The surgeon and his tools-the case for a focused orthopaedic theatre induction programme

<p>Abstract</p> <p>Background</p> <p>Induction programme for trainee doctors in the UK generally do not focus on the surgical aspects of their jobs. In this context we decided to conduct a telephonic survey among the hospitals belonging to three orthopaedic training regions in the UK from the point of view of the diversity of instrumentations and implants used for index procedures.</p> <p>Results</p> <p>We chose four index trauma & orthopaedic procedures (Total hip replacement, total knee replacement, intramedullary nailing and external fixator systems for long bone fractures). A telephonic survey was done in six NHS trust hospitals which were part of an orthopaedic training rotation (2 from England, 2 from Wales and 2 from Scotland). In total there were 39 different instrumentation systems for these 4 index procedures in the 6 trusts (see table <tblr tid="T1">1</tblr>). These comprise 12 Total hip replacement (THR) systems, 14 total knee replacement (TKR) systems, 9 intra-medullary nailing systems, and 4 external fixator systems. The number of different systems for each trust ranged from 7 to 19. There is a vast array of implants and instrumentation systems in each trust, as highlighted by our survey. The surgical tools are not the same in each hospitals. This situation is more complicated when trainees move to new hospitals as part of training rotations.</p> <tbl id="T1"> <title> <p>Table 1</p> </title> <caption> <p>Number of implants/instrumentations used in each of the 6 UK trusts (3 training regions).</p> </caption> <tblbdy cols="7"> <r> <c ca="left"> <p>IMPLANT</p> </c> <c ca="center"> <p>E1</p> </c> <c ca="center"> <p>E2</p> </c> <c ca="center"> <p>W1</p> </c> <c ca="center"> <p>W2</p> </c> <c ca="center"> <p>S1</p> </c> <c ca="center"> <p>S2</p> </c> </r> <r> <c cspan="7"> <hr/> </c> </r> <r> <c ca="left"> <p><it>Total Knee Replacement</it></p> </c> <c ca="center"> <p>4</p> </c> <c ca="center"> <p>5</p> </c> <c ca="center"> <p>2</p> </c> <c ca="center"> <p>4</p> </c> <c ca="center"> <p>3</p> </c> <c ca="center"> <p>2</p> </c> </r> <r> <c ca="left"> <p><it>Total Hip Replacement</it></p> </c> <c ca="center"> <p>3</p> </c> <c ca="center"> <p>4</p> </c> <c ca="center"> <p>3</p> </c> <c ca="center"> <p>6</p> </c> <c ca="center"> <p>3</p> </c> <c ca="center"> <p>3</p> </c> </r> <r> <c ca="left"> <p><it>Intramnedullary nailing</it></p> </c> <c ca="center"> <p>2</p> </c> <c ca="center"> <p>1</p> </c> <c ca="center"> <p>1</p> </c> <c ca="center"> <p>6</p> </c> <c ca="center"> <p>2</p> </c> <c ca="center"> <p>3</p> </c> </r> <r> <c ca="left"> <p><it>External fixators</it></p> </c> <c ca="center"> <p>2</p> </c> <c ca="center"> <p>3</p> </c> <c ca="center"> <p>2</p> </c> <c ca="center"> <p>2</p> </c> <c ca="center"> <p>1</p> </c> <c ca="center"> <p>1</p> </c> </r> <r> <c cspan="7"> <hr/> </c> </r> <r> <c ca="left"> <p><it>TOTAL</it></p> </c> <c ca="center"> <p>11</p> </c> <c ca="center"> <p>13</p> </c> <c ca="center"> <p>8</p> </c> <c ca="center"> <p>18</p> </c> <c ca="center"> <p>9</p> </c> <c ca="center"> <p>9</p> </c> </r> </tblbdy> <tblfn> <p>E = England, W = Wales, S = Scotland</p> </tblfn> </tbl> <p>Conclusion</p> <p>In view of this we feel that more focused theatre based induction programmes for higher surgical trainees is advocated in each hospital trust so trainees can familiarise themselves with the tools available to them. This could include discussion with the consultants and senior theatre staff along with representatives from the companies supplying the implants and instrumentation systems.</p

Type II spiral ganglion afferent neurons drive medial olivocochlear reflex suppression of the cochlear amplifier.

The dynamic adjustment of hearing sensitivity and frequency selectivity is mediated by the medial olivocochlear efferent reflex, which suppresses the gain of the 'cochlear amplifier' in each ear. Such efferent feedback is important for promoting discrimination of sounds in background noise, sound localization and protecting the cochleae from acoustic overstimulation. However, the sensory driver for the olivocochlear reflex is unknown. Here, we resolve this longstanding question using a mouse model null for the gene encoding the type III intermediate filament peripherin (Prph). Prph((-/-)) mice lacked type II spiral ganglion neuron innervation of the outer hair cells, whereas innervation of the inner hair cells by type I spiral ganglion neurons was normal. Compared with Prph((+/+)) controls, both contralateral and ipsilateral olivocochlear efferent-mediated suppression of the cochlear amplifier were absent in Prph((-/-)) mice, demonstrating that outer hair cells and their type II afferents constitute the sensory drive for the olivocochlear efferent reflex

An ultrasonographic evaluation of skin thickness in breast cancer patients after postmastectomy radiation therapy

Abstract Background To determine the usefulness of ultrasonography in the assessment of post radiotherapy skin changes in postmastectomy breast cancer patients. Methods Patients treated for postmastectomy radiotherapy in National University Hospital (NUH) and Tan Tock Seng Hospital (TTSH), Singapore between January 2004- December 2005 was recruited retrospectively. Ultrasound scan was performed on these Asian patients who had been treated to a total dose of 46-50 Gy with 1 cm bolus placed on the skin. The ultrasound scans were performed blinded to the RTOG scores, and the skin thickness of the individually marked points on the irradiated chest wall was compared to the corresponding points on the non-irradiated breast. Results The mean total skin thickness inclusive of the epidermis and the dermis of the right irradiated chest wall was 0.1712 mm (± 0.03392 mm) compared with the contra-lateral non-irradiated breast which was 0.1845 mm (± 0.04089 mm; p = 0.007). The left irradiated chest wall had a mean skin thickness of 0.1764 mm (± 0.03184 mm) compared with the right non-irradiated breast which was 0.1835 mm (± 0.02584 mm; p = 0.025). These independent t-tests produced a significant difference of reduced skin thickness on the right irradiated chest wall, p = 0.007 (p Conclusions This study has shown that there is a statistically significant difference between the skin thicknesses of the irradiated chest wall and the contra-lateral non-irradiated breast and a predisposition to chronic reactions was found in patients with acute RTOG scoring of grade1 and grade 2.</p

Recovery of end-organs and improved mortality in adult patient on ECMO.

Title: Recovery of End-Organs and Improved Mortality in Adult Patients on ECMO Joshua K Wong, BS1, Vei Shaun Siow, BS1, Thomas N Smith, BS1, Harrison Pitcher, MD2, Linda Bogar, MD2, Hitoshi Hirose, MD2 and Nicholas C Cavarocchi, MD2. 1Jefferson Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, United States, 19107 and 2Division of Cardiothoracic Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, United States, 19107. Body: With increasing use of ECMO in adults, we seek to objectively measure End-Organ recovery and correlate intensive care mortality scores and complications with patient survival. This is a retrospective review of patients who were placed on ECMO from Oct 2010 to Dec 2011. End-Organ function was measured through Pa02/Fi02 ratios, lactate levels, MELD and mortality scores (SAPSII/APACHEII/SOFA). Complications were recorded and analyzed. Twenty-three patients were placed on VA-ECMO and 5 on VV-ECMO. 22 (73%) patients were successfully weaned off ECMO, and 13 (46%) survived to discharge. In 12 patients with liver injury pre-ECMO, the median MELD score was 21 vs 13 post-ECMO (

Pretravel plans and discrepant trip experiences among travelers attending a tertiary care centre family travel medicine clinic

Background International travel can expose travelers to a number of health risks. Pretravel consultation (PC) helps mitigate risk and prepare travelers for health concerns that might arise. The assessment of risk, mitigation strategies, and relevance of pretravel advice is dependent on how closely travelers adhere to their planned travel itinerary and activities. We determined the proportion of returned travelers whose completed travel experiences differed from their stated travel itineraries, and identified discrepancies that significantly altered the traveler\u27s health risk and would have required alternative counseling during their PC. Methods We conducted a prospective cohort study at the SickKids\u27 Family Travel Clinic between October 2014 and November 2015. Returned travelers who completed a post-travel survey were included. Pretravel consultation assessments and post-trip surveys were compared to identify discrepant trip experiences. Results A total of 389 travelers presented to the clinic for a PC during the study period and 302 (77.6%) were enrolled. Post-travel surveys were received from 119 (39.4%) participants, representing 101 unique itineraries. The median participant age was 36.3 years (IQR 26.6- 47.5) and there were 73 female travelers (61%). Most participants (n = 87,73%) were healthy as well as Canadian born (n = 84, 71%). A quarter of travelers were visiting friends and relatives (VFR) (n = 30, 25.2%). The vast majority of returned travelers (n = 109, 92%) reported discrepant trip experiences involving trip duration, countries visited, accommodations, environmental surroundings and/or activities. Almost two thirds of these individuals (n = 68, 62%) would have required alternative pretravel counseling. We did not identify any demographic or planned trip characteristics that predicted discrepant trip experiences requiring alternative pretravel counseling. Conclusions The majority of travelers reported discrepant trip experiences and the discrepancies often affected health risk. Therefore, clinicians should consider providing broader counselling during the PC as discrepancies from planned travel are common

Accessibility-as-a-service an open-source reading assistive tool for education

As technology evolves, more and more articles and materials are readily available on the internet for the world to use. This project proposes and demonstrates the implementation of an application to further increase the accessibility of web pages, through the use of image recognition techniques, object detection, and optical character recognition (OCR). The proposed application allows users to input URLs and the application will process the web page in under a minute and outputs a modified web page with translated words detected from images

Social Knowledge Creation: Three Annotated Bibliographies

In 2012-2013 a team led by Ray Siemens at the Electronic Textual Cultures Lab (ETCL), University of Victoria, in collaboration with Implementing New Knowledge Environments (INKE), developed three annotated bibliographies under the rubric of social knowledge creation. The items for the bibliographies were gathered and annotated by members of the Electronic Textual Cultures Lab (ETCL) to form this tripartite document as a resource for students and researchers involved in the iNKE team and well beyond, iincluding at digital humanities seminars in Bern (June 2013) and Leipzig (July 2013)

Being Healthy: a Grounded Theory Study of Help Seeking Behaviour among Chinese Elders living in the UK

The health of older people is a priority in many countries as the world’s population ages. Attitudes towards help seeking behaviours in older people remain a largely unexplored field of research. This is particularly true for older minority groups where the place that they have migrated to presents both cultural and structural challenges. The UK, like other countries,has an increasingly aging Chinese population about who relatively little is known. This study used a qualitative grounded theory design following the approach of Glaser (1978). Qualitative data were collected using semi-structured interviews with 33 Chinese elders who were aged between 60 and 84, using purposive and theoretical sampling approaches. Data were analysed using the constant comparative method until data saturation occurred and a substantive theory was generated. ‘Being healthy’ (the core category) with four interrelated categories: self-management, normalizing/minimizing, access to health services, and being cured form the theory. The theory was generated around the core explanations provided by participants and Chinese elders’ concerns about health issues they face in their daily life. We also present data about how they direct their health-related activities towards meeting their physical and psychological goals of being healthy. Their differential understanding of diseases and a lack of information about health services were potent predictors of non�help seeking and ‘self’ rather than medical management of their illnesses. This study highlights the need for intervention and health support for Chinese elders

Investigating the Direct Meltwater Effect in Terrestrial Oxygenâ Isotope Paleoclimate Records Using an Isotopeâ Enabled Earth System Model

Variations in terrestrial oxygenâ isotope reconstructions from ice cores and speleothems have been primarily attributed to climatic changes of surface air temperature, precipitation amount, or atmospheric circulation. Here we demonstrate with the fully coupled isotopeâ enabled Community Earth System Model an additional process contributing to the oxygenâ isotope variations during glacial meltwater events. This process, termed â the direct meltwater effect,â involves propagating large amounts of isotopically depleted meltwater throughout the hydrological cycle and is independent of climatic changes. We find that the direct meltwater effect can make up 15â 35% of the δ18O signals in precipitation over Greenland and eastern Brazil for large freshwater forcings (0.25â 0.50 sverdrup (106 m3/s)). Model simulations further demonstrate that the direct meltwater effect increases with the magnitude and duration of the freshwater forcing and is sensitive to both the location and shape of the meltwater. These new modeling results have important implications for past climate interpretations of δ18O.Key PointsA portion of the δ18O signal in landâ based paleoclimate proxies can be attributed to the direct meltwater effect instead of climatic changesThe direct meltwater effect can make up 15â 35% of the δ18O signals in precipitation in Greenland and eastern Brazil for large meltwater eventsThe direct meltwater effect increases with the magnitude and duration of the freshwater forcing and is sensitive to location and shape dependentPeer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/141374/1/grl56782_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/141374/2/grl56782-sup-0001-Supporting_Information.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/141374/3/grl56782.pd

Circulating leukocyte telomere length is highly heritable among families of Arab descent

Background Telomere length, an indicator of ageing and longevity, has been correlated with several biomarkers of cardiometabolic disease in both Arab children and adults. It is not known, however, whether or not telomere length is a highly conserved inheritable trait in this homogeneous cohort, where age-related diseases are highly prevalent. As such, the aim of this study was to address the inheritability of telomere length in Saudi families and the impact of cardiometabolic disease biomarkers on telomere length. Methods A total of 119 randomly selected Saudi families (123 adults and 131 children) were included in this cross-sectional study. Anthropometrics were obtained and fasting blood samples were taken for routine analyses of fasting glucose and lipid profile. Leukocyte telomere length was determined using quantitative real time PCR. Results Telomere length was highly heritable as assessed by a parent-offspring regression [h2 = 0.64 (p = 0.0006)]. Telomere length was modestly associated with BMI (R2 0.07; p-value 0.0087), total cholesterol (R2 0.08; p-value 0.0033), and LDL-cholesterol (R2 0.15; p-value 3 x 10-5) after adjustments for gender, age and age within generation. Conclusion The high heritability of telomere length in Arab families, and the associations of telomere length with various cardiometabolic parameters suggest heritable genetic fetal and/or epigenetic influences on the early predisposition of Arab children to age-related diseases and accelerated ageing