alan silman

BackgroundArthroplasty registries are rarely used to inform encounters between clinician and patient. This study is part of a larger one which aimed to develop an information tool allowing both to benefit from previous patients’ experience after total hip arthroplasty (THA). This study focuses on generating the information tool specifically for pain outcomes.MethodsData from the Geneva Arthroplasty Registry (GAR) about patients receiving a primary elective THA between 1996 and 2019 was used. Selected outcomes were identified from patient and surgeon surveys: pain walking, climbing stairs, night pain, pain interference, and pain medication. Clusters of patients with homogeneous outcomes at 1, 5, and 10 years postoperatively were generated based on selected predictors evaluated preoperatively using conditional inference trees (CITs).ResultsData from 6,836 THAs were analysed and 14 CITs generated with 17 …

BackgroundImmigrants are exposed to numerous risk factors that may contribute to the development of chronic musculoskeletal pain. Recent political and environmental crises in North Africa and the Middle East have led to an increase in immigration to Europe that has challenged the healthcare system and especially the management of chronic conditions.ObjectiveThe aims of this scoping review are to investigate the burden, prevalence, and associated factors of chronic musculoskeletal pain in immigrants from North Africa and the Middle East in Europe during the last decade. The intentions of the review are to inform healthcare policymakers, to identify gaps in the literature, and aid the planning of future research.DesignOnline databases Medline, Embase, PubMed and Web of Science were used to identify epidemiological studies published from2012–2022 examining chronic pain in populations from North …

Leveraging registry data to improve patient-clinician communication about total hip arthroplasty: the case of 'patients like me' information tool - ORA - Oxford University Research Archive Logos Header links Search History Bookmarks 0 New Search About Deposit Help Footer links Policies Disclaimer Privacy Policy Cookies Accessibility Statement Copyright API Contact Skip to main NEW SEARCH About Deposit HELP 0 Back to Search CONTACT Name Email Comment Send message Actions Authors Bibliographic Details Item Description Terms of Use Metrics Export BibTeX EndNote RefWorks CC0 version of this metadata Conference item icon Conference item : Abstract Leveraging registry data to improve patient-clinician communication about total hip arthroplasty: the case of 'patients like me' information tool Publication status: Accepted Peer review status: Peer reviewed Actions Email Send the bibliographic …

Aims Symptomatic spinal stenosis is a very common problem, and decompression surgery has been shown to be superior to nonoperative treatment in selected patient groups. However, performing an instrumented fusion in addition to decompression may avoid revision and improve outcomes. The aim of the SpInOuT feasibility study was to establish whether a definitive randomized controlled trial (RCT) that accounted for the spectrum of pathology contributing to spinal stenosis, including pelvic incidence-lumbar lordosis (PI-LL) mismatch and mobile spondylolisthesis, could be conducted. Methods As part of the SpInOuT-F study, a pilot randomized trial was carried out across five NHS hospitals. Patients were randomized to either spinal decompression alone or spinal decompression plus instrumented fusion. Patient-reported outcome measures were collected at baseline and three …

The human microbiome plays a vital role in both health and disease. The evolution of molecular techniques to characterise entire microbiome communities has renewed interest in the involvement of microorganisms in the pathogenesis of Rheumatoid arthritis (RA). In this thesis, 16S and ITS amplicon sequencing were used to characterise bacterial and fungal DNA present in a range of human and mouse samples. Firstly, characterisation of the microbiome present in blood samples obtained from human RA, ankylosing spondylitis, and psoriatic arthritis patients was carried out, relative to healthy controls. Results revealed that the bacterial population in the serum of RA patients was distinct from the healthy state. Through the analysis of paired RA patient blood taken before and three months after treatment, partial microbiome normalisation was identified and was particularly evident in seronegative arthritis patients …

This review investigates the burden, prevalence, and associated factors of chronic musculoskeletal pain in immigrants in Europe during the last decade with a focus on immigrants from North Africa and the Middle East. The intentions of the review are to inform healthcare policymakers, to identify gaps in the literature, and aid the planning of future research. Eleven observational studies were identified using online databases. Data suggest that chronic pain is more prevalent, more widespread, and more severe in immigrants, and that chronic pain deteriorates with length of stay in the destination country. Immigrant women were identified as a particularly vulnerable group for developing chronic pain and comorbid mental health disorders. Older age, lower education, financial hardship, being underweight or obese, time in transit during migration, experience of trauma, and immigration status were also associated with chronic pain. Anxiety, depression, and post-traumatic stress disorder diagnoses were also more prevalent in immigrants and were significantly associated with chronic pain. Several gaps in the literature were identified: research is limited in terms of quantity and quality, does not reflect actual immigration trends, and does not account for immigration factors.

Objectives Psoriatic arthritis (PsA), is a complex inflammatory arthropathy with a heterogenous spectrum of disease presentation. Despite the vast therapeutic armamentarium, disease control in a considerable proportion of patients is suboptimal. The aim of this study was to assess the safety and efficacy of Janus kinase inhibitors (JAKi), in the management of key clinical domains of PsA including peripheral arthritis, psoriasis, enthesitis and dactylitis. Method Randomized placebo‐controlled trials (RCTs) of JAKi in PsA were identified by a systematic literature search using EMBASE, PubMed and CENTRAL. All included studies underwent meta‐analysis. Results A total of 5 RCTs were included. Patients were randomized to tofacitinib (n = 474), filgotinib (n = 65), upadacitinib (n = 1281) or placebo (n = 937). JAKi treatment was associated with superior efficacy across all primary outcome measures vs placebo …

As life expectancies rise globally, the number of people living with multiple chronic health conditions – commonly referred to as ‘multimorbidity’ – is rising. Multimorbidity has been recognised as especially challenging to respond to in countries whose health systems are under-funded, fragmented, and designed primarily for acute care, including in sub-Saharan Africa. A growing body of research in sub-Saharan Africa has sought to better understand the particular challenges multimorbidity poses in the region and to develop context-sensitive responses. However, with multimorbidity still crystallising as a subject of enquiry, there remains considerable heterogeneity in conceptualising multimorbidity across disciplines and fields, hindering coordinated action. In June 2022, 60 researchers, practitioners, and stakeholders with regional expertise from nine sub-Saharan African countries gathered in Blantyre, Malawi to discuss ongoing multimorbidity research across the region. Drawing on insights from disciplines including epidemiology, public health, clinical medicine, anthropology, history, and sociology, participants critically considered the meaning, singular potential, and limitations of the concept of multimorbidity in sub-Saharan Africa. The workshop emphasised  the need to move beyond a disease-centred concept of multimorbidity to one foregrounding patients’ values, needs, and social context; the importance of foregrounding structures and systems rather than behaviour and lifestyles; the value of a flexible (rather than standard) definition of multimorbidity; and the need to leverage local knowledge, expertise, resources, and infrastructure. The …