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Dixon Smith S, Aldington D, Hay G, Kumar A, Le Feuvre P, Moore A, Soliman N, Wever KE, Rice AS. "I did not expect the doctor to treat a ghost": a systematic review of published reports regarding chronic postamputation pain in British First World War veterans. Pain Rep 2023; 8:e1094. [PMID: 37860786 PMCID: PMC10584288 DOI: 10.1097/pr9.0000000000001094] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 06/13/2023] [Accepted: 07/21/2023] [Indexed: 10/21/2023] Open
Abstract
Limb trauma remains the most prevalent survivable major combat injury. In the First World War, more than 700,000 British soldiers received limb wounds and more than 41,000 underwent an amputation, creating one of the largest amputee cohorts in history. Postamputation pain affects up to 85% of military amputees, suggesting that up to 33,000 British First World War veterans potentially reported postamputation pain. This qualitative systematic review explores the professional medical conversation around clinical management of chronic postamputation pain in this patient cohort, its development over the 20th century, and how this information was disseminated among medical professionals. We searched The Lancet and British Medical Journal archives (1914-1985) for reports referring to postamputation pain, its prevalence, mechanisms, descriptors, or clinical management. Participants were First World War veterans with a limb amputation, excluding civilians and veterans of all other conflicts. The search identified 9809 potentially relevant texts, of which 101 met the inclusion criteria. Reports emerged as early as 1914 and the discussion continued over the next 4 decades. Unexpected findings included early advocacy of multidisciplinary pain management, concerns over addiction, and the effect of chronic pain on mental health emerging decades earlier than previously thought. Chronic postamputation pain is still a significant issue for military rehabilitation. Similarities between injury patterns in the First World War and recent Iraq and Afghanistan conflicts mean that these historical aspects remain relevant to today's military personnel, clinicians, researchers, and policymakers.
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Affiliation(s)
- Sarah Dixon Smith
- Pain Research, Department of Surgery & Cancer, Faculty of Medicine, Imperial College London, London, United Kingdom
- The Royal British Legion Centre for Blast Injury Studies, Faculty of Bioengineering, Imperial College London, London, United Kingdom
- The National Archives, Kew, United Kingdom
| | - Dominic Aldington
- Department of Anaesthesia, Royal Hampshire County Hospital, Winchester, United Kingdom
| | - George Hay
- The Commonwealth War Graves Commission, Maidenhead, United Kingdom
| | - Alexander Kumar
- Pain Research, Department of Surgery & Cancer, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Peter Le Feuvre
- Royal Centre for Defence Medicine, Birmingham, United Kingdom
| | - Andrew Moore
- Retired, Newton Ferrers, Plymouth, United Kingdom
| | - Nadia Soliman
- Pain Research, Department of Surgery & Cancer, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Kimberley E. Wever
- Department of Anaesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Andrew S.C. Rice
- Pain Research, Department of Surgery & Cancer, Faculty of Medicine, Imperial College London, London, United Kingdom
- The Royal British Legion Centre for Blast Injury Studies, Faculty of Bioengineering, Imperial College London, London, United Kingdom
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Salman D, Le Feuvre P, Hill O, Conway D, Taylor S, Turner S, Korgaonkar J, Hettiaratchy S, McGregor AH. Movement Foundations. The perceived impact of a digital rehabilitation tool for returning to fitness following a period of illness, including COVID-19 infection: a qualitative study. BMJ Open Sport Exerc Med 2023; 9:e001557. [PMID: 37063170 PMCID: PMC10083518 DOI: 10.1136/bmjsem-2023-001557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2023] [Indexed: 04/05/2023] Open
Abstract
Digital interventions can increase physical activity (PA) levels in adults. However, the COVID-19 pandemic highlighted the complexities faced when guiding people to start or return to PA following illness or inactivity. A digital tool, Movement Foundations, was developed to provide remote guidance on building strength and capacity across functional movement patterns, with graduated progression based on user responses and input. This qualitative study aimed to explore the perceived impacts of using the tool. Nine participants aged over 35 years from the healthcare and academic healthcare sectors were recruited to use it and were subsequently interviewed. Thematic analysis identified three themes falling under the overarching concept of ‘Capability, Opportunity and Motivation—Behaviour (COM-B) Plus’, encompassing: skills and capacity for movement; opportunities, motivations and barriers for movement; and a personalised, safe space in which to develop. Participants felt that the digital tool increased their capacity and confidence in movement and positively impacted their daily activities. External factors such as illness and stress clouded perceptions of the impacts of PA. Time, work pressures and needing equipment were still considered significant barriers to PA. Still, participants appreciated the flexibility and non-prescriptive nature of the tool and felt that it helped movement to become opportunistic and habitual. Increased capacity for PA and feeling the subsequent physical and mental effects positively influenced motivation. Structure and guidance, with graduated progress, were seen as protective. Guided self-reflection helped participants understand their capacity and limitations with regard to movement and promoted motivation. Although acquiring technical skills to guide movement may be important for those recovering from illness, participants found that a structure promoting individualised guidance, graduated progression and guided self-reflection were important motivational factors for continuing use. Digital interventions should consider these aspects when seeking to promote habitual PA.
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Affiliation(s)
- David Salman
- MSk Lab, Faculty of Medicine, Imperial College London, London, UK
- Emergency Medicine—Sport and Exercise Medicine, Imperial College Healthcare NHS Trust, London, UK
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Peter Le Feuvre
- MSk Lab, Faculty of Medicine, Imperial College London, London, UK
- Royal Centre for Defence Medicine (RCDM), John Radcliffe Hospital, Oxford, UK
| | - Oliver Hill
- MSk Lab, Faculty of Medicine, Imperial College London, London, UK
- Defence Medical Rehabilitation Centre (DMRC), Stanford Hall, Loughborough, UK
| | - Dean Conway
- MSk Lab, Faculty of Medicine, Imperial College London, London, UK
- Defence Medical Rehabilitation Centre (DMRC), Stanford Hall, Loughborough, UK
| | - Simon Taylor
- Suite 2C, Brosnan House, Rehab Guru, Potters Bar, UK
| | - Shruti Turner
- MSk Lab, Faculty of Medicine, Imperial College London, London, UK
| | - Jonathan Korgaonkar
- Emergency Medicine—Sport and Exercise Medicine, Imperial College Healthcare NHS Trust, London, UK
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Harris P, Kirkland R, Masanja S, Le Feuvre P, Montgomery S, Ansbro É, Woodman M, Harris M. Strengthening the primary care workforce to deliver high-quality care for non-communicable diseases in refugee settings: lessons learnt from a UNHCR partnership. BMJ Glob Health 2022; 7:bmjgh-2021-007334. [PMID: 35798443 PMCID: PMC9272076 DOI: 10.1136/bmjgh-2021-007334] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 01/27/2022] [Indexed: 12/21/2022] Open
Abstract
Non-communicable disease (NCD) prevention and care in humanitarian contexts has been a long-neglected issue. Healthcare systems in humanitarian settings have focused heavily on communicable diseases and immediate life-saving health needs. NCDs are a significant cause of morbidity and mortality in refugee settings, however, in many situations NCD care is not well integrated into primary healthcare services. Increased risk of poorer outcomes from COVID-19 for people living with NCDs has heightened the urgency of responding to NCDs and shone a spotlight on their relative neglect in these settings. Partnering with the United Nations Refugee Agency (UNHCR) since 2014, Primary Care International has provided clinical guidance and Training of Trainer (ToT) courses on NCDs to 649 health professionals working in primary care in refugee settings in 13 countries. Approximately 2300 healthcare workers (HCW) have been reached through cascade trainings over the last 6 years. Our experience has shown that, despite fragile health services, high staff turnover and competing clinical priorities, it is possible to improve NCD knowledge, skills and practice. ToT programmes are a feasible and practical format to deliver NCD training to mixed groups of HCW (doctors, nurses, technical officers, pharmacy technicians and community health workers). Clinical guidance must be adapted to local settings while co-creating an enabling environment for health workers is essential to deliver accessible, high-quality continuity of care for NCDs. On-going support for non-clinical systems change is equally critical for sustained impact. A shared responsibility for cascade training—and commitment from local health partners—is necessary to raise NCD awareness, influence local and national policy and to meet the UNHCR’s objective of facilitating access to integrated prevention and control of NCDs.
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Affiliation(s)
| | | | - Saimon Masanja
- School of Public Health, Catholic University of Health and Allied Sciences (CUHAS), Bugando Medical Centre, Mwanza, Tanzania
| | | | | | - Éimhín Ansbro
- Centre for Global Chronic Conditions, London School of Hygiene & Tropical Medicine, London, UK
| | - Michael Woodman
- The Office of the United Nations High Commissioner for Refugees, Geneva, Switzerland
| | - Matthew Harris
- Department of Primary Care and Public Health, Imperial College London, London, UK
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Musbahi O, Syed L, Le Feuvre P, Cobb J, Jones G. Public patient views of artificial intelligence in healthcare: A nominal group technique study. Digit Health 2021; 7:20552076211063682. [PMID: 34950499 PMCID: PMC8689636 DOI: 10.1177/20552076211063682] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Objectives The beliefs of laypeople and medical professionals often diverge with regards to disease, and technology has had a positive impact on how research is conducted. Surprisingly, given the expanding worldwide funding and research into Artificial Intelligence (AI) applications in healthcare, there is a paucity of research exploring the public patient perspective on this technology. Our study sets out to address this knowledge gap, by applying the Nominal Group Technique (NGT) to explore patient public views on AI. Methods A Nominal Group Technique (NGT) was used involving four study groups with seven participants in each group. This started with a silent generation of ideas regarding the benefits and concerns of AI in Healthcare. Then a group discussion and round-robin process were conducted until no new ideas were generated. Participants ranked their top five benefits and top five concerns regarding the use of AI in healthcare. A final group consensus was reached. Results Twenty-Eight participants were recruited with the mean age of 47 years. The top five benefits were: Faster health services, Greater accuracy in management, AI systems available 24/7, reducing workforce burden, and equality in healthcare decision making. The top five concerns were: Data cybersecurity, bias and quality of AI data, less human interaction, algorithm errors and responsibility, and limitation in technology. Conclusion This is the first formal qualitative study exploring patient public views on the use of AI in healthcare, and highlights that there is a clear understanding of the potential benefits delivered by this technology. Greater patient public group involvement, and a strong regulatory framework is recommended.
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Affiliation(s)
- Omar Musbahi
- MSK Lab, Imperial College London, Charing Cross Campus, Hammersmith, London, UK
| | - Labib Syed
- MSK Lab, Imperial College London, Charing Cross Campus, Hammersmith, London, UK
| | - Peter Le Feuvre
- MSK Lab, Imperial College London, Charing Cross Campus, Hammersmith, London, UK
| | - Justin Cobb
- MSK Lab, Imperial College London, Charing Cross Campus, Hammersmith, London, UK
| | - Gareth Jones
- MSK Lab, Imperial College London, Charing Cross Campus, Hammersmith, London, UK
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Henson DP, Edgar C, Ding Z, Sivapuratharasu B, Le Feuvre P, Finnegan ME, Quest R, McGregor AH, Bull AMJ. Understanding lower limb muscle volume adaptations to amputation. J Biomech 2021; 125:110599. [PMID: 34265657 DOI: 10.1016/j.jbiomech.2021.110599] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 10/08/2020] [Revised: 06/18/2021] [Accepted: 06/24/2021] [Indexed: 10/21/2022]
Abstract
Amputation of a major limb, and the subsequent return to movement with a prosthesis, requires the development of compensatory strategies to account for the loss. Such strategies, over time, lead to regional muscle atrophy and hypertrophy through chronic under or overuse of muscles compared to uninjured individuals. The aim of this study was to quantify the lower limb muscle parameters of persons with transtibial and transfemoral amputations using high resolution MRI to ascertain muscle volume and to determine regression equations for predicting muscle volume using femur- and tibia-length, pelvic-width, height, and mass. Twelve persons with limb loss participated in this study and their data were compared to six matched control subjects. Subjects with unilateral transtibial amputation showed whole-limb muscle volume loss in the residual-limb, whereas minor volume changes in the intact limb were found, providing evidence for a compensation strategy that is dominated by the intact-limb. Subjects with bilateral-transfemoral amputations showed significant muscle volume increases in the short adductor muscles with an insertion not affected by the amputation, the hip flexors, and the gluteus medius, and significant volume decreases in the longer adductor muscles, rectus femoris, and hamstrings. This study presents a benchmark measure of muscle volume discrepancies in persons with limb-loss, and can be used to understand the compensation strategies of persons with limb-loss and the impact on muscle volume, thus enabling the development of optimised intervention protocols, conditioning therapies, surgical techniques, and prosthetic devices that promote and enhance functional capability within the population of persons with limb loss.
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Affiliation(s)
- David P Henson
- The Royal British Legion Centre for Blast Injury Studies, Imperial College London, UK; The Department of Bioengineering, Imperial College London, UK.
| | - Caitlin Edgar
- The Royal British Legion Centre for Blast Injury Studies, Imperial College London, UK; The Department of Bioengineering, Imperial College London, UK
| | - Ziyun Ding
- The Royal British Legion Centre for Blast Injury Studies, Imperial College London, UK; The Department of Bioengineering, Imperial College London, UK; The Department of Mechanical Engineering, University of Birmingham, UK
| | - Biranavan Sivapuratharasu
- The Royal British Legion Centre for Blast Injury Studies, Imperial College London, UK; The Department of Bioengineering, Imperial College London, UK; The Department of Surgery and Cancer, Imperial College London, UK
| | - Peter Le Feuvre
- The Royal British Legion Centre for Blast Injury Studies, Imperial College London, UK; The Department of Surgery and Cancer, Imperial College London, UK
| | - Mary E Finnegan
- The Department of Bioengineering, Imperial College London, UK; The Department of Imaging, Imperial College Healthcare NHS Trust, Imperial College London, UK
| | - Rebecca Quest
- The Department of Bioengineering, Imperial College London, UK; The Department of Imaging, Imperial College Healthcare NHS Trust, Imperial College London, UK
| | - Alison H McGregor
- The Royal British Legion Centre for Blast Injury Studies, Imperial College London, UK; The Department of Surgery and Cancer, Imperial College London, UK
| | - Anthony M J Bull
- The Royal British Legion Centre for Blast Injury Studies, Imperial College London, UK; The Department of Bioengineering, Imperial College London, UK
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Affiliation(s)
- David Salman
- MSk Lab, Imperial College London, London W12 0BZ, UK
- Department of Primary Care and Public Health, Imperial College London
| | - Dane Vishnubala
- Department of Primary Care and Public Health, Imperial College London
- Hull-York Medical School, York, UK
| | - Peter Le Feuvre
- MSk Lab, Imperial College London, London W12 0BZ, UK
- HQ Army Medical Services, Robertson House, Camberley, UK
| | - Thomas Beaney
- Department of Primary Care and Public Health, Imperial College London
| | | | - Azeem Majeed
- Department of Primary Care and Public Health, Imperial College London
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Hargreaves S, Holmes AH, Saxena S, Le Feuvre P, Farah W, Shafi G, Chaudry J, Khan H, Friedland JS. Charging systems for migrants in primary care: the experiences of family doctors in a high-migrant area of London. J Travel Med 2008; 15:13-8. [PMID: 18217864 DOI: 10.1111/j.1708-8305.2007.00161.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [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: 11/27/2022]
Abstract
BACKGROUND There is speculation that a high number of migrants use free UK National Health Services to which they are not entitled. In response, the UK government has sought to develop and expand current overseas visitors (OVs) charging systems to target these noneligible migrants for payment. Current guidance to UK primary care providers is ambiguous, and little is known about existing procedures for dealing with new migrants. We aimed to explore the impact of OVs on primary care services and to assess the views of health-care providers about current charging systems. METHODS We undertook a 23-point semistructured questionnaire survey of family doctors working within a high-migrant area of London. Outcome measures were the following: the impact of OVs on their practices, current procedures for registering this patient group, and doctors' concerns around expanding existing charging systems. RESULTS Ninety-two doctors from 53 practices completed the survey (practice response rate 82.8%). Fifty-one (55.4%) of the 92 doctors reported having systems in place to identify and charge OVs requesting registration, and follow-up procedures differed across practices. Significantly more doctors [65 (70.7%)] reported not having any OVs on their practice lists receiving free consultations (p < 0.001; 298 OVs reported in total). Of the 24 (26.1%) doctors who did, this equated to approximately pound3,000 monthly lost income in total for uncharged consultations across all the practices within the survey site. Seventy-eight (84.8%) doctors want a better system to identify and charge OVs in primary care but question the workability of proposals to streamline charging procedures across primary and secondary care. Concerns were raised about the implications for migrants unable to access appropriate health care and the impact on public health priorities. CONCLUSIONS We identified variations in current procedures for identifying and registering OVs, which may result in the inappropriate exclusion of new migrants from free primary care services in the UK. Our findings suggest that the number of OVs receiving free primary care services is low. We need to explore models of appropriate health-care delivery to new migrants in the UK context, drawing on models of best practice from established health services in other migrant-receiving countries.
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Affiliation(s)
- Sally Hargreaves
- International Health Unit, Department of Infectious Diseases and Immunity, Faculty of Medicine, Imperial College London, London, UK
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