168 results found
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., Surg Endosc
BACKGROUND: Evidence supports early laparoscopic cholecystectomy for acute cholecystitis. Differences in treatment patterns between the USA and UK, associated outcomes and resource utilization are not well understood. METHODS: In this retrospective, observational study using national administrative data, emergency patients admitted with acute cholecystitis were identified in England (Hospital Episode Statistics 1998-2012) and USA (National Inpatient Sample 1998-2011). Proportions of patients who underwent emergency cholecystectomy, utilization of laparoscopy and associated outcomes including length of stay (LOS) and complications were compared. The effect of delayed treatment on subsequent readmissions was evaluated for England. RESULTS: Patients with a diagnosis of acute cholecystitis totaled 1,191,331 in the USA vs. 288 907 in England. Emergency cholecystectomy was performed in 628,395 (52.7% USA) and 45,299 (15.7% England) over the time period. Laparoscopy was more common in the USA (82.8 vs. 37.9%; p < 0.001). Pre-treatment (1 vs. 2 days; p < 0.001) and total ( 4 vs. 7 days; p < 0.001) LOS was lower in the USA. Overall incidence of bile duct injury was higher in England than the USA (0.83 vs. 0.43%; p < 0.001), but was no different following laparoscopic surgery (0.1%). In England, 40.5% of patients without an immediate cholecystectomy were subsequently readmitted with cholecystitis. An additional 14.5% were admitted for other biliary complications, amounting to 2.7 readmissions per patient in the year following primary admission. CONCLUSION: This study highlights management practices for acute cholecystitis in the USA and England. Despite best evidence, index admission laparoscopic cholecystectomy is performed less in England, which significantly impacts subsequent healthcare utilization.
Perera AH, Rudarakanchana N, Monzon L, et al., 2018, Cerebral embolization, silent cerebral infarction and neurocognitive decline after thoracic endovascular aortic repair., Br J Surg
BACKGROUND: Silent cerebral infarction is brain injury detected incidentally on imaging; it can be associated with cognitive decline and future stroke. This study investigated cerebral embolization, silent cerebral infarction and neurocognitive decline following thoracic endovascular aortic repair (TEVAR). METHODS: Patients undergoing elective or emergency TEVAR at Imperial College Healthcare NHS Trust and Guy's and St Thomas' NHS Foundation Trust between January 2012 and April 2015 were recruited. Aortic atheroma graded from 1 (normal) to 5 (mobile atheroma) was evaluated by preoperative CT. Patients underwent intraoperative transcranial Doppler imaging (TCD), preoperative and postoperative cerebral MRI, and neurocognitive assessment. RESULTS: Fifty-two patients underwent TEVAR. Higher rates of TCD-detected embolization were observed with greater aortic atheroma (median 207 for grade 4-5 versus 100 for grade 1-3; P = 0·042), more proximal landing zones (median 450 for zone 0-1 versus 72 for zone 3-4; P = 0·001), and during stent-graft deployment and contrast injection (P = 0·001). In univariable analysis, left subclavian artery bypass (β coefficient 0·423, s.e. 132·62, P = 0·005), proximal landing zone 0-1 (β coefficient 0·504, s.e. 170·57, P = 0·001) and arch hybrid procedure (β coefficient 0·514, s.e. 182·96, P < 0·001) were predictors of cerebral emboli. Cerebral infarction was detected in 25 of 31 patients (81 per cent) who underwent MRI: 21 (68 per cent) silent and four (13 per cent) clinical strokes. Neurocognitive decline was seen in six of seven domains assessed in 15 patients with silent cerebral infarction, with age a significant predictor of decline. CONCLUSION: This study demonstrates a high rate of cerebral embolization and neurocognitive decline affecting patients foll
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 Med Case Rep, Vol: 5, ISSN: 2050-313X
Right-sided aortic arches are rare, affecting approximately 0.1% of the population. They are a result of abnormal development of the primitive aortic arches and may present later in life with later life with aneurysmal expansion of the aberrant left subclavian artery 'Kommerell's diverticulum'. These can be challenging to treat effectively. We report a rare case presenting with mild dysphagia and right-sided aneurysmal aortic arch with aneurysmal aberrant left-sided. The patient underwent hybrid endovascular repair incorporating bilateral carotid-subclavian bypasses and dual-arch-branch endograft placement to the left and right common carotid arteries. Although endovascular approaches have been described, there are no reports of branched endografts in this scenario. Right-sided aneurysmal aortic arch and the aneurysmal aberrant left subclavian artery are rare and represent a significant therapeutic challenge. Endovascular repair in conjunction with extra-anatomical bypass utilising a custom-made branched thoracic endograft is feasible.
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
Godfrey AD, Riga C, Bicknell C, 2016, 750 preoperative elective aortic-conditioned for failure?, Vascular-Societies Annual Scientific Meeting, Publisher: WILEY-BLACKWELL, Pages: 14-14, ISSN: 0007-1323
Hull L, Bicknell C, Patel K, et al., 2016, Content Validation and Evaluation of an Endovascular Teamwork Assessment Tool, EUROPEAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY, Vol: 52, Pages: 11-20, ISSN: 1078-5884
Judah G, Valabhji J, Gunn L, et al., 2016, A randomised controlled trial on the impact of financial incentives on attendance at diabetic eye screening in London, 52nd Annual Meeting of the European-Association-for-the-Study-of-Diabetes (EASD), Publisher: SPRINGER, Pages: S65-S65, ISSN: 0012-186X
Judah G, Vlaev I, Gunn L, et al., 2016, Incentives in Diabetic Eye Assessment by Screening (IDEAS): study protocol of a three-arm randomized controlled trial using financial incentives to increase screening uptake in London, BMC OPHTHALMOLOGY, Vol: 16, ISSN: 1471-2415
Kakkos SK, Bicknell CD, Tsolakis IA, et al., 2016, Editor's Choice - Management of Secondary Aorto-enteric and Other Abdominal Arterio-enteric Fistulas: A Review and Pooled Data Analysis, EUROPEAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY, Vol: 52, Pages: 770-786, ISSN: 1078-5884
Khamis RY, Woollard KJ, Hyde GD, et al., 2016, Near Infrared Fluorescence (NIRF) Molecular Imaging of Oxidized LDL with an Autoantibody in Experimental Atherosclerosis, SCIENTIFIC REPORTS, Vol: 6, ISSN: 2045-2322
Kiru G, Bicknell C, 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 randomised placebo-controlled trial (AARDVARK), HEALTH TECHNOLOGY ASSESSMENT, Vol: 20, Pages: 1-+, ISSN: 1366-5278
Lear R, Riga C, Godfrey AD, et al., 2016, Multicentre observational study of surgical system failures in aortic procedures and their effect on patient outcomes, BRITISH JOURNAL OF SURGERY, Vol: 103, Pages: 1467-1475, ISSN: 0007-1323
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