1328 results found
Attaelmanan I, Bhatti YA, Harris M, et al., The development and diffusion of surgical frugal innovations – lessons for the NHS, LSE International Health Policy Conference 2017
Byrne B, Aylin P, Bottle RA, et al., Failure to engage in surgical quality improvement research is associated with poorer quality of care, Royal Society of Medicine, Coloproctology section: Overseas meeting in Leuven
Byrne B, Faiz O, Darzi A, et al., Do gastrointestinal cancer patients want to decide where they have tests and surgery? A questionnaire study., Digestive Disorders Federation
Khan DZ, Oude Vrielink TJC, Marcus H, et al., NeuroCYCLOPS: development and preclinical validation of a robotic platform for endoscopic neurosurgery, European Association of Neurosurgical Societies (EANS 2016), Publisher: European Association of Neurosurgical Societies
Kogkas A, Darzi A, Mylonas GP, Gaze-Driven Human-Robot Interaction in the Operating Theatre, 6th Joint Workshop on New Technologies for Computer/Robot Assisted Surgery (CRAS 2016)
Leff DR, Shetty K, Yang GZ, et al., Persistent Attentional Demands Despite Laparoscopic Skills Acquisition, JAMA Surgery, ISSN: 2168-6262
Oude Vrielink TJC, Darzi, Mylonas G, microCYCLOPS: A Robotic System for Microsurgical Applications, 6th Joint Workshop on New Technologies for Computer/Robot Assisted Surgery (CRAS 2016)
Seneci CA, Leibrandt KL, Wisanuvej PW, et al., Design of a smart 3D-printed wristed robotic surgical instrument with embedded force sensing and modularity, IROS 2016, ISSN: 2153-0866
St John ERC, Leff D, takats Z, et al., Rapid Evaporative Ionisation Mass Spectrometry of Electrosurgical Vapours for the Identification of Breast Pathology: Towards an Intelligent Knife for Breast Cancer Surgery, Breast Cancer Research, ISSN: 1465-542X
Taylor MJ, Kaur M, Sharma U, et al., Using virtual worlds for patient and public engagement., Int J Technol Knowl Soc, Vol: 9, Pages: 31-48, ISSN: 1832-3669
Patient and public involvement is fundamental in healthcare and many methods attempt to facilitate this engagement. The present study investigated use of computer-generated environments known as 'virtual worlds' (VW) as an involvement method. The VW used in the present research was Second Life, which is 3-dimensional, publically accessible and internet-based. It is accessed using digital self-representations, or 'avatars', through which users navigate the virtual environment and communicate with one another. Participants were patients with long-term conditions, frequently involved in shaping health research and care. Some had mobility and communication difficulties, potentially making involvement through traditional face-to-face modes of engagement challenging. There were 2 stages to this study. Stage-1: Participants were introduced to VWs and Second Life. This was followed by a face-to-face focus group discussion (FGD) in order to gain their views on use of SL. Stage-2: An FGD attended by 8 people (4 patients, 3 researchers, 1 healthcare professional) was conducted in Second Life. Training and support on using Second Life had been provided for participants. The FGD took place successfully, although some technical and communication difficulties were experienced. Data was collected in the form of interviews and questionnaires from the patients about their experience of using the virtual world. Participants recognised the potential of VWs as a platform for patient engagement, especially for those who suffer from chronic conditions that impact severely upon their mobility and communication. Participant feedback indicated that potential barriers include technical problems with VW programs and potential user inexperience of using VWs, which may be counteracted by ensuring provision of continuous training and support. In conclusion, this study established the feasibility of using VWs for patient FGDs and indicates a potential of use of VWs for engagement in future, partic
king HK, shang JS, liu JL, et al., Micro-IGES Robot for Transanal Robotic Microsurgery., In The Hamlyn Symposium on Medical Robotics.
kulasabanathan K, issa H, bhatti Y, et al., Do International Health Partnerships contribute to Reverse Innovation? A mixed methods study of THET-supported partnerships in the UK, Globalization and Health, ISSN: 1744-8603
patel NP, seneci CS, yang GZY, et al., Flexible platforms for natural orifice transluminal and endoluminal surgery. Endoscopy International Open, 2(02), E117-E123., Endoscopy International Open
Abeles A, Kwasnicki RM, Darzi A, 2017, Enhanced recovery after surgery: Current research insights and future direction., World J Gastrointest Surg, Vol: 9, Pages: 37-45
Since the concept of enhanced recovery after surgery (ERAS) was introduced in the late 1990s the idea of implementing specific interventions throughout the peri-operative period to improve patient recovery has been proven to be beneficial. Minimally invasive surgery is an integral component to ERAS and has dramatically improved post-operative outcomes. ERAS can be applicable to all surgical specialties with the core generic principles used together with added specialty specific interventions to allow for a comprehensive protocol, leading to improved clinical outcomes. Diffusion of ERAS into mainstream practice has been hindered due to minimal evidence to support individual facets and lack of method for monitoring and encouraging compliance. No single outcome measure fully captures recovery after surgery, rather multiple measures are necessary at each stage. More recently the pre-operative period has been the target of a number of strategies to improve clinical outcomes, described as prehabilitation. Innovation of technology in the surgical setting is also providing opportunities to overcome the challenges within ERAS, e.g., the use of wearable activity monitors to record information and provide feedback and motivation to patients peri-operatively. Both modernising ERAS and providing evidence for key strategies across specialties will ultimately lead to better, more reliable patient outcomes.
Alexander J, Gildea L, Balog J, et al., 2017, A novel methodology for in vivo endoscopic phenotyping of colorectal cancer based on real-time analysis of the mucosal lipidome: a prospective observational study of the iKnife, SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES, Vol: 31, Pages: 1361-1370, ISSN: 0930-2794
Bouras G, Burns EM, Howell AM, et al., 2017, Linked hospital and primary care database analysis of the impact of short-term complications on recurrence in laparoscopic inguinal hernia repair., Hernia, Vol: 21, Pages: 191-198
OBJECTIVE: To study the effects of short-term complications on recurrence following laparoscopic inguinal hernia repair using routine data. BACKGROUND: Linked primary and secondary care databases can evaluate the quality of inguinal hernia surgery by quantifying short- and long-term outcome together. METHODS: Longitudinal analysis of linked primary care (Clinical Practice Research Datalink) and hospital administrative (Hospital Episodes Statistics) databases quantified 30-day complications (wound infection and bleeding) and surgery for recurrence after primary repair performed between 1st April 1997 and 31st March 2012. RESULTS: Out of 41,545 primary inguinal hernia repairs, 10.3% (4296/41,545) were laparoscopic. Complications were less frequent following laparoscopic (1.8%, 78/4296) compared with open (3.5%, 1288/37,249) inguinal hernia repair (p < 0.05). Recurrence was more frequent following laparoscopic (3.5%, 84/2541) compared with open (1.2%, 366/31,859) repair (p < 0.05). Time to recurrence was shorter for laparoscopic (26.4 months SD 28.5) compared with open (46.7 months SD 37.6) repair (p < 0.05). Overall, complications were associated with recurrence (3.2%, 44/1366 with complications; 1.7%, 700/40,179 without complications; p < 0.05). Complications did not significantly increase the risk of recurrence in open hernia repair (OR = 1.49; 95% CI 0.97-2.30, p = 0.069). Complications following laparoscopic repair was significantly associated with increased risk of recurrence (OR = 7.86; 95% CI 3.46-17.85, p < 0.05). CONCLUSIONS: Complications recorded in linked routine data predicted recurrence following laparoscopic inguinal hernia repair. Focus must, therefore, be placed on achieving good short-term outcome, which is likely to translate to better longer term results using the laparoscopic approach.
Bouras G, Markar SR, Burns EM, et al., 2017, The psychological impact of symptoms related to esophagogastric cancer resection presenting in primary care: A national linked database study, EJSO, Vol: 43, Pages: 454-460, ISSN: 0748-7983
Chana P, Joy M, Casey N, et al., 2017, Cohort analysis of outcomes in 69 490 emergency general surgical admissions across an international benchmarking collaborative, BMJ OPEN, Vol: 7, ISSN: 2044-6055
Flott K, Fontana G, Dhingra-Kumar N, et al., 2017, Health care must mean safe care: enshrining patient safety in global health, LANCET, Vol: 389, Pages: 1279-1281, ISSN: 0140-6736
Harling L, Lambert J, Ashrafian H, et al., 2017, Elevated serum microRNA 483-5p levels may predict patients at risk of post-operative atrial fibrillation, EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY, Vol: 51, Pages: 73-78, ISSN: 1010-7940
Hassen Y, Johnston M, Barrow EJ, et al., 2017, Safety and the Use of Checklists in Acute Care Surgery, Acute Care Surgery Handbook Volume 1 General Aspects, Non-gastrointestinaI and Critical Care Emergencies, Publisher: Springer, ISBN: 9783319153407
This pocket manual is a practically oriented, wide-ranging guide to acute care surgery general aspects and to non-gastrointestinal emergencies.
Howell A-M, Burns EM, Hull L, et al., 2017, International recommendations for national patient safety incident reporting systems: an expert Delphi consensus-building process, BMJ QUALITY & SAFETY, Vol: 26, Pages: 150-163, ISSN: 2044-5415
Kulendran M, Borovoi L, Purkayastha S, et al., 2017, Impulsivity predicts weight loss after obesity surgery., Surg Obes Relat Dis
OBJECTIVE: There is evidence that executive function, and specifically inhibitory control, is related to obesity and eating behavior. The goal of this study was to determine whether personality traits and inhibitory control predict weight loss after bariatric procedures. Although the impressive weight reduction after bariatric surgery has been shown in short- and medium-term studies, the effect of personality traits on this reduction is uncertain. Specifically, the effect of impulsivity is still largely unknown. SETTING: Patients attending either a multidisciplinary information session or outpatient clinic at the Imperial Weight Management Centre were recruited with informed consent into the trial over a 4-month period from January to April 2013. Participants were invited to attend behavioral testing on an outpatient basis in a silent room invigilated by a single researcher. METHODS: Forty-five bariatric patients participated in the study (25 patients had a gastric bypass, with a mean BMI of 41.8 and age of 39.0 years; 20 had a sleeve gastrectomy, with a mean BMI of 47.2 and age of 49.0 years). All patients completed personality measures of impulsivity-Barratt's Impulsivity Scale, as well as behavioral measures of impulsivity-the stop-signal reaction-time (SSRT) task measuring inhibitory control and the temporal discounting task measuring reward processing. Those measures were examined in relation to weight loss 6 months after surgery. RESULTS: The surgical procedure and changes in the behavioral measure of inhibitory control (SSRT) were found to be significant predictors of reduction in body mass index (BMI) in patients undergoing bariatric surgery. The sleeve gastrectomy group found a reduction in BMI of 14.1%, which was significantly less than the 25% reduction in BMI in the gastric bypass group. The direction (parameter estimate) of the significant effect was positive for SSRT change, which indicates that pre- and postreduction in impulsivity predicts reduction
Leff DR, Yongue G, Vlaev I, et al., 2017, "Contemplating the Next Maneuver" Functional Neuroimaging Reveals Intraoperative Decision-making Strategies, ANNALS OF SURGERY, Vol: 265, Pages: 320-330, ISSN: 0003-4932
Leff DR, Yongue G, Vlaev I, et al., 2017, "Contemplating the Next Maneuver": Functional Neuroimaging Reveals Intraoperative Decision-making Strategies., Ann Surg, Vol: 265, Pages: 320-330
OBJECTIVE: To investigate differences in the quality, confidence, and consistency of intraoperative surgical decision making (DM) and using functional neuroimaging expose decision systems that operators use. SUMMARY BACKGROUND DATA: Novices are hypothesized to use conscious analysis (effortful DM) leading to activation across the dorsolateral prefrontal cortex, whereas experts are expected to use unconscious automation (habitual DM) in which decisions are recognition-primed and prefrontal cortex independent. METHODS: A total of 22 subjects (10 medical student novices, 7 residents, and 5 attendings) reviewed simulated laparoscopic cholecystectomy videos, determined the next safest operative maneuver upon video termination (10 s), and reported decision confidence. Video paradigms either declared ("primed") or withheld ("unprimed") the next operative maneuver. Simultaneously, changes in cortical oxygenated hemoglobin and deoxygenated hemoglobin inferring prefrontal activation were recorded using Optical Topography. Decision confidence, consistency (primed vs unprimed), and quality (script concordance) were assessed. RESULTS: Attendings and residents were significantly more certain (P < 0.001), and decision quality was superior (script concordance: attendings = 90%, residents = 78.3%, and novices = 53.3%). Decision consistency was significantly superior in experts (P < 0.001) and residents (P < 0.05) than novices (P = 0.183). During unprimed DM, novices showed significant activation of the dorsolateral prefrontal cortex, whereas this activation pattern was not observed among residents and attendings. During primed DM, significant activation was not observed in any group. CONCLUSIONS: Expert DM is characterized by improved quality, consistency, and confidence. The findings imply attendings use a habitual decision system, whereas novices use an effortful approach under uncertainty. In the presence of operative cues (primes), novices disengage
Manfield JH, Yu KK-H, Efthimiou E, et al., 2017, Bariatric Surgery or Non-surgical Weight Loss for Idiopathic Intracranial Hypertension? A Systematic Review and Comparison of Meta-analyses, OBESITY SURGERY, Vol: 27, Pages: 513-521, ISSN: 0960-8923
Nouraei SA, Dias A, Kanona H, et al., 2017, Impact of the method and success of pharyngeal reconstruction on the outcome of treating laryngeal and hypopharyngeal cancers with pharyngolaryngectomy: A national analysis., J Plast Reconstr Aesthet Surg, Vol: 70, Pages: 628-638
BACKGROUND: Surgical treatment of cancers that arise from or invade the hypopharynx presents major reconstructive challenges. Reconstructive failure exposes the airway and neck vessels to digestive contents. METHODS: We performed a national N = near-all analysis of the administrative dataset to identify pharyngolaryngectomies in England between 2002 and 2012. Information about morbidity, pharyngeal closure method and post-operative complications was derived. RESULTS: There were 1589 predominantly male (78%) patients whose mean age at surgery was 62 years. The commonest morbidities were hypertension (24%) and ischemic heart disease (11%). For 232 (15%) patients, pharyngolaryngectomy was performed during an emergency admission. The pharynx was closed primarily in 551 patients, with skin or muscle free or pedicled flaps in 755 patients and with jejunum and gastric pull-up in 123 and 160 patients, respectively. In-hospital mortality rate was 6% and was significantly higher in the gastric pull-up group (11%). Reconstructive failure had an odds ratio of 6.2 [95% confidence interval (CI) 2.4-16.1] for in-hospital death. The five-year survival was 57% and age, morbidities, emergency surgery, gastric pull-up, major acute cardiovascular events, renal failure and reconstructive failure independently worsened prognosis. Patients who underwent pharyngeal reconstruction with radial forearm or anterolateral thigh flaps had lower mortality rates than patients who had jejunum flap reconstruction (hazard ratio = 1.50 [95% CI 1.03-2.19]) or gastric pull-up (hazard ratio = 1.92 [95% CI 1.32-2.80]). CONCLUSIONS: Pharyngolaryngectomy carries a high degree of risk of morbidity and mortality. Reconstructive failure worsens short- and long-term prognosis, and the use of cutaneous free flaps appears to improve survival.
Nouraei SA, Virk JS, Middleton SE, et al., 2017, A national analysis of trends, outcomes and volume-outcome relationships in thyroid surgery., Clin Otolaryngol, Vol: 42, Pages: 354-365
OBJECTIVES: Thyroid conditions are common, and their incidence is increasing. Surgery is the mainstay treatment for many thyroid conditions, and understanding its utilisation trends and morbidity is central to improving patient care. DESIGN: An N = near-all analysis of the English administrative dataset to identify trends in thyroid surgery specialisation, volume-outcome relationships, and the incidence and risk factors for short- and long-term morbidity. MAIN OUTCOME MEASURES: Between 2004 and 2012, 72 594 patients underwent elective thyroidectomy in England. Information about age, sex, morbidities, nature of thyroid disease and surgery, adjuvant treatments and complications including hypocalcaemia and vocal palsy was recorded. RESULTS: Mean age at surgery was 49 ± 30, and a female predominance (82%) was observed. Most patients underwent hemithyroidectomy (51%) or total thyroidectomy (32%). Patients underwent surgery for benign (52.5%), benign inflammatory (21%) and malignant (17%) thyroid diseases. Thyroid surgery grew by 2.9% a year and increased in specialisation. Increased surgeon volume significantly reduced lengths of stay: the proportion of length of stay outliers fell from 11.8% for patients of occasional thyroidectomists (<5 per year) to 2.8% for patients of high-volume surgeons (>50 thyroidectomies a year). Post-discharge vocal palsy and hypocalcaemia occurred in 1.87% and 1.58% of cases, respectively. High-volume surgeons had a reduced incidence of vocal palsy, and volumes >30 were consistently protective. CONCLUSIONS: Thyroid surgery is increasingly specialised. High-volume surgeons, that is patients who perform 50 or more thyroidectomies per year, achieve lower complications and shorter lengths of stay.
Nouraei SAR, Mace AD, Middleton SE, et al., 2017, A stratified analysis of the perioperative outcome of 17623 patients undergoing major head and neck cancer surgery in England over 10 years: Towards an Informatics-based Outcomes Surveillance Framework, CLINICAL OTOLARYNGOLOGY, Vol: 42, Pages: 11-28, ISSN: 1749-4478
Pinto C, Garas G, Harling L, et al., 2017, Is endovascular treatment with multilayer flow modulator stent insertion a safe alternative to open surgery for high-risk patients with thoracoabdominal aortic aneurysm?, Ann Med Surg (Lond), Vol: 15, Pages: 1-8
A best evidence topic in cardiothoracic and vascular surgery was written according to a structured protocol. The question addressed was whether endovascular treatment with multilayer flow modulator stents (MFMS) can be considered a safe alternative to open surgery for high-risk patients with thoracoabdominal aortic aneurysm (TAAA). Altogether 27 papers were identified using the reported search, of which 11 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes, results, and study limitations are tabulated. The outcomes of interest were all-cause survival, aneurysm-related survival, branch vessel patency and major adverse events. Aneurysm-related survival exceeded 78% in almost all studies, with the exception of one where the MFMS was inserted outside the instructions for use. In that study the aneurysm-related survival was 28.9%. The branch vessel patency was higher than 95% in 10 studies and not reported in one. At 12-month follow-up, several studies showed a low incidence of major adverse events, including stroke, paraplegia and aneurysm rupture. We conclude that MFMS represent a suitable and safe treatment for high-risk patients with TAAA maintaining branch vessel patency when used within their instructions for use. However, a number of limitations must be considered when interpreting this evidence, particularly the complete lack of randomised controlled trials (RCTs), short follow-up in all studies, and heterogeneity of the pathologies among the different populations studied. Further innovative developments are needed to improve MFMS safety, expand their instructions for use, and enhance their efficacy.
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