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Journal articleYork T, Raj S, Ashdown T, et al., 2023, , BMC Medical Education, Vol: 23, Pages: 1-10, ISSN: 1472-6920
BackgroundTraumatic musculoskeletal injuries are a common presentation to emergency care, the first-line investigation often being plain radiography. The interpretation of this imaging frequently falls to less experienced clinicians despite well-established challenges in reporting. This study presents novel data of clinicians’ confidence in interpreting trauma radiographs, their perception of AI in healthcare, and their support for the development of systems applied to skeletal radiography.MethodsA novel questionnaire was distributed through a network of collaborators to clinicians across the Southeast of England. Over a three-month period, responses were compiled into a database before undergoing statistical review.ResultsThe responses of 297 participants were included. The mean self-assessed knowledge of AI in healthcare was 3.68 out of ten, with significantly higher knowledge reported by the most senior doctors (Specialty Trainee/Specialty Registrar or above = 4.88). 13.8% of participants reported an awareness of AI in their clinical practice.Overall, participants indicated substantial favourability towards AI in healthcare (7.87) and in AI applied to skeletal radiography (7.75). There was a preference for a hypothetical system indicating positive findings rather than ruling as negative (7.26 vs 6.20).ConclusionsThis study identifies clear support, amongst a cross section of student and qualified doctors, for both the general use of AI technology in healthcare and in its application to skeletal radiography for trauma. The development of systems to address this demand appear well founded and popular. The engagement of a small but reticent minority should be sought, along with improving the wider education of doctors on AI.
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Book chapterHopkins M, McMenemy L, Turner S, et al., 2023, , Blast Injury Science and Engineering A Guide for Clinicians and Researchers Second Edition, Pages: 447-478
Major limb amputation affects millions of people worldwide and became a common procedure in the latter years of the conflicts in Afghanistan and Iraq. Prosthetic devices are commonly introduced to lower-limb amputees to assist with mobility and functionality. Despite vast leaps in the technology of lower-limb prostheses, acceptance of a prosthesis is limited by the quality of interfacing between the residuum and the device. No single design fits all, and production of a socket is a complex task, requiring significant skill and expertise from the prosthetist. The fit and pressure distribution of the socket can significantly impact the health of the soft tissue, leading to conditions such as pressure sores if not properly managed. The residuum-socket interface is further complicated by natural volume fluctuations of the limb, issues with thermoregulation, infections and musculoskeletal pathologies. Researchers, clinicians and industry have attempted to better understand and inform optimal socket fit through computational and hardware methods, and surgical techniques such as direct skeletal fixation have been proposed to bypass the socket altogether. This chapter explores the nature of the prosthetic socket, common issues users present and methods to improve the interface between the residual limb and the prosthesis.
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Book chapterMcGregor AH, 2023, , Blast Injury Science and Engineering A Guide for Clinicians and Researchers Second Edition
This section builds on the journey of blast injury and the success of work to prevent and mitigate injury and the success of our clinical management of blast injuries. This short overview describes some of the factors that are discussed in the following chapters relating to long-term quality of life for survivors of blast injuries.
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Book chapterAnderson KM, McGregor AH, Masouros SD, et al., 2023, , Blast Injury Science and Engineering A Guide for Clinicians and Researchers Second Edition, Pages: 437-446
Continued advances are required to address mobility limitations caused by lower extremity blast injury. Individuals who experience persistent deficits following trauma may benefit from external support and/or offloading provided by ankle foot orthoses (AFOs). Currently available AFOs vary widely in their design and potential benefit. Carbon fibre custom dynamic ankle foot orthoses (CDOs) have been increasingly used to improve mobility after traumatic injury. CDOs are made predominantly from carbon fibre and are intended to restore function across a range of daily and high-energy activities. Patient-reported outcomes, physical performance measures, and biomechanics data from studies focusing on CDO use have demonstrated positive outcomes. CDOs consist of a proximal cuff, posterior carbon fibre strut, and footplate, which can be tuned to meet the needs of the patient. Available literature provides guidance related to key design considerations during the fitting process. Further, intensive training when combined with the CDO has been found to enhance clinical outcomes and facilitate successful return to high-energy activity. A majority of available data related to CDO use following limb trauma is focused on a subset of military personnel, and available civilian data is limited.
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Book chapterSilverman AK, Hendershot BD, McGregor AH, 2023, , Blast Injury Science and Engineering A Guide for Clinicians and Researchers Second Edition, Pages: 489-497
Rehabilitation after blast injury is critical for regaining mobility and functional independence. In addition to immediate rehabilitation goals to facilitate activities of daily living, rehabilitation should address movement patterns and prosthetic interventions that mitigate long-term secondary (musculoskeletal) conditions. For example, after limb loss, which is a common result of blast trauma, people experience disproportionately high rates of osteoarthritis and low back pain relative to the general population. These conditions often develop and/or deteriorate over time and can have detrimental effects on mobility and quality of life. In this chapter, we describe and summarise existing knowledge of these musculoskeletal conditions secondary to blast injuries that include limb loss. Relationships between movement strategies and biomechanical outcomes are also discussed. While many musculoskeletal health conditions are multifactorial in onset and progression, these conditions are strongly related to movement biomechanics, and thus can be mitigated through rehabilitation approaches. Specifically, rehabilitation strategies that balance immediate goals of clinical outcomes and community engagement with long-term goals of healthy joint mechanics are critical for this population. In addition, rehabilitation and prosthetic interventions should be continually monitored and delivered so that they appropriately account for movement adaptations and changing mobility needs of the individual.
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Book chapterKaufmann JJ, McMenemy L, Phillips ATM, et al., 2023, , Blast Injury Science and Engineering A Guide for Clinicians and Researchers Second Edition, Pages: 479-488
Bone mineral density (BMD) loss in lower-limb amputees has in the past been referred to as either osteopenia or osteoporosis. However, evidence and hypotheses in emerging literature are beginning to challenge this, suggesting that the use of these terms could be inappropriate due to key differences in the aetiology and mechanisms underpinning the bone loss in the younger amputee population. Computational and clinical analysis carried out within the Centre for Blast Injury Studies at Imperiaand the ADVANCE Study has provided strong evidence to support this stance. Investigating BMD discordance in the spine and femur of 153 lower-limb amputees and a frequency-matched control population has shown that bone loss in amputees is localised to the amputated limb rather than systemic (as it manifests in age-related osteoporosis). Combined musculoskeletal and finite element modelling goes some way to explaining the cause of this. Weight bearing through a prosthetic socket offloads the distal femur, and consequently large areas of the femoral shaft and neck experience significantly reduced levels of stimulation when compared to weight bearing on a healthy limb. The long-term result of this is a phenomenon that we refer to as unloading osteopenia.
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Journal articleBarrie A, Kent B, Supra Man Collaborative, 2023, , Bone Joint J, Vol: 105-B, Pages: 82-87
AIMS: Management of displaced paediatric supracondylar elbow fractures remains widely debated and actual practice is unclear. This national trainee collaboration aimed to evaluate surgical and postoperative management of these injuries across the UK. METHODS: This study was led by the South West Orthopaedic Research Division (SWORD) and performed by the Supra Man Collaborative. Displaced paediatric supracondylar elbow fractures undergoing surgery between 1 January 2019 and 31 December 2019 were retrospectively identified and their anonymized data were collected via Research Electronic Data Capture (REDCap). RESULTS: A total of 972 patients were identified across 41 hospitals. Mean age at injury was 6.3 years (1 to 15), 504 were male (52%), 583 involved the left side (60%), and 538 were Gartland type 3 fractures (55%). Median time from injury to theatre was 16 hours (interquartile range (IQR) 6.6 to 22), 300 patients (31%) underwent surgery on the day of injury, and 91 (9%) underwent surgery between 10:00 pm and 8:00 am. Overall, 910 patients (94%) had Kirschner (K)-wire) fixation and these were left percutaneous in 869 (95%), while 62 patients (6%) had manipulation under anaesthetic (MUA) and casting. Crossed K-wire configuration was used as fixation in 544 cases (59.5%). Overall, 208 of the fixation cases (61%) performed or supervised by a paediatric orthopaedic consultant underwent lateral-only fixation, whereas 153 (27%) of the fixation cases performed or supervised by a non-paediatric orthopaedic consultant used lateral-only fixation. In total, 129 percutaneous wires (16%) were removed in theatre. Of the 341 percutaneous wire fixations performed or supervised by a paediatric orthopaedic consultant, 11 (3%) underwent wire removal in theatre, whereas 118 (22%) of the 528 percutaneous wire fixation cases performed or supervised by a non-paediatric orthopaedic consultant underwent wire removal in theatre. Four MUA patients (6%) and seven K-wire fixation patients (0.
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Journal articleNewington L, Alexander C, Kirby P, et al., 2022, , PLoS One, Vol: 17, ISSN: 1932-6203
Objectives:The aims of this study were to explore individuals’ experiences of contributing to health research and to identify the types of impact that are perceived as important by participants or patient and public advisors. Specifically, research led by NMAHPP clinicians (Nursing, Midwifery, Allied health professions, Healthcare science, Psychology and Pharmacy).Methods:Semi-structured one-to-one interviews were conducted with health research participants and patient or public advisors. Interviewees were recruited from five UK sites and via social media. Interview transcripts were analysed using Thematic Analysis to identify key themes and areas of disagreement.Results:Twenty-one interviews were completed, and four main themes were identified. The first, optimising research experiences, included personal reflections and broader recommendations to improve participant experiences. The second, connecting health research with healthcare, described research as key for the continued development of healthcare, but illustrated that communication between research teams, participants, and clinicians could be improved. The third theme explored the personal impacts of contributing to research, with interviewees recalling common positive experiences. The final theme discussed capturing research impacts. Interviewees highlighted potential priorities for different stakeholders, but emphasised that financial impacts should not be the sole factor.Conclusion:Individuals who were involved in NMAHPP health research recalled positive experiences and reported good relationships with their research teams. They felt that their contributions were valued. Suggested strategies to optimise the research experience focused on simplifying documentation, clear signposting of the research activities involved, and feedback on the research findings. Routine sharing of relevant research data with clinicians was also recommended. Personal impacts included a deeper understanding of their health
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Journal articleBottle A, Liddle A, 2022, , BMJ Quality & Safety, Vol: 32, Pages: 244-246, ISSN: 2044-5423
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Journal articlevan Helden JFL, Martinez-Valdes E, Strutton PH, et al., 2022, , Journal of Electromyography and Kinesiology, Vol: 67, ISSN: 1050-6411
PURPOSE: To establish intra- and inter-session reliability of high-density surface electromyography (HDEMG)-derived parameters from the thoracic erector spinae (ES) during static and dynamic goal-directed voluntary movements of the trunk, and during functional reaching tasks. METHODS: Twenty participants performed: 1) static trunk extension, 2) dynamic trunk forward and lateral flexion, and 3) multidirectional functional reaching tasks on two occasions separated by 7.5 ± 1.2 days. Muscle activity was recorded bilaterally from the thoracic ES. Root mean square (RMS), coordinates of the barycentre, mean frequency (MNF), and entropy were derived from the HDEMG signals. Reliability was determined with intraclass correlation coefficient (ICC), coefficient of variation, and standard error of measurement. RESULTS: Good-to-excellent intra-session reliability was found for all parameters and tasks (ICC: 0.79-0.99), whereas inter-session reliability varied across tasks. Static tasks demonstrated higher reliability in most parameters compared to functional and dynamic tasks. Absolute RMS and MNF showed the highest overall reliability across tasks (ICC: 0.66-0.98), while reliability of the barycentre was influenced by the direction of the movements. CONCLUSION: RMS and MNF derived from HDEMG show consistent inter-session reliability in goal-directed voluntary movements of the trunk and reaching tasks, whereas the measures of the barycentre and entropy demonstrate task-dependent reliability.
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Journal articleAllen JE, Clunie G, Ma JK-Y, et al., 2022, , Dysphagia, Vol: 37, Pages: 1586-1598, ISSN: 0179-051X
Ultrasound (US) has an emerging evidence base for the assessment of swallowing and laryngeal function. Accessibility and technological advances support the use of US as a clinical assessment tool; however, there is insufficient evidence to support its translation into clinical practice. This study aimed to establish consensus on the priorities for translation of US into clinical practice for the assessment of swallowing and laryngeal function. Nominal Group Technique (NGT) was used as a formal method of consensus development. Clinicians and academics, all members of an international US working group, were invited to participate in the study. Two NGT meetings were held, where participants silently generated and then shared ideas. Participants anonymously ranked items. Rankings were aggregated before participants re-ranked items in order of priority. Discussions regarding rankings were recorded and transcribed to inform analysis. Member-checking with participants informed the final analysis. Participants (n = 15) were speech and language pathologists, physiotherapists and sonographers representing six countries. Fifteen items were identified and prioritised 1–13 (including two equally ranked items). Reliability, validity and normative data emerged as key areas for research while development of training protocols and engagement with stakeholders were considered vital to progressing US into practice. Analysis revealed common themes that might be addressed together in research, in addition to the ranked priority. A measured approach to the translation of US into clinical practice will enable effective implementation of this tool. Priorities may evolve as clinical and professional contexts shift, but this study provides a framework to advance research and clinical practice in this field.
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Journal articlePanhelleux B, Shalhoub J, Silverman A, et al., 2022, , Vascular, Vol: 30, Pages: 1149-1159, ISSN: 0967-2109
Objectives: Through knee amputation (TKA) is an umbrella term for several different surgical techniques, which may affect clinical and functional outcomes. This makes it hard to evaluate the benefits and need for a TKA approach. This paper seeks to: (1) Determine the number of TKAs performed compared with other major lower limb amputations (MLLA) in England over the past decade; (2) identify the theoretical concepts behind TKA surgical approaches and their potential effect on functional and clinical outcomes; and (3) provide a platform for discussion and research on TKA and surgical outcomes.Methods: National Health Service Hospital Episodes Statistics were used to obtain recent numbers of MLLAs in England. EMBASE and MEDLINE were searched using a systematic approach with predefined criteria for relevant literature on TKA surgery.Results: In the past decade, 4.6% of MLLA in England were TKAs. Twenty-six articles presenting TKA surgical techniques met our criteria. These articles detailed three TKA surgical techniques; the classical approach, which keeps the femur intact and retains the patella; the Mazet technique, which shaves the femoral condyles into a box shape; and the Gritti-Stokes technique, which divides the femur proximal to the level of the condyles and attaches the patella at the distal cut femur.Conclusions: TKA has persisted as a surgical approach over the past decade, with three core approaches identified. Studies reporting clinical, functional, and biomechanical outcomes of TKA frequently fail to distinguish between the 3 distinct and differing approaches, making direct comparisons difficult. Future studies that compare TKA approaches to one another and to other amputation levels are needed.
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Journal articleBehforootan S, Thorniley M, Minonzio J-G, et al., 2022, , Journal of the Mechanical Behavior of Biomedical Materials, Vol: 136, ISSN: 1751-6161
The bone quality of patients undergoing hip replacement surgery is poorly predicted by radiographs alone. With better bone quality information available to a surgeon, the operation can be performed more safely. The aim of this study was to investigate whether ultrasound signals of cortical bone at peripheral sites such as the tibia and radius can be used to predict the compressive mechanical properties of cortical bone at the femoral neck.We recruited 19 patients undergoing elective hip arthroplasty and assessed the radius and tibia of these patients with the Azalée guided wave ultrasound to estimate the porosity and thickness of the cortex. Excess bone tissues were collected from the femoral neck and the compressive mechanical properties of the cortex were characterised under a mechanical loading rig to determine stiffness, ultimate strength, and density. The correlations between the ultrasound measurements and mechanical properties were analysed using linear regression, Pearson correlation statistics, and multiple regression analysis.Cortical mechanical properties were weakly to moderately correlated with the ultrasound measurements at various sites (R2 = 0.00–0.36). The significant correlations found were not consistent across all 4 peripheral measurement sites. Additionally, weak to moderate ability of the ultrasound to predict mechanical properties at the neck of femur with multiple regression analysis was found (R2 = 0.00–0.48). Again, this was inconsistent across the different anatomical sites. Overall, the results demonstrate the need for ultrasound scans to be collected directly from clinically relevant sites such as the femoral neck due to the inconsistency of mechanical properties across various sites.
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Journal articleMiles A, McRae J, Clunie G, et al., 2022, , Dysphagia, Vol: 37, Pages: 1349-1374, ISSN: 0179-051X
COVID-19 has had an impact globally with millions infected, high mortality, significant economic ramifications, travel restrictions, national lockdowns, overloaded healthcare systems, effects on healthcare workers’ health and well-being, and large amounts of funding diverted into rapid vaccine development and implementation. Patients with COVID-19, especially those who become severely ill, have frequently developed dysphagia and dysphonia. Health professionals working in the field have needed to learn about this new disease while managing these patients with enhanced personal protective equipment. Emerging research suggests differences in the clinical symptoms and journey to recovery for patients with COVID-19 in comparison to other intensive care populations. New insights from outpatient clinics also suggest distinct presentations of dysphagia and dysphonia in people after COVID-19 who were not hospitalized or severely ill. This international expert panel provides commentary on the impact of the pandemic on speech pathologists and our current understanding of dysphagia and dysphonia in patients with COVID-19, from acute illness to long-term recovery. This narrative review provides a unique, comprehensive critical appraisal of published peer-reviewed primary data as well as emerging previously unpublished, original primary data from across the globe, including clinical symptoms, trajectory, and prognosis. We conclude with our international expert opinion on what we have learnt and where we need to go next as this pandemic continues across the globe.
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Journal articleNewman H, Clunie G, Wallace S, et al., 2022, , Journal of Critical Care, Vol: 72, Pages: 1-16, ISSN: 0883-9441
Purpose: Tracheostomy is a common surgical procedure in ICU. Whilst often life-saving, it can have important impacts on patients. Much of the literature on tracheostomy focuses on timing and technique of insertion, risk factors and complications. More knowledge of patient experience of tracheostomy in ICU is needed to support person-centred care.Materials and Methods: Qualitative systematic review and metasynthesis of the literature on adult experience of tracheostomy in ICU. Comprehensive search of four bibliographic databases and grey literature. Title and abstract screening and full text eligibility was completed independently by two reviewers. Metasynthesis was achieved using thematic synthesis, supported by a conceptual framework of humanised care.Results: 2971 search returns were screened on title and abstract and 127 full texts assessed for eligibility. Thirteen articles were included for analysis. Five descriptive and three analytical themes were revealed. The over-arching theme was ‘To be seen and heard as a whole person’. Patients wanted to be treated as a human, and having a voice made this easier.Conclusions: Voice restoration should be given high priority in the management of adults with a tracheostomy in ICU. Staff training should focus on both technical skills and compassionate care to improve person-centred outcomes.
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Journal articleHall AJ, Clement ND, Ojeda-Thies C, et al., 2022, , SURGEON-JOURNAL OF THE ROYAL COLLEGES OF SURGEONS OF EDINBURGH AND IRELAND, Vol: 20, Pages: E429-E446, ISSN: 1479-666X
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Journal articleRuparell K, Barve R, Tas RN, et al., 2022, , BMJ OPEN, Vol: 12, ISSN: 2044-6055
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- Citations: 6
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Journal articlevan der Feltz-Cornelis CM, Sweetman J, Allsopp G, et al., 2022, , PLoS One, Vol: 17, ISSN: 1932-6203
IntroductionAs mortality rates from COVID-19 disease fall, the high prevalence of long-term sequelae (Long COVID) is becoming increasingly widespread, challenging healthcare systems globally. Traditional pathways of care for Long Term Conditions (LTCs) have tended to be managed by disease-specific specialties, an approach that has been ineffective in delivering care for patients with multi-morbidity. The multi-system nature of Long COVID and its impact on physical and psychological health demands a more effective model of holistic, integrated care. The evolution of integrated care systems (ICSs) in the UK presents an important opportunity to explore areas of mutual benefit to LTC, multi-morbidity and Long COVID care. There may be benefits in comparing and contrasting ICPs for Long COVID with ICPs for other LTCs.Methods and analysisThis study aims to evaluate health services requirements for ICPs for Long COVID and their applicability to other LTCs including multi-morbidity and the overlap with medically not yet explained symptoms (MNYES). The study will follow a Delphi design and involve an expert panel of stakeholders including people with lived experience, as well as clinicians with expertise in Long COVID and other LTCs. Study processes will include expert panel and moderator panel meetings, surveys, and interviews. The Delphi process is part of the overall STIMULATE-ICP programme, aimed at improving integrated care for people with Long COVID.Ethics and disseminationEthical approval for this Delphi study has been obtained (Research Governance Board of the University of York) as have approvals for the other STIMULATE-ICP studies. Study outcomes are likely to inform policy for ICPs across LTCs. Results will be disseminated through scientific publication, conference presentation and communications with patients and stakeholders involved in care of other LTCs and Long COVID.
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Journal articleBicer M, Phillips ATM, Melis A, et al., 2022, , JOURNAL OF BIOMECHANICS, Vol: 144, ISSN: 0021-9290
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- Citations: 6
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Journal articleRowland S, Fitzgerald EJ, Lungren M, et al., 2022, , npj Digital Medicine, Vol: 5, Pages: 1-6, ISSN: 2398-6352
The global digital health market is worth approximately 300 billion USD1 and is predicted to grow by up to 25% this year. Consequently, medical professionals are increasingly required to use digital technologies such as telehealth platforms, AI-driven clinical decision-making tools, digitally enabled surgical tools, mHealth technologies, or electronic health care records (EHR), as part of care delivery. These technologies hold clear benefits for enabling more efficient, modern care delivery however there are significant challenges to implementation, including when and how to use them, how to enable an accurate medical diagnosis in a virtual environment, interpretation and relevance of novel data points from digital devices, the potential for automation bias, appropriate utilisation of and engagement with digital disease management platforms and continuity of care in a digital world. Several of these issues have become apparent through the pandemic due to the hasty deployment of novel technologies as ‘bolt-on’ solutions to address standalone challenges in healthcare delivery, without consideration of the broader healthcare architecture. The majority of practicing clinicians are not sufficiently trained in how to safely integrate digital health technologies into the clinical workflow before encountering such technologies in practice. The introduction of digital health technologies may therefore represent a risk for medical error and subsequent malpractice liability. Medical malpractice is frequently defined as a physician’s failure to comply with customary medical practice,2 however the application of this standard in the context of digital health is challenging. What are the accepted norms for history and examination during a telehealth consult? How should these be documented on electronic systems? When is it safe to offer digital first solutions for disease management? What is the custom for clinicians to ensure continuity of care? If there is a me
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