Team pay. Sterling innovation.
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Efficiency, Organizational↗
Biomedical subjects
Peter Reilly
Publications and source records attributed to Peter Reilly.
Spiradenocylindrocarcinoma: a malignant hybrid tumor.
BACKGROUND: Eccrine spiradenomas and cylindromas are benign, slowly growing, cutaneous adnexal neoplasms, recently hypothesized to arise from a common pluripotential cell; malignant variants are rare. We found 48 cases of malignant spiradenomas and 33 cases of malignant cylindromas reported in the English literature. Benign tumors demonstrating both spiradenomatous and cylindromatous features have been infrequently reported. Recent immunohistochemical studies of these two tumors have provided compelling evidence that these two tumors may merely represent a single tumor type with a spectrum of histological features. CASE REPORT: We describe two cases of a malignant variant of this rare hybrid tumor occurring in a 62-year-old male and a 72-year-old female. CONCLUSION: We propose the term 'spiradenocylindrocarcinoma' to describe malignant tumors with features of both a spiradenoma and a cylindroma. In conjunction with histological features of malignancy, p53 and Ki-67 immunohistochemical staining may provide helpful clues in determining the malignant potential of this tumor. Further studies are needed to clarify the biologic behavior of such lesions.
Adenoma, Sweat Gland↗
Emergency neurosurgery by general surgeons at a remote major hospital.
BACKGROUND: Due to the geographical remoteness of Darwin, which has no resident neurosurgeon, emergency transfer of patients for neurosurgery is usually impractical. In Darwin emergency neurosurgery must be undertaken by general surgeons. METHODS: Data from the operating theatre, Emergency Department and Intensive Care Unit were prospectively recorded on all patients who underwent an emergency neurosurgical procedure between January 1992 and June 2004. Outcomes were assessed by retrospective case note review. RESULTS: Three hundred and five neurosurgical procedures were performed upon 258 patients (average 26.5 procedures per year), including 130 craniotomies, 88 burr holes, 3 posterior fossa craniotomies, 2 decompressive frontal lobectomies, 4 decompressive craniectomies, 25 elevations of fracture and 33 ventricular drains only. Assault/domestic incident (31%) was a more common aetiology than motor vehicle accidents (29%). Outcome was best for extradural haematoma (82% good/moderate) and chronic subdural haematoma (84% good/moderate). In contrast, 44% with acute subdural haematoma and 77% with intracerebral haematoma died. Irrespective of type of bleed, Glasgow Coma Scale (GCS) score at presentation was a reliable predictor of outcome following surgery (61% correlation): 60% with GCS less than 9 died whereas 79% with GCS over 11 had a good recovery. Acute Physiology And Chronic Health Evaluation, version 2 and Simplified Acute Physiology Score, version 2 scores were also independent predictors of outcome. Time from presentation to operation for extradural haematoma and acute subdural haematoma was prolonged (more than 4 h) in 48% and was associated with worse outcome (P = 0.0001). Neither extremes of age nor the particular surgeon performing the operation affected outcome. CONCLUSIONS: General surgeons undertake a substantial number of procedures across a broad spectrum of emergency neurosurgery in Darwin. Outcomes following surgery appear acceptable.
APACHE↗
A novel technique to measure active tendon forces: application to the subscapularis tendon.
This paper describes the design and use of a novel system for quantification of active tendon forces. An arthroscopically implantable force probe (AIFP) was inserted arthroscopically into the subscapularis tendon of the shoulder in vivo. The output response of this device was calibrated in situ with known forces applied to the tendon using an arthroscopic technique. On recovery of motor control following interscalene regional anaesthesia, the force within the tendon during active muscle contraction was measured. The AIFP was then retrieved through an arthroscopic portal. The technique showed that the subscapularis may produce forces of 250 N during maximum internal rotation of the shoulder.
Arthroscopy↗
Recruiting and developing an effective workforce in the British NHS.
The British NHS faces major challenges recruiting, motivating and retaining staff in a period of sustained growth and change. This paper examines the prevalence of skill shortages and organisations' coping strategies, as well the factors that motivate staff in the workplace and in the NHS in particular. It argues that the evidence base for informed policy-making needs radical improvement. It then considers a number of approaches to pay that are being used or suggested to attract, motivate and retain staff. These include performance pay, team pay and local pay determination, as well as considering broader factors such as morale and staff development. The paper then draws together some conclusions for policy-makers. These argue that better evidence is needed as to what is happening in the public sector labour market in order to frame appropriate responses and that thorough evaluation of policy initiatives is necessary to establish their utility before their widespread implementation.
Employment↗
Retinoid chemoprevention in high-risk skin cancer patients.
More commonly known for their dramatic effects on acne and psoriasis for the past 20 years, systemic retinoids can be a valuable chemopreventive treatment option for those individuals in a wide variety of high-risk populations who are actively developing large numbers of sun-induced skin cancers.
Anticarcinogenic Agents↗
Arthroscopically insertable force probes in the rotator cuff in vivo.
In vivo loading data for the rotator cuff would be of value to scientists and clinicians interested in the shoulder. The Arthroscopically Insertable Force Probe (AIFP; Microstrain, Burlington, VT) offers a potential method for collecting this information. A technique for insertion and retrieval of the AIFP from the subscapularis is described. The method was initially established in a cadaveric model. The AIFP was inserted into the subscapularis tendon in 3 volunteers during diagnostic shoulder arthroscopy. After the motor effects of interscalene block had worn off, dynamic data relating to subscapularis tendon loading was collected. The AIFPs were removed through a port site by traction on a 0 (3.5 metric) nylon suture without complications.
Arthroscopes↗
Passive tension and gap formation of rotator cuff repairs.
The objectives of this study were to quantify the relationship between passive tension of rotator cuff repairs and arm position and to examine the effect of this tension on repair gap formation. Five patients undergoing open surgical rotator cuff repair of the supraspinatus tendon were recruited. Tendon tension was recorded as the supraspinatus was advanced into a bone trough and secured. The relationship between arm position and repair tension was then measured. Standardized rotator cuff tears were created in 3 cadaveric shoulders and repaired by use of the intraoperative technique. The difference in tension measured between 0 degrees and 30 degrees abduction was statically applied for 24 hours and the gap formation measured. Repair tension increased with advancement of the supraspinatus tendon into the bone trough. Abduction reduced the repair load. The mean reduction in load by 30 degrees abduction was 34 N. Twenty-four hours of 34-N loading caused gap formation of 9 mm in cadaveric rotator cuff repairs. Passive tension in surgically repaired rotator cuffs may contribute to repair failure and can be modified by arm positioning.
Adult↗
Supraspinatus tears: propagation and strain alteration.
It was hypothesized that there would be an alteration in strain when macroscopically normal supraspinatus tendons were subjected to three patterns of surgically created tear. The propagation of joint-side partial-thickness tears was also examined. Cadaveric shoulders were tested on a purpose-built rig with static loading from 20 to 200 N and during glenohumeral abduction from 0 degrees to 120 degrees with a 100-N tensile load. Differential variable reluctance transducers were used to calculate strain. Six-millimeter-wide midsubstance full-thickness tears (n = 2) caused an increase in bursal-side strain both with abduction 1.93% (90 degrees ) and with loading 0.33% (150 N). Intratendinous delamination (n = 2) increased joint-side strain during abduction and bursal-side strain with loading. A 2-mm-deep tear across the tendon insertion (n = 5) increased the bursal-side strain in abduction by 3.54% (120 degrees ) and with load by 2.53% (200 N). Tear propagation was observed from joint to bursal sides during abduction. Tendon failure occurred at the insertion.
Aged↗