ORCID Profile
0000-0002-4924-5653
Current Organisation
John Hunter Hospital
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Publisher: Springer Science and Business Media LLC
Date: 30-08-2017
Publisher: S. Karger AG
Date: 27-08-2016
DOI: 10.1159/000448088
Abstract: b i Objectives: /i /b To establish if exercise training intensity produces different effect sizes for quality of life in heart failure. b i Background: /i /b Exercise intensity is the primary stimulus for physical and mental adaptation. b i Methods: /i /b We conducted a MEDLINE search (1985 to February 2016) for exercise-based rehabilitation trials in heart failure using the search terms ‘exercise training', ‘left ventricular dysfunction', ‘peak V smlcap O /smlcap sub /sub ', ‘cardiomyopathy', and ‘systolic heart dysfunction'. b i Results: /i /b Twenty-five studies were included 4 (16%) comprised high-, 10 (40%) vigorous-, 9 (36%) moderate- and 0 (0%) low-intensity groups two studies were unclassified. The 25 studies provided a total of 2,385 participants, 1,223 exercising and 1,162 controls (36,056 patient-hours of training). Analyses reported significant improvement in total Minnesota living with heart failure (MLWHF) total score [mean difference (MD) -8.24, 95% CI -11.55 to -4.92, p 0.00001]. Physical MLWHF scorewas significantly improved in all studies (MD -2.89, 95% CI -4.27 to -1.50, p 0.00001). MLWHF total score was significantly reduced after high- (MD -13.74, 95% CI -21.34 to -6.14, p = 0.0004) and vigorous-intensity training (MD -8.56, 95% CI -12.77 to -4.35, p 0.0001) but not moderate-intensity training. A significant improvement in the total MLWHF score was seen after aerobic training (MD -3.87, 95% CI -6.97 to -0.78, p = 0.01), and combined aerobic and resistance training (MD -9.82, 95% CI -15.71 to -3.92, p = 0.001), but not resistance training. b i Conclusions: /i /b As exercise training intensity rises, so may the magnitude of improvement in quality of life in exercising patients. Aerobic-only or combined aerobic and resistance training may offer the greatest improvements in quality of life.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 04-2021
DOI: 10.1097/BOT.0000000000001962
Abstract: Venous thromboembolism (VTE) is a well-established complication after many orthopaedic injuries, such as hip and lower limb fractures. The use of direct oral anticoagulants (DOACs, previously termed novel oral anticoagulants) is well-established as thromboprophylaxis after major elective orthopaedic surgery, but not in the nonelective setting. The aim of this study was to investigate the effectiveness and safety of DOACs after nonelective lower limb fracture surgery. A systematic literature search of the MEDLINE, EMBASE, CINAHL, and CENTRAL databases was conducted. No limitation was placed on publication date, with only manuscripts printed in English were eligible. Included studies were either randomized controlled trials or prospective and retrospective comparative studies. Included studies compared DOACs to conventional methods of thromboprophylaxis in the postoperative period after surgical management of lower limb fractures. Outcomes included VTE, bleeding, wound complications, mortality, and adverse events. Eight studies met inclusion criteria, of which 7 compared direct factor Xa inhibitors (XaIs) with conventional VTE prophylaxis and one study compared a direct thrombin inhibitor with conventional VTE prophylaxis. Revman 5.3 (Nordic Cochrane Centre, Denmark) was used to complete the meta-analysis and generate forest plots. XaIs were shown to have lower rates of deep vein thrombosis (Odds ratio 0.59 95% confidence interval, 0.46–0.76 P 0.0001) and less pharmacologically attributable adverse events (Odds ratio 0.62 95% confidence interval, 0.46–0.82 P = 0.0007). There was difference between DOACs and conventional VTE prophylaxis regarding mortality, PE, symptomatic deep vein thrombosis, or bleeding events. The results generally support the use of DOACs for VTE prophylaxis after nonelective lower limb fracture surgery, such after hip fracture. The results more strongly support the use of XaIs however, more evidence is needed to fully assess DOACs' role in clinical practice. Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2022
Publisher: Elsevier BV
Date: 08-2019
DOI: 10.1016/J.ARTH.2019.03.070
Abstract: Displaced femoral neck fractures (DFNF) are common and can be treated with osteosynthesis, hemiarthroplasty (HA), or total hip arthroplasty (THA). There is no consensus as to which intervention is superior in managing DFNF. Studies were identified through a systematic search of the MEDLINE database, EMBASE database, and Cochrane Controlled Trials. Included studies were randomized or controlled trials (1966 to August 2018) comparing THA with HA for the management of DFNF. (www.crd.york.ac.uk/PROSPERO Identifier: CRD42018110057). Seventeen studies were included totaling 1364 patients (660 THA and 704 HA). THA was found to be superior to HA in terms of risk of reoperation, Harris Hip Score and Quality of Life (Short Form 36). Overall, the risk of dislocation was greater in THA group than HA in the first 4 years, after which there was no difference. There was no difference between THA and HA in terms of mortality or infection. Overall, THA appears to be superior to HA. THA should be the recommended intervention for DFNF in patients with a life expectancy >4 years and in patients younger than 80 years. However, both HA and THA are reasonable interventions in patients older than 80 years and with shorter life expectancy.
Publisher: British Editorial Society of Bone & Joint Surgery
Date: 02-2023
DOI: 10.1302/1358-992X.2023.2.083
Abstract: Distal femur fractures (DFF) are common, especially in the elderly and high energy trauma patients. Lateral locked osteosynthesis constructs have been widely used, however non-union and implant failures are not uncommon. Recent literature advocates for the liberal use of supplemental medial plating to augment lateral locked constructs. However, there is a lack of proprietary medial plate options, with some authors supporting the use of repurposing expensive anatomic pre-contoured plates. The aim of this study was to investigate the feasibility of a readily available cost-effective medial implant option. A retrospective analysis from January 2014 to June 2022 was performed on DFF (primary or revision) managed with supplemental medial plating with a Large Fragment Locking Compression Plate (LCP) T-Plate (~$240 AUD) via a medial sub-vastus approach. The T-plate was contoured and placed superior to the medial condyle. A combination of 4.5mm cortical, 5mm locking and/or 6.5mm cancellous screws were used, with oblique screw trajectories towards the distal lateral cortex of the lateral condyle. All extra-articular fractures and revision fixation cases were allowed to weight bear immediately. The primary outcome was union rate. This technique was utilised on sixteen patients 3 acute, 13 revisions mean age 52 years (range 16-85), 81% male, 5 open fractures. The union rate was 100%, with a median time to union of 29 weeks (IQR 18-46). The mean follow-up was 15 months. There were two complications: a deep infection requiring two debridements and a prominent screw requiring removal. The mean range of motion was 1–108 o . Supplemental medial plating of DFF with a Large Fragment LCP T-Plate is a feasible, safe, and economical option for both acute fixation and revisions. Further validation on a larger scale is warranted, along with considerations to developing a specific implant in line with these principles.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 21-02-2023
DOI: 10.1097/TA.0000000000003923
Abstract: Postinjury multiple organ failure (MOF) is the leading cause of late death in trauma patients. Although MOF was first described 50 years ago, its definition, epidemiology, and change in incidence over time are poorly understood. We aimed to describe the incidence of MOF in the context of different MOF definitions, study inclusion criteria, and its change over time. Cochrane Library, EMBASE, MEDLINE, PubMed, and Web of Science databases were searched for articles published between 1977 and 2022 in English and German. Random-effects meta-analysis was performed when applicable. The search returned 11,440 results, of which 842 full-text articles were screened. Multiple organ failure incidence was reported in 284 studies that used 11 unique inclusion criteria and 40 MOF definitions. One hundred six studies published from 1992 to 2022 were included. Weighted MOF incidence by publication year fluctuated from 11% to 56% without significant decrease over time. Multiple organ failure was defined using four scoring systems (Denver, Goris, Marshall, Sequential Organ Failure Assessment [SOFA]) and 10 different cutoff values. Overall, 351,942 trauma patients were included, of whom 82,971 (24%) developed MOF. The weighted incidences of MOF from meta-analysis of 30 eligible studies were as follows: 14.7% (95% confidence interval [CI], 12.1–17.2%) in Denver score , 12.7% (95% CI, 9.3–16.1%) in Denver score with blunt injuries only, 28.6% (95% CI, 12–45.1%) in Denver score , 25.6% (95% CI, 10.4–40.7%) in Goris score , 29.9% (95% CI, 14.9–45%) in Marshall score , 20.3% (95% CI, 9.4–31.2%) in Marshall score with blunt injuries only, 38.6% (95% CI, 33–44.3%) in SOFA score , 55.1% (95% CI, 49.7–60.5%) in SOFA score with blunt injuries only, and 34.8% (95% CI, 28.7–40.8%) in SOFA score . The incidence of postinjury MOF varies largely because of lack of a consensus definition and study population. Until an international consensus is reached, further research will be hindered. Systematic Review and Meta-analysis Level III.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-01-2022
DOI: 10.1097/TA.0000000000003528
Abstract: Hemodynamically unstable pelvic fracture patients are challenging to manage. Preperitoneal packing (PPP) and angioembolization (AE) are two interventions commonly used to help gain hemorrhage control. Recently, there has been a tendency to support PPP in hemodynamically unstable pelvic fracture seemingly in direct comparison with AE. However, it seems that key differences between published cohorts exist that limits a comparison between these two modalities. A systematic literature search of the MEDLINE, CINAHL, and EMBASE databases was conducted. Prospective and retrospective studies were eligible. No limitation was placed on publication date, with only manuscripts printed in English eligible (PROSPERO CRD42021236219). Included studies were retrospective and prospective cohort studies and a quasirandomized control trial. Studies reported demographic and outcome data on hemodynamically unstable patients with pelvis fractures that had either PPP or AE as their initial hemorrhage control intervention. The primary outcome was in-hospital mortality rate. Eighteen studies were included totaling 579 patients, of which 402 were treated with PPP and 177 with AE. Significant differences were found between AE and PPP in regard to age, presence of arterial hemorrhage, Injury Severity Score, and time to intervention. The crude mortality rate for PPP was 23%, and for AE, it was 32% ( p = 0.001). Analysis of dual-arm studies showed no significant difference in mortality. Interestingly, 27% of patients treated with PPP did not get adequate hemorrhage control and required subsequent AE. Because of bias, heterogeneity, and inadequate reporting of physiological data, a conclusive comparison between modalities is impossible. In addition, in more than a quarter of the cases treated with PPP, the patients did not achieve hemorrhage control until subsequent AE was performed. This systematic review highlights the need for standardized reporting in this high-risk group of trauma patients. Systematic review and meta-analysis, level III.
Publisher: British Editorial Society of Bone & Joint Surgery
Date: 02-2023
DOI: 10.1302/1358-992X.2023.2.054
Abstract: Prosthetic joint infections (PJI) are devastating complications. Our knowledge on hip fractureassociated hemiarthroplasty PJI (HHA-PJI) is limited compared to elective arthroplasty. The goal of this study was to describe the epidemiology, risk factors, management, and outcomes for HHA-PJI. A population-based (465,000) multicentre retrospective analysis of HHAs between 2006-2018 was conducted. PJI was defined by international consensus and treatment success as no return to theatre and survival to 90 days after the initial surgical management of the infection. Univariate, survival and competing risk regression analyses were performed. 1852 HHAs were identified (74% female age:84±7yrs -day-mortality:16.7%). Forty-three (2.3%) patients developed PJI [77±10yrs 56% female 90-day-mortality: 20.9%, Hazard-Ratio 1.6 95%CI 1.1-2.3,p=0.023]. The incidence of HHA-PJI was 0.77/100,000/year and 193/100,000/year for HHA. The median time to PJI was 26 (IQR 20-97) days with 53% polymicrobial growth and 41% multi-drug resistant organisms (MDRO). Competing risk regression identified younger age [Sub-Hazard-Ratio(SHR) 0.86, 95%CI 0.8-0.92,p .001], chronic kidney disease (SHR 3.41 95%CI 1.36-8.56, p=0.01), body mass index (SHR 6.81, 95%CI 2.25-20.65, p .001), urinary tract infection (SHR 1.89, 95%CI 1.02-3.5, p=0.04) and dementia (SHR 9.4, 95%CI 2.89-30.58,p .001) as significant risk factors for developing HHA-PJI. When infection treatment was successful (n=15, 38%), median survival was 1632 days (IQR 829-2084), as opposed to 215 days (IQR 20-1245) in those who failed, with a 90-day mortality of 30%(n=12). There was no significant difference in success among debridement, excision arthroplasty or revision arthroplasty. HHA PJI is uncommon but highly lethal. All currently identified predictors are non-modifiable. Due to the common polymicrobial and MDRO infections our standard antibiotic prophylaxis may not be adequate HHA-PJI is a different disease compared to elective PJI with distinct epidemiology, pathogens, risk factors and outcomes, which require targeted research specific to this unique population.
Publisher: Hindawi Limited
Date: 2017
DOI: 10.1155/2017/4721548
Abstract: Background . There is no consensus on whether closed kinetic chain (CKC) or open kinetic chain (OKC) exercises should be the intervention of choice following an anterior cruciate ligament (ACL) injury or reconstruction. Methods . A systematic search identified randomized controlled trials of OKC versus CKC exercise training in people who had undergone ACL reconstructive surgery. All published studies in this systematic review were comparisons between OKC and CKC groups. Results . Seven studies were included. Lysholm knee scoring scale was not significantly different between OKC and CKC exercise patients: MD: −1.03% CI: −13.02, 10.95 p value = 0.87 (Chi 2 = 0.18, df = 1, and p value = 0.67). Hughston clinic questionnaire scores were not significantly different between OKC and CKC exercise patients: MD: −1.29% (−12.02, 9.43) p value = 0.81 (Chi 2 = 0.01, df = 1, and p value = 0.93). Conclusions . While OKC and CKC may be beneficial during ACL surgical rehabilitation, there is insufficient evidence to suggest that either one is superior to the other.
Publisher: Elsevier BV
Date: 05-2018
DOI: 10.1016/J.DIABRES.2017.11.036
Abstract: To establish the relationship between exercise training and clinical outcomes in people with type I diabetes. Studies were identified through a MEDLINE search strategy, Cochrane Controlled Trials Registry, CINAHL, SPORTDiscus and Science Citation Index. The search strategy included a mix of key concepts related to trials of exercise training in people with type 1 diabetes glycaemic control. Searches were limited to prospective randomized or controlled trials of exercise training in humans with type 1 diabetes lasting 12 weeks or more. In exercised adults there were significant improvements in body mass Mean Difference (MD): -2.20 kg, 95% Confidence Interval (CI) -3.79-0.61, p = .007 body mass index (BMI) MD: -0.39 kg/m Exercise training improves some markers of type 1 diabetes severity particularly body mass, BMI, Peak VO
Publisher: Elsevier BV
Date: 10-2016
DOI: 10.1016/J.IJCARD.2016.07.046
Abstract: To quantify the change in effect sizes, for selected clinical outcome measures, in people with heart failure, from resistance exercise, either in isolation, or in combination with aerobic training. Most exercise training data in heart failure, relates to aerobic exercise, we sought to provide current evidence for the benefits of resistance training in this population. We conducted a MEDLINE search (1985 to May 1, 2016), for exercise based rehabilitation trials in heart failure, using search terms 'resistance training, combined training, left ventricular dysfunction, peak VO2, cardio-myopathy and systolic heart dysfunction'. The 27 included studies provided a total of 2321 participants, 1172 in an intervention and 1149 in either sedentary controls or aerobic exercise only groups, producing over 31,263 patient-hours of training. Mortality, hospitalization, resting blood pressure and Left ventricular fraction were all unchanged with resistance or combined aerobic and resistance training. Peak VO2 was improved in combined exercise vs. control MD of 1.43ml·kg(-1)·min(-1) (95% CI 0.63, 2.23, p=0.0004 and in resistance vs. control MD 3.99ml·kg(-1)·min(-1) (95% CI 1.47, 6.51, p=0.002). Quality of Life (MLwHFQ) was improved in combined vs. control MD -8.31 (95% CI -14.3, -2.33, p=0.006). Six-minute walk distance was improved combined exercise vs. control, MD 13.49m (95% CI 1.13, 25.84, p=0.03) and resistance vs. control MD 41.77m (95% CI 21.90, 61.64, p<0.0001): SMD 1.25 (95%CI 0.53, 1.98, p=0.0007). Resistance only or combined training improves peak VO2, quality of life and walking performance in heart failure patients.
Publisher: Royal Society of Chemistry (RSC)
Date: 2021
DOI: 10.1039/D1MH01263K
Abstract: This review presents an integrated perspective on the recent progress and advances of emerging iongel materials and their applications in the areas of energy, gas separation and (bio)electronics.
No related grants have been discovered for Daniel Lewis.