George Zafiropoulos | University of South Wales (original) (raw)

Papers by George Zafiropoulos

From 1998–2000 inclusive, we treated 155 acute, non-pathological fractures of the clavicle in adu... more From 1998–2000 inclusive, we treated 155 acute, non-pathological fractures of the clavicle in adults. We reviewed 134, of which 95 were involving the middle third. The average time of follow-up was 24 months (range 9–33). Aim of this retrospective study was to review the results of operative versus conservative treatment in a view to create a standard protocol for these fractures management. Men accounted 67 the average age being 26.8 (range 15–83) and 28 were women with average age 36.8 (range 23–91). We operated on 23 patients: 3 due to neurological symptoms of C6 nerve root irritation, 4 due to a symptomatic non-union, 10 due to severe displacement and comminution with pressure on the overlying skin and 6 due to their request in a view to earlier return to activity as they were skilled athletes. All fractures healed within 6–14 weeks, and return to normal activity level was 8 weeks on average ( range 2–12). A 3.5mm DCP plate was used in all cases. We treated conservatively 76 pat...

Introduction and Aims: The clavicle has several important functions each of which may be affected... more Introduction and Aims: The clavicle has several important functions each of which may be affected after fracture and malunion of the bone. The aim is to establish any association between shortening of the clavicle, following successful conservative management and clinical outcome. Method: 132 patients with history of an acute fracture of the clavicle were reviewed. None of them had previous pathology affecting shoulder function, prior to injury. Men accounted 93 with average age 25.4 years, and women 39 with average age 34.2 years. All underwent conservative management with standard protocols and the fracture was united. The length and relative shortening of the united clavicle were assessed on a standardised posteroanterior chest x-ray. Intra- and Inter-observer reliability of measurements were assessed. Clinical outcome was evaluated with the Constant score. Mean follow-up was 30 months. Results: Clavicular shortening following fracture union was 11.4 mm on average (range 3–25 mm)...

Purpose: We undertook a primarily cadaveric study of trabecular architecture of olecranon to link... more Purpose: We undertook a primarily cadaveric study of trabecular architecture of olecranon to link theory of biomechanics and morphological trabecular patterns of olecranon and secondly compare with real-life trabecular pattern in CT scans. Methods & Results: Eight pairs of ulnae (fresh-frozen bones) were obtained from cadavers following road traffic accidents, aged 25 to 60 (mean 34 years). None suffered from previous pathology of elbow. Half of the ulnae were sliced longitudinally, each slice 2–3 mm thick (Group I), and the other half vertically (Group II). After they were radiographed, orientation of trabeculae was studied. CT scans of 8 patients (Group III), originally performed for investigation of fractures of radial head, were studied for comparison of real life trabecular pattern of olecranon. In Group I, two main sets of trabeculae were observed. The first set consists of three bundles, which arise from anterior cortex and support subchondral area – the posterior third bundl...

Educational Research Review, 2015

Six Sigma methodology was used in a District General Hospital to assess the effect of the introdu... more Six Sigma methodology was used in a District General Hospital to assess the effect of the introduction of an educational programme to limit unnecessary admissions. The performance of the doctors involved in the programme was assessed. Ishikawa Fishbone and 5 S’s were initially used and Pareto analysis of their findings was performed. The results were analysed and it was found that it was favouring the use of this technique, as the Six Sigma value increased from 2.6 to 4 producing a 99.4% yield. In conclusion this study stresses that The Six Sigma methodology is an acceptable tool which can be used for improvement of the performance of a Hospital Department and also of individuals; it can easily be used to improve the service safety and the patients’ requirements.

Educational Research Review, 2017

Professionalism is important in all service-providing professions. Professional bodies have exten... more Professionalism is important in all service-providing professions. Professional bodies have extensive rules and regulations creating the foundations of the definition of professionalism, its meaning and these rules have to be followed. In view of this, healthcare students are given intensive training. A prospective study conducted in a District General Hospital, to establish if professionalism was clearly defined. A questionnaire with open questions was given to 75 students from different disciplines including medical, nursing and chiropractic students (25 individuals from each group). The participants were at the end of their studies. The General Medical Council (GMC) criteria for professionalism were used. They were discussed as part of their induction to the orthopaedic department and the questionnaire was given to them at the end of their placement. Their answers were grouped, categorised and the findings were then analysed. All groups demonstrated a good understanding of the de...

Purpose: Productivity and efficiency are key factors for an improved well-functioning organisatio... more Purpose: Productivity and efficiency are key factors for an improved well-functioning organisation. Six Sigma Methodology uses tools that can help quantify the improvement achieved. Healthcare organisations are known to apply these tools to check quality of their services and patient satisfaction. Design/Methodology/Approach: The study performed at a District General Hospital attempted clarification of reasons influencing the delays observed in Orthopaedic Outpatient Clinic. To achieve it, two audits were performed following managerial and open departmental meetings. The first audit was planned to investigate the potential reasons for the delays. Following organisational alterations according to the findings the second audit would close the loop and analyse the learned lessons using Six Sigma Methodology.. Findings: In the initial audit, run for two month, 2110 patients replied, after consenting verbally, to questionnaires asking their opinion of possible reasons influencing their l...

Educational Research Review, 2016

The introduction of a multidisciplinary meeting (MDM) was analysed through a retrospective empiri... more The introduction of a multidisciplinary meeting (MDM) was analysed through a retrospective empirical study. The question of using it as a valuable tool to reinforce inter-professional development was made. The data was collected from 60 forth year Chiropractic students, who were at the end of their education and who were practicing their discipline under supervision. They were chosen because they fulfilled the World Health Organisation’s criteria, as they had formed their professional identity. Data was collected via two-stage feedback interviews and was analysed qualitatively. Kirkpatrick’s hierarchy was then used. Findings were grouped in the hierarchy’s categories and analysed in a quantitative manner. It was found that the majority of the interviewees’ opinions supported the MDM as an educational tool and a number of them believed that cognitive learning was achieved, influencing their behaviour. They supported that it helped them understand other professionals. In addition, the...

Journal of Long-Term Effects of Medical Implants, 2019

Patella height appears to have a crucial role in knee biomechanics. Patellar malalignment and mal... more Patella height appears to have a crucial role in knee biomechanics. Patellar malalignment and maltracking are therefore believed to be associated with development and progression of patellofemoral pain and disease. Published data are scant regarding the effect of everyday tasks on patella height and patellofemoral disease. We included 150 subjects in a retrospective observational study. Group A had 75 subjects (24 male and 51 female, with a mean age of 58.5 yr), whose daily activities included squatting (the traditional Muslim praying position called Sujud). Group B had 75 subjects (42 male and 33 female, with a mean age of 47.6 yr), who were non-Muslim. Patella height was measured using Insall-Salvati (IS) and Blackburne-Peel (BP) ratios. The mean IS ratio was 0.86 (confidence interval [CI]: 0.7-1.02) for group A and 1.1 (CI: 0.96-1.23) for group B. The mean BP ratio was 0.66 (CI: 0.49-0.83) for group A and 0.89 (CI: 0.73-1.04) for group B. We found 26 subjects (34.7%) in group B to have patella alta, when measured by either ratio, compared to one subject (1.3%) in group A (p < 0.01) with patella alta. We found 61 subjects (81.3%) in group A to have patella baja, when measured by either ratio, compared to 21 subjects (28%) in group A (p < 0.01) with patella baja. In group A, the IS ratio was reduced in 29 subjects (38.7%), the BP ratio was reduced in 59 subjects (78.7%), and both were reduced in 27 subjects (36%). A similar pattern was noted for group B. Our results show that a significant increase in patella baja was associated with repeated squatting/kneeling, compared to the predominance of patella alta in the control group. On the basis of these findings, we hypothesize that biomechanical stresses associated with repeated hyperflexion of the knee asymmetrically affect the more flexible quadriceps muscle fibers greater than patella tendon fibers. Thus, repeated hyperflexion in everyday tasks leads to elongation of quadriceps fibers and patella baja.

Knee Surgery and Related Research, 2019

Osteonecrosis of the knee is a rare complication of arthroscopic surgery. It was first described ... more Osteonecrosis of the knee is a rare complication of arthroscopic surgery. It was first described by Brahme et al. 1) in 1991. There are 76 cases described in the literature in case reports and small case series 114). Of these, almost all are in the femoral condyles and occasionally in the medial tibial plateau. These patients are pre dominantly middleaged or elderly, with only 3 described cases in patients under the age of 40. No cases are described with post arthroscopic changes in the young in the lateral tibial plateau, and none to our knowledge with successful nonarthroplasty surgical intervention.

Journal of Arthritis, 2017

Background: Allogenic blood transfusions are expensive and associated with risks and complication... more Background: Allogenic blood transfusions are expensive and associated with risks and complications such as transmission of infections and incompatibility reactions. Aim: The objective of this study was to evaluate the efficacy of autologous blood transfusion in reducing the need for allogenic blood requirement after total hip replacement and also the cost benefit involved. Method: A retrospective case notes analysis of 178 consecutive patients undergoing total hip replacements from 2006 to 2007 were carried out. 73 patients belonged to Bellovac ® ABT (Astra Tech) drains for post-operative blood salvage group (ABT group) and 105 patients belonged to standard Bellovac ® (Astra Tech) vacuum drains group (Non-ABT group). Pre and post-operative haemoglobin (Hb) were compared between ABT and Non-ABT group in relation to type of surgery and anaesthesia. Results: 20 out of the 73 (27.3%) patients in ABT group and 45 out of 105 (42.8%) in Non-ABT group required blood transfusion (p=0.035). Forty six units (0.63 units per person) in ABT group and 106 units (1 unit per person) in Non-ABT were transfused in total (p=0.03). The average pre and post-operative Hb in ABT group were 13.1 and 9.6 while in Non-ABT group were 13.4 and 9.4 respectively. Conclusion: Autologous blood transfusion caused a reduction in the number of patients requiring blood transfusion and also reduced the amount of units transfused.

British Journal of Healthcare Management, 2015

The Six Sigma methodology was used in a district general hospital to assess the effect of quality... more The Six Sigma methodology was used in a district general hospital to assess the effect of quality in the introduction of an educational programme following a SWOT (strengths, weaknesses, opportunities and threats) analysis, with the goal to improve and control the hospital's budget by limiting unnecessary admissions. Pareto analysis was carried out on these findings. The resulting data were analysed indicating that the use of the Six Sigma methodology was favoured—the Six Sigma value increased from 1.2 to 3.9 producing a 99.07% yield (initial yield was 86.62%). In conclusion, this study argues that the Six Sigma methodology is an acceptable tool which can be used to improve the performance of a hospital department. It is also improves the effectiveness and performance of health workers without compromising patient safety or the quality of the service. It also helps in meeting the goals of all stakeholders and reduce the hospital's expenditure, thus saving public money from t...

International Journal of Medicine and Medical Sciences, 2016

Professionalism is under scrutiny in all service-providing professions. Healthcare is one of them... more Professionalism is under scrutiny in all service-providing professions. Healthcare is one of them. There are rules and regulations mentioned from professional bodies that place the foundations of the definition of professionalism which have to be followed. A prospective study was conducted in a District General Hospital, with the aim to establish if professionalism was clearly defined. A questionnaire with open questions was given to 242 individuals from different disciplines including healthcare workers, students and members of the public. Their answers were grouped and then categorised using the points that the General Medical Council (GMC) uses to characterise professionals. The participants were divided in different groups according to their discipline and their grade of seniority and the findings were then analysed. The majority of the answers support that Teamwork is one of the fundamental criteria that constitute professionalism. On the other hand, Health, meaning the wellbei...