear is which is the most effective material available for injection. To assess the effectiveness of alternative injection materials in the treatment of UVFP. We searched the Cochrane Ear, Nose and Throat Disorders Group Trials Register; the Cochrane Central Register of Controlled Trials (CENTRAL); PubMed; EMBASE; CINAHL; Web of Science; BIOSIS Previews; Cambridge Scientific Abstracts; ICTRP and additional sources for published and unpublished trials. The date of the most recent search was 23 March 2012. Randomised controlled trials (RCTs) of injectable materials in patients with UVFP. The outcomes of interest were patient and clinician-reported improvement, and adverse events. Two authors independently selected studies from the search results and extracted data. We used the Cochrane 'Risk of bias' tool to assess study quality. We identified no RCTs which met the inclusion criteria for this review. We excluded 18 studies on methodological grounds: 16 non-randomised studies; one RCT due to inadequate randomisation and inclusion of non-UVFP patients; and one RCT which compared two different particle sizes of the same injectable material. There is currently insufficient high-quality evidence for, or against, specific injectable materials for patients with UVFP. Future RCTs should aim to provide a direct comparison of the alternative materials currently available for injection medialisation.
Parker M.J.,Peterborough City Hospital
Bone and Joint Journal | Year: 2015
A total of 56 male patients with a displaced intracapsular fracture of the hip and a mean age of 81 years (62 to 94), were randomised to be treated with either a cemented hemiarthroplasty (the Exeter Trauma Stem) or reduction and internal fixation using the Targon Femoral Plate. All surviving patients were reviewed one year after the injury, at which time restoration of function and pain in the hip was assessed. There was no statistically significant difference in mortality between the two groups (7/26; 26.9% for hemiarthroplasty vs 10/30; 33.3% for internal fixation). No patient treated with a hemiarthroplasty required further surgery, but eight patients treated by internal fixation did (p = 0.005), five requiring hemiarthroplasty and three requiring total hip arthroplasty. Those treated by internal fixation had significantly more pain (p = 0.02). The restoration of mobility and independence were similar in the two groups. These results indicate that cemented hemiarthroplasty gives better results than internal fixation in elderly men with a displaced intracapsular fracture of the hip. © 2015 The British Editorial Society of Bone & Joint Surgery.
Cousley R.R.,Peterborough City Hospital |
Turner M.J.,Oral and Maxillofacial Surgery
Journal of Orthodontics | Year: 2014
Conventional orthognathic wafers are made by a process involving manual movement of stone dental models and acrylic laboratory fabrication. In addition, a facebow record and semi-adjustable articulator system are required for maxillary osteotomy cases. This paper introduces a novel process of producing both intermediate and final orthognathic surgical wafers using a combination of computerized digital model simulation and three-dimensional print fabrication, without the need for either a facebow record or the additional ionizing radiation exposure associated with cone beam computerized tomography. © 2014 British Orthodontic Society.
Randall-Carrick J.V.,Peterborough City Hospital
Journal of the Royal Army Medical Corps | Year: 2012
Whilst on operations, British military medical staff strive to provide high quality medical care to deployed soldiers. The application of UK Health Care Governance principles, particularly Clinical Professional Development (CPD), is especially challenging on operations. This article highlights some of the difficulties faced and the solutions generated to facilitate good CPD of Combat Medical Technicians (CMTs) deployed to Afghanistan on Operation HERRICK 13. The article describes the opportunities for CMTs to develop their skills in the assessment and management of trauma and primary health complaints. It also describes the difficulties in capturing this development especially when the supervision of CMTs was limited, with variable communication modalities and within the current limitations of the CMT portfolio. Solutions described include the use of individual reflective practice, face-to-face supervision and assessment by Medical Officers, Significant Event Reports, the mandatory After Action Review Process, and the development of formal standardised CMT CPD. This included refresher training after return from leave, Senior Medical Officer (SMO) weekly lectures and the SMO weekly report. Finally, the future of CMT CPD is raised and it is hoped that this article will stimulate debate into how to approach these challenges and refine these processes further.