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ABSTRACT: Routine spinal immobilization for trauma patients has become established in developed countries throughout the world. Cervical spinal injury is, however, relatively rare in trauma patients, and immobilization practice was developed largely without firm supporting evidence. In recent years, published evidence has suggested that spinal immobilization may in some cases be harmful. The purpose of this article is to critically review the evidence and the implications for trauma patient management and outcomes. We searched MEDLINE, the Cochrane Database, Index Medicus and article references with a broad search strategy. Relevant results were analysed and critically reviewed in the context of trauma patient management. Our findings present a growing body of evidence documenting the risks and complications of routine spinal immobilization. There is a possibility that immobilization could be contributing to mortality and morbidity in some patients and this warrants further investigation.
The surgeon: journal of the Royal Colleges of Surgeons of Edinburgh and Ireland 08/2010; 8(4):218-22. · 1.41 Impact Factor
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ABSTRACT: This article reports the lessons learnt from a period of retraining and from discussion with others who have been involved in a similar process. The conclusions are that retraining should only be undertaken once there is full agreement between all parties involved that it is necessary and feasible. There must also be agreement in advance of the criteria which will constitute successful retraining, and the actions which will be taken to ensure the rapid return of the retrainee to the type of practice which is being offered and has been accepted. The process of retraining requires especially close supervision and is very stressful for the retrainee. It is likely that this should only be undertaken in units specially staffed and funded to accommodate this type of work.
The surgeon: journal of the Royal Colleges of Surgeons of Edinburgh and Ireland 09/2005; 3(4):261-4. · 1.41 Impact Factor
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C Bulstrode
The surgeon: journal of the Royal Colleges of Surgeons of Edinburgh and Ireland 07/2005; 3(3):184-6. · 1.41 Impact Factor
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ABSTRACT: If the public are to be assured that surgeons are safe, then there must be some form of competence assessment on which a licence to practice is based. However, the assessment and the licence needs to be both appropriate to the training received by the surgeon and to the requirements of the post they propose to take up. The 'key-concept' described in this paper attempts to address this problem.
The surgeon: journal of the Royal Colleges of Surgeons of Edinburgh and Ireland 03/2004; 2(1):28-31. · 1.41 Impact Factor
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ABSTRACT: The current method for selecting surgeons of the future is neither objective nor relevant to present day needs. An assessment is needed which ranks potential trainees according to aptitude, motivation and diligence, all of which is validated. This task should be a core duty for the Royal Colleges of Surgeons working in close co-operation with surgical specialty associations.
The surgeon: journal of the Royal Colleges of Surgeons of Edinburgh and Ireland 01/2004; 1(6):328-31. · 1.41 Impact Factor
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ABSTRACT: To assess whether a new form of teaching, the 'donut round', is as good at imparting factual knowledge as interactive lectures in both the short-term and the long-term.
Randomised controlled trial.
University of Oxford Medical School.
106 fifth year clinical medical students taught half of their A&E/trauma course by donut round and half by lecture.
The results of multiple choice questions (MCQs) divided according to how the material was taught. Three MCQ papers were set: one at the end of a four-week course, one approximately 10 weeks later and a final exam approximately 17 months after the first.
At the first MCQ, the average result for questions taught by donut round was 41.0 (out of 50) and for those taught by conventional lecture was 40.1. At 10 weeks these averages fell to 36.3 and 37.3 and at 17 months they were 38.7 and 38.1, respectively. None of these pairs were significantly different. Ratios were calculated for each candidate by dividing their donut round score by their lecture score. The average ratios for the first, second and third MCQ papers were: 1.029, 1.007 and 1.027, respectively, and were not significantly different. The individual ratios of all candidates in all three MCQs were plotted against their equivalent total mark. The calculated linear regression showed a statistically significant advantage of donut rounds over lectures in those candidates who scored a total mark less than 89 (n=260, p=0.02).
Donut rounds are at least as good as lectures in imparting factual knowledge and may provide a selective advantage to weaker students.
The surgeon: journal of the Royal Colleges of Surgeons of Edinburgh and Ireland 05/2003; 1(2):76-80. · 1.41 Impact Factor
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ABSTRACT: A three-day course was designed to improve the skills of those who provide clinical training to medical students. This long-term follow up of past participants shows a sustained improvement to their skills, especially in terms of involving students in their own learning, and giving them positive feedback.
Journal of the Royal College of Surgeons of Edinburgh 09/2002; 47(4):619-22.
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BMJ 03/2001; 322(7283):426. · 14.09 Impact Factor
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The Lancet 12/2000; 356(9244):1788. · 38.28 Impact Factor
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C Bulstrode
The Practitioner 12/1998; 242(1592):752, 756, 761 passim.
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ABSTRACT: Undisplaced fractures of the hip can occasionally be difficult to diagnose on radiographs. We performed MRI scans on 33 patients who had post-traumatic painful hips but negative radiographs. Forty per cent of the patients had sustained a fractured neck of femur, 15 per cent had sustained an intertrochanteric fracture and 11 per cent had sustained other fractures around the hip; in one patient a tumour was demonstrated. No fracture was seen in 30 per cent of the patients scanned. MRI is well tolerated by elderly patients in pain, does not involve ionising radiation and provides early and accurate diagnosis in patients with X-ray negative post-traumatic hip pain.
Injury 02/1998; 29(1):61-3. · 1.98 Impact Factor
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C Bulstrode
Annals of The Royal College of Surgeons of England 04/1996; 78(2):129-32. · 1.23 Impact Factor
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ABSTRACT: Almost all doctors encounter difficulties in managing some patients. Previous studies have examined the characteristics of such patients: we have additionally studied the reasons why hospital doctors find these patients 'difficult to help'. Three clinics (two medical and one surgical) were studied. The consultants rated 60 (22%) of 293 attenders s severely or extremely difficult to help. Difficulty was associated with greater patient distress (odds ratio 3.9; 95% CI 2.0-7.7), less patient satisfaction (2.6; 1.3-5.0) and chronic attendance (5.0; 1.4-17.3). An interview study of 40 'difficult' patients indicated that doctors considered psycho-social factors more important in difficult patients (3.2; 1.3-7.7). Objective differences between the doctor's and the patient's aims for care also occurred more frequently for difficult patients (2.8; 1.1-7.2). Three common types of difficulty were identified; medically unexplained symptoms; co-existing social problems; and severe untreatable illness. A review of the management aims for patients whom doctors find 'difficult to help', combined with improved access to psycho-social care, could improve both the quality and the cost-effectiveness of hospital out-patient services.
The Quarterly journal of medicine 04/1994; 87(3):187-93.
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BMJ 04/1994; 308(6929):651. · 14.09 Impact Factor
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ABSTRACT: Survival analysis is a powerful tool for analysing the results of total joint replacement, but it has major drawbacks when the failure rates are very low. We have reviewed 35 recent survival analyses of joint replacements to assess the magnitude of these problems and make recommendations as to how they may be avoided.
Journal of Bone and Joint Surgery - British Volume 10/1993; 75(5):697-704. · 2.83 Impact Factor
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ABSTRACT: To report the incidence of elective total hip replacement and postoperative mortality, emergency readmission rates, and the demographic factors associated with these rates in a large defined population.
Analysis of linked, routine abstracts of hospital inpatient records and death certificates.
10 hospitals in six districts in Oxford Regional Health Authority covered by the Oxford record linkage study.
Records for 11,607 total hip replacements performed electively in 1976-85.
Incidence of operation, postoperative mortality, relative mortality ratios, and incidence of emergency readmission.
NHS operation rates increased over time from 43 to 58 operations/100,000 population. Variation in operation rates between districts reduced over time. Operation rates were on average 25% higher in women than men. There were 93 deaths (11/1000 operations) within 90 days of the operation and 208 emergency readmissions (28/1000 operations) within 28 days of discharge. Postoperative mortality and emergency readmission rates increased with age. No significant trend with time was found. Mortality in the 90 days after the operation was 2.5-fold higher (1.9 to 3.0) than in the rest of the first postoperative year. This represented an estimated excess of 6.5 (4.2 to 8.8) early postoperative deaths/1000 operations. Most deaths were ascribed to cardiovascular events. Thromboembolic disease was the commonest reason for emergency readmission.
The pronounced increase in operations in districts with initially low rates suggests a trend towards greater equity in the local provision of NHS hip arthroplasty. The early postoperative clusters of deaths attributed to cardiovascular disease and of readmissions for thromboembolic disease suggest that there is scope for investigating ways of reducing the incidence of major adverse postoperative events.
BMJ 01/1992; 303(6815):1431-5. · 14.09 Impact Factor
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ABSTRACT: Fifteen cadaveric dissections have been performed to determine the anatomic relationships of nucleotomy guide wires. All the 44 guide wires inserted were found to be in contact with at least one nerve root (eight transfixed a root). Guide wires passing anterior to the nerve roots always passed anterior to the center of the disc. Lateral displacement of the skin entry point made safe entry to the center of the disc impossible. Nerve root transfixion is likely to be a significant complication in percutaneous nucleotomy. Entry to the center of the disc avoiding the nerve roots is simplest if the skin entry is as near to the midline as possible.
Spine 02/1991; 16(1):39-42. · 2.08 Impact Factor
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ABSTRACT: As part of an audit of clinical practice in an orthopaedic unit for elective surgery, a study was made of the causes of cancellation of operations. Despite careful liaison with general practitioners, and a booked admission policy, over 6% of patients were cancelled as unsuitable. The results of this study suggest that the number of cancellations on medical grounds would be reduced by closer liaison with general practitioners, and the establishment of preadmission clinics. Ensuring that only consultants book patients for surgery would also reduce the number of cancellations due to incorrect indications for surgery.
Health trends 02/1991; 23(3):115-6.
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ABSTRACT: We have reviewed 368 osteotomies carried out for osteoarthritis of the hip at the Nuffield Orthopaedic Centre. Survivorship analysis showed that 10 years after osteotomy 47% had required no further surgery, and even after 20 years 23% had still not had a hip replacement. Hips with moderate arthritic change showed significantly better results than those with more severe degeneration. Osteotomies with varus angulation as well as medial displacement showed longer survival.
Journal of Bone and Joint Surgery - British Volume 12/1990; 72(6):1010-3. · 2.83 Impact Factor
