Abhilash Jain - Academia.edu (original) (raw)

Papers by Abhilash Jain

British Journal of Surgery, Jul 27, 2022

$Research paper thumbnail of Improving the care of patients with severe open fractures of the tibia$

The bone & joint journal, Mar 1, 2016

The management of open lower limb fractures in the United Kingdom has evolved over the last ten y... more The management of open lower limb fractures in the United Kingdom has evolved over the last ten years with the introduction of major trauma networks (MTNs), the publication of standards of care and the wide acceptance of a combined orthopaedic and plastic surgical approach to management. The aims of this study were to report recent changes in outcome of open tibial fractures following the implementation of these changes.

$Research paper thumbnail of Management of extra-articular fractures of the fifth metacarpal: Operative vs. Non-opeRaTive TrEatment (FORTE) – A systematic review and meta-analysis$

JPRAS Open, Jun 1, 2019

Aims: Extra-articular fifth metacarpal fractures are treated operatively and non-operatively with... more Aims: Extra-articular fifth metacarpal fractures are treated operatively and non-operatively without consensus. We aim to establish whether there are differences in patient-reported outcome, objective clinical outcome and adverse events for skeletally mature patients with closed extra-articular fractures of the 5th metacarpal that are treated operatively versus non-operatively.

Physiotherapy, Dec 1, 2021

BMJ Open, Mar 1, 2021

Objective Prioritisation of important treatment uncertainties for 'Common Conditions Affecting th... more Objective Prioritisation of important treatment uncertainties for 'Common Conditions Affecting the Hand and Wrist' via a UK-based James Lind Alliance Priority Setting Partnership. Setting This process was funded by a national charitable organisation and based in the UK. Participants Anyone with experience of common conditions affecting the adult hand and wrist, including patients, carers and healthcare professionals. All treatment modalities delivered by a hand specialist, including therapists, surgeons or other allied professionals, were considered. Interventions Established James Lind Alliance Priority Setting Partnership methods were employed. Electronic and paper questionnaires identified potential uncertainties. These were subsequently confirmed using relevant, up-to-date systematic reviews. A final list of top 10 research uncertainties was developed via a faceto-face workshop with representation from patients and clinicians. Impact of research was sought by surveying hand clinicians electronically. Outcome measures The survey responses and prioritisation-both survey and workshop based. Results There were 889 individually submitted questions from the initial survey, refined to 59 uncertainties across 32 themes. Eight additional uncertainties were added from published literature before prioritisation by 261 participants and the workshop allowed the final top 10 list to be finalised. The top 10 has so far contributed to the award of over £3.8 million of competitively awarded funding. Conclusions The Common Conditions in the Hand and Wrist Priority Setting Partnership identified important research questions and has allowed research funders to identify grant applications which are important to both patients and clinicians

British Journal of Surgery, Mar 1, 2021

Introduction: Dupuytren's diathesis describes an aggressive disease course with tendency for recu... more Introduction: Dupuytren's diathesis describes an aggressive disease course with tendency for recurrence or extension following intervention. Conventional factors associated with Dupuytren's diathesis are ethnicity, family history, bilateral and ectopic disease. Disease recurrence is not the only cause of poor outcome following intervention. This systematic review aimed to identify all factors that have been investigated for a potential association with the development, progression, recurrence and outcome of treatment in Dupuytren's diathesis. Method: A systematic review of MEDLINE, EMBASE and CINAHL using a PRISMA-compliant methodology up to February 2019 was conducted. Abstract screening and data extraction were performed in duplicate. Included prognostic cohort studies were quality assessed using the Quality in Prognosis Study tool. Result: The search revealed 2,661 records from which 11 full text articles reported both conventional diathesis factors and outcomes (in addition to recurrence) following intervention for Dupuytren's in 938 patients. Collectively 67% underwent fasciectomy and seven outcomes were reported: three patient reported outcome measures (DASH, quick-DASH and EQ-5D), three functional measures (grip strength, joint angle correction and range of motion) and treatment complications. Two studies used multiple univariate statistical techniques and found no significant association between diathesis factors and disease outcome. Conclusion: This systematic review challenges conventional notions of Diathesis factors and provides a comprehensive appraisal of factors associated with poor outcome following intervention for Dupuytren's disease. Take-home message: Conventional factors associated with recurrence in Dupuytren's disease are not associated with poor outcome following intervention.

BMJ evidence-based medicine, Apr 12, 2019

Recruitment to clinical trials requires efficient and timely identification of suitable participa... more Recruitment to clinical trials requires efficient and timely identification of suitable participants. Trial coordination and recruitment can be difficult in practice and can result in appropriate participants being missed. Communication between the core trial team and the recruiters ‘on the ground’ ensures all potentially eligible participants are identified and approached for recruitment.1 Much has been published regarding the use of smartphone-based communication tools in clinical care, including considerations of clinical governance and data. We present our experience of using the smartphone communication app: ‘WhatsApp’ to manage the logistics of a surgical randomised controlled trial. WhatsApp is advantageous in that it is easy to download and operate2 given that 80%–98% of clinicians own a smartphone,3 4 Furthermore, unlike email, it is an immediate communication tool with the potential for multiple group conversations with members able to contribute simultaneously and contemporaneously. It is also inclusive of all trial team members allowing everyone to be updated with the trial progress and ‘on-the-ground’ issues in real time. Our experience is drawn from the observation of two UK-based plastic surgery tertiary centres running a multicentre hand trauma surgery trial involving paediatric patients: The Nail bed INJury …

$Research paper thumbnail of Microbiological and functional outcomes after open extremity fractures sustained overseas: The experience of a UK level I trauma centre$

JPRAS Open, Mar 1, 2018

Conclusion: Patients with open extremity fractures transferred from overseas present the unique c... more Conclusion: Patients with open extremity fractures transferred from overseas present the unique challenge of poly-microbial infection in addition to extensive traumatic wounds. Favourable outcomes can be achieved despite positive microbiological findings on tissue culture with adequate antimicrobial therapy. The decision to salvage the limb and the complexity of reconstruction used should be based on the chance of achieving meaningful functional recovery, mainly determined by the extent of bony injury. The complexity of reconstruction was based on the predicted long-term functionality of the salvaged limb.

Annals of The Royal College of Surgeons of England, 2020

INTRODUCTION Achieving a standard of clinical research at the pinnacle of the evidence pyramid is... more INTRODUCTION Achieving a standard of clinical research at the pinnacle of the evidence pyramid is historically expensive and logistically challenging. Research collaboratives have delivered high-impact prospective multicentre audits and clinical trials by using trainee networks with a range of enabling technology. This review outlines such use of technology in the UK and provides a framework of recommended technologies for future studies. METHODS A review of the literature identified technology used in collaborative projects. Additional technologies were identified through web searches. Technologies were grouped into themes including access (networking and engagement), collaboration and event organisation. The technologies available to support each theme were studied further to outline relative benefits and limitations. FINDINGS Thirty-three articles from trainee research collaboratives were identified. The most frequently documented technologies were social media applications, website platforms and research databases. The Supportive Technologies in Collaborative Research framework is proposed, providing a structure for using the technologies available to support multicentre collaboration. Such technologies are often overlooked in the literature by established and start-up collaborative project groups. If used correctly, they might help to overcome the physical, logistical and financial barriers of multicentre clinical trials.

Journal of Plastic Reconstructive and Aesthetic Surgery, Sep 1, 2018

Conclusion This is the first UK evaluation of SNOM-PET. It may be safely utilized for LL PET. UL ... more Conclusion This is the first UK evaluation of SNOM-PET. It may be safely utilized for LL PET. UL PET should be surgically explored. SNOM-PET may avoid unwarranted surgical exploration, associated complications and cost.

British Journal of Dermatology, Sep 16, 2020

 6 local recurrences were found in the WLE group and 0 in the MMS group.  In individuals with p... more  6 local recurrences were found in the WLE group and 0 in the MMS group.  In individuals with primary DFSP who underwent WLE, complete histological clearance occurred less frequently at the first attempt (81.4%) compared to those who were treated with MMS (86.6%).

British Journal of Surgery

Lay Summary Every year in the UK, around 10 000 children need to have operations to mend injuries... more Lay Summary Every year in the UK, around 10 000 children need to have operations to mend injuries to the bed of their fingernails. Currently, most children have their fingernail placed back on the injured nail bed after the operation. The NINJA trial found that children were slightly less likely to have an infection if the nail was thrown away rather than being put back, but the difference between groups was small and could have be due to chance. This study looked at whether replacing the nail is cost-effective compared with throwing it away. Using data from the NINJA trial, we compared costs, healthcare use, and quality of life and assessed the cost-effectiveness of replacing the nail. It was found that throwing the nail away after surgery would save the National Health Service (NHS) £75 (€85) per operation compared with placing the nail back on the nail bed. Changing clinical practice could save the NHS in England £720 000 (€819 000) per year.

$Research paper thumbnail of International Lower Limb Collaborative (INTELLECT) study: a multicentre, international retrospective audit of lower extremity open fractures$

British Journal of Surgery

Sixty-two centres in 16 countries contributed with 2,694 open fractures cases to an international... more Sixty-two centres in 16 countries contributed with 2,694 open fractures cases to an international, multi-centric, retrospective cohort study involving different healthcare settings. The INTELLECT study results show that there are significant disparities on the management of open lower limb fractures internationally. A timely, multidisciplinary, guideline-directed care is a protective factor for developing infective complications, non-union and requiring an amputation.

JPRAS Open, 2021

The incidence of open tibia/fibula fractures in the elderly is increasing, but current national g... more The incidence of open tibia/fibula fractures in the elderly is increasing, but current national guidelines focus on the aggressive treatment of high-energy injuries in younger patients. There is conflicting evidence regarding whether older age affects treatment provision and outcomes in open fractures. The aim of this study was to determine if elderly patients are sustaining a different injury to younger patients and how their treatment and outcomes differ. This may have implications for future guidelines and verify their application in the elderly. In this retrospective single centre cohort study (December 2015–July 2018), we compared the injury characteristics, operative management and outcomes of elderly (≥65 years) and younger (18–65 years) patients with open tibia/fibula fractures. An extended cohort examined free flap reconstruction. In total, 157 patients were included. High-energy injuries were commoner in younger patients (88% vs 37%; p<0.001). Most were Gustilo-Anderson IIIb in both age groups. Elderly patients waited longer until debridement (21:19 vs 19:00 h) and had longer inpatient stays (23 vs 15 days). There was no difference in time to antibiotics, operative approach or post-operative complications. Despite the low-energy nature of elderly patients’ injuries, the severity of soft tissue insult was equivalent to younger patients with high-energy injuries. Our data suggest that age and co-morbidities should not prohibit lower limb reconstruction. The current application of generic guidelines appears suitable in the elderly, particularly in the acute management. We suggest current management pathways and targets be reviewed to reflect the greater need for peri-operative optimisation and rehabilitation in elderly patients.

British Journal of Dermatology, 2020

This is a repository copy of Incomplete surgical excision of keratinocyte skin cancers: a systema... more This is a repository copy of Incomplete surgical excision of keratinocyte skin cancers: a systematic review and meta-analysis..

ObjectivesThis systematic review aims to assess the quality of literature supporting surgical int... more ObjectivesThis systematic review aims to assess the quality of literature supporting surgical interventions for paediatric extravasation injury and to determine and summarize their outcomes.MethodsWe performed a systematic review by searching Ovid MEDLINE and EMBASE as well as AMED, CINAHL, Cochrane Central Register of Controlled Trials (CENTRAL), Cochrane Database of Systematic Reviews andclinicaltrials.govfrom inception to February 2019. All studies other than case reports were eligible for inclusion if the population was younger than 18 years old, there was a surgical intervention aimed at treating extravasation injury and they reported on outcomes. Risk of bias was graded according to the National Institutes of Health (NIH) study quality assessment tools.Results26 studies involving 728 children were included – one before-and-after study and 25 case series. Extravasation injuries were mainly confined to skin and subcutaneous tissues but severe complications were also encountered,...

Plastic and Reconstructive Surgery - Global Open, 2019

Background: There are a number of site-specific patient-reported outcome measures (PROMs) for han... more Background: There are a number of site-specific patient-reported outcome measures (PROMs) for hand conditions used in clinical practice and research for assessing the efficacy of surgical and nonsurgical interventions. The most commonly used hand-relevant PROMs are as follows: Disabilities of the Arm, Shoulder and Hand (DASH), QuickDASH (qDASH), Michigan Hand Questionnaire (MHQ), Patient Evaluation Measure (PEM), Upper Extremity Functional Index (UEFI), and Duruoz Hand Index (DHI). There has been no systematic evaluation of the published psychometric properties of these PROMs. Methods: A PRISMA-compliant systematic review of the development and validation studies of these hand PROMs was prospectively registered in PROSPERO and conducted to assess their psychometric properties. A search strategy was applied to Medline, Embase, PsycINFO, and CINAHL. screening was performed in duplicate. Assessment of psychometric properties was performed. Results: The search retrieved 943 articles, of...

BMJ Evidence-Based Medicine, 2019