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Cohn A.,Watford General Hospital
Nursing children and young people | Year: 2011

This article provides a basic introduction to constipation and stool withholding. Anatomy and physiology, psychology and the various treatment options, including fluid, fibre and laxatives, are covered. Source


Smith T.O.,Norwich University | Smith T.O.,University of East Anglia | Hing C.B.,Watford General Hospital
Knee | Year: 2010

Proponents of tourniquets postulate that they optimise intra-operative visibility and reduce blood loss. This study compared the outcomes of tourniquet assisted to non-tourniquet assisted total knee replacement (TKR). A systematic review was undertaken of the electronic databases Medline, CINAHL, AMED and EMBASE, in addition to a review of unpublished material and a hand search of pertinent orthopaedic journals. The evidence-base was critically appraised using a tool from the Cochrane Bone, Joint and Muscle Trauma Group. Fifteen studies were identified evaluating 16 outcome measures and parameters of 1040 TKRs in 991 patients. There was a significantly greater intra-operative blood loss in non-tourniquet compared to tourniquet assisted surgery (p = 0.004). There was no significant difference between the groups for total blood loss or transfusion rate (p = 0.22; p = 0.48). There was a trend for greater complications in tourniquet compared to non-tourniquet patients. There was no difference between the groups for any other outcome measure assessed. In conclusion, this systematic review has found that there is no advantage to using a tourniquet in knee replacement surgery for reduction of transfusion requirements. © 2009 Elsevier B.V. All rights reserved. Source


Smith T.O.,Norwich University | Smith T.O.,University of East Anglia | Davies L.,Watford General Hospital | Hing C.B.,Norwich University
Knee Surgery, Sports Traumatology, Arthroscopy | Year: 2010

There is no consensus in the literature regarding the optimal timing of surgical reconstruction of the ruptured anterior cruciate ligament (ACL). Previous authors have suggested that early reconstruction may facilitate an early return to work or sport but may increase the incidence of post-operative complications such as arthrofibrosis. This study systematically reviewed the literature to determine whether ACL reconstruction should be performed acutely following rupture. Medline, CINAHL, AMED, EMBASE databases and grey literature were reviewed with a meta-analysis of pooled mean differences where appropriate. Six papers including 370 ACL reconstructions were included. Early ACL reconstructions were considered as those undertaken within a mean of 3 weeks post-injury; delayed ACL reconstructions were those undertaken a minimum of 6 weeks post-injury. We found there was no difference in clinical outcome between patients who underwent early compared to delayed ACL reconstruction. However, this conclusion is based on the current literature which has substantial methodological limitations. © Springer-Verlag 2009. Source


Dala-Ali B.M.,Middlesex University | Lloyd M.A.,Watford General Hospital | Al-Abed Y.,Middlesex University
Surgeon | Year: 2011

Mobile technology is continuously improving and it is important that all physicians are aware of its new advances. Smartphones have the potential to improve diagnostic skills and education of a surgeon.The iPhone is a popular type of smartphone in the market. This article intends to educate surgeons about its uses, functions and medical applications. The phone is an invaluable tool for the modern day surgeon. © 2010 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Source


Parr S.,Watford General Hospital | May S.,Sheffield Hallam University
Physiotherapy (United Kingdom) | Year: 2014

Background: Evidence-based practice has become fundamentally important in the field of musculoskeletal physiotherapy, which include clinical practice guidelines, such as those developed by National Institute for Health and Clinical Excellence (NICE) for low back pain. Objectives: To gauge whether musculoskeletal physiotherapist working in the UK are compliant with the NICE guidelines for back pain, and if they believe them to be practical and relevant to their current practice. Design: Descriptive cross-sectional voluntary electronic survey. Methods: A survey of musculoskeletal physiotherapists currently working in the UK was conducted through an anonymous online data collection website over a two month data collection period. Data was collected about demographic details of participants, and their views about the NICE guidelines through a specially designed questionnaire, and are presented descriptively. Results: Two hundred and twenty-three therapists participated. Following a thematic content analysis seven key themes were identified about the guidelines: they facilitated evidence-based practice; they were unrealistic and idealistic; they did not facilitate a multimodal approach; they promoted largely a passive approach; they challenged therapist autonomy; they were outdated; they lacked relevance and specificity. Conclusion: Musculoskeletal physiotherapists strongly believe in the principles of EBP, and thought the NICE back pain guidelines were relevant to their practice. However the recommendations made within the guidelines were not realistic in day to day practice and they impacted negatively on the practice in a number of ways. © 2013 Chartered Society of Physiotherapy. Source

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