Modelling the effects of the weather on admissions to UK trauma units : a cross-sectional study

Objective To assess the relationship between daily trauma admissions and observed weather variables, using data from the Trauma Audit and Research Network of England and Wales and the UK Meteorological Office. Design A cross-sectional study. Setting Twenty-one accident and emergency departments (ED) located across England. Participants All patients arriving at one of the selected ED, with a subsequent death, inpatient stay of greater than 3 days, interhospital transfer or requiring critical care between 1 January 1996 and 31 December 2006. Main Outcome Measures Daily counts of adult and paediatric trauma admissions. Results Multivariate regression analysis indicated that there were strong seasonal trends in paediatric (χ2 likelihood ratio test p<0.001), and adult (p=0.016) trauma admissions. For adults, each rise of 5°C in the maximum daily temperature and each additional 2 h of sunshine caused increases in trauma admissions of 1.8% and 1.9%. Effects in the paediatric group were considerably larger, with similar increases in temperature and hours of sunshine causing increases in trauma admissions of 10% and 6%. Each drop of 5°C in the minimum daily temperature, eg, due to a severe night time frost, caused adult trauma admissions to increase by 3.2%. Also the presence of snow increased adult trauma admissions by 7.9%. Conclusion This is the largest study of its kind to investigate and quantify the relationship between trauma admissions and the weather. The results show clear associations that have direct application for planning and resource management in UK ED

The Warwick patellofemoral arthroplasty trial : a randomised clinical trial of total knee arthroplasty versus patellofemoral arthroplasty in patients with severe arthritis of the patellofemoral joint

Background Severe arthritis of the knee is a disabling condition, with over 50,000 knee replacements performed each year in the UK. Isolated patellofemoral joint arthritis occurs in over 10% of these patients with the treatment options being patellofemoral arthroplasty or total knee arthroplasty. Whilst many surgeons believe total knee arthroplasty is the 'gold standard' treatment for severe knee arthritis, patellofemoral arthroplasty has certain potential advantages. Primarily, because this operation allows the patient to keep the majority of their own knee joint; preserving bone-stock and the patients' own ligaments. Patellofemoral arthroplasty has also been recognised as a less 'invasive' operation than primary total knee arthroplasty, facilitating a more rapid recovery. There are currently no published results of randomised clinical trials comparing the two arthroplasty techniques. The primary objective of the current study is to assess whether there is a difference in functional knee scores and quality of life outcome assessments at one year post-operation between patellofemoral arthroplasty and total knee arthroplasty. The secondary objective is to assess the complication rates for both procedures. Methods/design Patients who are deemed suitable, by an Orthopaedic Consultant, for patellofemoral arthroplasty and medically fit for surgery are eligible to take part in this trial. The consenting patients will be randomised in a 1:1 allocation to a total knee or patellofemoral arthroplasty. The randomisation sequence will be computer generated and administered by a central independent randomisation service. Following consent, all participants will have their knee function, quality of life and physical activity level assessed through questionnaires. The assigned surgery will then be performed using the preferred technique and implant of the operating surgeon. The first post-operative assessments will take place at six weeks, followed by further assessments at 3, 6 and 12 months. At each assessment time point all complications will be recorded. In addition, community and social care services usage will be collected using a patient questionnaire at 3, 6 & 12 months. The patients will then be sent an annual postal questionnaire. The questionnaire will ask about any problems, knee pain and function following their knee arthroplasty to monitor long-term function and failure rates. Discussion This trial is expected to deliver results in early 2013

The Avon patellofemoral joint replacement : five year results from an independent centre

Between May 1998 and May 2007 we carried out 50 Avon patellofemoral joint replacements in 32 patients with isolated patellofemoral osteoarthritis. There were no revisions in the first five years, giving a cumulative survival of 100% for those with a minimum follow-up of five years. The mean follow-up was 5.3 years (2.1 to 10.2). The median Oxford knee score was 30.5 (interquartile range 22.25 to 42.25). In patients with bilateral replacements the median Euroqol General health score was 50 which was significantly lower than that of 75 in those with a unilateral replacement (p = 0.047). The main complication was progression of disease, which was identified radiologically in 11 knees (22%). This highlights the need for accurate selection of patients. Our findings suggest that the Avon prosthesis survives well and gives a satisfactory functional outcome in the medium term