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1. The Use of Different Sepsis Risk Stratification Tools on the Wards and in Emergency Departments Uncovers Different Mortality Risks: Results of the Three Welsh National Multicenter Point-Prevalence Studies

Author

Harry J. A. Unwin, MBBCh, BSc, Maja Kopczynska, MBBCh, BSc, Richard Pugh, FRCA, Laura J. P. Tan, MBBS, BSc, Christian P. Subbe, MD, Gemma Ellis, MSc, Paul Morgan, FRCA, Peter Havalda, MD, Ben Sharif, MBBCh, John Burke, MSc, Tamas Szakmany, MD, PhD, FCCM, on behalf of Welsh Digital Data Collection Platform (WDDCP) Collaborators, Maria Hobrok, Moriah Thomas, Annie Burden, Nadia Youssef, Katherine Carnegie, Helena Colling-Sylvester, Natasha Logier, Meshari Alsaeed, Hannah Williams, Arfa Ayob, Nor Farzana, Sweta Parida, David Lawson, Emily Evans, Laura Jane Davis, Billie Atkins, Llywela Wyn Davies, Lee Sanders-Crook, Steffan Treharne Seal, Alice Cains, Richard Pugh, Katy Crisp, Sarah Venning, Ella Sykes, Stephanie Narine, Georgia Parry, Emily Angela Dillon, Qi Zhuang Siah, Ting Yang, Tyler Jones, Parvathi Thara, Emma Wood, Lara Wirt, Georgina St Pier, Richard Betts, Kyriaki Mitsaki, Mari Tachweed Pierce, Sioned Davies, Yakeen Hafouda, Erin Ifan, Grace Lacey, Francesca Mitchell, John Lynch, Michal Mazur, Lezia D’Souza, Bethan Ponting, Terrance Lau, Ruairidh Kerrigan, Lucy Morgan, Roshan Vindla, Claudia Zeicu, Becky James, Amirah Amin Ariff, Wan Binti Wan Azzlan, Charlotte Collins, Elizabeth Wickens, Alisa Norbee, Aliya Zulkefli, Thomas Haddock, Megan Thomas, Matthew Lee, Miriam Cynan, Nik-Syakirah Nik Azis, Imogen Hay, Catherine Russell, Margriet Vreugdenhil, Mustafa Abdimalik, Joseph Davies, Peter Havalda, Angharad Evans, Kate Robertson, Grace Gitau, Mei-yin Gruber, Thomas Telford, Anas Qarout, Naomi Nandra, Hannah Garrard, James Cutler, Rhiannon Tammy Jones, Amy Prideaux, Timothy Spence, Sarah Hardie, Harriet Seymour, Sam Willis, Matthew Warlow, Shanali Thanthilla, Thomas Downs, Nina Foley, Chad McKeown, Akshita Dandawate, Holleh Shayan-Arani, Ellie Taylor, Oliver Kyriakides, Rachel Price, Ffion Haf Mackey, Emily Haines, Samuel Chun, Nilarnti Vignarajah, Tessa Chamberlain, Dongying Zhao, Nayanatara Nadeesha T Tantirige, Naomi Dennehey, Georgina Evans, John Watts, Ceri Battle, Ryan Jones, Selina Jones, Charlotte James, James O’Hanlon, Isabella Bridges, Bethany Hughes, Leo Polchar, Elise Bisson, Charlotte Mykura, Lara Money, Joshua McKenna, Sarah Kinsman, Demiana Hanna, Emily Baker, Harrison Sprague, Liam Sharma, Tom Pontin, Emma Shore, Tamara Hughes, Sam Nightingale, Philby Baby, Matthew Shield, Alice Cross, Jenna Boss, Olivia Ross, George Ashton, Kimaya Pandit, Daniel Davies, Cameron Garbutt, Charlotte Johnston, Marcus Cox, Chantal Roberts, Alessia Waller, Laura Heekin, Kathy Wang, Rhianna Church, Shrina Patel, Marianne Broderick, Hannah Whillis, Daniel Craig Hathaway, Emel Yildirim, Caitlin Atkins, Elin Walters, Carys Durie, Robert James Hamilton Sinnerton, Benjamin Tanner, Julimar Abreu, Kiran Bashir, Vincent Hamlyn, Amelia Tee, Zoe Ann Hinchcliffe, Rita Otto, Georgie Covell, Megan Stone, Victoria Maidman, Katherine Godfray, Rhidian Caradine, Hannah Beetham, Adanna Nicole Anomneze-Collins, Jeanette Tan, Yasmina Abdelrazik, Azizah Khan, Nabihah Malik, Aidan Clack, Lewis Oliva, Tyler Thomas, Adam George Mounce, Anoopama Ramjeeawon, Ndaba Mtunzi, Duncan Soppitt, Jay Hale, Jack Wellington, Robert Buchanan Ross, Danielle Lis, Rebecca Parsonson, Jude Joseph-Gubra, Ajitha Arunthavarajah, Jessica Nicholas, Aaron Harris, Henry Atkinson, Jessica Webster, Tim Burnett, Josephine Raffan Gowar, Sam DeFriend, Jasmine Whitaker, Elizabeth Beasant, Luis Macchiavello, Danyal Usman, Abdullah Mahdi, Tiffany Ye Tze Shan, Nick Savill, Jennifer Gee, Lizzie Hodges, Ami Desai, Hannah Rossiter, Matthew Taylor, Kevin Pinto, Eleanor Hartley, Oscar Emanuel, Rhiannon Long, Megan Selby, Elilis Wardle, Alexandra Urquhart, Jack Barrington, Matthew Ashman, Elizabeth Adcock, Amelia Dickinson, Rebecca Jordache, Rym Chafai El Alaoui, Sophie Stovold, Sam Vickery, Nia Jones, Alice O’Donnell, Monty Cuthbert, Osa Eghosa, Muhammad Karim, Lowri Williams, Louise Tucker, Tom Downs, Rebecca Walford, Annabelle Hook, Adam Mounce, Emily Eccles, Ross Edwards, Kirtika Ramesh, Charlie Hall, Maria Lazarou, Rhidian Jones, Katy McGillian, Hari Singh Bhachoo, Zoe The, Vithusha Inpahas, Ruchi Desai, Yusuf Cheema, Andrew Hughes, Olivia Cranage, Felicity Bee, Khalid Osman, Humza Khan, Jennifer Pitt, Charlotte Pickwick, Jorge Carter, Fiona Andrew, Naseera Seedat, Roshni Patel, Megan Walker, Alicia Boam, Jessica Randall, Beth Bowyer, Josh Edwards, Natasha Jones, Emma Walker, Ailsa MacNaught, Swagath Balachandran, Abbie Shipley, Jennifer Louise Kent, Samuel Tilley, Bethany Davies, Emma Withers, Krishna Parmar, Lucie Webber, Angelica Sharma, Amy Handley, Alexandra Gordon, Lucy Allen, Rebecca Paddock, Harriet Penney, Lopa Banerjee, Chloe Victoria Vanderpump, Kate Harding, John Burke, Orsolya Minik, Nia Jarrett, Ellie Rowe, Adanna Anomneze-Collins, Harry Griffiths, Sarah Pengelly, Ffion Bennett, Ahmed Bilal, Abdullah El-badawey, Bethan Ellis, Luke Cook, Harriet Elizabeth Valentine Maine, Kiri Armstrong, Hannah Beresford, Timia Raven-Gregg, Tom Liddell-Lowe, Caitlin Ong, Harriet Reed, Frederika Alice St John, Weronika Julia Kozuch, Isabelle Ray, Irukshi Anuprabha Silva, Sin Ting Natalie Cheng, Umme-Laila Ali, Noreena Syed, Luke Murphy, Thomas Grother, Harry Smith, Rachel Watson, Omar Marei, Emma Kirby, Anna Gilfedder, Lydia Maw, Sarah O’Connor, Charlotte Maden, Helena Jones, Hazel Preston, Nur Amirah Binti Maliki, Mark Zimmerman, Jessica Webber, Llewelyn Jones, Rebecca Phillips, Lauren McCarthy, Emily Hubbard, Leo Duffy, Abigail Guerrier Sadler, Tamas Szakmany, Owen Richards, Charles King, Charlotte Killick, Yusuf Chema, Kavita Shergill, Yi Huen, Lillian Lau, Hannah Mustafa Ali, Lucas Wilcock, Molly Timlin, Ayeesha Rela, Daniel Smith, Sarah Ireland, Jennifer Evans, Nayanatara Poobalan, Jessica Pearce, Thivya V Vadiveloo, Zoe Black, Daniel Elis Samuel, Humaira Hussain, Joanna Hawkins, Zeid Atiyah, Rebecca Creamer, Maham Zafar, Ahmad Almazeedi, Hannah Brunnock, Zain Nasser, Mekha Jeyanthi, Poorya Moghbel, Katie Kwan, Isobel Sutherland, Frank Davis, Abigail Rogers, Zhao Xuan Tan, Clare Chantrill, Amal Robertson, Jonathan Foulkes, Rahana Khanam, Jomcy John, Sarah Hannah Meehan, Huria Metezai, Hannah Dawson, Navrhinaa Vadivale, Camilla Lee, Amrit Dhadda, Sian Cleaver, Genna Logue, Joy Inns, Isabel Jones, Robyn Howcroft, Carys Gilbert, Matthew Bradley, Louise Pike, Rachel Keeling, Charldré Banks, Eleanor Cochrane, James McFadyen, Matthew Mo, Emily Ireland, Esme Brittain, Ihssen Laid, Charlotte Green, Adriel Mcforrester, Xuong Michelle Ly, Mariana Nalbanti, Raven Joseph, Jack Tagg, David Purchase, Pan Myat, Ayako Niina, Tyler Joshua Jones, Lowri Hughes Thomas, Natalie Hoyle, Patrick Benc, Ellen Davies, Meng-Chieh Wu, David Fellows, Sam Tilley, Eloise Baxendale, Karishma Khan, Andrew Forrester, Oliver Moore, Hse Juinn Lim, Aimee Owen, Faris Hussain, Nima-banu Allybocus, Maneha Sethi, Harry Waring, Adeel Khan, Claire Smith, Nicholas Doyle, Mohammad Yahya Amjad, Luke Galloway, Paul Morgan, Gemma Ellis, Robert Lundin, Haamed Al Hassan, Bethan Markall, Namratha Kaur, Emmanuel Onyango, Heather Beard, Elliot Field, Ellen Nelson-Rowe, Lizzie Adcock, Amelia Stoddart, Frederika St John, Mathoorika Sivananthan, Rhys Jones, Sung Yeon Kwak, Lily Farakish, Holly Rhys-Ellis, Kate Moss, Tallulah Ray, Tessa David, Talea Roberts, Annie Quy, Aniket Paranjape, Nutchanun Poolworaluk, Mary Keast, Si Liang Yao, Dion Manning, Isobel Irwin, Umair Asim, Emelia Boggon, Ibrahim Alkurd, Genevieve Lawerece, Jade Brown, Emily Murphy, Evie Lambert, Jeremy Guilford, Beth Payne, Mariam Almulaifi, Arwel Poacher, Sashiananthan Ganesananthan, Berenice Cunningham-Walker, Chloe Spooner, Akanksha Kiran, Nabeegh Nadeem, Vidhi Unadkat, Esme Sparey, David Li, Jessica Smith, India Corrin, Amit Kurani, Paul McNulty, Ceri Brown, Wojciech Groblewski, Szilvia Szoke, Amelia Redman, Esther McKeag, Anastasia Donnir, Gaautham Ravishangar, Emanuela Howard, Charlotte Salmon, Sara Tanatova, Jasmine Kew, Megan Eilis Clark, Ellen Hannay, Olesya Godsafe, Christina Houghton, Francesca Lavric, Rachel Mallinson, Chris Littler, Harsha Reddy, Andrew Campbell, Benedict Soo, Rachel Evans, Georgina Donowho, Alexandra Cawthra, Maddison Davies, Matthew Lawrence Ashman, Jamie Scriven, James Vautrey, Shannon Seet, Imogen Britton, Abigail Hodgson, Emma Twohey, Joseph Robbins, Vanessa Yeo Yung Ling, Kimiya Asjadi, Carven Chin Yee Shean, Zoe McCarroll, Oritseweyimi Amatotsero, Hei Man Priscilla Chan, John Ng Cho Hui, Antonia Ashaye, Josephine Acheampong, Ayowade Adeleye, Saber Ahmed, Alexandra Chrysostomou, Harry Unwin, Eshen Ang, Niamh McSwiney, Yin Yin Lim, Zong Xuan Lee, Svetlana Kulikouskaya, Nur Zulkifili, Sheryl Lim, Lim Xin, Adiya Urazbayeva, Nur Haslina Ahmad Hanif, Yau Ke Ying, Alice Coleclough, Eilis Higgins, Naomi Spencer, Tze Gee Ng, Sam Booth, Stephanie Wai Yee Ng, Christian P Subbe, Isabella Patterson, Wen Li Chia, Abdullah Mukit, Hei Yi Vivian Pak, Felicity Lock, Mariana Nalmpanti, Shôn Alun Thomas, Tanisha Burgher, Alfred Wei Zhen Yeo, Siwan Powell Jones, Charlie Miles, Millicent Perry, Holly Burton, Katharine Powell, Luthfun Nessa, Aalaa Fadlalla, Rhian Morgan, Elizabeth Hodges, Amelia Heal, Chloe Scott, Alice Tayler, Thomas Chandy, Abduahad Taufik, James Cochrane, Samuel Willis, Sieh Yen Heng, Alex Cooper, Henrik Graf von der Pahlen, Isabella Talbot, Robin Gwyn Roberts, Jessica Sharma Smith, Aisling Sweeney, Cerian Roberts, Laura Bausor, Chania, Daniah Thomas, Elen Wyn Puw, Ronan A Lyons, and Judith E Hall

Subjects
Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract

OBJECTIVES:. To compare the performance of Sequential Organ Failure Assessment, systemic inflammatory response syndrome, Red Flag Sepsis, and National Institute of Clinical Excellence sepsis risk stratification tools in the identification of patients at greatest risk of mortality from sepsis in nonintensive care environments. DESIGN:. Secondary analysis of three annual 24-hour point-prevalence study periods. SETTING:. The general wards and emergency departments of 14 acute hospitals across Wales. Studies were conducted on the third Wednesday of October in 2017, 2018, and 2019. PATIENTS:. We screened all patients presenting to the emergency department and on the general wards. MEASUREMENTS AND MAIN RESULTS:. We recruited 1,271 patients, of which 724 (56.9%) had systemic inflammatory response syndrome greater than or equal to 2, 679 (53.4%) had Sequential Organ Failure Assessment greater than or equal to 2, and 977 (76.9%) had Red Flag Sepsis. When stratified according to National Institute of Clinical Excellence guidelines, 450 patients (35.4%) were in the “High risk” category in comparison with 665 (52.3%) in “Moderate to High risk” and 156 (12.3%) in “Low risk” category. In a planned sensitivity analysis, we found that none of the tools accurately predicted mortality at 90 days, and Sequential Organ Failure Assessment and National Institute of Clinical Excellence tools showed only moderate discriminatory power for mortality at 7 and 14 days. Furthermore, we could not find any significant correlation with any of the tools at any of the mortality time points. CONCLUSIONS:. Our data suggest that the sepsis risk stratification tools currently utilized in emergency departments and on the general wards do not predict mortality adequately. This is illustrated by the disparity in mortality risk of the populations captured by each instrument, as well as the weak concordance between them. We propose that future studies on the development of sepsis identification tools should focus on identifying predicator values of both the short- and long-term outcomes of sepsis.

Published
2021
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2. Sepsis-related deaths in the at-risk population on the wards: attributable fraction of mortality in a large point-prevalence study

Author

Maja Kopczynska, Ben Sharif, Sian Cleaver, Naomi Spencer, Amit Kurani, Camilla Lee, Jessica Davis, Carys Durie, Jude Joseph-Gubral, Angelica Sharma, Lucy Allen, Billie Atkins, Alex Gordon, Llewelyn Jones, Amy Noble, Matthew Bradley, Henry Atkinson, Joy Inns, Harriet Penney, Carys Gilbert, Rebecca Walford, Louise Pike, Ross Edwards, Robyn Howcroft, Hazel Preston, Jennifer Gee, Nicholas Doyle, Charlotte Maden, Claire Smith, Nik Syakirah Nik Azis, Navrhinaa Vadivale, Tamas Szakmany, and Welsh Digital Data Collection Platform Collaborators

Subjects
Sepsis, Critical care, Frailty, Mortality, Medicine, Biology (General), QH301-705.5, Science (General), Q1-390
Abstract

Abstract Objective Sepsis mortality is reported to be high worldwide, however recently the attributable fraction of mortality due to sepsis (AFsepsis) has been questioned. If improvements in treatment options are to be evaluated, it is important to know what proportion of deaths are potentially preventable or modifiable after a sepsis episode. The aim of the study was to establish the fraction of deaths directly related to the sepsis episode on the general wards and emergency departments. Results 839 patients were recruited over the two 24-h periods in 2016 and 2017. 521 patients fulfilled SEPSIS-3 criteria. 166 patients (32.4%) with sepsis and 56 patients (17.6%) without sepsis died within 90 days. Out of the 166 sepsis deaths 12 (7.2%) could have been directly related to sepsis, 28 (16.9%) possibly related and 96 (57.8%) were not related to sepsis. Overall AFsepsis was 24.1%. Upon analysis of the 40 deaths likely to be attributable to sepsis, we found that 31 patients (77.5%) had the Clinical Frailty Score ≥ 6, 28 (70%) had existing DNA-CPR order and 17 had limitations of care orders (42.5%).

Published
2018
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3. Reducing orthopaedic theatre exposure during the COVID-19 lockdown: does a shift towards virtual reality-based training offer a solution?

Author

Adam Arshad, Amit Zaveri, and Henry Atkinson

Subjects
Orthopedic surgery, RD701-811
Abstract

Orthopaedic training in the United Kingdom has changed little from the Halstedian apprenticeship model of graduated responsibility, with the mantra “see one, do one, teach one”. Whilst still relevant in surgical teaching, the current and ongoing disruption to surgical training secondary to the coronavirus disease 2019 (COVID-19) outbreak highlights the need for alternative methods of experiential surgical learning, which allow for the development of the knowledge, skills, and attitudes of orthopaedic surgeons, to be sought.

Published
2021
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4. Individualised radial extracorporeal shock wave therapy (rESWT) for symptomatic calcific shoulder tendinopathy: a retrospective clinical study

Author

Nikolaos Malliaropoulos, Dawn Thompson, Maria Meke, Debasish Pyne, Dimosthenis Alaseirlis, Henry Atkinson, Vasileios Korakakis, and Heinz Lohrer

Subjects
ESWT, Radial extracorporeal shockwave therapy, Recurrence rate, Symptomatic shoulder calcifying tendinopathy, Treatment, Diseases of the musculoskeletal system, RC925-935
Abstract

Abstract Background A retrospective single centre cohort analysis was performed to evaluate an individualised radial extracorporeal shock wave therapy (rESWT) protocol for treatment of symptomatic calcific shoulder tendinopathy. Methods 67 patients (79 Shoulders) were identified with 76 shoulders included for analysis. rESWT treatment protocol was adapted according to individual response to treatment. Variables included number of sessions, shockwave impulses, pressure and frequency. Success rate was estimated as the percentage of patients having ≥60% visual analogue score (VAS) pain decrease at follow-up. Recurrence at 1 year was recorded. Results Using this individualised symptom guided protocol, patients underwent a mean of 7 ± 1.5 rESWT sessions, with mean pressure of 1.7 ± 0.2 bar, mean frequency of 5 ± 0.3 Hz and 2175 ± 266 impulses. The mean pre-treatment VAS score of 6.7 ± 1.1 was significantly decreased to 3.2 ± 0.8 immediately post-treatment, 2.6 ± 0.9 at 1 month, 1.7 ± 1.0 at 3 months and 0.8 ± 1.0 at 1 year follow up (α = 0.05). One-year success rate was estimated at 92% and 1-year recurrence rate was 7%. Conclusions We conclude that in this retrospective study an individualised rESWT protocol resulted in a high success rate with low number of recurrences. Randomised controlled trials to support these findings are recommended.

Published
2017
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8. Fistula of a pancreatic pseudocyst into the superior mesenteric and portal veins causing erythema nodosum and aseptic polyarthritis - case report and review of literature

Author

Colović R, Aleksandar D. Ninić, Cedomir Vucetic, Nikica Grubor, and Dushan Henry Atkinson

Subjects
medicine.medical_specialty, Pancreatic disease, Pancreatic pseudocyst, medicine.medical_treatment, 03 medical and health sciences, 0302 clinical medicine, medicine, pseudocyst-portal vein fistula, Fat necrosis, 030212 general & internal medicine, pancreas, pancreatic disease syndrome, Pancreatic duct, business.industry, General Medicine, medicine.disease, Pancreaticoduodenectomy, 3. Good health, Surgery, medicine.anatomical_structure, Pancreatitis, Medicine, business, Pancreas, Vasculitis
Abstract

Introduction. Extra-pancreatic complications of acute and chronic pancreatitis that do not relate to vital organs are rare. The most common include subcutaneous paniculitis, arthritis, bone marrow fat necrosis, and vasculitis. These associated conditions have been termed pancreatic disease syndrome (PDS), which can occur not only with pancreatitis but also in other pancreatic diseases. PDS is believed to be caused by circulating pancreatic enzymes, which can occur when the pancreas is in direct communication with the circulation. Pancreatic pseudocyst erosion into the superior mesenteric and portal veins is extremely rare; and there have only been 22 previously reported cases in literature. The authors endeavoured to describe a manifestation of PDS with formation of a pseudocystic-portal fistula, its complications, and propose adequate surgical management. Case outline. We present a 37-year-old man with chronic alcoholic pancreatitis and a pancreatic pseudocyst within the head of the pancreas which communicated with the main pancreatic duct on one side and eroded into the superior mesenteric and portal veins on the other, causing erythema nodosum-like vasculitis, and polyarthritis. The patient was initially treated conservatively, but subsequently required multiple arthrotomies and finally underwent pylorus preserving duodenopancreatectomy and direct repair of the affected veins. Conclusion. The majority of cases required aggressive surgical intervention due to heightened risk of hemorrhage. In patients who develop disseminated fat necrosis, an earlier surgical intervention can be justified. The authors would recommend that, where practical, a pylorus-preserving pancreaticoduodenectomy should be performed.

Published
2021

9. The UK Foot and Ankle COVID-19 National (FAlCoN) Audit – Regional Variations in COVID-19 Infection and National Foot and Ankle Surgical Activity

Author

Lyndon W Mason, Karan Malhotra, Linzy Houchen-Wollof, Jitendra Mangwani, Ziad Harb, Ruth Richardson, Richard Gadd, Alexander Kerr, William Clay, Arijit Mallick, Amit Bhargava, Madhu Tiruveedhula, Andrew Walls, Maurice O'Flaherty, Julie Craig, Daniel Dawson, Philip McCaughey, Jonathan Crean, Brijesh Ayyasamy, Pradeep Prasad, Anoop Ansnd, Yasir Tarar, Xin Yin Choo, Shaik Yousufuddin, Andrew Stone, Mohammed Amer, Francesca Haarer, Tom Barrow, Vishwajeet Singh, Sayani Junaid, Natasha Houssain, Vivek Dhukaram, Khalil Elbayyouk, Zain ul Abiddin, Samir Salih, Angus Fong, Abhishek Arora, Luc Louette, Giles Faria, Andrew Smith, Shivashanker Aithal, Dhanushka Palihawadana, Ramtin Pir-Siahbazy, Aamir Zubairy, Barry Rose, Annie McCormack, Maira Vega-Poblete, Karim Wahed, Khalid Malik, Sohail Yousaf, Andrea Sott, Dimosthenis Evangelidis, Paul Hamilton, Sarah Abbott, Akarshan Naraen, Turab A Syed, Biju Benjamin, Catarina Ferreira, Efstathios Drampalos, Kishore Kumar Dasari, Ahmed Galhoum, Daniel Marsland, Robin Elliot, Alex Chowdhury, Tareq Tareef, Javed Salim, Viren Mishra, Suheil Amanat, Robbie Ray, Venu Kavarthapu, Raju Ahluwalia, Rohi Shah, Shirley Lyle, Andy Molloy, Verity Currall, Catherine Hatzantonis, Joseph Dixon, Thomas Goff, Jason Eyre, Ehab Kheir, Kurt Haendlmayer, Erin Demoulin, Zulfikar Ali, Faye Loughenbury, Sufyan Mansoor, Alexander Butcher, Rory Bonner, Anamika Saha, Gareth Ewan Mcknight, Prashan Lokanathan, Rupert Lees, Peter Harrison, Andrew Kelly, Hamish Macdonald, George Slade, Robert Clayton, Scott Middleton, Erlend Oag, David T Loveday, Henry Atkinson, James Dalrymple, Amit Zaveri, Priya Jani, Ramon Fernandes, Sarah Johnson-Lynn, Lynne Robertson-McPartlin, Elizabeth Alderton, Dave Townshend, Anna Porter, Nicole McLaughlin, John Guiguis, Harish Kurup, Nijil Vasukutty, Ashim Wokhlu, Abidemi Ogunsola, Togay Koc, Simon Hodkinson, Billy Jowett, Samer Shamoon, Qamar Mustafa, Adam Stoneham, Luke Duggleby, Kar Teoh, Shahahoor Ali, Raisa Islam, Mike Butler, Ciaran Brennan, Toby Jennison, Tariq Karim, Stephen Milner, Arya Mishra, Hemant Singh, Anil Haldar, Basil Budair, James MacKenzie, Huan Dong, Hari Prem, Rosemary Wall, Edward Dawe, Sarah Sexton, Christopher O'Dowd-Booth, Sadeeq Azeez, Galini Mavromatidou, Claire Topliss, Nilesh Makwana, Debashis Dass, Sameera Abas, Manikandar Srinivas Cheruvu, Adam Devany, Edmund Ieong, Ben Rudge, Prathamesh Kane, Abhijit Guha, Eric Ho Ming Suen, Amr Eldessouky, Ahmed Isam Saad, Ibrahim Ali, Benjamin Hickey, Anand Pillai, Amirul Islam, Zeeshan Akbar, Tom Naylor, Umair Khan, Charlie Jowett, Mohamed Mahmoud, Gunay Cryer, and Stuart Place

Subjects
Adult, medicine.medical_specialty, Coronavirus disease 2019 (COVID-19), Regional anaesthesia, Audit, Article, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, medicine, Humans, Orthopedics and Sports Medicine, Elective surgery, National audit, national audit, Retrospective Studies, SARS-Cov-2, foot and ankle surgery, 030222 orthopedics, SARS-CoV-2, business.industry, Foot and ankle surgery, COVID-19, regional variation, 030229 sport sciences, United Kingdom, elective, trauma, diabetes, medicine.anatomical_structure, Communicable Disease Control, Ankle, business, Foot (unit)
Abstract

Aims This paper details the impact of COVID-19 on foot and ankle activity in the UK. It describes regional variations and COVID-19 infection rate in patients undergoing foot and ankle surgery before, during and after the first national lock-down. Patients & methods This was a multicentre, retrospective, UK-based, national audit on foot and ankle patients who underwent surgery between 13th January and 31st July 2020. Data was examined pre- UK national lockdown, during lockdown (23rd March to 11th May 2020) and post-lockdown. All adult patients undergoing foot and ankle surgery in an operating theatre during the study period included from 43 participating centres in England, Scotland, Wales and Northern Ireland. Regional, demographic and COVID-19 related data were captured. Results 6644 patients were included. In total 0.53% of operated patients contracted COVID-19 (n = 35). The rate of COVID-19 infection was highest during lockdown (2.11%, n = 16) and lowest after lockdown (0.16%, n = 3). Overall mean activity during lockdown was 24.44% of pre-lockdown activity with decreases in trauma, diabetic and elective foot and ankle surgery; the change in elective surgery was most marked with only 1.73% activity during lock down and 10.72% activity post lockdown as compared to pre-lockdown. There was marked regional variation in numbers of cases performed, but the proportion of decrease in cases during and after lockdown was comparable between all regions. There was also a significant difference between rates of COVID-19 and timing of peak, cumulative COVID-19 infections between regions with the highest rate noted in South East England (3.21%). The overall national peak infection rate was 1.37%, occurring during the final week of lockdown. General anaesthetic remained the most common method of anaesthesia for foot and ankle surgery, although a significant increase in regional anaesthesia was witnessed in the lock-down and post-lockdown periods. Conclusions National surgical activity reduced significantly for all cases across the country during lockdown with only a slow subsequent increase in elective activity. The COVID-19 infection rate and peaks differed significantly across the country. Clinical relevance This paper highlights a significant regional variation in COVID-19 infection rates and peak of COVID-19 infections across the country; this data may be useful in planning response to subsequent waves. The cumulative COVID-19 infection rates suggest that the risk of contracting COVID-19 in patients undergoing foot and ankle surgery is not insignificant. The marked decrease in, and slow recovery of elective activity seen will need to be considered when planning restoration of elective foot and ankle services.

Published
2021
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10. Sepsis-related deaths in the at-risk population on the wards: attributable fraction of mortality in a large point-prevalence study

Author

Joy Inns, Jessica Davis, Ben Sharif, Amit Kurani, Angelica Sharma, Carys Durie, Nik Syakira Nik Azis, Llewelyn Jones, Harriet Penney, A. Noble, Hazel Preston, Henry Atkinson, Lucy Allen, Charlotte Maden, Jennifer Gee, Billi Atkins, Camilla Lee, Maja Kopczynska, Nicholas Doyle, Carys Gilbert, Rebecca Walford, Sian Cleaver, Navrhinaa Vadivale, R. Edwards, Jude Joseph-Gubral, Naomi Spencer, Matthew Bradley, Robyn Howcroft, Claire Smith, Louise Pike, Alexandra Gordon, and Tamas Szakmany

Subjects
Adult, Male, medicine.medical_specialty, Adolescent, Sepsis mortality, Organ Dysfunction Scores, Prevalence, lcsh:Medicine, General Biochemistry, Genetics and Molecular Biology, Sepsis, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Cause of Death, Epidemiology, Patients' Rooms, medicine, Humans, 030212 general & internal medicine, Hospital Mortality, Mortality, lcsh:Science (General), lcsh:QH301-705.5, At-Risk Population, Aged, Aged, 80 and over, Frailty, business.industry, Septic shock, lcsh:R, 030208 emergency & critical care medicine, Retrospective cohort study, General Medicine, Middle Aged, medicine.disease, Hospitals, United Kingdom, Research Note, Critical care, Cross-Sectional Studies, lcsh:Biology (General), Attributable risk, Emergency medicine, Female, business, Emergency Service, Hospital, lcsh:Q1-390
Abstract

Objective Sepsis mortality is reported to be high worldwide, however recently the attributable fraction of mortality due to sepsis (AFsepsis) has been questioned. If improvements in treatment options are to be evaluated, it is important to know what proportion of deaths are potentially preventable or modifiable after a sepsis episode. The aim of the study was to establish the fraction of deaths directly related to the sepsis episode on the general wards and emergency departments. Results 839 patients were recruited over the two 24-h periods in 2016 and 2017. 521 patients fulfilled SEPSIS-3 criteria. 166 patients (32.4%) with sepsis and 56 patients (17.6%) without sepsis died within 90 days. Out of the 166 sepsis deaths 12 (7.2%) could have been directly related to sepsis, 28 (16.9%) possibly related and 96 (57.8%) were not related to sepsis. Overall AFsepsis was 24.1%. Upon analysis of the 40 deaths likely to be attributable to sepsis, we found that 31 patients (77.5%) had the Clinical Frailty Score ≥ 6, 28 (70%) had existing DNA-CPR order and 17 had limitations of care orders (42.5%). Electronic supplementary material The online version of this article (10.1186/s13104-018-3819-2) contains supplementary material, which is available to authorized users.

Published
2018
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11. Molecular-level analysis of the wetting behavior of imidazolium-based ionic liquids on bismuth telluride surfaces

Author

Jason E. Bara, Henry Atkinson, and C. Heath Turner

Subjects
Materials science, Applied Mathematics, General Chemical Engineering, General Chemistry, Thermoelectric materials, Exfoliation joint, Industrial and Manufacturing Engineering, Ion, Contact angle, chemistry.chemical_compound, Molecular dynamics, chemistry, Chemical physics, Ionic liquid, Bismuth telluride, Wetting
Abstract

Bismuth telluride is among the most studied thermoelectric materials. Its performance, which is among the highest around room temperature, is dependent on exfoliation to thin nanosheets. While previous research has examined the exfoliation mechanism by ionic liquids (ILs), this study provides more detailed information about the solid-liquid interface, including predicted values for IL contact angles (θ) on Bi2Te3. Molecular dynamics simulations are employed to compute θ and other properties of interest, including mass and charge ordering, adsorption energy, and electrostatic potential. All properties save the latter are strongly dependent on anion size and slightly dependent on cation size. The IL contact angles display a wide range of values, from 97.7° for the smallest ions to 53.2° for the largest ions. An analysis of the molecular-level interactions in these systems serves to explain this behavior, and they indicate that reduced cohesive interactions in bulkier liquids are primarily responsible.

Published
2020
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12. [Untitled]

Author

Nik Syakira Nik Azis, Charlotte Maden, Harriet Penney, Carys Gilbert, Louise Pike, Jennifer Gee, Billie Atkins, Lucy Allen, Maja Kopczynska, Claire Smith, Jude Joseph-Gubral, Ben Sharif, Navrhinaa Vadivale, Henry Atkinson, Llewelyn Jones, Judith A. Hall, Alexandra Gordon, Tamas Szakmany, and Joy Inns

Subjects
Sepsis, medicine.medical_specialty, business.industry, Internal medicine, Attributable risk, medicine, Critical Care and Intensive Care Medicine, medicine.disease, business, At-Risk Population
Published
2019
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13. Early dentistry in Victoria, Australia

Author

Henry, Atkinson

Subjects
Victoria, History of Dentistry, Humans, Schools, Dental, History, 19th Century, History, 20th Century
Abstract

At the time of settlement and in the years leading up to the establishment in 1884 of the Odontological Society of Victoria, dentistry was an unregulated activity practised simultaneously by those that had received the best apprenticeship training and those that had no training what-so-ever. Under the influence of dentists such as John Iliffe however, this situation was soon to change. In 1887 the first Dental Act was passed making it a legal requirement for anyone practicing dentistry to be registered. In 1890, the Melbourne Dental Hospital opened its doors to its first patients, and in 1897, the Australian College of Dentistry, later to become a school within the University of Melbourne, began teaching a dental course. Combined, these three moments in history lead to the eradication of the unscrupulous practitioner and laid the path for the development and professionalization of dentistry in the state of Victoria.

Published
2015

14. Analysis of CD23 antigen expression in B-chronic lymphocytic leukaemia and its correlation with clinical parameters.

Author

Natasa Colovic, Nada Kraguljac, and Henry Atkinson

Abstract

Abstract  B-Chronic lymphocytic leukaemia (B-CLL) is a monoclonal malignancy characterized by an accumulation of terminally differentiated small and anergic B lymphocytes in the blood, bone marrow and other tissues. CD23 antigen, a trans-membrane glycoprotein, promotes the activation and proliferation of normal B lymphocytes and has an important role in the process of malignant transformation in B-CLL. This retrospective cohort study of 77 consecutive newly diagnosed B-CLL patients, 43 males, 34 females, median age of 62 years, examined CD23 expression and correlations with clinical parameters. CD23+ was negatively correlated with pro-lymphocyte infiltration of the bone marrow (P P P 40% had longer survival (92.8 months) than those expressing P = 0.001). CD23 is not uniformly expressed by lymphocytes in B-CLL patients, and the differences in expression are dependent on a number of clinical parameters, including the peripheral blood lymphocyte count and the degree of pro-lymphocyte infiltration of the bone marrow. CD23 expression is significantly decreased in patients with extremely high lymphocyte counts (PBL counts of >100 × 109/l) and in the advanced stages of disease. [ABSTRACT FROM AUTHOR]

Published
2008

15. Outcomes of primary thyroid non-Hodgkin’s Lymphoma.

Author

Milica Čolović, Slavko Matić, Emrush Kryeziu, Dragica Tomin, Nataša Čolović, and Henry Atkinson

Abstract

Abstract  Primary non-Hodgkin’s lymphoma (NHL) of the thyroid gland is a rare disease with an incidence of 0.5 per 100,000 population. Stages IE and IIE thyroid NHL have been traditionally treated by surgical resection; however, modern treatment consists of chemotherapy and local radiotherapy, and surgery is often reserved for tissue diagnosis and relief of airway compression. We retrospectively reviewed the management and outcomes of nine consecutive patients with thyroid NHL, eight females and one male (median age 63 yr, range 34-71 yr) treated between 1994 and 1999. Five patients had disease stage IE and 4 stage IIE. Median follow-up was 72 mo. Pathohistology and immunohistochemistry identified two patients with mucosa-associated lymphoid tissue (MALT), three follicular center cell lymphoma (FCC), two patients large B-cell lymphoma (BLCL), one a marginal zone lymphoma (MZL), and one patient a peripheral T-cell lymphoma (PTCL). Total thyroidectomy was performed in three patients and subtotal thyroidectomy in four. One (MALT) patient underwent surgery alone; three patients surgery, radiotherapy, and chemotherapy (two FCC, one PTCL); three patients surgery and chemotherapy (one MALT, one FCC, one LBCL); and two chemotherapy alone (one LBCL, one MZL). Median survival was 79 mo (range 13–124 mo). The PTCL patient, a 34-yr-old man, died from disseminated disease at 13 mo despite secondary chemotherapy, and one LBCL patient with extensively invasive local disease died from stroke 17 mo after diagnosis. The remaining seven patients remain in remission with no local or systemic relapse at a mean of 86 mo. With appropriate therapy primary thyroid NHL has a favorable course; however, prognosis depends on the histology, local spread, and the stage of the disease at presentation, as well as the patient’s performance status. Surgery in combination with chemotherapy and/or radiotherapy is still warranted for intermediate and high-grade thyroid NHLs, with over 77% of patients achieving long-term remission. Peripheral T-cell lymphoma carries a poor prognosis. [ABSTRACT FROM AUTHOR]

Published
2007

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