Andrew Rhys Davies

Imperial College London | Imperial · Department of Bioengineering

Aims Reverse shoulder arthroplasty (RSA) has become the most common type of shoulder arthroplasty used in the UK, and a better understanding of the outcomes after revision of a failed RSA is needed. The aim of this study was to review the current evidence systematically to determine patient-reported outcome measures and the rates of re-revision and...

Aims The Getting It Right First Time (GIRFT) programme has set targets to achieve 85% touchtime utilisation by 2024/25. Touchtime utilisation is a measure of theatre productivity, defined as the time from the start of anaesthesia to the time a patient leaves the theatre for all cases on a defined theatre list as a percentage of total available thea...

Aims Shoulder arthroplasty is effective in the management of end-stage glenohumeral joint arthritis. However, it is major surgery and patients must balance multiple factors when considering the procedure. An understanding of patients’ decision-making processes may facilitate greater support of those considering shoulder arthroplasty and inform the...

Aims Metal and ceramic humeral head bearing surfaces are available choices in anatomical shoulder arthroplasties. Wear studies have shown superior performance of ceramic heads, however comparison of clinical outcomes according to bearing surface in total shoulder arthroplasty (TSA) and hemiarthroplasty (HA) is limited. This study aimed to compare t...

50 Studies Every Orthopaedic Surgeon Should Know is a compilation of landmark studies from all subspecialties within emergency and elective trauma and orthopaedic practice. It is written in an accessible way, appropriate for an array of practicing experts, allied healthcare professionals, and students with the goal of disseminating findings from hi...

Background and purpose: Total shoulder arthroplasty (TSA) and hemiarthroplasty (HA) are used in the management of osteoarthritis of the glenohumeral joint. We aimed to determine whether TSA or HA resulted in a lower risk of adverse outcomes in patients of all ages with osteoarthritis and an intact rotator cuff and in a subgroup of patients aged 60...

Aims With up to 40% of patients having patellofemoral joint osteoarthritis (PFJ OA), the two arthroplasty options are to replace solely the patellofemoral joint via patellofemoral arthroplasty (PFA), or the entire knee via total knee arthroplasty (TKA). The aim of this study was to assess postoperative success of second-generation PFAs compared to...

Background Multiple non-arthroplasty surgical techniques are described for the management of large and massive irreparable rotator cuff tears. There is currently no consensus on the best management strategy. Our aim was to compare clinical outcomes following arthroscopic debridement, arthroscopic partial cuff repair, superior capsule reconstruction...

Background In high-energy femoral shaft fractures (FSFs), ipsilateral femoral neck fractures (FNFs) can be missed by conventional trauma computed topography (CT) imaging, resulting in increased treatment costs and patient complications. Preliminary evidence suggests that a rapid, limited-sequence pelvis and hip magnetic resonance imaging (MRI) prot...

Introduction The COVID-19 pandemic has brought a series of new challenges to the management of surgical patients. The consent process relies on a foundation of open and non-coerced discussion between clinician and patient, which includes all the potential risks of surgery. This must be updated to incorporate the additional risks of surgery during t...

Aims Our aim was to investigate the management of patients who were admitted to hospital with an acute haemarthrosis whilst taking oral anticoagulants, and highlight the outcomes of different management strategies. Methods A retrospective review was performed of all orthopaedic admissions over a 42-month period (January 2015–July 2018) to the Orth...

The number of shoulder replacements performed each year continues to increase, and the need for revision replacements has grown accordingly. The outcome of a revision replacement may influence which primary implant is selected and the timing of primary surgery, particularly in younger patients. The aim of this study was to establish the expected im...

Introduction Increasing numbers of young patients receive shoulder replacements. Greater information on outcomes is needed to inform implant choice. The aim of this study was to investigate the survivorship and clinical effectiveness of hemiarthroplasty and anatomical total shoulder arthroplasty (TSA) in patients younger than 65 years. Method A sy...

Introduction Pain management in patients with hip fractures can be challenging. Poor pain control is associated with reduced mobility and increased morbidity. Inadequate analgesia in patients with dementia is a concern. After using several different alternatives, transdermal buprenorphine was chosen as a standardised approach for analgesia in patie...

Background and aims Prophylactic hypothermia, often used in critically ill patients with traumatic brain injury, reduces energy expenditure and may affect energy delivered by nutrition therapy. The primary objective of this study was to measure energy expenditure in hypothermic patients over the first 3 days after traumatic brain injury (TBI). Seco...

Surgical services have been hugely disrupted by COVID-19 and have had to evolve rapidly in response. The best practice for consent mandates that risks associated with surgical treatment during a pandemic be discussed. This study aimed to assess whether patients undergoing orthopaedic operations were being consented for the risk of contacting COVID-...

Background International guidelines recommend critically ill adults receive more protein than most usually receive. We aimed to establish the feasibility of a trial to evaluate whether feeding protein to international recommendations would improve outcomes, in which one group received protein doses representative of international guideline recommen...

Aims: To evaluate the effect of energy-dense vs routine enteral nutrition on day-90 mortality by ethnic group in critically ill adults. Methods: Pre-planned subgroup analysis of the 1,257 New Zealanders in a 4,000-participant randomised trial comparing energy-dense enteral nutrition (1.5kcal/mL) with routine enteral nutrition (1kcal/mL) in mecha...

Introduction The mortality of patients with neck-of-femur (NOF) fractures remains high, with increasing recognition of a subgroup of patients with predictable mortality. The role of palliative care in this group is poorly understood and underdeveloped. This research aims to investigate current clinician attitudes toward palliative care for patients...

Functional outcomes at 12 months were a secondary outcome of the randomized DECRA trial of early decompressive craniectomy for severe diffuse traumatic brain injury (TBI) and refractory intracranial hypertension. In the DECRA trial, patients were randomly allocated 1:1 to either early decompressive craniectomy or intensive medical therapies (standa...

Rationale: The long-term effects of delivering approximately 100% of recommended calorie intake via the enteral route during critical illness compared to a lesser amount of calories are unknown. Objectives: Our hypotheses were that achieving approximately 100% of recommended calorie intake during critical illness would increase quality of life s...

The paramedian forehead flap is commonly used in nasal reconstruction, and survival of the distal part of the flap is usually essential for a good cosmetic outcome. Venous congestion leading to tissue necrosis is a recognized complication with this flap. The standard paramedian forehead flap is designed with a number of aims. These are to include t...

Background: In the critically ill, energy delivery from enteral nutrition (EN) is often less than the estimated energy requirement. Parenteral nutrition (PN) as a supplement to EN may increase energy delivery. We aimed to determine if an individually titrated supplemental PN strategy commenced 48-72 hours following ICU admission and continued for...

Preoperative fasting is necessary to reduce the risk of regurgitation of gastric contents and pulmonary aspiration in patients undergoing general anaesthetic and procedural sedation. Excessive fasting is associated with metabolic, cardiovascular and gastrointestinal complications and patient discomfort. We aimed to reduce the fasting time for patie...

Background Patients with a neck of femur fracture have a high mortality rate. National outcomes have improved significantly as the management of this patient group is prioritized. In 2016, however, 4398 (6.7%) patients died within 30 days of admission. Objective To investigate whether palliative care could be integrated early in the care plan for...

Background Little is currently known about nutrition intake and energy requirements in the post–intensive care unit (ICU) hospitalization period in critically ill patients. We aimed to describe energy and protein intake, and determine the feasibility of measuring energy expenditure during the post‐ICU hospitalization period in critically ill adults...

Background: Mechanical ventilation is a life-saving intervention that maintains gas exchange in patients with acute respiratory distress syndrome (ARDS); however, it is associated with high mortality and it may augment, or even initiate, lung injury. An open lung ventilation strategy that combines alveolar recruitment manoeuvres with individually...

The perks and pitfalls of the traditional publication process.

Acute kidney injury (AKI) is associated with increased patient morbidity, mortality and an extended hospital stay. The financial burden to the National Health Service is high and it can affect up to one in five inpatients. Optimal fluid balance management is essential for the prevention of AKI and this can be particularly challenging in the patient...

Background The Augmented Versus Routine Approach to Giving Energy Trial (TARGET) is the largest blinded enteral nutrition (EN) intervention trial evaluating energy delivery to be conducted in the critically ill. To determine the external validity of TARGET results, nutrition practices in intensive care units (ICUs) in Australia and New Zealand (ANZ...

Background: The amount of energy required to improve clinical outcomes in critically ill adults is unknown. Objective: The aim of this systematic review and meta-analysis was to evaluate the impact of near target energy delivery to critically ill adults on mortality and other clinically relevant outcomes. Design: Following PRISMA guidelines, M...

PurposeTo analyze the relationship between hypercapnia developing within the first 48 h after the start of mechanical ventilation and outcome in patients with acute respiratory distress syndrome (ARDS). Patients and methodsWe performed a secondary analysis of three prospective non-interventional cohort studies focusing on ARDS patients from 927 int...

Purpose: In neurologically critically ill patients with mechanical ventilation (MV), the development of acute respiratory distress syndrome (ARDS) is a major contributor to morbidity and mortality, but the role of ventilatory management has been scarcely evaluated. We evaluate the association of tidal volume, level of PEEP and driving pressure wit...

Background: The medial sural artery perforator (MSAP) flap is becoming a popular strategy for reconstructing intraoral defects. We present a case in which no MSAPs were present, however, a perforator-based calf flap was successfully raised on the sural artery and used for tongue reconstruction. A corresponding anatomic study was undertaken to esta...

Importance: Effective therapy has not been established for patients with agitated delirium receiving mechanical ventilation. Objective: To determine the effectiveness of dexmedetomidine when added to standard care in patients with agitated delirium receiving mechanical ventilation.Design, Setting, and Participants The Dexmedetomidine to Lessen...

Background: Nutrition is one of the fundamentals of care provided to critically ill adults. The volume of enteral nutrition received, however, is often much less than prescribed due to multiple functional and process issues. To deliver the prescribed volume and correct the energy deficit associated with enteral nutrition alone, parenteral nutritio...

Background: Whilst nutrition is vital to survival in health, the precise role of nutrition during critical illness is controversial. More specifically, the exact amount of energy that is required during critical illness to optimally influence clinical outcomes remains unknown. The aim of this systematic literature review and meta-analysis is to ev...

To describe current nutrition delivery practices and to identify barriers to nutrition in patients receiving venovenous or venoarterial extracorporeal membrane oxygenation (ECMO) in multiple centres in Australia and New Zealand. A prospective, multicentre, observational study, set in eight intensive care units in Australia and New Zealand, of adult...

Near-peer teaching and electronic learning (e-learning) are two effective modern teaching styles. Near-peer sessions provide a supportive learning environment that benefits both the students and the tutor. E-learning resources are flexible and easily distributed. Careful construction and regular editing can ensure that students receive all of the e...

There are limited data available about the role of sedation and analgesia during noninvasive positive pressure ventilation (NPPV). The objective of study was to estimate the effect of analgesic or sedative drugs on the failure of NPPV. We studied patients who received at least 2 h of NPPV as first-line therapy in a prospective observational study c...

The aim of this study was to describe and compare the changes in ventilator management and complications over time as well as variables associated with 28-day hospital mortality in patients receiving mechanical ventilation (MV) after cardiac arrest. Secondary analysis of three prospective, observational multicenter studies conducted in 1998, 2004 a...

Acute kidney injury (AKI) is characterized by severe loss of glomerular filtration rate (GFR) and is associated with a prolonged intensive care unit (ICU) stay and increased risk of death. No interventions have yet been shown to prevent AKI or preserve GFR in critically ill patients. Evidence from mammalian physiology and small clinical trials sugg...

BACKGROUND: Extracorporeal membrane oxygenation (ECMO) is a form of life support that targets the heart and lungs. Extracorporeal membrane oxygenation for severe respiratory failure accesses and returns blood from the venous system and provides non-pulmonary gas exchange. Extracorporeal membrane oxygenation for severe cardiac failure or for refract...

Purpose of review: To examine the utility and technical challenges of applying veno-arterial extracorporeal membrane oxygenation for acute cardiovascular failure in adults with acute and chronic causes of heart failure. Recent findings: The role of mechanical circulatory support in acute cardiovascular continues to evolve as technology and clini...

Background: Critically ill patients typically receive ∼60% of estimated calorie requirements. Objectives: We aimed to determine whether the substitution of a 1.5-kcal/mL enteral nutrition solution for a 1.0-kcal/mL solution resulted in greater calorie delivery to critically ill patients and establish the feasibility of conducting a multicenter,...

An increasing weight of evidence is demonstrating that sleep deprivation and circadian rhythm disruption in doctors are associated with human error and harm to both patients and doctors. The increasing junior doctor workforce entering the hospital system in Australia provides a rare opportunity for workplace and roster reforms. There are cultural,...

Importance: Systematic reviews suggest adult patients in intensive care units (ICUs) with relative contraindications to early enteral nutrition (EN) may benefit from parenteral nutrition (PN) provided within 24 hours of ICU admission. Objective: To determine whether providing early PN to critically ill adults with relative contraindications to e...

The largest cohort of critically ill patients evaluating intragastric and small intestinal delivery of nutrients was recently reported. This systematic review included recent data to compare the effects of small bowel and intragastric delivery of enteral nutrients in adult critically ill patients. This is a systematic review of all randomised contr...

Background: In a recent multicenter randomized trial comparing unfractionated heparin (UFH) with low-molecular-weight heparin (dalteparin) for thromboprophylaxis in 3,746 critically ill patients, 17 patients (0.5%) developed heparin-induced thrombocytopenia (HIT) based on serotonin-release assay-positive (SRA+) status. A trend to a lower frequency...

Purpose: Delivery of enteral nutrition (EN) to ICU patients is commonly interrupted for diagnostic and therapeutic procedures. We investigated this practice in a cohort of trauma and surgical ICU patients. Methods: This was a retrospective single-center study conducted in a 15-bed trauma ICU of a university-affiliated teaching hospital. Descript...

Rationale: Baseline characteristics and management have changed over time in patients requiring mechanical ventilation; however, the impact of these changes on patient outcomes is unclear. Objectives: To estimate whether mortality in mechanically ventilated patients has changed over time. Methods: Prospective cohort studies conducted in 1998,...

Background: Traumatic flail chest injury is a potentially life threatening condition traditionally treated with invasive mechanical ventilation to splint the chest wall. Longer-term sequelae of pain, deformity, and physical restriction are well described. This study investigated the impact of operative fixation in these patients. Study design: A...

Introduction: Measuring bleeding in critical care trials is challenging. We determined the reliability of adjudicated bleeding assessments in a large thromboprophylaxis trial in the intensive care unit (ICU). Materials and methods: PROphylaxis for ThromboEmbolism in Critical Care Trial (PROTECT) was an international randomized controlled trial t...

Introduction The purpose of the study was to assess the long term outcome and quality of life of patients with acute respiratory distress syndrome (ARDS) receiving extracorporeal membrane oxygenation (ECMO) for refractory hypoxemia. Methods A retrospective observational study with prospective health related quality of life (HRQoL) assessment was c...

There is uncertainty about which end points should be used for Phase II trials in critically ill patients. To systematically evaluate potential end points for Phase II trials in critically ill patients. A report outlining a process of literature review and recommendations from a consensus meeting conducted on behalf of the Australian and New Zealan...

To describe the design, development and implementation of an organ and tissue donation after cardiac death (DCD) program, evaluate its success and assess its impact on tissue and organ availability and the number of donors after brain death. Prospective collection of patient characteristics and outcomes for actual and potential donors from 2000 to...

Current guidelines recommend enteral nutrition in critically ill adults; however, poor gastric motility often prevents nutritional targets being met. We hypothesized that early nasojejunal nutrition would improve the delivery of enteral nutrition. Prospective, randomized, controlled trial. Seventeen multidisciplinary, closed, medical/surgical, inte...

Enteral nutrition (EN) is widely accepted as the preferred method for providing nutrition therapy to critically ill patients. However, optimal energy goals and the best way to achieve those goals are ill defined. To determine the type and energy concentration of commonly prescribed EN formulations and whether energy-dense formulations (> 1 kcal/mL)...

Guidelines for nutrition support in pancreatitis have been inconsistently adapted to clinical practice. The International Consensus Guideline Committee (ICGC) established a pancreatitis task force to review published guidelines for pancreatitis in nutrition support. A PubMed search using the terms pancreatitis, acute pancreatitis, chronic pancreati...

Intensive care patients with traumatic brain injury (TBI) are at high risk of developing deep vein thrombosis (DVT). A high rate of DVT was reported before routine thromboprophylaxis, but the current DVT rate in TBI patients receiving best-practice mechanical and pharmacological prophylaxis is unknown. To determine the prevalence of DVT among TBI p...

Tidal volume and plateau pressure minimisation are the standard components of a protective lung ventilation strategy for patients with acute respiratory distress syndrome (ARDS). Open lung strategies, including higher positive end-expiratory pressure (PEEP) and recruitment manoeuvres to date have not proven efficacious. This study examines the effe...

To determine nutritional therapy practices of patients with severe acute pancreatitis (defined as those receiving critical care management in an intensive care unit or high-dependency unit) in Australia and New Zealand with focus on the choice of enteral nutrition or parenteral nutrition. Prospective observational multicentered study performed at 4...

It is unclear whether decompressive craniectomy improves the functional outcome in patients with severe traumatic brain injury and refractory raised intracranial pressure. From December 2002 through April 2010, we randomly assigned 155 adults with severe diffuse traumatic brain injury and intracranial hypertension that was refractory to first-tier...

To describe the technical challenges, efficacy, complications and maternal and infant outcomes associated with extracorporeal membrane oxygenation (ECMO) for severe adult respiratory distress syndrome (ARDS) in pregnant or postpartum patients during the 2009 H1N1 pandemic. Twelve critically ill pregnant and postpartum women were included in this re...