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2. Collaborative Overview of coronaVIrus impact on ORTHopaedic training in the UK (COVI - ORTH UK)

Author

Abdalla, Samir, A'Court, Jamie, Allport, Jack, Andrew, Stefanie, Ankers, Thomas, Archer, James E., Asp, Rebecka AM., Athanatos, Lambros, Bailey, Morgan, Barrett-Lee, Joe JT., Baxter, Ian, Beaumont, Oliver, Benjamin-Laing, Harry, Bhatty, Usman N., Bleibleh, Sabri, Blong, Jessica, Budair, Basil, Carter, Joseph, Cash, Thomas, Chauhan, Govind S., Choudhry, Nameer, Clegg, Rachael, Collins, Thomas, Crate, Georgina, Cross, George WV., Crosswell, Sebastien CR., Crowther, Ian, Cuthbert, Rory, Dahill, Mark A., Das, Rishi, Edward Davies, Peter Samuel, Dawson, Daniel, Dhadwal, Anil, Dickenson, Edward, Dimock, Richard AC., Dong, Huan, Donnelly, Thomas, Dorman, Sara, Dott, Cameron, D'sa, Prashanth, Dupley, Leanne, Durst, Alexander, Eastley, Nicholas, Ebreo, Darren, Egglestone, Anthony, Evans, Douglas, Fagir, Mohamed, Fenner, Christopher, Ferguson, David, Flannery, Oliver, Fraig, Hossam, Gandham, Surya, Gibson, Catherine, Gillespie, Matthew, Gordon, Robin, Graham, Selina, Grant, Michael J., Gwyn, Rhodri, Haddon, Alexandra, Hamoodi, Zaid, Harris, Luke, Harrison, William D., Hawkes, David H., Hillier, David, Hillier-Smith, Ryan, Hirst, John Timothy, Hodhody, Ghazal, Holmes, David, Houston, James, Hughes, Michael, Ingoe, Helen, Jones, Mark D., Jordan, Stevan, Kang, Hean Wu, Kanya, Luliana, Kapur, Benjamin, Karam, Edward, Kaye, Angus, Kennedy, James, Khan, Mohsin, Khan, Shoaib, Kinnair, Anthony, Knapper, Thomas D., Konarski, Alastair, Sunil Kumar, Karadi Hari, Kurar, Langhit, Kwaees, Tariq, Lennox-Warburton, Hannah, Liaw, Frank, Liew, Ignatius, Limb, Richard, Lin, Zoe, Lloyd, Thomas, Lum, Joann, Luo, Weisang, Lynch, John M., Machin, John T., Maheswaran, Tim, Mahmood, Fahd, Mahmood, Ihsan, Mahmoud, Samer SS., Martin, Rebecca, Matharu, Gulraj S., Matheron, George, McKenna, Raymond, McLoughlin, Kathryn, Mehta, Nisarg, Miller, James, Mohamed, Mohamed, Nagy, Mathias, Navaratnam, Devaraj M., Newman, Michael, Newton, Ashley, Ng, Jimmy, Tun Ngu, Albert Wee, Oputa, Tobenna, Ormsby, Neal, Page, Piers RJ., Panagiotopoulos, Andreas C., Park, Chang, Parkes, Rebekah J., Pearce, Jack, Quarcoopome, Jared, Ramasamy, Ashok, Rashid, Fatima, Rasidovic, Damir, Raval, Parag, Raval, Pradyumna, Reddy, Gautam, Remtulla, Mohammed abbas, Render, Luke, Richardson, Charlotte, Riddlestone, Peter, Riley, James, Rogers, Sophie, Rohman, Lebur, Segaren, Neil, Singh, Abhinav, Singhal, Rohit, Smith, Adam, Stamp, Gregory FW., Stoddart, Michael Thomas, Stoneham, Adam CS., Stoner, Rebecca, Studnicka, Kasia, Tahir, Muaaz, Thiruchandran, Gajendiran, Tonge, Xenia, Unsworth, Richard Mark, Vejsbjerg, Karen A., Wasim, Abdus Samee, Whitham, Robert DJ., Wynell-Mayow, William, Yates, Jonathan, Zreik, Nasri, Chan, Matthew, Jayatilaka, Malwattage Lara Tania, As-Sultany, Mohammed, Gabr, Ayman, Thornton, Luke, Graham, Simon, Mason, Lyndon, and Farrar, Nicholas Greville

Published
2021
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3. The rate of disuse osteopenia in admitted, non‐weight‐bearing patients.

Author

Walley, Kempland C., Farrar, Nicholas R., Muralidharan, Aditya, Monovoukas, Demetri A., Eichman, Jack, Klueh, Michael P., Baumann, Anthony N., Perdue, Aaron M., Hake, Mark E., and Ahn, Jaimo

Subjects
*BONE density, *OSTEOPENIA, *LUMBAR vertebrae, *COMPUTED tomography, *SEDENTARY behavior
Abstract

Disuse osteopenia is a well‐recognized consequence of prolonged physical inactivity, but its rate after orthopaedic injuries necessitating non‐weight‐bearing is not well studied. The purpose of this study was to estimate the rate of disuse osteopenia at the lumbar spine and proximal femur in patients with lower extremity trauma admitted to the hospital. We performed a retrospective chart review of patients with lower extremity trauma with a period of strict non‐weight‐bearing between completion of two computed tomography (CT) scans. The radiodensity of the proximal femur or lumbar vertebrae was measured from the earliest and latest available CT scans within the non‐weight‐bearing timeframe. The change in estimated bone mineral density (eBMD) was calculated as a proxy for disuse osteopenia. A total of 189,111 patients were screened, with 17 patients in the proximal femur group and 15 patients in the lumbar spine group meeting inclusion and exclusion criteria. The average rate of change in eBMD of the proximal femur was a decrease of 7.54 HU/day, 95% confidence interval (CI) [3.65, 11.43]. The average rate of change in eBMD of the lumbar spine was an increase of 1.45 HU/day, 95% CI [−3.15, 6.06]. In admitted, non‐weight‐bearing orthopaedic trauma patients, our novel study suggests that the proximal femur experiences disuse osteopenia during periods of non‐weight‐bearing, although this finding was not observed at the lumbar spine. The clinical significance of this data underscores the important consideration of disuse osteopenia by all physicians when caring for patients that may require non‐weight‐bearing restrictions. [ABSTRACT FROM AUTHOR]

Published
2024
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5. Tacit knowledge, learning and expertise in dry stone walling

Author

Farrar, Nicholas Stewart

Subjects
693.1, LC Special aspects of education, TH Building construction, TA Engineering (General). Civil engineering (General)
Abstract

This is a detailed study of learning in the context of dry stone walling. It examines what happens in the learning situation. The aim of this work was: 'To understand the nature of expertise in dry stone walling, how it is understood by those practising the craft, and how it is transmitted to others'. The main research questions were, therefore: What happens when dry stone wallers are learning their craft? How do they acquire expertise in dry stone walling? How is this learning communicated? This process necessitated developing a way of engaging with the practitioners, eliciting descriptive data about what they were doing, and why they were doing it, through interviews (or conversations) with both individuals and groups, whilst they practiced their skill. Twenty three wailers were interviewed as they worked, building walls. The material obtained was analysed under seven different themes: 'Knowing how' The use of tacit knowledge or intuition 'Flow' Constant decision making, reflection and learning from mistakes Individual and subjective variations and experiences The relevance of emotion The use of 'rules of thumb' or maxims. Learning walling does not fit simply into any of the seven themes. It is contextualised, complex and individual. It demonstrates tacit knowledge and intuition. It involves emotion, sometimes consciously, sometimes not. It involves memory, problem solving, and learning from mistakes, and reflection. Maxims or 'rules of thumb' were a key element in the learning process at all stages. Linear stages of learning were not evidenced. Deep understanding of the practice is evidenced, and the wider learning and teaching implications are explored.

Published
2006

7. Comparison of true blood loss between short and long cephalomedullary nail fixation of geriatric hip fractures, a retrospective cohort study.

Author

Schaffer, Nathaniel E., Singh, Manak, McHugh, Michael A., Perdue, Aaron M., Ahn, Jaimo, MOTR Collaborative, Alford, Andrea I., Davenport, Ryan, Eichman, Jack, Farrar, Nicholas, Fuster, Francisco, Guthrie, S. Trent, Hakeos, William M., Hankenson, Kurt D., Hoegler, Joseph J., Muscatelli, Stefano R., Offerman, Alexandra, Piche, Joshua, Walley, Kempland C., and Weick, Jack

Subjects
ORTHOPEDIC implants, CONFIDENCE intervals, BLOOD transfusion, HIP fractures, RETROSPECTIVE studies, ACQUISITION of data, REGRESSION analysis, COMPARATIVE studies, FRACTURE fixation, MEDICAL records, DESCRIPTIVE statistics, RESEARCH funding, BLOOD loss estimation, ELDER care, LONGITUDINAL method, OLD age
Abstract

Purpose: Existing literature is discrepant on the differences in blood loss and need for transfusion between short and long cephalomedullary nails used for extracapsular geriatric hip fractures. However, prior studies used the inaccurate estimated rather than the more accurate 'calculated' blood loss based on hematocrit dilution (Gibon in IO 37:735–739, 2013, Mercuriali in CMRO 13:465–478, 1996). This study sought to clarify whether use of short nails is associated with clinically meaningful reductions in calculated blood loss and resultant need for transfusion. Methods: A retrospective cohort study using bivariate and propensity score-weighted linear regression analyses was conducted examining 1442 geriatric (ages 60–105) patients undergoing cephalomedullary fixation of extracapsular hip fractures over 10 years at two trauma centers. Implant dimensions, pre and postoperative laboratory values, preoperative medications, and comorbidities were recorded. Two groups were compared based on nail length (greater or less than 235 mm). Results: Short nails were associated with a 26% reduction in calculated blood loss (95% confidence interval: 17–35%; p < 10–14) and a 24-min (36%) reduction in mean operative time (95% confidence interval: 21–26 min; p < 10–71). The absolute reduction in transfusion risk was 21% (95% confidence interval: 16–26%; p < 10–13) yielding a number needed to treat of 4.8 (95% confidence interval: 3.9–6.4) with short nails to prevent one transfusion. No difference in reoperation, periprosthetic fracture, or mortality was noted between groups. Conclusion: Use of short compared to long cephalomedullary nails for geriatric extracapsular hip fractures confers reduced blood loss, need for transfusion, and operative time without a difference in complications. [ABSTRACT FROM AUTHOR]

Published
2023
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10. Maxims, Tacit Knowledge and Learning: Developing Expertise in Dry Stone Walling

Author

Farrar, Nicholas and Trorey, Gill

Abstract

This study attempts to further our understanding of how expertise is acquired in a specific vocational context. Using unstructured interviews with both individuals and groups, carried out whilst engaged in practice, it examines what happens when dry stone wallers are developing their skills, how they gain expertise and how they communicate their learning. It was concluded that learning a craft such as dry stone walling is complex and individual. Learning was clearly contextualised and did not take place in linear stages. The use of maxims or "rules of thumb" was a key element in the learning process, and the use of tacit knowledge and intuition were much in evidence as expertise developed. By questioning whether expertise can be achieved by following a set of rules, or that it progresses in a specific, set direction, the study also highlights the reflective and emotional aspects of becoming an "expert" that are likely to be relevant to other vocational areas.

Published
2008
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11. Anterior Ankle Skin Surface Pressures in Lower Extremity Splints: Minimizing Insult after Injury

Author

Walton, David M., Farrar, Nicholas, Shams, Kameron A., Mell, Kristopher, Holmes, James R., and Talusan, Paul G.

Subjects
body regions, Orthopedic surgery, Article, RD701-811
Abstract

Category: Ankle; Trauma; Other Introduction/Purpose: Though ubiquitously utilized in orthopaedic trauma, lower extremity splints are not without their associated iatrogenic risk of morbidity. In fact, improper splinting not only necessitates replacement, but splint-related soft tissue complications are the second most common iatrogenic cause for referral to plastic surgery. Improper splinting techniques include inadequate molding of plaster/fiberglass splints, inadequate padding over bony prominences, excessive compressive forces from elastic bandages applied too aggressively, and/or pressure areas created by applying padding and casting material in varying joint positions. While clinicians commonly pad bony prominences to minimize skin pressure, the effect of joint position on skin pressure and, more specifically, changing joint position, is understudied. The purpose of this study is to evaluate anterior ankle skin pressure secondary to joint position change during splinting. Methods: Following ethics approval by our institutional review board, various constructs of lower extremity, short-leg splints were applied to two healthy subjects (2 limbs total in this preliminary data set) with an underlying pressure transducer (Tekscan I- Scan system (Tekscan Inc, South Boston, MA, USA) on the skin surface centered on the anterior ankle on the tibialis anterior tendon. All subjects underwent anterior ankle surface pressure assessment when padding was applied in maximum plantar flexion and neutral position for conventional short leg splints application. Percent change from initial contact pressure centered on the tibialis anterior with either Webril (Covidien/Medtronic, Dublin, Ireland), or Specialist Cotton Blend Cast Padding (BSN Medical, Charlotte, NC, USA) were calculated. Neutral position of the foot/ankle will be confirmed with goniometer. Results: There were 2 limbs total that were analyzed for the presentation of pilot data for this study. The percent change in anterior ankle contact pressure when padding was applied in maximum plantarflexion (PF) and then placed in neutral was increased at least two-fold without the addition of plaster and subsequently with the addition of plaster in lower extremity short leg splints (Figure 1). Conclusion: In this pilot data, we report significant increases in anterior ankle contact pressures when splint padding is applied in plantar-flexion and re-positioned into neutral during splint application which may precipitate iatrogenic pressure ulcers in patients sustaining foot/ankle trauma. This data, though preliminary, underscores the importance in proper splinting techniques for all clinicians that manage lower extremity trauma (eg, orthopaedic surgery, emergency medicine, urgent care, etc).

Published
2022

14. Collaborative Overview of coronaVIrus impact on ORTHopaedic training in the UK (COVI - ORTH UK)

Author

Jayatilaka, Malwattage Lara Tania, primary, As-Sultany, Mohammed, additional, Gabr, Ayman, additional, Thornton, Luke, additional, Graham, Simon, additional, Mason, Lyndon, additional, Farrar, Nicholas Greville, additional, Abdalla, Samir, additional, A'Court, Jamie, additional, Allport, Jack, additional, Andrew, Stefanie, additional, Ankers, Thomas, additional, Archer, James E., additional, Asp, Rebecka AM., additional, Athanatos, Lambros, additional, Bailey, Morgan, additional, Barrett-Lee, Joe JT., additional, Baxter, Ian, additional, Beaumont, Oliver, additional, Benjamin-Laing, Harry, additional, Bhatty, Usman N., additional, Bleibleh, Sabri, additional, Blong, Jessica, additional, Budair, Basil, additional, Carter, Joseph, additional, Cash, Thomas, additional, Chauhan, Govind S., additional, Choudhry, Nameer, additional, Clegg, Rachael, additional, Collins, Thomas, additional, Crate, Georgina, additional, Cross, George WV., additional, Crosswell, Sebastien CR., additional, Crowther, Ian, additional, Cuthbert, Rory, additional, Dahill, Mark A., additional, Das, Rishi, additional, Edward Davies, Peter Samuel, additional, Dawson, Daniel, additional, Dhadwal, Anil, additional, Dickenson, Edward, additional, Dimock, Richard AC., additional, Dong, Huan, additional, Donnelly, Thomas, additional, Dorman, Sara, additional, Dott, Cameron, additional, D'sa, Prashanth, additional, Dupley, Leanne, additional, Durst, Alexander, additional, Eastley, Nicholas, additional, Ebreo, Darren, additional, Egglestone, Anthony, additional, Evans, Douglas, additional, Fagir, Mohamed, additional, Fenner, Christopher, additional, Ferguson, David, additional, Flannery, Oliver, additional, Fraig, Hossam, additional, Gandham, Surya, additional, Gibson, Catherine, additional, Gillespie, Matthew, additional, Gordon, Robin, additional, Graham, Selina, additional, Grant, Michael J., additional, Gwyn, Rhodri, additional, Haddon, Alexandra, additional, Hamoodi, Zaid, additional, Harris, Luke, additional, Harrison, William D., additional, Hawkes, David H., additional, Hillier, David, additional, Hillier-Smith, Ryan, additional, Hirst, John Timothy, additional, Hodhody, Ghazal, additional, Holmes, David, additional, Houston, James, additional, Hughes, Michael, additional, Ingoe, Helen, additional, Jones, Mark D., additional, Jordan, Stevan, additional, Kang, Hean Wu, additional, Kanya, Luliana, additional, Kapur, Benjamin, additional, Karam, Edward, additional, Kaye, Angus, additional, Kennedy, James, additional, Khan, Mohsin, additional, Khan, Shoaib, additional, Kinnair, Anthony, additional, Knapper, Thomas D., additional, Konarski, Alastair, additional, Sunil Kumar, Karadi Hari, additional, Kurar, Langhit, additional, Kwaees, Tariq, additional, Lennox-Warburton, Hannah, additional, Liaw, Frank, additional, Liew, Ignatius, additional, Limb, Richard, additional, Lin, Zoe, additional, Lloyd, Thomas, additional, Lum, Joann, additional, Luo, Weisang, additional, Lynch, John M., additional, Machin, John T., additional, Maheswaran, Tim, additional, Mahmood, Fahd, additional, Mahmood, Ihsan, additional, Mahmoud, Samer SS., additional, Martin, Rebecca, additional, Matharu, Gulraj S., additional, Matheron, George, additional, McKenna, Raymond, additional, McLoughlin, Kathryn, additional, Mehta, Nisarg, additional, Miller, James, additional, Mohamed, Mohamed, additional, Nagy, Mathias, additional, Navaratnam, Devaraj M., additional, Newman, Michael, additional, Newton, Ashley, additional, Ng, Jimmy, additional, Tun Ngu, Albert Wee, additional, Oputa, Tobenna, additional, Ormsby, Neal, additional, Page, Piers RJ., additional, Panagiotopoulos, Andreas C., additional, Park, Chang, additional, Parkes, Rebekah J., additional, Pearce, Jack, additional, Quarcoopome, Jared, additional, Ramasamy, Ashok, additional, Rashid, Fatima, additional, Rasidovic, Damir, additional, Raval, Parag, additional, Raval, Pradyumna, additional, Reddy, Gautam, additional, Remtulla, Mohammed abbas, additional, Render, Luke, additional, Richardson, Charlotte, additional, Riddlestone, Peter, additional, Riley, James, additional, Rogers, Sophie, additional, Rohman, Lebur, additional, Segaren, Neil, additional, Singh, Abhinav, additional, Singhal, Rohit, additional, Smith, Adam, additional, Stamp, Gregory FW., additional, Stoddart, Michael Thomas, additional, Stoneham, Adam CS., additional, Stoner, Rebecca, additional, Studnicka, Kasia, additional, Tahir, Muaaz, additional, Thiruchandran, Gajendiran, additional, Tonge, Xenia, additional, Unsworth, Richard Mark, additional, Vejsbjerg, Karen A., additional, Wasim, Abdus Samee, additional, Whitham, Robert DJ., additional, Wynell-Mayow, William, additional, Yates, Jonathan, additional, Zreik, Nasri, additional, and Chan, Matthew, additional

Published
2021
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15. Treatment Patterns for Distal Radius Fractures Before and After Appropriate Use Criteria Adoption.

Author

Samade, Richard, Zaki, Omar, Farrell, Nolan, Farrar, Nicholas, and Goyal, Kanu S.

Abstract

Background: The purpose of this study was to determine agreement with the American Academy of Orthopaedic Surgery Appropriate Use Criteria (AUC) for distal radius fractures (DRFs), before and after their adoption, and secondarily determine predictors of operative management. Methods: A single-institution retrospective cohort study comparing patients treated either nonoperatively (115 patients) or operatively (767 patients) for DRFs between May 1, 2008, and May 1, 2018, by 8 hand surgeons was performed. Data included demographics, injury characteristics, DRF radiographic measurements, treatment rendered, and their appropriateness according to the AUC. Statistical testing used the Fisher and χ2 tests, t test, and multiple variable logistic regression, with a significance level of.05. Results: Overall, there was a significant increase in AUC agreement for operatively treated DRFs (82.7%-89.3%, P =.01), but no difference in agreement for nonoperatively treated DRFs (12.5%-10.7%, P =.77). Age <80 years, AO classes other than B, intra-articular displacement >1 mm, radial inclination <18°, high-energy mechanism of injury, and greater than 1 week to treatment were independent predictors of operative treatment. The area under the curve for the validated regression model using the aforementioned predictors was 0.82. Conclusion: Agreement with AUC for DRFs increased after its adoption for operatively treated, but not for nonoperatively treated, fractures. In addition, a predictive model for operative treatment was developed and validated. Future studies may benefit from further model refinement and testing in other patient cohorts. [ABSTRACT FROM AUTHOR]

Published
2022
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19. Complete Killing of Agar Lawn Biofilms by Systematic Spacing of Antibiotic-Loaded Calcium Sulfate Beads

Author

Dusane, Devendra H., primary, Brooks, Jacob R., additional, Sindeldecker, Devin, additional, Peters, Casey W., additional, Li, Anthony, additional, Farrar, Nicholas R., additional, Diamond, Scott M., additional, Knecht, Cory S., additional, Plaut, Roger D., additional, Delury, Craig, additional, Aiken, Sean S., additional, Laycock, Phillip A., additional, Sullivan, Anne, additional, Granger, Jeffrey F., additional, and Stoodley, Paul, additional

Published
2019
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26. Tacit knowledge, learning and expertise in dry stone walling

Author

Farrar, Nicholas Stewart

Subjects
TA, LC, TH
Abstract

This is a detailed study of learning in the context of dry stone walling. It examines\ud what happens in the learning situation. The aim of this work was:\ud 'To understand the nature of expertise in dry stone walling, how it is understood\ud by those practising the craft, and how it is transmitted to others'.\ud \ud \ud The main research questions were, therefore:\ud \ud What happens when dry stone wallers are learning their craft?\ud \ud How do they acquire expertise in dry stone walling?\ud \ud How is this learning communicated?\ud \ud \ud This process necessitated developing a way of engaging with the practitioners,\ud eliciting descriptive data about what they were doing, and why they were doing it,\ud through interviews (or conversations) with both individuals and groups, whilst\ud they practiced their skill. Twenty three wailers were interviewed as they worked,\ud building walls.\ud \ud \ud The material obtained was analysed under seven different themes:\ud \ud 'Knowing how'\ud \ud The use of tacit knowledge or intuition\ud \ud 'Flow'\ud \ud Constant decision making, reflection and learning from mistakes\ud \ud Individual and subjective variations and experiences\ud \ud The relevance of emotion\ud \ud The use of 'rules of thumb' or maxims.\ud \ud \ud Learning walling does not fit simply into any of the seven themes. It is\ud contextualised, complex and individual. It demonstrates tacit knowledge and\ud intuition. It involves emotion, sometimes consciously, sometimes not. It involves\ud memory, problem solving, and learning from mistakes, and reflection. Maxims or\ud 'rules of thumb' were a key element in the learning process at all stages. Linear\ud stages of learning were not evidenced. Deep understanding of the practice is\ud evidenced, and the wider learning and teaching implications are explored.

27. With Respect to Old Age: Long Term Care--Rights and Responsibilities (Book).

Author

Farrar, Nicholas S.

Subjects
GREAT Britain. Royal Commission on Long Term Care, ELDER care, NONFICTION
Abstract

The article reviews the book "With Respect to Old Age: Long Term Care--Rights and Responsibilities, (volumes 1, 2 & 3)," by the Royal Commission on Long Term Care.

Published
2000

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