المؤلفون: Metcalfe, David, Hoeritzauer, Ingrid, Angus, Michelle, Novak, Alex, Hutton, Mike, Woodfield, Julie

مصطلحات موضوعية: Practice review

الوصف: Cauda equina syndrome (CES) is a spinal emergency that can be challenging to identify from among the many patients presenting to EDs with low back and/or radicular leg pain. This article presents a practical guide to the assessment and early management of patients with suspected CES as well as an up-to-date review of the most important studies in this area that should inform clinical practice in the ED.

وصف الملف: text/html

العلاقة: http://emj.bmj.com/cgi/content/short/40/11/787Test; http://dx.doi.org/10.1136/emermed-2023-213151Test

الإتاحة: https://doi.org/10.1136/emermed-2023-213151Test
http://emj.bmj.com/cgi/content/short/40/11/787Test

المؤلفون: Ojelade, Elizabeth, Koris, Jacob, Van-Hove, Maria, Gray, William K., Briggs, Tim W. R., Hutton, Mike

المصدر: Global Spine Journal ; ISSN 2192-5682 2192-5690

مصطلحات موضوعية: Neurology (clinical), Orthopedics and Sports Medicine, Surgery

الوصف: Study Design Retrospective analysis of an administrative dataset. Objective This study aims to investigate changing practice over a six-year period in the use of repeated lumbar facet joint injections/medial branch blocks in England. Methods Patient data were extracted from the Hospital Episodes Statistics database for the period 1st April 2015 to 31st March 2021 for the index lumbar injection and for repeat lumbar injections performed within one year of the first. The exposure of interest was two injections within 180 days or three within one year. Patients aged <17 years and where the body site was listed as cervical, thoracic or sacral were excluded. Results Data were available for 134,249 patients of which, 8,922 (6.6%) had either two injections within 180 days or three injections within one year. First injections fell from 42,511 in 2015/16 to 13,368 in 2019/20 as did the number of repeat injections: 4,018 to 424 for the same period. If all years had the same carbon footprint as 2019/20, 2.8 kilotons of CO 2 e would have been saved over the five years, enough to power 2,575 average UK homes for 1 year. The financial cost of injections decreased from £27.6 million in 2015/16 to £7.9 million in 2019/20. Conclusions The number of patients having repeated lumbar injections has decreased over time but has not been eliminated. More work is needed to educate patients and clinicians regarding alternative and more effective treatments.

الإتاحة: https://doi.org/10.1177/21925682231203651Test

المؤلفون: Heyl, Johannes, Hardy, Flavien, Gray, William K, Tucker, Katie, Marchã, Maria JM, Yates, Jeremy, Briggs, Tim WR, Hutton, Mike

المصدر: Archives of Orthopaedic and Trauma Surgery , 144 pp. 1129-1137. (2024)

مصطلحات موضوعية: Posterior lumbar decompression, Discectomy, Spinal surgery

الوصف: Purpose: This study aimed to identify factors associated with poorer patient outcomes for lumbar decompression and/or discectomy (PLDD).// Methods: We extracted data from the Hospital Episodes Statistics database for the 5 years from 1st April 2014 to 31st March 2019. Patients undergoing an elective one- or two-level PLDD aged ≥ 17 years and without evidence of revision surgery during the index stay were included. The primary patient outcome measure was readmission within 90 days post-discharge.// Results: Data for 93,813 PLDDs across 111 hospital trusts were analysed. For the primary outcome, greater age [< 40 years vs 70–79 years odds ratio (OR) 1.28 (95% confidence interval (CI) 1.14 to 1.42), < 40 years vs ≥ 80 years OR 2.01 (95% CI 1.76–2.30)], female sex [OR 1.09 (95% CI 1.02–1.16)], surgery over two spinal levels [OR 1.16 (95% CI 1.06–1.26)] and the comorbidities chronic pulmonary disease, connective tissue disease, liver disease, diabetes, hemi/paraplegia, renal disease and cancer were all associated with emergency readmission within 90 days. Other outcomes studied had a similar pattern of associations.// Conclusions: A high-throughput PLDD pathway will not be suitable for all patients. Extra care should be taken for patients aged ≥ 70 years, females, patients undergoing surgery over two spinal levels and those with specific comorbidities or generalised frailty.

العلاقة: https://discovery.ucl.ac.uk/id/eprint/10188327Test/

الإتاحة: https://discovery.ucl.ac.uk/id/eprint/10188327Test/

المؤلفون: Goacher, Edward, Yardanov, Stefan, Phillips, Richard, Budu, Alexandru, Dyson, Edward, Ivanov, Marcel, Barton, Gary, Hutton, Mike, Gardner, Adrian, Quraishi, Nasir A., Grahovac, Gordan, Jung, Josephine, Demetriades, Andreas K., Vergara, Pierluigi, Pereira, Erlick, Arzoglou, Vasileios, Francis, Jibin, Trivedi, Rikin, Davies, Benjamin M., Kotter, Mark R.N.

المساهمون: NIHR Clinician Scientist Award and BMD a NIHR Clinical Doctoral Research Fellowship, Clinician Scientist Award, NHS, the National Institute for Health Research or the Department of Health and Social Care

المصدر: British Journal of Neurosurgery ; page 1-5 ; ISSN 0268-8697 1360-046X

الإتاحة: https://doi.org/10.1080/02688697.2024.2346566Test

المؤلفون: Gray, William K., Day, Jamie, Briggs, Tim W. R., Hutton, Mike

المصدر: Global Spine Journal; Apr2024, Vol. 14 Issue 3, p978-985, 8p

مصطلحات موضوعية: DISCECTOMY, PATIENT readmissions, NUMERIC databases, SCIENTIFIC observation, HOSPITAL emergency services, HOSPITAL statistics

مصطلحات جغرافية: ENGLAND

مستخلص: Study design: Retrospective cohort study. Objectives: Same-day discharge is widely used in many surgical specialities. If carefully planned, it can improve patient outcomes whilst using resources efficiently. We aimed to investigate the safety of same-day discharge following a posterior lumbar decompression and/or discectomy (PLDD). Methods: This was a retrospective analysis of administrative data. We extracted data from the Hospital Episodes Statistics database for the 5 years from 1^st April 2014 to 31^st March 2019. Patients undergoing an elective one or two level PLDD aged 19-54 years during the index stay were included. The primary exposure variable was same-day discharge or post-surgery overnight stay and the primary outcome was emergency hospital readmission within 90 days post-discharge. Results: Data were available for 45,814 PLDD performed across 103 hospital trusts of which 7914 (17.3%) were performed as same-day discharge. Same-day discharge rates varied from 87.7% to 0% across the 90 hospital trusts that operated on more than 50 patients during the study period. Fourteen (15.6%) trusts had same-day discharge rates above 30% and 57 (63.3%) trusts had same-day discharge rates below 10%. The odds of emergency hospital readmission within 90 days were lower for same-day discharge patients (odds ratio.72 (95% confidence interval.61 to.85). There was no difference in outcomes for patients seen at trusts with a same-day discharge rate of ≥30% compared to trusts with a same-day discharge rate of ≤10%. Conclusions: Same-day discharge low-complexity elective PLDD is safe in adult patients below the age of 55 years. There is potential for many providers to substantially increase their rates of same-day discharge. [ABSTRACT FROM AUTHOR]

: Copyright of Global Spine Journal is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

المؤلفون: Davies, Benjamin M, Mowforth, Oliver, Wood, Helen, Karimi, Zahabiya, Sadler, Iwan, Tetreault, Lindsay, Milligan, Jamie, Wilson, Jamie R F, Kalsi-Ryan, Sukhvinder, Furlan, Julio C, Kawaguchi, Yoshiharu, Ito, Manabu, Zipser, Carl Moritz, Boerger, Timothy F, Vaccaro, Alexander R, Murphy, Rory K J, Hutton, Mike, Rodrigues-Pinto, Ricardo, Koljonen, Paul A, Harrop, James S, Aarabi, Bizhan, Rahimi-Movaghar, Vafa, Kurpad, Shekar N, Guest, James D, Wilson, Jefferson R, Kwon, Brian K, Kotter, Mark R N, Fehlings, Michael G

المصدر: Global spine journal ; 12 ; 1_suppl ; 28S ; 38S ; England

مصطلحات موضوعية: cervical, degenerative cervical myelopathy, disability, disc herniation, myelopathy, ossification posterior longitudinal ligament, policy, prioritization, research prioritization, review, spondylosis, spondylotic, stenosis

الوصف: Study Design: Literature Review (Narrative) Objective: To introduce the number one research priority for Degenerative Cervical Myelopathy (DCM): Raising Awareness. Methods: Raising awareness has been recognized by AO Spine RECODE-DCM as the number one research priority. This article reviews the evidence that awareness is low, the potential drivers, and why this must be addressed. Case studies of success from other diseases are also reviewed, drawing potential parallels and opportunities for DCM. Results: DCM may affect as many as 1 in 50 adults, yet few will receive a diagnosis and those that do will wait many years for it. This leads to poorer outcomes from surgery and greater disability. DCM is rarely featured in healthcare professional training programs and has received relatively little research funding (<2% of Amyotrophic Lateral Sclerosis or Multiple Sclerosis over the last 25 years). The transformation of stroke and acute coronary syndrome services, from a position of best supportive care with occasional surgery over 50 years ago, to avoidable disability today, represents transferable examples of success and potential opportunities for DCM. Central to this is raising awareness. Conclusion: Despite the devastating burden on the patient, recognition across research, clinical practice, and healthcare policy are limited. DCM represents a significant unmet need that must become an international public health priority. © The Author(s) 2022. ; https://doi.org/10.1177/21925682211050927Test

العلاقة: Global Spine Journal; http://hdl.handle.net/10713/18232Test

الإتاحة: https://doi.org/10.1177/21925682211050927Test
http://hdl.handle.net/10713/18232Test

المؤلفون: Gray, William K., Day, Jamie, Briggs, Tim W. R., Hutton, Mike

المصدر: Global Spine Journal ; volume 14, issue 3, page 978-985 ; ISSN 2192-5682 2192-5690

مصطلحات موضوعية: Neurology (clinical), Orthopedics and Sports Medicine, Surgery

الوصف: Study design Retrospective cohort study. Objectives Same-day discharge is widely used in many surgical specialities. If carefully planned, it can improve patient outcomes whilst using resources efficiently. We aimed to investigate the safety of same-day discharge following a posterior lumbar decompression and/or discectomy (PLDD). Methods This was a retrospective analysis of administrative data. We extracted data from the Hospital Episodes Statistics database for the 5 years from 1 st April 2014 to 31 st March 2019. Patients undergoing an elective one or two level PLDD aged 19-54 years during the index stay were included. The primary exposure variable was same-day discharge or post-surgery overnight stay and the primary outcome was emergency hospital readmission within 90 days post-discharge. Results Data were available for 45,814 PLDD performed across 103 hospital trusts of which 7914 (17.3%) were performed as same-day discharge. Same-day discharge rates varied from 87.7% to 0% across the 90 hospital trusts that operated on more than 50 patients during the study period. Fourteen (15.6%) trusts had same-day discharge rates above 30% and 57 (63.3%) trusts had same-day discharge rates below 10%. The odds of emergency hospital readmission within 90 days were lower for same-day discharge patients (odds ratio .72 (95% confidence interval .61 to .85). There was no difference in outcomes for patients seen at trusts with a same-day discharge rate of ≥30% compared to trusts with a same-day discharge rate of ≤10%. Conclusions Same-day discharge low-complexity elective PLDD is safe in adult patients below the age of 55 years. There is potential for many providers to substantially increase their rates of same-day discharge.

الإتاحة: https://doi.org/10.1177/21925682221131764Test

المؤلفون: Davies, Benjamin M., Francis, Jibin J., Butler, Max B., Mowforth, Oliver, Goacher, Edward, Starkey, Michelle, Kolias, Angelos, Wynne-Jones, Guy, Hutton, Mike, Selvanathan, Senthil, Thomson, Simon, Laing, Rodney J. C., Hutchinson, Peter J., Kotter, Mark R. N.

مصطلحات موضوعية: Cohort Studies, Humans, Adult, Female, Male, Middle Aged, Surgery, Internationality, Neurosurgeons/trends, Surveys and Questionnaires, Cervical spondylotic myelopathy, Cervical Vertebrae/*surgery, Decompression, Surgical/methods/trends, Degenerative cervical myelopathy, Laminectomy, Laminectomy and fusion, Laminectomy/methods/trends, Laminoplasty, Laminoplasty/methods/trends, Neurosurgical Procedures/*methods/trends, Spinal Cord Diseases/epidemiology/*surgery, Spinal Fusion/methods/trends, Survey

الوصف: Degenerative cervical myelopathy (DCM) results from compression of the cervical spine cord as a result of age related changes in the cervical spine, and affects up to 2% of adults, leading to progressive disability. Surgical decompression is the mainstay of treatment, but there remains significant variation in surgical approaches used. This survey was conducted in order to define current practice amongst spine surgeons worldwide, as a possible prelude to further studies comparing surgical approaches. METHODS: An electronic survey was developed and piloted by the investigators using SurveyMonkey. Collected data was categorical and is presented using summary statistics. Where applicable, statistical comparisons were made using a Chi-Squared test. The level of significance for all statistical analyses was defined as p < 0.05. All analysis, including graphs was performed using R (R Studio). RESULTS: 127 surgeons, from 30 countries completed the survey; principally UK (66, 52%) and North America (15, 12%). Respondents were predominantly Neurosurgeons by training (108, 85%) of whom 84 (75%) reported Spinal Surgery as the principal part of their practice. The majority indicated they selected their surgical procedure for multi-level DCM on a case by case basis (62, 49%). Overall, a posterior approach was more popular for multi-level DCM (74, 58%). Region, speciality or annual multi-level case load did not influence this significantly. However, there was a trend for North American surgeons to be more likely to favour a posterior approach. CONCLUSIONS: A posterior approach was favoured and more commonly used to treat multi-level DCM, in an international cohort of surgeons. Posterior techniques including laminectomy, laminectomy and fusion or laminoplasty appeared to be equally popular. ; The article is available via Open Access. Click on the 'Additional link' above to access the full-text. ; Published version, accepted version

العلاقة: https://linkinghub.elsevier.com/retrieve/pii/S0967-5868Test(21)00066-7; Davies, B. M. et al. (2021) ‘Current surgical practice for multi-level degenerative cervical myelopathy: Findings from an international survey of spinal surgeons.’, Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia, 87, pp. 84–88. doi:10.1016/j.jocn.2021.01.049.; https://rde.dspace-express.com/handle/11287/622036Test; Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia

الإتاحة: https://doi.org/10.1016/j.jocn.2021.01.049Test
https://rde.dspace-express.com/handle/11287/622036Test

المؤلفون: Hutton, Mike

مرشدي الرسالة: MacDonald, Glen, Geography

مصطلحات موضوعية: geography, expansion, Alberta, Parkland-Boreal Forest, ecotone boundary, mid-Holocene, climatic warming, hypsithermal, Mariana Lake

الوصف: A 7.09 m lacustrine sediment core was taken from Mariana Lake, Alberta (55º57'N, 112º01'W) to determine if the regional vegetational complex had been affected by the mid-Holocene Hypsithermal. Dating control was provided by 6 radiocarbon dates, with a second degree polynomial fitted to the dates to give an age to depth curve. The basal date of the core is 11 300 ± 110 yr BP. Fossil pollen analysis of the core revealed five distinct pollen zones. Between 11 856 and 10 434 yr BP the study site supported a sparse herb dominated vegetation. A spruce and shrub birch assemblage followed, from 10 434 to 9 100 yr BP, with increased vegetation density. The climate was likely similar to today. This was replaced by a paper birch and spruce complex from 9 100 to 7 638 yr BP likely as a result of warming climate. A mild Hypsithermal effect is recorded between 7 638 and 5 623 yr BP. A forest of decreased crown density was created, with spruce, paper birch and poplar being the major vegetational components. Modern conditions have existed at the site from 5 623 yr BP onwards, though it is hypothesised the regional water budget may have increased slightly around 2 228 yr BP; increased peat development appears to have occurred at this time. Through the use of difference diagrams the site is compared to three other published sites which, along with Mariana Lake, form a north-south transect from the southern Boreal Forest to the northern Alberta Boreal Forest. The hypsithermal vegetation changes varies with distance to the Parkland-Boreal Forest ecotone boundary. It is concluded the parkland did not reach Mariana Lake during the mid-Holocene, though conditions at the site became similar to those at the southern edge of the Boreal Forest that is proximal to the parkland.
Thesis
Bachelor of Arts (BA)

الإتاحة: http://hdl.handle.net/11375/18628Test

المؤلفون: He, Yi, Hutton, Mike, Chan, Steven, De Gruijl, Robert, Govindaraju, Rama, Patil, Nishant, Li, Yanjing

المصدر: Proceedings of the 50th Annual International Symposium on Computer Architecture

الإتاحة: https://doi.org/10.1145/3579371.3589105Test