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This document reports the numbers of prostheses recorded and reported to the NJR between 1 January and 31 December 2020. The tables show volumes of components as they have been entered into the registry, regardless of construct. The procedure counts in this document are presented without adjustment and may vary from counts found in the corresponding main NJR Annual Report analysis. If a procedure has been submitted with missing implant information this will also cause numbers to differ. Procedure counts below four have been suppressed. Components are listed and described according to the current classifications used in the registry. It must be noted that due to COVID-19, the ratio of revision to primary procedures increased in 2020 and this may affect the relative changes in the types and brands of implants used in comparison to previous years. As this document was not published for 2019 Annual Report data, comparison has been made with the 2018 Annual Report data.
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The voluntary sector was central to the COVID-19 response: fulfilling basic needs, highlighting new and existing inequalities and coordinating action where the state had been slow to respond. This book curates rigorous academic, policy and practice-based research into the response and adaptation of the UK voluntary sector during the pandemic. Contributions explore the ways the sector responded to new challenges and the longer-term consequences for the sector's workforce, volunteers and beneficiaries. Written for researchers and practitioners, this book considers what the voluntary sector can learn from the pandemic to maximise its contribution in the event of future crises. © Bristol University Press 2022. All rights reserved.
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Introduction: Germ cell tumors, including germinomas, account for 10% of pediatric chronic Diabetes Insipidus (DI) cases. Delays in diagnosis of germinomas are generally longer than six months, however, no reported cases of suprasellar germinomas causing chronic DI and precocious puberty have been known to exceed a 5-year delay in both treatment of DI symptoms and a definitive diagnosis. Case Description: A 10-year-old Hispanic male presented with a 5-year history of polydipsia and polyuria. He underwent evaluation in Venezuela, where DI was reportedly 'ruled out';however, no head MRI was performed. After two years in the US struggling to acquire insurance, he presented to his pediatrician with worsening symptoms. A head MRI, ordered to evaluate dilute high-volume urine output, revealed a suprasellar mass. He was admitted for diagnostic evaluation and met the criteria for DI. Notably, he had an elevated Beta-Human Chorionic Gonadotropin (B-HCG) level. Biopsy confirmed the diagnosis of a Central Nervous System (CNS) germinoma. He was treated with DDAVP and proton therapy with subsequent remission of his tumor. Discussion: Throughout the patient's disease course, there were multiple delays in seeking and receiving care. These include a 5-year delay in seeking care despite worsening symptoms, a one-month delay in completing a 24-hour urine collection, a one-month delay in consulting pediatric nephrology, and another month delay before completing a retroperitoneal ultrasound. Multiple medical and socio-economic factors led to these delays. The patient did not present with symptoms more typical of CNS Germinomas like headaches, nausea, and vomiting. He had no visual disturbances despite mass effect on his optic chiasm. His increased stretched penis length and Tanner staging, which were identified later in his disease course, were contradicted by his pre-pubertal testicular volume and bone age. The patient is from a Spanishspeaking/Limited English Proficiency (SSLEP) household. While Spanish interpreters were present at each appointment, the language barrier proved to be a consistent issue. Initially, the child's mother indicated that the diagnosis of DI was 'ruled out' in Venezuela. In reality, the recommended imaging was never performed. Mychart messages left by his father further highlighted communication difficulties. Without access to an interpreter, he was forced to use broken English to relay his concerns. These frantic messages indicated misunderstandings regarding scheduling with various services and completing vital labs. Care only proceeded after significant physician intervention. Poverty in Venezuela, lack of insurance, and anxiety regarding COVID-19 also contributed to these delays. Conclusion: To our knowledge, this is the first case report of a pediatric patient presenting with a 5-year history of untreated polyuria and polydipsia due to undiagnosed DI with a B-HCG secreting CNS germinoma, without spinal metastasis. This study also illustrates the importance of supporting SSLEP families as they grapple with the complicated process of navigating our healthcare system. Sagittal T1 post gadolinium contrast image (A) and axial T2 FLAIR image (B) show an enigmatic, homogeneous, briskly enhancing mass in the suprasellar cistern (red arrow) with mass effect on the optic chiasm which is displaced upward and anteriorly (green arrow).
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Commentary: Reporting on the weather may seem at first glance to be a very light story, but it can actually be a serious reflection of how we see ourselves and our changing perception of the world. In 1996, the author embarked on a light-hearted survey of 23 daily papers to find what New Zealand news-papers' weather reports said about their attitudes to the world. In the middle of the 2020 COVID lockdown he reran the survey to see what had changed.
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The global impact of the COVID-19 pandemic has made the annual Social Policy Review even more critical than before. This comprehensive volume addresses critical debates throughout the international social policy field over the past year with a key focus on responses to COVID-19 and implications for social policy. Expert contributors address important issues including foodbanks, caring for older family members, lockdowns around the globe, gender, technology and migration during a pandemic. Published in association with the Social Policy Association, this annual review is fundamental reading for students and academics in social policy, social welfare and related disciplines. © Bristol University Press/Social Policy Association 2021. All rights reserved.
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INTRODUCTION: People presenting with shoulder pain considered to be of musculoskeletal origin is common in primary care but diagnosing the cause of the pain is contentious, leading to uncertainty in management. To inform optimal primary care for patients with shoulder pain, the study aims to (1) to investigate the short-term and long-term outcomes (overall prognosis) of shoulder pain, (2) estimate costs of care, (3) develop a prognostic model for predicting individuals' level and risk of pain and disability at 6 months and (4) investigate experiences and opinions of patients and healthcare professionals regarding diagnosis, prognosis and management of shoulder pain. METHODS AND ANALYSIS: The Prognostic And Diagnostic Assessment of the Shoulder (PANDA-S) study is a longitudinal clinical cohort with linked qualitative study. At least 400 people presenting to general practice and physiotherapy services in the UK will be recruited. Participants will complete questionnaires at baseline, 3, 6, 12, 24 and 36 months. Short-term data will be collected weekly between baseline and 12 weeks via Short Message Serevice (SMS) text or software application. Participants will be offered clinical (physiotherapist) and ultrasound (sonographer) assessments at baseline. Qualitative interviews with ≈15 dyads of patients and their healthcare professional (general practitioner or physiotherapist).Short-term and long-term trajectories of Shoulder Pain and Disability Index (using SPADI) will be described, using latent class growth analysis. Health economic analysis will estimate direct costs of care and indirect costs related to work absence and productivity losses. Multivariable regression analysis will be used to develop a prognostic model predicting future levels of pain and disability at 6 months using penalisation methods to adjust for overfitting. The added predictive value of prespecified physical examination tests and ultrasound findings will be examined. For the qualitative interviews an inductive, exploratory framework will be adopted using thematic analysis to investigate decision making, perspectives of patients and clinicians on the importance of diagnostic and prognostic information when negotiating treatment and referral options. ETHICS AND DISSEMINATION: The PANDA-S study has ethical approval from Yorkshire and The Humber-Sheffield Research Ethics Committee, UK (18/YH/0346, IRAS Number: 242750). Results will be disseminated through peer-reviewed publications, social and mainstream media, professional conferences, and the patient and public involvement and engagement group supporting this study, and through newsletters, leaflets and posters in participating sites. TRIAL REGISTRATION NUMBER: ISRCTN46948079.
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Shoulder Pain , Shoulder , Humans , Physical Therapy Modalities , Prognosis , Referral and Consultation , Shoulder Pain/diagnosis , Shoulder Pain/therapyABSTRACT
Data regarding angiographic characteristics, clinical profile, and inhospital outcomes of patients with coronavirus disease 2019 (COVID-19) referred for coronary angiography (CAG) are scarce. This is an observational study analyzing confirmed patients with COVID-19 referred for CAG from 10 European centers. We included 57 patients (mean age: 66 ± 15 years, 82% male) , of whom 18% had previous myocardial infarction (MI) and 29% had renal insufficiency and chronic pulmonary disease. ST-segment elevation myocardial infarction (STEMI) was the most frequent indication for CAG (58%). Coronavirus disease 2019 was confirmed after CAG in 86% and classified as mild in 49%, with 21% fully asymptomatic. A culprit lesion was identified in 79% and high thrombus burden in 42%; 7% had stent thrombosis. At 40 days follow-up, 16 (28%) patients experienced a major adverse cardiovascular event (MACE): 12 deaths (92% noncardiac), 1 MI, 2 stent thrombosis, and 1 stroke. In an European multicenter registry, patients with confirmed COVID-19 infection referred for CAG during the first wave of the severe acute respiratory syndrome coronavirus 2 pandemic presented mostly with STEMI and were predominantly males with comorbidities. Severity of COVID-19 was in general noncritical and 21% were asymptomatic at the time of CAG. Culprit coronary lesions with high thrombus burden were frequently identified, with a rate of stent thrombosis of 7%. The incidence of MACE at 40 days was high (28%), mostly due to noncardiac death.
Subject(s)
COVID-19 , Percutaneous Coronary Intervention , Aged , Aged, 80 and over , Coronary Angiography , Disease Outbreaks , Female , Humans , Male , Middle Aged , Registries , SARS-CoV-2 , Treatment OutcomeABSTRACT
Introduction: The COVID 19 pandemic resulted in significant restrictions for routine, non urgent clinical services, including sexual health. In line with national guidance we suspended all routine walk-in services. To preserve services for as many patients as possible we immediately implemented a remote access telemedicine service. Anticipating that this might evolve to become a permanent future model for service delivery we also sought patient opinion of the new service. Methods: All patients who received a telephone consultation between 8th April-15th May 2020 received a text message with an anonymised patient satisfaction questionnaire. Patients who did not attend and those reporting sexual assault were excluded. Results: 898 patients were sent the survey with 174 completed responses, ∧20% response rate. Of responders, the majority were female - female 82.2% male 17.8%, reflecting our integrated contraception and GUM service. Overall, 93.7% (163/174) would use the service again, 26.2% (46/174) would prefer a face to face appointment and 4.6% (8/174) reported their needs were not met by a telephone consultation. Discussion: Previously there has been encouraging research into the use of digital technologies for medical consultations. There is limited existing evidence for application of these within the field of Sexual Health. Whilst telemedicine will not be appropriate for a minority of patients our early experience suggests that this modality works well for the majority of users. 93.7% would use the service again. Additionally, this service not only accommodates users but it also allows clinical staff to work remotely. This reduces footfall onto clinical sites and allows higher risk staff to continue effective working.