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Turnbull G, Blacklock C, Akhtar A, Dunstan E, Ballantyne JA. Experience of an anatomic femoral stem in a UK orthopaedic centre beyond 20 years of follow-up. Eur J Orthop Surg Traumatol 2024; 34:2155-2162. [PMID: 38565783 PMCID: PMC11101503 DOI: 10.1007/s00590-024-03901-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 03/07/2024] [Indexed: 04/04/2024]
Abstract
INTRODUCTION Increasing interest in the use of anatomical stems has developed as the prevalence of periprosthetic fractures (PPFs) continues to increase. The primary aim of this study was to determine the long-term survivorship and PPF rate of an anatomical femoral stem in a single UK centre. PATIENTS AND METHODS Between 2000 and 2002, 94 consecutive THAs were performed using the 170 mm Lubinus SP II anatomical femoral stem in our institution. Patient demographics, operative details and clinical outcomes were collected prospectively in an arthroplasty database. Patient records and national radiographic archives were reviewed finally at a mean of 21.5 years (SD 0.7) following surgery to identify occurrence of subsequent revision surgery, dislocation or periprosthetic fracture. RESULTS Mean patient age at surgery was 65.8 years (SD 12.5, 34-88 years). There were 48 women (51%). Osteoarthritis was the operative indication in 88 patients (94%). Analysis of all-cause THA failure demonstrated a survivorship of 98.5% (95% confidence interval [CI], 98.0-99.3%) at 10 years and 96.7% (94.5-98.9%) at 21 years. The 20-year stem survival for aseptic loosening was 100% with no cases of significant lysis found (lucent line > 2 mm) and no stems required revision. Patient demographics did not appear to influence risk of revision (p > 0.05). There were 2 revisions in total (2 for acetabular loosening with original stems retained). There were no PPFs identified at mean 21.5 year follow-up and 5 dislocations (5%). CONCLUSIONS The Lubinus SP II 170 mm stem demonstrated excellent survivorship and negligible PPF rates over 20 years following primary THA.
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Affiliation(s)
- G Turnbull
- National Treatment Centre Fife Orthopaedics, Victoria Hospital, Hayfield Road, Kirkcaldy, KY2 5AH, Scotland, UK.
- The Royal Infirmary of Edinburgh, 51 Little France Cres, Old Dalkeith Rd, Edinburgh, EH16 4SA, Scotland, UK.
| | - C Blacklock
- National Treatment Centre Fife Orthopaedics, Victoria Hospital, Hayfield Road, Kirkcaldy, KY2 5AH, Scotland, UK
| | - A Akhtar
- National Treatment Centre Fife Orthopaedics, Victoria Hospital, Hayfield Road, Kirkcaldy, KY2 5AH, Scotland, UK
| | - E Dunstan
- National Treatment Centre Fife Orthopaedics, Victoria Hospital, Hayfield Road, Kirkcaldy, KY2 5AH, Scotland, UK
| | - J A Ballantyne
- National Treatment Centre Fife Orthopaedics, Victoria Hospital, Hayfield Road, Kirkcaldy, KY2 5AH, Scotland, UK
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Blacklock C, McGlasson C, Chew D, Murfitt K, Hoq M. Challenges in measuring gender identity among transgender, gender diverse, and non-binary young people. Public Health 2021; 200:e4-e5. [PMID: 34666905 DOI: 10.1016/j.puhe.2021.09.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 09/13/2021] [Indexed: 11/30/2022]
Affiliation(s)
- C Blacklock
- Murdoch Children's Research Institute, 50 Flemington Rd, Parkville, VIC, 3052, Australia; Swinburne University of Technology, John St, Hawthorn, VIC, 2133, Australia
| | - C McGlasson
- Murdoch Children's Research Institute, 50 Flemington Rd, Parkville, VIC, 3052, Australia
| | - D Chew
- Murdoch Children's Research Institute, 50 Flemington Rd, Parkville, VIC, 3052, Australia; The Royal Children's Hospital, 50 Flemington Rd, Parkville, VIC, 3052, Australia; Department of Medicine, Austin Health, 145 Studley Rd, Heidelberg, VIC, 3084, Australia
| | - K Murfitt
- Murdoch Children's Research Institute, 50 Flemington Rd, Parkville, VIC, 3052, Australia; The University of Melbourne, 50 Flemington Rd, Parkville, VIC, 3052, Australia
| | - M Hoq
- Murdoch Children's Research Institute, 50 Flemington Rd, Parkville, VIC, 3052, Australia; The Royal Children's Hospital, 50 Flemington Rd, Parkville, VIC, 3052, Australia.
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Blacklock C, Jones K, Baker G, Kealey D. 1270 Secondary Survey Documentation in Trauma Patients - A Review Following Implementation of a Dedicated Trauma Ward. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Introduction
A secondary survey is a detailed head to toe assessment performed in trauma patients following initial primary survey and patient stabilisation. It forms part of the ATLS guidelines and is an important tool in the recognition of patient injury. We performed an audit within the Regional Trauma Unit to assess the standard of documentation of secondary surveys in trauma admissions. We then repeated this audit following staff teaching and the implementation of a dedicated Trauma Ward, with an aim of improving secondary survey documentation and the early recognition and management of associated injuries.
Method
Admission notes for all trauma patients admitted in the three months prior to the opening of the dedicated Trauma Ward were reviewed for documentation of a secondary survey (n = 30), with the incidence of any missed injuries on follow up recorded. A further audit loop was then performed on all trauma admissions following the opening of the Trauma Ward and trauma staff teaching (n = 52).
Results
Complete documentation of a full secondary survey improved from 10% to 98% for trauma patient admissions. This also improved early identification of initially missed injuries from the primary survey including extremity fractures, chest trauma, and multi-ligament knee injuries.
Conclusions
Secondary surveys are an important tool in assessing trauma patients and can help identify significant injuries. The implementation of a dedicated Trauma Ward along with teaching to the trauma staff has led to an improvement in performance of secondary surveys with a direct improvement in identifying associated injuries in trauma patients.
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Affiliation(s)
- C Blacklock
- Royal Victoria Hospital, Belfast, United Kingdom
| | - K Jones
- Royal Victoria Hospital, Belfast, United Kingdom
| | - G Baker
- Royal Victoria Hospital, Belfast, United Kingdom
| | - D Kealey
- Royal Victoria Hospital, Belfast, United Kingdom
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Blacklock C, Ward AM, Heneghan C, Thompson M. Exploring the migration decisions of health workers and trainees from Africa: a meta-ethnographic synthesis. Soc Sci Med 2013; 100:99-106. [PMID: 24444844 DOI: 10.1016/j.socscimed.2013.10.032] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2011] [Revised: 09/10/2013] [Accepted: 10/28/2013] [Indexed: 10/26/2022]
Abstract
The migration of healthcare workers from Africa depletes countries already suffering from substantial staffing shortages and considerable disease burdens. The recruitment of such individuals by high income countries has been condemned by the World Health Organisation. However, understanding the reasons why healthcare workers migrate is essential, in order to attempt to alter migration decisions. We aimed to systematically analyse factors influencing healthcare workers' decisions to migrate from Africa. We systematically searched CINAHL (1980-Nov 2010), Embase (1980-Nov 2010), Global Health (1973-Nov 2010) and Medline (1950-Nov 2010) for qualitative studies of healthcare workers from Africa which specifically explored views about migration. Two reviewers identified articles, extracted data and assessed quality of included studies. Meta-ethnography was used to synthesise new lines of understanding and meaning from the data. The search identified 1203 articles from which we included six studies of healthcare workers trained in seven African countries, namely doctors or medical students (two studies), nurses (three), and pharmacy students (one study). Using meta-ethnographic synthesis we produced six lines of argument relating to the migration decisions of healthcare workers: 1) Struggle to realise unmet material expectations of self, family and society, 2) Strain and emotion, interpersonal discord, and insecurity in workplace, 3) Fear from threats to personal or family safety, in and out of workplace, 4) Absence of adequate professional support and development, 5) Desire for professional prestige and respect, 6) Conviction that hopes and goals for the future will be fulfilled overseas. We conclude that a complex interaction of factors contribute to the migration decisions of healthcare workers from Africa. Some of the factors identified are more amenable to change than others, and addressing these may significantly affect migration decisions of African healthcare workers in the future.
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Affiliation(s)
- C Blacklock
- Department of Primary Care Health Sciences, 2nd Floor, New Radcliffe House, Walton Street, Jericho, Oxford OX2 6NW, UK.
| | - A M Ward
- Department of Primary Care Health Sciences, 2nd Floor, New Radcliffe House, Walton Street, Jericho, Oxford OX2 6NW, UK
| | - C Heneghan
- Department of Primary Care Health Sciences, 2nd Floor, New Radcliffe House, Walton Street, Jericho, Oxford OX2 6NW, UK
| | - M Thompson
- Department of Primary Care Health Sciences, 2nd Floor, New Radcliffe House, Walton Street, Jericho, Oxford OX2 6NW, UK; Department of Family Medicine, University of Washington, Seattle, USA
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Heneghan C, Blacklock C, Perera R, Davis R, Banerjee A, Gill P, Liew S, Chamas L, Hernandez J, Mahtani K, Hayward G, Harrison S, Lasserson D, Mickan S, Sellers C, Carnes D, Homer K, Steed L, Ross J, Denny N, Goyder C, Thompson M, Ward A. Evidence for non-communicable diseases: analysis of Cochrane reviews and randomised trials by World Bank classification. BMJ Open 2013; 3:bmjopen-2013-003298. [PMID: 23833146 PMCID: PMC3703573 DOI: 10.1136/bmjopen-2013-003298] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Prevalence of non-communicable diseases (NCDs) is increasing globally, with the greatest projected increases in low-income and middle-income countries. We sought to quantify the proportion of Cochrane evidence relating to NCDs derived from such countries. METHODS We searched the Cochrane database of systematic reviews for reviews relating to NCDs highlighted in the WHO NCD action plan (cardiovascular, cancers, diabetes and chronic respiratory diseases). We excluded reviews at the protocol stage and those that were repeated or had been withdrawn. For each review, two independent researchers extracted data relating to the country of the corresponding author and the number of trials and participants from countries, using the World Bank classification of gross national income per capita. RESULTS 797 reviews were analysed, with a reported total number of 12 340 trials and 10 937 306 participants. Of the corresponding authors 90% were from high-income countries (41% from the UK). Of the 746 reviews in which at least one trial had met the inclusion criteria, only 55% provided a summary of the country of included trials. Analysis of the 633 reviews in which country of trials could be established revealed that almost 90% of trials and over 80% of participants were from high-income countries. 438 (5%) trials including 1 145 013 (11.7%) participants were undertaken in low-middle income countries. We found that only 13 (0.15%) trials with 982 (0.01%) participants were undertaken in low-income countries. Other than the five Cochrane NCD corresponding authors from South Africa, only one other corresponding author was from Africa (Gambia). DISCUSSION The overwhelming body of evidence for NCDs pertains to high-income countries, with only a small number of review authors based in low-income settings. As a consequence, there is an urgent need for research infrastructure and funding for the undertaking of high-quality trials in this area.
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Affiliation(s)
- C Heneghan
- Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Blacklock C, Mayon-White R, Coad N, Thompson M. Which symptoms and clinical features correctly identify serious respiratory infection in children attending a paediatric assessment unit? Arch Dis Child 2011; 96:708-14. [PMID: 21586436 DOI: 10.1136/adc.2010.206243] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Parent-reported symptoms are frequently used to triage children, but little is known about which symptoms identify children with serious respiratory infections. The authors aimed to identify symptoms and triage findings predictive of serious respiratory infection, and to quantify agreement between parent and nurse assessment. DESIGN Prospective diagnostic cohort study. SETTING Paediatric Assessment Unit, University Hospitals Coventry and Warwickshire NHS Trust. PATIENTS 535 children aged between 3 months and 12 years with suspected acute infection. METHODS Parents completed a symptom questionnaire on arrival. Children were triaged by a nurse, who measured routine vital signs. The final diagnosis at discharge was used as the outcome. Symptoms and triage findings were analysed to identify features diagnostic of serious respiratory infection. Agreement between parent and triage nurse assessment was measured and kappa values calculated. RESULTS Parent-reported symptoms were poor indicators of serious respiratory infection (positive likelihood ratio (LR+) 0.56-1.93) and agreed poorly with nurse assessment (kappa 0.22-0.56). The best predictor was clinical assessment of respiratory distress (LR+ 5.04). Oxygen saturations <94% were highly specific (specificity 95.1%) but had poor sensitivity (35.6%). Tachypnoea (defined by current Advanced Paediatric Life Support standards) offered little discriminatory value. CONCLUSION Parent-reported symptoms were unreliable discriminators of serious respiratory infection in children with suspected acute infection, and did not correlate well with nurse assessment. Using symptoms to identify higher risk children in this setting is unreliable. Nurse triage assessment of respiratory distress and some vital signs are important predictors.
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Affiliation(s)
- C Blacklock
- Department of Primary Health Care, Oxford University, Rosemary Rue Building, Old Road Campus, Headington, Oxford OX3 7LF, UK.
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McCreadie R, Macdonald E, Blacklock C, Tilak-Singh D, Wiles D, Halliday J, Paterson J. Dietary intake of schizophrenic patients in Nithsdale, Scotland: case-control study. BMJ 1998; 317:784-5. [PMID: 9740565 PMCID: PMC28668 DOI: 10.1136/bmj.317.7161.784] [Citation(s) in RCA: 128] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- R McCreadie
- Department of Clinical Research, Crichton Royal Hospital, Dumfries DG1 4TG.
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Paterson JR, Blacklock C, Campbell G, Wiles D, Lawrence JR. The identification of salicylates as normal constituents of serum: a link between diet and health? J Clin Pathol 1998; 51:502-5. [PMID: 9797725 PMCID: PMC500801 DOI: 10.1136/jcp.51.7.502] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
AIM To examine sera for the presence of salicylic acid and 2,3- and 2,5-dihydroxybenzoic acids (2,3- and 2,5-DHBA), in individuals not taking salicylate drugs. METHODS Extracts of acidified serum samples were analysed by high performance liquid chromatography with electro-chemical detection. The chromatographic conditions were altered, and the retention times of the unknown compounds compared against authentic salicylic acid, 2,3-DHBA, and 2,5-DHBA. Serum samples (some spiked with salicylic acid) were incubated with salicylate hydroxylase and analyses undertaken. An extract of acidified serum was derivatised using N-methyl-N-trimethylsilyltrifluoroacetamide and the salicylic acid derivative identified by gas chromatography-mass spectrometry. RESULTS Salicylic acid, 2,3-DHBA, and 2,5-DHBA were identified as being normal constituents of serum. CONCLUSIONS Salicylic acid, 2,3-DHBA, and 2,5-DHBA possess anti-inflammatory properties. The finding that these compounds are present as normal constituents of serum, possibly arising from diet, raises important questions as to their role in the promotion of health.
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Affiliation(s)
- J R Paterson
- Department of Biochemistry, Dumfries and Galloway Royal Infirmary, UK
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Sattar N, Blacklock C. Serum antioxidant activity after myocardial infarction. Ann Clin Biochem 1998; 35 ( Pt 2):333-4. [PMID: 9547918 DOI: 10.1177/000456329803500233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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