Imperial College London

MrColinBicknell

Faculty of MedicineDepartment of Surgery & Cancer

Clinical Reader in Vascular Surgery
 
 
 
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Contact

 

+44 (0)20 3312 6428colin.bicknell

 
 
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Location

 

1020Queen Elizabeth the Queen Mother Wing (QEQM)St Mary's Campus

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Summary

 

Publications

Publication Type
Year
to

203 results found

Cheung S, Rahman R, Bicknell C, Stoyanov D, Chang P-L, Li M, Rolls A, Desender L, Van Herzeele I, Hamady M, Riga Cet al., 2020, Comparison of manual versus robot-assisted contralateral gate cannulation in patients undergoing endovascular aneurysm repair., Int J Comput Assist Radiol Surg

PURPOSE: Robotic endovascular technology may offer advantages over conventional manual catheter techniques. Our aim was to compare the endovascular catheter path-length (PL) for robotic versus manual contralateral gate cannulation during endovascular aneurysm repair (EVAR), using video motion analysis (VMA). METHODS: This was a multicentre retrospective cohort study with fluoroscopic video recordings of 24 EVAR cases (14 robotic, 10 manual) performed by experienced operators (> 50 procedures), obtained from four leading European centres. Groups were comparable with no statistically significant differences in aneurysm size (p = 0.47) or vessel tortuosity (p = 0.68). Two trained assessors used VMA to calculate the catheter PL during contralateral gate cannulation for robotic versus manual approaches. RESULTS: There was a high degree of inter-observer reliability (Cronbach's α > 0.99) for VMA. Median robotic PL was 35.7 cm [interquartile range, IQR (30.8-51.0)] versus 74.1 cm [IQR (44.3-170.4)] for manual cannulation, p = 0.019. Robotic cases had a median cannulation time of 5.33 min [IQR (4.58-6.49)] versus 1.24 min [IQR (1.13-1.35)] in manual cases (p = 0.0083). Generated efficiency ratios (PL/aorto-iliac centrelines) was 1.6 (1.2-2.1) in robotic cases versus 2.6 (1.7-7.0) in manual, p = 0.031. CONCLUSION: Robot-assisted contralateral gate cannulation in EVAR leads to decreased navigation path lengths and increased economy of movement compared with manual catheter techniques. The benefit could be maximised by prioritising robotic catheter shaping over habituated reliance on guidewire manipulation. Robotic technology has the potential to reduce the endovascular footprint during manipulations even for experienced operators with the added advantage of zero radiation exposure.

Journal article

Aufegger L, Bùi KH, Bicknell C, Darzi Aet al., 2020, Designing a paediatric hospital information tool with children, parents, and healthcare staff: a UX study., BMC Pediatr, Vol: 20

BACKGROUND: The hospital patient pathway for having treatment procedures can be daunting for younger patients and their family members, especially when they are about to undergo a complex intervention. Opportunities to mentally prepare young patients for their hospital treatments, e.g. for surgical procedures, include tools such as therapeutic clowns, medical dolls, or books and board games. However, while promising in reducing pre-operative anxiety and negative behaviours, they may be resource intensive, costly, and not always readily available. In this study, we co-designed a digital hospital information system with children, parents and clinicians, in order to prepare children undergoing medical treatment. METHOD: The study took place in the UK and consisted of two parts: In part 1, we purposively sampled 37 participants (n=22 parents, and n=15 clinicians) to understand perceptions and concerns of an hospital information platform specifically design for and addressed to children. In part 2, 14 children and 11 parents attended an audio and video recorded co-design workshop alongside a graphic designer and the research team to have their ideas explored and reflected on for the design of such information technology. Consequently, we used collected data to conduct thematic analysis and narrative synthesis. RESULTS: Findings from the survey were categorised into four themes: (1) the prospect of a hospital information system (parents' inputs); (2) content-specific information needed for the information system (parents' and clinicians' inputs); (3) using the virtual information system to connect young patients and parents (parents' inputs); and (4) how to use the virtual hospital information system from a clinician's perspective (clinicians' inputs). In contrast, the workshop highlighted points in times children were most distressed/relaxed, and derived the ideal hospital visit in both their and their parents' perspectives. CONCLUSIONS: The findings support the use of v

Journal article

Hamady M, Bicknell C, 2020, Challenges of Total Endovascular Repair of Chronic Type B Aortic Dissection, CARDIOVASCULAR AND INTERVENTIONAL RADIOLOGY, ISSN: 0174-1551

Journal article

Aufegger L, Alabi M, Darzi A, Bicknell Cet al., 2020, Sharing leadership: Current attitudes, barriers and needs of clinical and non-clinical managers in UK's integrated care system, BMJ Leader, Vol: 4, Pages: 128-134

© Background As systems become more complex, shared leadership (SL) has been suggested to have a dominant role in improving cross-functional working tailored to organisational needs. Little, however, is known about the benefits of SL in healthcare management, especially for UK's recently formed integrated care system (ICS). The aim of this study was to understand current attitudes, barriers and needs of clinical and non-clinical managers sharing leadership responsibilities in the ICS. Method Twenty clinical and non-clinical leaders in 15 organisations were interviewed to understand current cross-functional leadership collaborations, and the potential SL may have on the recently established ICS in the National Health Service (NHS). The data were transcribed and analysed thematically. Results Findings showed perceptions and experiences of clinical and non-clinical healthcare management in relation to: (1) motivation to execute a leadership position, including the need to step up and a sense of duty; (2) attitudes towards interdisciplinary working, which is reflected in conflicts due to different values and expertise; (3) SL skills and behaviours, including the need for mutual understanding and cooperative attitudes by means of effective communication and collaboration; and (4) barriers to achieve SL in the ICS, such as bureaucracy, and a lack of time and support. Conclusions SL may help improve current leadership cultures within the NHS; however, for SL to have a tangible impact, it needs to be delivered as part of leadership development for doctors in postgraduate training, and development programmes for aspiring, emerging and established leaders, with clear lines of communication.

Journal article

Ramjeeawon A, Sharrock AE, Morbi A, Martin G, Riga C, Bicknell Cet al., 2020, Using Fully-Immersive Simulation Training with Structured Debrief to Improve Nontechnical Skills in Emergency Endovascular Surgery., J Surg Educ, Vol: 77, Pages: 1300-1311

OBJECTIVE: Assess whether fully-immersive simulation training with structured debriefing of a standardized emergency thoracic endovascular aortic repair (TEVAR) scenario improves team-work performance of the lead surgeon. Secondary aims: assess whether technical skills (TS) and radiation safety behaviors (RSB) improved concurrently. DESIGN: Pre-post study. SETTING: UK-based training days. PARTICIPANTS: General and vascular surgical trainees (n = 16). INTERVENTION(S): Fully-immersive simulation training with structured debriefing of a standardized emergency TEVAR scenario. Following standardized emergency TEVAR technical training, trainees led 2 standardized fully-immersive endovascular surgery simulations, with scripted support from a passive surgical team. A non-TS (NTS) structured debrief was delivered following simulations. NTS were assessed using the validated observational teamwork assessment for surgery tool post hoc using video recordings of simulations. TS were assessed through time taken to complete each step of the procedure, as defined during technical training. RSB were assessed through checking for presence of pre-defined actions and the length of time fluoroscopy was used during each simulation. RESULTS: Total observational teamwork assessment for surgery scores improved following structured debrief (p = 0.005, median 52.55/90 vs 73.0/90), alongside all constituent domains - communication (p < 0.001, median 11.7/20 vs 16.6/20), coordination (p < 0.001, median 8.6/15 vs 13.4/15), cooperation (p < 0.001, median 13.15/20 vs 16.35/20), leadership (p < 0.001, median 8.70/15 vs 11.30/15) and monitoring (p < 0.001, median 9.85/20 vs 14.85/20). TS improved; time to complete 12 of 13 procedural steps improved (p < 0.027). Fluoroscopy time (seconds) decreased (p = 0.339, 543.6 vs 495.5), frequency lead surgeons checked the team were wearing leads increased (p = 0.125, 3 vs 7) and asked the team to step back before screening increased (p = 0.003

Journal article

Gogalniceanu P, Bicknell C, Reader T, Sevdalis N, Mamode Net al., 2020, We Asked the Experts: Delivering Resilient Surgical Care in a Crisis-Five Survival Strategies for Front-Line Surgeons, WORLD JOURNAL OF SURGERY, Vol: 44, Pages: 3597-3599, ISSN: 0364-2313

Journal article

Munshi B, Doyle BJ, Ritter JC, Jansen S, Parker LP, Riambau V, Bicknell C, Norman PE, Wanhainen Aet al., 2020, Surgical Decision Making in Uncomplicated Type B Aortic Dissection: A Survey of Australian/New Zealand and European Surgeons, EUROPEAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY, Vol: 60, Pages: 194-200, ISSN: 1078-5884

Journal article

Rolls A, Sudarsanam A, Luo X, Aylwin C, Bicknell C, Davies A, Gibbs R, Jaffer U, Jenkins M, Nott D, Riga C, Shalhoub J, Sritharan TG, Standfield Net al., 2020, COVID-19 and vascular surgery at a Central London teaching hospital, British Journal of Surgery, Vol: 107, Pages: e311-e312, ISSN: 0007-1323

Journal article

Kirkilesis G, Kakkos SK, Bicknell C, Salim S, Kakavia Ket al., 2020, Treatment of distal deep vein thrombosis., Cochrane Database Syst Rev, Vol: 4

BACKGROUND: The treatment of distal (below the knee) deep vein thrombosis (DVT) is not clearly established. Distal DVT can either be treated with anticoagulation, or monitored with close follow-up to detect progression to the proximal veins (above the knee), which requires anticoagulation. Proponents of this monitoring strategy base their decision to withhold anticoagulation on the fact that progression is rare and most people can be spared from potential bleeding and other adverse effects of anticoagulation. OBJECTIVES: To assess the effects of different treatment interventions for people with distal (below the knee) deep vein thrombosis (DVT). SEARCH METHODS: The Cochrane Vascular Information Specialist searched the Cochrane Vascular Specialised Register, CENTRAL, MEDLINE, Embase and CINAHL databases and World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.gov trials registers to 12 February 2019. We also undertook reference checking to identify additional studies. SELECTION CRITERIA: Randomised controlled trials (RCTs) for the treatment of distal DVT. DATA COLLECTION AND ANALYSIS: Two review authors independently selected trials and extracted data. We resolved disagreements by discussion. Primary outcomes of interest were recurrence of venous thromboembolism (VTE), DVT and major bleeding and follow up ranged from three months to two years. We performed fixed-effect model meta-analyses with risk ratio (RRs) and 95% confidence intervals (CIs). We assessed the certainty of the evidence using GRADE. MAIN RESULTS: We identified eight RCTs reporting on 1239 participants. Five trials randomised participants to anticoagulation for up to three months versus no anticoagulation. Three trials compared anticoagulation treatment for different time periods. Anticoagulant compared to no intervention or placebo for distal DVT treatment Anticoagulation with a vitamin K antagonist (VKA) reduced the risk of recurrent VTE during follow-up compa

Journal article

Salim S, Locci R, Martin G, Gibbs R, Jenkins M, Hamady M, Riga C, Bicknell C, Imperial Vascular Unit Collaboratorset al., 2020, Short- and long-term outcomes in isolated penetrating aortic ulcer disease, Journal of Vascular Surgery, Vol: 72, Pages: 84-91, ISSN: 0741-5214

BACKGROUND: The optimum management of isolated penetrating aortic ulceration (PAU), with no associated intramural hematoma or aortic dissection is not clear. We evaluate the short- and long-term outcomes in isolated PAU to better inform management strategies. METHODS: We conducted a retrospective review of 43 consecutive patients (mean age, 72.2 years; 26 men) with isolated PAU (excluding intramural hematoma/aortic dissection) managed at a single tertiary vascular unit between November 2007 and April 2019. Twenty-one percent had PAU of the arch, 62% of the thoracic aorta, and 17% of the abdominal aorta. Conservative and surgical groups were analyzed separately. Primary outcomes included mortality, PAU progression, and interventional complications. RESULTS: Initially, 67% of patients (29/43) were managed conservatively; they had significantly smaller PAU neck widths (P = .04), PAU depths (P = .004), and lower rates of associated aneurysmal change (P = .004) compared with those initially requiring surgery. Four patients (4/29) initially managed conservatively eventually required surgical management at a mean time interval of 49.75 months (range, 9.03-104.33 months) primarily owing to aneurysmal degeneration. Initially, 33% of patients (14/43) underwent surgical management; 7 of the 14 procedures were urgent. Of the 18 patients, 17 eventually managed with surgical intervention had an endovascular repair; 2 of the 17 endovascular cases involved supra-aortic debranching, six used scalloped, fenestrated, or chimney stents. The overall long-term mortality was 30% (mean follow-up, 48 months; range, 0-136 months) with no significant difference between the conservatively and surgically managed groups (P = .98). No aortic-related deaths were documented during follow-up in those managed conservatively. There was no in-hospital mortality after surgical repair. Of these 18 patients, two required reintervention within 30 days for t

Journal article

John IJ, Choo H, Pettengell CJ, Riga CV, Martin GFJ, Bicknell CDet al., 2019, Patient views on surgeon-specific outcome reporting in vascular surgery: novel validated patient questionnaire study., Annals of Surgery, Pages: 1-8, ISSN: 0003-4932

BACKGROUND: SSMD are used to enhance transparency, improve quality and facilitate patient choice. The use of SSMD is controversial, but patients' views on such data are largely unknown. OBJECTIVES: The aim of this study was therefore to explore the views of patients and to identify their priorities for outcome reporting in vascular surgery. METHODS: A prospective questionnaire study of 165 patients receiving care in a single academic vascular unit was performed. Data on patients' current understanding and use of SSMD, together with future priorities were collected. RESULTS: Of the 165 patients 80% were unaware of SSMD. 72% thought they should be made aware of the data, although 63% thought they were likely to misinterpret the results. The majority recognized the utility of SSMD to inform treatment (60%) and surgeon (53%) choice. The majority prioritize the patient-surgeon relationship (90%) and past experiences of care (71%) when making treatment decisions. A significant majority (66% vs 49%; P < 0.005) would favour hospital-level to surgeon-level data. The main patient priorities for future outcome reporting were waiting list length (56%), the quality of hospital facilities (55%), and patient satisfaction (54%). CONCLUSIONS: The aims of SSMD reporting are not currently being met, and both patients and healthcare professionals have shared concerns over the nature and usefulness of the data. Patients express a preference for hospital-level outcomes and prioritize the experience of receiving care over outcomes when making treatment decisions. Future outcome reporting should include patient-directed hospital-level metrics that are readily accessible and understood by all.

Journal article

Knighton A, Martin G, Sounderajah V, Warren L, Markiewicz O, Riga C, Bicknell Cet al., 2019, Avoidable 30‐day readmissions in patients undergoing vascular surgery, BJS Open, Vol: 3, Pages: 759-766, ISSN: 2474-9842

Background: Vascular surgery has one of the highest unplanned 30-day readmission rates of all surgical specialities. The degree to which these may be avoidable and the optimal strategies to reduce their occurrence is unknown. The aim of this study was to identify and classify avoidable 30-day readmissions in patients undergoing vascular surgery in order to plan targeted interventions to reduce their occurrence, improve outcomes and reduce cost.Methods: A retrospective analysis of discharges over a 12-month period from a single tertiary vascular unit was performed. A multidisciplinary panel conducted a manual case note review to identify and classify those 30-day unplanned emergency readmissions deemed avoidable.Results: An unplanned 30-day readmission occurred in 72/885 (8.1%) admissions. These unplanned readmissions were deemed avoidable in 50.0% (36/72) and were most frequently due to unresolved medical issues (19/36, 52.8%) and inappropriate admission with the potential for outpatient management (7/36, 19.4%). A smaller number were due to inadequate social care provision (4/36, 11.1%) and the occurrence of other avoidable adverse events (4/36, 11.1%). Conclusion: Half of all 30-day readmissions in vascular patients are potentially avoidable. Multidisciplinary coordination of inpatient care and the transition from hospital to community care following discharge need to be improved.

Journal article

Hanna L, Gibbs R, Fadl A, Kashef E, Riga C, Bicknell C, Jenkins M, Hamady Met al., 2019, Midterm to long-term outcomes of scallop endografts in the management of aortic disease with unfavorable proximal landing zone in the arch, Fall Meeting of the Frank-J-Veith-International-Society / VEITH Symposium, Publisher: Elsevier, Pages: E145-E145, ISSN: 0741-5214

Conference paper

Kirkilesis G, Kakkos SK, Bicknell C, Salim S, Kakavia Ket al., 2019, Treatment of distal deep vein thrombosis, Cochrane Database of Systematic Reviews, Vol: 2019

© 2019 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To assess the effects of different treatment interventions for people with distal (below the knee) deep vein thrombosis (DVT).

Journal article

Bicknell C, Powell JT, 2019, Intramural haematoma remains an enigma, European Heart Journal, Vol: 40, Pages: 2737-2739, ISSN: 1522-9645

Journal article

Archer SA, Pinto A, Vuik S, Bicknell C, Faiz O, Byrne B, Johnston M, Skapinakis P, Athanasiou T, Vincent C, Darzi Aet al., 2019, Surgery, complications and quality of life: a longitudinal cohort study exploring the role of psychosocial factors, Annals of Surgery, Vol: 270, Pages: 95-101, ISSN: 0003-4932

Objective:To determine if psychosocial factors moderate the relationship between surgical complications and quality of life (QoL).Summary Background:Patients who experience surgical complications have significantly worse post-operative QoL than patients with an uncomplicated recovery. Psychosocial factors, such as coping style and level of social support influence how people deal with stressful events, but it is unclear if they impact on QoL following a surgical complication. These findings can inform the development of appropriate interventions that support patients post-operatively. Methods:This is a longitudinal cohort study; data were collected at pre-op, 1 month post-op, 4 months post-op and 12 months post-op. A total of 785 patients undergoing major elective gastro-intestinal, vascular or cardio-thoracic surgery were recruited from 28 National Health Service (NHS) sites in England and Scotland took part in the study.Results:Patients who experience major surgical complications report significantly reduced levels of physical and mental QoL (p<0.05) but they make a full recovery over time. Findings indicate that a range of psychosocial factors such as the use of humor as a coping style and the level of health care professional support may moderate the impact of surgical complications on QoL.Conclusion:Surgical complications alongside other socio-demographic and psychosocial factors contribute to changes in QoL; the results from this exploratory study suggest that interventions that increase the availability of healthcare professional support and promote more effective coping strategies prior to surgery may be useful, particularly in the earlier stages of recovery where QoL is most severely compromised. However, these relationships should be further explored in longitudinal studies that include other types of surgery and employ rigorous recruitment and follow up procedures.

Journal article

Aufegger L, Bicknell C, Soane E, Ashrafian H, Darzi Aet al., 2019, Understanding health management and safety decisions using signal processing and machine learning, BMC Medical Research Methodology, Vol: 19, ISSN: 1471-2288

BackgroundSmall group research in healthcare is important because it deals with interaction and decision-making processes that can help to identify and improve safer patient treatment and care. However, the number of studies is limited due to time- and resource-intensive data processing. The aim of this study was to examine the feasibility of using signal processing and machine learning techniques to understand teamwork and behaviour related to healthcare management and patient safety, and to contribute to literature and research of teamwork in healthcare.MethodsClinical and non-clinical healthcare professionals organised into 28 teams took part in a video- and audio-recorded role-play exercise that represented a fictional healthcare system, and included the opportunity to discuss and improve healthcare management and patient safety. Group interactions were analysed using the recurrence quantification analysis (RQA; Knight et al., 2016), a signal processing method that examines stability, determinism, and complexity of group interactions. Data were benchmarked against self-reported quality of team participation and social support. Transcripts of group conversations were explored using the topic modelling approach (Blei et al., 2003), a machine learning method that helps to identify emerging themes within large corpora of qualitative data.ResultsGroups exhibited stable group interactions that were positively correlated with perceived social support, and negatively correlated with predictive behaviour. Data processing of the qualitative data revealed conversations focused on: (1) the management of patient incidents; (2) the responsibilities among team members; (3) the importance of a good internal team environment; and (4) the hospital culture.ConclusionsThis study has shed new light on small group research using signal processing and machine learning methods. Future studies are encouraged to use these methods in the healthcare context, and to conduct further research

Journal article

Aufegger L, Shariq O, Bicknell C, Ashrafian H, Darzi Aet al., 2019, Can shared leadership enhance clinical team management? A systematic review, Leadership in Health Services, Vol: 32, Pages: 309-335, ISSN: 1751-1879

PurposeResearch in psychology or management science has shown that shared leadership (SL) enhances information sharing, fosters participation and empowers team members within the decision-making processes, ultimately improving the quality of performance outcomes. Little has been done and, thus, less is known of the value and use of SL in acute healthcare teams. The purpose of this study is to (1) explore, identify and critically assess patterns and behaviour of SL in acute healthcare teams; and (2) evaluate to what extent SL may benefit and accomplish safer care in acute patient treatment and healthcare delivery.Design/methodology/approachThe authors conducted a review that followed the PRISMA-P reporting guidelines. A variety of sources were searched in April 2018 for studies containing primary research that focused on SL in acute healthcare teams. The outcome of interest was a well-specified assessment of SL, and an evaluation of the extent SL may enhance team performance, lead to safer patient care and healthcare delivery in acute healthcare teams.FindingsAfter the study selection process, 11 out of 1,383 studies were included in the review. Studies used a qualitative, quantitative or mixed-methods approach. Emerging themes based on behavioural observations that contributed to SL were: shared mental model; social support and situational awareness; and psychological safety. High-performing teams showed more SL behaviour, teams with less seniority displayed more traditional leadership styles and SL was associated with increased team satisfaction.Research limitations/implicationsEvidence to date suggests that SL may be of benefit to improve performance outcomes in acute healthcare team settings. However, the discrepancy of SL assessments within existing studies and their small sample sizes highlights the need for a large, good quality randomized controlled trial to validate this indication.Originality/valueAlthough studies have acknowledged the relevance of SL in he

Journal article

Rolls AE, Riga CV, Rahim SU, Willaert W, Van Herzeele I, Stoyanov DV, Hamady MS, Cheshire NJ, Bicknell CDet al., 2019, The use of video motion analysis to determine the impact of anatomic complexity on endovascular performance in carotid artery stenting, JOURNAL OF VASCULAR SURGERY, Vol: 69, Pages: 1482-1489, ISSN: 0741-5214

Journal article

Bakhsh A, Martin GFJ, Bicknell CD, Pettengell C, Riga Cet al., 2019, An Evaluation of the Impact of High-Fidelity Endovascular Simulation on Surgeon Stress and Technical Performance, JOURNAL OF SURGICAL EDUCATION, Vol: 76, Pages: 864-871, ISSN: 1931-7204

Journal article

Currie J, Bond RR, McCullagh P, Black P, Finlay DD, Gallagher S, Kearney P, Peace A, Stoyanov D, Bicknell CD, Leslie S, Gallagher AGet al., 2019, Wearable technology-based metrics for predicting operator performance during cardiac catheterisation, INTERNATIONAL JOURNAL OF COMPUTER ASSISTED RADIOLOGY AND SURGERY, Vol: 14, Pages: 645-657, ISSN: 1861-6410

Journal article

Epstein DM, Gohel MS, Heatley F, Liu X, Bradbury A, Bulbulia R, Cullum N, Nyamekye I, Poskitt KR, Renton S, Warwick J, Davies AH, Gohel MS, Read D, Hargreaves S, Dhillon K, Anwar M, Liddle A, Brown H, Mercer K, Gill F, Liu A, Jepson W, Wormwell A, Rafferty H, Davies AH, Dhillon K, Kaur R, Solomon E, Sritharan K, Velineni R, Lim CS, Busuttil A, Bootun R, Bicknell C, Jenkins M, Lane T, Serjeant E, Poskitt K, Bulbulia R, Waldron J, Wolfrey G, Slim F, Davies C, Emerson L, Grasty M, Whyman M, Wakeley C, Cooper A, Clapp J, Hogg N, Howard J, Dyer J, Lyes S, Teemul D, Harvey K, Pride M, Kindon A, Price H, Flemming L, Birch G, Holmes H, Weston J, Joseph T, Eiffel R, Ojimba T, Wilson T, Hodgson A, Robinson L, Todhunter J, Heagarty D, Mckeane A, McCarthy R, Barwell J, Northcott C, Elstone A, West C, Chong P, Gerrard D, Croucher A, Levy S, Martin C, Craig T, Carradice D, Firth A, Clarke E, Oswald A, Sinclair J, Chetter I, El-Sheikha J, Nandhra S, Leung C, Scott J, Dewhirst N, Woods J, Russell D, Darwood R, Troxler M, Thackeray J, Bell D, Watson D, Williamson L, Coulston J, Eyers P, Darvall K, Hunter I, Stewart A, Moss A, Rewbury J, Adams C, Vickery L, Foote L, Durman H, Venn F, Hill P, James K, Luxton F, Greenwell D, Roberts K, Mitchell S, Tate M, Mills H, Garnham A, Hobbs S, McIntosh D, Green M, Collins K, Rankin J, Poulton P, Isgar V, Renton S, Dhillon K, Trivedi M, Kafeza M, Parsapour S, Moore H, Najem M, Connarty S, Albon H, Lloyd C, Trant J, Vohra R, McCormack J, Marshall J, Hardy V, Rogoveanu R, Goff W, Garnham A, Gidda R, Merotra S, Shiralkar S, Jayatunga A, Pathak R, Rehman A, Randhawa K, Lewis J, Fullwood S, Jennings S, Cole S, Wall M, Ranaboldo C, Hulin S, Clarke C, Fennelly R, Cooper R, Boyes R, Draper C, Harris L, Mead D, Bradbury A, Kelly L, Bate G, Davies H, Popplewell M, Claridge M, Gannon M, Khaira H, Scriven M, Wilmink T, Adam D, Nasr H, Dodd D, Nawaz S, Humphreys J, Barnes M, Sorrell J, Swift D, Phillips P, Trender H, Fenwick N, Rittoo D, Baker S, Mitchell Ret al., 2019, Cost-effectiveness analysis of a randomized clinical trial of early versus deferred endovenous ablation of superficial venous reflux in patients with venous ulceration, British Journal of Surgery, Vol: 106, Pages: 555-562, ISSN: 0007-1323

BackgroundTreatment of superficial venous reflux in addition to compression therapy accelerates venous leg ulcer healing and reduces ulcer recurrence. The aim of this study was to evaluate the costs and cost‐effectiveness of early versus delayed endovenous treatment of patients with venous leg ulcers.MethodsThis was a within‐trial cost‐utility analysis with a 1‐year time horizon using data from the EVRA (Early Venous Reflux Ablation) trial. The study compared early versus deferred endovenous ablation for superficial venous truncal reflux in patients with a venous leg ulcer. The outcome measure was the cost per quality‐adjusted life‐year (QALY) over 1 year. Sensitivity analyses were conducted with alternative methods of handling missing data, alternative preference weights for health‐related quality of life, and per protocol.ResultsAfter early intervention, the mean(s.e.m.) cost was higher (difference in cost per patient £163(318) (€184(358))) and early intervention was associated with more QALYs at 1 year (mean(s.e.m.) difference 0·041(0·017)). The incremental cost‐effectiveness ratio (ICER) was £3976 (€4482) per QALY. There was an 89 per cent probability that early venous intervention is cost‐effective at a threshold of £20 000 (€22 546)/QALY. Sensitivity analyses produced similar results, confirming that early treatment of superficial reflux is highly likely to be cost‐effective.ConclusionEarly treatment of superficial reflux is highly likely to be cost‐effective in patients with venous leg ulcers over 1 year. Registration number: ISRCTN02335796 (http://www.isrctn.com).

Journal article

Zamir M, Jenkins M, Burfitt N, Bicknell C, Gibbs R, Hamady Met al., 2019, Short-term and Midterm Results of Fenestrated Anaconda Endograft in Patients with Previous Endovascular Aneurysm Repair, JOURNAL OF VASCULAR AND INTERVENTIONAL RADIOLOGY, Vol: 30, Pages: 546-553, ISSN: 1051-0443

Journal article

Chi W, Liu J, Abdelaziz MEMK, Dagnino G, Riga C, Bicknell C, Yang G-Zet al., 2019, Trajectory Optimization of Robot-Assisted Endovascular Catheterization with Reinforcement Learning, 25th IEEE/RSJ International Conference on Intelligent Robots and Systems (IROS), Publisher: IEEE, Pages: 3875-3881, ISSN: 2153-0858

Conference paper

Kneebone RL, Oakes F, Bicknell C, 2019, Reframing surgical simulation: the textile body as metaphor, The Lancet, Vol: 393, Pages: 22-23, ISSN: 0140-6736

Journal article

Normahani P, Kwasnicki R, Bicknell C, Allen L, Jenkins MP, Gibbs R, Cheshire N, Darzi A, Riga Cet al., 2018, Wearable sensor technology efficacy in peripheral vascular disease (wSTEP): a randomized controlled trial, Annals of Surgery, Vol: 268, Pages: 1113-1118, ISSN: 1528-1140

OBJECTIVE: To evaluate the effect of using wearable activity monitors (WAMs) in patients with intermittent claudication (IC) within a single-center randomized controlled trial. BACKGROUND: WAMs allow users to set daily activity targets and monitor their progress. They may offer an alternative treatment to supervised exercise programs (SEPs) for patients with IC. METHODS: Thirty-seven patients with IC were recruited and randomized into intervention or control group. The intervention consisted of a feedback-enabled, wrist-worn activity monitor (WAM) in addition to access to SEP. The control group was given access to SEP only. The outcome measures were maximum walking distance (MWD), claudication distance (CD), and quality of life as measured by the VascuQol questionnaire. Participants were assessed upon recruitment, and at 3, 6, and 12 months. RESULTS: Patients in the WAM group showed significant improvement in MWD at 3 and 6 months (80-112 m, to 178 m; P < 0.001), which was sustained at 12 months. The WAM group also increased CD (40 vs 110 m; P < 0.001) and VascuQol score (4.7 vs 5.8; P = 0.004). The control group saw a temporary increase in VascuQol score at 6 months (4.5 vs 4.7; P = 0.028), but no other improvements in MWD or CD were observed. Significantly higher improvements in MWD were seen in the WAM group compared with that in the control group at 6 months (82 vs -5 m; P = 0.009, r = 0.47) and 12 months (69 vs 7.5 m; P = 0.011, r = 0.52). CONCLUSIONS: The study demonstrates the significant, sustained benefit of WAM-led technologies for patients with IC. This potentially resource-sparing intervention is likely to provide a valuable adjunct or alternative to SEP.

Journal article

Doyen B, Bicknell CD, Riga CV, Van Herzeele Iet al., 2018, Evidence Based Training Strategies to Improve Clinical Practice in Endovascular Aneurysm Repair, EUROPEAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY, Vol: 56, Pages: 751-758, ISSN: 1078-5884

Journal article

Martin G, Pettengell C, John I, Sounderajah V, Riga C, Bicknell Cet al., 2018, What Do Patients Want to Know About Their Surgeon? Stakeholder Views of Surgeon-Specific Mortality Data, 45th Annual VEITHSymposium, Publisher: MOSBY-ELSEVIER, Pages: E161-E161, ISSN: 0741-5214

Conference paper

Rao AM, Bottle A, Bicknell C, Darzi A, Aylin Pet al., 2018, Trajectory modelling to assess trends in long-term readmission rate among abdominal aortic aneurysm patients, Surgery Research and Practice, Vol: 2018, ISSN: 2356-7759

Introduction. The aim of the study was to use trajectory analysis to categorise high-impact users based on their long-term readmission rate and identify their predictors following AAA (abdominal aortic aneurysm) repair. Methods. In this retrospective cohort study, group-based trajectory modelling (GBTM) was performed on the patient cohort (2006-2009) identified through national administrative data from all NHS English hospitals. Proc Traj software was used in SAS program to conduct GBTM, which classified patient population into groups based on their annual readmission rates during a 5-year period following primary AAA repair. Based on the trends of readmission rates, patients were classified into low- and high-impact users. The high-impact group had a higher annual readmission rate throughout 5-year follow-up. Short-term high-impact users had initial high readmission rate followed by rapid decline, whereas chronic high-impact users continued to have high readmission rate. Results. Based on the trends in readmission rates, GBTM classified elective AAA repair () patients into 2 groups: low impact (82.0%) and high impact (18.0%). High-impact users were significantly associated with female sex () undergoing other vascular procedures (), poor socioeconomic status index (), older age (), and higher comorbidity score (). The AUC for c-statistics was 0.84. Patients with ruptured AAA repair () had 3 groups: low impact (82.7%), short-term high impact (7.2%), and chronic high impact (10.1%). Chronic high impact users were significantly associated with renal failure (), heart failure (P = 0.01), peripheral vascular disease (), female sex (P = 0.02), open repair (), and undergoing other related procedures (). The AUC for c-statistics was 0.71. Conclusion. Patients with persistent high readmission rates exist among AAA population; however, their readmissions and mortality are not related to AAA repair. They may benefit from optimization of their medical management of comorbiditie

Journal article

Judah G, Darzi A, Vlaev I, Gunn L, King D, King D, Valabhji J, Bicknell Cet al., 2018, Financial disincentives? A three-armed randomised controlled trial of the effect of financial Incentives in Diabetic Eye Assessment by Screening (IDEAS) trial, British Journal of Ophthalmology, Vol: 102, Pages: 1014-1020, ISSN: 0007-1161

OBJECTIVE: Conflicting evidence exists regarding the impact of financial incentives on encouraging attendance at medical screening appointments. The primary aim was to determine whether financial incentives increase attendance at diabetic eye screening in persistent non-attenders. METHODS AND ANALYSIS: A three-armed randomised controlled trial was conducted in London in 2015. 1051 participants aged over 16 years, who had not attended eye screening appointments for 2 years or more, were randomised (1.4:1:1 randomisation ratio) to receive the usual invitation letter (control), an offer of £10 cash for attending screening (fixed incentive) or a 1 in 100 chance of winning £1000 (lottery incentive) if they attend. The primary outcome was the proportion of invitees attending screening, and a comparative analysis was performed to assess group differences. Pairwise comparisons of attendance rates were performed, using a conservative Bonferroni correction for independent comparisons. RESULTS: 34/435 (7.8%) of control, 17/312 (5.5%) of fixed incentive and 10/304 (3.3%) of lottery incentive groups attended. Participants who received any incentive were significantly less likely to attend their appointment compared with controls (risk ratio (RR)=0.56; 95% CI 0.34 to 0.92). Those in the probabilistic incentive group (RR=0.42; 95% CI 0.18 to 0.98), but not the fixed incentive group (RR=1.66; 95% CI 0.65 to 4.21), were significantly less likely to attend than those in the control group. CONCLUSION: Financial incentives, particularly lottery-based incentives, attract fewer patients to diabetic eye screening than standard invites in this population. Financial incentives should not be used to promote screening unless tested in context, as they may negatively affect attendance rates.

Journal article

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