John O'Byrne - Academia.edu (original) (raw)

Papers by John O'Byrne

Irish Journal of Medical Science (1971 -), 2017

IntroductionThe General Medical Council (GMC) of the UK states that doctors have a duty to train ... more IntroductionThe General Medical Council (GMC) of the UK states that doctors have a duty to train and contribute to the education of colleagues, and that those involved in formal clinical teaching should have a teaching qualification.ObjectivesWe sought to evaluate the current levels of engagement of surgical trainees and recently appointed surgical consultants in clinical teaching.MethodsAll trainees who commenced a basic or higher surgical training post during or after 2007 were invited to participate. The electronic questionnaire was administered using the survey tool GetFeedback, collecting information regarding subspecialty, current role, quantity of teaching that respondents engaged in and who they taught and teaching motivations and barriers.ResultsThere were 128 respondents out of 358 invitations to participate (36% response rate). Less than half (39%) of respondents had attended formal courses on clinical education. Over 70% of respondents engaged in clinical teaching for two or more hours each week. A lack of time and resources were noted as barriers to engaging in teaching. We found a low number of those involved in teaching seeking feedback after teaching sessions.ConclusionIn surgery, the apprenticeship model is still the framework for developing the surgeons of the future. In attempting to produce a highly skilled workforce for the future, we rely on those in senior positions to train those coming through; higher surgical trainees are relied on to teach the core surgical trainees and so on. Our study shows a low level of formalisation of this model.

Journal of Obstetrics and Gynaecology, 2015

The art of symphysiotomy for delivery in the instance of cephalopelvic disproportion has been a d... more The art of symphysiotomy for delivery in the instance of cephalopelvic disproportion has been a dying art since the advent of caesarean section but in Ireland this surgical procedure was not abolished until 1992. This practice is still present in the developing world and in some circumstances used in developed countries. This study offers some insights on the 40-year follow-up of patients who had undergone symphysiotomy.

$Research paper thumbnail of Computational modelling of long bone fractures fixed with locking plates - How can the risk of implant failure be reduced?$

Journal of orthopaedics, 2013

The Locking Compression Plate (LCP) is part of a new plate generation requiring an adapted surgic... more The Locking Compression Plate (LCP) is part of a new plate generation requiring an adapted surgical technique and new thinking about commonly used concepts of internal fixation using plates. Knowledge of the fixation stability provided by these new plates is very limited and clarification is still necessary to determine how the mechanical stability and the risk of implant failure can best be controlled. Upon validation, a finite element model of an LCP attached to a cylinder was developed to simulate and analyse the biomechanics of a transverse long bone fracture fixed with a locking plate. Of special interest were the factors influencing the mechanical conditions at the fracture site, the control of interfragmentary movement and implant failure. Several factors were shown to influence stability in compression. Increasing translation and/or fracture angle post fixation reduced construct stability. Axial stiffness was also influenced by the working length and plate-bone distance. The...

The Journal of bone and joint surgery. British volume, 2011

We developed a method of applying vibration to the impaction bone grafting process and assessed i... more We developed a method of applying vibration to the impaction bone grafting process and assessed its effect on the mechanical properties of the impacted graft. Washed morsellised bovine femoral heads were impacted into shear test rings. A range of frequencies of vibration was tested, as measured using an accelerometer housed in a vibration chamber. Each shear test was repeated at four different normal loads to generate stress-strain curves. The Mohr-Coulomb failure envelope from which shear strength and interlocking values are derived was plotted for each test. The experiments were repeated with the addition of blood in order to replicate a saturated environment. Graft impacted with the addition of vibration at all frequencies showed improved shear strength when compared with impaction without vibration, with 60 Hz giving the largest effect. Under saturated conditions the addition of vibration was detrimental to the shear strength of the aggregate. The civil-engineering principles of...

Osteoarthritis and Cartilage, 2009

Conclusions: The HJL shows efficacy and safety in patients with symptomatic hip OA. We can consid... more Conclusions: The HJL shows efficacy and safety in patients with symptomatic hip OA. We can consider it as a low cost alternative treatment for OA. It is performed quickly, in 30 minutes, and there are not serious complications.

Irish Journal of Medical Science, 2013

Irish Journal of Medical Science, 2012

Background We designed, implemented and assessed an interactive musculoskeletal teaching module f... more Background We designed, implemented and assessed an interactive musculoskeletal teaching module for fourthyear medical students. Over a 2-week period, students followed a programme of alternating lectures, interactive tutorials, case discussions, clinical examination and 'how to do' sessions using patients and clinical models. Methods Over a 4-month period, 140 fourth-year medical students rotated for 2 weeks through a new interactive musculoskeletal teaching module in an elective orthopaedic hospital. To assess the impact of our module, a basiccompetency examination in musculoskeletal medicine was developed and validated. Each student completed the examination on the first and last days of the module. We also assessed musculoskeletal basic knowledge in students from a different medical school, receiving a classic lecturing programme. Results In the pre-course assessment, only 20 % of students achieved an overall pass rate. The pass rate increased to 85 % in post-course examination. Students found particularly beneficial the interactive tutorial approach, with 48 % finding this to be the single most effective teaching method. When compared with students who completed a classic lecturing programme, students attending our interactive module scored higher in all aspects of musculoskeletal knowledge. Significance This study highlights the benefits and need for more interactive teaching of musculoskeletal medicine in medical schools.

Irish Journal of Medical Science, 1992

Imperfections of continence do occur following low anterior resection (LAR), and may present with... more Imperfections of continence do occur following low anterior resection (LAR), and may present with increased stool frequency or varying degrees of incontinence. This impaired continence has been related to a fall in resting anal sphincteric pressure and may be secondary to a direct injury to the sphincter during transana] passage of the stapling device, or damage to its nerve supply at rectal mobilisation. We have studied the relative contribution of each mechanism to this anal sphineteric impairment, by comparing handsewn anastomoses (n = 7) to transanal stapled anastomoses (n = 7), in 14 dogs undergoing LAR. Anorectal manometry was performed preoperatively, and again on the 10th postoperative day. Resting anal pressure was significantly reduced after both stapled anastomoses (prcop 49 (+3) mmHg; postop 20 (+4) mmHg p<O.O01), and handsewn anastomoses (prcop 46 (i4) mmHg; postop 35 (+4) mmHg p<0.0I). This reduction in postoperative resting anal pressure was more marked in the stapled group who sustained a 60% reduction relative to a 24% reduction in the handsewn group (p < 0.05). A reduction in resting anal canal pressure would appear to be an inevitable consequence of a rectal sphincter saving resection, whether tramanal manipulation is necessary or not. Damage to its parasympathetic innervationis responsible for theintemal sphincter dysfunction which follows a handsewn LAR. The additional pressure drop after a stapled anastomosis is most likely due to peranal manipulation trauma to the internal sphincter. Preoperative manometry may identify patients at high risk of developing a postoperative continence problem in whom avoidance of transanal instrumentation may be desirable.

International Orthopaedics, 2006

Infection remains a devastating complication of joint replacement surgery causing a significant b... more Infection remains a devastating complication of joint replacement surgery causing a significant burden to both patient and surgeon. However, despite exhaustive prophylactic measures, intraoperative contamination still occurs during cemented arthroplasty with current infection rates of 1-2%. A study was undertaken to determine the incidence of perioperative contamination in cemented arthroplasty patients, to identify contaminating organisms, to identify contaminated regions within the operative wound, to identify factors associated with increased contamination, and finally to assess the medium-term clinical outcome in patients with confirmed intraoperative wound contamination. Eighty consecutive patients undergoing hip and knee cemented arthroplasty were prospectively enrolled over a 6-month period. All scrubbed personnel wore total body exhaust isolation suits and procedures were carried out in ultra-clean air theatres. Of 441 samples, contamination was identified at 21 sites (4.8%) representing a cohort of 18 patients (22.5%). Longer duration of surgery predisposed to higher contamination rates while lower contamination rates were significantly related to fewer gowned personnel within the ultra-clean system, and fewer total personnel in theatre during the procedure. None of the patients developed clinical evidence of deep prosthetic infection at follow-up. We noted a high incidence of intraoperative contamination despite standard prophylaxis. However, this was not reflected by a similar rate of postoperative infection. This may be due to a small bacterial inoculum in each case or may be due to the therapeutic effect of perioperative intravenous antibiotic prophylaxis. taux élevé de contaminations opératoires malgré les précautions prophylactiques ne se retrouve pas dans un taux similaire d'infections post-opératoires. Ceci est peut-être due à la petitesse de l'inoculum bactérien dans chaque cas ou encore à l'effet thérapeutique de l'antibiothérapie prophylactique intra-veineuse.

Irish Journal of Medical Science, 1991

Non-specific abdominal pain (NSAP) is a well-recognized clinical problem which places a significa... more Non-specific abdominal pain (NSAP) is a well-recognized clinical problem which places a significant burden on health resources. We studied 100 premenopausal women who were admitted consecutively through the Accident and Emergency Department of the Mater Misericordiae Hospital to assess final diagnosis, duration of hospital stay, extent of investigation, recurrence of symptoms and final diagnosis. The patients were placed in the following diagnostic categories: Gynaecological (30%), Renal (9%), Acute appendicitis (23%), Miscellaneous (9%) and Non-specific abdominal pain which accounted for 29% of the admissions. The mean duration of hospital stay for patients with NSAP was 67 days, one third underwent specialized investigations and one third underwent appendicectomies for normal appendices. On review, one year after admission, 66% of patients admitted with NSAP were asymptomatic.

Orthopaedic Proceedings, Mar 1, 2006

Background Presentations at national meetings provide an important forum to relay research findin... more Background Presentations at national meetings provide an important forum to relay research findings in all areas of Orthopaedic surgery. Orthopaedic surgical trainees are encouraged throughout the training process to participate, present and ultimately publish their research. Indeed the well known mantra ‘Publish or Perish’ signifies the pressure trainees are sometimes placed under in order to achieve professional success. The number of original published papers is often the yardstick by which professional appointments are made. We aimed to determine the overall publication rates of presentations from the 2001 and 2002 Irish Orthopaedic Association meetings and to determine whether publication rates differed among other national Orthopaedic meetings and amongst the subspecialties. Methods A comprehensive literature review was conducted using the proceedings of the 2002 & 2003 IOA meetings using Pubmed and Medline. Time to publication, orthopaedic subspecialty and journal was analyse...

Background Meticillin-resistant Staphylococcus aureus (MRSA) are endemic in hospitals throughout ... more Background Meticillin-resistant Staphylococcus aureus (MRSA) are endemic in hospitals throughout Ireland and present a major concern in hospital hygiene causing significant morbidity, mortality and imposing a significant financial burden. This is particularly true in the field of orthopaedic surgery where a nosocomial MRSA infection can prove catastrophic to a patient9s recovery from surgery. Much has been made of the possibility of healthcare workers acting as vectors for the transmission of MRSA and other pathogenic bacteria in the hospital setting. This focus has led to the implementation of strict hand decontamination policies in hospitals in order to counter the possibility of staff - patient transmission of such bacteria. Investigations have also attempted to assess the bacterial contamination of work uniforms such as white coats, ties and scrubs. An area that has been generally overlooked however, is the assessment of the bacterial contamination some of the most commonly hand...

Knee Surgery, Sports Traumatology, Arthroscopy, 2021

Purpose Unicompartmental knee arthroplasty (UKA) provides patients with an alternative treatment ... more Purpose Unicompartmental knee arthroplasty (UKA) provides patients with an alternative treatment to TKA in isolated medial compartment osteoarthritis providing better functional outcomes and faster recovery in the short term. Our aim was to quantify revision rates, predictors of revision, mortality rate and functionality of the Oxford Phase 3 UKA in a non-designer institution. Methods This was a retrospective review of prospectively collected regional registry data. All Oxford Phase 3 UKAs performed for medial tibio-femoral osteoarthritis of the knee joint were included from a single academic institution between the period of January 1st 2006 and December 30th 2009. Kaplan-Meier survivorship curves adjusting for loss to follow-up and deceased patients were generated. Primary outcome variables included all-cause and aseptic revision. Secondary outcome variables included functional outcome scores. Patients were reviewed at 6 months, 2 years, 5 years, 10 years and 15 years. Results A t...

European Journal of Orthopaedic Surgery & Traumatology, 2006

Urinary retention following total hip and knee arthroplasty is a common problem, frequently requi... more Urinary retention following total hip and knee arthroplasty is a common problem, frequently requiring catheterisation in the immediate post-operative period. The direct relationship between urinary tract instrumentation and deep sepsis in total hip replacements is well documented. This prospective study analysed 164 male patients who underwent primary arthroplasty between September 2004 and March 2005 inclusive. Upon admission and prior to surgery, all patients answered an eight-point urinary symptom questionnaire and were tested on their ability to micturate while supine. Thirtythree patients required urinary catheterisation, 131 did not. The mean age of the catheterised group was 71.4 years and the non-catheterised group was 63.6 years (P<0.001). There was no difference in blood loss between the two groups. With regards to the symptom questionnaire, the mean score in the catheter group was 4.1 and the non-catheter group was 1.8 (P<0.001). The ability to micturate in a supine position was of no predictive value with 23 patients in the catheter group able to do so. These results show the value of a urinary symptom questionnaire used pre-operatively in predicting those who may require post-operative urinary catheterisation. By appropriate use of this tool, patients with potential for post-operative retention may be identified before surgery. Keywords Infection AE Total hip replacement AE Urinary catheterisation Ne´cessite´de cathe´ter ve´sical post-ope´ratoire pre´coce dans les arthroplasties de premie`re intention

The Foot, 1996

This paper describes the technique and outcome of the manipulation and strapping of idiopathic cl... more This paper describes the technique and outcome of the manipulation and strapping of idiopathic clubfoot, using malleable aluminium finger splints in the neonatal period. We report the results of treating 103 feet, over a consecutive 9-year period. Surgery was required in 59 feet (57%) over a follow-up period of 4 years and 10 months. The splint complication rate was 4%. The advantages of the splinting method are discussed. This is the first report of the results of this particular technique.

The bone & joint journal, 2013

Peri-prosthetic osteolysis and subsequent aseptic loosening is the most common reason for revisin... more Peri-prosthetic osteolysis and subsequent aseptic loosening is the most common reason for revising total hip replacements. Wear particles originating from the prosthetic components interact with multiple cell types in the peri-prosthetic region resulting in an inflammatory process that ultimately leads to peri-prosthetic bone loss. These cells include macrophages, osteoclasts, osteoblasts and fibroblasts. The majority of research in peri-prosthetic osteolysis has concentrated on the role played by osteoclasts and macrophages. The purpose of this review is to assess the role of the osteoblast in peri-prosthetic osteolysis. In peri-prosthetic osteolysis, wear particles may affect osteoblasts and contribute to the osteolytic process by two mechanisms. First, particles and metallic ions have been shown to inhibit the osteoblast in terms of its ability to secrete mineralised bone matrix, by reducing calcium deposition, alkaline phosphatase activity and its ability to proliferate. Secondl...

Journal of Pediatric Orthopaedics, 1997

Sixteen patients with cerebral palsy causing equinovarus deformity were treated surgically. All o... more Sixteen patients with cerebral palsy causing equinovarus deformity were treated surgically. All of these patients underwent preoperative gait analysis by using a CODA-3 motion analyzer. The equinus deformity was assessed by using sagittal kinematics, and in particular, the range of movement of the ankle during stance phase and the maximal dorsiflexion during swing. The varus deformity was assessed by the degree of varus of the foot at prepositioning. The degree of varus was obtained by measuring the angle generated between the plane of progression and a line joining a marker on the heel to a marker on the fifth metatarsal in the transverse plane. All patients underwent split tibialis posterior tendon transfer and, in 13, this was combined with tendo calcaneus lengthening. Clinical assessment and gait analysis repeated 1 year postoperatively confirmed good outcome after split tibialis posterior tendon transfer in combination with gastrocnemius lengthening. This was confirmed by using sagittal kinematic analysis and quantitative assessment of the degree of varus of the foot at the time of prepositioning.

Journal of Child Neurology, 1998

Gait disorders in cerebral palsy can be accurately analyzed using the CODA-3 system presenting qu... more Gait disorders in cerebral palsy can be accurately analyzed using the CODA-3 system presenting quantitative data representing movement of the hip, knee, and ankle in the sagittal plane. We describe a technique that classifies abnormal gait automatically on the basis of sagittal kinematic data. Fifty-five hemiplegic and 91 diplegic patients were analyzed using an opto-electronic scanner (CODA-3). The sagittal kinematics of the affected limb in hemiplegics correlated with those of both affected limbs in diplegics. We introduce the concept of the "plegic limb." Sagittal kinematics of 237 affected limbs were studied using cluster statistical analysis. Eight clear groups emerged. The predominant clinical features, typical of each group, were identified and described (eg, stiff leg gait, genu recurvatum, or crouch gait). We propose this classification system as a new technique to use gait analysis data to automatically classify abnormal movements of the lower limb in cerebral pa...

Journal of Bone and Joint Surgery - British Volume, 2010

Orthopaedic surgery is in an exciting transitional period as modern surgical interventions, impla... more Orthopaedic surgery is in an exciting transitional period as modern surgical interventions, implants and scientific developments are providing new therapeutic options. As advances in basic science and technology improve our understanding of the pathology and repair of musculoskeletal tissue, traditional operations may be replaced by newer, less invasive procedures which are more appropriately targeted at the underlying pathophysiology. However, evidence-based practice will remain a basic requirement of care. Orthopaedic surgeons can and should remain at the forefront of the development of novel therapeutic interventions and their application. Progression of the potential of bench research into an improved array of orthopaedic treatments in an effective yet safe manner will require the development of a subgroup of specialists with extended training in research to play an important role in bridging the gap between laboratory science and clinical practice. International regulations reg...