Maintaining body temperature during surgery.
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Humans↗
Biomedical subjects
B E Scammell
Publications and source records attributed to B E Scammell.
Developing learning outcomes for an ideal MSc course in sports and exercise medicine.
OBJECTIVE: To develop learning outcomes for an ideal MSc in sports and exercise medicine. METHODS: Twenty nine learning outcomes were developed based on the learning outcomes, aims, and objectives of current sports medicine courses, occupational standards, and other related data. Using a Likert scale, the opinion of MSc/Dip course directors in the United Kingdom, Ireland, Australia, New Zealand, and South Africa as well as teachers, graduates, and students of the MSc/Dip course at the University of Nottingham were surveyed. An email questionnaire listing the 29 learning outcomes was sent to the subjects. A mixed reminder via email or mail was used. The results were treated as ordinal data, and reliability and internal consistency of the questionnaire was tested using Cronbach's coefficient alpha. RESULTS: Response rates were high (75% course directors, 79%, 54%, and 78% University of Nottingham teachers, graduates, and students respectively). The questionnaire was highly reliable (alpha>0.8). The total scores of all but one of the responders were above the midpoint (>87, possible range 29-145). Most course directors (>80%) agreed or strongly agreed with each of the learning outcomes, except two. Most of the other subjects also agreed or strongly agreed with the learning outcomes, with few exceptions. CONCLUSION: The results suggest that there is a consensus among subjects that the final listed learning outcomes should be included in an ideal MSc in sports and exercise medicine.
Attitude of Health Personnel↗
The value of combining single photon emission computerised tomography and computerised tomography in the investigation of spondylolysis.
The aim of this study was to assess the diagnostic value of combining single photon emission computerised tomography (SPECT) with reverse gantry computerised tomography (rg-CT) in the investigation of spondylolysis. Patient characteristics and imaging results in 118 patients, aged 8-44 years, with low back pain (LBP) were analysed. SPECT showed increased scintigraphic uptake in 80 patients, and spondylolysis was identified on rg-CT in 53. The Cohen Kappa ratio of 0.362 (95% CI: 0.198-0.526) suggests only fair agreement for the result of increased scintigraphic activity with the finding of spondylolysis on rg-CT. We conclude that these investigations give mutually exclusive information, which leads to four diagnostic categories. When there was increased scintigraphic activity on SPECT, 58.8% (95% CI: 48.0-69.5%) of patients had spondylolysis on rg-CT. With rest from provoking activities, these lesions may heal. We interpret the findings of increased scintigraphic activity, but no spondylolysis demonstrated on rg-CT as indicating a bone stress response. These also require rest from provoking activity to prevent a stress fracture developing. In this study, 84.2% (95% CI: 72.67-95.8%) of those patients without increased activity on SPECT had no spondylolysis identified on rg-CT. These patients may need further investigations such as magnetic resonance imaging (MRI) to diagnose pathology, which typically does not involve the posterior elements--but rest from sport may not be so important. There were five patients in our study, without increased scintigraphic activity, but in whom bilateral chronic-appearing (wide separation, smooth sclerotic bone margins) spondylolyses were identified at L5. These all were anticipated from previous plain radiographs or MRI. This group will almost certainly not heal, and if the spondylolyses are the cause of pain these vertebrae will need stabilisation by surgery if physiotherapy fails.
Adolescent↗
Electromagnetic augmentation of antibiotic efficacy in infection of orthopaedic implants.
Infection of orthopaedic implants is a significant problem, with increased antibiotic resistance of adherent 'biofilm' bacteria causing difficulties in treatment. We have investigated the in vitro effect of a pulsed electromagnetic field (PEMF) on the efficacy of antibiotics in the treatment of infection of implants. Five-day biofilms of Staphylococcus epidermidis were grown on the tips of stainless-steel pegs. They were exposed for 12 hours to varying concentrations of gentamicin or vancomycin in microtitre trays at 37 degrees C and 5% CO2. The test group were exposed to a PEMF. The control tray was not exposed to a PEMF. After exposure to antibiotic the pegs were incubated overnight, before standard plating onto blood agar for colony counting. Exposure to a PEMF increased the effectiveness of gentamicin against the five-day biofilms of Staphylococcus epidermidis. In three of five experiments there was reduction of at least 50% in the minimum biofilm inhibitory concentration. In a fourth experiment there was a two-log difference in colony count at 160 mg/l of gentamicin. Analysis of variance (ANOVA) confirmed an effect by a PEMF on the efficacy of gentamicin which was significant at p < 0.05. There was no significant effect with vancomycin.
Analysis of Variance↗
Methicillin-resistant Staphylococcus aureus incidence and outcome in patients with neck of femur fractures.
Since the 1980s, methicillin-resistant Staphylococcus aureus (MRSA) has been identified as a significant infectious agent with an increasing incidence within both hospitals and the community. The aim of this study was to measure the incidence of MRSA colonization in patients admitted with a neck of femur fracture requiring implant surgery and to assess the outcome of these cases. We also sought to identify any risk factors associated with MRSA colonization, and to assess the need for any prophylactic treatment to prevent postoperative MRSA infection. Nasal, perineal and (where present) wound site swabs were taken on a sequential series of patients admitted with a neck of femur fracture who required a surgical implant. The presence of MRSA isolates from these swabs and the presence of a significant postoperative infection in both the colonized and non-colonized patients were recorded. A total of 66 patients were enrolled in the study, of whom 63 had surgical treatment for their fracture. A total of four patients were found to be colonized with MRSA. Of the study group, 27 patients had been admitted to hospital in the previous year, three of whom were found to be colonized with MRSA. Four of the patients were noted to have a postoperative infection-all of these cases were in the non-colonized group. The incidence of MRSA colonized patients in this series was 6%-a figure broadly consistent with previous studies. This does not appear to justify the routine screening of all neck of femur fracture admissions, though the results do suggest that a selective policy of screening only those who patients who had been admitted to hospital within the last year may be profitable. Our study does not appear to show any correlation between MRSA colonization and postoperative infection however. This is consistent with previous studies and does not support the adoption of an aggressive strategy for detection or eradication of MRSA prior to neck of femur fracture surgery.
Cross Infection↗
Reduced bone formation in UK Gulf War veterans: a bone histomorphometric study.
AIMS: Gulf War veterans report a high prevalence of musculoskeletal symptoms. The aim of this study was to establish whether there were abnormalities in bone turnover and remodelling in a group of symptomatic subjects who had served in the Gulf War. METHODS: Iliac crest bone biopsies were obtained from 17 Gulf War veterans who were seeking litigation and compared with those of 13 age and sex matched healthy controls. Bone histomorphometry was performed using image analysis. RESULTS: Cancellous bone area was significantly lower in Gulf War veterans than in control subjects (p = 0.027) and this was associated with a significantly reduced mineral apposition rate (p = 0.002), mean wall width (p < 0.0001), and bone formation rate at the tissue level (p < 0.0001). CONCLUSIONS: These results demonstrate that in this group of Gulf War veterans there was a significant reduction in bone formation at both the cellular and tissue level and this was associated with a reduction in cancellous bone area. The cause of these abnormalities is unknown but might be related to potentially harmful exposures during service in the Gulf War or to changes in life style as a result of chronic ill health. The clinical relevance of the observed reduction in bone formation remains to be established.
Adult↗
Electromagnetic fields for bone healing.
Electrical stimulation has been applied in a number of different ways to influence tissue healing. Most of the early work was carried out by orthopedic surgeons looking for new ways of enhancing fracture healing, particularly those fractures that had developed into nonunions. Electrical energy can be supplied to a fracture by direct application of electrodes or inducing current by use of pulsed electromagnetic field or capacitive coupling. Many of these techniques have not been standardized, so interpretation of the literature can be difficult and misleading. Despite this, there have been a few good laboratory and clinical studies to investigate the effect of electrical stimulation on fracture healing, which are reviewed. These do not permit recommendation or rejection of the technique per se; however, there is some room for optimism. The authors present some of the guidelines for using this treatment modality but suggest that all treatment should be carried out as part of a clinical trial in order to generate reliable data.
Journal Article↗
Reduced bone formation after exposure to organophosphates.
Bone histomorphometric analysis in 24 agricultural workers with chronic organophosphate exposure showed significantly lower bone formation at tissue and cellular level than in healthy controls.
Agricultural Workers' Diseases↗
A new role for the chondrocyte in fracture repair: endochondral ossification includes direct bone formation by former chondrocytes.
We studied the endochondral ossification that occurs during the transition of soft to hard callus during fracture healing in the rabbit. During this process, parts of the cartilaginous soft callus are invaded by capillaries, and new bone is laid down onto the central unresorbed cartilage struts. We found that the chondrocytes within these cartilage struts changed phenotype and became bone-forming cells which directly replaced the central cartilage core with bone matrix. We have termed this bone "lacunar" bone to distinguish it from the "vascular" bone laid down by osteoblasts. With time the lacunar bone spread beyond the confines of the lacunae and gradually replaced all the cartilage matrix that was originally present in the early endochondral spicules. The lacunar bone could still be distinguished from the vascular bone as follows: (1) it was woven bone, whereas vascular bone was lamellar bone; (2) it contained acid phosphatase activity, whereas vascular bone did not; and (3) it had strong antigenicity for bone sialoprotein, whereas this noncollagenous protein was undetectable in vascular bone. Eventually the hard callus was resorbed and remodeled, but at an interim period of endochondral ossification the direct replacement of cartilaginous callus by the formation of lacunar bone is a rapid mechanism by which the mechanical strength of fracture callus is increased.
Acid Phosphatase↗
Biomechanics of intra-articular and extra-articular reconstruction of the anterior cruciate ligament.
Many methods of reconstruction for ACL deficiency have been described, but little is known about their biomechanical properties. We examined extra-articular (EA), intra-articular (IA) and combined (EA+IA) reconstructions in ten cadaver knees after the ACL had been ruptured by the performance of a rapid anterior drawer movement. Stability at each stage before and after rupture and reconstruction was tested by anterior drawer, Lachman, varus-valgus and tibial rotation tests. Both IA and IA+EA reconstructions restored normal stability, while EA reconstructions improved stability but did not restore it to normal. The addition of an EA procedure to an IA procedure made no difference to knee stability. We conclude that in cases of isolated ACL deficiency there is no biomechanical basis for EA reconstruction, either alone or in addition to an IA reconstruction.
Aged↗
Results of proctocolectomy for Crohn's disease.
Seventy-four patients have had a one-stage proctocolectomy for the management of Crohn's disease. Indications for operation were: acute colitis 28 per cent, chronic colitis 39 per cent, perianal disease 13 per cent, proctitis and perianal disease 8 per cent, bleeding 5 per cent, coexisting colonic malignancy 7 per cent. There were two hospital deaths (2.7 per cent), both associated with sepsis. Late deaths (n = 13) were most commonly associated with reoperations for recurrent disease (n = 3), cardiovascular disease (n = 4) and colorectal carcinoma (n = 1). Postoperative complications were principally associated with sepsis. Cumulative reoperation rates at 5 and 10 years were 19 and 24 per cent respectively. Recurrence was unrelated to the age of the patients, the duration of disease, or the presence of ileal disease at the time of colectomy.
Adolescent↗
The unrestrained coach passenger--an injury complex.
Details are given of the injuries sustained by 16 occupants of a coach that overturned. An injury of the forequarter common to 10 patients is described. An explanation for this injury complex is proposed and its prevention is discussed.
Accidents, Traffic↗
Delayed perineal wound healing after proctectomy for Crohn's colitis.
The rate of perineal wound healing was assessed in a series of 112 patients undergoing proctectomy for Crohn's colitis. Healing was impaired in patients with a high fistula-in-ano or a rectovaginal fistula pre-operatively, faecal contamination and postoperative perineal sepsis. Early healing (within 12 weeks) occurred in 63 per cent of the patients. Healing was delayed by over one year in 21 patients, and in 10 patients the perineal wounds never healed.
Adult↗
Influence of rectal washout on bacterial counts in the rectal stump.
Forty-three patients undergoing a restorative colorectal resection were randomized to have their rectal stump washed out with either 0.9 per cent saline, 2.5 per cent povidone-iodine or 0.3 per cent sodium hypochlorite. The bacterial counts before and after washout for Escherichia coli and Bacteroides fragilis were compared using the Mann-Whitney U test. There was no significant difference in the counts for E. coli before and after washout with saline (log 9.7-log 9.7 organisms/ml) and saline had no influence on the counts of B. fragilis (log 7.9-log 6.5 organisms/ml). Hypochlorite was associated with a significant reduction in E. coli counts (log 6.1-log 1.1 organisms/ml, P less than 0.005) and the counts of B. fragilis (log 8.1-log 0.0 organisms/ml, P less than 0.005). The counts of B. fragilis were significantly reduced by povidone-iodine (log 8.1-log 1.1 organisms/ml, P less than 0.005) but there was no significant reduction in counts of E. coli (log 5.6-log 5.3 organisms/ml). The data suggest that sodium hypochlorite is better than povidone-iodine or saline as a rectal washout for colorectal anastomosis.
Bacteroides fragilis↗