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Article ; Online: Updates in diagnostic tools for diagnosing nerve injury and compressions.

Bourke, Gráinne / Wade, Ryckie G / van Alfen, Nens

The Journal of hand surgery, European volume

2024 , Page(s) 17531934241238736

Abstract: Predicting prognosis after nerve injury and compression can be challenging, even for the experienced clinician. Although thorough clinical assessment can aid diagnosis, we cannot always be precise about long-term functional recovery of either motor or ... ...

Abstract	Predicting prognosis after nerve injury and compression can be challenging, even for the experienced clinician. Although thorough clinical assessment can aid diagnosis, we cannot always be precise about long-term functional recovery of either motor or sensory nerves. To evaluate the severity of nerve injury, surgical exploration remains the gold standard, particularly after iatrogenic injury and major nerve injury from trauma, such as brachial plexus injury. Recently, advances in imaging techniques (ultrasound, magnetic resonance imaging [MRI] and MR neurography) along with multimodality assessment, including electrodiagnostic testing, have allowed us to have a better preoperative understanding of nerve continuity and prediction of nerve health and possible recovery. This article outlines the current and potential roles for clinical assessment, exploratory surgery, electrodiagnostic testing ultrasound and MRI in entrapment neuropathies, inflammatory neuritis and trauma. Emphasis is placed on those modalities that are improving in diagnostic accuracy of nerve assessment before any surgical intervention.
Language	English
Publishing date	2024-03-27
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	2272801-6
ISSN	2043-6289 ; 1753-1934
ISSN (online)	2043-6289
ISSN	1753-1934
DOI	10.1177/17531934241238736
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Article ; Online: Response to: Preoperative perforator mapping: Accuracy, bias, concordance and the devil.

Kiely, John R / Wade, Ryckie G

Journal of plastic, reconstructive & aesthetic surgery : JPRAS

2021 Volume 74, Issue 10, Page(s) 2776–2820

MeSH term(s)	Diagnostic Imaging/methods ; Diagnostic Imaging/statistics & numerical data ; Epigastric Arteries/diagnostic imaging ; Humans ; Mammaplasty/methods ; Perforator Flap/blood supply ; Preoperative Care/methods ; Systematic Reviews as Topic/methods
Language	English
Publishing date	2021-06-18
Publishing country	Netherlands
Document type	Letter
ZDB-ID	2217750-4
ISSN	1878-0539 ; 1748-6815 ; 0007-1226
ISSN (online)	1878-0539
ISSN	1748-6815 ; 0007-1226
DOI	10.1016/j.bjps.2021.05.058
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Article ; Online: Bacterial sensitivity to chlorhexidine and povidone-iodine antiseptics over time: a systematic review and meta-analysis of human-derived data.

Aftab, Raiyyan / Dodhia, Vikash H / Jeanes, Christopher / Wade, Ryckie G

Scientific reports

2023 Volume 13, Issue 1, Page(s) 347

Abstract: Surgical site infection (SSI) is the most common complication of surgery, increasing healthcare costs and hospital stay. Chlorhexidine (CHX) and povidone-iodine (PVI) are used for skin antisepsis, minimising SSIs. There is concern that resistance to ... ...

Abstract	Surgical site infection (SSI) is the most common complication of surgery, increasing healthcare costs and hospital stay. Chlorhexidine (CHX) and povidone-iodine (PVI) are used for skin antisepsis, minimising SSIs. There is concern that resistance to topical biocides may be emergeing, although the potential clinical implications remain unclear. The objective of this systematic review was to determine whether the minimum bactericidal concentration (MBC) of topical preparations of CHX or PVI have changed over time, in microbes relevant to SSI. We included studies reporting the MBC of laboratory and clinical isolates of common microbes to CHX and PVI. We excluded studies using non-human samples and antimicrobial solvents or mixtures with other active substances. MBC was pooled in random effects meta-analyses and the change in MBC over time was explored using meta-regression. Seventy-nine studies were included, analysing 6218 microbes over 45 years. Most studies investigated CHX (93%), with insufficient data for meta-analysis of PVI. There was no change in the MBC of CHX to Staphylococci or Streptococci over time. Overall, we find no evidence of reduced susceptibility of common SSI-causing microbes to CHX over time. This provides reassurance and confidence in the worldwide guidance that CHX should remain the first-choice agent for surgical skin antisepsis.
MeSH term(s)	Humans ; Anti-Infective Agents, Local/pharmacology ; Povidone-Iodine/pharmacology ; Chlorhexidine/pharmacology ; Preoperative Care ; Surgical Wound Infection/prevention & control
Chemical Substances	Anti-Infective Agents, Local ; Povidone-Iodine (85H0HZU99M) ; Chlorhexidine (R4KO0DY52L)
Language	English
Publishing date	2023-01-07
Publishing country	England
Document type	Meta-Analysis ; Systematic Review ; Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2615211-3
ISSN	2045-2322 ; 2045-2322
ISSN (online)	2045-2322
ISSN	2045-2322
DOI	10.1038/s41598-022-26658-1
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Article ; Online: Image analysis of cutaneous melanoma histology: a systematic review and meta-analysis.

Clarke, Emily L / Wade, Ryckie G / Magee, Derek / Newton-Bishop, Julia / Treanor, Darren

Scientific reports

2023 Volume 13, Issue 1, Page(s) 4774

Abstract: The current subjective histopathological assessment of cutaneous melanoma is challenging. The application of image analysis algorithms to histological images may facilitate improvements in workflow and prognostication. To date, several individual ... ...

Abstract	The current subjective histopathological assessment of cutaneous melanoma is challenging. The application of image analysis algorithms to histological images may facilitate improvements in workflow and prognostication. To date, several individual algorithms applied to melanoma histological images have been reported with variations in approach and reported accuracies. Histological digital images can be created using a camera mounted on a light microscope, or through whole slide image (WSI) generation using a whole slide scanner. Before any such tool could be integrated into clinical workflow, the accuracy of the technology should be carefully evaluated and summarised. Therefore, the objective of this review was to evaluate the accuracy of existing image analysis algorithms applied to digital histological images of cutaneous melanoma. Database searching of PubMed and Embase from inception to 11th March 2022 was conducted alongside citation checking and examining reports from organisations. All studies reporting accuracy of any image analysis applied to histological images of cutaneous melanoma, were included. The reference standard was any histological assessment of haematoxylin and eosin-stained slides and/or immunohistochemical staining. Citations were independently deduplicated and screened by two review authors and disagreements were resolved through discussion. The data was extracted concerning study demographics; type of image analysis; type of reference standard; conditions included and test statistics to construct 2 × 2 tables. Data was extracted in accordance with our protocol and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses-Diagnostic Test Accuracy (PRISMA-DTA) Statement. A bivariate random-effects meta-analysis was used to estimate summary sensitivities and specificities with 95% confidence intervals (CI). Assessment of methodological quality was conducted using a tailored version of the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. The primary outcome was the pooled sensitivity and specificity of image analysis applied to cutaneous melanoma histological images. Sixteen studies were included in the systematic review, representing 4,888 specimens. Six studies were included in the meta-analysis. The mean sensitivity and specificity of automated image analysis algorithms applied to melanoma histological images was 90% (CI 82%, 95%) and 92% (CI 79%, 97%), respectively. Based on limited and heterogeneous data, image analysis appears to offer high accuracy when applied to histological images of cutaneous melanoma. However, given the early exploratory nature of these studies, further development work is necessary to improve their performance.
MeSH term(s)	Humans ; Skin Neoplasms/diagnosis ; Skin Neoplasms/pathology ; Melanoma/diagnostic imaging ; Melanoma/pathology ; Sensitivity and Specificity ; Algorithms ; Melanoma, Cutaneous Malignant
Language	English
Publishing date	2023-03-23
Publishing country	England
Document type	Meta-Analysis ; Systematic Review ; Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2615211-3
ISSN	2045-2322 ; 2045-2322
ISSN (online)	2045-2322
ISSN	2045-2322
DOI	10.1038/s41598-023-31526-7
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Article ; Online: Hand and wrist surgery on anticoagulants and antiplatelets: A systematic review and meta-analysis.

Stone, Matthew J / Wilks, Daniel J / Wade, Ryckie G

Journal of plastic, reconstructive & aesthetic surgery : JPRAS

2020 Volume 73, Issue 8, Page(s) 1413–1423

Abstract: Introduction: Approximately 2% of the population are anticoagulated and over 50% of over 65-year-olds are prescribed antiplatelet agents. Several systematic reviews have shown the safety of interrupting anticoagulation and antiplatelets for non- ... ...

Abstract	Introduction: Approximately 2% of the population are anticoagulated and over 50% of over 65-year-olds are prescribed antiplatelet agents. Several systematic reviews have shown the safety of interrupting anticoagulation and antiplatelets for non-emergency surgery, although such reviews excluded upper limb procedures and represents the rationale for this review. Methods: The literature was systematically searched for studies concerning the outcomes of adult hand or wrist surgery on patients receiving anticoagulation or antiplatelet agents in direct comparison to controls (no anticoagulation or antiplatelet agents, or interruption of either). The primary outcome was reoperation for any complication related to postoperative bleeding, within 30 postoperative days. Results: Nine cohort studies (3628 individuals; 3863 operations) were included. Based on very low-quality evidence, anticoagulation did not affect the risk of reoperation for bleeding (RR 2.4 [95% CI 0.1, 57]; 3 studies, n=443) or bruising (RR 2.5 [95% CI 1.0, 6.3]; n=124; I Conclusions: Given the sparsity of events (bleeding and bruising) and low-quality of the literature, no firm conclusions can be drawn. The decision to interrupt antiplatelets or anticoagulants should be made jointly with expert physicians and the patient. Registration: PROSPERO ID CRD42018087755.
MeSH term(s)	Anticoagulants/administration & dosage ; Hand/surgery ; Hemorrhage/prevention & control ; Hemorrhage/surgery ; Humans ; Platelet Aggregation Inhibitors/administration & dosage ; Postoperative Complications/prevention & control ; Postoperative Complications/surgery ; Reoperation ; Wrist/surgery
Chemical Substances	Anticoagulants ; Platelet Aggregation Inhibitors
Language	English
Publishing date	2020-05-19
Publishing country	Netherlands
Document type	Journal Article ; Meta-Analysis ; Systematic Review
ZDB-ID	2217750-4
ISSN	1878-0539 ; 1748-6815 ; 0007-1226
ISSN (online)	1878-0539
ISSN	1748-6815 ; 0007-1226
DOI	10.1016/j.bjps.2020.05.017
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Article ; Online: The accuracy of different modalities of perforator mapping for unilateral DIEP flap breast reconstruction: A systematic review and meta-analysis.

Kiely, John / Kumar, Mayank / Wade, Ryckie G

Journal of plastic, reconstructive & aesthetic surgery : JPRAS

2020 Volume 74, Issue 5, Page(s) 945–956

Abstract: Background: Perforator mapping may be performed prior to deep inferior epigastric perforator (DIEP) flap breast reconstruction to guide perforator selection. However, the accuracy of different imaging modalities remains unknown. This review aimed to ... ...

Abstract	Background: Perforator mapping may be performed prior to deep inferior epigastric perforator (DIEP) flap breast reconstruction to guide perforator selection. However, the accuracy of different imaging modalities remains unknown. This review aimed to evaluate the accuracy of different modalities for locating perforators for unipedicled DIEP flap breast reconstruction. Methods: MEDLINE and EMBASE were searched from inception to 24th September 2019 for studies concerning adult women undergoing DIEP flap breast reconstruction with preoperative perforator mapping. The index test was pre-operative imaging and the reference standard was intraoperative identification. Results: 21 articles with 1146 women were included. Six methods were described; handheld doppler, colour doppler (duplex) ultrasonography, computed tomography angiography, magnetic resonance angiography (MRA), direct infrared thermography with and without doppler. Meta-analysis revealed 94% (95% CI 88-99%) of DIEPs identified as the 'dominant perforator' on imaging were chosen as dominant perforators intraoperatively. Colour doppler (Duplex) ultrasonography had the lowest agreement (mean 74% [95% CI 67-81%]) whilst MRA had the highest agreement (mean 97% [95% CI 86-100%]). There was no statistically significant difference in the performance of different tests. All studies were subject to bias as the operators had knowledge of the index test prior to conducting the reference standard. Conclusions: Based upon limited evidence, cross sectional (CT/MR) imaging modalities for preoperative DIEP mapping appear to have similar accuracy and perform better than ultrasound.
MeSH term(s)	Breast Neoplasms/diagnostic imaging ; Breast Neoplasms/surgery ; Epigastric Arteries/diagnostic imaging ; Epigastric Arteries/transplantation ; Female ; Humans ; Mammaplasty/methods ; Perforator Flap/blood supply ; Preoperative Care
Language	English
Publishing date	2020-12-10
Publishing country	Netherlands
Document type	Journal Article ; Meta-Analysis ; Systematic Review
ZDB-ID	2217750-4
ISSN	1878-0539 ; 1748-6815 ; 0007-1226
ISSN (online)	1878-0539
ISSN	1748-6815 ; 0007-1226
DOI	10.1016/j.bjps.2020.12.005
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Article ; Online: Meta-analysis of the normal diffusion tensor imaging values of the median nerve and how they change in carpal tunnel syndrome.

Rojoa, Djamila / Raheman, Firas / Rassam, Joseph / Wade, Ryckie G

Scientific reports

2021 Volume 11, Issue 1, Page(s) 20935

Abstract: Carpal tunnel syndrome (CTS) leads to distortion of axonal architecture, demyelination and fibrosis within the median nerve. Diffusion tensor imaging (DTI) characterises tissue microstructure and generates reproducible proxy measures of nerve 'health' ... ...

Abstract	Carpal tunnel syndrome (CTS) leads to distortion of axonal architecture, demyelination and fibrosis within the median nerve. Diffusion tensor imaging (DTI) characterises tissue microstructure and generates reproducible proxy measures of nerve 'health' which are sensitive to myelination, axon diameter, fiber density and organisation. This meta-analysis summarises the normal DTI values of the median nerve, and how they change in CTS. This systematic review included studies reporting DTI of the median nerve at the level of the wrist in adults. The primary outcome was to determine the normal fractional anisotropy (FA) and mean diffusivity (MD) of the median nerve. Secondarily, we show how the FA and MD differ between asymptomatic adults and patients with CTS, and how these differences are independent of the acquisition methods. We included 32 studies of 2643 wrists, belonging to 1575 asymptomatic adults and 1068 patients with CTS. The normal FA was 0.58 (95% CI 0.56, 0.59) and the normal MD was 1.138 × 10
MeSH term(s)	Carpal Tunnel Syndrome/diagnostic imaging ; Diffusion Magnetic Resonance Imaging/methods ; Diffusion Tensor Imaging/methods ; Humans ; Median Nerve/diagnostic imaging ; Reference Values ; Wrist Joint/diagnostic imaging
Language	English
Publishing date	2021-10-22
Publishing country	England
Document type	Journal Article ; Meta-Analysis ; Research Support, Non-U.S. Gov't ; Review
ZDB-ID	2615211-3
ISSN	2045-2322 ; 2045-2322
ISSN (online)	2045-2322
ISSN	2045-2322
DOI	10.1038/s41598-021-00353-z
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Article ; Online: Disseminating Hand Surgery Research Using Social Media: The Relationship Between Altmetrics and Citations.

Yoshimura, Ryo / Grant, Michael C / Gardiner, Matthew D / Wade, Ryckie G

The Journal of hand surgery

2021 Volume 46, Issue 9, Page(s) 740–747

Abstract: Purpose: Social media adds to the traditional methods of research dissemination. It allows researchers and publishers to immediately share content directly with interested end users on a global scale. Alternative metrics (altmetrics) are new ... ...

Abstract	Purpose: Social media adds to the traditional methods of research dissemination. It allows researchers and publishers to immediately share content directly with interested end users on a global scale. Alternative metrics (altmetrics) are new bibliometrics that describe article-level activity on platforms such as Twitter, Wikipedia, and online news media. Altmetrics are strongly associated with citation counts in numerous medical disciplines. The aim of this study was to investigate the relationship of altmetrics to citation counts in the field of hand surgery. Methods: Altmetric Explorer was used to extract data on altmetrics and citation rates for articles published in 2017 in 6 prominent hand surgery journals. Multivariable negative binomial regression was used to estimate the relationship between citation counts and predictors (presented as the incidence rate ratio with a 95% confidence interval [CI]). Results: Overall, 624 articles were included. Mentions on social media platforms were independently associated with more citations (adjusted incidence rate ratio 1.04 [95% CI 1.02-1.05]). The factor that most influenced the rate of citations was the journal in which the article was published; articles in the Journal of Hand Surgery had at least 1 more citation than articles published elsewhere (median difference 3 [interquartile range {IQR} 2-3]) and had a median Altmetric Attention Score which was 3 points higher (IQR 2-3) than articles published elsewhere. Conclusions: The dissemination of hand surgery research through social media channels is associated with substantial and measurable improvements in short-term citation rates CLINICAL RELEVANCE: Social media appears to be a valuable tool for communicating important research directly to hand surgeons in a timely and succinct manner.
MeSH term(s)	Bibliometrics ; Hand/surgery ; Humans ; Journal Impact Factor ; Social Media ; Specialties, Surgical
Language	English
Publishing date	2021-05-26
Publishing country	United States
Document type	Journal Article
ZDB-ID	605716-0
ISSN	1531-6564 ; 0363-5023
ISSN (online)	1531-6564
ISSN	0363-5023
DOI	10.1016/j.jhsa.2021.03.028
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Article ; Online: Primary treatment of type B post-axial ulnar polydactyly: A systematic review and meta-analysis.

Samarendra, Harsh / Wade, Ryckie G / Glanvill, Louise / Wormald, Justin / Jain, Abhilash

JPRAS open

2022 Volume 34, Page(s) 21–33

Abstract: Optimal management of pedunculated ulnar polydactyly is not defined. This systematic review summarises objective and patient-reported outcomes following primary treatment. Two authors screened articles for inclusion according to a PROSPERO published ... ...

Abstract	Optimal management of pedunculated ulnar polydactyly is not defined. This systematic review summarises objective and patient-reported outcomes following primary treatment. Two authors screened articles for inclusion according to a PROSPERO published protocol. The meta-analysis of adverse events was performed, and a narrative synthesis of satisfaction and patient-reported outcomes was reported. The risk of bias was assessed using Cochrane's ROBINS-I tool. Of 1650 articles identified, 15 were eligible, including 13 single-arm and 2 multi-arm studies. Complications were 6 times as likely with ligation procedures (22%), compared to surgical removal (1%) whether this was performed in the outpatient setting or operating theatre (OR 6.89 [95% CI 1.73, 27]). Parent-reported satisfaction was high for all treatments. Studies were at high risk of bias and low methodological quality. Outcome measurement and follow-up were heterogenous. Well-designed prospective observational and experimental studies are required to inform practice, incorporating clinician and parent-reported outcomes and economic analyses. Level of evidence: I.
Language	English
Publishing date	2022-05-13
Publishing country	Netherlands
Document type	Journal Article ; Review
ZDB-ID	2834721-3
ISSN	2352-5878 ; 2352-5878
ISSN (online)	2352-5878
ISSN	2352-5878
DOI	10.1016/j.jpra.2022.05.002
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Article ; Online: Meta-analysis of the normal diffusion tensor imaging values of the peripheral nerves in the upper limb.

Wade, Ryckie G / Lu, Fangqing / Poruslrani, Yohan / Karia, Chiraag / Feltbower, Richard G / Plein, Sven / Bourke, Grainne / Teh, Irvin

Scientific reports

2023 Volume 13, Issue 1, Page(s) 4852

Abstract: Peripheral neuropathy affects 1 in 10 adults over the age of 40 years. Given the absence of a reliable diagnostic test for peripheral neuropathy, there has been a surge of research into diffusion tensor imaging (DTI) because it characterises nerve ... ...

Abstract	Peripheral neuropathy affects 1 in 10 adults over the age of 40 years. Given the absence of a reliable diagnostic test for peripheral neuropathy, there has been a surge of research into diffusion tensor imaging (DTI) because it characterises nerve microstructure and provides reproducible proxy measures of myelination, axon diameter, fibre density and organisation. Before researchers and clinicians can reliably use diffusion tensor imaging to assess the 'health' of the major nerves of the upper limb, we must understand the "normal" range of values and how they vary with experimental conditions. We searched PubMed, Embase, medRxiv and bioRxiv for studies which reported the findings of DTI of the upper limb in healthy adults. Four review authors independently triple extracted data. Using the meta suite of Stata 17, we estimated the normal fractional anisotropy (FA) and diffusivity (mean, MD; radial, RD; axial AD) values of the median, radial and ulnar nerve in the arm, elbow and forearm. Using meta-regression, we explored how DTI metrics varied with age and experimental conditions. We included 20 studies reporting data from 391 limbs, belonging to 346 adults (189 males and 154 females, ~ 1.2 M:1F) of mean age 34 years (median 31, range 20-80). In the arm, there was no difference in the FA (pooled mean 0.59 mm
MeSH term(s)	Adult ; Male ; Female ; Humans ; Diffusion Tensor Imaging/methods ; Reference Values ; Peripheral Nerves/diagnostic imaging ; Ulnar Nerve ; Forearm/innervation ; Anisotropy
Language	English
Publishing date	2023-03-24
Publishing country	England
Document type	Meta-Analysis ; Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2615211-3
ISSN	2045-2322 ; 2045-2322
ISSN (online)	2045-2322
ISSN	2045-2322
DOI	10.1038/s41598-023-31307-2
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