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Biomedical subjects

G Bannister

Publications and source records attributed to G Bannister.

At least 19 recordsLinked to original sources
PubMed2005

Survey of operating theatre ventilation facilities for minimally invasive surgery in Great Britain and Northern Ireland: current practice and considerations for the future.

Increasing use of minimally invasive surgery (MIS) and other invasive procedures has raised the question of what ventilation facilities are appropriate for such procedures to prevent infection. The Hospital Infection Society (HIS) Working Party on Infection Control in Operating Theatres undertook a survey of practice in Great Britain and Northern Ireland on the ventilation facilities provided for a variety of MIS and other procedures. Five hundred and fifty questionnaires were forwarded to HIS members, and 186 (39%) replies were received. Fifty-eight percent were from district general hospitals (DGHs). Designated theatres for orthopaedic surgery (although not necessarily ultraclean ventilated theatres) were available in more than 80% of hospitals, with approximately 50% of hospitals having designated theatres for a variety of other surgical subspecialities. Approximately two-thirds of urological procedures were performed in conventionally ventilated operating theatres. Most radiological procedures were performed in non-ventilated theatres or treatment rooms. In around half of the DGHs and university/referral hospitals, orthopaedic MIS procedures such as arthroscopy were performed in ultraclean ventilated theatres. This survey revealed considerable variation in the use of conventionally ventilated theatres and ultraclean ventilated theatres. In particular, many radiological and anaesthetic procedures are performed in treatment rooms or ventilated rooms with less than 20 air changes per hour. Whilst it is not clear whether this is acceptable practice given current knowledge, large-scale clinical trials to determine what standards of ventilation are appropriate to minimize infection for these types of procedures would be difficult to conduct. Research is needed on the relative risk of airborne infection for a variety of procedures, including whether all prosthetic implant procedures should be carried out in ultraclean ventilated theatres, as infection associated with implants is often of airborne origin and of considerable clinical significance.

Air Microbiology↗
PubMed2003

An analysis associating the presence of Claviceps purpurea in grassland with the incidence of type 1 diabetes.

We introduce our paper by briefly outlining how we came to the conclusion that neurons in the brain and cells in other tissues can be killed by high intracellular concentrations of calcium ions (Ca(2+)). The life cycle of Claviceps purpurea is then described before theoretical information is drawn upon which indicates that ergot alkaloids can inactivate alpha adrenergic receptors for noradrenaline released from sympathetic nerve terminals. We deduce that inhibition of these receptors by ergot alkaloids leads to an increase in intracellular Ca(2+) concentration which can cause the death of the insulin producing cells of the pancreas.

Alkaloids↗
PubMed2003

Primary total hip replacement.

Primary hip replacement requires careful patient selection, a knowledge of available prostheses, thorough pre-operative planning, familiarity with surgical exposures and sufficient manual dexterity to carry out the procedure. The aim of hip replacement is to restore the biomechanics of the diseased joint as closely as is practical. Failure to observe these principals results in premature failure of the joint replacement.

Acetabulum↗
PubMed2001

Factors affecting employment after whiplash injury.

Of 586 employed patients with a whiplash injury 40 (7%) did not return to work. The risk was increased by three times in heavy manual workers, two and a half times in patients with prior psychological symptoms and doubled for each increase of grade of disability. The length of time off work doubled in patients with a psychological history and trebled for each increase in grade of disability. The self-employed were half as likely to take time off work, but recovered significantly more slowly than employees.

Anxiety↗
PubMed2000

Prognosis following a second whiplash injury.

Five percent of the population have suffered a whiplash injury. Of these, 43% suffer long-term symptoms. We undertook a retrospective study of 79 patients who had suffered two whiplash injuries. The severity of each patient's symptoms was assessed after the first and second injuries using the Gargan and Bannister classification. Overall, 84% of patients reported increased symptoms following the second injury. Ninety-seven percent of patients who had been symptom free before the second injury reported persisting discomfort.

Adult↗
PubMed1999

Displaced intracapsular neck of femur fractures in mobile independent patients: total hip replacement or hemiarthroplasty?

The aim of this study was to compare the outcome of total hip replacement (THR) with hemiarthroplasty in mobile and socially independent patients with displaced intracapsular fractured neck of femur. Thirty-two patients who had been treated by THR were reviewed after a mean of 3.7 years and compared with 42 patients who had been treated by hemiarthroplasty who were reviewed at 3.9 years. At follow-up none of the THRs had required revision whereas 38% of the hemiarthroplasties had required conversion to THR. Six percent of THRs had dislocated. The modified Harris Hip score rated 86% of THRs as 'good' or 'excellent,' whereas only 12% of the remaining hemiarthroplasties achieved a similar rating. Seventy-seven percent of the patients who had received a THR estimated that they could walk more than a mile compared to 27% of the remaining hemiarthroplasties. THR gave a vastly superior functional outcome compared to hemiarthroplasty in this group of patients.

Aged↗
PubMed1999

A randomised controlled trial. Shifting boundaries of doctors and physiotherapists in orthopaedic outpatient departments.

OBJECTIVE: To evaluate the effectiveness and cost effectiveness of specially trained physiotherapists in the assessment and management of defined referrals to hospital orthopaedic departments. DESIGN: Randomised controlled trial. SETTING: Orthopaedic outpatient departments in two hospitals. SUBJECTS: 481 patients with musculoskeletal problems referred for specialist orthopaedic opinion. INTERVENTIONS: Initial assessment and management undertaken by post-Fellowship junior orthopaedic surgeons, or by specially trained physiotherapists working in an extended role (orthopaedic physiotherapy specialists). MAIN OUTCOME MEASURES: Patient centred measures of pain, functional disability and perceived handicap. RESULTS: A total of 654 patients were eligible to join the trial, 481 (73.6%) gave their consent to be randomised. The two arms (doctor n = 244, physiotherapist n = 237) were similar at baseline. Baseline and follow up questionnaires were completed by 383 patients (79.6%). The mean time to follow up was 5.6 months after randomisation, with similar distributions of intervals to follow up in both arms. The only outcome for which there was a statistically or clinically important difference between arms was in a measure of patient satisfaction, which favoured the physiotherapist arm. A cost minimisation analysis showed no significant differences in direct costs to the patient or NHS primary care costs. Direct hospital costs were lower (p < 0.00001) in the physiotherapist arm (mean cost per patient = 256 Pounds, n = 232), as they were less likely to order radiographs and to refer patients for orthopaedic surgery than were the junior doctors (mean cost per patient in arm = 498 Pounds, n = 238). CONCLUSIONS: On the basis of the patient centred outcomes measured in this randomised trial, orthopaedic physiotherapy specialists are as effective as post-Fellowship junior staff and clinical assistant orthopaedic surgeons in the initial assessment and management of new referrals to outpatient orthopaedic departments, and generate lower initial direct hospital costs.

Adolescent↗
PubMed1997

A comparison of the penetration of cefuroxime and cephamandole into bone, fat and haematoma fluid in patients undergoing total hip replacement.

Twelve patients undergoing total hip anthroplasty received, at the induction of anaesthesia, cephamandole (1 g) and cefuroxime (1.5 g); further doses of cephamandole (1 g) and cefuroxime (750 mg) were given at 8 and 16 h after the operation. Routine total hip arthroplasty was performed and at timed intervals during operation samples of bone, fat and blood were collected for assay for HPLC analysis. Samples of the haematoma fluid that formed around the operation site and further blood samples were also collected at 7 and 15 h after the operation. Although considerable variation was observed in the bone and fat concentrations of both agents, the cefuroxime levels were substantially higher than those of cephamandole, with mean values for bone of cefuroxime 36.0 mg/L (95% CI 29.0-43.0 mg/L) and cephamandole 18.3 mg/L (95% CI 14.2-22.4 mg/L) and for fat of cefuroxime 15.0 mg/L (95% CI 11.1-18.9 mg/L) and cephamandole 11.2 mg/L (95% CI 7.2-15.2 mg/L). When corrected for blood concentrations the penetration of both agents was similar (bone, 43.6% cefuroxime and 37.8% cephamandole; fat, 16.0% cefuroxime and 19.2% cephamandole). Cefuroxime concentrations in haematoma drain fluid were higher than those of cephamandole 6-8 h after the operation (17.8 versus 8.3 mg/L) but lower at 14-16 h (7.7 versus 9.6 mg/L). We conclude that there are no significant differences between the bone, fat or haematoma penetration of cefuroxime and cephamandole and that any differences in the absolute levels of the two agents are due to differences in the total drug administered rather than their ability to penetrate into these sites. Time-kill curves for cefuroxime and cephamandole against five clinical isolates of Staphylococcus aureus failed to identify any significant differences between the rates of kill for the two agents at the concentrations seen in bone, fat or haematoma fluid. For both prophylaxis regimens antibiotic concentrations exceeded the MICs for potential pathogens for the duration of the operation and also in the haematoma which surrounds the operation site for up to 24 h after the operation.

Adipose Tissue↗
PubMed1997

The behavioural response to whiplash injury.

We studied 50 consecutive patients presenting at an accident department after rear-end vehicle collisions and recorded symptoms and psychological test scores within one week of injury, at three months and at two years. The range of neck movement was noted at three months. Within one week of injury, psychological test scores were normal in 82% of the group but became abnormal in 81% of the patients with intrusive or disabling symptoms at over three months (p < 0.001) and remained abnormal in 69% at two years. The clinical outcome after two years could be predicted at three months with 76% accuracy by neck stiffness, 74% by psychological score and 82% by a combination of these variables. The severity of symptoms after a whiplash injury is related both to the physical restriction of neck movement and to psychological disorder. The latter becomes established within three months of the injury.

Accidents, Traffic↗
PubMed1996

Does total hip arthroplasty predispose to chronic venous insufficiency?

One hundred thirty-four limbs (40% retrieval) were reviewed 14 to 21 years after total hip arthroplasty. Each had been screened for deep vein thrombosis following surgery by the fibrinogen uptake test, with proximal thrombi confirmed venographically. The limbs were assessed for chronic venous insufficiency with a standard clinical grade and photoplethysmography. Clinical chronic venous insufficiency was found in 4 of 36 (12%) limbs without and 11 of 98 (11%) with previous thrombosis (chi-square = .09, P = .77). Clinical chronic venous insufficiency was detected in 9% of limbs (6/67) with calf thrombi, 0% of limbs (0/11) with isolated femoral thrombi, and 25% of limbs (5/20) with calf and femoral thrombi. After photoplethysmographic assessment, only 2 of 98 (2%) cases were thought to be attributable to thrombosis after hip arthroplasty (95% confidence interval, 0.2-7.2). Despite a high incidence of deep vein thrombosis diagnosed on the fibrinogen uptake test after total hip arthroplasty, symptomatic deep chronic venous insufficiency was an unusual outcome 14 to 21 years later.

Aged↗
PubMed1995

Predicting the prognosis after proximal femoral fracture.

In 338 patients with proximal femoral fractures, age, sex, residence and mobility on admission were found to predict mortality, mobility and housing requirements after 1 year. Application of these data should permit better targeting of rehabilitation and earlier initiation of rehousing arrangements after proximal femoral fracture.

Age Factors↗
PubMed1993

Radiological measurement of radial shortening in Colles' fracture.

100 consecutive patients with Colles' fracture were assessed functionally three months after the injury, and the result correlated with initial shortening of the radius. Three methods were used to measure radial shortening; only the one that measured the distance from distal radial to distal ulnar surfaces correlated with functional outcome. It is concluded that this is the most valid method of measurement and the deficiencies of the other methods are discussed.

Colles' Fracture↗
PubMed1992

Effect of cup geometry and the presence of cement on acetabular component fixation.

Two series of implanted conical, polyethylene Ring cups were studied clinically and radiographically. In one series the cups were uncemented while in the second cement was used. The results using cemented conical cups were then compared with results using a cemented cup of hemispherical design to study the effect of cup geometry. At 7-8 years a total of 3.8% of the cemented conical series and 2.9% of the uncemented were revised for aseptic loosening. At 9 years survivorship was identical. Migration of the sockets occurred in approximately 25% of both series and was directly related to cup cover of less than 80% (P < 0.001). The series of cemented hemispherical cups were reviewed after an identical period. Although the numbers revised for loosening were comparable in this and the cemented conical group, radiological migration was statistically greater in the latter (P < 0.001). Alternative methods of socket preparation and cement technique were thought to be the most likely explanation for the observed differences.

Acetabulum↗
PubMed1992

Acromioclavicular disruption in first class rugby players.

In a random sample of 105 first class rugby players, 45% gave a history of injury of the acromioclavicular joint. All continued to play at the highest level. The effects of the injury appeared to be minimal. Supraspinatus impingement syndrome commonly associated with acromioclavicular pathology was sought, but not found.

Acromioclavicular Joint↗
PubMed1988

Mechanical failure in the femoral component in total hip replacement.

Bone-cement lucency and migration into varus position, expressed as failure modes lb and IV, appear to be unfavorable. The majority of prostheses carry a collar that rests on cement, and in such implant types, migration of up to 4 mm within the cement mantle does not appear to be associated with an increased risk of revision.

Bone Resorption↗