Publications
241 results found
Panoulas V, Thyregod HG, Nihoyannopoulos P, et al., 2016, Increased survival of females with severe aortic stenosis after transcatheter aortic valve implantation compared to surgical aortic valve replacement; a meta-analysis of randomised controlled studies, Congress of the European-Society-of-Cardiology (ESC), Publisher: OXFORD UNIV PRESS, Pages: 72-72, ISSN: 0195-668X
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, ISSN: 1366-5278
BACKGROUND: Although data are inconsistent, angiotensin-converting enzyme inhibitors (ACE-Is) have been associated with a reduced incidence of abdominal aortic aneurysm (AAA) rupture in analysis of administrative databases. OBJECTIVES: (1) To investigate whether or not the ACE-I perindopril (Coversyl arginine, Servier) reduces small AAA growth rate and (2) to evaluate blood pressure (BP)-independent effects of perindopril on small AAA growth and to compare the repeatability of measurement of internal and external aneurysm diameters. DESIGN: A three-arm, multicentre, single-blind, randomised placebo-controlled trial. SETTING: Fourteen hospitals in England. PARTICIPANTS: Men or women aged ≥ 55 years with an AAA of 3.0-5.4 cm in diameter by internal or external measurement according to ultrasonography and who met the trial eligibility criteria. INTERVENTIONS: Patients were randomised to receive 10 mg of perindopril arginine daily, 5 mg of the calcium channel blocker amlodipine daily or placebo daily. MAIN OUTCOME MEASURES: The primary outcome was AAA diameter growth using external measurements in the longitudinal plane, which in-trial studies suggested was the preferred measure. Secondary outcome measures included AAA rupture, AAA repair, modelling of the time taken for the AAA to reach the threshold for intervention (5.5 cm) or referral for surgery, tolerance of study medication (measured by compliance, adverse events and quality of life) and a comparison of the repeatability of measures of internal and external AAA diameter. Patients were followed up every 3-6 months over 2 years. RESULTS: In total, 227 patients were recruited and randomised into the three groups, which were generally well matched at baseline. Multilevel modelling was used to determine the maximum likelihood estimates for AAA diameter growth. No significant differences in the estimates of annual growth were apparent [1.68 (standard error 0.02) mm, 1.77 (0.
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
Ruparelia N, Panoulas VF, Frame A, et al., 2016, Impact of clinical and procedural factors upon C reactive protein dynamics following transcatheter aortic valve implantation, World Journal of Cardiology, Vol: 8, Pages: 425-431, ISSN: 1949-8462
AIM: To determine the effect of procedural and clinical factors upon C reactive protein (CRP) dynamics following transcatheter aortic valve implantation (TAVI). METHODS: Two hundred and eight consecutive patients that underwent transfemoral TAVI at two hospitals (Imperial, College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom and San Raffaele Scientific Institute, Milan, Italy) were included. Daily venous plasma CRP levels were measured for up to 7 d following the procedure (or up to discharge). Procedural factors and 30-d safety outcomes according to the Valve Academic Research Consortium 2 definition were collected. RESULTS: Following TAVI, CRP significantly increased reaching a peak on day 3 of 87.6 ± 5.5 mg/dL, P < 0.001. Patients who developed clinical signs and symptoms of sepsis had significantly increased levels of CRP (P < 0.001). The presence of diabetes mellitus was associated with a significantly higher peak CRP level at day 3 (78.4 ± 3.2 vs 92.2 ± 4.4, P < 0.001). There was no difference in peak CRP release following balloon-expandable or self-expandable TAVI implantation (94.8 ± 9.1 vs 81.9 ± 6.9, P = 0.34) or if post-dilatation was required (86.9 ± 6.3 vs 96.6 ± 5.3, P = 0.42), however, when pre-TAVI balloon aortic valvuloplasty was performed this resulted in a significant increase in the peak CRP (110.1 ± 8.9 vs 51.6 ± 3.7, P < 0.001). The development of a major vascular complication did result in a significantly increased maximal CRP release (153.7 ± 11.9 vs 83.3 ± 7.4, P = 0.02) and there was a trend toward a higher peak CRP following major/life-threatening bleeding (113.2 ± 9.3 vs 82.7 ± 7.5, P = 0.12) although this did not reach statistical significance. CRP was not found to be a predictor of 30-d mortality on univariate analysis. CONCLUSION: Careful attention should be paid to baseline clinical characteristics and procedura
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: 1528-1140
OBJECTIVE: To assess the effect of patient-specific virtual reality rehearsal (PsR) before endovascular infrarenal aneurysm repair (EVAR) on technical performance and procedural errors. BACKGROUND: Endovascular procedures, including EVAR, are executed in a complex multidisciplinary environment, often treating high-risk patients. Consequently, this may lead to patient harm and procedural inefficiency. PsR enables the endovascular team to evaluate and practice the case in a virtual environment before treating the real patient. METHODS: A multicenter, prospective, randomized controlled trial recruited 100 patients with a nonruptured infrarenal aortic or iliac aneurysm between September 2012 and June 2014. Cases were randomized to preoperative PsR or standard care (no PsR). Primary outcome measures were errors during the real procedure and technical operative metrics (total endovascular and fluoroscopy time, contrast volume, number of angiograms, and radiation dose). RESULTS: There was a 26% [95% confidence interval (CI) 9%-40%, P = 0.004) reduction in minor errors, a 76% (95% CI 30%-92%, P = 0.009) reduction in major errors, and a 27% (95% CI 8.2%-42%, P = 0.007) reduction in errors causing procedural delay in the PsR group. The number of angiograms performed to visualize proximal and distal landing zones was 23% (95% CI 8%-36%, P = 0.005) and 21% (95% CI 7%-32%, P = 0.004) lower in the PsR group. CONCLUSIONS: PsR before EVAR can be used in different hospital settings by teams with various EVAR experience. It reduces perioperative errors and the number of angiograms required to deploy the stent graft, thereby reducing delays. Ultimately, it may improve patient safety and procedural efficiency.
Pettengell C, Sharrock A, Nafisee D, et al., 2016, Endovascular non-technical skills assessment in trainees (Endo-OTAS), Vascular Societies Annual Scientific Meeting, Publisher: Wiley, Pages: 24-24, ISSN: 1365-2168
Normahani P, Bicknell C, Allen L, et al., 2016, Wearable Sensor Technology Efficacy in Peripheral Vascular Disease: A RCT, Vascular Societies Annual Scientific Meeting, Publisher: Wiley, Pages: 22-22, ISSN: 1365-2168
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, Pages: 21-21, ISSN: 1365-2168
Godfrey AD, Riga C, Bicknell C, 2016, 750 preoperative elective aortic-conditioned for failure?, Vascular-Societies Annual Scientific Meeting, Publisher: Wiley, Pages: 14-14, ISSN: 1365-2168
Martin G, Riga C, Gibbs R, et al., 2016, Short- and Long-term Results of Hybrid Arch and Proximal Descending Thoracic Aortic Repair: A Benchmark for New Technologies, Journal of Endovascular Therapy, Vol: 23, Pages: 783-790, ISSN: 1545-1550
PURPOSE: To evaluate the short- and long-term outcomes of hybrid repair of the arch and proximal descending aorta in a single tertiary center for aortic disease. METHODS: A retrospective analysis was performed of 55 patients (median age 67 years; 36 men) who underwent hybrid repair of thoracic aortic pathology with involvement of the arch between January 2005 and May 2015 at a single tertiary center. The pathologies included 40 (73%) with aneurysmal disease, 10 (18%) acute type B aortic dissections, 2 with acute aortic syndrome, an acute type A dissection, and left and aberrant right subclavian artery aneurysms. Seven (13%) procedures were performed as an emergency. Demographics and procedure characteristics were collected for analysis of survival and reinterventions. RESULTS: Complete aortic debranching was performed in 14 (25%) to facilitate endograft placement in zone 0; debranching was partial in 20 (36%) patients for zone 1 deployments and 21 (38%) for zone 2. Primary technical success was achieved in 51 (93%) cases. One patient died in-hospital from aneurysm rupture following aortic debranching prior to stent-graft repair. In another, the stent-graft procedure proved infeasible and was abandoned. The other 2 technical failures were due to type Ia endoleaks. Five (9%) patients died in-hospital (4 of 48 elective and 1 of 7 emergency cases); 2 of these patients died within 30 days (4%). Eight (14%) patients had a stroke, 6 of 48 elective and 2 of the 7 emergency patients. Spinal cord ischemia was reported in 3 (6%) patients. Mean follow-up was 74.6 months. Overall cumulative survival was 70% at 1 year, 68% at 2 years, and 57% at 5 years. Reintervention to the proximal landing zone for type Ia endoleak was required in 6% of cases. The overall rate of aortic reintervention was 18% at 1 year, 21% at 2 years, and 36% at 5 years. Overall extra-anatomic graft patency was 99%. CONCLUSION: Hybrid repair of the aortic arch and proximal descending thoracic aorta is technic
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: 1532-2165
OBJECTIVE/BACKGROUND: To modify, content validate, and evaluate a teamwork assessment tool for use in endovascular surgery. METHODS: A multistage, multimethod study was conducted. Stage 1 included expert review and modification of the existing Observational Teamwork Assessment for Surgery (OTAS) tool. Stage 2 included identification of additional exemplar behaviours contributing to effective teamwork and enhanced patient safety in endovascular surgery (using real-time observation, focus groups, and semistructured interviews of multidisciplinary teams). Stage 3 included content validation of exemplar behaviours using expert consensus according to established psychometric recommendations and evaluation of structure, content, feasibility, and usability of the Endovascular Observational Teamwork Assessment Tool (Endo-OTAS) by an expert multidisciplinary panel. Stage 4 included final team expert review of exemplars. RESULTS: OTAS core team behaviours were maintained (communication, coordination, cooperation, leadership team monitoring). Of the 114 OTAS behavioural exemplars, 19 were modified, four removed, and 39 additional endovascular-specific behaviours identified. Content validation of these 153 exemplar behaviours showed that 113/153 (73.9%) reached the predetermined Item-Content Validity Index rating for teamwork and/or patient safety. After expert team review, 140/153 (91.5%) exemplars were deemed to warrant inclusion in the tool. More than 90% of the expert panel agreed that Endo-OTAS is an appropriate teamwork assessment tool with observable behaviours. Some concerns were noted about the time required to conduct observations and provide performance feedback. CONCLUSION: Endo-OTAS is a novel teamwork assessment tool, with evidence for content validity and relevance to endovascular teams. Endo-OTAS enables systematic objective assessment of the quality of team performance during endovascular procedures.
Mazomenos EB, Chang PL, Rippel RA, et al., 2016, Catheter manipulation analysis for objective performance and technical skills assessment in transcatheter aortic valve implantation., International Journal of Computer Assisted Radiology and Surgery, Vol: 11, Pages: 1121-1131, ISSN: 1861-6410
PURPOSE: Transcatheter aortic valve implantation (TAVI) demands precise and efficient handling of surgical instruments within the confines of the aortic anatomy. Operational performance and dexterous skills are critical for patient safety, and objective methods are assessed with a number of manipulation features, derived from the kinematic analysis of the catheter/guidewire in fluoroscopy video sequences. METHODS: A silicon phantom model of a type I aortic arch was used for this study. Twelve endovascular surgeons, divided into two experience groups, experts ([Formula: see text]) and novices ([Formula: see text]), performed cannulation of the aorta, representative of valve placement in TAVI. Each participant completed two TAVI experiments, one with conventional catheters and one with the Magellan robotic platform. Video sequences of the fluoroscopic monitor were recorded for procedural processing. A semi-automated tracking software provided the 2D coordinates of the catheter/guidewire tip. In addition, the aorta phantom was segmented in the videos and the shape of the entire catheter was manually annotated in a subset of the available video frames using crowdsourcing. The TAVI procedure was divided into two stages, and various metrics, representative of the catheter's overall navigation as well as its relative movement to the vessel wall, were developed. RESULTS: Experts consistently exhibited lower values of procedure time and dimensionless jerk, and higher average speed and acceleration than novices. Robotic navigation resulted in increased average distance to the vessel wall in both groups, a surrogate measure of safety and reduced risk of embolisation. Discrimination of experience level and types of equipment was achieved with the generated motion features and established clustering algorithms. CONCLUSIONS: Evaluation of surgical skills is possible through the analysis of the catheter/guidewire motion pattern. The use of robotic endovascular platforms seems to e
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
BACKGROUND: Diabetes is an increasing public health problem in the UK and globally. Diabetic retinopathy is a microvascular complication of diabetes, and is one of the leading causes of blindness in the UK working age population. The diabetic eye screening programme in England aims to invite all people with diabetes aged 12 or over for retinal photography to screen for the presence of diabetic retinopathy. However, attendance rates are only 81 %, leaving many people at risk of preventable sight loss. METHODS: This is a three arm randomized controlled trial to investigate the impact of different types of financial incentives (based on principles from behavioral economics) on increasing attendance at diabetic eye screening appointments in London. Eligible participants will be aged 16 or over, and are those who have been invited to screening appointments annually, but who have not attended, or telephoned to rearrange an appointment, within the last 24 months. Eligible participants will be randomized to one of three conditions: 1. Control condition (usual invitation letter) 2. Fixed incentive condition (usual invitation letter, including a voucher for £10 if they attend their appointment) 3. Probabilistic incentive condition (invitation letter, including a voucher for a 1 in 100 chance of winning £1000 if they attend their appointment). Participants will be sent invitation letters, and the primary outcome will be whether or not they attend their appointment. One thousand participants will be included in total, randomized with a ratio of 1.4:1:1. In order to test whether the incentive scheme has a differential impact on patients from different demographic or socio-economic groups, information will be recorded on age, gender, distance from screening center, socio-economic status and length of time since they were last screened. A cost-effectiveness analysis will also be performed. DISCUSSION: This study will be the first trial of financial incentives
Scott AJ, Bicknell CD, 2016, Contemporary Management of Acute Type B Dissection, EUROPEAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY, Vol: 51, Pages: 452-459, ISSN: 1078-5884
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- Citations: 24
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
We aimed to develop a quantitative antibody-based near infrared fluorescence (NIRF) approachfor the imaging of oxidized LDL in atherosclerosis. LO1, a well- characterized monoclonalautoantibody that reacts with malondialdehyde-conjugated LDL, was labeled with a NIRF dye toyield LO1-750. LO1-750 specifically identified necrotic core in ex vivo human coronary lesions.Injection of LO1-750 into high fat (HF) fed atherosclerotic Ldlr-/-mice led to specific focallocalization within the aortic arch and its branches, as detected by fluorescence moleculartomography (FMT) combined with micro-computed tomography (CT). Ex vivo confocalmicroscopy confirmed LO1-750 subendothelial localization of LO1-750 at sites ofatherosclerosis, in the vicinity of macrophages. When compared with a NIRF reporter of MMPactivity (MMPSense-645-FAST), both probes produced statistically significant increases inNIRF signal in the Ldlr-/- model in relation to duration of HF diet. When withdrawing the HFdiet, the reduction in oxLDL accumulation, as demonstrated with LO1-750, was less markedthan the effect seen on MMP activity. In the rabbit, in vivo injected LO1-750 localization wassuccessfully imaged ex vivo in aortic lesions with a customised intra-arterial NIRF detectioncatheter. A partially humanized chimeric LO1-Fab-Cys localized similarly to the parentantibody in murine atheroma showing promise for future translation.
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
In endovascular surgery and cardiology, robotic catheters are emerging as a promising technology for enhanced catheter manipulation and navigation while reducing radiation exposure. For robotic catheter systems especially with tendon actuation, a key challenge is the localisation of the catheter shape and position within the anatomy. An effective approach is through image-based catheter/guidewire detection and tracking. However, these are difficult problems due to the thin appearance of the instruments in the image and the low signal-to-noise ratio of fluoroscopy. In this letter, we propose a deformable B-spline tube model, which can effectively represent the shape of a catheter and guidewire. The model allows fitting using a region-based probabilistic algorithm, which does not rely on intensity gradients but exploits a signed distance function and the nonparametric distributions of measurements. Unlike previous B-spline fitting approaches, which optimise the spline with respect to control points, we propose a knot-driven scheme with an equidistance prior to better fit complex curves. Our probabilistic framework shows promising results for catheter and guidewire tracking in different procedures even with handling overlapping instrument segments. We present empirical studies using phantom model data and in vivo fluoroscopic sequences with annotated ground truth. Our results indicate that the proposed approach can precisely model the catheter and guidewire contours in near real time, and this information can be embedded in a robotic catheter control loop or utilised for image-guidance.
Wadge H, Bicknell C, Vlaev I, 2015, Perceived ethical acceptability of financial incentives to improve diabetic eye screening attendance, BMJ Open Diabetes Research and Care, Vol: 3, ISSN: 2052-4897
OBJECTIVE: To test the ethical acceptability of using financial incentives to increase diabetic retinopathy screening attendance. BACKGROUND: Financial incentives could be an effective way to increase attendance at screening for diabetic retinopathy, although there can be ethical concerns about this approach. DESIGN: Survey of people with diabetes in North West London. Those who were due to attend a screening appointment were invited to complete a questionnaire. Key demographic variables included age, gender, and deprivation. SETTING AND PARTICIPANTS: A questionnaire was issued to those invited to attend screening in North West London and those who run the screening service. The questionnaire captured views on aspects of the ethical problem and different incentive types. MAIN VARIABLES STUDIED: It captured views on the different dimensions of the ethical problem and different types of incentive. In order to understand how views might vary within a population, demographic variables were used to analyze the results. RESULTS AND CONCLUSIONS: Vouchers were found to be the most acceptable form of incentive, significantly more so than cash payments. Most rejected the notion of targeting those who need incentivizing, preferring equality. Age was an important factor, with those aged between 40 and 64 the most optimistic about the potential benefits. Higher levels of deprivation were linked to increased acceptability scores. While some ethical concerns are strongly held among certain groups, there is also much support for the principle of incentivizing positive behaviors. This paves the way for future research into the effectiveness of incentivizing diabetic retinopathy screening attendance.
Hamady MS, 2015, Medical Errors inIR: Where Are We? A Systematic Review., Journal of Vascular and Interventional Radiology, Vol: 26, Pages: 1741-1743, ISSN: 1535-7732
We conducted a comprehensive literature search on medical errors in Interventional Radiology (IR).Our search only retrieved three studies, which quantitatively assessed the incidence of errors in IR. A total number of 503 patients were included in the studies. All studies instituted a change in practice in order to reduce the incidence of errors. They have all demonstrated a significant reduction in IR errors following implementation of their proposed intervention. Our search highlights the paucity of studies quantitatively assessing medical errors in IR. We urge further research into the field in order to enhance patient safety.
Vyas R, Hull L, Rudarakanchana N, et al., 2015, Assessment of endovascular surgery teams is feasible and reliable using a structured rating scale: Endo-OTAS, International Surgical Congress of the Association-of-Surgeons-of-Great-Britain-and-Ireland, Publisher: WILEY-BLACKWELL, Pages: 18-18, ISSN: 0007-1323
Rafii-Tari H, Riga C, Payne C, et al., 2015, Reducing contact forces in the arch and supra-aortic vessels using the Magellan robot, Journal of Vascular Surgery, ISSN: 1097-6809
Sastry P, Hughes V, Hayes P, et al., 2015, The ETTAA study protocol: a UK-wide observational study of 'Effective Treatments for Thoracic Aortic Aneurysm'., BMJ Open, Vol: 5, Pages: 1-8, ISSN: 2044-6055
INTRODUCTION: Chronic thoracic aortic aneurysm (CTAA) affecting the arch or descending aorta is an indolent but life-threatening condition with a rising prevalence as the UK population ages. Treatment may be in the form of open surgical repair (OSR) surgery, endovascular stent grafting (ESG) or best medical therapy (BMT). Currently, there is no consensus on the best management strategy, and no UK-specific economic studies that assess outcomes beyond the chosen procedure, but this is required in the context of greater demand for treatment and limited National Health Service (NHS) resources. METHODS AND ANALYSIS: This is a prospective, multicentre observational study with statistical and economic modelling of patients with CTAA affecting the arch or descending aorta. We aim to gain an understanding of how treatments are currently chosen, and to determine the clinical effectiveness and cost-effectiveness of the three available treatment strategies (BMT, ESG and OSR). This will be achieved by: (1) following consecutive patients who are referred to the teams collaborating in this proposal and collecting data regarding quality of life (QoL), medical events and hospital stays over a maximum of 5 years; (2) statistical analysis of the comparative effectiveness of the three treatments; and (3) economic modelling of the comparative cost-effectiveness of the three treatments. Primary study outcomes are: aneurysm growth, QoL, freedom from reintervention, freedom from death or permanent neurological injury, incremental cost per quality-adjusted life year gained. ETHICS AND DISSEMINATION: The study will generate an evidence base to guide patients and clinicians to determine the indications and timing of treatment, as well as informing healthcare decision-makers about which treatments the NHS should provide. The study has achieved ethical approval and will be disseminated primarily in the form of a Health Technology Assessment monograph at its completion. TRIAL REGISTRATION NUMBER
Bosanquet DC, Twine CP, Tang TY, et al., 2015, Pragmatic Minimum Reporting Standards for Thoracic Endovascular Aortic Repair, JOURNAL OF ENDOVASCULAR THERAPY, Vol: 22, Pages: 356-367, ISSN: 1526-6028
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- Citations: 8
Rafii-Tari H, Payne C, Liu J, et al., 2015, Towards Automated Surgical Skill Evaluation of Endovascular Catheterization Tasks based on Force and Motion Signatures, IEEE International Conference on Robotics and Automation (ICRA), Pages: 1789-1794
Hodgkinson JD, Cheshire N, Bicknell C, et al., 2015, A novel endovascular treatment for long-standing high-flow arteriovenous fistula, JOURNAL OF VASCULAR SURGERY, Vol: 61, Pages: 1321-1323, ISSN: 0741-5214
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- Citations: 2
Athanasopoulos LV, Bicknell CD, Anderson JR, et al., 2015, Leiomyosarcoma of the Thoracic Aorta in a Patient with Hypertrophic Cardiomyopathy, ANNALS OF VASCULAR SURGERY, Vol: 29, ISSN: 0890-5096
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- Citations: 1
Morton D, Bicknell CD, 2015, Should surgical training include involvement in a clinical trial?, BMJ-BRITISH MEDICAL JOURNAL, Vol: 350, ISSN: 0959-535X
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- Citations: 4
Bicknell C, Powell JT, 2015, Aortic disease: thoracic endovascular aortic repair, HEART, Vol: 101, Pages: 586-591, ISSN: 1355-6037
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- Citations: 26
Tuffaha H, Amer T, Jayia P, et al., 2015, The STAR score: a method for auditing clinical records, Annals of the Royal College of Surgeons of England, Vol: 94, Pages: 235-239, ISSN: 1478-7083
INTRODUCTIONAdequate medical note keeping is critical in delivering high quality healthcare. However, there are few robust tools available for the auditing of notes. The aim of this paper was to describe the design, validation and implementation of a novel scoring tool to objectively assess surgical notes.METHODSAn initial ‘path finding’ study was performed to evaluate the quality of note keeping using the CRABEL scoring tool. The findings prompted the development of the Surgical Tool for Auditing Records (STAR) as an alternative. STAR was validated using inter-rater reliability analysis. An audit cycle of surgical notes using STAR was performed. The results were analysed and a structured form for the completion of surgical notes was introduced to see if the quality improved in the next audit cycle using STAR. An education exercise was conducted and all participants said the exercise would change their practice, with 25% implementing major changes.RESULTSStatistical analysis of STAR showed that it is reliable (Cronbach’s a = 0.959). On completing the audit cycle, there was an overall increase in the STAR score from 83.344% to 97.675% (p<0.001) with significant improvements in the documentation of the initial clerking from 59.0% to 96.5% (p<0.001) and subsequent entries from 78.4% to 96.1% (p<0.001).CONCLUSIONSThe authors believe in the value of STAR as an effective, reliable and reproducible tool. Coupled with the application of structured forms to note keeping, it can significantly improve the quality of surgical documentation and can be implemented universally.
Perera AH, Rudarakanchana N, Bicknell CD, et al., 2015, Silent cerebral infarction and neurocognitive decline following Thoracic Endovascular Aortic Repair, BRITISH JOURNAL OF SURGERY, Vol: 102, Pages: 5-5, ISSN: 0007-1323
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- Citations: 4
Li M, Riga C, Cheung S, et al., 2015, Occupational Radiation Exposure during FEVAR: A Stage-By-Stage Analysis, BRITISH JOURNAL OF SURGERY, Vol: 102, Pages: 23-23, ISSN: 0007-1323
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- Citations: 1
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