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Johnston MJ, Singh P, Pucher PH, et al., 2015, Systematic review with meta-analysis of the impact of surgical fellowship training on patient outcomes, BRITISH JOURNAL OF SURGERY, Vol: 102, Pages: 1156-1166, ISSN: 0007-1323
BackgroundThe number of surgeons entering fellowship training before independent practice is increasing. This may have a negative impact on surgeons in training. The impact of fellowship training on patient outcomes is not yet known. This review aimed to investigate the impact of fellowship training in surgery on patient outcomes.MethodsA systematic review of the literature was conducted to identify studies exploring the structural and surgeon‐specific characteristics of fellowship training on patient outcomes. Data from these studies were extracted, synthesized and reported qualitatively, or quantitatively through meta‐analysis.ResultsTwenty‐three studies were included. The mortality rate for patients in centres with an affiliated fellowship programme was lower than that for centres without (odds ratio 0·86, 95 per cent c.i. 0·84 to 0·88), as was the rate of complications (odds ratio 0·90, 0·78 to 1·02). Surgeons without fellowship training converted more laparoscopic operations to open surgery than those with fellowship training (risk ratio (RR) 1·04, 95 per cent c.i. 1·03 to 1·05). Comparison of outcomes for senior surgeons versus current fellows showed no differences in rates of mortality (RR 1·00, 1·00 to 1·01), complications (RR 1·03, 0·98 to 1·08) or conversion to open surgery (RR 1·01, 1·00 to 1·01).ConclusionFellowship training appears to have a positive impact on patient outcomes.
Tolley N, Garas G, Palazzo F, et al., 2015, Long-term prospective evaluation comparing robotic parathyroidectomy with minimally invasive open parathyroidectomy for primary hyperparathyroidism, Head and Neck, Vol: 38, Pages: E300-E306, ISSN: 1043-3074
BackgroundTargeted parathyroidectomy is a popular technique for localized pathology. No single technique is established as superior. The purpose of this study was to compare robotic-assisted parathyroidectomy (RAP) with the most common approach.MethodsThis was a prospective, nonrandomized study. Fifteen consecutive patients who underwent RAP were compared to 15 matched controls undergoing focused lateral parathyroidectomy (FLP).ResultsBiochemical cure occurred in 29 of 30 patients (97%). No major complications occurred, although there was 1 robotic conversion. RAP demonstrated a significant time reduction (R2 = 0.436; p = .01) but took much longer to perform than FLP (119 minutes vs 34 minutes; p = .001). RAP was associated with less initial postoperative pain (p = .036) and higher satisfaction with scar cosmesis (p = .002) until 6 months. Quality of life (QOL) improved in both groups (p = .007).ConclusionRAP provides superior early cosmesis with equivalent global health improvement compared to FLP. The high cost and learning curve may preclude widespread adoption. Further evaluation is necessary to establish its clinical efficacy regarding scar cosmesis.
Byrne BE, Vincent CA, Stebbing J, et al., 2015, FALLING EMERGENCY OPERATION RATES AND REDUCED MORTALITY AFTER COLON CANCER SURGERY IN ENGLAND: A COHORT STUDY, 2nd Digestive-Disorders-Federation Conference, Publisher: BMJ PUBLISHING GROUP, Pages: A339-A340, ISSN: 0017-5749
Introduction Recent years have seen many changes within colorectal surgery. Laparoscopic techniques, fast track management, and bowel cancer screening have become widespread. This study examined changes in surgical treatment and outcomes for colon cancer over time against background registration rates, with subgroup analysis by urgency and age.Method Annual data on colon cancer registrations and population size was obtained. Administrative data were used to identify adults undergoing colonic resection for cancer in England between April 1998 and March 2012. Cancer registrations, treatment and mortality rates were age-standardised. The proportion of registrations undergoing surgery was examined, and subgroups were analysed by urgency of admission and age group. Temporal trends were assessed using the Joinpoint Regression Program (National Cancer Institute, USA).Results The standardised rate of colon cancer registration rose from 27.1 to 29.1 per 100 000 population. The proportion of registrations undergoing surgery fell, from approximately 67% to 57% (Annual Percentage Change = −1.44, p < 0.05), due to a significant fall in non-elective operating; the elective treatment rate did not change. Postoperative 90-day mortality rates fell across all age groups for elective and non-elective surgery, from approximately 6.5% to 3% and 19% to 13%, respectively.Conclusion Colon cancer registrations increased over time. The surgical treatment rate per colon cancer fell, due to falling rates of non-elective surgery. Possible explanations include improved early detection of colon cancer, changes in case selection, and improvements in non-surgical treatments. Postoperative mortality fell significantly after elective and non-elective surgery for all age groups. Considered together, these findings suggest a global improvement in the quality of surgical care for colon cancer. Future studies should include non-surgical treatments with information on stage of cancer at presentat
Chana P, Casey N, Chang D, et al., 2015, The delivery of high-risk emergency general surgery across the dr foster global comparators network: an examination of international outcomes, 2nd Digestive-Disorders-Federation Conference, Publisher: BMJ PUBLISHING GROUP, Pages: A48-A48, ISSN: 0017-5749
Introduction The Dr Foster Global Comparators Network (GC) aims to improve quality in healthcare by promoting inter-hospital collaboration through sharing of outcome data and benchmarking standards.This study aims to utilise the GC database to establish whether geographical differences in outcomes exist following high-risk emergency general surgery (EGS) admissions, whilst determining if structural differences between healthcare systems can be linked to high-quality care.Method Discharge data for a cohort of EGS patients were collated using a pre-determined protocol. Hierarchical logistic regression analysis was performed to examine geographical and structural differences between GC hospitals.Results 69,490 patients, admitted to 23 centres across Australia, England and the USA with high-risk EGS diagnoses from 2007–2012 were identified. Outcomes including: seven/thirty-day mortality, readmission and length of stay were all superior in the USA.19,082 patients (27%) underwent emergency abdominal surgery. No geographical differences in mortality were seen at seven-days in this subgroup. Thirty-day mortality (OR = 1.47) readmission (OR = 1.42) and length of stay (OR = 1.98) were all worse in the UK.Across this cohort, patient factors, (age, pathology and co-morbidity) were significantly associated with worse outcome as were structural factors including: low ITU bed ratios, high unit volume and inter-hospital transfers. Having dedicated EGS teams cleared of elective commitments with formalised handover of patients was associated with shorter length of stay.Conclusion Post-operative outcomes were similar at seven but not at thirty-days. This may be attributable to better infrastructure and resource allocation towards EGS in the US. The costs associated with this healthcare gain were not measured.
King D, Zaman S, Zaman SS, et al., 2015, Identifying Quality Indicators Used by Patients to Choose Secondary Health Care Providers: A Mixed Methods Approach, JMIR MHEALTH AND UHEALTH, Vol: 3, ISSN: 2291-5222
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- Citations: 10
Jilka SR, Callahan R, Sevdalis N, et al., 2015, "Nothing About Me Without Me": An Interpretative Review of Patient Accessible Electronic Health Records, Journal of Medical Internet Research, Vol: 17, ISSN: 1439-4456
BackgroundPatient accessible electronic health records (PAEHRs) enable patients to access and manage personalclinical information that is made available to them by their health care providers (HCPs). It is thought thatthe shared management nature of medical record access improves patient outcomes and improves patientsatisfaction. However, recent reviews have found that this is not the case. Furthermore, little research hasfocused on PAEHRs from the HCP viewpoint. HCPs include physicians, nurses, and service providers.ObjectiveWe provide a systematic review of reviews of the impact of giving patients record access from both apatient and HCP point of view. The review covers a broad range of outcome measures, including patientsafety, patient satisfaction, privacy and security, self-efficacy, and health outcome.MethodsA systematic search was conducted using Web of Science to identify review articles on the impact ofPAEHRs. Our search was limited to English-language reviews published between January 2002 andNovember 2014. A total of 73 citations were retrieved from a series of Boolean search terms including“review*” with “patient access to records”. These reviews went through a novel scoring system analysiswhereby we calculated how many positive outcomes were reported per every outcome measureinvestigated. This provided a way to quantify the impact of PAEHRs.Results1 1 2 1112Ten reviews covering chronic patients (eg, diabetes and hypertension) and primary care patients, as well asHCPs were found but eight were included for the analysis of outcome measures. We found mixedoutcomes across both patient and HCP groups, with approximately half of the reviews showing positivechanges with record access. Patients believe that record access increases their perception of control;however, outcome measures thought to create psychological concerns (such as patient anxiety as a result ofseeing their medical record) are still unanswered. Nurses are more likely th
Sabharwal S, Carter A, Darzi LA, et al., 2015, The methodological quality of health economic evaluations for the management of hip fractures: A systematic review of the literature, SURGEON-JOURNAL OF THE ROYAL COLLEGES OF SURGEONS OF EDINBURGH AND IRELAND, Vol: 13, Pages: 170-176, ISSN: 1479-666X
Background and objectivesApproximately 76,000 people a year sustain a hip fracture in the UK and the estimated cost to the NHS is £1.4 billion a year. Health economic evaluations (HEEs) are one of the methods employed by decision makers to deliver healthcare policy supported by clinical and economic evidence. The objective of this study was to (1) identify and characterize HEEs for the management of patients with hip fractures, and (2) examine their methodological quality.MethodsA literature search was performed in MEDLINE, EMBASE and the NHS Economic Evaluation Database. Studies that met the specified definition for a HEE and evaluated hip fracture management were included. Methodological quality was assessed using the Consensus on Health Economic Criteria (CHEC).ResultsTwenty-seven publications met the inclusion criteria of this study and were included in our descriptive and methodological analysis. Domains of methodology that performed poorly included use of an appropriate time horizon (66.7% of studies), incremental analysis of costs and outcomes (63%), future discounting (44.4%), sensitivity analysis (40.7%), declaration of conflicts of interest (37%) and discussion of ethical considerations (29.6%).ConclusionsHEEs for patients with hip fractures are increasing in publication in recent years. Most of these studies fail to adopt a societal perspective and key aspects of their methodology are poor. The development of future HEEs in this field must adhere to established principles of methodology, so that better quality research can be used to inform health policy on the management of patients with a hip fracture.
Byrne BE, Aylin P, Bottle A, et al., 2015, PTU-269 Lack of engagement in surgical quality improvement research is associated with poorer quality of care, 2nd Digestive-Disorders-Federation Conference, Publisher: BMJ Publishing Group, Pages: A179-A180, ISSN: 0017-5749
Byrne BE, Faiz OD, Darzi A, et al., 2015, Do gastrointestinal cancer patients want to decide where they have tests and surgery? a questionnaire study of provider choice and information needs, 2nd Digestive-Disorders-Federation Conference, Publisher: BMJ PUBLISHING GROUP, Pages: A119-A120, ISSN: 0017-5749
Introduction Choice of provider has been an important strategy among policy makers over recent years, intended, in part, to drive improvements in quality and efficiency of health care. Provider choice has been relatively under-studied among patients with cancer, compared with benign disease. This study examines decision-making experiences, preferences and information needs among patients who have had surgery for gastrointestinal cancer.Method This questionnaire study used the single-item Control Preferences Scale to determine patients’ experiences and preferences when being referred for tests, and choosing where to have surgery. Participants used a Likert scale to rate the importance of 23 information items covering a variety of structures, process and outcomes at hospital- and department-level. Participants were recruited by post and online.Results 463 responses were included. Where indicated, 334 of 415 (80.5%) respondents had upper gastrointestinal cancer. Postal response rates were higher than online (47.2% vs 23.1%,p < 0.001). Patients reported very low levels of involvement in provider choice, with their doctor deciding where they underwent tests or surgery in 77.0% and 81.8% of cases, respectively. Over two-thirds of participants would have preferred greater involvement in provider choice. Information on how long cancer patients wait for treatment, annual operative volume and postoperative mortality rate, as well as retained foreign bodies and infection rates were considered very important.Conclusion There is a substantial unmet desire for greater involvement in provider choice among gastrointestinal cancer patients. Participants in this study attached particular importance to surgery-specific information. Improving involvement and information provision will require a coordinated approach in both primary and secondary care. Greater involvement in decision-making may increase satisfaction and contribute to a greater sense of control among these patien
King HK, Shang JS, Liu JL, et al., 2015, Micro-IGES Robot for Transanal Robotic Microsurgery., In The Hamlyn Symposium on Medical Robotics.
Nouraei SAR, Hudovsky A, Frampton AE, et al., 2015, A Study of Clinical Coding Accuracy in Surgery <i>Implications for the Use of Administrative Big Data for Outcomes Management</i>, ANNALS OF SURGERY, Vol: 261, Pages: 1096-1107, ISSN: 0003-4932
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- Citations: 45
Muirhead L, Kinross JM, Preece R, et al., 2015, A PROSPECTIVE, OBSERVATIONAL STUDY OF SURGICAL AND ENDOSCOPIC RAPID EVAPORATIVE IONISATION MASS SPECTROMETRY (REIMS) FOR REAL TIME ANALYSIS OF THE COLONIC MUCOSAL LIPIDOME IN COLORECTAL CANCER, 2nd Digestive-Disorders-Federation Conference, Publisher: BMJ PUBLISHING GROUP, Pages: A50-A51, ISSN: 0017-5749
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Bouras G, Burns EM, Bottle A, et al., 2015, COMBINED EFFECTS OF REOPERATION AND VENOUS THROMBOEMBOLISM IN GASTROINTESTINAL SURGERY: EVALUATION OF POSTOPERATIVE COMPLICATIONS USING LINKED HOSPITAL AND PRIMARY CARE DATA, 2nd Digestive-Disorders-Federation Conference, Publisher: BMJ PUBLISHING GROUP, Pages: A277-A278, ISSN: 0017-5749
Carter AW, Mossialos E, Darzi A, 2015, A national incident reporting and learning system in England and Wales, but at what cost?, EXPERT REVIEW OF PHARMACOECONOMICS & OUTCOMES RESEARCH, Vol: 15, Pages: 365-368, ISSN: 1473-7167
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Bouras G, Burns EM, Howell A-M, et al., 2015, LINKED HOSPITAL AND PRIMARY CARE DATABASE STUDY OF VENOUS THROMBOEMBOLISM AND ASSOCIATED MORTALITY FOLLOWING GENERAL SURGICAL PROCEDURES IN ENGLAND, 2nd Digestive-Disorders-Federation Conference, Publisher: BMJ PUBLISHING GROUP, Pages: A44-A45, ISSN: 0017-5749
Bouras G, Burns EM, Bottle A, et al., 2015, LINKED PRIMARY CARE AND HOSPITAL DATABASE ANALYSIS OF TRENDS IN LAPAROSCOPY, SHORT-TERM COMPLICATIONS AND RECURRENCE FOLLOWING INGUINAL HERNIA REPAIR IN ENGLAND, 2nd Digestive-Disorders-Federation Conference, Publisher: BMJ PUBLISHING GROUP, Pages: A185-A185, ISSN: 0017-5749
Johnston MJ, Davis RE, Arora S, et al., 2015, Raising the Alarm: A Cross-Sectional Study Exploring the Factors Affecting Patients' Willingness to Escalate Care on Surgical Wards, WORLD JOURNAL OF SURGERY, Vol: 39, Pages: 2207-2213, ISSN: 0364-2313
BackgroundDelays in escalation of care for patients may contribute to poor outcome. The factors that influence surgical patients’ willingness to call for help on wards are currently unknown. This study explored the factors that affect patients’ willingness to call for help on surgical wards; how patients call for help and to whom; how to encourage patients to call for help, and the barriers to patients calling for help.MethodsA cross-sectional study was conducted in three London hospitals using a questionnaire designed through expert opinion and the published literature. A total of 155 surgical patients (83 % response rate) participated.ResultsPatients were more willing to call for help using the bedside buzzer or by calling a nurse compared to a doctor (p < 0.001). The prompts to calling for help patients were most likely to act on were bleeding and pain. Patients were more willing to call for help if encouraged by a healthcare professional than a relative or fellow patient (p < 0.01). Patients were more likely to worry about taking up too much time when calling for help than being perceived as difficult (p < 0.001). For some prompts, male patients were more willing to call for help (p < 0.05).ConclusionsThis is the first study to identify factors affecting patients’ willingness to call for help on surgical wards. Interventions that take these factors into account can be developed to encourage patients to call for help and may avoid delays in treatment.
Singh P, Aggarwal R, Tahir M, et al., 2015, A randomized controlled study to evaluate the role of video-based coaching in training laparoscopic skills, Annals of Surgery, Vol: 261, Pages: 862-869, ISSN: 0003-4932
Objective: This study evaluates whether video-based coaching can enhance laparoscopic surgical skills performance.Background: Many professions utilize coaching to improve performance. The sports industry employs video analysis to maximize improvement from every performance.Methods: Laparoscopic novices were baseline tested and then trained on a validated virtual reality (VR) laparoscopic cholecystectomy (LC) curriculum. After competence, subjects were randomized on a 1:1 ratio and each performed 5 VRLCs. After each LC, intervention group subjects received video-based coaching by a surgeon, utilizing an adaptation of the GROW (Goals, Reality, Options, Wrap-up) coaching model. Control subjects viewed online surgical lectures. All subjects then performed 2 porcine LCs. Performance was assessed by blinded video review using validated global rating scales.Results: Twenty subjects were recruited. No significant differences were observed between groups in baseline performance and in VRLC1. For each subsequent repetition, intervention subjects significantly outperformed controls on all global rating scales. Interventions outperformed controls in porcine LC1 [Global Operative Assessment of Laparoscopic Skills: (20.5 vs 15.5; P = 0.011), Objective Structured Assessment of Technical Skills: (21.5vs 14.5; P = 0.001), and Operative Performance Rating System: (26 vs 19.5; P = 0.001)] and porcine LC2 [Global Operative Assessment of Laparoscopic Skills: (28 vs 17.5; P = 0.005), Objective Structured Assessment of Technical Skills: (30 vs 16.5; P < 0.001), and Operative Performance Rating System: (36 vs 21; P = 0.004)]. Intervention subjects took significantly longer than controls in porcine LC1 (2920 vs 2004 seconds; P = 0.009) and LC2 (2297 vs 1683; P = 0.003).Conclusions: Despite equivalent exposure to practical laparoscopic skills training, video-based coaching enhanced the quality of laparoscopic surgical performance on both VR and porcine LCs, although at the expense of incr
Guenther S, Muirhead LJ, Speller AVM, et al., 2015, Spatially resolved metabolic phenotyping of breast cancer by desorption electrospray ionization mass spectrometry, Cancer Research, Vol: 75, Pages: 1828-1837, ISSN: 0008-5472
Breast cancer is a heterogeneous disease characterized by varying responses to therapeutic agents and significant differences in long-term survival. Thus, there remains an unmet need for early diagnostic and prognostic tools and improved histologic characterization for more accurate disease stratification and personalized therapeutic intervention. This study evaluated a comprehensive metabolic phenotyping method in breast cancer tissue that uses desorption electrospray ionization mass spectrometry imaging (DESI MSI), both as a novel diagnostic tool and as a method to further characterize metabolic changes in breast cancer tissue and the tumor microenvironment. In this prospective single-center study, 126 intraoperative tissue biopsies from tumor and tumor bed from 50 patients undergoing surgical resections were subject to DESI MSI. Global DESI MSI models were able to distinguish adipose, stromal, and glandular tissue based on their metabolomic fingerprint. Tumor tissue and tumor-associated stroma showed evident changes in their fatty acid and phospholipid composition compared with normal glandular and stromal tissue. Diagnosis of breast cancer was achieved with an accuracy of 98.2% based on DESI MSI data (PPV 0.96, NVP 1, specificity 0.96, sensitivity 1). In the tumor group, correlation between metabolomic profile and tumor grade/hormone receptor status was found. Overall classification accuracy was 87.7% (PPV 0.92, NPV 0.9, specificity 0.9, sensitivity 0.92). These results demonstrate that DESI MSI may be a valuable tool in the improved diagnosis of breast cancer in the future. The identified tumor-associated metabolic changes support theories of de novo lipogenesis in tumor tissue and the role of stroma tissue in tumor growth and development and overall disease prognosis. Cancer Res; 75(9); 1828–37. ©2015 AACR.
Johnston M, Arora S, Anderson O, et al., 2015, Escalation of care in surgery: a systematic risk assessment to prevent avoidable harm in hospitalized patients, Annals of Surgery, Vol: 261, Pages: 831-838, ISSN: 0003-4932
Objective: To systematically risk assess and analyze the escalation of care process in surgery so as to identify problems and provide recommendations for intervention.Background: The ability to escalate care appropriately when managing deteriorating patients is a hallmark of surgical competence and safe postoperative care. Healthcare-Failure-Mode-Effects-Analysis (HFMEA) is a methodology adapted from safety-critical industries, which allows for hazardous process failures to be prospectively identified and solutions to be recommended.Methods: Forty-two hours of ethnographic observations on surgical wards in 3 London hospitals (phase 1) formed the basis of an escalation process diagram. A risk-assessment survey identified failures associated with process steps and attributed hazard scores (phase 2). Patient safety and clinical risk experts validated hazard scores through a group consensus meeting (phase 3). Hazardous failures were taken forward to multidisciplinary HFMEA where cause analysis was applied and interventions were recommended (phase 4).Results: Observations identified 33 steps in the escalation process. The risk-assessment survey (30 surgical staff members, 100% response) and expert consensus group identified 18 hazardous failures associated with these steps. The HFMEA team identified 3 adequately controlled failures; therefore, 15 were subjected to cause analysis. Outdated communication technology, understaffing, and hierarchical barriers were identified as root causes of failure. Participants recommended interventions based on these findings including defined escalation protocols, human factors education, enhanced communication technology, and improved clinical supervision.Conclusions: Failures in the escalation process amenable to intervention were systematically identified. This mapping of the escalation process will allow tailored interventions to enhance surgical training and patient safety.
Byrne B, Faiz O, Darzi A, et al., 2015, Do gastrointestinal cancer patients want to decide where they have tests and surgery? A questionnaire study., Digestive Disorders Federation
Byrne B, Aylin P, Bottle R, et al., 2015, Lack of engagement in surgical quality improvement research is associated with poorer quality of care., Digestive Disorders Federation
Nouraei SA, Virk JS, Hudovsky A, et al., 2015, Accuracy of clinician-clinical coder information handover following acute medical admissions: implication for using administrative datasets in clinical outcomes management, Journal of Public Health, Vol: 38, Pages: 352-362, ISSN: 1741-3850
BACKGROUND: We evaluated the accuracy, limitations and potential sources of improvement in the clinical utility of the administrative dataset for acute medicine admissions. METHODS: Accuracy of clinical coding in 8888 patient discharges following an emergency medical hospital admission to a teaching hospital and a district hospital over 3 years was ascertained by a coding accuracy audit team in respect of the primary and secondary diagnoses, morbidities and financial variance. RESULTS: There was at least one change to the original coding in 4889 admissions (55%) and to the primary diagnosis of at least one finished consultant episodes of 1496 spells (16.8%). There were significant changes in the number of secondary diagnoses and the Charlson morbidity index following the audit. Charlson score increased in 8.2% and decreased in 2.3% of patients. An income variance of £816 977 (+5.0%) or £91.92 per patient was observed. CONCLUSIONS: The importance and applications of coded healthcare big data within the NHS is increasing. The accuracy of coding is dependent on high-fidelity information transfer between clinicians and coders, which is prone to subjectivity, variability and error. We recommend greater involvement of clinicians as part of multidisciplinary teams to improve data accuracy, and urgent action to improve abstraction and clarity of assignment of strategic diagnoses like pneumonia and renal failure.
Hughes-Hallett A, Pratt P, Mayer E, et al., 2015, Using preoperative imaging for intraoperative guidance: a case of mistaken identity, International Journal of Medical Robotics and Computer Assisted Surgery, Vol: 12, Pages: 262-267, ISSN: 1478-596X
BACKGROUND: Surgical image guidance systems to date have tended to rely on reconstructions of preoperative datasets. This paper assesses the accuracy of these reconstructions to establish whether they are appropriate for use in image guidance platforms. METHODS: Nine raters (two experts in image interpretation and preparation, three in image interpretation, and four in neither interpretation nor preparation) were asked to perform a segmentation of ten renal tumours (four cystic and six solid tumours). These segmentations were compared with a gold standard consensus segmentation generated using a previously validated algorithm. RESULTS: Average sensitivity and positive predictive value (PPV) were 0.902 and 0.891, respectively. When assessing for variability between raters, significant differences were seen in the PPV, sensitivity and incursions and excursions from consensus tumour boundary. CONCLUSIONS: This paper has demonstrated that the interpretation required for the segmentation of preoperative imaging of renal tumours introduces significant inconsistency and inaccuracy. Copyright © 2015 John Wiley & Sons, Ltd.
Keown OP, Darzi A, 2015, The quality narrative in health care, LANCET, Vol: 385, Pages: 1367-1368, ISSN: 0140-6736
Kwasnicki RM, Ali R, Jordan SJ, et al., 2015, A wearable mobility assessment device for total knee replacement: A longitudinal feasibility study, International Journal of Surgery, Vol: 18, Pages: 14-20, ISSN: 1743-9191
BackgroundTotal knee replacement currently lacks robust indications and objective follow-up metrics. Patients and healthcare staff are under-equipped to optimise outcomes. This study aims to investigate the feasibility of using an ear-worn motion sensor (e-AR, Imperial College London) to conduct objective, home-based mobility assessments in the peri-operative setting.MethodsFourteen patients on the waiting list for knee replacement, and 15 healthy subjects, were recruited. Pre-operatively, and at 1, 3, 6, 12 and 24 weeks post-operatively, patients underwent functional mobility testing (Timed Up and Go), knee examination (including range of motion), and an activity protocol whilst wearing the e-AR sensor. Features extracted from sensor motion data were used to assess patient performance and predict patients' recovery phase.ResultsSensor-derived peri-operative mobility trends correlated with clinical measures in several activities, allowing functional recovery of individual subjects to be profiled and compared, including the detection of a complication. Sensor data features enabled classification of subjects into normal, pre-operative and 24-week post-operative groups with 89% (median) accuracy. Classification accuracy was reduced to 69% when including all time intervals.DiscussionThis study demonstrates a novel, objective method of assessing peri-operative mobility, which could be used to supplement surgical decision-making and facilitate community-based follow-up.
Byrne B, Aylin P, Bottle RA, et al., 2015, 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
Pucher PH, Sodergren MH, Lord AC, et al., 2015, Consumer demand for surgical innovation: a systematic review of public perception of NOTES, Surgical Endoscopy, Vol: 29, Pages: 774-780, ISSN: 0930-2794
BackgroundThe full scope of benefits offered by NOTES over traditional laparoscopy, if any, is not yet fully clear. Perceived patient demand for truly “scarless surgery” is often referenced one of the driving factors in the continued development of this relatively new technique. The true scale of patient preference and demand for NOTES as a surgical technique is unknown. This review aims to summarise currently available literature on the topic of patient perceptions of NOTES to guide future development of the technique.MethodsA comprehensive search of PubMed and Web of Science electronic databases was performed on 1st Jan 2014. To be considered for inclusion, articles were required to assess and report the perception of NOTES in a sample of laypersons (patients or general public). The primary endpoint assessed was acceptance or preference rates expressed by patients for NOTES procedures. Reasons given for preference or rejection of NOTES were recorded, as well as preferred access routes and any predicting factors of NOTES acceptance.ResultsInitial search returned 1,334 results, resulting in 15 articles included in final data synthesis. These polled a total of 4,420 subjects. Acceptance of NOTES ranged between 41 and 84 %. Compared to a laparoscopic approach, preference rates for NOTES ranged from 0 to 78 %. Reasons for preferring NOTES were largely centred on potentially reduced recovery time, complications (particularly with reference to hernias) and postoperative pain. Improved cosmesis also played a role, but was secondary to the above issues. Overall, study quality was poor.ConclusionsThis review suggests significant public interest in NOTES and scarless surgery in general. Further research and consideration of differences in public perceptions across regions, countries and cultures are required.
Patel N, Darzi A, Teare J, 2015, The endoscopy evolution: 'the superscope era', Frontline Gastroenterology, Vol: 6, Pages: 101-107, ISSN: 2041-4145
Developments to the design of the flexible endoscope are transforming the field of gastroenterology. There is a drive to improve colonic adenoma detection rates leading to advancements in the design of the colonoscope. Novel endoscopes now allow increased visualisation of colonic mucosa, including behind colonic folds, and aim to reduce pain associated with the procedure. In addition, a shift in surgical paradigm towards minimally invasive endoluminal surgery has meant innovations in flexible platforms are being sought. There are a number of limitations of the basic endoscope. These include a lack of stability and triangulation of instruments. Modifications to the flexible endoscope design form the basis of a number of newly developed and research platforms, some of which are discussed in this review.
Johnston MJ, Arora S, King D, et al., 2015, A systematic review to identify the factors that affect failure to rescue and escalation of care in surgery, Surgery, Vol: 157, Pages: 752-763, ISSN: 0039-6060
BackgroundThe relationship between the ability to recognize and respond to patient deterioration (escalate care) and its role in preventing failure to rescue (FTR; mortality after a surgical complication) has not been explored. The aim of this systematic review was to determine the incidence of, and factors contributing to, FTR and delayed escalation of care for surgical patients.MethodsA search of MEDLINE, EMBASE PsycINFO, the Cochrane Database of Systematic Reviews, and the Cochrane Central Register of Controlled Trials was conducted to identify articles exploring FTR, escalation of care, and interventions that influence outcomes. Screening of 19,887 citations led to inclusion of 42 articles.ResultsThe reported incidence of FTR varied between 8.0 and 16.9%. FTR was inversely related to hospital volume and nurse staffing levels. Delayed escalation occurred in 20.7–47.1% of patients and was associated with greater mortality rates in 4 studies (P < .05). Causes of delayed escalation included hierarchy and failures in communication. Of five interventional studies, two reported a significant decrease in intensive care admissions (P < .01) after introduction of escalation protocols; only 1 study reported an improvement in mortality.ConclusionThis systematic review explored factors linking FTR and escalation of care in surgery. Important factors that contribute to the avoidance of preventable harm include the recognition and communication of serious deterioration to implement definitive treatment. Targeted interventions aiming to improve these factors may contribute to enhanced patient outcome.
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