2022 Northern Publications

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    Corrigendum to 'An international genome-wide meta-analysis of primary biliary cholangitis: Novel risk loci and candidate drugs' [J Hepatol 2021;75(3):572-581]
    (Elsevier, 2022-02-01) Cordell, H. J.; Fryett, J. J.; Ueno, K.; Darlay, R.; Aiba, Y.; Hitomi, Y.; Kawashima, M.; Nishida, N.; Khor, S. S.; Gervais, O.; Kawai, Y.; Nagasaki, M.; Tokunaga, K.; Tang, R.; Shi, Y.; Li, Z.; Juran, B. D.; Atkinson, E. J.; Gerussi, A.; Carbone, M.; Asselta, R.; Cheung, A.; de Andrade, M.; Baras, A.; Horowitz, J.; Ferreira, M. A. R.; Sun, D.; Jones, D. E.; Flack, S.; Spicer, A.; Mulcahy, V. L.; Byun, J.; Han, Y.; Sandford, R. N.; Lazaridis, K. N.; Amos, C. I.; Hirschfield, G. M.; Seldin, M. F.; Invernizzi, P.; Siminovitch, K. A.; Ma, X.; Nakamura, M.; Mells, G. F.
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    The British Orthopaedic Surgery Surveillance study: slipped capital femoral epiphysis: the epidemiology and two-year outcomes from a prospective cohort in Great Britain
    (Atypon, 2022-04-01) Perry, D. C.; Arch, B.; Appelbe, D.; Francis, P.; Craven, J.; Monsell, F. P.; Williamson, P.; Knight, M.
    AIMS: The aim of this study was to inform the epidemiology and treatment of slipped capital femoral epiphysis (SCFE). METHODS: This was an anonymized comprehensive cohort study, with a nested consented cohort, following the the Idea, Development, Exploration, Assessment, Long-term study (IDEAL) framework. A total of 143 of 144 hospitals treating SCFE in Great Britain participated over an 18-month period. Patients were cross-checked against national administrative data and potential missing patients were identified. Clinician-reported outcomes were collected until two years. Patient-reported outcome measures (PROMs) were collected for a subset of participants. RESULTS: A total of 486 children (513 hips) were newly affected, with a median of two patients (interquartile range 0 to 4) per hospital. The annual incidence was 3.34 (95% confidence interval (CI) 3.01 to 3.67) per 100,000 six- to 18-year-olds. Time to diagnosis in stable disease was increased in severe deformity. There was considerable variation in surgical strategy among those unable to walk at diagnosis (66 urgent surgery vs 43 surgery after interval delay), those with severe radiological deformity (34 fixation with deformity correction vs 36 without correction) and those with unaffected opposite hips (120 prophylactic fixation vs 286 no fixation). Independent risk factors for avascular necrosis (AVN) were the inability of the child to walk at presentation to hospital (adjusted odds ratio (aOR) 4.4 (95% CI 1.7 to 11.4)) and surgical technique of open reduction and internal fixation (aOR 7.5 (95% CI 2.4 to 23.2)). Overall, 33 unaffected untreated opposite hips (11.5%) were treated for SCFE by two-year follow-up. Age was the only independent risk factor for contralateral SCFE, with age under 12.5 years the optimal cut-off to define 'at risk'. Of hips treated with prophylactic fixation, none had SCFE, though complications included femoral fracture, AVN, and revision surgery. PROMs demonstrated the marked impact on quality of life on the child because of SCFE. CONCLUSION: The experience of individual hospitals is limited and mechanisms to consolidate learning may enhance care. Diagnostic delays were common and radiological severity worsened with increasing time to diagnosis. There was unexplained variation in treatment, some of which exposes children to significant risks that should be evaluated through randomized controlled trials. Cite this article: Bone Joint J 2022;104-B(4):519-528.
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    The British Orthopaedic Surgery Surveillance study: Perthes' disease: the epidemiology and two-year outcomes from a prospective cohort in Great Britain
    (Atypon, 2022-04-01) Perry, D. C.; Arch, B.; Appelbe, D.; Francis, P.; Craven, J.; Monsell, F. P.; Williamson, P.; Knight, M.
    AIMS: The aim of this study was to evaluate the epidemiology and treatment of Perthes' disease of the hip. METHODS: This was an anonymized comprehensive cohort study of Perthes' disease, with a nested consented cohort. A total of 143 of 144 hospitals treating children's hip disease in the UK participated over an 18-month period. Cases were cross-checked using a secondary independent reporting network of trainee surgeons to minimize those missing. Clinician-reported outcomes were collected until two years. Patient-reported outcome measures (PROMs) were collected for a subset of participants. RESULTS: Overall, 371 children (396 hips) were newly affected by Perthes' disease arising from 63 hospitals, with a median of two patients (interquartile range 1.0 to 5.5) per hospital. The annual incidence was 2.48 patients (95% confidence interval (CI) 2.20 to 2.76) per 100,000 zero- to 14-year-olds. Of these, 117 hips (36.4%) were treated surgically. There was considerable variation in the treatment strategy, and an optimized decision tree identified joint stiffness and age above eight years as the key determinants for containment surgery. A total of 348 hips (88.5%) had outcomes to two years, of which 227 were in the late reossification stage for which a hip shape outcome (Stulberg grade) was assigned. The independent predictors of a poorer radiological outcome were female sex (odds ratio (OR) 2.27 (95% CI 1.19 to 4.35)), age above six years (OR 2.62 (95% CI (1.30 to 5.28)), and over 50% radiological collapse at inclusion (OR 2.19 (95% CI 0.99 to 4.83)). Surgery had no effect on radiological outcomes (OR 1.03 (95% CI 0.55 to 1.96)). PROMs indicated the marked effect of the disease on the child, which persisted at two years. CONCLUSION: Despite the frequency of containment surgery, we found no evidence of improved outcomes. There appears to be a sufficient case volume and community equipoise among surgeons to embark on a randomized clinical trial to definitively investigate the effectiveness of containment surgery. Cite this article: Bone Joint J 2022;104-B(4):510-518.
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    The ability of physiotherapists to identify psychosocial factors in patients with musculoskeletal pain: A scoping review
    (Wiley, 2022-12-23) Henning, M.; Smith, M.
    BACKGROUND: It is not known how well physiotherapists identify psychosocial factors in people with musculoskeletal pain, when using clinical judgement. The purpose of this scoping review was to examine the research related to physiotherapist ability in identifying psychosocial factors and to subsequently identify gaps in the literature to help direct future research. DATA SOURCES: Searches using relevant key words, were conducted of Medline, Cinahl, the Cochrane Library, PEDro, PubMed, Scopus and Google Scholar. All primary quantitative and qualitative research from the year 2000 onwards, which met the search criteria, were included. DATA EXTRACTION AND SYNTHESIS: A data extraction tool was used to tabulate data regarding demographics, study design and key findings of the included papers. The Mixed Methods Appraisals Tool (MMAT) was utilised to help examine the quality of included studies. RESULTS: Overall, the quality of the included studies was moderate. The total number of studies which met the inclusion criteria was relatively small (n = 20). The most common method for determining ability was comparison of physiotherapist estimations with validated screening tools or questionnaires. Physiotherapist estimates of psychosocial factors were poor and in the qualitative research, the lack of clinician confidence in psychosocial assessment was evident. CONCLUSION: The available research suggests that physiotherapists lack confidence and ability in identifying psychosocial factors. More rigorous, mixed-methods research is warranted to capture the complexity of the research question.
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    Antibiotic review kit for hospitals (ARK-Hospital): a stepped-wedge cluster-randomised controlled trial
    (Elsevier, 2022-10-04) Llewelyn, M. J.; Budgell, E. P.; Laskawiec-Szkonter, M.; Cross, E. L. A.; Alexander, R.; Bond, S.; Coles, P.; Conlon-Bingham, G.; Dymond, S.; Evans, M.; Fok, R.; Frost, K. J.; Garcia-Arias, V.; Glass, S.; Gormley, C.; Gray, K.; Hamson, C.; Harvey, D.; Hills, T.; Iyer, S.; Johnson, A.; Jones, N.; Kang, P.; Kiapi, G.; Mack, D.; Makanga, C.; Mawer, D.; McCullagh, B.; Mirfenderesky, M.; McEwen, R.; Nag, S.; Nagar, A.; Northfield, J.; O'Driscoll, J.; Pegden, A.; Porter, R.; Powell, N.; Price, D.; Sheridan, E.; Slatter, M.; Stewart, B.; Watson, C.; Weichert, I.; Sivyer, K.; Wordsworth, S.; Quaddy, J.; Santillo, M.; Krusche, A.; Roope, L. S. J.; Mowbray, F.; Hand, K. S.; Dobson, M.; Crook, D. W.; Vaughan, L.; Hopkins, S.; Yardley, L.; Peto, T. E. A.; Walker, A. S.
    BACKGROUND: Strategies to reduce antibiotic overuse in hospitals depend on prescribers taking decisions to stop unnecessary antibiotic use. There is scarce evidence for how to support these decisions. We evaluated a multifaceted behaviour change intervention (ie, the antibiotic review kit) designed to reduce antibiotic use among adult acute general medical inpatients by increasing appropriate decisions to stop antibiotics at clinical review. METHODS: We performed a stepped-wedge, cluster (hospital)-randomised controlled trial using computer-generated sequence randomisation of eligible hospitals in seven calendar-time blocks in the UK. Hospitals were eligible for inclusion if they admitted adult non-elective general or medical inpatients, had a local representative to champion the intervention, and could provide the required study data. Hospital clusters were randomised to an implementation date occurring at 1-2 week intervals, and the date was concealed until 12 weeks before implementation, when local preparations were designed to start. The intervention effect was assessed using data from pseudonymised routine electronic health records, ward-level antibiotic dispensing, Clostridioides difficile tests, prescription audits, and an implementation process evaluation. Co-primary outcomes were monthly antibiotic defined daily doses per adult acute general medical admission (hospital-level, superiority) and all-cause mortality within 30 days of admission (patient level, non-inferiority margin of 5%). Outcomes were assessed in the modified intention-to-treat population (ie, excluding sites that withdrew before implementation). Intervention effects were assessed by use of interrupted time series analyses within each site, estimating overall effects through random-effects meta-analysis, with heterogeneity across prespecified potential modifiers assessed by use of meta-regression. This trial is completed and is registered with ISRCTN, ISRCTN12674243. FINDINGS: 58 hospital organisations expressed an interest in participating. Three pilot sites implemented the intervention between Sept 25 and Nov 20, 2017. 43 further sites were randomised to implement the intervention between Feb 12, 2018, and July 1, 2019, and seven sites withdrew before implementation. 39 sites were followed up for at least 14 months. Adjusted estimates showed reductions in total antibiotic defined daily doses per acute general medical admission (-4·8% per year, 95% CI -9·1 to -0·2) following the intervention. Among 7 160 421 acute general medical admissions, the ARK intervention was associated with an immediate change of -2·7% (95% CI -5·7 to 0·3) and sustained change of 3·0% (-0·1 to 6·2) in adjusted 30-day mortality. INTERPRETATION: The antibiotic review kit intervention resulted in sustained reductions in antibiotic use among adult acute general medical inpatients. The weak, inconsistent intervention effects on mortality are probably explained by the onset of the COVID-19 pandemic. Hospitals should use the antibiotic review kit to reduce antibiotic overuse. FUNDING: UK National Institute for Health and Care Research.