144 results on '"Timothy W. R. Briggs"'
Search Results
2. Osteosarcoma Associated With Diamond-Blackfan Anaemia: A Case of a Child Receiving Growth Hormone Therapy
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Robert S. Lee, Deborah Higgs, Omar Haddo, Jean Pringle, and Timothy W. R. Briggs
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Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Purpose: Diamond–Blackfan anaemia (DBA) is a rare pure congenital red cell aplasia, usually presenting in infancy or early childhood. The literature suggests a predisposition to haemopoietic malignancy but in addition solid tumours have been reported, with five cases of osteosarcoma described.
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- 2004
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3. An Evaluation of the Diagnostic Accuracy of the Grade of Preoperative Biopsy Compared to Surgical Excision in Chondrosarcoma of the Long Bones
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Robert Jennings, Nicholas Riley, Barry Rose, Roberto Rossi, John A. Skinner, Steven R. Cannon, Timothy W. R. Briggs, Rob Pollock, and Asif Saifuddin
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Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Chondrosarcoma is the second most common primary malignant bone tumour. Distinguishing between grades is not necessarily straightforward and may alter the disease management. We evaluated the correlation between histological grading of the preoperative image-guided needle biopsy and the resection specimen of 78 consecutive cases of chondrosarcoma of the femur, humerus, and tibia. In 11 instances, there was a discrepancy in histological grade between the biopsy and surgical specimen. Therefore, there was an 85.9% (67/78) accuracy rate for pre-operative histological grading of chondrosarcoma, based on needle biopsy. However, the accuracy of the diagnostic biopsy to distinguish low-grade from high-grade chondrosarcoma was 93.6% (73/78). We conclude that accurate image-guided biopsy is a very useful adjunct in determining histological grade of chondrosarcoma and the subsequent treatment plan. At present, a multidisciplinary approach, comprising experienced orthopaedic surgeons, radiologists, and pathologists, offers the most reliable means of accurately diagnosing and grading of chondrosarcoma of long bones.
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- 2010
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- View/download PDF
4. Use of a Distal Radius Endoprosthesis Following Resection of a Bone Tumour: A Case Report
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Kishan Gokaraju, Kesavan Sri-Ram, James Donaldson, Michael T. R. Parratt, Gordon W. Blunn, Steve R. Cannon, and Timothy W. R. Briggs
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Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Limited literature is available on the reconstruction of the distal radius using prosthetic replacement following resection of a bone tumour. We present the first reported case, in the English literature, of the use of an entirely metal endoprosthesis for the reconstruction of the distal radius. This case involves a 66-year-old male who was treated for giant cell tumour of the distal radius with surgical excision of the lesion and replacement of the defect using a predominantly titanium endoprosthesis. He was followed-up for 56 months following surgery and had a good functional outcome with no associated pain or complications. We propose that the use of a primarily titanium endoprosthesis for the reconstruction of a bone defect of the distal radius is a suitable alternative, providing good function of the forearm with satisfactory range of movement at the wrist and adequate pain relief.
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- 2009
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- View/download PDF
5. BNT162b2 vaccine uptake and effectiveness in UK healthcare workers – a single centre cohort study
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Tariq Azamgarhi, Timothy W. R. Briggs, Simon Warren, Ashik Shah, John A. Skinner, Iva Hauptmannova, and Michelle Hodgkinson
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Adult ,Male ,medicine.medical_specialty ,COVID-19 Vaccines ,Time Factors ,Adolescent ,Health Personnel ,Science ,Ethnic group ,General Physics and Astronomy ,Kaplan-Meier Estimate ,030204 cardiovascular system & hematology ,Policy and public health in microbiology ,Article ,General Biochemistry, Genetics and Molecular Biology ,Cohort Studies ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Vaccination Refusal ,RNA vaccines ,Internal medicine ,Health care ,medicine ,Humans ,030212 general & internal medicine ,Young adult ,BNT162 Vaccine ,Proportional Hazards Models ,Multidisciplinary ,SARS-CoV-2 ,Proportional hazards model ,business.industry ,Vaccination ,COVID-19 ,General Chemistry ,Middle Aged ,Hospitals ,United Kingdom ,Single centre ,Viral infection ,Female ,business ,Cohort study - Abstract
In this single centre cohort study we assessed BNT162B2 vaccine uptake and effectiveness among UK healthcare workers (HCWs) during a time of high community COVID-19 prevalence. Early uptake among HCWs was 62.3% (1409/2260), however there were significant differences in uptake between age groups, ethnic origins, and job roles. Uptake increased to 72.9% after a vaccine hesitancy working group implemented specific measures. In the 42 days after vaccination, 49 new cases of COVID-19 were identified, of which 7 (14.3%) occurred in HCWs who were beyond 10 days of vaccination. Kaplan–Meier curves for partially vaccinated and unvaccinated groups were congruent until day 14 and continued to diverge up to 42 days. Cox regression analysis showed a 70.0% (95%CI 6.0–91.0; p=0.04) risk reduction for COVID-19 infection in partially vaccinated HCWs. Here we report early vaccination rates among HCWs are generally high although uptake is lower in certain groups. It is possible to improve vaccine uptake and efforts should focus on this, however, significant resource is required. The BNT162B2 vaccine is effective from 14 days post-vaccination in a frontline clinical setting and protection continues beyond 21 days post 1st dose without a 2nd dose, being given., Several vaccines for COVID-19 have received emergency approval. Here, the authors describe BNT162B2 vaccine uptake and effectiveness among UK healthcare workers in a single centre cohort study during a time of high community COVID-19 prevalence.
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- 2021
6. Multiple injections for low back pain: What’s the future?
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Francis Brooks, Oluwatobi O Onafowokan, Nicola F. Fine, Oliver M. Stokes, Mike Hutton, and Timothy W. R. Briggs
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medicine.medical_specialty ,MEDLINE ,Zygapophyseal Joint ,Injections, Intra-Articular ,Facet joint ,03 medical and health sciences ,Strength of evidence ,0302 clinical medicine ,medicine ,Humans ,Orthopedics and Sports Medicine ,030222 orthopedics ,business.industry ,Mesh term ,Facet joint injection ,Nerve Block ,Low back pain ,medicine.anatomical_structure ,England ,Physical therapy ,Surgery ,Lumbar spine ,Neurosurgery ,medicine.symptom ,business ,Low Back Pain ,030217 neurology & neurosurgery - Abstract
To examine the strength of evidence available for multiple facet joint injections (FJIs) and medial branch blocks (MBBs), and to report on the variations in the NHS England framework using the getting it right first time (GIRFT) data. Systematic review using patient, intervention, comparison, outcome and study strategy. The literature search using Cochrane, MEDLINE and EMBASE databases using MeSH terms: lumbar spine, spinal injection and facet joint (“Appendix A”). Three studies were identified that investigated the efficacy of multiple FJIs or MBBs. None of these studies reported sustained positive outcomes at long-term follow-up. There is a paucity of levels I and II evidence available for the efficacy of multiple FJIs and MBBs in treating low back pain. GIRFT data show a high degree of variation in the use of multiple FJIs, which would not be supported by the literature. These slides can be retrieved under Electronic Supplementary Material.
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- 2020
7. The role of intermittent PTH administration in conjunction with allogenic stem cell treatment to stimulate fracture healing
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Liza Osagie-Clouard, Mathias P.G. Bostrom, Timothy W. R. Briggs, Gorden Blunn, Anita Sanghani-Kerai, and Richard Meeson
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medicine.medical_specialty ,Combination therapy ,Callus formation ,Nonunion ,delayed union fracture ,Urology ,Parathyroid hormone ,Fracture healing ,Bone healing ,Diseases of the musculoskeletal system ,Stem cells ,stiffness ,Teriparatide ,Medicine ,parathyroid hormone ,Orthopedics and Sports Medicine ,Femur ,Tibia ,mesenchymal stem cells (MSCs) ,business.industry ,stem cells in the treatment ,medicine.disease ,rats ,femora ,RC925-935 ,Bone Fracture ,Surgery ,nonunions ,combination therapies ,business ,medicine.drug - Abstract
Aims A growing number of fractures progress to delayed or nonunion, causing significant morbidity and socioeconomic impact. Localized delivery of stem cells and subcutaneous parathyroid hormone (PTH) has been shown individually to accelerate bony regeneration. This study aimed to combine the therapies with the aim of upregulating fracture healing. Methods A 1.5 mm femoral osteotomy (delayed union model) was created in 48 female juvenile Wistar rats, aged six to nine months, and stabilized using an external fixator. At day 0, animals were treated with intrafracture injections of 1 × 106 cells/kg bone marrow mesenchymal stem cells (MSCs) suspended in fibrin, daily subcutaneous injections of high (100 μg/kg) or low (25 μg/kg) dose PTH 1-34, or a combination of PTH and MSCs. A group with an empty gap served as a control. Five weeks post-surgery, the femur was excised for radiological, histomorphometric, micro-CT, and mechanical analysis. Results Combination therapy treatment led to increased callus formation compared to controls. In the high-dose combination group there was significantly greater mineralized tissue volume and trabecular parameters compared to controls (p = 0.039). This translated to significantly improved stiffness (and ultimate load to failure (p = 0.049). The high-dose combination therapy group had the most significant improvement in mean modified Radiographic Union Score for Tibia fractures (RUST) compared to controls (13.8 (SD 1.3) vs 5.8 (SD 0.5)). All groups demonstrated significant increases in the radiological scores – RUST and Allen score – histologically compared to controls. Conclusion We demonstrate the beneficial effect of localized MSC injections on fracture healing combined with low- or high-dose teriparatide, with efficacy dependent on PTH dose. Cite this article: Bone Joint Res 2021;10(10):659–667.
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- 2021
8. 236 Novel Guidelines to Avoid Routine Blood Tests After Robotic Assisted Radical Prostatectomy (RARP)
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Timothy W. R. Briggs, K Flora, A.K. Sharma, A Sridha, Aijaz Rashid, Prabhakar Rajan, N Sha, Senthil Nathan, S Patel, N William, A Kelka, V Kasivisvanatha, Prasanna Sooriakumaran, Benjamin W. Lamb, Greg Shaw, J Collin, Y Phuah, J Kell, S Mia, P Cleaveland, A Nathan, and Nancy Hanna
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medicine.medical_specialty ,Robotic assisted ,Prostatectomy ,business.industry ,General surgery ,medicine.medical_treatment ,medicine ,Surgery ,business - Abstract
Introduction Patients undergoing RARP commonly require routine post-operative blood tests. This practice dates from an era of open surgery, with increased blood loss and complications. We aim to improve specificity of blood test requests with novel guidelines. Method 1039 consecutive RARP patients at two tertiary urology centres in the UK were audited. Novel guidelines constructed based on risk stratified evidence from the initial audit were used to prospectively audit 133 patients. Results 16% had clinical concerns post-operatively. 1% and 4% had an intra- and post-operative complication. Intra- or post-operative clinical judgement flagged post-operative complications in 99.9%. 80% had routine blood tests with no clinical concerns. 6% had delayed discharge due to delayed processing of blood tests. 0.9% received a peri-operative transfusion. Re-Audit Novel guidelines reduced the number of blood tests requested from 100% to 36%. Specificity in diagnosing a complication improved from 0% to 67%. Discharge delays reduced from 6% to 0% and no post-operative complications were missed (sensitivity 100%). Conclusions Routine blood tests, without an indication, did not flag any additional post-operative complications. Blood transfusion is rare for RARP. Novel guidelines to request post-operative blood tests will reduce costs and discharge delays whilst maintaining appropriate patient safety and care.
- Published
- 2021
9. Transurethral resection of bladder tumour as day-case surgery: Evidence of effectiveness from the UK Getting it Right First Time (GIRFT) programme
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William K. Gray, Jamie Day, Simon Harrison, and Timothy W. R. Briggs
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medicine.medical_specialty ,business.industry ,030503 health policy & services ,Urology ,General surgery ,Bladder tumour ,030232 urology & nephrology ,Resection ,03 medical and health sciences ,0302 clinical medicine ,Ambulatory care ,Medicine ,Surgery ,Day case surgery ,0305 other medical science ,business - Abstract
We aimed to investigate outcomes of transurethral resection of bladder tumour (TURBT) surgery when performed as day-case surgery compared to outcomes for patients who stayed ⩾ 1 night in hospital. Data were taken from the 2017–2018 Hospital Episodes Statistics data set, which contains data for all TURBT procedures conducted within the National Health Service in England. Data were categorised as those seen as day-cases and those that involved an overnight stay. Of 19,383 TURBT procedures, 3466 (17.9%) were classified as day-case surgery. Those who had an overnight stay were significantly older and were significantly more likely to be male, and have significantly greater frailty and comorbidity. After adjusting for confounders, those with an overnight stay had significantly poorer outcomes with regard to mortality and emergency readmission rates. Comparing trusts with the highest and lowest rate, of overnight stay, there were no differences in the profiles of the patients seen or in outcomes. Patients undergoing TURBT as day-case surgery have at least as good outcomes as those having an overnight stay. Investigation of the technical quality of the tumour resection, patient experience and quality of life after day-case surgery for TURBT would provide further insight. Evidence level: 2b
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- 2019
10. The influence of parathyroid hormone 1-34 on the osteogenic characteristics of adipose- and bone-marrow-derived mesenchymal stem cells from juvenile and ovarectomized rats
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Gordon Blunn, Anita Sanghani-Kerai, Melanie J. Coathup, Timothy W. R. Briggs, Liza Osagie-Clouard, and Richard Meeson
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0303 health sciences ,Adipose ,Mesenchymal stem cell ,Parathyroid hormone ,Adipose tissue ,Biology ,03 medical and health sciences ,Mesenchymal Stem Cell ,0302 clinical medicine ,medicine.anatomical_structure ,Parathyroid Hormone ,Bone Marrow ,030220 oncology & carcinogenesis ,medicine ,Cancer research ,Juvenile ,Bone Biology ,Orthopedics and Sports Medicine ,Surgery ,Bone marrow ,Bone regeneration ,030304 developmental biology - Abstract
Objectives Mesenchymal stem cells (MSCs) are of growing interest in terms of bone regeneration. Most preclinical trials utilize bone-marrow-derived mesenchymal stem cells (bMSCs), although this is not without isolation and expansion difficulties. The aim of this study was: to compare the characteristics of bMSCs and adipose-derived mesenchymal stem cells (AdMSCs) from juvenile, adult, and ovarectomized (OVX) rats; and to assess the effect of human parathyroid hormone (hPTH) 1-34 on their osteogenic potential and migration to stromal cell-derived factor-1 (SDF-1). Methods Cells were isolated from the adipose and bone marrow of juvenile, adult, and previously OVX Wistar rats, and were characterized with flow cytometry, proliferation assays, osteogenic and adipogenic differentiation, and migration to SDF-1. Experiments were repeated with and without intermittent hPTH 1-34. Results Juvenile and adult MSCs demonstrated significantly increased osteogenic and adipogenic differentiation and superior migration towards SDF-1 compared with OVX groups; this was the case for AdMSCs and bMSCs equally. Parathyroid hormone (PTH) increased parameters of osteogenic differentiation and migration to SDF-1. This was significant for all cell types, although it had the most significant effect on cells derived from OVX animals. bMSCs from all groups showed increased mineralization and migration to SDF-1 compared with AdMSCs. Conclusion Juvenile MSCs showed significantly greater migration to SDF-1 and significantly greater osteogenic and adipogenic differentiation compared with cells from osteopenic rats; this was true for bMSCs and AdMSCs. The addition of PTH increased these characteristics, with the most significant effect on cells derived from OVX animals, further illustrating possible clinical application of both PTH and MSCs in bone regenerative therapies. Cite this article:L. Osagie-Clouard, A. Sanghani-Kerai, M. Coathup, R. Meeson, T. Briggs, G. Blunn. The influence of parathyroid hormone 1-34 on the osteogenic characteristics of adipose- and bone-marrow-derived mesenchymal stem cells from juvenile and ovarectomized rats. Bone Joint Res 2019;8:397–404. DOI: 10.1302/2046-3758.88.BJR-2019-0018.R1.
- Published
- 2019
11. Biomechanics of two external fixator devices used in rat femoral fractures
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Catherine J. Pendegrass, Melanie J. Coathup, Gordon Blunn, Richard Meeson, Timothy W. R. Briggs, Mehran Moazen, Liza Osagie-Clouard, and Joshua Kaufmann
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030203 arthritis & rheumatology ,Materials science ,medicine.medical_treatment ,0206 medical engineering ,Biomechanics ,Torsion (mechanics) ,Stiffness ,Fracture mechanics ,02 engineering and technology ,Bone healing ,Femoral fracture ,medicine.disease ,Osteotomy ,020601 biomedical engineering ,03 medical and health sciences ,0302 clinical medicine ,Fracture fixation ,medicine ,Orthopedics and Sports Medicine ,medicine.symptom ,Biomedical engineering - Abstract
The use of external fixators allows for the direct investigation of newly formed interfragmentary bone, and the radiographic evaluation of the fracture. We validated the results of a finite element model with the in vitro stiffness' of two widely used external fixator devices used for in vivo analysis of fracture healing in rat femoral fractures with differing construction (Ti alloy ExFix1 and PEEK ExFix2). Rat femoral fracture fixation was modelled using two external fixators. For both constructs an osteotomy of 2.75 mm was used, and offset maintained at 5 mm. Tufnol, served as standardized substitutes for rat femora. Constructs were loaded under axial compression and torsion. Overall axial and torsional stiffness were compared between the in vitro models and FE results. FE models were also used to compare the fracture movement and overall pattern of von Mises stress across the external fixators. In vitro axial stiffness of ExFix1 was 29.26 N/mm ± 3.83 compared to ExFix2 6.31 N/mm ± 0.67 (p*
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- 2019
12. A novel ceramic coating for reduced metal ion release in metal‐on‐metal hip surgery
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Gordon Blunn, J Meswania, Roberta Ferro de Godoy, Timothy W. R. Briggs, Tim Marriott, Melanie J. Coathup, Philippa Tyler, Hannah Wilson, Imran Khan, and Rikin Hargunani
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Chromium ,Male ,Ceramics ,Materials science ,Arthroplasty, Replacement, Hip ,Biomedical Engineering ,chemistry.chemical_element ,engineering.material ,Ceramic coating ,Biomaterials ,Metal ,03 medical and health sciences ,0302 clinical medicine ,Coating ,Bearing surface ,Animals ,Ions ,Hip surgery ,030222 orthopedics ,Sheep ,Cobalt ,chemistry ,030220 oncology & carcinogenesis ,visual_art ,Metal-on-Metal Joint Prostheses ,visual_art.visual_art_medium ,engineering ,Hip Prosthesis ,Total hip arthroplasty ,Biomedical engineering - Abstract
An ovine total hip arthroplasty model was developed to evaluate metal ion release, wear, the biological response and adverse tissue reaction to metal-on-metal (MoM) bearing materials. The performance of an advanced superlattice ceramic coating (SLC) was evaluated as a bearing surface and experimental groups divided into; (1) MoM articulating surfaces coated with a SLC coating (SLC-MoM), (2) uncoated MoM surfaces (MoM), and (3) metal on polyethylene (MoP) surfaces. Implants remained in vivo for 13 months and blood chromium (Cr) and cobalt (Co) metal ion levels were measured pre and postoperatively. Synovial tissue was graded using an ALVAL scoring system. When compared with the MoM group, sheep with SLC-MoM implants showed significantly lower levels of chromium and cobalt metal ions within blood over the 13-month period. Evidence of gray tissue staining was observed in the synovium of implants in the MOM group. A significantly lower ALVAL score was measured in the SLC-MoM group (3.88) when compared with MoM components (6.67) (p = 0.010). ALVAL results showed no significant difference when SLC-MOM components were compared to MoP (5.25). This model was able to distinguish wear and the effect of released debris between different bearing combinations and demonstrated the effect of a SLC coating when applied onto the bearing surface. © 2018 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater 107B: 1760-1771, 2019.
- Published
- 2018
13. Surgery of the Knee
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Timothy W. R. Briggs, Alexander D. Liddle, and Lee A David
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medicine.medical_specialty ,business.industry ,Medicine ,business ,Surgery - Published
- 2020
14. Novel guidelines to avoid routine blood tests after Robot Assisted Radical Prostatectomy (RARP)
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B. Lamb, A Nathan, Timothy W. R. Briggs, Nancy Hanna, Nimish Shah, Y Phuah, Senthil Nathan, S Patel, A. Kelkar, Prabhakar Rajan, John Hines, Prasanna Sooriakumaran, Paul Cleaveland, Aijaz Rashid, Justin W. Collins, Saiful Miah, Ashwin Sridhar, V. Kasivisvanathan, John D. Kelly, Greg Shaw, and K Flora
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medicine.medical_specialty ,business.industry ,Prostatectomy ,Urology ,medicine.medical_treatment ,Medicine ,Robot ,business ,lcsh:Diseases of the genitourinary system. Urology ,lcsh:RC870-923 ,lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,lcsh:RC254-282 - Published
- 2020
15. Identifying unwarranted variation in clinical practice between healthcare providers in England: Analysis of administrative data over time for the Getting It Right First Time programme
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Simon Harrison, Jamie Day, Timothy W. R. Briggs, and William K. Gray
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medicine.medical_specialty ,Funnel plot ,Quality management ,business.industry ,030503 health policy & services ,Health Policy ,Health Personnel ,Gold standard ,Public Health, Environmental and Occupational Health ,State Medicine ,Hospitalization ,03 medical and health sciences ,England ,Common cause and special cause ,Family medicine ,Health care ,medicine ,Humans ,Observational study ,Metric (unit) ,Time point ,0305 other medical science ,business ,Retrospective Studies - Abstract
RATIONALE, AIMS, AND OBJECTIVES The Getting It Right First Time programme aims to reduce variation in clinical practice that unduly impacts on outcomes for patients in the National Health Service (NHS) in England; often termed "unwarranted variation." However, there is no "gold standard" method for detecting unwarranted variation. The aim of this study was to describe a method to allow such variation in recorded practice or patient outcomes between NHS trusts to be detected using data over multiple time periods. By looking at variation over time, it was hoped that patterns that could be missed by looking at data at a single time point, or averaged over a longer time period, could be identified. METHODS This was a retrospective time-series analysis of observational administrative data. Data were extracted from the Hospital Episodes Statistics database for two exemplar aspects of clinical practice within the field of urology: (a) use of ureteric stents on first emergency admission to treat urinary tract stones and (b) waiting times for definitive surgery for urinary retention. Data were categorized into 3-month time periods and three rules were used to detect unwarranted variation in the outcome metric relative to the national average: (a) two of any three consecutive values greater than two standard deviations above the mean, (b) four of any five consecutive values greater than one standard deviation above the mean, and (c) eight consecutive values above the mean. RESULTS For the urinary tract stones dataset, 24 trusts were identified as having unwarranted variation in the outcomes using funnel plots and 23 trusts using the time-series method. For the urinary retention data, 18 trusted were identified as having unwarranted variation in the outcomes using funnel plots and 22 trusts using the time-series method. CONCLUSIONS The time-series method may complement other methods to help identify unwarranted variation.
- Published
- 2020
16. Otorhinolaryngology litigation in England: 727 clinical negligence cases against the National Health Service
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John T Machin, Ahmad Hariri, Andrew Marshall, Cherrie Ho, Annakan Victor Navaratnam, and Timothy W. R. Briggs
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Rhinology ,medicine.medical_specialty ,business.industry ,Incidence (epidemiology) ,General surgery ,Malpractice ,Subspecialty ,National health service ,State Medicine ,03 medical and health sciences ,Otolaryngology ,0302 clinical medicine ,Otorhinolaryngology ,England ,Informed consent ,Otology ,030220 oncology & carcinogenesis ,medicine ,Humans ,030223 otorhinolaryngology ,business ,health care economics and organizations - Abstract
INTRODUCTION Litigation against the National Health Service (NHS) in England is rising. The aim of this study was to determine the incidence and characteristics of otorhinolaryngology clinical negligence claims in England. METHODS A retrospective review was undertaken of all clinical negligence claims in England held by NHS Resolution relating to otorhinolaryngology between April 2013 and April 2018. Analysis was performed using information for cause, patient injury and claim cost. Where claim information was adequately detailed, the authors categorised claims by subspecialty, diagnosis and surgery. RESULTS A total number of 727 claims were identified with an estimated potential cost of £108 million. Out of these, 463 were closed claims. Including open claim reserves, the mean cost of a claim was £148 923. Head and neck surgery was the subspecialty with the highest number of claims (n = 313, 43%) and highest cost (£51.5 million) followed by otology (n = 171, £24.5 million) and rhinology (n = 171, £13.6 million). Over half of claims were associated with an operation (n = 429, 59%) where mastoid surgery (n = 46) and endoscopic sinus surgery (n = 46) were equally associated with the greatest number of claims. The most frequent causes for clinical negligence claims included failure or delay to diagnose (n = 178, 25%), failure or delay to treat (n = 136, 19%), intra-operative complications (n = 130, 18%) and failure of the consent process (n = 107, 15%). DISCUSSION Clinical negligence claims in otorhinolaryngology are related to several different components of patient management and are not limited to postoperative complications. This study highlights the importance of robust pathways in out-patient diagnostics and the consenting process in order to deliver better patient care and reduce the impact of litigation. Keywords informed consent, malpractice, clinical negligence claims, litigation, otolaryngology.
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- 2020
17. Fixation Method and Subsequent Revision Rates for Elective Primary Hip Arthroplasty in People Aged 70 Years and Older: Analysis of National Administrative Data Sets by the UK Getting It Right First Time Program
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Timothy W. R. Briggs, Jamie Day, William K. Gray, and Matthew Barker
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Reoperation ,medicine.medical_specialty ,medicine.medical_treatment ,Arthroplasty, Replacement, Hip ,Prosthesis Design ,State Medicine ,03 medical and health sciences ,Fixation (surgical) ,0302 clinical medicine ,Subsequent revision ,medicine ,Humans ,Orthopedics and Sports Medicine ,Registries ,Aged ,Aged, 80 and over ,030222 orthopedics ,business.industry ,General surgery ,Hazard ratio ,Fixation method ,Arthroplasty ,Confidence interval ,United Kingdom ,Prosthesis Failure ,England ,Orthopedic surgery ,Hip Prosthesis ,business ,Total hip arthroplasty - Abstract
Background We aimed to understand the role of fixation method in predicting subsequent revision rates in people aged 70 years and older undergoing elective primary total hip arthroplasty (THA) within the UK National Health Service (NHS). Methods Data on elective primary THAs conducted in people aged 70 years and older between April 1, 2012, and March 31, 2018, and subsequent revisions conducted up to March 31, 2019, were extracted from the Hospital Episodes Statistics database for all NHS procedures in England. A flexible parametric competing risks model was used to identify the role of fixation method in predicting revision and adjust for age, sex, frailty, year of surgery, and all-cause mortality. Results Data were available for 190,656 procedures. Crude revision rates at 1-7 years follow-up in those who had cemented, hybrid/reverse hybrid, and uncemented fixation were 1.8%, 1.8%, and 2.3%, respectively. There was a high level of variation between NHS trusts in the proportionate use of fixation method. The differences in the hazard of revision between uncemented and cemented fixation (hazard ratio, 1.238 [95% confidence interval, 1.148-1.336]) and hybrid/reverse hybrid fixation (hazard ratio, 1.184 [95% confidence interval, 1.082-1.297]) were both significant. In secondary analysis, there was evidence that revision rates in trusts where uncemented fixation predominated were not significantly lower for uncemented fixation compared to all other fixation methods. Conclusions Revision rates were significantly higher for elective primary THA in people aged 70 years and older who have uncemented fixation, compared to those who had cemented and hybrid/reverse hybrid fixation.
- Published
- 2020
18. PD43-05 QI: DO WE NEED PRE-OP GROUP AND SCREEN SAMPLES AND ROUTINE POST-OP BLOODS FOR RARP
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A Nathan, Ashwin Sridhar, Greg Shaw, Timothy W. R. Briggs, Senthil Nathan, Prasanna Sooriakumaran, A. Kelkar, Prabhakar Rajan, and John Kelly
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medicine.medical_specialty ,business.industry ,Robotic assisted ,Prostatectomy ,Urology ,medicine.medical_treatment ,Medicine ,business ,Surgery - Abstract
INTRODUCTION AND OBJECTIVE:Patients undergoing Robotic Assisted Radical Prostatectomy (RARP) commonly require 2 group and screen samples pre-operatively. However, literature suggests intra-operativ...
- Published
- 2020
19. A Review of the Surgical Management of Extrathoracic Solitary Fibrous Tumors
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Timothy W. R. Briggs, A Olivier, Mathew David Sewell, Johnson Platinum, Deborah M. Eastwood, Babar Kayani, and Anil Sharma
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Cancer Research ,Solitary fibrous tumor ,medicine.medical_specialty ,medicine.medical_treatment ,MEDLINE ,Cochrane Library ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,medicine ,Adjuvant therapy ,Humans ,Pelvis ,business.industry ,Disease Management ,Thoracic Neoplasms ,Prognosis ,medicine.disease ,Review article ,Radiation therapy ,medicine.anatomical_structure ,Oncology ,Solitary Fibrous Tumors ,030220 oncology & carcinogenesis ,Abdomen ,Radiology ,business ,030217 neurology & neurosurgery - Abstract
Objectives Extrathoracic solitary fibrous tumors (ESFTs) are rare low-to-intermediate grade spindle-cell neoplasms of pluripotent fibroblastic or myofibroblastic origin. This review explores prognostic factors in the management of ESFTs and provides guidance on optimal treatment regimens based on the current literature. Patients and methods Electronic searches were performed using MEDLINE, Embase, and the Cochrane library to identify studies on prognostic factors in the management of ESFTs published between January 1970 and June 2016. The literature search and review process identified 100 articles that were included in this review article. This included both surgical and nonsurgical studies on the management of ESFTs. Results Surgical excision with wide resection margins forms the mainstay of treatment and provides optimal long-term oncological outcomes. Large tumor size (>5 to 10 cm diameter), inadequate resection margins, malignant histologic features, dedifferentiation, and tumor location within the abdomen/pelvis are associated with adverse oncological outcomes. Radiotherapy may be used for preoperative tumor shrinkage and/or as adjuvant therapy in patients with malignant disease or incomplete surgical margins. Chemotherapy with molecular-targeted therapies has produced promising results and the results of further phase 2 trials are awaited. Conclusions Routine long-term follow-up is essential for benign and malignant disease to enable early detection and treatment of recurrent disease.
- Published
- 2018
20. Antimicrobial photodynamic therapy—a promising treatment for prosthetic joint infections
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Caroline Bagley, Gordon Blunn, Timothy W. R. Briggs, Simon Hislop, Rita Ramalhete, Melanie J. Coathup, and D McKenna
- Subjects
Methicillin-Resistant Staphylococcus aureus ,Prosthetic joint infection ,Staphylococcus aureus ,Prosthesis-Related Infections ,medicine.medical_treatment ,Photodynamic therapy ,Dermatology ,medicine.disease_cause ,Microbiology ,030207 dermatology & venereal diseases ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,Anti-Infective Agents ,Staphylococcus epidermidis ,Journal Article ,medicine ,Alloys ,Humans ,Titanium ,030222 orthopedics ,Methylene blue ,Photosensitizing Agents ,biology ,Pseudomonas aeruginosa ,Lasers ,Biofilm ,Dose-Response Relationship, Radiation ,Prostheses and Implants ,Staphylococcal Infections ,biology.organism_classification ,Antimicrobial ,Plankton ,Acinetobacter baumannii ,chemistry ,Photochemotherapy ,Biofilms ,Surgery ,Original Article ,Joints - Abstract
Periprosthetic joint infection (PJI) is associated with high patient morbidity and a large financial cost. This study investigated Photodynamic Therapy (PDT) as a means of eradicating bacteria that cause PJI, using a laser with a 665-nm wavelength and methylene blue (MB) as the photosensitizer. The effectiveness of MB concentration on the growth inhibition of methicillin-sensitive Staphylococcus aureus (MSSA), methicillin-resistant Staphylococcus aureus (MRSA), Staphylococcus epidermidis, Pseudomonas aeruginosa and Acinetobacter baumannii was investigated. The effect of laser dose was also investigated and the optimized PDT method was used to investigate its bactericidal effect on species within planktonic culture and following the formation of a biofilm on polished titanium and hydroxyapatite coated titanium discs. Results showed that Staphylococci were eradicated at the lowest concentration of 0.1 mM methylene blue (MB). With P. aeruginosa and A. baumannii, increasing the MB concentration improved the bactericidal effect. When the laser dose was increased, results showed that the higher the power of the laser the more bacteria were eradicated with a laser power ≥ 35 J/cm2 and an irradiance of 35 mW/cm2, eradicating all S. epidermidis. The optimized PDT method had a significant bactericidal effect against planktonic MRSA and S. epidermidis compared to MB alone, laser alone, or control (no treatment). When biofilms were formed, PDT treatment had a significantly higher bactericidal effect than MB alone and laser alone for all species of bacteria investigated on the polished disc surfaces. P. aeruginosa grown in a biofilm was shown to be less sensitive to PDT when compared to Staphylococci, and a HA-coated surface reduced the effectiveness of PDT. This study demonstrated that PDT is effective for killing bacteria that cause PJI.
- Published
- 2017
21. The sensitivity, specificity, and diagnostic accuracy of whole-bone MRI for identifying skip metastases in appendicular osteosarcoma and Ewing sarcoma
- Author
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James R Barnett, Asif Saifuddin, Timothy W. R. Briggs, Panagiotis D. Gikas, and Craig Gerrand
- Subjects
Male ,medicine.medical_specialty ,Adolescent ,Long bone ,Diagnostic accuracy ,Bone Neoplasms ,Sarcoma, Ewing ,Bone Sarcoma ,Sensitivity and Specificity ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Late Recurrence ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Neoplasm Metastasis ,030203 arthritis & rheumatology ,Osteosarcoma ,business.industry ,Biopsy, Needle ,medicine.disease ,Magnetic Resonance Imaging ,medicine.anatomical_structure ,Needle biopsy ,Orthopedic surgery ,Female ,Sarcoma ,Radiology ,business - Abstract
Pre-operative whole-bone MRI is required to assess intra-osseous tumour extent and to identify skip metastases in cases of bone sarcoma. The current study aims to determine the sensitivity, specificity, and diagnostic accuracy of whole-bone MRI for the identification of skip metastases. Review of 162 patients with long bone osteosarcoma or Ewing sarcoma who had undergone whole-bone MRI to assess intra-osseous tumour length and identify skip metastases. Comparison was made with post-chemotherapy MRI to look for a change in the appearance of suspected skip metastases, and resection specimens were assessed for the presence of skip metastases. The presence of local osseous recurrence was determined at final follow-up. There were 112 males and 50 females (mean age 18.8 years), with 119 osteosarcomas and 43 Ewing sarcomas. Skip metastases were diagnosed on whole-bone MRI in 23 cases (14.2%). In 2 cases, pre-operative needle biopsy diagnosed enchondromata, resulting in false positive diagnoses. Skip metastases were diagnosed in the resection specimens in 3 cases, and based on comparison with post-chemotherapy MRI in 12. There was no evidence of local osseous recurrence in 160 patients, while late recurrence occurred in 2 patients. Sensitivity was calculated as 88.2%, specificity as 97.6%, and diagnostic accuracy as 96.7%. Whole-bone MRI has a high sensitivity, specificity, and diagnostic accuracy for the identification of skip metastases in osteosarcoma and Ewing sarcoma. The possibility of false positive skip lesions and late local osseous recurrence is also highlighted.
- Published
- 2019
22. Non-invasive massive growing prostheses reduce infection in paediatric cancer patients
- Author
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Timothy W. R. Briggs, Melanie J. Coathup, Samee Ahmad, John A. Skinner, Gordon Blunn, William Aston, and Julian Maempel
- Subjects
Male ,medicine.medical_specialty ,Prosthesis-Related Infections ,Adolescent ,aseptic loosening ,Aseptic loosening ,Bone Neoplasms ,growing implants ,Prosthesis Implantation ,03 medical and health sciences ,0302 clinical medicine ,Paediatric cancer ,lcsh:Orthopedic surgery ,medicine ,Humans ,massive endoprostheses ,Child ,030222 orthopedics ,Bone cancer ,business.industry ,Non invasive ,Infant ,Sarcoma ,bone cancer ,030229 sport sciences ,Prostheses and Implants ,Plastic Surgery Procedures ,medicine.disease ,Survival Analysis ,infection ,Surgery ,lcsh:RD701-811 ,Treatment Outcome ,Child, Preschool ,Female ,business - Abstract
Purpose: In this study, we asked the question of whether non-invasive (NI) extendible bone tumour implants are as reliable and reduce infection when compared with patients who received a minimally invasive (MI) extendible implant.Methods: Forty-two NI extendible bone tumour implants were investigated at a mean follow-up of 22 months (range, 1–87 months) and 63 MI implants at a mean follow-up of 49 months (range, 1–156 months).Results: Kaplan–Meier analysis showed that the probability of MI implant survival was 58.8% compared with 78.6% in NI patients. No significant difference between these two patient groups was found. Infection was the main reason for failure in the MI implant group where nine (35%) implants were revised. However, only one (11%) NI implant was revised for infection (p = 0.042). None of the NI implants failed due to aseptic loosening; however, six (23%) MI implants were revised for aseptic loosening of the intramedullary stem. Four (15%) of the failed MI implants were revised due to full extension and five (56%) of failed NI implants were replaced as the implant had been fully extended where the patient still required growth.Conclusion: Where possible, an NI massive prosthesis should be used in this patient group. Our results suggest that MI prostheses should be infrequently used due to the high incidence of infection. Lengthening of NI prostheses is painless, can be carried out in the clinic and is more cost-effective. However, further work is required to increase the amount of growth potential available in these implants.
- Published
- 2019
23. Osteomimetic matrix components alter cell migration and drug response in a 3D tumour-engineered osteosarcoma model
- Author
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M. Pavlou, Umber Cheema, Mittal Shah, Timothy W. R. Briggs, P. D. Gikas, and S.J. Roberts
- Subjects
musculoskeletal diseases ,0206 medical engineering ,Cell ,Biomedical Engineering ,Bone Matrix ,Bone Neoplasms ,02 engineering and technology ,Matrix (biology) ,Biochemistry ,Models, Biological ,Biomaterials ,Laminin ,Biomimetic Materials ,Cell Line, Tumor ,medicine ,Humans ,Doxorubicin ,Neoplasm Invasiveness ,Molecular Biology ,Osteosarcoma ,biology ,Bone cancer ,Cell migration ,General Medicine ,021001 nanoscience & nanotechnology ,medicine.disease ,020601 biomedical engineering ,Extracellular Matrix ,Fibronectin ,medicine.anatomical_structure ,biology.protein ,Cancer research ,0210 nano-technology ,Biotechnology ,medicine.drug - Abstract
Osteosarcoma management continues to lack the appropriate prognostic tools to assign personalised treatment. This leaves non-responders to standard care vulnerable to recurring disease and pulmonary metastases. Developing 3D in vitro disease models to serve as a test bed for personalised treatment is a promising approach to address this issue. This study describes the generation of 3D osteosarcoma models termed "tumouroids", which are geometrically compartmentalised to reproduce the bone cancer mass and its surrounding. Although the tumour microenvironment impacts osteosarcoma in many ways, this model focussed on interrogating the influence of a biomimetic matrix on tumour cell behaviour. The 3D matrix was supplemented with the bone-marrow proteins laminin, fibronectin and NuOss® bone granules. This led to increased invasion of osteosarcoma cell aggregates from within the bone-like matrix into the surrounding acellular bone marrow-like ECM. The presence of bone granules also yielded an atypical molecular profile of osteosarcoma cells, suggesting malignant metabolic reprogramming. Changes include decreased MMP-9 (p 0.05) and increased PTEN (p 0.05), MCP-1 (p 0.01) and MCT-4 (p 0.05) gene expression. This complex 3D biomimetic composition also changed cellular responses to doxorubicin, a common chemotherapeutic agent used to treat osteosarcoma, and reproduced key issues of in vivo treatment like drug penetrance and doxorubicin-induced bone toxicity. This work highlights the importance of a biomimetic matrix in 3D osteosarcoma models for both basic and translational research. STATEMENT OF SIGNIFICANCE: This study describes the generation of 3D osteosarcoma models termed "tumouroids", which are geometrically compartmentalised to reproduce the bone cancer mass and its environment. Utilising this novel model, specific parameters of osteosarcoma growth and invasion were investigated. Osteosarcoma cell lines proliferate at a slower rate, exhibit malignant metabolic reprogramming, and respond to drug intervention at lower concentrations of doxorubicin hydrochloride in matrix-complex compared to basic tumouroids. As such, this study provides evidence that the tumour microenvironment impacts osteosarcoma in many ways. The osteosarcoma tumouroid described herein may form the basis of a personalised-medicine strategy, which will allow the testing of drug effectiveness similar to that used for antibiotic selection for pathogenic bacteria.
- Published
- 2019
24. Stanmore noninvasive extendible endoprosthesis in the treatment of bone sarcoma in the preadolescent
- Author
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Marco Manfrini, Rob Pollock, Eric L. Staals, Panagiotis D. Gikas, Timothy W. R. Briggs, M. R. Medellin, Davide Maria Donati, Adesegun Abudu, Andrea Sambri, Sambri A., Staals E., Medellin M.R., Abudu A., Gikas P., Pollock R., Briggs T.W.R., Donati D.M., and Manfrini M.
- Subjects
Male ,medicine.medical_specialty ,magnetic ,medicine.medical_treatment ,Bone Neoplasms ,Bone Sarcoma ,Bone Neoplasm ,bone tumor ,Prosthesis Design ,Prosthesis ,03 medical and health sciences ,Distal femur ,0302 clinical medicine ,Retrospective Studie ,medicine ,Humans ,Stage (cooking) ,Child ,Survival rate ,pediatric tumor ,Retrospective Studies ,Osteosarcoma ,Bone-Anchored Prosthesis ,business.industry ,Mortality rate ,Femoral Neoplasms ,General Medicine ,Skeletal maturity ,lengthening prosthesi ,Surgery ,Prosthesis Failure ,Treatment Outcome ,Oncology ,030220 oncology & carcinogenesis ,Child, Preschool ,030211 gastroenterology & hepatology ,Female ,Femoral Neoplasm ,Implant ,distal femur ,business ,Human - Abstract
Aims The aim of this study is to assess outcomes of patients ≤12 years who undergo Stanmore noninvasive extendible endoprosthetic replacement of the distal femur (DF NIEPR). Patients and methods A total of 101 children (mean age 9.6 years) were included. All complications which required further surgery were recorded. Clinical and functional outcomes were evaluated with Musculoskeletal Tumor Society (MSTS) scores at a mean follow-up of 64 months (range 6-174). Results Thirty-one (30.7%) patients died at a mean of 33 months. Forty had prosthesis removed after a mean of 43 months (range, 7-103). Attaining of the full lengthening potential before skeletal maturity was the most frequent reason for revision surgery, particularly in those with smaller lengthening potential (P = 0.039). Implant survival rate for other causes was 61.7% at 5 years and 45.0% at 10 years. At final follow-up mean MSTS score was 26 (range, 13-29). Twenty-two (21.5%) patients had a final limb-length discrepancy (LLD) > 2 cm. Conclusions DF NIEPR produces a good functional outcome, with the prevention of major LLD at skeletal maturity in the majority of the cases. We suggest patient selection criteria to account for the stage of the disease due to the high cost of the NIEPR, and high percentage requiring revision, and a 60% mortality rate in those patients presenting with distant disease burden.
- Published
- 2019
25. Prognostic Factors in the Operative Management of Sacral Chordomas
- Author
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Babar Kayani, Richard Williams, Robin Pollock, Sammy A. Hanna, John A. Skinner, Timothy W. R. Briggs, Kimberly-Anne Tan, and Mathew D. Sewell
- Subjects
Adult ,Male ,medicine.medical_specialty ,Prognostic variable ,Kaplan-Meier Estimate ,Disease ,Neurosurgical Procedures ,Metastasis ,Chordoma ,medicine ,Humans ,Neoplasm Invasiveness ,Neoplasm Metastasis ,Aged ,Retrospective Studies ,Aged, 80 and over ,Sacroiliac joint ,Spinal Neoplasms ,medicine.diagnostic_test ,Sacrococcygeal Region ,business.industry ,Hazard ratio ,Magnetic resonance imaging ,Middle Aged ,Prognosis ,medicine.disease ,Survival Analysis ,Confidence interval ,Surgery ,medicine.anatomical_structure ,Female ,Neurology (clinical) ,Neoplasm Recurrence, Local ,business ,Follow-Up Studies - Abstract
Surgical resection of sacral chordomas offers the best long-term prognosis but has high rates of local recurrence, metastases, and mortality. Most prognostic studies are limited by low patient numbers, variation in treatment, follow-up, and prognostic variables studied. The objective of this study was to identify factors associated with recurrence, metastasis, and survival.Retrospective review of 58 patients undergoing sacrectomy for chordoma with a mean age of 63 years (range: 41-80 years) and a mean follow-up of 45.3 months (range: 2-144 months). Data on prognostic variables and outcomes were collected. Forty-two patients underwent a combined anterior and posterior approach and 16 underwent a posterior-only approach.Twenty-six patients (44.8%) died during follow-up. Kaplan-Meier estimates for 5- and 10-year survival were 62% and 26%, respectively. Local recurrence occurred in 32 patients (51.7%) and metastases in 19 (32.7%). Adequacy of resection margins was the most important predictor of disease recurrence, metastases, and survival. Tumors8 cm were associated with significantly increased risk of metastases and reduced survival (P0.05). Dedifferentiated disease and infiltration of the sacroiliac joints and/or adjacent musculature were also associated with reduced survival. Median survival was 23 months for patients with gluteus maximus invasion, 66 months for gluteus maximus and piriformis invasion, 67 months for piriformis invasion, and 90 months for patients with no muscle invasion.Patients with inadequate resection margins, tumors8 cm, sacroiliac joint and/or musculature infiltration, and dedifferentiated disease have significantly worse oncologic outcomes. Involvement of gluteus maximus alone confers a higher risk of metastases and local recurrence than involvement of piriformis and gluteus maximus, or piriformis alone.
- Published
- 2015
26. Can spinal surgery in England be saved from litigation: a review of 978 clinical negligence claims against the NHS
- Author
-
Timothy W. R. Briggs, John Hardman, William Harrison, John T. Machin, and Mike Hutton
- Subjects
medicine.medical_specialty ,Cauda equina syndrome ,State Medicine ,Clinical negligence ,03 medical and health sciences ,0302 clinical medicine ,Informed consent ,Malpractice ,medicine ,Humans ,Orthopedics and Sports Medicine ,Orthopedic Procedures ,030212 general & internal medicine ,health care economics and organizations ,Retrospective Studies ,business.industry ,General surgery ,medicine.disease ,Spinal surgery ,Spine ,Never events ,England ,Orthopedic surgery ,Surgery ,Neurosurgery ,business ,030217 neurology & neurosurgery - Abstract
The aim of this study is to evaluate the true incidence of all clinical negligence claims against spinal surgery performed by orthopaedic spinal surgeons and neurosurgeons in the National Health Service (NHS) in England, including both open and closed claims. This study was a retrospective review of 978 clinical negligence claims held by NHS Resolution against spinal surgery cases identified from claims against ‘Neurosurgery’ and ‘Orthopaedic Surgery’. This category included all emergency, trauma and elective work and all open and closed cases without exclusion between April 2012 and April 2017. Clinical negligence claims in spinal surgery were estimated to cost £535.5 million over this five-year period. There is a trend of both increasing volume and estimated costs of claims. The most common causes for claims were ‘judgement/timing’ (512 claims, 52.35%), ‘interpretation of results/clinical picture’ (255 claims, 26.07%), ‘unsatisfactory outcome to surgery’ (192 claims, 19.63%), ‘fail to warn/informed consent’ (80 claims, 8.13%) and ‘never events’ including ‘wrong site surgery’ or ‘retained instrument post-operation’ (26 claims, 2.66%). A sub-analysis of 3 years including 574 claims revealed the most prevalent pathologies were iatrogenic nerve damage (132 claims, 23.00%), cauda equina syndrome (CES) (131 claims, 22.82%), inadequate decompression (91 claims, 15.85%), iatrogenic cord damage (72 claims, 12.54%), and infection (51 claims, 8.89%). The volume and costs of clinical negligence claims is threatening the future of spinal surgery. If spinal surgery is to continue to serve the patients who need it, most thorough investigation, implementation and sharing of lessons learned from litigation claims must be systematically carried out. These slides can be retrieved under Electronic Supplementary Material.
- Published
- 2018
27. Malignant Tumors of the Foot and Ankle
- Author
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Jonathan S. Palmer, Panagiotis D. Gikas, Dishan Singh, Timothy W. R. Briggs, and Paul O’Donnell
- Published
- 2018
28. Developing a nomogram for prediction of early urinary continence after robotic prostatectomy incorporating patient, MRI and operative factors
- Author
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Greg Shaw, Senthil Nathan, Prasanna Sooriakumaran, Timothy W. R. Briggs, A. Kelkar, N. Pavan, Clare Allen, C. Gregorio, D. Gu, Ashwin Sridhar, and Prabhakar Rajan
- Subjects
medicine.medical_specialty ,Urinary continence ,business.industry ,Urology ,Medicine ,Nomogram ,business ,Robotic prostatectomy - Published
- 2019
29. Sufficient Competence to Enter the Unsupervised Practice of Orthopaedics: What Is It, When Does It Occur, and Do We Know It When We See It?
- Author
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Richard L. Cruess, Vincent D. Pellegrini, Peter C. Ferguson, Sylvia R. Cruess, and Timothy W. R. Briggs
- Subjects
Canada ,Medical education ,business.industry ,MEDLINE ,Graduate medical education ,Internship and Residency ,The Orthopaedic Forum ,General Medicine ,Guideline ,Surgical procedures ,Competency-Based Education ,United Kingdom ,United States ,Accreditation ,Orthopedics ,Humans ,Medicine ,Orthopedics and Sports Medicine ,Surgery ,Clinical Competence ,Independent practice ,Clinical competence ,business ,Competence (human resources) - Abstract
The goal of residency programs is to provide an educational venue with graduated responsibility and increasing levels of independence as preparation for entering the unsupervised practice of medicine. Surgical programs are required to both cultivate and convey skills pursuant to three fundamental domains: a sufficient fund of knowledge, technical competence in surgical procedures, and a degree of professionalism to enable ethical independent practice. Never before has the expectation that residency programs provide graduated responsibility in preparation for entering the unsupervised practice of medicine been so clearly articulated as it has by Nasca in the recent Accreditation Council for Graduate Medical Education (ACGME) work-hour guideline revisions. The Royal College of Physicians and Surgeons has provided similar guidance in Canada. Yet, as we progress further into the second decade of work-hour restrictions, it is unclear that we have adequately defined or can recognize the critical end points essential to trainee competency. What is clear is that we must achieve these end points in a manner different from that prior to the introduction of work-hour restrictions. We present the current state of thinking from North America and contrast this with the evolving medical educational process in the United Kingdom.
- Published
- 2015
30. Undergraduate and foundation training in trauma and orthopaedics: junior doctors have their say
- Author
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Yaser Ghani, Sujith Konan, Jon Palmer, Raj R Thakrar, P. D. Gikas, Timothy W. R. Briggs, James Donaldson, and A Olivier
- Subjects
Medical education ,medicine.medical_specialty ,Medical staff ,business.industry ,education ,Undergraduate education ,Foundation (evidence) ,General Medicine ,Orthopedics ,Clinical training ,Orthopedic surgery ,Medical Staff, Hospital ,Humans ,Wounds and Injuries ,Medicine ,Musculoskeletal health ,Clinical Competence ,Curriculum ,Musculoskeletal Diseases ,Clinical competence ,business ,Education, Medical, Undergraduate - Abstract
Undergraduate education in musculoskeletal health is currently insufficient in most medical schools worldwide, in both basic sciences and clinical training. A national survey was carried out to obtain views of current doctors from various specialties about undergraduate and foundation training in trauma and orthopaedics.
- Published
- 2015
31. Effectiveness of a tailored neck training program on neck strength, movement, and fatigue in under-19 male rugby players: a randomized controlled pilot study
- Author
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Don Gatherer, Terence F McLoughlin, M. T. R. Parratt, K Gallagher, Jonathan R. Perera, Timothy W. R. Briggs, and Matthew D Barrett
- Subjects
scrum ,medicine.medical_specialty ,youth ,business.industry ,Test group ,injury ,muscle ,Range of movement ,Cervical spine ,Neck muscles ,Exercise program ,Multicenter study ,Physical therapy ,Medicine ,business ,Training program ,sport ,Open Access Journal of Sports Medicine ,Balance (ability) ,Original Research - Abstract
Matthew D Barrett,1 Terence F McLoughlin,2 Kieran R Gallagher,1 Don Gatherer,3 Michael TR Parratt,1 Jonathan R Perera,1 Tim WR Briggs1 1Royal National Orthopaedic Hospital, Stanmore, Middlesex, United Kingdom; 2Royal Liverpool University Hospital, Liverpool, Mersey Deanery, United Kingdom; 3The Gatherer Partnership, Aylesbury, United Kingdom Purpose: To investigate the effect of a tailored neck muscle conditioning program on neck muscle strength, neck muscle fatigue, and range of neck movement in 16–18-year-old male rugby players. Materials and methods: Thirty-four male rugby players were divided into forward and back playing positions and randomized within these groups. Seventeen players were randomly assigned to each group. The test group was given a tailored 6-week exercise regime based on their baseline measurements to be performed three times a week in addition to their normal training and playing. The control group trained and played as normal. The outcome measures used were cervical spine range of movement, neck strength, and neck muscle fatigability. Results: There were no clinically relevant statistically significant differences between the two groups. Trends identified between the two groups suggest that a tailored neck exercise program increases neck strength, particularly neck extension, and increases resistance to fatigue, as well as influencing right- and left-sided neck muscle balance. A reduction in range of movement was also demonstrated in the test group. There was a great deal of variability in range of movement and strength within this age group. No previously undiagnosed neck conditions were detected, and there were no adverse events reported. Conclusion: This study has shown that neck strength, range of movement, and susceptibility of the neck muscles to fatigue can be influenced using a focused neck training regime. It forms an important basis for a larger, multicenter study to ensure the neck is given due attention in rugby training and receives the same focus of conditioning as other parts of the body. Keywords: injury, sport, muscle, youth, scrum
- Published
- 2015
32. Hydroxyapatite-coated Collars Reduce Radiolucent Line Progression in Cemented Distal Femoral Bone Tumor Implants
- Author
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Robin Pollock, Panagiotis D. Gikas, Stephen R. Cannon, Melanie J. Coathup, Timothy W. R. Briggs, William Aston, Gordon Blunn, A P Sanghrajka, and John A. Skinner
- Subjects
Adult ,Male ,medicine.medical_specialty ,Adolescent ,medicine.medical_treatment ,Radiodensity ,Femoral Neoplasms ,Chondrosarcoma ,Dentistry ,Bone Neoplasms ,Prosthesis ,Osseointegration ,law.invention ,Intramedullary rod ,Coated Materials, Biocompatible ,law ,medicine ,Humans ,Orthopedics and Sports Medicine ,Aged ,Osteosarcoma ,business.industry ,Prostheses and Implants ,General Medicine ,Middle Aged ,medicine.disease ,Prosthesis Failure ,Surgery ,Durapatite ,Basic Research ,Orthopedic surgery ,Female ,Implant ,business - Abstract
Aseptic loosening of massive bone tumor implants is a major cause of prosthesis failure. Evidence suggests that an osteointegrated hydroxyapatite (HA)-coated collar would reduce the incidence of aseptic loosening around the cemented intramedullary stem in distal femoral bone tumor prostheses. Because these implants often are used in young patients with a tumor, such treatment might extend the longevity of tumor implants. Questions/purposes We asked whether (1) HA-coated collars were more likely to osteointegrate; (2) HA collars were associated with fewer progressive radiolucent lines around the stem-cement interface; and (3) HA-coated collars were associated with less bone loss at the bone-shoulder implant junction?Twenty-two patients were pair-matched to one of two groups--either (1) implants with a HA-coated ingrowth collar (HA Collar Group); or (2) implants without an ingrowth collar (Noncollar Group). Age, sex, and length of followup were similar in both groups. HA-coated collars were developed and used at our institution from 1992 to address the high failure rate attributable to aseptic loosening in patients with massive bone tumor implants. Before this, smooth titanium shafts were used routinely adjacent to bone at the transection site. The minimum followup was 2 years (mean, 7 years; range, 2-12 years). Radiographs obtained throughout the followup period were analyzed and osteointegration at the shaft of the implant quantified. Radiolucent line progression around the cemented stem was semi-quantitatively assessed and cortical bone loss at the bone-shoulder implant junction was measured during the followup period.Comparison of the most recent radiographs showed nine of 11 patients had osteointegrated HA collars, whereas only one patient in the Noncollar Group had osteointegration (p0.001). The radiolucent line score quantified around the cemented stem was lower in the HA Collar Group when compared with the Noncollar Group (p = 0.001). Results showed an increase in cortical bone loss at the bone-shoulder implant junction in the Noncollar Group when compared with the HA Collar Group (p0.001).Osteointegration at the implant collar resulted in fewer radiolucent lines adjacent to the intramedullary cemented stem and decreased cortical bone loss immediately adjacent to the transection site. These results suggest that the HA collar may help reduce the risk of aseptic loosening in patients with this type of implant, but longer followup and a larger prospective comparison series are necessary to prove this more definitively.
- Published
- 2015
33. Outcomes of infected revision knee arthroplasty managed by two-stage revision in a tertiary referral centre
- Author
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Rob Pollock, John A. Skinner, Jonathan Miles, Vijai S. Ranawat, John Stammers, Richard Carrington, Steven Kahane, and Timothy W. R. Briggs
- Subjects
Adult ,Male ,Reoperation ,medicine.medical_specialty ,Prosthesis-Related Infections ,medicine.medical_treatment ,Periprosthetic ,Tertiary Care Centers ,Young Adult ,Drug Resistance, Multiple, Bacterial ,Humans ,Medicine ,Orthopedics and Sports Medicine ,Young adult ,Prosthesis-Related Infection ,Arthroplasty, Replacement, Knee ,Aged ,Retrospective Studies ,Aged, 80 and over ,Bacteria ,business.industry ,Gold standard ,Retrospective cohort study ,Evidence-based medicine ,Middle Aged ,Arthroplasty ,Anti-Bacterial Agents ,Surgery ,Cohort ,Female ,Knee Prosthesis ,business - Abstract
Background A two-stage revision remains the gold standard to eradicate deep infection in total knee arthroplasty. Higher failure rates are associated with a number of factors including poly-microbial infections, multiresistant organisms and previous operations. The aims are to investigate [1] the overall success rate of a two-stage revision for infections in TKA, [2] the outcome of repeat two-stage revisions in recurrent infections and [3] the factors affecting the outcomes of such cases. Methods We present the outcomes of a consecutive, retrospective case series of 51 periprosthetic joint infections managed with a two-stage revision knee arthroplasty over a three year period. Results Forty-six (90%) of 51 were referred from other hospitals. Infection was successfully eradicated in 24 (65%) of 37 patients undergoing an initial two-stage procedure. Following a failed two-stage revision, a repeat two-stage revision was performed in 19 patients eradicating infection in 8 (42%). A third two-stage was performed in five of these patients eradicating infection in three with an average follow-up of 43months. Multidrug resistance was present in 69%, and 47% of the patients were infected with multiple organisms. All unsuccessful outcomes involved at least one multidrug-resistant organism compared to 43% in the successful cohort ( P =0.0002). Serological markers prior to a second-stage procedure were not significantly different between successful and unsuccessful outcome groups. Conclusion Single or multiple two-stage revisions can eradicate infection despite previous failed attempts. In this series, failure is associated with multidrug resistance, previous failed attempts to eradicate infection and a less favourable host response. Level of evidence IV
- Published
- 2015
34. Custom rotating hinge total knee arthroplasty in patients with poliomyelitis affected limbs
- Author
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Robin Pollock, Babar Kayani, Jeeshan Rahman, Richard Carrington, John A. Skinner, Jonathan Miles, Sammy A. Hanna, and Timothy W. R. Briggs
- Subjects
Joint Instability ,Male ,musculoskeletal diseases ,medicine.medical_specialty ,Ligamentous laxity ,Knee Joint ,medicine.medical_treatment ,Prosthesis Design ,Prosthesis ,law.invention ,Intramedullary rod ,law ,Deformity ,Humans ,Medicine ,Orthopedics and Sports Medicine ,Range of Motion, Articular ,Arthroplasty, Replacement, Knee ,Aged ,Retrospective Studies ,Aged, 80 and over ,business.industry ,Middle Aged ,Osteoarthritis, Knee ,musculoskeletal system ,medicine.disease ,Arthroplasty ,Surgery ,Orthopedic surgery ,Female ,medicine.symptom ,Knee Prosthesis ,business ,Range of motion ,Oxford knee score ,Poliomyelitis - Abstract
Total knee arthroplasty (TKA) in limbs affected by poliomyelitis is a technically challenging procedure. These patients often demonstrate acquired articular and metaphyseal angular deformities, bone loss, narrowness of the intramedullary canals, impaired quadriceps strength, flexion contractures and ligamentous laxity producing painful hyperextension. Thus, using condylar knee designs in these patients will likely result in early failure because of instability and abnormal load distribution. The aim of this study was to assess the outcomes associated with use of the customised (SMILES) rotating-hinge knee system at our institution for TKA in poliomyelitis-affected limbs. We retrospectively reviewed the outcome of 14 TKAs using the (SMILES) prosthesis in 13 patients with limbs affected by poliomyelitis. All patients had painful unstable knees with hyperextension. There were ten females and three males with a mean age of 66 years (range 51–84) at time of surgery. Patients were followed up clinically, radiologically and functionally with the Oxford knee score (OKS). Mean follow-up was 72 months (16–156). There were no immediate or early complications. One patient fell and sustained a peri-prosthetic fracture at seven months requiring revision to a longer stem. Radiological evaluation showed satisfactory alignment with no signs of loosening in all cases. Mean OKS improved from 11.6 (4–18) to 31.5 (18–40) postoperatively (p
- Published
- 2014
35. Evaluation and model of rehabilitation for primary malignant bone sarcoma patients after limb salvage
- Author
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Katayoon Bamdad, Suzy Hudson, and Timothy W. R. Briggs
- Subjects
medicine.medical_specialty ,Rehabilitation ,business.industry ,Limb salvage ,medicine.medical_treatment ,Physical Therapy, Sports Therapy and Rehabilitation ,Bone Sarcoma ,Lower limb ,medicine.anatomical_structure ,medicine ,Physical therapy ,Upper limb ,business ,Rehabilitation interventions - Abstract
Background and aims It has long been suspected that the rehabilitation available to patients with primary malignant bone sarcoma (PMBS) is not always adequate and appropriate to their needs. The National Specialised Commissioning Group (NSCG) commissioned the 2012–2013 Quality Improvement Development and Innovation Scheme (QIDIS) project (rehabilitation programme) to review the current rehabilitation services available to the PMBS patient groups at all five bone sarcoma specialist centres in England. Methods The 220 participating PMBS patients were provided with questionnaires, and clinicians at the participating centres were interviewed face-to-face. Patients were analysed in groups: upper limb and lower limb, and in the subgroups major and minor surgery. The groups were compared according to their preferences for rehabilitation interventions, the additional rehabilitation post-surgery that they felt was or would have been beneficial, and by their Toronto Extremity Salvage Scores (TESS). Results Out of the 220 questionnaires provided, 136 questionnaires were returned (a 62% response rate). This study identified the lack of the following factors to be associated with PMBS patients' rehabilitation and functional outcomes: equitable access to rehabilitation treatments; suitable rehabilitation admission; allied health professional (AHP) clinical progress reviews; a reliable and equitable referral system with robust referral criteria; a rehabilitation case coordinator; a nationally accepted functional outcome measure; and patients' involvement in the management of their rehabilitation to achieve the best possible outcome. Conclusions This study identified gaps in the current rehabilitation services for PMBS patients and makes several recommendations. The authors designed a postoperative model of rehabilitation, which identifies a number of target areas that may improve current rehabilitation services and enable rehabilitation professionals to assess a PMBS patient's needs to identify the most suitable rehabilitation programme for them.
- Published
- 2014
36. Autologous Chondrocyte Implantation in the Knee
- Author
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Timothy W. R. Briggs, Baljinder S. Dhinsa, K Gallagher, Richard Carrington, George E. Bentley, S.Z. Nawaz, and John A. Skinner
- Subjects
Adult ,Cartilage, Articular ,Male ,medicine.medical_specialty ,Adolescent ,Knee Joint ,Kaplan-Meier Estimate ,Osteoarthritis ,Young Adult ,Chondrocytes ,Survivorship curve ,medicine ,Humans ,Orthopedics and Sports Medicine ,Autografts ,Autologous chondrocyte implantation ,Survival analysis ,Analysis of Variance ,Pain, Postoperative ,Proportional hazards model ,business.industry ,Graft Survival ,Hazard ratio ,General Medicine ,Middle Aged ,medicine.disease ,Arthralgia ,Confidence interval ,Surgery ,Treatment Outcome ,Cohort ,Female ,Joint Diseases ,business ,Cartilage Diseases - Abstract
Background: From 1998 to 2008, 1000 skeletally mature patients underwent autologous chondrocyte implantation for an osteochondral defect of the knee. We evaluated the functional outcomes in 827 of 869 patients who had undergone autologous chondrocyte implantation with Chondron or periosteum (ACI-C/ACI-P) or matrix-assisted chondrocyte implantation (MACI) and attempted to identify factors that influenced outcome. Methods: The age of the patient, the size and site of the osteochondral lesion, previous surgery, and the presence of early osteoarthritis were assessed for their influence on outcomes. Each factor was evaluated in a separate Cox proportional hazards model with use of hazard ratios (HRs), with 95% confidence intervals (CIs), describing the likelihood of failure for that particular factor. Outcomes were assessed with use of the modified Cincinnati score, visual analog scale pain score, and Stanmore functional score. Results: The mean duration of follow-up was 6.2 years (range, two to twelve years). The mean age was thirty-four years (range, fourteen to fifty-six years), with 493 males and 334 females. The average size of the defect was 409 mm2 (range, 64 to 2075 mm2). Four hundred and twenty-one procedures (51%) were performed on the medial femoral condyle; 109 (13%), on the lateral femoral condyle; 200 (24%), on the patella; and fifty (6%), on the trochlea. Kaplan-Meier survival analysis revealed that the unadjusted graft survival rate was 78.2% at five years and 50.7% and ten years for the entire cohort. No difference was found between the survival rates of the ACI-C/ACI-P and MACI techniques (HR = 0.948, 95% CI = 0.738 to 1.219, p = 0.678). There was a significant postoperative improvement in the function and pain scores of all three outcome measures (p < 0.002). Survivorship in the group with a previous cartilage regenerative procedure was inferior to that in patients with a previously untreated lesion, with failure five times more likely in the former group (HR = 4.718, standard error [SE] = 0.742, 95% CI = 3.466 to 6.420, p < 0.001). Degenerative change in any compartment had a significant detrimental effect on survivorship, with survivorship worsening as the osteoarthritis grade increased (Grade 1: HR = 2.077, 95% CI = 1.299 to 3.322, p = 0.002; Grade 2: HR = 3.450, 95% CI = 2.646 to 4.498, p < 0.001; and Grade 3: HR = 3.820, 95% CI = 2.185 to 6.677, p < 0.001). Conclusions: Our study demonstrated an overall graft survival of 78% at five years and 51% beyond ten years following both autologous chondrocyte implantation techniques. Despite study limitations, our results demonstrate that autologous chondrocyte implantation for the treatment of osteochondral defects of the knee can achieve good results. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
- Published
- 2014
37. Learning curves of retzius-sparing robotic assisted radical prostatectomy for early continence recovery and margin outcomes: Results from a UK high-volume centre
- Author
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Senthil Nathan, Prasanna Sooriakumaran, Prabhakar Rajan, Ashwin Sridhar, Timothy W. R. Briggs, J. Kelly, Greg Shaw, O. Al Kadhi, and A. Kelkar
- Subjects
medicine.medical_specialty ,Learning curve ,Margin (machine learning) ,Robotic assisted ,business.industry ,Prostatectomy ,Urology ,medicine.medical_treatment ,medicine ,business ,Surgery ,Volume (compression) - Published
- 2018
38. Enhanced Recovery after Surgery (ERAS) program with Robot Assisted Radical Prostatectomy (RALP) safely improves post-operative length of stay
- Author
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Eoin Dinneen, Ashwin Sridhar, Senthil Nathan, Prasanna Sooriakumaran, A. Kelkar, Greg Shaw, Hilary Baker, A. Mohammed, Timothy W. R. Briggs, D. Patel, Prabhakar Rajan, and J. Kelly
- Subjects
medicine.medical_specialty ,Prostatectomy ,business.industry ,Urology ,medicine.medical_treatment ,medicine ,Post operative ,business ,Enhanced recovery after surgery ,Surgery - Published
- 2019
39. The NeuroSAFE RCT Feasibility Study
- Author
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Rajendra Persad, Timothy W. R. Briggs, Clare Allen, N. Oakley, A. Haider, Senthil Nathan, Jack Grierson, D. Heffernan-Ho, A. Freeman, Eoin Dinneen, and Greg Shaw
- Subjects
medicine.medical_specialty ,Randomized controlled trial ,business.industry ,law ,Urology ,Physical therapy ,Medicine ,business ,law.invention - Published
- 2019
40. Outcomes of salvage radical prostatectomy after high intensity focused ultrasounds: analysis of the UK's largest series
- Author
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Timothy W. R. Briggs, Prabhakar Rajan, Ashwin Sridhar, J. Kelly, A. Kelkar, Greg Shaw, Prasanna Sooriakumaran, A Nathan, Nicola Pavan, Senthil Nathan, and R. De Groote
- Subjects
medicine.medical_specialty ,Series (stratigraphy) ,business.industry ,Prostatectomy ,Urology ,General surgery ,High intensity focused ,medicine.medical_treatment ,Medicine ,business - Published
- 2019
41. Determining adverse risk factors for urinary continence recovery after robotic radical prostatectomy and methods to enable early recovery
- Author
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Nicola Pavan, Prasanna Sooriakumaran, A. Kelkar, Prabhakar Rajan, Senthil Nathan, Ashwin Sridhar, Clare Allen, Wei Shen Tan, Greg Shaw, Timothy W. R. Briggs, A. Rawlinson, and D. Gu
- Subjects
medicine.medical_specialty ,Urinary continence ,business.industry ,Prostatectomy ,Urology ,medicine.medical_treatment ,Early recovery ,Medicine ,business - Published
- 2019
42. Single centre outcomes from a large series of robotic salvage prostatectomies
- Author
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J. Kelly, Timothy W. R. Briggs, R. De Groote, Senthil Nathan, Prabhakar Rajan, Greg Shaw, Prasanna Sooriakumaran, A Nathan, A. Kelkar, Ashwin Sridhar, and Nicola Pavan
- Subjects
Single centre ,medicine.medical_specialty ,business.industry ,Urology ,General surgery ,Medicine ,Large series ,business - Published
- 2019
43. NeuroSAFE PROOF: A multi-centre feasibility study to evaluate the ability to randomize men with prostate cancer into an RCT comparing NeuroSAFE robotic-assisted radical prostatectomy (RARP) to standard RARP
- Author
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Eoin Dinneen, Aiman Haider, Senthil Nathan, N. Oakley, Edward Rowe, Greg Shaw, Timothy W. R. Briggs, Chris Brew-Graves, Rajendra Persad, Clare Allen, and A. Freeman
- Subjects
medicine.medical_specialty ,business.industry ,Prostatectomy ,Robotic assisted ,Urology ,medicine.medical_treatment ,medicine.disease ,law.invention ,Prostate cancer ,Randomized controlled trial ,law ,Medicine ,Multi centre ,business - Published
- 2019
44. The chavasse report
- Author
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Timothy W. R. Briggs
- Subjects
History ,Operations management ,General Medicine ,Service personnel ,Functional recovery ,First world war ,Management - Abstract
So far in 2014 we have commemorated the 70th anniversary of the D-Day landings and the 100th anniversary of the outbreak of the First World War. In september we watched the Invictus games, which showed the amazing fortitude and functional recovery of our wounded service personnel.
- Published
- 2014
45. Long-Term Survival of Cemented Distal Femoral Endoprostheses with a Hydroxyapatite-Coated Collar
- Author
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Robin Pollock, John A. Skinner, Gordon Blunn, Stephen R. Cannon, William Aston, Paul Unwin, Melanie J. Coathup, Vineet Batta, and Timothy W. R. Briggs
- Subjects
Adult ,Male ,medicine.medical_specialty ,Adolescent ,medicine.medical_treatment ,Bone Neoplasms ,Osseointegration ,Collar ,Prosthesis Implantation ,Coated Materials, Biocompatible ,medicine ,Humans ,Orthopedics and Sports Medicine ,Femur ,Aged ,Bone growth ,business.industry ,Prostheses and Implants ,General Medicine ,Middle Aged ,Surgery ,Radiography ,Durapatite ,Treatment Outcome ,Primary bone ,Amputation ,Orthopedic surgery ,Female ,Implant ,business ,Follow-Up Studies - Abstract
Background: The objective of this study was to examine the degree of osteointegration into a hydroxyapatite-coated collar and relate this finding to aseptic loosening in patients with a distal femoral replacement used to treat primary bone cancer. Our hypothesis was that the implant collar would increase osteointegration and reduce the rate of aseptic implant loosening. Methods: Sixty-one patients treated with a primary cemented distal femoral prosthesis between 1992 and 2001 were included in this study. The mean duration of follow-up was 8.5 years (range, two to eighteen years). Extracortical bone growth into the grooved hydroxyapatite-coated collar was quantified radiographically. Histological sections through four hydroxyapatite-coated collars and four implants with no collar, retrieved following amputation due to local recurrence or at autopsy at a mean of 3.5 years (range, 1.4 to 6.1 years) after implantation, were evaluated as well. Results: Five (8%) of the implants were revised because of aseptic loosening, 3% of the implants fractured, and 3% were revised because of infection. Six limbs (10%) required amputation because of local tumor recurrence. On radiographs, osteointegration into the collar was seen to have occurred in 70% of the patients and did not correlate with sex, age, diagnosis, or length of time postoperatively. Histological analysis showed mature lamellar bone within the grooves of the hydroxyapatite-coated collar, and bone was observed in direct contact with the hydroxyapatite coating. Extracortical bone failed to make direct contact with the surface of the implants manufactured without a collar. Conclusions: The use of cemented distal femoral massive bone tumor prostheses with a hydroxyapatite-coated collar located at the shoulder of the implant was followed by a low (8%) rate of revision due to aseptic loosening. The use of hydroxyapatite grooved collars may lead to osteointegration of the implant shoulder (collar) and may reduce the rate of aseptic loosening. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
- Published
- 2013
46. Implant Use for Primary Hip and Knee Arthroplasty
- Author
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Elizabeth Gillott, Stephen Ng Man Sun, Timothy W. R. Briggs, and Jagmeet S. Bhamra
- Subjects
medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Survivorship curve ,medicine ,Physical therapy ,Dentistry ,Orthopedics and Sports Medicine ,Implant ,business ,Arthroplasty ,Prosthesis - Abstract
Implants used for hip and knee arthroplasties have recently come under increased scrutiny. In England, a large variety of prostheses are currently being used. With the need for savings within the NHS of up to £20 billion over the next five years, we should be ‘getting it right first time’ by using the most reliable implants with proven survivorship. The 8th Annual Report from the NJR (2011) reporting on prostheses used in 2010 was analysed to determine whether implants had published survivorship data. This study demonstrates that the majority of implants did have long-term results but a small percentage had no published data. The cost of these implants was calculated to see if the implants provided best value for money based on survivorship. Implant choice was also correlated to revision rates published in the NJR report (2011) to help determine whether their continued use was justified.
- Published
- 2013
47. Identification of the biopsy track in musculoskeletal tumour surgery
- Author
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B. G. I. Spiegelberg, Asif Saifuddin, Sebastian Dawson-Bowling, John A. Skinner, Robin Pollock, W Aston, Timothy W. R. Briggs, A. Mohan, and Azal Jalgaonkar
- Subjects
Novel technique ,Muscle Neoplasms ,medicine.medical_specialty ,Tumour surgery ,medicine.diagnostic_test ,business.industry ,Track (disk drive) ,Biopsy, Needle ,Bone Neoplasms ,India ink ,Carbon ,Surgery ,Biopsy Site ,Biopsy ,Humans ,Medicine ,Orthopedics and Sports Medicine ,Prospective Studies ,business ,Prospective cohort study ,Complication - Abstract
Local recurrence along the biopsy track is a known complication of percutaneous needle biopsy of malignant musculoskeletal tumours. In order to completely excise the track with the tumour its identification is essential, but this becomes increasingly difficult over time. In an initial prospective study, 22 of 45 patients (48.8%) identified over a three-month period, treated by resection of a musculoskeletal tumour, had an unidentifiable biopsy site at operation, with identification statistically more difficult after 50 days. We therefore introduced the practice of marking the biopsy site with India ink. In all 55 patients undergoing this procedure, the biopsy track was identified pre-operatively (100%); this difference was statistically significant. We recommend this technique as a safe, easy and accurate means of ensuring adequate excision of the biopsy track. Cite this article: Bone Joint J 2013;95-B:250–3.
- Published
- 2013
48. Primary and Revision Total Hip Arthroplasty in Osteogenesis Imperfecta
- Author
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Timothy W. R. Briggs, Sarah K. Muirhead-Allwood, Harry Krishnan, John A. Skinner, Richard Carrington, Jonathan Miles, and Nirav K. Patel
- Subjects
Adult ,Male ,Reoperation ,musculoskeletal diseases ,medicine.medical_specialty ,Arthroplasty, Replacement, Hip ,medicine.medical_treatment ,Oxford hip score ,Young Adult ,medicine ,Humans ,Orthopedics and Sports Medicine ,Survival rate ,Retrospective Studies ,business.industry ,Incidence (epidemiology) ,Recurrent fractures ,Retrospective cohort study ,Middle Aged ,Osteogenesis Imperfecta ,medicine.disease ,Arthroplasty ,Prosthesis Failure ,Surgery ,Treatment Outcome ,Osteogenesis imperfecta ,Female ,Hip Prosthesis ,business ,Follow-Up Studies ,Forecasting ,Total hip arthroplasty - Abstract
Due to an increasing lifespan, patients with osteogenesis imperfecta have a high incidence of hip osteoarthritis. The presence of recurrent fractures and deformities make primary and particularly revision total hip arthroplasty challenging. We present a series of patients with osteogenesis imperfecta undergoing total hip arthroplasty at a tertiary referral centre with a median follow-up of 7.6 years (4 to 35 years). There were four primary total hip arthroplasties and eight revision total hip arthroplasties performed in four patients. Three femoral components were custom computer assisted design computer assisted manufactured. The survival rate of the primary total hip arthroplasty was 16% and there were ten complications: five intraoperative fractures, one case of septic loosening and four cases of aseptic loosening. Patients with pre-operative acetabular protrusio were significantly more likely to require revision surgery (p = 0.02). At latest follow-up, the median Oxford hip score was 41 (37 to 46). As the largest series of primary and revision total hip arthroplasty performed in patients with osteogenesis imperfecta, we report good medium to long-term outcomes. Pre-Operative planning and consideration of custom made prostheses have an important role in these complex cases.
- Published
- 2013
49. The Effect of Femoral Head Size on Functional Outcome in Primary Total Hip Arthroplasty: A Single-Blinded Randomised Controlled Trial
- Author
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Robin Pollock, Mathew D. Sewell, Sammy A. Hanna, Richard Carrington, Jonathan Miles, Kesavan Sri-Ram, William Aston, and Timothy W. R. Briggs
- Subjects
Male ,medicine.medical_specialty ,Arthroplasty, Replacement, Hip ,medicine.medical_treatment ,Prosthesis Design ,law.invention ,Femoral head ,Randomized controlled trial ,Quality of life ,law ,medicine ,Humans ,Single-Blind Method ,Orthopedics and Sports Medicine ,Prospective Studies ,Large head ,Prospective cohort study ,Aged ,business.industry ,Femur Head ,Arthroplasty ,Surgery ,Treatment Outcome ,medicine.anatomical_structure ,Female ,Hip Prosthesis ,Range of motion ,business ,Total hip arthroplasty - Abstract
We conducted a prospective single-blinded randomised controlled trial to compare the functional and quality of life outcomes in two groups of patients between 60 and 80 years of age undergoing THR; the first receiving a small head (28–32 mm) metal on polyethylene (MoP) articulation, and the second receiving a large head (44–54 mm) metal on metal (MoM) articulation. We recruited 49 patients and randomised them into one of the two groups (22 MoP and 27 MoM). The results demonstrated no statistical difference in any of the assessed functional outcomes at any follow-up point (p>0.05). There were no dislocations or revisions in either group. Although it has been suggested that large head MoM articulations in THA offer superior stability and function, our results suggest that small head MoP articulations can achieve comparable ROM, function and quality of life at short-term follow-up.
- Published
- 2012
50. Augmenting the osseointegration of endoprostheses using laser-sintered porous collars: an in vivo study
- Author
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Mukai Chimutengwende-Gordon, Melanie J. Coathup, Gordon Blunn, W. Aston, A. Mumith, and Timothy W. R. Briggs
- Subjects
medicine.medical_specialty ,Durapatite ,0206 medical engineering ,02 engineering and technology ,Prosthesis Design ,Osseointegration ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Coated Materials, Biocompatible ,In vivo ,law ,medicine ,Animals ,Orthopedics and Sports Medicine ,Tibia ,Porosity ,Fixation (histology) ,Titanium ,030222 orthopedics ,Sheep ,business.industry ,Lasers ,Prostheses and Implants ,Biocompatible material ,020601 biomedical engineering ,Surgery ,Prosthesis Failure ,Selective laser sintering ,Female ,business ,Biomedical engineering - Abstract
AimsMassive endoprostheses rely on extra-cortical bone bridging (ECBB) to enhance fixation. The aim of this study was to investigate the role of selective laser sintered (SLS) porous collars in augmenting the osseointegration of these prostheses.Materials and MethodsThe two novel designs of porous SLS collars, one with small pores (Ø700 μm, SP) and one with large pores (Ø1500 μm, LP), were compared in an ovine tibial diaphyseal model. Osseointegration of these collars was compared with that of a clinically used solid, grooved design (G). At six months post-operatively, the ovine tibias were retrieved and underwent radiological and histological analysis.ResultsPorous collars provided a significantly greater surface (p < 0.001) for the ingrowth of bone than the standard grooved design. Significantly greater extracortical pedicle formation was seen radiologically around the grooved design (length p = 0.002, thickness p < 0.001, surface area p = 0.002) than around the porous collars. However, the ingrowth of bone occurred from the transection site into the porous structure of both types of collar. A fivefold increase in integration was seen with the SP and a threefold increase in the LP design when compared with G (p < 0.001).ConclusionSLS porous collars allow the direct ingrowth of more bone and are better than current designs which rely on surface ongrowth and ECBB. Cite this article: Bone Joint J 2017;99-B:276–82.
- Published
- 2016
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