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Journal of Geriatric Cardiology 2020年第8期17卷 510-518页

作者： Ying LIANG Shao-Ping NIE Xiao WANG Ashley Thomas Elizabeth Thompson Guan-Qi ZHAO Jing HAN Jing WANG Mark J D Griffiths Emergency&Critical Care Center Beijing Anzhen HospitalCapital Medical UniversityBeijingChina peri-operative medicine barts health nhs trust LondonUK

Intermediate-and high-risk pulmonary embolism(PE)is a life-threatening medical emergency with high morbidity and *** of the treatment options for PE involve clinicians from multiple *** Embolism Response Teams(PERTs)have been developed to coordinate the multidisciplinary team of clinicians to streamline the decision making process and develop individualised treatment plans in a timely *** first PERT was established in 2012 and subsequently multiple centres worldwide have introduced this model for the management of intermediate-and high-risk *** this review,we evaluate the organisational structure and algorithms of different PERT services and compare data from pre-and post-PERT services to determine the impact of PERT on *** consider the cost and time implications of this multidisciplinary 24-hour service and suggest areas for further research and review.

关键词： Multidisciplinary Pulmonary embolism Pulmonary Embolism Response Team

Eye and foot checks in patients with diabetes on haemodialysis: Are they done,and who does them?

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World Journal of Diabetes 2017年第9期8卷 436-439页

作者： Nadira Bibi Mothojakan Shazia Hussain Kieran McCafferty Mohammed Magdi Yaqoob Tahseen Ahmad Chowdhury Department of Diabetes and Metabolism Barts Health NHS Trust the Royal London Hospital Department of Nephrology Barts Health NHS Trust the Royal London Hospital

AIM To determine if retinal and foot checks are carried out on patients with diabetes receiving *** Eighty-four patients with diabetes receiving haemodialysis were asked if they recalled having eye and foot screening in the last year, and if so, by whom was the check *** Seventy-seven(91.7%) patients recalled having an eye check in the preceding 12 mo. Of these, 52(67.5%) did so in an ophthalmology clinic, 17(22%) in retinal screening, three(3.9%) in an optician clinic. Three patients(3.9%) went to both ophthalmology and retinal screening, and two (2.6%) attended an ophthalmology and optician. Seventy (83.3%) patients recalled having a foot check in the preceding 12 mo. Of these, 33 (47.1%) were done by practice nurse, 14 (20%) by a diabetes nurse, 11 (15.7%) by a general practitioner, eight (11.4%) by a chiropodist, and four (5.7%) were each checked by renal nurse, diabetes consultant, junior doctor, or unknown person at a foot *** Most patients with diabetes on haemodialysis are able to recall having an eye check in the last year, although 8.3% could not. A significant proportion of patients could not recall having a foot check (16.7%) in the last year. This baseline audit suggests that an improvement in the rate of foot screening is important to achieve in patients with diabetes on haemodialysis in our unit.

关键词： Diabetes Haemodialysis Foot screening Retinal screening

Using simulation to train orthopaedic trainees in non-technical skills: A pilot study

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World Journal of Orthopedics 2016年第8期7卷 475-480页

作者： Samuel R Heaton Zoe Little Kash Akhtar Manoj Ramachandran Joshua Lee Centre for Orthopaedics Royal London Hospital Barts Health NHS Trust

AIM: To enhance non-technical skills and to analyse participant's experience of a course tailored for orth-opaedic ***: A Delphi technique was used to develop a course in human factors specific to orthopaedic residents. Twenty-six residents(six per course) participated in total with seven course facilitators all trained in Crisis Resource Management providing structured feedback. Six scenarios recreated challenging real-life situations using high-fidelity mannequins and simulated patients. Environments included a simulated operating suite, clinic room and ward setting. All were undertaken in a purpose built simulation suite utilising actors, mock operating rooms, mock clinical rooms and a high fidelity adult patient simulator organised through a simulation control room. Participants completed a 5-point Likert scale questionnaire(strongly disagree to strongly agree) before and after the course. This assessed their understanding of non-technical skills, scenario validity, relevance to orthopaedic training and predicted impact of the course on future practice. A course evaluation questionnaire was also completed to assess participants' feedback on the value and quality of the course ***: Twenty-six orthopaedic residents participated(24 male, 2 female; post-graduation 5-10 years), mean year of residency program 2.6 out of 6 years required in the United Kingdom. Pre-course questionnaires showedthat while the majority of candidates recognised the importance of non-technical(NT) skills in orthopaedic training they demonstrated poor understanding of non-technical skills and their role. This improved significantly after the course(Likert score 3.0-4.2) and the perceived importance of these skills was reported as good or very good in 100%. The course was reported as enjoyable and provided an unthreatening learning environment with the candidates placing particular value on the learning opportunity provided by reflecting on their performance. All agreed

关键词： Teaching Learning Simulation Nontechnical Surgery

Total knee arthroplasty in patients with Paget's disease of bone: A systematic review

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World Journal of Orthopedics 2018年第10期9卷 229-234页

作者： Ravi Popat Konstantinos Tsitskaris Steven Millington Sebastian Dawson-Bowling Sammy A Hanna Department of Trauma and Orthopaedic Surgery the Hillingdon Hospitals NHS Foundation Trust Department of Trauma and Orthopaedic Surgery Barts Health NHS Trust

AIM To determine the functional outcomes, complications and revision rates following total knee arthroplasty(TKA) in patients with Paget's disease of bone(PDB). METHODS A systematic review of the literature was performed. Four studies with a total of 54 TKAs were included for analysis. Functional outcomes, pain scores, complications and revision rates were assessed. The mean age was 72.0 years and the mean follow-up was 7.5 *** All studies reported significant improvement in knee function and pain scores following TKA. There were 2 cases of aseptic loosening, with one patient requiring revision of the femoral component 10 years after the index procedure. Malalignment, bone loss, soft tissue contractures were the most commonly reported intraoperative challenges. There were five cases(9%) that were complicated by intra-operative patellar tendon *** The findings support the use of TKA in patients with PDB. The post-operative functional outcomes are largely similar to other patients, however there are specific perioperative challenges that have been highlighted, in particular the high risk for patellar tendon avulsion.

关键词： Total knee arthroplasty Paget’s disease of bone Revision Loosening Paget’s disease

Total hip arthroplasty in patients with Paget's disease of bone: A systematic review

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World Journal of Orthopedics 2017年第4期8卷 357-363页

作者： Sammy A Hanna Sebastian Dawson-Bowling Steven Millington Rej Bhumbra Pramod Achan Department of Trauma and Orthopaedic Surgery Royal London HospitalBarts Health NHS Trust

AIM To investigate the clinical and functional outcomes following total hip arthroplasty(THA) in patients with Paget's *** We carried out a systematic review of the literature to determine the functional outcome, complications and revision rates of THA in patients with Paget's disease. Eight studies involving 358 hips were reviewed. The mean age was 70.4 years and follow-up was 8.3 years. There were 247 cemented THAs(69%), 105 uncemented THAs(29%) and 6 hybrid THAs(2%). RESULTS All studies reported significant improvement in hip function following THA. There were 19 cases of aseptic loosening(5%) at a mean of 8.6 years. Three cases occurred in the uncemented cohort(3%) at a mean of 15.3 years and 16 cases developed in the cemented group(6%) at a mean of 7.5 years(P = 0.2052). There were 27 revisions in the 358 cases(8%) occurring at a mean of 7 years. Six revisions occurred in the uncemented cohort(6%) at a mean of 8.6 years and 21 in the cemented cohort(9%) at a mean of 6.5 years(P = 0.5117). CONCLUSION The findings support the use of THA in patients with Paget's disease hip arthropathy. The post-operative functional outcome is largely similar to other patients; however, the revision rate is higher with aseptic loosening being the most common reason for revision. Uncemented implants appear to be associated with a lower failure rate, however, there were no modern stem designs fixed using current generation cementing techniques used in the reported studies, and as such, caution is advised when drawing any conclusions.

关键词： Total hip arthroplasty Paget’s disease Revision Loosening Heterotopic ossification

Is overhydration in peritoneal dialysis patients associated with cardiac mortality that might be reversible?

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World Journal of Nephrology 2016年第5期5卷 448-454页

作者： Elizabeth Oei Klara Paudel Annemarie Visser Hazel Finney Stanley L Fan Department of Renal medicine and Transplantation Barts Health NHS Trust Department of Nutrition and Dietetics Barts Health NHS Trust Department of Clinical Biochemistry Barts Health NHS Trust

AIMTo study the relationship between overhydration （OH） in peritoneal dialysis （PD） patients and cardiac ***, as measured by body composition monitor （BCM）, is associated with increased mortality in dialysis pa-tients. BCM has been used to guide treatment on the assumption that correcting OH will improve cardiac morbidity and mortality although data demonstrating causality that is reversible is limited. We wished to determine if OH in PD patients predicted cardiac mor-tality, and if there was a correlation between OH and cardiac troponin-T （cTnT） levels. Finally, we wished to determine if improving OH values would lead to a decrement in cTnT. All prevalent PD patients over the study period of 57 mo who had contemporaneous BCM and cTnT measurements were followed irrespective of transplantation or PD technique failure. We also studied a cohort of patients with who had severe OH （〉＋2L）.The Fresenius Body Composition Monitor was used to obtain hydration parameters. cTnT levels were done as part of routine clinical care. Data was analysed using SPSS version *** were 48 deaths in the 336 patients. The patients that died from cardiac or non-cardiac causes were similar with respect to their age, incidence of diabetes mellitus, gender, ethnicity and cause of renal failure. However, the patients with cardiac causes of death had significantly shorter dialysis vintage （10.3 mo vs 37.0 mo, P 〈 0.0001） and were significantly more overhydrated by BCM measurement （2.95 L vs 1.35 L, P 〈 0.05）. The mean （standard error of the means） hydration status of the 336 patients was ＋1.15 （0.12） L and the median [interquartile range （IQR）] cTnT level was 43.5 （20-90） ng/L. The cTnT results were not normally distributed and were therefore transformed logarithmically. There was a statistically significant correlation between Log （cTnT） with the OH value （Spearman r value 0.425, P 〈 0.0001）. We identifed a sub-group of patients that were severely overhydrated; m

关键词： Bioimpedance Fluid status peritoneal dialysis Mortality Overhydration Cardiac troponin

Adolescent Lisfranc injury treated with TightRope^(TM):A case report and review of literature

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World Journal of Orthopedics 2019年第2期10卷 115-122页

作者： Themistoklis Tzatzairis Gregory Firth Lee Parker Royal London Hospital Paediatric Orthopaedic Department Barts NHS Trust Royal London Hospital Foot and Ankle Orthopaedic department Barts NHS Trust

BACKGROUND Lisfranc injuries are rare and can be easily missed. This injury is extremely rare in children, with limited published data. Different treatment options have been described; one of the options in adults is the "mini" TightRope^(TM) Syndesmosis Device that provides non-rigid fixation with impressive results. However, there is no reference regarding the use of this device in *** SUMMARY We describe the case of an 11-year-old girl who sustained a Lisfranc injury of her right foot that was initially missed in the Accident and Emergency department of her local hospital. This case was a ligamentous/periosteal sleeve avulsion type of Lisfranc injury and a percutaneous technique using the "mini" TightRope^(TM)syndesmosis device was used. Clinical and radiological results were excellent at final follow *** The "mini" TightRope^(TM) syndesmosis device is a promising method of fixation for children with certain Lisfranc injuries. This method has many advantages,including the non-rigid type of the fixation and no need for subsequent metalwork removal.

关键词： Lisfranc Injury Foot Tightrope Paediatric Case report

Improved lifestyle is associated with improved depression,anxiety and wellbeing over time in UK healthcare professionals during the COVID-19 pandemic:insights from the CoPE-HCP cohort study

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General Psychiatry 2023年第1期36卷 19-27页

作者： Mohammed Y Khanji George Collett Thomas Godec Carmela Maniero Sher May Ng Imrana Siddiqui Jaya Gupta Vikas Kapil Ajay Gupta William Harvey Research Institute Queen Mary University of LondonLondonUK Department of Cardiology Barts Heart CentreSaint Bartholomew's HospitalBarts Health NHS TrustLondonUK Newham University Hospital Barts Health NHS TrustLondonUK Wellbeing Hub Newham Training HubLondonUK nhs North East London CCG LondonUK Child and Adolescent Mental health Service South West London and St George's Mental Health NHS TrustLondonUK

Background One potential modifiable factor to improve the mental health of healthcare professionals(HCPs)during the pandemic is *** This study aimed to assess whether an improved lifestyle during the pandemic is associated with improved mental health symptoms and mental well-being in HCPs over *** This was a cohort study involving an online survey distributed at two separate time points during the pandemic(baseline(July–September 2020)and follow-up(December 2020–March 2021))to HCPs working in primary or secondary care in the *** surveys assessed for major depressive disorder(MDD)(Patient health Questionnaire-9(PHQ-9)),generalised anxiety disorder(GAD)(Generalised Anxiety Disorder-7(GAD-7)),mental well-being(Short Warwick-Edinburgh Mental Well-being Score(SWEMWBS))and self-reported lifestyle change(compared with the start of the pandemic)on multiple *** scores were calculated to estimate overall lifestyle change compared with that before the pandemic(at both baseline and follow-up).At each time point,separate logistic regression models were constructed to relate the lifestyle change score with the presence of MDD,GAD and low mental *** regression models were also developed relating the change in lifestyle scores from baseline to follow-up to changes in PHQ-9,GAD-7 and SWEMWBS *** 613 HCPs completed both baseline assessment and follow-up *** significant cross-sectional associations between increased lifestyle change scores and a reduced risk of MDD,GAD and low mental well-being were observed at both baseline and *** the study period,a whole unit increase in the change in novel scores(ie,improved overall lifestyle)over 4 months was inversely associated with changes in PHQ-9(adjusted coefficient:−0.51,95%confidence interval(CI):−0.73 to−0.30,p<0.001)and GAD-7 scores(adjusted coefficient:−0.32,95%CI:−0.53 to−0.10,p=0.004)and positively associated with the change in SWEMWBS scores

关键词： Edinburgh lifestyle coefficient

Modern management of anal fistula

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World Journal of Gastroenterology 2015年第1期21卷 12-20页

作者： Elsa Limura Pasquale Giordano Department of Colorectal Surgery Whipps Cross HospitalBarts Health NHS TrustLondon E11 1NRUnited Kingdom

Ideal surgical treatment for anal fistula should aim to eradicate sepsis and promote healing of the tract,whilst preserving the sphincters and the mechanism of *** the simple and most distal fistulae,conventional surgical options such as laying open of the fistula tract seem to be relatively safe and therefore,well accepted in clinical ***,for the more complex fistulae where a significant proportion of the anal sphincter is involved,great concern remains about damaging the sphincter and subsequent poor functional outcome,which is quite inevitable following conventional surgical *** this reason,over the last twodecades,many sphincter-preserving procedures for the treatment of anal fistula have been introduced with the common goal of minimising the injury to the anal sphincters and preserving optimal *** them,the ligation of intersphincteric fistula tract procedure appears to be safe and effective and may be routinely considered for complex anal *** technique,the anal fistula plug,derived from porcine small intestinal submucosa,is safe but modestly effective in long-term follow-up,with success rates varying from 24%-88%.The failure rate may be due to its extrusion from the fistula *** obviate that,a new designed plug(GORE BioA ) was introduced,but long term data regarding its efficacy are *** glue showed poor and variable healing rate(14%-74%).Fi La C and video-assisted anal fistula treatment procedures,respectively using laser and electrode energy,are expensive and yet to be thoroughly assessed in clinical ***,a therapy using autologous adiposederived stem cells has been *** properties of regenerating tissues and suppressing inflammatory response must be better investigated on anal fistulae,and studies remain in *** aim of this present article is to review the pertinent literature,describing the advantages and limitations of new sphincterpreserving techniques.

关键词： Anal fistula management Ligation of intersphincter

Stereotactic radiotherapy for intrahepatic cholangiocarcinoma

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World Journal of Gastrointestinal Oncology 2022年第8期14卷 1478-1489页

作者： Aditya Borakati Farid Froghi Ricky H Bhogal Vasileios K Mavroeidis Department of Surgery The Royal London HospitalBarts Health NHS TrustLondon E11FRUnited Kingdom Department of HPB and Liver Transplantation Surgery Royal Free Hospital NHS Foundation TrustLondon NW32QGUnited Kingdom Department of Academic Surgery The Royal Marsden NHS Foundation TrustLondon SW36JJUnited Kingdom

Intrahepatic cholangiocarcinoma(iCCA)is an aggressive malignancy with an increasing incidence worldwide and poor prognosis,despite several advances and continuous efforts to develop effective *** surgical resection is the mainstay of treatment and offers a potentially curative option,but is only possible in less than a third of patients,owing to advanced *** is a well-established treatment in the adjuvant and palliative setting,however,confers limited *** radiotherapy is challenging due to local *** recent advances in stereotactic ablative radiotherapy(SABR),it is now possible to focus ablative beams of radiotherapy precisely aimed at tumours to minimise damage to surrounding *** review details the history,technical background and application of SABR to iCCA,with directions for future research suggested.

关键词： Cholangiocarcinoma Intrahepatic Stereotactic ablative radiotherapy Stereotactic body radiotherapy Radiotherapy Liver cancer Hepatectomy