240 results found
Patel K, Sounderajah V, Hanna L, et al., 2023, Quantifying the burden of survivorship associated with infrarenal abdominal aortic aneurysms., J Vasc Surg, Vol: 78, Pages: 549-557.e23
OBJECTIVES: Survivorship encompasses the physical, psychological, social, functional, and economic experience of a living with a chronic condition for both the patient and their caregiver. It is made up of nine distinct domains and remains understudied in nononcological pathologies, including infrarenal abdominal aortic aneurysmal disease (AAA). This review aims to quantify the extent to which existing AAA literature addresses the burden of survivorship. METHODS: The MEDLINE, EMBASE, and PsychINFO databases were searched from 1989 through September 2022. Randomized controlled trials, observational studies, and case series were included. Eligible studies had to detail outcomes related to survivorship in patients with AAA. Owing to the heterogeneity between studies and outcomes, no meta-analysis was conducted. Study quality was assessed with specific risk of bias tools. RESULTS: A total of 158 studies were included. Of these, only five (treatment complications, physical functioning, comorbidities, caregivers, and mental health) of the nine domains of survivorship have been studied previously. The available evidence is of variable quality; most studies display a moderate to high risk of bias, are of an observational study design, are based within a limited number of countries, and consist of an insufficient follow-up period. The most frequent complication after EVAR was endoleak. EVAR is associated with poorer long-term outcomes compared with open surgical repair in most studies retrieved. EVAR showed better outcomes in regard to physical functioning in the short term, but this advantage was lost in the long term. The most common comorbidity studied was obesity. No significant differences were found between open surgical repair and EVAR in terms of impact on caregivers. Depression is associated with various comorbidities and increased the risk of a nonhospital discharge. CONCLUSIONS: This review highlights the absence of robust evidence regarding survivorship in AAA. A
Demblon M-C, Bicknell C, Aufegger L, 2023, Systematic review of the development and effectiveness of digital health information interventions, compared with usual care, in supporting patient preparation for paediatric hospital care, and the impact on their health outcomes, Frontiers in Health Services, Vol: 3, Pages: 1-28, ISSN: 2813-0146
Background and aim: Elective surgery can be overwhelming for children, leading to pre-operative anxiety, which is associated with adverse clinical and behavioural outcomes. Evidence shows that paediatric preparation digital health interventions (DHIs) can contribute to reduced pre-operative anxiety and negative behavioural changes. However, this evidence does not consider their design and development in the context of behavioural science. This systematic review used the Theoretical Domains Framework (TDF) to evaluate the design and development of DHIs used to support children up to 14 years of age and their parents, prepare for hospital procedures, and determine any correlation to health outcomes. It also considered whether any behavioural frameworks and co-production were utilised in their design.Methods: A search of the MEDLINE, EMBASE, PsycINFO, and HMIC databases was carried out, looking for original, empirical research using digital paediatric preparation technologies to reduce pre-operative anxiety and behavioural changes. Limitations for the period (2000–2022), English language, and age applied.Results: Seventeen studies were included, sixteen randomised control trials and one before and after evaluation study. The results suggest that paediatric preparation DHIs that score highly against the TDF are (1) associated with improved health outcomes, (2) incorporate the use of co-production and behavioural science in their design, (3) are interactive, and (4) are used at home in advance of the planned procedure.Conclusion: Paediatric preparation DHIs that are co-produced and designed in the context of behavioural science are associated with reduced pre-operative anxiety and improved health outcomes and may be more cost-effective than other interventions.Systematic Review Registration: https://www.crd.york.ac.uk/prospero/, identifier: CRD42022274182.
Pouncey AL, Sweeting MJ, Bicknell C, et al., 2023, Sex-specific differences in the standard of care for infrarenal abdominal aortic aneurysm repair, and risk of major adverse cardiovascular events and death., Br J Surg, Vol: 110, Pages: 481-488
BACKGROUND: This study investigated whether sex-specific differences in preoperative/perioperative standard of care (SOC) account for disparity in outcomes after elective infrarenal abdominal aortic aneurysm repair. METHODS: This was a retrospective cohort study of elective infrarenal abdominal aortic aneurysm repairs (2013-2020) using depersonalized patient-level National Vascular Registry data. SOC was defined for waiting times, preoperative assessment (multidisciplinary/anaesthetic review), cardiovascular risk prevention, and perioperative medication. The primary outcome was major cardiovascular event and/or death (MACED). RESULTS: Some 21 810 patients with an infrarenal abdominal aortic aneurysm were included, 2380 women and 19 430 men. Women less often underwent aneurysm repair within SOC waiting times (51.5 versus 59.3 per cent; P < 0.001), but were equally likely to receive preoperative assessment (72.1 versus 72.5 per cent; P = 0.742). Women were less likely to receive secondary prevention for known cardiac disease (34.9 versus 39.6 per cent; P = 0.015), but more often met overall cardiovascular risk prevention standards (52.1 versus 47.3 per cent; P < 0.001). Women were at greater risk of MACED (open: 12.0 versus 8.9 per cent, P < 0.001; endovascular: 4.9 versus 2.9 per cent, P < 0.001; risk-adjusted OR 1.33, 95 per cent c.i. 1.12 to 1.59). A significant reduction in the odds of MACED was associated with preoperative assessment (OR 0.86, 0.75 to 0.98) and SOC waiting times (OR 0.78, 0.69 to 0.87). There was insufficient evidence to confirm a significant sex-specific difference in the effect of SOC preoperative assessment (women: OR 0.69, 0.50 to 0.97; men: OR 0.89, 0.77 to 1.03; interaction P = 0.170) or SOC waiting times (women: OR 0.84, 0.62 to 1.16; men: OR 0.76, 0.67 to 0.87; interaction P = 0.570) on the risk of MACED. CONCLUSION: SOC waiting times and preoperative assessment were not met for both sexes, which was associated with an increas
Pouncey A, Bicknell C, 2022, One Step at a Time Outside Instructions For Use for Endovascular Aortic Repair, EUROPEAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY, Vol: 64, Pages: 620-620, ISSN: 1078-5884
Caradu C, Puges M, Cazanave C, et al., 2022, Outcomes of patients with aortic vascular graft and endograft infections initially contra-indicated for complete graft explantation, JOURNAL OF VASCULAR SURGERY, Vol: 76, Pages: 1364-+, ISSN: 0741-5214
Aggarwal R, Patel K, Khanderia E, et al., 2022, CONTINUOUS REMOTE MONITORING WEARABLE DEVICES IN PATIENTS UNDERGOING BARIATRIC SURGERY: A FEASIBILITY STUDY Emergent technology, new non standard and bariatric surgery, 25th IFSO World Congress, Publisher: SPRINGER, Pages: 124-124, ISSN: 0960-8923
Kirkilesis G, Kakkos SK, Bicknell C, et al., 2022, Treatment of distal deep vein thrombosis, EMERGENCIAS, Vol: 34, Pages: 220-221, ISSN: 1137-6821
Gordon B, Thomas MG, Darzi A, et al., 2022, Systems leadership: how chief executives manage tension between organisation and system pressures, BMJ LEADER
de Vries J-PPM, Zuidema R, Bicknell CD, et al., 2022, European Expert Opinion on Infrarenal Sealing Zone Definition and Management in Endovascular Aortic Repair Patients: A Delphi Consensus, JOURNAL OF ENDOVASCULAR THERAPY, ISSN: 1526-6028
Pouncey AL, Khan A, Alharahsheh B, et al., 2022, Hypothesis for the increased rate of thromboembolic and microembolic complications following abdominal aortic aneurysm repair in women, European Journal of Vascular and Endovascular Surgery, Vol: 63, Pages: 348-349, ISSN: 1078-5884
Stenson KM, Loftus IM, Chetter I, et al., 2022, A Multi-Centre, Single-Arm Clinical Study to Confirm Safety and Performance of PuraStat (R), for the Management of Bleeding in Elective Carotid Artery Surgery, CLINICAL AND APPLIED THROMBOSIS-HEMOSTASIS, Vol: 28, ISSN: 1076-0296
Sharples L, Sastry P, Freeman C, et al., 2022, Endovascular stent grafting and open surgical replacement for chronic thoracic aortic aneurysms: a systematic review and prospective cohort study, HEALTH TECHNOLOGY ASSESSMENT, Vol: 26, Pages: 1-+, ISSN: 1366-5278
John IJ, Choo H, Pettengell CJ, et al., 2021, Patient views on surgeon-specific outcome reporting in vascular surgery: novel validated patient questionnaire study, Annals of Surgery, Vol: 274, Pages: e1030-e1037, ISSN: 0003-4932
BACKGROUND: SSMD are used to enhance transparency, improve quality and facilitate patient choice. The use of SSMD is controversial, but patients' views on such data are largely unknown. OBJECTIVES: The aim of this study was therefore to explore the views of patients and to identify their priorities for outcome reporting in vascular surgery. METHODS: A prospective questionnaire study of 165 patients receiving care in a single academic vascular unit was performed. Data on patients' current understanding and use of SSMD, together with future priorities were collected. RESULTS: Of the 165 patients 80% were unaware of SSMD. 72% thought they should be made aware of the data, although 63% thought they were likely to misinterpret the results. The majority recognized the utility of SSMD to inform treatment (60%) and surgeon (53%) choice. The majority prioritize the patient-surgeon relationship (90%) and past experiences of care (71%) when making treatment decisions. A significant majority (66% vs 49%; P < 0.005) would favour hospital-level to surgeon-level data. The main patient priorities for future outcome reporting were waiting list length (56%), the quality of hospital facilities (55%), and patient satisfaction (54%). CONCLUSIONS: The aims of SSMD reporting are not currently being met, and both patients and healthcare professionals have shared concerns over the nature and usefulness of the data. Patients express a preference for hospital-level outcomes and prioritize the experience of receiving care over outcomes when making treatment decisions. Future outcome reporting should include patient-directed hospital-level metrics that are readily accessible and understood by all.
Sharples L, Sastry P, Freeman C, et al., 2021, Aneurysm growth, survival, and quality of life in untreated thoracic aortic aneurysms: the effective treatments for thoracic aortic aneurysms study, European Heart Journal, Vol: 43, Pages: 2356-2369, ISSN: 0195-668X
AimsTo observe, describe, and evaluate management and timing of intervention for patients with untreated thoracic aortic aneurysms.Methods and resultsProspective study of UK National Health Service (NHS) patients aged ≥18 years, with new/existing arch or descending thoracic aortic aneurysms of ≥4 cm diameter, followed up until death, intervention, withdrawal, or July 2019. Outcomes were aneurysm growth, survival, quality of life (using the EQ-5D-5L utility index), and hospital admissions. Between 2014 and 2018, 886 patients were recruited from 30 NHS vascular/cardiothoracic units. Maximum aneurysm diameter was in the descending aorta in 725 (82%) patients, growing at 0.2 cm (0.17–0.24) per year. Aneurysms of ≥4 cm in the arch increased by 0.07 cm (0.02–0.12) per year. Baseline diameter was related to age and comorbidities, and no clinical correlates of growth were found. During follow-up, 129 patients died, 64 from aneurysm-related events. Adjusting for age, sex, and New York Heart Association dyspnoea index, risk of death increased with aneurysm size at baseline [hazard ratio (HR): 1.88 (95% confidence interval: 1.64–2.16) per cm, P < 0.001] and with growth [HR: 2.02 (1.70–2.41) per cm, P < 0.001]. Hospital admissions increased with aneurysm size [relative risk: 1.21 (1.05–1.38) per cm, P = 0.008]. Quality of life decreased annually for each 10-year increase in age [–0.013 (–0.019 to –0.007), P < 0.001] and for current smoking [–0.043 (–0.064 to –0.023), P = 0.004]. Aneurysm size was not associated with change in quality of life.ConclusionInternational guidelines should consider increasing monitoring intervals to 12 months for small aneurysms and increasing intervention thresholds. Individualized decisions about surveillance/intervention should consider age, sex, size, growth, patient characteristics, and surgical risk.
Bicknell CD, Beck AW, 2021, A Technical Tour de Force, but Not for the Faint of Heart!, EUROPEAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY, Vol: 62, Pages: 746-746, ISSN: 1078-5884
Bicknell CD, 2021, Standard EVAR Can Be Used in Most Challenging Necks: For the Motion, EUROPEAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY, Vol: 62, Pages: 678-679, ISSN: 1078-5884
Patel SR, Ormesher DC, Smith SR, et al., 2021, A risk-adjusted and anatomically stratified cohort comparison study of open surgery, endovascular techniques and medical management for juxtarenal aortic aneurysms - the UK COMPlex AneurySm Study (UK-COMPASS): a study protocol, BMJ OPEN, Vol: 11, ISSN: 2044-6055
Patel K, Aggarwal R, Martin G, et al., 2021, Feasibility of a multi-parametric continuous monitoring wearable device in patients undergoing bariatric surgery, 12th Annual Scientific Meeting of the British-Obesity-and-Metabolic-Surgery-Society (BOMSS), Publisher: SPRINGER, Pages: S12-S12, ISSN: 0960-8923
Hanna L, Abdullah A, Kashef E, et al., 2021, Four-year results of the Bolton relay proximal scallop endograft in the management of thoracic and thoracoabdominal aortic pathology with unfavorable proximal landing zone, JOURNAL OF VASCULAR SURGERY, Vol: 74, Pages: 1447-1455, ISSN: 0741-5214
Martin G, Bicknell C, 2021, Another Endogarment to Choose From, But Where Does This Fit in to the Treatment Algorithm for TBAD? COMMENT, EUROPEAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY, Vol: 62, Pages: 575-575, ISSN: 1078-5884
Pouncey AL, David M, Morris R, et al., 2021, Systematic review and meta-analysis of sex-specific differences in adverse events after open and endovascular intact abdominal aortic aneurysm repair: consistent worse outcomes for women, European Journal of Vascular and Endovascular Surgery, Vol: 62, Pages: 367-378, ISSN: 1078-5884
Objective: Previously, reports have shown women experience higher mortality than men after elective open (OAR) and endovascular (EVAR) repair of abdominal aortic aneurysm (AAA).With recent improvements in overall AAA repair outcomes, this study aimed to identify whether sex-specific disparity has been ameliorated by modern practice, and to define sex-specific differences in peri/post-operative complications and pre-operative status; factors which may contribute to poor outcome.Methods: Systematic review, meta-analysis and meta-regression of sex-specific differences in 30-day mortality and complications conducted according to PRISMA guidance (Prospero registrationCRD42020176398). Papers with ≥50 women, reporting sex-specific outcomes, following intact primary AAA repair, from 2000-2020 world-wide were included; separate analyses for EVAR and OAR. Data sources: Medline, Embase and CENTRAL databases 2005-2020 searched using ProQuest Dialog™. Results: 26 studies (371,215 men,65,465 women) included. Meta-analysis and meta-regression indicated sex-specific odds ratios(ORs) for 30-day mortality were unchanged from 2000-2020.Mortality risk was higher in women for OAR and more so for EVAR (OR [95%CI] 1.49 [1.37,1.61];1.86 [1.59,2.17] respectively) and remained following multivariable risk-adjustment. Transfusion, pulmonary complications and bowel ischemia were more common in women after OAR and EVAR (OAR: ORs 1.81 [1.60,2.04], 1.40 [1.28,1.53], 1.54 [1.36,1.75]; EVAR: ORs 2.18[2.08,2.29] 1.44 [1.17,1.77], 1.99 [1.51,2.62] respectively). Arterial injury, limb ischemia, renal and cardiac complications were more common in women after EVAR (ORs 3.02 [1.62-5.65], 2.13[1.48-3.06], 1.46 [1.22-1.72] and 1.19[1.03,1.37] respectively); the latter was associated with greater mortality risk on meta-regression. Conclusions: Increased mortality risk for women following AAA repair remains. Women had higher incidence of transfusion, pulmonary and bowel complications after EVAR and
Pouncey AL, Alharehsheh B, Khan A, et al., 2021, Quantification of Sex-specific Differences in Aorto-iliac Complexity for Patients Undergoing Abdominal Aortic Aneurysm Repair: A Retrospective Cohort Study., Vascular Society Annual Scientific Meeting 2021
Patel K, Sounderajah V, Normahani P, et al., 2021, Quantifying the burden of survivorship associated with infra-renal abdominal aortic aneurysm repair: a systematic review, Publisher: OXFORD UNIV PRESS, ISSN: 0007-1323
Aufegger L, Soane E, Darzi A, et al., 2021, Shared leadership in tertiary care: design of a simulation for patient safety decision-making in healthcare management teams, BMJ Simulation & Technology Enhanced Learning, Vol: 7, Pages: 216-222, ISSN: 2056-6697
Introduction Simulation-based training (SBT) on shared leadership (SL) and group decision-making (GDM) can contribute to the safe and efficient functioning of a healthcare system, yet it is rarely incorporated into healthcare management training. The aim of this study was design, develop and validate a robust and evidence-based SBT to explore and train SL and GDM.Method Using a two-stage iterative simulation design approach, 103 clinical and non-clinical managerial students and healthcare professionals took part in an SBT that contained real-world problems and opportunities to improve patient safety set within a fictional context. Self-report data were gathered, and a focus group was conducted to address the simulation’s degree of realism, content, relevance, as well as areas for improvement.Results Participants experienced the simulation scenario, the material and the role assignment as realistic and representative of real-world tasks and decision contexts, and as a good opportunity to identify and enact relevant tasks, behaviours and knowledge related to SL and GDM. Areas for improvement were highlighted with regard to involving an actor who challenges SL and GDM; more preparatory time to allow for an enhanced familiarisation of the content; and, video debriefs to reflect on relevant behaviours and team processes.Conclusions Our simulation was perceived as an effective method to develop SL and GDM within the context of patient safety and healthcare management. Future studies could extend this scenario method to other areas of healthcare service and delivery, and to different sectors that require diverse groups to make complex decisions.
Pouncey AL, David M, Morris R, et al., 2021, THE IMPACT OF CARDIOVASCULAR DISEASE ON SEX-SPECIFIC ADVERSE OUTCOMES FOLLOWING INTACT ABDOMINAL AORTIC ANEURYSM REPAIR: A SYSTEMATIC REVIEW, META-ANALYSIS & META-REGRESSION, Publisher: BMJ PUBLISHING GROUP, Pages: A30-A32, ISSN: 1355-6037
Chan C, Sounderajah V, Normahani P, et al., 2021, Wearable activity monitors in home based exercise therapy for patients with intermittent claudication: a systematic review, European Journal of Vascular and Endovascular Surgery, Vol: 61, Pages: 676-687, ISSN: 1078-5884
OBJECTIVE: Intermittent claudication (IC) can severely limit functional capacity and quality of life. Supervised exercise therapy is the recommended first line management; however, this is often limited by accessibility, compliance and cost. As such, there has been an increased interest in the use of wearable activity monitors (WAMs) in home based telemonitoring exercise programmes for claudicants. This review aims to evaluate the efficacy of WAM as a feedback and monitoring tool in home based exercise programmes for patients with IC. DATA SOURCES: A search strategy was devised. The databases MEDLINE, EMBASE, and Web of Science were searched through to April 2020. REVIEW METHODS: Randomised trials and prospective trials were included. Eligible trials had to incorporate WAMs as a feedback tool to target walking/exercise behaviour. The primary outcome was the change in walking ability. Study quality was assessed with risk of bias tool. RESULTS: A total of 1148 records were retrieved. Of these, eight randomised controlled trials and one prospective cohort study, all of which compared a WAM intervention against standard care and/or supervised exercise, met the inclusion criteria. Owing to heterogeneity between studies, no meta-analysis was conducted. WAM interventions improved measures of walking ability (heterogeneous outcomes such as maximum walking distance, claudication distance and six minute walk distance), increased daily walking activity (steps/day), cardiovascular metrics (maximum oxygen consumption), and quality of life. CONCLUSION: There is some evidence that home based WAM interventions are beneficial for improving walking ability and quality of life in patients with IC. However, existing studies are limited by inadequate sample size, duration, and appropriate power. Achieving consensus on outcome reporting and study methods, as well as maximising device adherence, is needed.
Normahani P, Anwar IY, Courtney A, et al., 2021, Factors associated with infrainguinal bypass graft patency at 1-year; a retrospective analysis of a single centre experience, Perfusion (United Kingdom), Vol: 37, Pages: 276-283, ISSN: 1477-111X
Introduction:The aim of this study was to identify factors associated with primary graft patency 1 year following open lower limb revascularisation (LLR) at a tertiary referral vascular service.Methods:A retrospective analysis of patients undergoing infra-inguinal bypass surgery between January 2016 and May 2017 at a tertiary vascular centre (St Mary’s Hospital, London) was performed. Data regarding patient demographics, comorbidities, type of operation and post-operative anti-thrombotic strategy were collected. Quality of run-off score was assessed from pre-operative imaging.Results:Seventy-seven cases were included in the analysis. Overall, the primary patency rate at 1-year was 63.6% (n = 49/77) and the secondary patency rate was 67.5% (n = 52/77). Independent variables with statistically significant inferior patency rates at 1-year were (1) bypasses with below knee targets (p = 0.0096), (2) chronic limb threatening ischaemia indication (p = 0.038), (3) previous ipsilateral revascularisation (p < 0.001) and (4) absence of hypertension history (p = 0.041). There was also a trend towards significance for American Society of Anesthesiologists (ASA) grade (p = 0.06). Independent variables with log-rank test p values of <0.1 were included in a Cox proportional hazards model. The only variable with a statistically significant impact on primary patency rates was previous open or endovascular ipsilateral revascularisation (HR 2.44 (1.04–5.7), p = 0.04).Conclusion:At 1-year follow-up, previous ipsilateral revascularisation was the most significant factor in affecting patency rates. Patients in this subgroup should therefore be deemed high-risk, which should be reflected in the informed consent and peri-operative management.
Salim S, Martin G, Bicknell C, 2021, Isolated penetrating aortic ulcers can be followed safely: but why would you? Reply, JOURNAL OF VASCULAR SURGERY, Vol: 73, Pages: 1115-1115, ISSN: 0741-5214
Aufegger L, Yanar C, Bicknell C, et al., 2021, The risk-value trade-off: price and brand information impact consumers’ intentions to purchase OTC drugs, Journal of Pharmaceutical Policy and Practice, Vol: 14, ISSN: 2052-3211
BackgroundEuropean countries face fiscal pressure regarding the long-term sustainability of their healthcare system due to increasing levels of public health expenditures and mounting demographic pressures. The promotion of generic drugs is considered to be an efficient means to tackle these challenges; however, market diffusion remains slow. The aim of this study was to investigate the impact of price and brand cues on purchase intentions by means of Direct-to-Consumer (DTC) advertising, and to build on the market cue evaluation model by Dodd et al.MethodsParticipants rated purchase intentions on six DTC adverts varying in price and brand information, followed by self-reports on purchase intentions, attitudes towards generics, brand loyalty, price consciousness, as well as perceptions of quality, risk and value. Open-ended questions explored attitudes toward generic drugs.ResultsBrand information and purchase intentions were mediated by perceived risk and perceived quality, while price information influenced purchase intention through perceptions of quality, risk and value. Consumers’ purchase behaviour was furthermore influenced by unawareness and misconceptions, past experiences, and advertising as a decision-making tool.ConclusionsAdvertisements, including price and brand information, are an important tool to improve consumers’ awareness of the availability of different OTC drugs. Practical and theoretical implications are discussed.
Martin G, Scatling-Birch Y, Balaji S, et al., 2021, Examining the impact of psychological distress on short-term postoperative outcomes after elective endovascular aneurysm repair (EVAR)., Journal of Psychosomatic Research, ISSN: 0022-3999
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