Author
Iain K. Moppett
Other affiliations: British Orthopaedic Association, Nottingham University Hospitals NHS Trust, Queen's University ...read more
Bio: Iain K. Moppett is an academic researcher from University of Nottingham. The author has contributed to research in topics: Hip fracture & Population. The author has an hindex of 31, co-authored 132 publications receiving 3160 citations. Previous affiliations of Iain K. Moppett include British Orthopaedic Association & Nottingham University Hospitals NHS Trust.
Papers published on a yearly basis
Papers
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TL;DR: A scoring system that reliably predicts the probability of mortality at 30 days for patients after hip fracture is developed and validated and incorporated into a risk score, the Nottingham Hip Fracture Score.
Abstract: Background Hip fractures are common in the elderly and have a high 30 day postoperative mortality. The ability to recognize patients at high risk of poor outcomes before operation would be an important clinical advance. This study has determined key prognostic factors predicting 30 day mortality in a hip fracture population, and incorporated them into a scoring system to be used on admission. Methods A cohort study was conducted at the Queen's Medical Centre, Nottingham, over a period of 7 yr. Complete data were collected from 4967 patients and analysed. Forward univariate logistic regression was used to select the independent predictor variables of 30 day mortality, and then multivariate logistic regression was applied to the data to construct and validate the scoring system. Results The variables found to be independent predictors of mortality at 30 days were: age (66–85 yr, ≥86 yr), sex (male), number of co-morbidities (≥2), mini-mental test score (≤6 out of 10), admission haemoglobin concentration (≤10 g dl−1), living in an institution, and presence of malignant disease. These variables were subsequently incorporated into a risk score, the Nottingham Hip Fracture Score. The number of deaths observed at 30 days, and the number of deaths predicted by the scoring system, indicated good concordance (χ2 test, P=0.79). The area ( se ) under the receiver operating characteristic curve was 0.719 (0.018), which demonstrated a reasonable predictive value for the score. Conclusions We have developed and validated a scoring system that reliably predicts the probability of mortality at 30 days for patients after hip fracture.
283 citations
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TL;DR: There is very little evidence positively in favour of any treatments or packages of early care for head-injured patients; however, prompt, specialist neurocritical care is associated with improved outcome.
Abstract: This review examines the evidence base for the early management of head-injured patients. Traumatic brain injury (TBI) is common, carries a high morbidity and mortality, and has no specific treatment. The pathology of head injury is increasingly well understood. Mechanical forces result in shearing and compression of neuronal and vascular tissue at the time of impact. A series of pathological events may then ensue leading to further brain injury. This secondary injury may be amenable to intervention and is worsened by secondary physiological insults. Various risk factors for poor outcome after TBI have been identified. Most of these are fixed at the time of injury such as age, gender, mechanism of injury, and presenting signs (Glasgow Coma Scale and pupillary signs), but some such as hypotension and hypoxia are potential areas for medical intervention. There is very little evidence positively in favour of any treatments or packages of early care; however, prompt, specialist neurocritical care is associated with improved outcome. Various drugs that target specific pathways in the pathophysiology of brain injury have been the subject of animal and human research, but, to date, none has been proved to be successful in improving outcome.
257 citations
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TL;DR: The Nottingham Hip Fracture Score can be used to stratify the risk of 1 yr mortality after hip fracture surgery and was investigated whether the NHFS was a predictor of 1 year mortality in patients undergoing surgical repair of fractured neck of femur.
Abstract: Background Surgical repair of hip fractures is associated with high postoperative mortality. The identification of high-risk patients might be of value in aiding clinical management decisions and resource allocation. The Nottingham Hip Fracture Score (NHFS) is a scoring system validated for the prediction of 30 day mortality after hip fracture surgery. It is made up of seven independent predictors of mortality that have been incorporated into a risk score: age (66–85 and ≥86 yr); sex (male); number of co-morbidities (≥2), admission mini-mental test score (≤6 out of 10), admission haemoglobin concentration (≤10 g dl−1), living in an institution; and the presence of malignancy. We investigated whether the NHFS was a predictor of 1 yr mortality in patients undergoing surgical repair of fractured neck of femur. Methods NHFS was retrospectively calculated for 6202 patients who had undergone hip fracture surgery between 1999 and 2009. One year and 30 day postoperative mortality data were collected both from hospital statistics and the Office of National Statistics. Results Overall mortality was 8.3% at 30 days and 29.3% at 1 yr. An NHFS of ≤4 was considered low risk and a score of ≥5 high risk. Survival was greater in the low-risk group at 30 days [96.5% vs 86.3% (P Conclusions NHFS can be used to stratify the risk of 1 yr mortality after hip fracture surgery.
178 citations
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TL;DR: Among patients with a hip fracture, accelerated surgery did not significantly lower the risk of mortality or a composite of major complications compared with standard care.
172 citations
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TL;DR: An overview of current knowledge on the subject with an assessment of the quality of the evidence is provided in order to allow anaesthetists all over Europe to integrate – wherever possible – this knowledge into daily patient care.
Abstract: The purpose of these guidelines on the preoperative evaluation of the adult non-cardiac surgery patient is to present recommendations based on available relevant clinical evidence. The ultimate aims of preoperative evaluation are two-fold. First, we aim to identify those patients for whom the perioperative period may constitute an increased risk of morbidity and mortality, aside from the risks associated with the underlying disease. Second, this should help us to design perioperative strategies that aim to reduce additional perioperative risks. Very few well performed randomised studies on the topic are available and many recommendations rely heavily on expert opinion and are adapted specifically to the healthcare systems in individual countries. This report aims to provide an overview of current knowledge on the subject with an assessment of the quality of the evidence in order to allow anaesthetists all over Europe to integrate - wherever possible - this knowledge into daily patient care. The Guidelines Committee of the European Society of Anaesthesiology (ESA) formed a task force with members of subcommittees of scientific subcommittees and individual members of the ESA. Electronic databases were searched from the year 2000 until July 2010 without language restrictions. These searches produced 15 425 abstracts. Relevant systematic reviews with meta-analyses, randomised controlled trials, cohort studies, case-control studies and cross-sectional surveys were selected. The Scottish Intercollegiate Guidelines Network grading system was used to assess the level of evidence and to grade recommendations. The final draft guideline was posted on the ESA website for 4 weeks and the link was sent to all ESA members, individual or national (thus including most European national anaesthesia societies). Comments were collated and the guidelines amended as appropriate. When the final draft was complete, the Guidelines Committee and ESA Board ratified the guidelines.
170 citations
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01 Mar 2007
TL;DR: An initiative to develop uniform standards for defining and classifying AKI and to establish a forum for multidisciplinary interaction to improve care for patients with or at risk for AKI is described.
Abstract: Acute kidney injury (AKI) is a complex disorder for which currently there is no accepted definition. Having a uniform standard for diagnosing and classifying AKI would enhance our ability to manage these patients. Future clinical and translational research in AKI will require collaborative networks of investigators drawn from various disciplines, dissemination of information via multidisciplinary joint conferences and publications, and improved translation of knowledge from pre-clinical research. We describe an initiative to develop uniform standards for defining and classifying AKI and to establish a forum for multidisciplinary interaction to improve care for patients with or at risk for AKI. Members representing key societies in critical care and nephrology along with additional experts in adult and pediatric AKI participated in a two day conference in Amsterdam, The Netherlands, in September 2005 and were assigned to one of three workgroups. Each group's discussions formed the basis for draft recommendations that were later refined and improved during discussion with the larger group. Dissenting opinions were also noted. The final draft recommendations were circulated to all participants and subsequently agreed upon as the consensus recommendations for this report. Participating societies endorsed the recommendations and agreed to help disseminate the results. The term AKI is proposed to represent the entire spectrum of acute renal failure. Diagnostic criteria for AKI are proposed based on acute alterations in serum creatinine or urine output. A staging system for AKI which reflects quantitative changes in serum creatinine and urine output has been developed. We describe the formation of a multidisciplinary collaborative network focused on AKI. We have proposed uniform standards for diagnosing and classifying AKI which will need to be validated in future studies. The Acute Kidney Injury Network offers a mechanism for proceeding with efforts to improve patient outcomes.
5,467 citations
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1,835 citations
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TL;DR: In childhood, traumatic brain injury poses the unique challenges of an injury to a developing brain and the dynamic pattern of recovery over time, so the treatment needs to be multifaceted and starts at the scene of the injury and extends into the home and school.
Abstract: In childhood, traumatic brain injury (TBI) poses the unique challenges of an injury to a developing brain and the dynamic pattern of recovery over time, inflicted TBI and its medicolegal ramifications. The mechanisms of injury vary with age, as do the mechanisms that lead to the primary brain injury. As it is common, and is the leading cause of death and disability in the USA and Canada, prevention is the key, and we may need increased legislation to facilitate this. Despite its prevalence, there is an almost urgent need for research to help guide the optimal management and improve outcomes. Indeed, contrary to common belief, children with severe TBI have a worse outcome and many of the consequences present in teenage years or later. The treatment needs, therefore, to be multifaceted and starts at the scene of the injury and extends into the home and school. In order to do this, the care needs to be multidisciplinary from specialists with a specific interest in TBI and to involve the family, and will often span many decades.
1,747 citations
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TL;DR: Editor's Choice – European Society for Vascular Surgery (ESVS) 2019 Clinical Practice Guidelines on the Management of Abdominal Aorto-iliac Artery Aneurysms.
1,493 citations
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TL;DR: Clinicians will find the recommendations in these revised CPGs useful in their daily work and can be reassured that the recommendations have been vetted thoroughly by the most rigorous scientific process, so that cardiovascular clinicians worldwide may deliver optimal, standardized care.
Abstract: AAA
: abdominal aortic aneurysm
ACEI
: angiotensin converting enzyme inhibitor
ACS
: acute coronary syndromes
AF
: atrial fibrillation
AKI
: acute kidney injury
AKIN
: Acute Kidney Injury Network
ARB
: angiotensin receptor blocker
ASA
: American Society of Anesthesiologists
b.i.d.
: bis in diem (twice daily)
BBSA
: Beta-Blocker in Spinal Anesthesia
BMS
: bare-metal stent
BNP
: B-type natriuretic peptide
bpm
: beats per minute
CABG
: coronary artery bypass graft
CAD
: coronary artery disease
CARP
: Coronary Artery Revascularization Prophylaxis
CAS
: carotid artery stenting
CASS
: Coronary Artery Surgery Study
CEA
: carotid endarterectomy
CHA2DS2-VASc
: cardiac failure, hypertension, age ≥75 (doubled), diabetes, stroke (doubled)-vascular disease, age 65–74 and sex category (female)
CI
: confidence interval
CI-AKI
: contrast-induced acute kidney injury
CKD
: chronic kidney disease
CKD-EPI
: Chronic Kidney Disease Epidemiology Collaboration
Cmax
: maximum concentration
CMR
: cardiovascular magnetic resonance
COPD
: chronic obstructive pulmonary disease
CPG
: Committee for Practice Guidelines
CPX/CPET
: cardiopulmonary exercise test
CRP
: C-reactive protein
CRT
: cardiac resynchronization therapy
CRT-D
: cardiac resynchronization therapy defibrillator
CT
: computed tomography
cTnI
: cardiac troponin I
cTnT
: cardiac troponin T
CVD
: cardiovascular disease
CYP3a4
: cytochrome P3a4 enzyme
DAPT
: dual anti-platelet therapy
DECREASE
: Dutch Echocardiographic Cardiac Risk Evaluation Applying Stress Echocardiography
DES
: drug-eluting stent
DIPOM
: DIabetic Post-Operative Mortality and Morbidity
DSE
: dobutamine stress echocardiography
ECG
: electrocardiography/electrocardiographically/electrocardiogram
eGFR
: estimated glomerular filtration rate
ESA
: European Society of Anaesthesiology
ESC
: European Society of Cardiology
EVAR
: endovascular abdominal aortic aneurysm repair
FEV1
: Forced expiratory volume in 1 second
HbA1c
: glycosylated haemoglobin
HF-PEF
: heart failure with preserved left ventricular ejection fraction
HF-REF
: heart failure with reduced left ventricular ejection fraction
ICD
: implantable cardioverter defibrillator
ICU
: intensive care unit
IHD
: ischaemic heart disease
INR
: international normalized ratio
IOCM
: iso-osmolar contrast medium
KDIGO
: Kidney Disease: Improving Global Outcomes
LMWH
: low molecular weight heparin
LOCM
: low-osmolar contrast medium
LV
: left ventricular
LVEF
: left ventricular ejection fraction
MaVS
: Metoprolol after Vascular Surgery
MDRD
: Modification of Diet in Renal Disease
MET
: metabolic equivalent
MRI
: magnetic resonance imaging
NHS
: National Health Service
NOAC
: non-vitamin K oral anticoagulant
NSQIP
: National Surgical Quality Improvement Program
NSTE-ACS
: non-ST-elevation acute coronary syndromes
NT-proBNP
: N-terminal pro-BNP
O2
: oxygen
OHS
: obesity hypoventilation syndrome
OR
: odds ratio
P gp
: platelet glycoprotein
PAC
: pulmonary artery catheter
PAD
: peripheral artery disease
PAH
: pulmonary artery hypertension
PCC
: prothrombin complex concentrate
PCI
: percutaneous coronary intervention
POBBLE
: Peri-Operative Beta-BLockadE
POISE
: Peri-Operative ISchemic Evaluation
POISE-2
: Peri-Operative ISchemic Evaluation 2
q.d.
: quaque die (once daily)
RIFLE
: Risk, Injury, Failure, Loss, End-stage renal disease
SPECT
: single photon emission computed tomography
SVT
: supraventricular tachycardia
SYNTAX
: Synergy between Percutaneous Coronary Intervention with TAXUS and Cardiac Surgery
TAVI
: transcatheter aortic valve implantation
TdP
: torsades de pointes
TIA
: transient ischaemic attack
TOE
: transoesophageal echocardiography
TOD
: transoesophageal doppler
TTE
: transthoracic echocardiography
UFH
: unfractionated heparin
VATS
: video-assisted thoracic surgery
VHD
: valvular heart disease
VISION
: Vascular Events In Noncardiac Surgery Patients Cohort Evaluation
VKA
: vitamin K antagonist
VPB
: ventricular premature beat
VT
: ventricular tachycardia
Guidelines summarize and evaluate all available evidence, at the time of the writing process, on a particular issue with the aim of assisting health professionals in selecting the best management strategies for an individual patient with a given condition, taking into account the impact on outcome, as well as the risk–benefit ratio of particular diagnostic …
1,353 citations