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Birmingham, United Kingdom

Pearson S.J.,Selly Oak Hospital
International Journal of Therapy and Rehabilitation | Year: 2014

Manual hyperinflation (MH) is widely used by respiratory physiotherapists on intensive care units. The incidence of MH-associated barotrauma is not well documented. Literature reviewed focused on MH, its uses and peak airway pressures (PAPs) associated with barotrauma. This study investigated PAPs reached by nurses and physiotherapists when performing MH. Although the results were not significant, there were many points of interest highlighted. © 2009, MA Healthcare Ltd. All rights reserved. Source


Brown K.V.,U.S. Army | Murray C.K.,U.S. Army | Clasper J.C.,Selly Oak Hospital
Journal of Trauma - Injury, Infection and Critical Care | Year: 2010

Background: During the wars in Iraq and Afghanistan, extremity injuries have predominated; however, no systematic review of field and stabilization care with subsequent infectious complications exists. This study evaluates the infectious complications and possible risk factors of British military casualties with mangled extremities, highlighting initial care and infections. Methods: This is a retrospective cohort study of British military casualties in Iraq and Afghanistan between August 2003 and May 2008. Casualties with mangled extremities undergoing limb salvage were evaluated for management strategies at the time of injury through evacuation back to the United Kingdom and subsequent infections. Results: There were 84 casualties with 85 extremities (20 infected and 65 uninfected). Infected extremities had more Gustilo Classification IIIb. There were no differences by Injury Severity Score, age, durations from injury to evacuation, or surgery, or arrival in England, use of clotting materials, or method of extremity stabilization between infected and uninfected extremity injuries. Tourniquet use in the field and fasciotomy were associated with infections. Antimicrobial coverage was associated with infections. Staphylococcus aureus were recovered later in casualties' clinical course in contrast to early recovery of Acinetobacter. On multivariate analysis, tourniquet in the field, antibiotics during evacuation and in the operating room, and fasciotomy were associated with infection as were certain bacteria, notably, Pseudomonas aeruginosa. Conclusions: Infections occurred in 24% of those with mangled extremities including 6% with osteomyelitis. Certain procedures, likely reflective of injury severity, were associated with infections along with certain bacteria, P. aeruginosa and possibly S. aureus. Continued clarification is required for antimicrobial coverage (penicillin-based regimens vs. additional anaerobic coverage) and certain surgical procedures to improve casualty care. © 2010 by Lippincott Williams & Wilkins. Source


Rajaratnam R.,Selly Oak Hospital
Cochrane database of systematic reviews (Online) | Year: 2010

BACKGROUND: Melasma is an acquired symmetrical pigmentary disorder where confluent grey-brown patches typically appear on the face. Available treatments for melasma are unsatisfactory. OBJECTIVES: To assess interventions used in the management of all types of melasma: epidermal, dermal, and mixed. SEARCH STRATEGY: In May 2010 we searched the Cochrane Skin Group Specialised Register, the Cochrane Central Register of Controlled Trials (Clinical Trials) in The Cochrane Library, MEDLINE, EMBASE, PsycINFO, and LILACS. Reference lists of articles and ongoing trials registries were also searched. SELECTION CRITERIA: Randomised controlled trials that evaluated topical and systemic interventions for melasma. DATA COLLECTION AND ANALYSIS: Study selection, assessment of methodological quality, data extraction, and analysis was carried out by two authors independently. MAIN RESULTS: We included 20 studies with a total of 2125 participants covering 23 different treatments. Statistical pooling of the data was not possible due to the heterogeneity of treatments. Each study involved a different set of interventions. They can be grouped into those including a bleaching agent such as hydroquinone, triple-combination creams (hydroquinone, tretinoin, and fluocinolone acetonide), and combination therapies (hydroquinone cream and glycolic acid peels), as well as less conventional therapies including rucinol, vitamin C iontophoresis, and skin-lightening complexes like Thiospot and Gigawhite.Triple-combination cream was significantly more effective at lightening melasma than hydroquinone alone (RR 1.58, 95% CI 1.26 to 1.97) or when compared to the dual combinations of tretinoin and hydroquinone (RR 2.75, 95% CI 1.59 to 4.74), tretinoin and fluocinolone acetonide (RR 14.00, 95% CI 4.43 to 44.25), or hydroquinone and fluocinolone acetonide (RR 10.50, 95% CI 3.85 to 28.60).Azelaic acid (20%) was significantly more effective than 2% hydroquinone (RR 1.25, 95% CI 1.06 to 1.48) at lightening melasma but not when compared to 4% hydroquinone (RR 1.11, 95% CI 0.94 to 1.32).In two studies where tretinoin was compared to placebo, participants rated their melasma as significantly improved in one (RR 13, 95% CI 1.88 to 89.74) but not the other. In both studies by other objective measures tretinoin treatment significantly reduced the severity of melasma.Thiospot was more effective than placebo (SMD -2.61, 95% CI -3.76 to -1.47).The adverse events most commonly reported were mild and transient such as skin irritation, itching, burning, and stinging. AUTHORS' CONCLUSIONS: The quality of studies evaluating melasma treatments was generally poor and available treatments inadequate. High-quality randomised controlled trials on well-defined participants with long-term outcomes to determine the duration of response are needed. Source


Porter K.,Selly Oak Hospital
Trauma | Year: 2010

Treatment of the ?pilon? fracture provides one of the greatest challenges to orthopaedic surgeons today. The force required to fracture the distal tibia can lead to complex fracture configurations and significant soft tissue compromise that challenge subsequent repair. High complication rates have encouraged extensive research over decades into an operative method that limits the insult to the surrounding soft tissue envelope whilst maintaining the stability of the fixation obtained. Two main techniques of fixation that meet such criteria have evolved more than others namely, open reduction and internal fixation (ORIF-two-staged protocol) and external fixation (ankle sparing hybrid fixation). Advances in these techniques have seen a significant reduction in the rate of catastrophic complications such as amputation, osteomyelitis and arthrodesis. The legacy of the pilon fracture, however, is such that it is hard to decide which treatment method is best and indeed severe fractures (AO classification type C2 or 3 or Reudi and Allgower type III) are better treated with primary arthrodesis and even amputation in some cases. Both methods have their drawbacks. A high prevalence of pin tract infections and possibly inadequate reduction may occur in some cases treated with external fixators. There is considerable variability of outcome with the two-staged protocol depending on the patients treated, the judgement and skill of the surgeon operating and risk of soft tissue compromise. The two-staged protocol seems to have a greater following and seems on the surface to get over many typical complications. No one treatment method is best for all fractures; in fact both are equally good for simpler fractures. It is their outcome in treating severe fractures that will determine which of the two methods is best and which could be adequately tested with a randomised controlled trial. © The Author(s), 2010. Source


Fenton P.,Bank of The West | Porter K.,Selly Oak Hospital
Trauma | Year: 2011

Tibial plateau fractures are uncommon injuries of the proximal tibia which vary in severity from minimally displaced stable injuries to high energy complex fractures with significant articular and metaphyseal comminution and severe associated soft tissue injuries. Following initial assessment and appropriate investigation a number of management options are available to the treating surgeon. We discuss the presentation, initial management and investigation as well as outlining the various treatment options with an emphasis on operative treatment. We further discuss the common complications and outcomes following tibial plateau fracture. © The Author(s) 2011. Source

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