Guidelines for the ethical conduct of medical research involving children. Royal College of Paediatrics, Child Health: Ethics Advisory Committee.
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Child↗
Biomedical subjects
P Shelley
Publications and source records attributed to P Shelley.
Journal accessibility through Webpages.
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Abstracting and Indexing↗
Further novel milbemycin antibiotics from Streptomyces sp. E225. Fermentation, isolation and structure elucidation.
Ten novel alpha and beta class milbemycins have been isolated and characterized from the Streptomyces sp. E225, which has previously been shown to produce four related milbemycins. Some of the metabolites contain new structural features including, VM48641 which possesses an alpha-methoxyl substituent at C-27, and VM48642 which contains a furan ring at the terminus of the C-26 side chain. Several of these new compounds were shown to possess potent anthelmintic activity. An analysis of NMR chemical shift trends in this series of metabolites is presented.
Animals↗
Better team management--better team care?
Team building should not be a 'bolt-on' extra, it should be a well planned, integrated part of developing teams and assisting their leaders. When asked to facilitate team building by a group of NHS managers we developed a framework which enabled individual members of staff to become more effective in the way they communicated with each other, their teams and in turn within the organization. Facing the challenge posed by complex organizational changes, staff were able to use 3 training days to increase and develop their awareness of the principles of teamwork, better team management, and how a process of leadership and team building could help yield better patient care.
Education, Nursing, Continuing↗
Managing pain in children. Taking action.
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Adolescent↗
Re-attachment of the un-united trochanter in Charnley low friction arthroplasty.
In a prospective study, a double crossover wire with a compression spring was used to re-attach 52 un-united trochanters at revision operations on total hip arthroplasties. Bony union was achieved in 42 (81%) and was not influenced by the duration of the nonunion or the separation gap. The new method compared favourably with earlier revisions at which other methods of trochanteric re-attachment had been used.
Adult↗
Long-term results of hip arthroplasty for failure of previous surgery.
We report a retrospective review of 127 low friction arthroplasties carried out for the failure of a previous hip operation. After an average follow-up of 10.4 years, 20% of cases required further revision, over half of them for deep infection. We estimated from the radiographic appearances that eventual failure by loosening was probable in 58% on the femoral side and 56% on the acetabular side of the arthroplasties.
Adolescent↗
Socket design and cement pressurisation in the Charnley low-friction arthroplasty.
An experimental evaluation was made of the efficacy of an unflanged cup, an ogee-flanged cup and the Exeter pressuriser in the pressurisation of acetabular cement. Only a very modest injection pressure could be generated through an unflanged socket and even this was readily lost as the socket "bottomed out". The ogee-flanged socket gave a consistently high injection pressure which could be maintained throughout the process of polymerisation. The Exeter pressuriser gave marginally better results. Of the two cements tested, Palacos with gentamicin showed better intrusion than CMW Type 1 cement, but it also allowed greater extrusion once pressure was released. The importance of maintaining a continuous pressure on the cement throughout polymerisation is emphasised.
Bone Cements↗
Mechanical loosening of the stem in Charnley arthroplasties. Identification of the "at risk" factors.
A retrospective review of 72 cases of Charnley low friction arthroplasty revised for stem loosening, has identified a number of "at risk" factors. These were: previous hip surgery and, in radiographs taken at one year, demarcation of the distal cement and fracture of the cement near the tip of the stem. Separation of the back of the stem from the cement, as an isolated feature, was not considered significant. Endosteal cavitation of the femoral shaft, rare in the first year, indicated loosening of some duration. Patients whose radiographs show the "at risk" changes, should be followed-up indefinitely in order to plan timely revision and avoid gross loss of the femoral bone stock.
Adult↗
The correlation between the roentgenographic appearance and operative findings at the bone-cement junction of the socket in Charnley low friction arthroplasties.
In a series of 200 Charnley low friction arthroplasties revised for various reasons, the preoperative anteroposterior roentgenograms were categorized in terms of demarcation at the bone-cement interface of the socket and compared with the operative findings of movement at the bone-cement junction. All sockets showing no demarcation were found to be fixed soundly. Seven percent of the sockets showing demarcation of the outer one-third only were loose, and when two-thirds of the sockets were demarcated, 71% were loose. Ninety-four percent of the sockets with complete demarcation and all sockets that had migrated were found to be loose at revision. There is a definite correlation between roentgenographic demarcation and socket loosening. The more extensive the demarcation, the more likely it is that the socket is loose. Radiographic demarcation of the cemented socket is a prognostic sign for eventual failure.
Adult↗
Deep infection in Charnley low-friction arthroplasty. Comparison of plain and gentamicin-loaded cement.
A retrospective review of 1542 Charnley low-friction arthroplasties was carried out to compare the incidence of deep infection arising after plain and gentamicin-containing acrylic cement. There was no significant difference between the two series in primary operations, the infection rate being 1.72% and 1.65% respectively. However, in secondary operations (conversions and revisions) the gentamicin-containing cement gave significantly better results--a 0.81% infection rate as compared with 3.46%. All operations were performed in a clean air enclosure using total-body exhaust suits. Radiological diagnosis of deep infection was possible within one year of operation in all cases. Late haematogenous infection occurred in one case and was related to a skin lesion.
Adult↗
Reattachment of the greater trochanter after hip replacement.
A method of performing a biplanar intracapsular trochanteric osteotomy with a Gigli saw was designed and tested prospectively in 431 cases of Charnley low friction arthroplasty. Three methods of trochanteric reattachment were tested, and a double cross-over wire with a compression spring was best; this method was successful in 222 out of 226 patients (98.2%), of which half were revision operations. Adduction seemed to be the main movement leading to trochanteric detachment.
Bone Wires↗