Factors Affecting the Outcomes in Bilateral Total Knee Arthroplasty: A Case Report

The purpose of this case study was to determine the effects of femoral nerve block use during total knee arthroplasty on the return of quadriceps activation and functional outcomes in a single patient. This case study focused on an individual case consisting of simultaneous bilateral knee replacement. The individual received a femoral nerve block in one knee and traditional anesthesia in the other. We considered the improvement in functional outcomes following surgery. It was expected that the femoral nerve block will delay the activation of the quadriceps muscle and the return of functional measures. However, the femoral nerve block will modulate pain more successfully compared to the standard pain control procedures. This case study will also address the effect of femoral nerve blocks on quadriceps, particularly Vastus Medialis Oblique, reactivation following TKA. If so, for how long is quadriceps activation delayed. Is return of balance and proprioceptive control delayed following use of a femoral nerve block during TKA

Increasing the generalisability of improvement research with an improvement replication programme

If a quality improvement is found effective in one setting, would the same effects be found elsewhere? Could the same change be implemented in another setting? These are just two of the ‘generalisation questions’ which decision-makers face in considering whether to act on reported improvement. In this paper, some of the issues are considered and a programme of research for testing improvements in different settings is proposed to build theory and practical guidance about implementation and results in different settings

An Asymmetric Horner-Wittig reaction: Synthesis of Phytosterols and unravelling their role in disease.

Phytosterols are major components of food and are structurally related to cholesterol, but differ from it by virtue of a carbon substituent at the C-24 position and in some cases, a double bond between C-22 and C-23 (Figure i). Furthermore, phytosterols are shown to have protective actions against colon, breast, and prostate cancer1; further investigation is required as their mode of action is unknown. Thus, reported herein is the design and synthetic implementation required to construct these naturally occurring compounds. Figure i : Cholesterol Construction towards a double bond flanked by two asymmetric carbon atoms, observed in the phytosterol side chain, will be synthesised using an asymmetric Horner-Wittig (H-W) reaction, involving a chiral α-substituted aldehyde and a chiral β-substituted phosphine oxide. In addition to the synthesis, the stereochemical outcomes of these H-W reactions were probed. The results demonstrated, that by varying the steric bulk, electronic nature, and aromatic properties of the groups β to the phosphorus and α to the aldehyde can control the cis/trans selectivity in alkene formation. Finally, to display the utility of this methodology, the phytosterol compounds will be synthesised and tested in MD-MBA-231 cancer cell lines, allowing further investigation into the phytosterol mechanism of action

Predictors of patient non-attendance at Improving Access to Psychological Therapy services demonstration sites

© 2014 The Authors. Published by Elsevier B.V. Background Improving Access to Psychological Therapy (IAPT) services have increased the number of people with common mental health disorders receiving psychological therapy in England, but concerns remain about how equitably these services are accessed.Method Using cohort patient data (N=363) collected as part of the independent evaluation of the two demonstration sites, logistic regression was utilised to identify socio-demographic, clinical and service factors predictive of IAPT non-attendance.Results Significant predictors of IAPT first session non-attendance by patients were: lower non-risk score on the Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM); more frequent thoughts of "being better off dead" (derived from the CORE-OM); either a very recent onset of common mental health disorder (1 month or less) or a long term condition (more than 2 years); and site.Limitations The small sample and low response rate are limitations, as the sample may not be representative of all those referred to IAPT services. The predictive power of the logistic regression model is limited and suggests other variables not available in the dataset may also be important predictors.Conclusions The clinical characteristics of risk to self, severity of emotional distress, and illness duration, along with site, were more predictive of IAPT non-attendance than socio-demographic characteristics. Further testing of the relationship between these variables and IAPT non-attendance is recommended. Clinicians should monitor IAPT uptake in those they refer and implement strategies to increase their engagement with services, particularly when referring people presenting with suicidal ideation or more chronic illness

Ticking the right boxes: A critical examination of the perceptions and attitudes towards the black, Asian and minority ethnic (BAME) acronym in the UK

© 2222 The Author(s). This is an open access article distributed under the Creative Commons Attribution License, CC BY, see: https://creativecommons.org/licenses/by/4.0/The Black Lives Matter movement and coronavirus pandemic have raised awareness of society's categorisation of non-white people and institutional language used. We add to contemporary debate on the BAME acronym (Black, Asian and minority ethnic) by providing a critical examination of the perceptions and attitudes towards it in the UK. Drawing on in-depth interviews with women from these communities who were working in the hyper-masculinised and white-dominated sporting industry, we privilege the voices of those who traditionally have been omitted. Adopting a Critical Race Theory approach and an intersectional lens three overarching themes were identified: rejection and indifference towards the BAME acronym; filling in the form – inadequacies of the system; and, making up the quota – perpetuating (work-related) insecurity(ies). The findings provide analytical insight into institutional language and highlight the potential for the BAME acronym to cause distress and alienation while preserving the concept of Whiteness.Peer reviewe

Size matters: First-in-human study of a novel 4 French REBOA device

Background Resuscitative endovascular balloon occlusion of the aorta (REBOA) is an emerging technique used for non-compressible torso hemorrhage. However, its current use continues to be limited and there is a need for a simple, fast, and low profile REBOA device. Our objective was to evaluate the feasibility of a novel 4 French REBOA device called the COBRA-OS (Control of Bleeding, Resuscitation, Arterial Occlusion System). Methods This study is the first-in-human feasibility trial of the COBRA-OS. Due to the difficulty of trialing the device in the trauma setting, we performed a feasibility study using organ donors (due to the potential usefulness of the COBRA-OS for normothermic regional perfusion) after neurological determination of death (NDD) prior to organ retrieval. Bilateral 4 French introducer sheaths were placed in both femoral arteries and the COBRA-OS was advanced up the right side and deployed in the thoracic aorta (Zone 1). Once aortic occlusion was confirmed via the left-sided arterial line, the device was deflated, moved to the infrarenal aorta (Zone 3), and redeployed. Results A total of 7 NDD organ donors were entered into the study, 71% men, with a mean age 46.6 years (range 26 to 64). The COBRA-OS was able to occlude the aorta in Zones 1 and 3 in all patients. The mean time of placing a 4 French sheath was 47.7 seconds (n=13, range 28 to 66 seconds). The mean time from skin to Zone 1 aortic occlusion was 70.1 seconds (range 58 to 105 seconds); mean balloon volumes were 15 mL for Zone 1 (range 13 to 20 mL) and 9 mL for Zone 3 (range 6 to 15 mL); there were no complications and visual inspection of the aorta in all patients revealed no injury. Discussion The COBRA-OS is a novel 4 French REBOA device that has demonstrated fast and safe aortic occlusion in this first-in-human feasibility study. Level of evidence Level V, therapeutic

What factors affect implementation of early rehabilitation into intensive care unit practice? A qualitative study with clinicians

Purpose To identify the barriers and enablers that influence clinicians' implementation of early rehabilitation in critical care. Materials and methods Qualitative study involving 26 multidisciplinary participants who were recruited using purposive sampling. Four focus groups were conducted using semistructured questions to explore attitudes, beliefs, and experiences. Data were transcribed verbatim and thematic analysis was performed. Results Six themes emerged, as follows: (1) the clinicians' expectations and knowledge (including rationale for rehabilitation, perceived benefits, and experience), (2) the evidence for and application of rehabilitation (including beliefs regarding when to intervene), (3) patient factors (including prognosis, sedation, delirium, cooperation, motivation, goals, and family), (4) safety considerations (including physiological stability and presence of devices or lines), (5) environmental influences (staffing, resources, equipment, time, and competing priorities), and (6) culture and teamwork. Key strategies identified to facilitate rehabilitation included addressing educational needs for all multidisciplinary team members, supporting junior nursing staff, and potential expansion of physiotherapy staffing hours to closer align with the 24-hour patient care model. Conclusions Key barriers to implementation of early rehabilitation in critical care are diverse and include both clinician- and health care system–related factors. Research targeted at bridging this evidence-practice gap is required to improve provision of rehabilitation. © 2016 Elsevier Inc

Unfitness to Plead. Volume 1: Report.

This has been produced along with Volume 2: Draft Legislation as a combined document Presented to Parliament pursuant to section 3(2) of the Law Commissions Act 1965 Ordered by the House of Commons to be printed on 12 January 201