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  1. Article ; Online: A comparative study of hip fracture care and outcomes in major trauma centres versus trauma units.

    Tyas, Ben / Lukic, John / Harrison, John / Singisetti, Kiran

    Injury

    2022  Volume 53, Issue 4, Page(s) 1455–1458

    Abstract: Introduction: There is good evidence to support that major trauma networks significantly reduce morbidity and mortality in severely injured patients. However, following the introduction of major trauma centres (MTCs) in England in 2012, early concerns ... ...

    Abstract Introduction: There is good evidence to support that major trauma networks significantly reduce morbidity and mortality in severely injured patients. However, following the introduction of major trauma centres (MTCs) in England in 2012, early concerns were raised regarding the effect on hip fracture patients. The aim of our study was to review data from the National Hip Fracture Database for fractured neck of femur (FNOF) patients, comparing patient outcomes between MTCs and trauma units (TUs), and the national regions of the UK.
    Methods: NHFD data from 2018 for all hospitals in England, Wales and NI was collected using the charts and dashboards available online. We recorded data for the following outcomes: time to surgery, acute hospital length of stay, overall hospital length of stay, discharge to original residence within 120 days, crude 30-day mortality and adjusted 30-day mortality. We conducted a one-way ANOVA test to calculate statistical differences for each outcome measure by MTC vs TU and then separately for the regions of the UK divided into England, Wales and Northern Ireland (NI).
    Results: Data for 175 hospitals are included in this study; 22 of which were MTCs. The total number of operative cases were 65,848. 9668 of these occurred in MTC compared to 56,180 in TUs. This equates to an annual average of 439 per MTC and 367 per TU. Despite this, there was no statistically significant difference observed in all outcomes for MTC vs TU. Patients in NI waited longer for their surgery (60.3 h, p < 0.001), whilst patients in Wales had the longest overall hospital length of stay (31.6 days, p < 0.001). However, there was no difference in patients' crude 30-day mortality (p = 0.480) or adjusted 30-day mortality (p = 0.191).
    Conclusion: These findings are reassuring for MTCs in England. We found no evidence to suggest that FNOF patients are treated inferiorly, or have worse outcomes, at MTCs vs TUs. FNOF patients in NI waited longer for their surgery but this did not have any significant difference on 30-day mortality rates. The care of FNOF patients in NI may warrant further study.
    MeSH term(s) Databases, Factual ; England ; Hip Fractures/mortality ; Hip Fractures/surgery ; Humans ; Length of Stay ; Northern Ireland ; Outcome Assessment, Health Care ; Retrospective Studies ; Trauma Centers/statistics & numerical data ; Wales
    Language English
    Publishing date 2022-02-09
    Publishing country Netherlands
    Document type Comparative Study ; Journal Article
    ZDB-ID 218778-4
    ISSN 1879-0267 ; 0020-1383
    ISSN (online) 1879-0267
    ISSN 0020-1383
    DOI 10.1016/j.injury.2022.02.018
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article: Effect of Covid-19 on best practice care of hip fracture patients: An analysis from the National Hip Fracture Database (NHFD).

    Tyas, Ben / Wilkinson, Mike / Singisetti, Kiran

    The surgeon : journal of the Royal Colleges of Surgeons of Edinburgh and Ireland

    2021  Volume 19, Issue 5, Page(s) e298–e303

    Abstract: Background: Best practice tariff (BPT) has brought significant improvements in hip fracture care; the 2019 report showing a 30-day mortality of 6.1%. Data relating to more than 65,000 patients who sustain a fractured neck of femur (FNOF) are recorded ... ...

    Abstract Background: Best practice tariff (BPT) has brought significant improvements in hip fracture care; the 2019 report showing a 30-day mortality of 6.1%. Data relating to more than 65,000 patients who sustain a fractured neck of femur (FNOF) are recorded each year in the National Hip Fracture Database (NHFD). The aim of our study was to review the impact of COVID-19 on BPT.
    Methods: Data was extracted from the NHFD for England, Wales and Northern Ireland. The months of March to June 2020 (lockdown period related to COVID-19) were compared to the same period in 2019. Data used in this study was collated and analysed between 14th and 17th October 2020.
    Results: Data for more than 40,000 patients was reviewed. BPT dropped -4.3% in March, -12.6% in April, -12.9% in May 2020, and -7.2% in June. Prompt surgery remained stable (four-month average + 0.1%). The most significant changes were noted for timely orthogeriatric review (-7.6%, p < 0.001), bone health assessment (-7.3%, p < 0.001) and post-operative delirium assessment (-6.6%, p < 0.001). 30-day mortality increased to 13.7% in March 2020 and remained high in April 2020 (11.3%) and May (7.3%). Acute hospital length of stay was lowest in May 2020 (11.7 days).
    Conclusion: Patients sustaining FNOF in March 2020 had an associated 30-day mortality of 13.7%. During the COVID-19 pandemic, there was a significant reduction in BPT. The most significant changes were observed in timely orthogeriatric review. Maintaining a high standard of multidisciplinary care for this vulnerable group of patients is crucial during future spikes of COVID-19.
    MeSH term(s) Benchmarking ; COVID-19/epidemiology ; COVID-19/prevention & control ; COVID-19/transmission ; Communicable Disease Control ; Databases, Factual ; Hip Fractures/complications ; Hip Fractures/mortality ; Hip Fractures/surgery ; Humans ; Length of Stay ; Quality Indicators, Health Care ; Retrospective Studies ; State Medicine ; Survival Rate ; Treatment Outcome ; United Kingdom
    Language English
    Publishing date 2021-02-01
    Publishing country Scotland
    Document type Journal Article
    ZDB-ID 2102927-1
    ISSN 1479-666X
    ISSN 1479-666X
    DOI 10.1016/j.surge.2021.01.003
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article: A rare case of calcific tendinitis of biceps femoris presenting with lateral knee pain.

    Akhtar, Muhammad Adeel / Tyas, Ben / Bethapudi, Sarath

    Journal of clinical orthopaedics and trauma

    2020  Volume 11, Issue Suppl 4, Page(s) S660–S662

    Abstract: Distal biceps femoris tendon is an unusual site of calcific tendinitis and a rare cause of knee pain. We present a case of 72-year-old lady who presented with a six-month history of pain over the lateral aspect of knee. Subsequent imaging demonstrated ... ...

    Abstract Distal biceps femoris tendon is an unusual site of calcific tendinitis and a rare cause of knee pain. We present a case of 72-year-old lady who presented with a six-month history of pain over the lateral aspect of knee. Subsequent imaging demonstrated calcific deposits within the biceps femoris tendon substance. She was then successfully treated with ultrasound-guided barbotage of the calcium deposits and peri-tendinous corticosteroid injection. Clinical awareness of the unusual sites of calcific tendinitis with imaging evidence is important for early diagnosis and appropriate management.
    Language English
    Publishing date 2020-04-15
    Publishing country India
    Document type Journal Article
    ZDB-ID 2596956-0
    ISSN 2213-3445 ; 0976-5662
    ISSN (online) 2213-3445
    ISSN 0976-5662
    DOI 10.1016/j.jcot.2020.04.015
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: Long-term implant survival following hemiarthroplasty for fractured neck of femur.

    Tyas, Ben / Marsh, Martin / de Steiger, Richard / Lorimer, Michelle / Petheram, Timothy G / Inman, Dominic S / Reed, Mike R / Jameson, Simon S

    The bone & joint journal

    2023  Volume 105-B, Issue 8, Page(s) 864–871

    Abstract: Aims: Several different designs of hemiarthroplasty are used to treat intracapsular fractures of the proximal femur, with large variations in costs. No clinical benefit of modular over monoblock designs has been reported in the literature. Long-term ... ...

    Abstract Aims: Several different designs of hemiarthroplasty are used to treat intracapsular fractures of the proximal femur, with large variations in costs. No clinical benefit of modular over monoblock designs has been reported in the literature. Long-term data are lacking. The aim of this study was to report the ten-year implant survival of commonly used designs of hemiarthroplasty.
    Methods: Patients recorded by the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) between 1 September 1999 and 31 December 2020 who underwent hemiarthroplasty for the treatment of a hip fracture with the following implants were included: a cemented monoblock Exeter Trauma Stem (ETS), cemented Exeter V40 with a bipolar head, a monoblock Thompsons prosthesis (Cobalt/Chromium or Titanium), and an Exeter V40 with a Unitrax head. Overall and age-defined cumulative revision rates were compared over the ten years following surgery.
    Results: A total of 41,949 hemiarthroplasties were included. Exeter V40 with a Unitrax head was the most commonly used (n = 20,707, 49.4%). The overall rate of revision was small. A total of 28,201 patients (67.2%) were aged > 80 years. There were no significant differences in revision rates across all designs of hemiarthroplasty in patients of this age at any time. The revision rates for all designs were < 3.5%, three years postoperatively. At subsequent times the ETS and Exeter V40 with a bipolar head performed well in all age groups. The unadjusted ten-year mortality rate for the whole cohort was 82.2%.
    Conclusion: There was no difference in implant survival between all the designs of hemiarthroplasty in the first three years following surgery, supporting the selection of a cost-effective design of hemiarthroplasty for most patients with an intracapsular fracture of the hip, as determined by local availability and costs. Beyond this, the ETS and Exeter bipolar designs performed well in all age groups.
    MeSH term(s) Humans ; Hemiarthroplasty ; Femoral Neck Fractures/surgery ; Treatment Outcome ; Reoperation ; Australia/epidemiology ; Hip Prosthesis ; Femur/surgery ; Spinal Fractures/surgery ; Arthroplasty, Replacement, Hip ; Prosthesis Design
    Language English
    Publishing date 2023-08-01
    Publishing country England
    Document type Journal Article
    ZDB-ID 2697156-2
    ISSN 2049-4408 ; 2049-4394
    ISSN (online) 2049-4408
    ISSN 2049-4394
    DOI 10.1302/0301-620X.105B8.BJJ-2022-1150.R3
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article ; Online: Quantification and severity grading of femoral vessel compression by adverse reactions to metal debris in metal-on-metal total hip arthroplasty.

    Al-Khatib, Yousef / Tyas, Ben / Kalson, Nicholas S / Agni, Nickil / Bhutani, Priyesh / Petheram, Timothy / Carluke, Ian / Partington, Paul

    Hip international : the journal of clinical and experimental research on hip pathology and therapy

    2023  Volume 34, Issue 2, Page(s) 215–220

    Abstract: Introduction: Metal-on-metal (MoM) total hip arthroplasty (THA) may cause adverse reactions to metal debris (ARMD). ARMD causing femoral vessel compression with serious complications has been described in case reports, but the rate of compression by ... ...

    Abstract Introduction: Metal-on-metal (MoM) total hip arthroplasty (THA) may cause adverse reactions to metal debris (ARMD). ARMD causing femoral vessel compression with serious complications has been described in case reports, but the rate of compression by ARMD is not known. This study aims to investigate the rate, and quantify the severity, of femoral vessel compression in MoM hips with ARMD lesions.
    Methods: Patients under surveillance for MoM THA investigated with MRI were studied. In patients with confirmed ARMD, femoral artery (FA) and vein (FV) diameters were measured at the point of maximal compression and compared to contralateral vessels. The primary outcome measure was presence or absence of compression. Cases were then classified by compression ratios. Secondary outcome measures were rates of deep vein thrombosis, revision surgery and time to ARMD from index procedure.
    Results: MRI scans for 436 patients with MoM THA were screened. Of these, 211/436 (48.4%) showed evidence of ARMD. Measurements were obtained on 133/211 (63.0%) patients. The FV was compressed in 102/133 (76.7%) and FA in 58/133 (43.6%), while 31/133 (23.3%) patients had no compression. In FVs, 42 demonstrated mild compression, 39 moderate and 21 severe. In FAs, none were severely compressed, 6 were moderate and 52 showed mild compression. There were 3 DVT cases, 2 in patients with moderate FV compression and 1 in patients without FV compression. Revision rates were highest in patients with severe FV compression (14/21, 66.7%). The mean time for MRI-diagnosed ARMD from index procedure was 8 years and 1 month (range 11 months-14.5 years).
    Conclusions: Extra-luminal compression of the femoral vessels was found in >75% of patients with ARMD. Although it is not clear whether revision for femoral vessel compression is required, quantification of FV compression may be useful for surgeons and radiologists considering revision for ARMD.
    MeSH term(s) Humans ; Arthroplasty, Replacement, Hip/adverse effects ; Hip Prosthesis/adverse effects ; Metal-on-Metal Joint Prostheses/adverse effects ; Metals/adverse effects ; Femur ; Reoperation ; Prosthesis Design ; Prosthesis Failure ; Retrospective Studies
    Chemical Substances Metals
    Language English
    Publishing date 2023-08-07
    Publishing country United States
    Document type Journal Article
    ZDB-ID 1162513-2
    ISSN 1724-6067 ; 1120-7000
    ISSN (online) 1724-6067
    ISSN 1120-7000
    DOI 10.1177/11207000231190738
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article ; Online: Reoperation and revision rates at ten years after 1,312 cemented Thompson's hemiarthroplasties : any need to change to a different implant?

    Khan, Sameer K / Tyas, Ben / Shenfine, Amy / Jameson, Simon S / Inman, Dominic S / Muller, Scott D / Reed, Mike R

    Bone & joint open

    2022  Volume 3, Issue 9, Page(s) 710–715

    Abstract: Aims: Despite multiple trials and case series on hip hemiarthroplasty designs, guidance is still lacking on which implant to use. One particularly deficient area is long-term outcomes. We present over 1,000 consecutive cemented Thompson's ... ...

    Abstract Aims: Despite multiple trials and case series on hip hemiarthroplasty designs, guidance is still lacking on which implant to use. One particularly deficient area is long-term outcomes. We present over 1,000 consecutive cemented Thompson's hemiarthroplasties over a ten-year period, recording all accessible patient and implant outcomes.
    Methods: Patient identifiers for a consecutive cohort treated between 1 January 2003 and 31 December 2011 were linked to radiographs, surgical notes, clinic letters, and mortality data from a national dataset. This allowed charting of their postoperative course, complications, readmissions, returns to theatre, revisions, and deaths. We also identified all postoperative attendances at the Emergency and Outpatient Departments, and recorded any subsequent skeletal injuries.
    Results: In total, 1,312 Thompson's hemiarthroplasties were analyzed (mean age at surgery 82.8 years); 125 complications were recorded, necessitating 82 returns to theatre. These included 14 patients undergoing aspiration or manipulation under anaesthesia, 68 reoperations (5.2%) for debridement and implant retention (n = 12), haematoma evacuation (n = 2), open reduction for dislocation (n = 1), fixation of periprosthetic fracture (n = 5), and 48 revised stems (3.7%), for infection (n = 13), dislocation (n = 12), aseptic loosening (n = 9), persistent pain (n = 6), periprosthetic fracture (n = 4), acetabular erosion (n = 3), and metastatic bone disease (n = 1). Their status at ten years is summarized as follows: 1,180 (89.9%) dead without revision, 34 (2.6%) dead having had revision, 84 (6.6%) alive with the stem unrevised, and 14 (1.1%) alive having had revision. Cumulative implant survivorship was 90.3% at ten years; patient survivorship was 7.4%.
    Conclusion: The Thompson's stem demonstrates very low rates of complications requiring reoperation and revision, up to ten years after the index procedure. Fewer than one in ten patients live for ten years after fracture. This study supports the use of a cemented Thompson's implant as a cost-effective option for frail hip fracture patients.Cite this article:
    Language English
    Publishing date 2022-08-18
    Publishing country England
    Document type Journal Article
    ISSN 2633-1462
    ISSN (online) 2633-1462
    DOI 10.1302/2633-1462.39.BJO-2022-0084
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  7. Article: Antibiotic resistance profiles of deep surgical site infections in hip hemiarthroplasty; comparing low dose single antibiotic versus high dose dual antibiotic impregnated cement.

    Tyas, Ben / Marsh, Martin / Oswald, Tamsin / Refaie, Ramsay / Molyneux, Catherine / Reed, Mike

    Journal of bone and joint infection

    2018  Volume 3, Issue 3, Page(s) 123–129

    Abstract: Objectives: ...

    Abstract Objectives:
    Language English
    Publishing date 2018-06-11
    Publishing country Germany
    Document type Journal Article
    ISSN 2206-3552
    ISSN 2206-3552
    DOI 10.7150/jbji.22192
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  8. Article ; Online: A Review of Survival Analysis Methods Used in NICE Technology Appraisals of Cancer Treatments: Consistency, Limitations, and Areas for Improvement.

    Bell Gorrod, Helen / Kearns, Ben / Stevens, John / Thokala, Praveen / Labeit, Alexander / Latimer, Nicholas / Tyas, David / Sowdani, Ahmed

    Medical decision making : an international journal of the Society for Medical Decision Making

    2019  Volume 39, Issue 8, Page(s) 899–909

    Abstract: Objectives. ...

    Abstract Objectives.
    MeSH term(s) England/epidemiology ; Guideline Adherence/statistics & numerical data ; Humans ; Neoplasms/mortality ; Neoplasms/therapy ; Progression-Free Survival ; Proportional Hazards Models ; Survival Analysis ; Technology Assessment, Biomedical ; Treatment Outcome
    Language English
    Publishing date 2019-11-09
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't ; Review
    ZDB-ID 604497-9
    ISSN 1552-681X ; 0272-989X
    ISSN (online) 1552-681X
    ISSN 0272-989X
    DOI 10.1177/0272989X19881967
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  9. Article: Controlled overexpression of Pax6 in vivo negatively autoregulates the Pax6 locus, causing cell-autonomous defects of late cortical progenitor proliferation with little effect on cortical arealization.

    Manuel, Martine / Georgala, Petrina A / Carr, Catherine B / Chanas, Simon / Kleinjan, Dirk A / Martynoga, Ben / Mason, John O / Molinek, Michael / Pinson, Jeni / Pratt, Thomas / Quinn, Jane C / Simpson, T Ian / Tyas, David A / van Heyningen, Veronica / West, John D / Price, David J

    Development (Cambridge, England)

    2007  Volume 134, Issue 3, Page(s) 545–555

    Abstract: Levels of expression of the transcription factor Pax6 vary throughout corticogenesis in a rostro-lateral(high) to caudo-medial(low) gradient across the cortical proliferative zone. Previous loss-of-function studies have indicated that Pax6 is required ... ...

    Abstract Levels of expression of the transcription factor Pax6 vary throughout corticogenesis in a rostro-lateral(high) to caudo-medial(low) gradient across the cortical proliferative zone. Previous loss-of-function studies have indicated that Pax6 is required for normal cortical progenitor proliferation, neuronal differentiation, cortical lamination and cortical arealization, but whether and how its level of expression affects its function is unclear. We studied the developing cortex of PAX77 YAC transgenic mice carrying several copies of the human PAX6 locus with its full complement of regulatory regions. We found that PAX77 embryos express Pax6 in a normal spatial pattern, with levels up to three times higher than wild type. By crossing PAX77 mice with a new YAC transgenic line that reports Pax6 expression (DTy54), we showed that increased expression is limited by negative autoregulation. Increased expression reduces proliferation of late cortical progenitors specifically, and analysis of PAX77<---->wild-type chimeras indicates that the defect is cell autonomous. We analyzed cortical arealization in PAX77 mice and found that, whereas the loss of Pax6 shifts caudal cortical areas rostrally, Pax6 overexpression at levels predicted to shift rostral areas caudally has very little effect. These findings indicate that Pax6 levels are stabilized by autoregulation, that the proliferation of cortical progenitors is sensitive to altered Pax6 levels and that cortical arealization is not.
    MeSH term(s) Animals ; Base Sequence ; Cell Proliferation ; Cerebral Cortex/cytology ; Cerebral Cortex/embryology ; Cerebral Cortex/metabolism ; DNA Primers/genetics ; Embryonic Stem Cells/cytology ; Embryonic Stem Cells/metabolism ; Eye Proteins/genetics ; Eye Proteins/metabolism ; Gene Dosage ; Gene Expression Regulation, Developmental ; Homeodomain Proteins/genetics ; Homeodomain Proteins/metabolism ; Homeostasis ; Humans ; Mice ; Mice, Transgenic ; Models, Neurological ; PAX6 Transcription Factor ; Paired Box Transcription Factors/genetics ; Paired Box Transcription Factors/metabolism ; Recombinant Proteins/genetics ; Recombinant Proteins/metabolism ; Repressor Proteins/genetics ; Repressor Proteins/metabolism
    Chemical Substances DNA Primers ; Eye Proteins ; Homeodomain Proteins ; PAX6 Transcription Factor ; PAX6 protein, human ; Paired Box Transcription Factors ; Pax6 protein, mouse ; Recombinant Proteins ; Repressor Proteins
    Language English
    Publishing date 2007-01-03
    Publishing country England
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 90607-4
    ISSN 1477-9129 ; 0950-1991
    ISSN (online) 1477-9129
    ISSN 0950-1991
    DOI 10.1242/dev.02764
    Database MEDical Literature Analysis and Retrieval System OnLINE

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