Development of assessment in hip arthroplasty review

AbstractThis thesis describes the development of criteria in hip arthroplasty review. The insertion of a hip replacement brings relief from pain and improved function but the artificial joint does not last indefinitely. Periodic review provides the opportunity to assess the state of the joint in order to identify a failing hip arthroplasty.A literature search was conducted on the subject of failing hip arthroplasty and the findings are summarised. There was a lack of standardisation of methodology but an emphasis on the need for review because of the commonly asymptomatic nature of a failing hip arthroplasty.The review process has traditionally been completed by medical members of the orthopaedic team but there has been a recent change to include non-medical health professionals in this work. A lack of formalised educational programmes has led to innovative ways of achieving the required competency, and one such method is described for the development of a skill in interpretation of x-ray images of hip replacements.Radiographic assessment is an important component of hip arthroplasty review and includes the measurement of osteolytic lesions, a phenomenon caused by the wear particles produced from the articulating surfaces of the artificial joint. A simple, clinical tool was developed to measure these irregularly shaped lesions and the testing of the tool is described.Finally, a clinical study was conducted to explore the association between changes on a patient reported outcome measure and x-ray changes over the same period of time. The patients had all received a hip replacement approximately seven years earlier (mid-term) and so were at a stage when signs of deterioration of the hip joint were likely to appear. This thesis makes a contribution to the scientific base of arthroplasty review. It demonstrates a training model for non-medical health professions to acquire the skills needed to conduct the review. It employs basic research to develop a simple and reliable tool for use in the clinical situation. It shows that, for patients reviewed at mid-term, it is essential to include an x-ray as well as a joint-specific patient reported outcome measure. This information is important for future service planning and development of practitioners, and is of benefit to patients through adding to the evidence about the criteria for arthroplasty review

The trypanosome alternative oxidase:a potential drug target?

New drugs against Trypanosoma brucei, the causative agent of Human African Trypanosomiasis, are urgently needed to replace the highly toxic and largely ineffective therapies currently used. The trypanosome alternative oxidase (TAO) is an essential and unique mitochondrial protein in these parasites and is absent from mammalian mitochondria, making it an attractive drug target. The structure and function of the protein are now well characterized, with several inhibitors reported in the literature which show potential as clinical drug candidates. In this review we provide an update on the functional activity and structural aspects of TAO. We then discuss TAO inhibitors reported to date, problems encountered with in vivo testing of these compounds, and discuss the future of TAO as a therapeutic target.PostprintPeer reviewe

Setting up an arthroplasty care practitioner-led virtual clinic for follow-up of orthopaedic patients

AbstractThis article provides an overview of the set up for an arthroplasty care practitioner (ACP)-led virtual orthopaedic clinic (VOC). Suitable patients attend a local hospital for an X-ray and complete a questionnaire, but do not physically attend a clinic. This has been running successfully in a university teaching hospital and has led to cost savings, a reduction in outpatient waiting times and high levels of patient satisfaction. Similar clinics have the potential to become normal practice across the NHS. This article outlines the steps necessary to implement a successful VOC. The lessons learnt during this exercise may be useful for other ACPs when setting up a VOC

A New Test of a Theory about Old Mosquitoes

In vector control, it is widely accepted that killing adult mosquitoes would sharply reduce the proportion of old mosquitoes and cause the greatest changes to malaria transmission. The principle is based on a mathematical model of the sporozoite rate (the proportion of infective mosquitoes) that emphasized changes in mosquito age. Killing adult mosquitoes also reduces mosquito population densities, which are directly proportional to human biting rates (the number of bites, per person, per day). Eect sizes of vector control can be compared using sporozoite rates and human biting rates, which are commonly measured. We argue that human biting rates convey more use- ful information for planning, monitoring and evaluating vector control, and operational research should focus on understanding mosquito ecology

A Double-Mode RR Lyrae Star with a Strong Fundamental Mode Component

NSVS 5222076, a thirteenth magnitude star in the Northern Sky Variability Survey, was identified by Oaster as a possible new double-mode RR Lyrae star. We confirm the double-mode nature of NSVS 5222076, supplementing the survey data with new V band photometry. NSVS 5222076 has a fundamental mode period of 0.4940 day and a first overtone period of 0.3668 day. Its fundamental mode light curve has an amplitude twice as large as that of the first overtone mode, a ratio very rarely seen. Data from the literature are used to discuss the location in the Petersen diagram of double-mode RR Lyrae stars having strong fundamental mode pulsation. Such stars tend to occur toward the short period end of the Petersen diagram, and NSVS 5222976 is no exception to this rule.Comment: 14 pages, 4 figures, To be published in the March, 2006, issue of PAS

Hip and knee replacements: Should we follow them up? A survey of orthopaedic health professionals

The aim of this study was to collect evidence on the current view of orthopaedic health professionals on follow-up services after hip or knee replacement. It consisted of a short survey that was distributed, following ethical approval, at the British Association for Surgery of the Knee (BASK) and the British Hip Society 2018 annual meetings with the agreement of their executive committees.One hundred and seventy-two delegates completed the surveys with a high response rate. The majority of respondents were orthopaedic consultants (mean years since qualification = 18), with 13% of the participants from an allied health professional or research background. Results showed that 87% (hips) and 78% (knees) of healthcare professionals (HCPs) supported long-term follow-up by the orthopaedic community with 33% stating that changes are needed in the intervals for review and age limits as recommended in the current NICE guidelines. Freehand comments noted concerns about skilled assessment and cost; some included suggestions for alternative models of care. Seventy-four percent of HCPs were in favour of using arthroplasty practitioner services with the majority preferring a virtual arthroplasty practitioner service. Forty-six percent of HCPs were aware of their local National Health Service plans for sustainability and transformation (STP). Of these, 61% reported that their responses were not consistent with their local STP. In conclusion, there continues to be widespread support for arthroplasty follow-up services. However, with the current pressure on healthcare resources, a re-evaluation of recommended follow-up services and their method of delivery is required

The use of tissue adhesive as an adjunct to wound closure in knee arthroplasty does not reduce wound ooze

IntroductionPersistent wound ooze has been associated with prolonged length of hospital stay and increased risk of infection. Recently, the use of tissue adhesive after hip and knee arthroplasty has been described. We believe that knee arthroplasty wounds exhibit different behavior compared to hip arthroplasty due to the increased wound-margin tension associated with knee flexion.Patients and methodsForty-three patients undergoing total knee arthroplasty (TKA) by a single surgeon were studied. All wounds were closed using staples with or without tissue adhesive. Post-operatively, the wounds were reviewed daily for ooze. Dressings were changed only if soaked > 50% or if there was persistent wound discharge of more than 2 × 2 cm at 72 h.ResultsThere were 21 patients in the tissue adhesive (group 1), 22 in the non-tissue adhesive (group 2) with the average age for group 1 of 72.2 years and for group 2 of 69.3 years. The median length of stay for both groups was 4 days (range of 3–7 days for group 1 and 2–6 days for group 2) (P = 0.960). The tissue adhesive group showed a statistically significant reduction in wound ooze on day 1 (P = 0.019); however, the difference was not significant on the following days. The median for the number of dressing changes for group 1 was zero changes and for group 2, one change. This was not statistically significant (P = 0.112). No complications were observed in both groups and there were no reactions to the tissue adhesive.ConclusionThe data from this case series suggest that the use of tissue adhesive may reduce wound ooze on day 1 only. The latter is most likely due to significant tensile forces to which the knee arthroplasty wound is subjected in the immediate post-operative rehabilitation. Further, the cost of tissue adhesive is not offset by reduced dressing changes or length of hospital stay

Damage function for historic paper. Part I: Fitness for use

Background In heritage science literature and in preventive conservation practice, damage functions are used to model material behaviour and specifically damage (unacceptable change), as a result of the presence of a stressor over time. For such functions to be of use in the context of collection management, it is important to define a range of parameters, such as who the stakeholders are (e.g. the public, curators, researchers), the mode of use (e.g. display, storage, manual handling), the long-term planning horizon (i.e. when in the future it is deemed acceptable for an item to become damaged or unfit for use), and what the threshold of damage is, i.e. extent of physical change assessed as damage. Results In this paper, we explore the threshold of fitness for use for archival and library paper documents used for display or reading in the context of access in reading rooms by the general public. Change is considered in the context of discolouration and mechanical deterioration such as tears and missing pieces: forms of physical deterioration that accumulate with time in libraries and archives. We also explore whether the threshold fitness for use is defined differently for objects perceived to be of different value, and for different modes of use. The data were collected in a series of fitness-for-use workshops carried out with readers/visitors in heritage institutions using principles of Design of Experiments. Conclusions The results show that when no particular value is pre-assigned to an archival or library document, missing pieces influenced readers/visitors’ subjective judgements of fitness-for-use to a greater extent than did discolouration and tears (which had little or no influence). This finding was most apparent in the display context in comparison to the reading room context. The finding also best applied when readers/visitors were not given a value scenario (in comparison to when they were asked to think about the document having personal or historic value). It can be estimated that, in general, items become unfit when text is evidently missing. However, if the visitor/reader is prompted to think of a document in terms of its historic value, then change in a document has little impact on fitness for use