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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: 1365-2168
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
Sepehripour AH, Eckersley M, Jiskani A, et al., 2018, Selective serotonin reuptake inhibitor use and outcomes following cardiac surgery-a systematic review., J Thorac Dis, Vol: 10, Pages: 1112-1120, ISSN: 2072-1439
A high prevalence of depression is observed in patients undergoing cardiac surgery, and depression has been shown to be an independent predictor of morbidity and mortality in this patient population. Selective serotonin re-uptake inhibitors (SSRIs) are the first-line recommended therapy for depressive disorders, however due to their platelet inhibitory actions they have been associated with increased incidences of post-operative bleeding. This review has sought to address whether the use of SSRIs is associated with a higher rate of mortality, major adverse events or bleeding events following cardiac surgery. A retrospective literature search selected studies comparing the use of SSRIs with no SSRI use in patients undergoing cardiac surgery. Seven of the ten studies analysed reported no significant difference in mortality in SSRI users. Five of the seven studies reporting bleeding events demonstrated no significant difference in SSRI users. Three of the five studies reporting other significant morbidity demonstrated no significant difference in SSRI users. Our study demonstrates the safety of the use of SSRIs for the treatment of depressive disorders in patients undergoing cardiac surgery.
Haddad AE, Ashrafian H, Athanasiou T, 2018, Diagnostic meta-analysis: Case study in surger, Diagnostic Meta-Analysis: A Useful Tool for Clinical Decision-Making, Pages: 285-302, ISBN: 9783319789651
Surgery and surgical research are continually expanding fields that derive from the increasing global volume of surgical patients and pathology combined with the growth of surgical capability and novel technological innovations. As a result, there are associated diagnostic requirements due to the expansive nature of available surgical techniques, tools, and surgical evidence. Diagnostic accuracy meta-analysis can help clarify diagnostic decisions in all elements of the surgical patient pathway including the quantitative synthesis of evidence for (1) specific elements to the pre-, peri-, and postoperative period, (2) surgical and medical pathology, (3) advances in disease imaging and tissue guidance, and (4) awareness of new devices ranging from operative monitoring/diagnostic devices, stapling instruments, and robots. The process and methodology of diagnosis meta-analysis in surgery is described with contemporary surgical cases. Techniques of data presentation and analysis are reviewed for surgical procedures and pathologies. Barriers and typical problems in surgical diagnostic meta-analysis are also considered and discussed. Diagnostic meta-analytical techniques can offer a prime solution through which to process the ever-increasing volume of surgical outcome data into meaningful information for enhancing clinical outcomes, supporting safety, and developing the next generation of cutting-edge surgical technology.
Theodoulou I, Nicolaides M, Athanasiou T, et al., 2018, Simulation-Based Learning Strategies to Teach Undergraduate Students Basic Surgical Skills: A Systematic Review., J Surg Educ, Vol: 75, Pages: 1374-1388
OBJECTIVE: We aimed to identify and critically appraise all literature surrounding simulation-based learning (SBL) courses, to assess their relevance as tools for undergraduate surgical education, and create a design framework targeted at standardizing future SBL. METHODS: We performed a systematic review of the literature using a specific keyword strategy to search at MEDLINE database. RESULTS: Of the 2371 potentially eligible titles, 472 were shortlisted and only 40 explored active interventions in undergraduate medical education. Of those, 20 were conducted in the United States, 9 in Europe and 11 in the rest of the world. Nineteen studies assessed the effectiveness of SBL by comparing students' attributes before and after interventions, 1 study assessed a new tool of surgical assessment and 16 studies evaluated SBL courses from the students' perspectives. Of those 40 studies, 12 used dry laboratory, 7 wet laboratory, 12 mixed, and 9 cadaveric SBL interventions. The extent to which positive results were obtained from dry, wet, mixed, and cadaveric laboratories were 75%, 57%, 92%, and 100%, respectively. Consequently, the SBL design framework was devised, providing a foundation upon which future SBL interventions can be designed such that learning outcomes are optimized. CONCLUSIONS: SBL is an important step in surgical education, investing in a safer and more efficient generation of surgeons. Standardization of these efforts can be accelerated with SBL design framework, a comprehensive guide to designing future interventions for basic surgical training at the undergraduate level.
Rao C, Smith FM, Martin AP, et al., 2017, A Cost-Effectiveness Analysis of Contact X-ray Brachytherapy for theTreatment of Patients with Rectal Cancer Following a Partial Responseto Chemoradiotherapy, Clinical Oncology, ISSN: 0936-6555
AimsFollowing chemoradiotherapy in patients with rectal cancer, the addition of contact X-ray brachytherapy (CXB) in partial responders might increase the proportion of patients with a clinical complete response (cCR) and who are thus suitable for watch and wait management. However, the long-term cost-effectiveness of this approach has not been evaluated.Materials and methodsDecision analytical modelling and a Markov simulation were used to compare long-term costs, quality-adjusted life years (QALYs) and cost-effectiveness from a third-party payer (National Health Service) perspective for treatment strategies after chemoradiotherapy; watch and wait with CXB when a cCR was not initially achieved after external beam radiotherapy (EBRT) (WWCXB), watch and wait with EBRT alone (WWEBRT) and radical surgery for all patients. The effect of uncertainty in model parameters and patient demographics was investigated.ResultsWWCXB had a higher QALY payoff than both radical surgery and WWEBRT and was less costly in most scenarios and demographic cohorts. In all plausible scenarios, WWCXB was the most cost-effective, at a threshold of £20 000/QALY. This finding was insensitive to uncertainty associated with model parameters.ConclusionsWWCXB is likely to be cost-effective compared with both WWEBRT alone and radical surgery. These findings support the use of CXB boost as an adjunct to a watch and wait strategy.
Archer SA, Hull L, Soukup T, et al., 2017, Development of a Theoretical Framework of Factors Affecting Patient Safety Incident Reporting: A Theoretical Review of the Literature, BMJ Open, Vol: 7, ISSN: 2044-6055
Objectives The development and implementation of incident reporting systems within healthcare continues to be a fundamental strategy to reduce preventable patient harm and improve the quality and safety of healthcare. We sought to identify factors contributing to patient safety incident reporting.Design To facilitate improvements in incident reporting, a theoretical framework, encompassing factors that act as barriers and enablers ofreporting, was developed. Embase, Ovid MEDLINE(R) and PsycINFO were searched to identify relevant articles published between January 1980 and May 2014. A comprehensive search strategy including MeSH terms and keywords was developed to identify relevant articles. Data were extracted by three independent researchers; to ensure the accuracy of data extraction, all studies eligible for inclusion were rescreened by two reviewers.Results The literature search identified 3049 potentially eligible articles; of these, 110 articles, including >29 726 participants, met the inclusion criteria. In total, 748 barriers were identified (frequency count) across the 110 articles. In comparison, 372 facilitators to incident reporting and 118 negative cases were identified. The top two barriers cited were fear of adverse consequences (161, representing 21.52% of barriers) and process and systems of reporting (110, representing 14.71% of barriers). In comparison, the top two facilitators were organisational (97, representing 26.08% of facilitators) and process and systems of reporting (75, representing 20.16% of facilitators).Conclusion A wide range of factors contributing to engagement in incident reporting exist. Efforts that address the current tendency to under-report must consider the full range of factors in order to develop interventions as well as a strategic policy approach for improvement.
Garas G, Markar SR, Malietzis G, et al., 2017, Induced Bias Due to Crossover Within Randomized Controlled Trials in Surgical Oncology: A Meta-regression Analysis of Minimally Invasive versus Open Surgery for the Treatment of Gastrointestinal Cancer., Annals of Surgical Oncology, Vol: 25, Pages: 221-230, ISSN: 1068-9265
BACKGROUND: Randomized controlled trials (RCTs) inform clinical practice and have provided the evidence base for introducing minimally invasive surgery (MIS) in surgical oncology. Crossover (unplanned intraoperative conversion of MIS to open surgery) may affect clinical outcomes and the effect size generated from RCTs with homogenization of randomized groups. OBJECTIVES: Our aims were to identify modifiable factors associated with crossover and assess the impact of crossover on clinical endpoints. METHODS: A systematic review was performed to identify all RCTs comparing MIS with open surgery for gastrointestinal cancer (1990-2017). Meta-regression analysis was performed to analyze factors associated with crossover and the influence of crossover on endpoints, including 30-day mortality, anastomotic leak rate, and early complications. RESULTS: Forty RCTs were included, reporting on 11,625 patients from 320 centers. Crossover was shown to affect one in eight patients (mean 12.6%, range 0-45%) and increased with American Society of Anesthesiologists score (β = + 0.895; p = 0.050). Pretrial surgeon volume (β = - 2.344; p = 0.037), composite RCT quality score (β = - 7.594; p = 0.014), and site of tumor (β = - 12.031; p = 0.021, favoring lower over upper gastrointestinal tumors) showed an inverse relationship with crossover. Importantly, multivariate weighted linear regression revealed a statistically significant positive correlation between crossover and 30-day mortality (β = + 0.125; p = 0.033), anastomotic leak rate (β = + 0.550; p = 0.004), and early complications (β = + 1.255; p = 0.001), based on intention-to-treat analysis. CONCLUSIONS: Crossover in trials was associated with an increase in 30-day mortality, anastomotic leak rate, and early complications within the MIS group based on intention-
Ahmad MU, Sharif KA, Qayyum H, et al., 2017, Assessing the use of magnetic resonance imaging virtopsy as an alternative to autopsy: a systematic review and meta-analysis., Postgrad Med J, Vol: 93, Pages: 671-678
BACKGROUND: The post mortem examination or autopsy is a trusted method of identifying the cause of death. Patients and their families may oppose an autopsy for a variety of reasons, including fear of mutilation or owing to religious and personal beliefs. Imaging alternatives to autopsy have been explored, which may provide a viable alternative. OBJECTIVE: To explore the possibility of using MRI virtopsy to establish the cause of death as an alternative to the traditional post mortem examination or autopsy. METHODS: Systematic review was carried out of all studies, without language restriction, identified from Medline, Cochrane (1960-2016) and Embase (1991-2016) up to December 2016. Further searches were performed using the bibliographies of articles and abstracts. All studies reporting the diagnosis of the cause of death by both MRI virtopsy and traditional autopsy were included. RESULTS: Five studies with 107 patients, contributed to a summative quantitative outcome in adults. The combined sensitivity of MRI virtopsy was 0.82 (95% CI 0.56 to 0.94) with a diagnostic odds ratio (DOR) of 11.1 (95% CI 2.2 to 57.0). There was no significant heterogeneity between studies (Q=1.96, df=4, p=0.75, I2=0). Eight studies, with 953 patients contributed to a summative quantitative outcome in children. The combined sensitivity of MRI virtopsy was 0.73 (95% CI 0.59 to 0.84) with a DOR of 6.44 (95% CI 1.36 to 30.51). There was significant heterogeneity between studies (Q=34.95, df=7, p<0.01, I2=80). CONCLUSION: MRI virtopsy may offer a viable alternative to traditional autopsy. By using MRI virtopsy, a potential cost reduction of at least 33% is feasible, and therefore ought to be considered in eligible patients.
Shetty K, Poo SXW, Sriskandarajah K, et al., 2017, "The longest way round is the shortest way home": an overhaul of surgical ward rounds, World Journal of Surgery, Vol: 42, Pages: 937-949, ISSN: 1432-2323
BACKGROUND: Ward rounds, a keystone of hospital surgical practice, have recently been under the spotlight. Poor-quality ward rounds can lead to a greater number of adverse events, thereby cascading to an increased financial strain on our already burdened healthcare systems. Faced with mounting pressures from both outside and inside health organizations, concerted efforts are required to restore it back into prominence where it can no longer take a backseat to the other duties of a surgeon. METHODS: The nucleus of this narrative review is derived from an extensive literature search on surgical ward rounds. RESULTS: In this review, we focus on the need for reforms, current characteristics of surgical ward rounds, obstacles encountered by competing interests and proposed solutions in delivery of effective ward rounds that can meet with newly laid guidelines. CONCLUSION: Ward rounds should be standardized and prioritized to improve patient care.
Chow A, Stuckey DJ, Kidher E, et al., 2017, Human Induced Pluripotent Stem Cell-Derived Cardiomyocyte Encapsulating Bioactive Hydrogels Improve Rat Heart Function Post Myocardial Infarction., Stem Cell Reports, Vol: 9, Pages: 1415-1422, ISSN: 2213-6711
Tissue engineering offers an exciting possibility for cardiac repair post myocardial infarction. We assessed the effects of combined polyethylene glycol hydrogel (PEG), human induced pluripotent stem cell-derived cardiomyocyte (iPSC-CM), and erythropoietin (EPO) therapy in a rat model of myocardial infarction. PEG with/out iPSC-CMs and EPO; iPSC-CMs in saline; or saline alone was injected into infarcted hearts shortly after infarction. Injection of almost any combination of the therapeutics limited acute elevations in chamber volumes. After 10 weeks, attenuation of ventricular remodeling was identified in all groups that received PEG injections, while ejection fractions were significantly increased in the gel-EPO, cell, and gel-cell-EPO groups. In all treatment groups, infarct thickness was increased and regions of muscle were identified within the scar. However, no grafted cells were detected. Hence, iPSC-CM-encapsulating bioactive hydrogel therapy can improve cardiac function post myocardial infarction and increase infarct thickness and muscle content despite a lack of sustained donor-cell engraftment.
Markar SR, Naik R, Malietzis G, et al., 2017, Component analysis of enhanced recovery pathways for esophagectomy, Diseases of the Esophagus, Vol: 30, ISSN: 1120-8694
The objective of this systematic review is to identify key components of enhanced recovery protocols (ERP) that lead to improved length of hospital stay (LOS) following esophagectomy. Relevant electronic databases were searched for studies comparing clinical outcome from esophagectomy followed by a conventional pathway versus ERP. Relevant outcome measures were compared and metaregression was performed to identify the key ERP components associated with reduced in LOS. Thirteen publications were included, ERP was associated with no changes in in-hospital mortality, total complications, anastomotic leak, or pulmonary complications compared with a conventional pathway, however LOS was reduced in the ERP group. Metaregression identified that immediate extubation was associated with reduced LOS (OR = −0.51, 95%CI −0.77 to −0.25; P < 0.01). Several postoperative factors were associated with a significant reduction in length of hospital stay, and in order of most important were (i) gastrograffin swallow ≤5 days (OR = −4.27, 95%CI −4.50 to −4.03); (ii) mobilization on postoperative day ≤1 (OR = −2.49, 95%CI −2.63 to −2.34); (iii) removal of urinary catheter ≤2 days (OR = −0.99, 95%CI −1.15 to −0.84); (iv) oral intake with at least sips of fluid ≤1 day (OR = −0.96, 95%CI −1.24 to −0.68); (v) enteral diet with feeding jejunostomy or gastrostomy ≤ 1 day (OR = −0.57, 95%CI −0.80 to −0.35) and (vi) epidural removal ≤ 4 days (OR = −0.17, 95%CI −0.27 to −0.07). Several core ERP components and principles appear to be associated with LOS reduction. These elements should form a part of the core ERP for the specialty, while surgical teams incorporate other elements through an iterative process.
Erridge S, Pucher PH, Markar SR, et al., 2017, Meta-analysis of determinants of survival following treatment of recurrent hepatocellular carcinoma, British Journal of Surgery, Vol: 104, Pages: 1433-1442, ISSN: 1365-2168
BackgroundIntrahepatic recurrence of hepatocellular carcinoma (HCC) following resection is common. However, no current consensus guidelines exist to inform management decisions in these patients. Systematic review and meta-analysis of survival following different treatment modalities may allow improved treatment selection. This review aimed to identify the optimum treatment strategies for HCC recurrence.MethodsA systematic review, up to September 2016, was conducted in accordance with MOOSE guidelines. The primary outcome was the hazard ratio for overall survival of different treatment modalities. Meta-analysis of different treatment modalities was carried out using a random-effects model, with further assessment of additional prognostic factors for survival.ResultsNineteen cohort studies (2764 patients) were included in final data analysis. The median 5-year survival rates after repeat hepatectomy (525 patients), ablation (658) and transarterial chemoembolization (TACE) (855) were 35·2, 48·3 and 15·5 per cent respectively. Pooled analysis of ten studies demonstrated no significant difference between overall survival after ablation versus repeat hepatectomy (hazard ratio 1·03, 95 per cent c.i. 0·68 to 1·55; P = 0·897). Pooled analysis of seven studies comparing TACE with repeat hepatectomy showed no statistically significant difference in survival (hazard ratio 1·61, 0·99 to 2·63; P = 0·056).ConclusionBased on these limited data, there does not appear to be a significant difference in survival between patients undergoing repeat hepatectomy or ablation for recurrent HCC. The results also identify important negative prognostic factors (short disease-free interval, multiple hepatic metastases and large hepatic metastases), which may influence choice of treatment.
Moscarelli M, Athanasiou T, Speziale G, et al., 2017, The value of adding sub-valvular procedures for chronic ischemic mitral regurgitation surgery: a meta-analysis, PERFUSION-UK, Vol: 32, Pages: 436-445, ISSN: 0267-6591
Theodosopoulou M, Dor F, Rituerto DC, et al., 2017, VIEWS OF UK RENAL PATIENTS REGARDING DECEASED ORGAN DONATION, Publisher: WILEY, Pages: 433-433, ISSN: 0934-0874
Theodosopoulou M, Dor F, Rituerto DC, et al., 2017, HEALTH LITERACY PRACTICES AMONG DUTCH HOSPITAL ADMINISTRATIVE PERSONNEL, Publisher: WILEY, Pages: 433-433, ISSN: 0934-0874
Theodosopoulou M, Casanova Rituerto D, Dor F, et al., 2017, HEALTH LITERACY: THE ROLE OF PERSONAL EXPERIENCE IN DECEASED ORGAN DONATION, Publisher: WILEY, Pages: 432-432, ISSN: 0934-0874
Theodosopoulou M, Dor F, Casanova Rituerto D, et al., 2017, LOOKING AT DECEASED ORGAN DONATION CAMPAIGNS FROM LAY PEOPLE'S EYES, Publisher: WILEY, Pages: 433-433, ISSN: 0934-0874
Theodosopoulou M, Casanova D, Dor F, et al., 2017, SPANISH MEDICAL STUDENTS AND DECEASED ORGAN DONATION, Publisher: WILEY, Pages: 184-184, ISSN: 0934-0874
Murugesu S, Saso S, Jones BP, et al., 2017, Does the use of calcium ionophore during artificial oocyte activation demonstrate an effect on pregnancy rate? A meta-analysis, FERTILITY AND STERILITY, Vol: 108, Pages: 468-+, ISSN: 0015-0282
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Garas G, Cingolani I, Panzarasa P, et al., 2017, Network analysis of surgical innovation: Measuring value and the virality of diffusion in robotic surgery., PLoS ONE, Vol: 12, ISSN: 1932-6203
BACKGROUND: Existing surgical innovation frameworks suffer from a unifying limitation, their qualitative nature. A rigorous approach to measuring surgical innovation is needed that extends beyond detecting simply publication, citation, and patent counts and instead uncovers an implementation-based value from the structure of the entire adoption cascades produced over time by diffusion processes. Based on the principles of evidence-based medicine and existing surgical regulatory frameworks, the surgical innovation funnel is described. This illustrates the different stages through which innovation in surgery typically progresses. The aim is to propose a novel and quantitative network-based framework that will permit modeling and visualizing innovation diffusion cascades in surgery and measuring virality and value of innovations. MATERIALS AND METHODS: Network analysis of constructed citation networks of all articles concerned with robotic surgery (n = 13,240, Scopus®) was performed (1974-2014). The virality of each cascade was measured as was innovation value (measured by the innovation index) derived from the evidence-based stage occupied by the corresponding seed article in the surgical innovation funnel. The network-based surgical innovation metrics were also validated against real world big data (National Inpatient Sample-NIS®). RESULTS: Rankings of surgical innovation across specialties by cascade size and structural virality (structural depth and width) were found to correlate closely with the ranking by innovation value (Spearman's rank correlation coefficient = 0.758 (p = 0.01), 0.782 (p = 0.008), 0.624 (p = 0.05), respectively) which in turn matches the ranking based on real world big data from the NIS® (Spearman's coefficient = 0.673;p = 0.033). CONCLUSION: Network analysis offers unique new opportunities for understanding, modeling and measuring surgical innovation, and ultimately for assessing and comparing generative value between different sp
Harling L, Athanasiou T, Ashrafian H, et al., 2017, Pre-operative serum VCAM-1 as a biomarker of atrial fibrillation after coronary artery bypass grafting, Journal of Cardiothoracic Surgery, Vol: 12, ISSN: 1749-8090
ObjectiveSystemic inflammation is a recognised contributory factor in the pathogenesis of de novo post-operative atrial fibrillation after cardiac surgery. This study aims to determine whether serum soluble vascular endothelial cell adhesion molecule (sVCAM-1) may predict the onset of POAF in patients under going coronary artery bypass grafting.Methods34 patients undergoing non-emergent, on-pump CABG were prospectively recruited. Plasma was obtained at 24 h pre-operatively and at 48 and 96 h post-operatively. POAF was defined by continuous Holter recording. Inter-group comparisons were performed using student t-test or ANOVA as appropriate.ResultsThirteen (13/34) patients developed POAF at a mean of 2.5 days post-operatively. Serum sVCAM-1 was significantly increased in the pre-operative serum of POAF when compared to non-POAF patients (p = 0.022). No significant difference was observed between the groups at 48 h (p = 0.073) or 96 h (p = 0.135) post-operatively. sVCAM-1 had a sensitivity of 60.0% and specificity of 77.27%, with an overall diagnostic accuracy of 75.2% in predicting POAF.ConclusionssVCAM-1 concentration in the pre-operative serum of patients undergoing CABG may accurately predict the onset of de novo POAF. As such, serum sVCAM-1 may be used as a predictive biomarker for this common arrhythmia. Further work must now perform prospective, targeted validation of these results in a larger patient cohort.
Jamel S, Markar SR, Malietzis G, et al., 2017, Prognostic significance of peritoneal lavage cytology in staging gastric cancer: systematic review and meta-analysis, Gastric Cancer, Vol: 21, Pages: 10-18, ISSN: 1436-3291
BackgroundPeritoneal cytology has been used as a part of the cancer staging of gastric cancer patients. The primary aim of this systematic review was to evaluate the value of peritoneal cytology as part of the staging of gastric cancer and survival prediction. The second aim was to establish if positive cytology may be modified by neoadjuvant therapy, to improve prognosis.MethodsAn electronic literature search was performed using Embase, Medline, Web of Science, and Cochrane library databases up to January 2016. The logarithm of the hazard ratio (HR) with 95% confidence intervals (CI) was used as the primary summary statistic. Comparative studies were used, and the outcome measure was survival in three groups: (1) positive versus negative cytology at staging laparoscopy immediately preceding surgery; (2) effect of neoadjuvant therapy on cytology and survival; and (3) positive cytology in the absence of macroscopic peritoneal disease was compared with obvious macroscopic peritoneal disease.ResultsPooled analysis demonstrated that positive cytology was associated with significantly reduced overall survival (HR, 3.46; 95% CI, 2.77–4.31; P < 0.0001). Interestingly, negative cytology following neoadjuvant chemotherapy was associated with significantly improved overall survival (HR, 0.42; 95% CI, 0.31–0.57; P < 0.0001). The absence of macroscopic peritoneal disease with positive cytology was associated with significantly improved overall survival (HR, 0.64; 95% CI, 0.56–0.73; P < 0.0001).ConclusionThis study suggests that patients with initial positive cytology may have a good prognosis following neoadjuvant treatment if the cytology results change to negative after treatment.
Pannick SAJ, Athanasiou T, Long SJ, et al., 2017, Translating staff experience into organisational improvement: the HEADS-UP stepped wedge, cluster controlled, non-randomised trial, BMJ Open, Vol: 7, ISSN: 2044-6055
Objectives:Frontline insights into care delivery correlate with patients’ clinical outcomes. These outcomes might be improved through near-real time identification and mitigation of staff concerns. We evaluated the effects of a prospective frontline surveillance system on patient and team outcomes.Design:Prospective, stepped wedge, non-randomised, cluster controlled trial; pre-specified per protocol analysis for high fidelity intervention delivery.Participants:Seven interdisciplinary medical ward teams, from two hospitals in the United Kingdom.Intervention:Prospective clinical team surveillance (PCTS): structured daily interdisciplinary briefings to capture staff concerns, with organisational facilitation and feedback.Main measures:The primary outcome was excess length of stay (eLOS): an admission more than 24 hours longer than the local average for comparable patients. Secondary outcomes included safety and teamwork climates, and incident reporting. Mixed-effects models adjusted for time effects, age, comorbidity, palliation status, and ward admissions. Safety and teamwork climates were measured with the Safety Attitudes Questionnaire. High fidelity PCTS delivery comprised high engagement and high briefing frequency.Results:Implementation fidelity was variable, both in briefing frequency (median 80% working days/month, interquartile range 65-90%), and engagement (median 70 issues/ward/month, interquartile range 34-113). 1714/6518 (26.3%) intervention admissions had eLOS vs 1279/4927 (26.0%) control admissions, an absolute risk increase of 0.3%. PCTS increased eLOS in the adjusted intention-to-treat model (OR 1.32, 95% CI 1.10-1.58, p=0.003). Conversely, high fidelity PCTS reduced eLOS (OR 0.79, 95% CI 0.67-0.94, p=0.006). High fidelity PCTS also increased total, high yield, and non-nurse incident reports (incidence rate ratios 1.28-1.79, all p<0.002). Sustained PCTS significantly improved safety and teamwork climates over time.Conclusions:This study highli
Theodosopoulou M, Dor F, Casanova D, et al., 2017, Health Literacy regarding Deceased Organ Donation: the presentation of ethical issues regarding medical procedures in three European official websites, International Congress of the Association-of-Surgeons-of-Great-Britain-and-Ireland, Publisher: WILEY, Pages: 147-148, ISSN: 0007-1323
Garas G, Cingolani I, Panzarasa P, et al., 2017, 0527 - Networks of surgical innovation: measuring value and the virality of diffusion the example of robotic surgery, International Congress of the Association-of-Surgeons-of-Great-Britain-and-Ireland, Publisher: Wiley, Pages: 229-229, ISSN: 1365-2168
Garas G, Markar S, Malietzis G, et al., 2017, Induced bias due to crossover in randomised controlled trials in surgical oncology, International Congress of the Association-of-Surgeons-of-Great-Britain-and-Ireland, Publisher: WILEY, Pages: 36-37, ISSN: 0007-1323
Athanasopoulos LV, Casula RP, Punjabi PP, et al., 2017, A technical review of subvalvular techniques for repair of ischaemic mitral regurgitation and their associated echocardiographic and survival outcomes, Interactive Cardiovascular and Thoracic Surgery, Vol: 25, Pages: 975-982, ISSN: 1569-9293
Subvalvular techniques are gaining ground as adjunct procedures for addressing ischaemic mitral regurgitation. The aim of this study was to describe the different techniques and assess their results. A systematic review of the literature was performed. The end points of interest were recurrence of mitral regurgitation, cardiac events and early and late echocardiographic measurements. After initial screening, 450 articles were identified, of which 24 provided the best available evidence on the topic. The different subvalvular techniques had similar mortality rates when compared with the standard restrictive annuloplasty. Recurrence of mitral regurgitation was of lower degree and the remodelling process was better for these techniques. Reoperation rates were also quite low. The subvalvular techniques showed superiority, addressing more successfully the leaflet tethering. However, larger randomized studies are needed to confirm these early positive results.
Pirola S, Cheng Z, Jarral OA, et al., 2017, On the choice of outlet boundary conditions for patient-specific analysis of aortic flow using computational fluid dynamics, Journal of Biomechanics, Vol: 60, Pages: 15-21, ISSN: 1873-2380
Boundary conditions (BCs) are an essential part in computational fluid dynamics (CFD) simulations of blood flow in large arteries. Although several studies have investigated the influence of BCs on predicted flow patterns and hemodynamic wall parameters in various arterial models, there is a lack of comprehensive assessment of outlet BCs for patient-specific analysis of aortic flow. In this study, five different sets of outlet BCs were tested and compared using a subject-specific model of a normal aorta. Phase-contrast magnetic resonance imaging (PC-MRI) was performed on the same subject and velocity profiles extracted from the in vivo measurements were used as the inlet boundary condition. Computational results obtained with different outlet BCs were assessed in terms of their agreement with the PC-MRI velocity data and key hemodynamic parameters, such as pressure and flow waveforms and wall shear stress related indices. Our results showed that the best overall performance was achieved by using a well-tuned three-element Windkessel model at all model outlets, which not only gave a good agreement with in vivo flow data, but also produced physiological pressure waveforms and values. On the other hand, opening outlet BCs with zero pressure at multiple outlets failed to reproduce any physiologically relevant flow and pressure features.
Malietzis G, Thorn C, Currie A, et al., 2017, MYOPENIA IS ASSOCIATED WITH REDUCED ACTIVE COMPLIANCE IN AN ENHANCED RECOVERY PROGRAMME IN PATIENTS WITH COLORECTAL CANCER., Annual Scientific Meeting of the American-Society-of-Colon-and-Rectal-Surgeons, Publisher: LIPPINCOTT WILLIAMS & WILKINS, Pages: E329-E330, ISSN: 0012-3706
Soylu E, Kidher E, Ashrafian H, et al., 2017, A systematic review of left ventricular cardio-endoscopic surgery, Journal of Cardiothoracic Surgery, Vol: 12, ISSN: 1749-8090
Better visualisation, accurate resection and avoidance of ventriculotomy associated with use of endoscopic devices during intracardiac surgery has led to increasing interest in their use. The possibility of combining a cardio-endoscopic technique with either minimally invasive or totally endoscopic cardiac surgery provides an incentive for its further development. Several devices have been used, however their uptake has been limited due to uncertainty around their impact on patient outcomes. A systematic review of the literature identified 34 studies, incorporating 54 subjects undergoing treatment of left ventricular tumours, thrombus or hypertrophic myocardium using a cardio-endoscopic technique. There were no mortalities (0%; 0/47). In 12 studies, the follow-up period was longer than 30 days. There were no post-operative complications apart from one case of atrial fibrillation (2.2%; 1/46). Complete resection of left ventricular lesion was achieved in all cases (100%; 50/50). These successful results demonstrate that the cardio-endoscopic technique is a useful adjunct in resection of left ventricular tumours, thrombus and hypertrophic myocardium. This approach facilitates accurate resection of pathological tissue from left ventricle whilst avoiding exposure related valvular damage and adverse effects associated with ventriculotomy. Future research should focus on designing adequately powered comparative randomised trials focusing on major cardiac and cerebrovascular morbidity outcomes in both the short and long-term. In this way, we may have a more comprehensive picture of both the safety and efficacy of this technique and determine whether such devices could be safely adopted for routine use in minimal access or robotic intra-cardiac surgery.
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