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.
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.
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.
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.
World M.J.,Selly Oak Hospital
NDT Plus | Year: 2011
This article provides some background on military nephrology in the UK. The primary objective of the Defence Medical Services is the maintenance of operational capability of military personnel. This includes exclusion of nephrological diseases that might reduce renal reserve to a critical level under field conditions, increasing susceptibility to trauma, burns, infection and adverse environmental conditions and increasing the need for renal support. Renal failure potentially compromises not only the patient but also his comrades through reduced staffing and inability to execute the military mission. Safety of weapon systems for which the patient is responsible may be reduced. At forward locations, need for evacuation may put aircraft or vehicles and their crew with medical attendants at unnecessary risk. Regular follow-up and continuity of care are difficult owing to the demands of military life that include frequent postings and deployments. © Crown copyright 2011.
Lamb D.,Selly Oak Hospital
Nursing Clinics of North America | Year: 2010
Modern warfare has generated a significant increase in blast injuries, which demand careful management during planning and while undertaking air transfer. Pain management following multiple injuries can be challenging even when a patient is cared for in a stationary health care setting; this is further complicated by the additional stressors of flight. This article describes health care governance initiatives implemented by the Aeromedical Evacuation Squadron, based at Royal Air Force (RAF), United Kingdom. It focuses on quality and performance improvements via a program of clinical-effectiveness auditing. © 2010.
Collin B.,Selly Oak Hospital |
Rajaratnam R.,Selly Oak Hospital |
Lim R.,Selly Oak Hospital |
Lewis H.,Selly Oak Hospital
Clinical and Experimental Dermatology | Year: 2010
Background. Sarcoidosis is a multisystem granulomatous disease of unknown aetiology, which most often involves the lungs and lymphatic system. Cutaneous involvement is found in approximately 25% of cases of sarcoid. Most previous studies of cutaneous sarcoidosis have been drawn from populations with defined pulmonary disease, so may represent a population with more systemic involvement. Objective. We describe a cohort of patients with cutaneous sarcoid seen in a dermatology department. Methods. Case records were reviewed for patients with a histopathological diagnosis of noncaseating sarcoidal granuloma on skin biopsy, taken between 1996 and 2005. Results. In total, 34 patient records were analysed; 21 patients were found to have extracutaneous systemic sarcoid and 10 patients had sarcoid localized to the skin. Patients with lupus pernio and with ulcerated sarcoid lesions all had extracutaneous disease. No other cutaneous features, including the extent of cutaneous disease, were found to be predictive of systemic involvement. Conclusions. All patients presenting to a dermatology department with cutaneous sarcoidal granulomas require investigation for systemic sarcoid. Our data suggest that approximately 30% of patients seen in a dermatology clinic with cutaneous sarcoidal granulomas will have disease apparently limited to the skin. © 2009 British Association of Dermatologists.
Quah C.,Royal Derby Hospital |
Swamy G.,Queens Medical Center |
Lewis J.,Queens Medical Center |
Kendrew J.,Selly Oak Hospital |
Badhe N.,Queens Medical Center
Knee | Year: 2012
Introduction: Stiffness following total knee arthroplasty (TKA) is a disabling problem resulting in pain and reduced function. Objective: The aim of our study was to evaluate the natural course of fixed flexion deformity (FFD ) following primary total knee arthroplasty. Methods: Prospective review of 1626 patients undergoing primary TKA from 2001 to 2006 with a minimum of 4. year follow up. Demographic data included post-operative range of motion; type of prosthesis used, treatment modalities for stiffness and the final range of motion were recorded. FFD was defined as class 1(5-15 degrees) and Class 2 (> 15 degrees). Patients with a pre-operative FFD of > 15, infection, stiffness treated with manipulation or revision surgery were excluded from the study. Results: Of the 1626 patients evaluated, 170 (10.5%) presented with a FFD. 18 patients were excluded from the study and 16 were lost to follow up. 124 (91.2%) were class 1 and 12 (8.8%) were class 2. FFD improved from a mean of 8.8 degrees to 0.4 degrees (p<0.0001) in 11.4. months. In 94.1% patients the FFD completely resolved (i.e. < 5 degrees) at a mean of 10.8. months (p<0.0001). In the remaining 5.9% of patients, FFD improved from a mean of 16.4 to 6.9 degrees at a mean follow up of 21.5. months (p<0.0001). Conclusion: A gradual improvement in the FFD can be expected up to 2. years and a small residual flexion contracture does not cause functional deficit. Level of evidence: Prospective cohort study, level 3. © 2011 Elsevier B.V.
Haldane A.G.,Selly Oak Hospital
Journal of the Royal Army Medical Corps | Year: 2010
OBJECTIVES: To determine the number of medical emergency response team (MERT) patients undergoing advanced airway management in the peri-evacuation phase and to determine the indications for airway interventions undertaken in flight. METHODS: This was a retrospective study. Data was collected from patient report and mission debrief forms completed after each MERT mission during Operation HERRICK 10 (April-October 2009). All patients that received advanced airway interventions before or during evacuation were identified. RESULTS: MERTs were involved in the primary transfer of 534 patients during the period studied, 56 (10.5%) underwent advanced airway management, of which 31 (5.8% of total) were initiated by the MERT in the peri-evacuation phase. Twenty five cases (4.7%) underwent advanced airway management by other pre-hospital providers prior to MERT arrival. Of the 31 advanced airway interventions undertaken in-flight, cardiac arrest was the primary indication in only nine cases. CONCLUSIONS: The figure of 56 patients requiring advanced airway management is at the higher end of the range expected from the study of historical military data. This may reflect the doctrine of "intelligent tasking", that is sending this physician-led team to the most seriously injured casualties.
Finnegan A.,Selly Oak Hospital
Journal of the Royal Army Medical Corps | Year: 2010
OBJECTIVES: To critically evaluate the predisposing factors and symptomatology that resulted in serving officers and soldiers requiring a Mental Health (MH) assessment. METHODS: 317 regular Army personnel who required a formal MH assessment completed a survey that detailed the predisposing factors and symptoms leading to the referral. SPSSv10 was used for data management and analysis of the data by descriptive and inferential statistical methods. RESULTS: Three quarter presented with at least two predisposing factors, the commonest being family issues (42%), relationship problems (40%) and general military stress (39%). Up to half of young male Soldiers required a MH assessment as a result of wanting to leave the Army, and were positively associated with self harming ideology. Female soldiers are significantly over represented. No-one reported feeling isolated. CONCLUSION: The majority of personnel accessing the Army MH Services present with multi-factorial problems and symptoms that should result in colleagues being aware of their distress, and every effort must be made to support these soldiers within unit lines. That no one reported feeling isolated, challenges the perception that soldiers with MH problems are stigmatised. In those young male soldiers who wish to leave the Army there are indicators that significant periods of notice to leave can have a negative impact on MH. It is unclear why females are more likely to require support. If the emerging themes noted in this study are addressed, and the lessons learnt encapsulated within a predictive theoretical model, then the result could be an improvement in operational capability through the early return of Army personnel and Officers to full duty.