177 results found
Archer S, Pinto A, Vuik S, et al., 2018, Surgery, Complications, and Quality of Life: A Longitudinal Cohort Study Exploring the Role of Psychosocial Factors., Ann Surg
OBJECTIVE: To determine whether psychosocial factors moderate the relationship between surgical complications and quality of life (QoL). BACKGROUND: Patients who experience surgical complications have significantly worse postoperative 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 whether they affect QoL following a surgical complication. These findings can inform the development of appropriate interventions that support patients postoperatively. METHODS: This is a longitudinal cohort study; data were collected pre-op, 1 month post-op, 4 months post-op, and 12 months post-op. A total of 785 patients undergoing major elective gastrointestinal, vascular, or cardiothoracic surgery who were recruited from 28 National Health Service 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. CONCLUSIONS: Surgical complications alongside other sociodemographic 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 before 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.
Chi W, Liu J, Rafii-Tari H, et al., 2018, Learning-based endovascular navigation through the use of non-rigid registration for collaborative robotic catheterization, INTERNATIONAL JOURNAL OF COMPUTER ASSISTED RADIOLOGY AND SURGERY, Vol: 13, Pages: 855-864, ISSN: 1861-6410
Judah G, Darzi A, Vlaev I, et al., 2018, Financial disincentives? A three-armed randomised controlled trial of the effect of financial Incentives in Diabetic Eye Assessment by Screening (IDEAS) trial., Br J Ophthalmol, Vol: 102, Pages: 1014-1020
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.
Li MM, Hamady MS, Bicknell CD, et al., 2018, Flexible robotic catheters in the visceral segment of the aorta: advantages and limitations., J Cardiovasc Surg (Torino), Vol: 59, Pages: 317-321
Flexible robotic catheters are an emerging technology which provide an elegant solution to the challenges of conventional endovascular intervention. Originally developed for interventional cardiology and electrophysiology procedures, remotely steerable robotic catheters such as the Magellan system enable greater precision and enhanced stability during target vessel navigation. These technical advantages facilitate improved treatment of disease in the arterial tree, as well as allowing execution of otherwise unfeasible procedures. Occupational radiation exposure is an emerging concern with the use of increasingly complex endovascular interventions. The robotic systems offer an added benefit of radiation reduction, as the operator is seated away from the radiation source during manipulation of the catheter. Pre-clinical studies have demonstrated reduction in force and frequency of vessel wall contact, resulting in reduced tissue trauma, as well as improved procedural times. Both safety and feasibility have been demonstrated in early clinical reports, with the first robot-assisted fenestrated endovascular aortic repair in 2013. Following from this, the Magellan system has been used to successfully undertake a variety of complex aortic procedures, including fenestrated/branched endovascular aortic repair, embolization, and angioplasty.
Martin G, Patel N, Grant Y, et al., 2018, Antihypertensive medication adherence in chronic type B aortic dissection is an important consideration in the management debate, JOURNAL OF VASCULAR SURGERY, Vol: 68, Pages: 693-+, ISSN: 0741-5214
Murray AC, Markar S, Mackenzie H, et al., 2018, An observational study of the timing of surgery, use of laparoscopy and outcomes for acute cholecystitis in the USA and UK, SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES, Vol: 32, Pages: 3055-3063, ISSN: 0930-2794
Perera AH, Rudarakanchana N, Monzon L, et al., 2018, Cerebral embolization, silent cerebral infarction and neurocognitive decline after thoracic endovascular aortic repair, BRITISH JOURNAL OF SURGERY, Vol: 105, Pages: 366-378, ISSN: 0007-1323
Rao A, Bottle A, Bicknell C, et al., 2018, Common Sequences of Emergency Readmissions among High-Impact Users following AAA Repair., Surg Res Pract, Vol: 2018, ISSN: 2356-7759
Introduction: The aim of the study was to examine common sequences of causes of readmissions among those patients with multiple hospital admissions, high-impact users, after abdominal aortic aneurysm (AAA) repair and to focus on strategies to reduce long-term readmission rate. Methods: The patient cohort (2006-2009) included patients from Hospital Episodes Statistics, the national administrative data of all NHS English hospitals, and followed up for 5 years. Group-based trajectory modelling and sequence analysis were performed on the data. Results: From a total of 16,973 elective AAA repair patients, 18% (n=3055) were high-impact users. The high-impact users among ruptured abdominal aortic aneurysm (rAAA) repair constituted 17.3% of the patient population (n=4144). There were 2 subtypes of high-impact users, short-term (7.2%) with initial high readmission rate following by rapid decline and chronic high-impact (10.1%) with persistently high readmission rate. Common causes of readmissions following elective AAA repair were respiratory tract infection (7.3%), aortic graft complications (6.0%), unspecified chest pain (5.8%), and gastrointestinal haemorrhage (4.8%). However, high-impact users included significantly increased number of patients with multiple readmissions and distinct sequences of readmissions mainly consisting of COPD (4.7%), respiratory tract infection (4.7%), and ischaemic heart disease (3.3%). Conclusion: A significant number of patients were high-impact users after AAA repair. They had a common and distinct sequence of causes of readmissions following AAA repair, mainly consisting of cardiopulmonary conditions and aortic graft complications. The common causes of long-term mortality were not related to AAA repair. The quality of care can be improved by identifying these patients early and focusing on prevention of cardiopulmonary diseases in the community.
Rolls AE, Bicknell CD, Cheshire NJ, et al., 2018, The current state of flexide catheter robotics for endovascular interventions., J Cardiovasc Surg (Torino), Vol: 59, Pages: 307-309
Rudarakanchana N, Hamady M, Harris S, et al., 2018, Early outcomes of patients transferred with ruptured suprarenal aneurysm or dissection, ANNALS OF THE ROYAL COLLEGE OF SURGEONS OF ENGLAND, Vol: 100, Pages: 316-321, ISSN: 0035-8843
Weerakkody R, Ross D, Parry DA, et al., 2018, Targeted genetic analysis in a large cohort of familial and sporadic cases of aneurysm or dissection of the thoracic aorta., Genet Med
PurposeThoracic aortic aneurysm/aortic dissection (TAAD) is a disorder with highly variable age of onset and phenotype. We sought to determine the prevalence of pathogenic variants in TAAD-associated genes in a mixed cohort of sporadic and familial TAAD patients and identify relevant genotype-phenotype relationships.MethodsWe used a targeted polymerase chain reaction and next-generation sequencing-based panel for genetic analysis of 15 TAAD-associated genes in 1,025 unrelated TAAD cases.ResultsWe identified 49 pathogenic or likely pathogenic (P/LP) variants in 47 cases (4.9% of those successfully sequenced). Almost half of the variants were in nonsyndromic cases with no known family history of aortic disease. Twenty-five variants were within FBN1 and two patients were found to harbor two P/LP variants. Presence of a related syndrome, younger age at presentation, family history of aortic disease, and involvement of the ascending aorta increased the risk of carrying a P/LP variant.ConclusionGiven the poor prognosis of TAAD that is undiagnosed prior to acute rupture or dissection, genetic analysis of both familial and sporadic cases of TAAD will lead to new diagnoses, more informed management, and possibly reduced mortality through earlier, preclinical diagnosis in genetically determined cases and their family members.Genetics in Medicine advance online publication, 15 March 2018; doi:10.1038/gim.2018.27.
Chi W, Rafii-Tari H, Payne CJ, et al., 2017, A learning based training and skill assessment platform with haptic guidance for endovascular catheterization, Pages: 2357-2363, ISSN: 1050-4729
© 2017 IEEE. Increasing demands in endovascular intervention have motivated technical skill training and competency-based measures of performance. However, there are no well-established online metrics for technical skill assessment; few studies have explored operator behavioral patterns from catheter motion and operator hand motions. This paper proposes a platform for active online training and objective assessment of endovascular skills, through learning optimum catheter motions from multiple demonstrations. An ungrounded hand-held haptic device for providing intuitive haptic guidance to novice users based on this learnt information is also proposed. Statistical models are implemented to extract the underlying catheter motion patterns, and utilize them for performance evaluation and haptic guidance. The results show significant improvements in endovascular navigation for inexperienced operators. Finer catheter motions were achieved with the provided haptic guidance. The results suggest that the proposed platform can be integrated into current clinical training setups, and motivate the improvement of endovascular training platforms with better realism.
Desender L, Van Herzeele I, Lachat M, et al., 2017, A Multicentre Trial of Patient specific Rehearsal Prior to EVAR: Impact on Procedural Planning and Team Performance, EUROPEAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY, Vol: 53, Pages: 354-361, ISSN: 1078-5884
Desender LM, Van Herzeele I, Rancic Z, et al., 2017, Patient-Specific Simulation of Endovascular Thoracic Aortic Repair: Initial Experience, ANNALS OF THORACIC SURGERY, Vol: 104, Pages: 336-341, ISSN: 0003-4975
Hamady M, Sharma PM, Patel R, et al., 2017, Hybrid endovascular repair of aneurysmal right-sided aortic arch and Kommerell's diverticulum using a two-vessel branched stent graft: Case report and review of literature, SAGE OPEN MEDICAL CASE REPORTS, Vol: 5, ISSN: 2050-313X
Judah G, Darzi A, Vlaev I, et al., 2017, Incentives in Diabetic Eye Assessment by Screening (IDEAS) trial: a three-armed randomised controlled trial of financial incentives, Health Services and Delivery Research, Vol: 5, Pages: 1-60, ISSN: 2050-4349
Background:The UK national diabetic eye screening (DES) programme invites diabetic patients aged>12 years annually. Simple and cost-effective methods are needed to increase screening uptake. This trialtests the impact on uptake of two financial incentive schemes, based on behavioural economic principles.Objectives:To test whether or not financial incentives encourage screening attendance. Secondarily tounderstand if the type of financial incentive scheme used affects screening uptake or attracts patients witha different sociodemographic status to regular attenders. If financial incentives were found to improveattendance, then a final objective was to test cost-effectiveness.Design:Three-armed randomised controlled trial.Setting:DES clinic within St Mary’s Hospital, London, covering patients from the areas of Kensington,Chelsea and Westminster.Participants:Patients aged≥16 years, who had not attended their DES appointment for≥2 years.Interventions:(1) Fixed incentive–invitation letter and £10 for attending screening; (2) probabilistic(lottery) incentive–invitation letter and 1% chance of winning £1000 for attending screening; and(3) control–invitation letter only.Main outcome measures:The primary outcome was screening attendance. Rates for control versus fixedand lottery incentive groups were compared using relative risk (RR) and risk difference with corresponding95% confidence intervals (CIs).Results:A total of 1274 patients were eligible and randomised; 223 patients became ineligible beforeinvite and 1051 participants were invited (control,n=435; fixed group,n=312; lottery group,n=304).Thirty-four (7.8%, 95% CI 5.29% to 10.34%) control, 17 (5.5%, 95% CI 2.93% to 7.97%) fixed groupand 10 (3.3%, 95% CI 1.28% to 5.29%) lottery group participants attended. Participants offered incentives were 44% less likely to attend screening than controls (RR 0.56, 95% CI 0.34 to 0.92). Examining incentivegroups separately, the lottery gr
Lear R, Godfrey AD, Riga C, et al., 2017, The Impact of System Factors on Quality and Safety in Arterial Surgery: A Systematic Review, EUROPEAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY, Vol: 54, Pages: 79-93, ISSN: 1078-5884
Lear R, Godfrey AD, Riga C, et al., 2017, Surgeons' Perceptions of the Causes of Preventable Harm in Arterial Surgery: A Mixed-Methods Study, EUROPEAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY, Vol: 54, Pages: 778-786, ISSN: 1078-5884
Lee S-L, 2017, Examining the use of a novel dynamic endovascular simulator to facilitate intelligent localization and robotic technologies, Vascular-Societies Annual Scientific Meeting, Publisher: WILEY, Pages: 16-16, ISSN: 0007-1323
Normahani P, Kwasnicki R, Bicknell C, et al., 2017, Wearable Sensor Technology Efficacy in Peripheral Vascular Disease (wSTEP): A Randomized Controlled Trial., Ann Surg
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.
Perera AH, Riga CV, Monzon L, et al., 2017, Robotic Arch Catheter Placement Reduces Cerebral Embolization During Thoracic Endovascular Aortic Repair (TEVAR), EUROPEAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY, Vol: 53, Pages: 362-369, ISSN: 1078-5884
Perera AH, Riga CV, Monzon L, et al., 2017, Response to Commentary on "Robotic Arch Catheter Placement Reduces Cerebral Embolisation During Thoracic Endovascular Aortic Repair (TEVAR)", EUROPEAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY, Vol: 54, Pages: 126-127, ISSN: 1078-5884
Rafii-Tari H, Payne CJ, Bicknell C, et al., 2017, Objective Assessment of Endovascular Navigation Skills with Force Sensing, ANNALS OF BIOMEDICAL ENGINEERING, Vol: 45, Pages: 1315-1327, ISSN: 0090-6964
Ramjeeawon A, Sharrock AE, Morbi A, et al., 2017, Exploring the effect of a structured debrief on measurable performance outcomes during endovascular surgery simulation, International Congress of the Association-of-Surgeons-of-Great-Britain-and-Ireland, Publisher: WILEY, Pages: 41-42, ISSN: 0007-1323
Ribe L, Bicknell CD, Gibbs RG, et al., 2017, Long-term results of intra-arterial onyx injection for type II endoleaks following endovascular aneurysm repair, VASCULAR, Vol: 25, Pages: 266-271, ISSN: 1708-5381
Rolls AE, Riga CV, Rahim S, et al., 2017, Video motion analysis in live coronary angiography differentiates levels of experience and provides a novel method of skill assessment, EUROINTERVENTION, Vol: 13, Pages: E1460-E1467, ISSN: 1774-024X
Bicknell CD, Kiru G, Falaschetti E, et al., 2016, An evaluation of the effect of an angiotensin-converting enzyme inhibitor on the growth rate of small abdominal aortic aneurysms: a randomized placebo-controlled trial (AARDVARK), EUROPEAN HEART JOURNAL, Vol: 37, Pages: 3213-3221, ISSN: 0195-668X
Chang P-L, Rolls A, De Praetere H, et al., 2016, Robust Catheter and Guidewire Tracking Using B-Spline Tube Model and Pixel-Wise Posteriors, IEEE ROBOTICS AND AUTOMATION LETTERS, Vol: 1, Pages: 303-308, ISSN: 2377-3766
Cheung S, Bicknell C, Stoyanov D, et al., 2016, Robot-Assisted EVAR: Video Motion Analysis in Live Cases, Vascular-Societies Annual Scientific Meeting, Publisher: WILEY-BLACKWELL, Pages: 21-21, ISSN: 0007-1323
Desender LM, Van Herzeele I, Lachat ML, et al., 2016, Patient-specific Rehearsal Before EVAR: Influence on Technical and Nontechnical Operative Performance. A Randomized Controlled Trial, ANNALS OF SURGERY, Vol: 264, Pages: 703-709, ISSN: 0003-4932
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