Publications
573 results found
Acharya M, Harling L, Moscarelli M, et al., 2016, Influence of Body Mass Index on outcomes after minimal-access aortic valve replacement through a J-shaped partial upper sternotomy, Journal of Cardiothoracic Surgery, Vol: 11, ISSN: 1749-8090
Objective: Minimal-access aortic valve replacement (MAAVR) may reduce post-operative blood loss and transfusion requirements, decrease post-operative pain, shorten length stay and enhance cosmesis. This may be particularly advantageous in overweight/obese patients, who are at increased risk of post-operative complications. Obese patients are however often denied MAAVR due to the perceived technical procedural difficulty. This retrospective analysis sought to determine the effect of BMI on post-operative outcomes in patients undergoing MAAVR.Methods: Ninety isolated elective MAAVR procedures performed between May 2006-October 2013 were recruited. Intra- and post-operative data were prospectively collected. Ordinary least squares univariate linear regression analysis was performed to determine the effect of BMI as a continuous variable on post-operative outcomes. One-way ANOVA and Chi-squared testing was used to assess differences in outcomes between patients with BMI <25 (n=36) and BMI ≥25 (n=54) as appropriate.Results: There was no peri-operative mortality, myocardial infarction or stroke. Univariate regression demonstrated longer cross-clamp times (p=0.0218) and a trend towards increased bypass times (p=0.0615) in patients with higher BMI. BMI ≥25 was associated with an increased incidence of hospital-acquired pneumonia (p=0.020) and new-onset atrial fibrillation (p=0.036) compared to BMI <25. However, raised BMI did not extend ICU (p=0.3310) or overall hospital stay (p=0.2614). Similar rates of sternal wound complications, inotrope requirements and renal dysfunction were observed in both normal- and overweight/obese-BMI groups. Furthermore, increasing BMI correlated with reduced mechanical ventilation time (p=0.039) and early post-operative blood loss (p=0.004).Conclusions: Our results demonstrate that within the range of this study, MAAVR is a safe, reproducible and effective procedure, affording equivalent clinical outcomes in both overweight/obese a
Patel N, Alexander J, Ashrafian H, et al., 2016, Meta-analysis comparing differing methods of endoscopic therapy for colorectal lesions, WORLD JOURNAL OF META-ANALYSIS, Vol: 4, Pages: 44-54, ISSN: 2308-3840
Patel N, Patel K, Ashrafian H, et al., 2016, Colorectal endoscopic submucosal dissection: Systematic review of mid-term clinical outcomes., Digestive Endoscopy, Vol: 28, Pages: 405-416, ISSN: 0915-5635
With a drive towards minimally invasive surgery, endoscopic submucosal dissection (ESD) is now gaining popularity. In a number of East Asian countries, ESD is now the treatment of choice for early non-metastatic gastric cancer, but the outcomes of ESD for colorectal lesions are unclear. The present review summarizes the mid-term outcomes of colorectal ESD including complication and recurrence rates. A systematic literature search was done in May 2014, identifying 20 publications reporting the outcomes of colorectal ESD which were included in this review. En-bloc resection rates, complete (R0) resection rates, endoscopic clearance rates, complication and recurrences rates were analyzed. Statistical pooling was done to calculate weighted means using random effects modeling. Twenty studies reporting the outcomes of 3060 colorectal ESD procedures were reported. Overall weighted en-bloc resection rate was 89% (95% CI: 83-94%), R0 resection rate 76% (95% CI: 69-83%), endoscopic clearance rate 94% (95% CI: 90-97%) and recurrence rate 1% (95% CI: 0.5-2%). Studies that followed up patients for over 1 year were found to have an en-bloc resection rate of 91% (95% CI: 86-96%), R0 resection rate of 81% (95% CI: 75-88%), endoscopic clearance rate 93% (95% CI: 90-97%) and recurrence rate of 0.8% (95% CI: 0.4-1%). Colorectal ESD can be carried out effectively and safely with a 1% recurrence rate. Further studies with longer follow-up periods are required to determine whether colorectal ESD is a viable alternative to conventional surgical therapy.
Athanasiou T, Patel V, Garas G, et al., 2016, Mentoring perception and academic performance: an Academic Health Science Centre survey, Postgraduate Medical Journal, Vol: 92, Pages: 597-602, ISSN: 1469-0756
Purpose To determine the association between professors' self-perception of mentoring skills and their academic performance.Design Two hundred and fifteen professors from Imperial College London, the first Academic Health Science Centre (AHSC) in the UK, were surveyed. The instrument adopted was the Mentorship Skills Self-Assessment Survey. Statement scores were aggregated to provide a score for each shared core, mentor-specific and mentee-specific skill. Univariate and multivariate regression analyses were used to evaluate their relationship with quantitative measures of academic performance (publications, citations and h-index).Results There were 104 professors that responded (response rate 48%). There were no statistically significant negative correlations between any mentoring statement and any performance measure. In contrast, several mentoring survey items were positively correlated with academic performance. The total survey score for frequency of application of mentoring skills had a statistically significant positive association with number of publications (B=0.012, SE=0.004, p=0.006), as did the frequency of acquiring mentors with number of citations (B=1.572, SE=0.702, p=0.030). Building trust and managing risks had a statistically significant positive association with h-index (B=0.941, SE=0.460, p=0.047 and B=0.613, SE=0.287, p=0.038, respectively).Conclusions This study supports the view that mentoring is associated with high academic performance. Importantly, it suggests that frequent use of mentoring skills and quality of mentoring have positive effects on academic performance. Formal mentoring programmes should be considered a fundamental part of all AHSCs’ configuration.
Soylu E, Harling L, Ashrafian H, et al., 2016, A systematic review of the safety and efficacy of distal coronary artery anastomotic devices, EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY, Vol: 49, Pages: 732-745, ISSN: 1010-7940
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- Citations: 9
Tan A, Ashrafian H, Scott AJ, et al., 2016, Robotic surgery: disruptive innovation or unfulfilled promise? A systematic review and meta-analysis of the first 30 years, Surgical Endoscopy and Other Interventional Techniques, Vol: 30, Pages: 4330-4352, ISSN: 1432-2218
Background Robotic surgery has been in existence for30 years. This study aimed to evaluate the overall perioperativeoutcomes of robotic surgery compared with opensurgery (OS) and conventional minimally invasive surgery(MIS) across various surgical procedures.Methods MEDLINE, EMBASE, PsycINFO, and ClinicalTrials.govwere searched from 1990 up to October 2013with no language restriction. Relevant review articles werehand-searched for remaining studies. Randomised controlledtrials (RCTs) and prospective comparative studies(PROs) on perioperative outcomes, regardless of patientage and sex, were included. Primary outcomes were bloodloss, blood transfusion rate, operative time, length of hospitalstay, and 30-day overall complication rate.Results We identified 99 relevant articles (108 studies,14,448 patients). For robotic versus OS, 50 studies (11 RCTs,39 PROs) demonstrated reduction in blood loss [ratio of means(RoM) 0.505, 95 % confidence interval (CI) 0.408–0.602],transfusion rate [risk ratio (RR) 0.272, 95 % CI 0.165–0.449],length of hospital stay (RoM 0.695, 0.615–0.774), and 30-dayoverall complication rate (RR 0.637, 0.483–0.838) in favour ofrobotic surgery. For robotic versus MIS, 58 studies (21 RCTs,37 PROs) demonstrated reduced blood loss (RoM 0.853,0.736–0.969) and transfusion rate (RR 0.621, 0.390–0.988) infavour of robotic surgery but similar length of hospital stay(RoM 0.982, 0.936–1.027) and 30-day overall complicationrate (RR 0.988, 0.822–1.188). In both comparisons, roboticsurgery prolonged operative time (OS: RoM 1.073,1.022–1.124; MIS: RoM 1.135, 1.096–1.173). The benefits ofrobotic surgery lacked robustness on RCT-sensitivity analyses.However, many studies, including the relatively fewavailable RCTs, suffered from high risk of bias and inadequatestatistical power.Conclusions Our results showed that robotic surgerycontributed positively to some perioperative outcomes butlonger operative times rem
Ashrafian H, Athanasiou T, Nicholson JK, et al., 2016, Unmet Medical Needs, Metabolic Phenotyping in Personalized and Public Healthcare, Pages: 1-15, ISBN: 9780128003442
Despite dramatic strides in health care, there are persistent and far-reaching medical needs that remain unmet. These include challenges in disease management, health care technology, socioeconomics, and health processes. These should be considered in a context of shifting pathology, where global trends in communicable and noncommunicable diseases remain in flux. Personalized Medicine can potentially address many of these persistent needs. We define this as the tailored management and/or prevention of disease according to the specific characteristics of a stratified individual, subpopulation, or population to enhance patient care. These characteristics are derived from the integrated evaluation of phenotype, genotype, and treatment bioresponses realized through a systems biomedicine "-omics" approach. This employs complex multivariate, network, and hierarchical computation in the context of best evidence-based practice. It offers precision in diagnosis and treatments, in addition to the generation of targeted therapeutics. This approach may offer novel strategies in addressing future unmet medical needs.
Kaufman N, Khurana I, 2016, Using Digital Health Technology to Prevent and Treat Diabetes., Diabetes Technol Ther, Vol: 18 Suppl 1, Pages: S56-S68
Chaudhry UAR, Harling L, Ashrafian H, et al., 2016, Surgical management of infected cardiac implantable electronic devices, INTERNATIONAL JOURNAL OF CARDIOLOGY, Vol: 203, Pages: 714-721, ISSN: 0167-5273
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- Citations: 8
Ashrafian H, 2016, Leonardo da Vinci's Mona Lisa : Medical Differentials and Primary Biliary Cholangitis., Acta Gastroenterol Belg, Vol: 79, Pages: 375-379, ISSN: 1784-3227
Ashrafian H, Harling L, Toma T, et al., 2015, Type 1 diabetes mellitus and bariatric surgery: a systematic review and meta-analysis, Obesity Surgery, Vol: 26, Pages: 1697-1704, ISSN: 1708-0428
BackgroundType 1 diabetes mellitus (T1DM) has a rising global prevalence. Although it is vastly outnumbered by type 2 diabetes mellitus rates, it remains a persistent worldwide source of morbidity and mortality. Increasingly, its sufferers are afflicted by obesity and its complications. The objective of the study is to quantify the effects of bariatric surgery on T1DM by appraising the primary outcomes of glycosylated haemoglobin (HbA1c), insulin requirements and body mass index (BMI). Secondary outcomes included blood pressure, triglycerides and cholesterol biochemistry.MethodsA systematic review of studies reporting pre-operative and post-operative outcomes in T1DM patients undergoing bariatric surgery was done. Data were meta-analysed using random effects modelling. Subgroup analysis and quality scoring were assessed.ResultsBariatric surgery in obese T1DM patients is associated with a significant reduction in insulin requirement (−48.95 units, 95 % CI of −56.27, −41.62), insulin requirement per kilogramme (−0.391, 95 % CI of −0.51, −0.27), HbA1c (−0.933, 95 % CI of −1.604, −0.262) and BMI (−11.04 kg/m2, 95 % CI of −13.49, −8.59). Surgery is also associated with a statistically significant reduction in systolic and diastolic blood pressure and a significant beneficial rise in HDL. Heterogeneity in these results was high, and study quality was low overall.ConclusionsBariatric surgery in obese T1DM patients is associated with a significant improvement in insulin requirement and a significant though modest effect on HbA1c. These early results require further substantiation with future studies focusing on higher levels of evidence. This may offer a deeper understanding of diabetogenesis and can contribute to better selection and stratification of diabetic patients for metabolic surgery and future metabolic treatment strategies.
Protopapas AD, Ashrafian H, Athanasiou T, 2015, Tumour thrombi in the cavae, Charing Cross Symposium 2016
BACKGROUND: Renal cell carcinomas and other retroperitoneal tumours propagate tumour thrombi in the inferior vena cava, often well into the thorax. These intrathoracic caval tumour thrombi (ICTT) are of interest to the cardiothoracic surgeon: We consider two ICTT subgroups that correspond to the wider ‘Neves and Zincke’ classification: ICTT-III (extracardiac) extending just above the hepatic veins and ICTT-IV (intracardiac). METHODS: Review of case series for evidence on the peri-operative management of ICTT.RESULTS: We identified and retained for data extraction 29 series with 784 patients, 453 cases of extracardiac and 331 of intracardiac tumour thrombi. Average age was 59 years. 98% of the tumours were RCC, 1% adrenal and Wilms’ tumours and 1% transitional cell carcinomas.The prevalent incision was chevron (rooftop) with or without tandem sternotomy. Mortality was 10% (5% for ICTT-III, 15% for ICTT-IV). Morbidity was 56% (36% for ICTT-III, 64% for ICTT-IV). Bleeding necessitating reoperation was the commonest complication (14%). The transfusion requirements reflected the estimated blood loss: 2.6 Litres of blood loss and 2.4 Litres of blood products for the ICTT-III subgroup and 3.7 Litres of blood loss and 3.5 Litres of blood products for ICTT-IV. Operative and anaesthetic times exceeded 5 hours Hospital stay averaged 13 days. Variations in perioperative care included: pre-operative embolisation, peri-operative transoesophageal echo, surgical incisions and use of extracorporeal circulation (perfusion).CONCLUSIONS: -Surgery for ICTT is resource-intensive. -It requires provision for massive transfusion and prolonged in-hospital recovery times.
Chaudhry UAR, Harling L, Sepehripour AH, et al., 2015, Beating-Heart Versus Conventional On-Pump Coronary Artery Bypass Grafting: A Meta-Analysis of Clinical Outcomes, ANNALS OF THORACIC SURGERY, Vol: 100, Pages: 2251-2261, ISSN: 0003-4975
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- Citations: 27
Bower G, Toma T, Harling L, et al., 2015, Bariatric Surgery and Non-Alcoholic Fatty Liver Disease: a Systematic Review of Liver Biochemistry and Histology, OBESITY SURGERY, Vol: 25, Pages: 2280-2289, ISSN: 0960-8923
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- Citations: 153
Ahmad MS, Ashrafian H, Alsaleh M, et al., 2015, Role of metabolic phenotyping in understanding obesity and related conditions in Gulf Co-operation Council countries, Clinical Obesity, Vol: 5, Pages: 302-311, ISSN: 1758-8111
Obesity is a major health concern in the Middle East and the incidence is rising in all sections of the population. Efforts to control obesity through diet and lifestyle interventions, and by surgical means, have had limited effect, and the gene–environment interactions underpinning the development of obesity and related pathologies such as metabolic syndrome, cardiovascular disease and certain cancers are poorly defined. Lifestyle, genetics, inflammation and the interaction between the intestinal bacteria and host metabolism have all been implicated in creating an obesogenic environment. We summarize the role of metabolic and microbial phenotyping in understanding the aetiopathogenesis of obesity and in characterizing the metabolic responses to surgical and non-surgical interventions, and explore the potential for clinical translation of this approach.
Antonakis PT, Ashrafian H, Martinez-Isla A, 2015, Pancreatic insulinomas: laparoscopic management, WORLD JOURNAL OF GASTROINTESTINAL ENDOSCOPY, Vol: 7, Pages: 1197-1207, ISSN: 1948-5190
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- Citations: 18
Jose Segura-Sampedro J, Ashrafian H, Navarro-Sanchez A, et al., 2015, Small bowel obstruction due to laparoscopic barbed sutures: An unknown complication?, REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS, Vol: 107, Pages: 677-680, ISSN: 1130-0108
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- Citations: 16
Ashrafian H, 2015, Catherine of Aragon (1485-1536): the red malar rash of familial SLE in a Tudor red rose queen, RHEUMATOLOGY INTERNATIONAL, Vol: 35, Pages: 1949-1950, ISSN: 0172-8172
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- Citations: 1
Sepehripour AH, Chaudhry UA, Suliman A, et al., 2015, How revascularization on the beating heart with cardiopulmonary bypass compares to off-pump? A meta-analysis of observational studies, Interactive Cardiovascular and Thoracic Surgery, Vol: 22, Pages: 63-71, ISSN: 1569-9293
Off-pump coronary artery bypass surgery has been a controversial area of debate and the outcome profile of the technique has been thoroughly investigated. Scepticism regarding the reported outcomes and the conduct of the randomized trials comparing this technique with conventional on-pump coronary artery bypass surgery has been widely voiced, and the technique of off-pump surgery remains as an infrequently adopted approach to myocardial revascularization worldwide. Criticisms of the technique are related to lower rates of complete revascularization and its unknown long-term consequences, the significant detrimental effects on mortality and major adverse events when emergency conversion is required, and the significant lack of long-term survival and morbidity data. The hybrid technique of myocardial revascularization on the beating heart with the use of cardiopulmonary bypass may theoretically provide the beneficial effects of off-pump surgery in terms of myocardial protection and organ protection, while providing the safety and stability of on-pump surgery to allow complete revascularization. Large randomized comparison to support evidence-based choices is currently lacking. In this article, we have meta-analysed the outcomes of on-pump beating heart surgery in comparison with off-pump surgery focusing on major adverse cardiovascular and cerebrovascular adverse events (MACCE) including mortality, stroke and myocardial infarction and the degree of revascularization and number of bypass grafts performed. It was demonstrated that the beating heart on-pump technique allows a significantly higher number of bypass grafts to be performed, resulting in significantly higher degree of revascularization. We have also demonstrated a slightly higher rate of 30-day mortality and MACCE with the technique although not at a statistically significant level. These results should be considered alongside the population risk profile, where a significantly higher risk cohort had undergone
Navarro-Sanchez A, Ashrafian H, Martinez-Isla A, 2015, An Abnormal Intraoperative Cholangiogram, JAMA SURGERY, Vol: 150, Pages: 1009-1010, ISSN: 2168-6254
Protopapas AD, Ashrafian H, Athanasiou T, 2015, Dura censor sed censor: A reviewer’s ongoing audit of 11 years in the journals of the European Association for Cardio-thoracic Surgery, Frontiers - simulation for training in cardiothoracic surgery
Ashrafian H, 2015, Surgical philosophy: Concepts of modern surgery paralleled to Sun Tzu's 'Art of War', ISBN: 9781498732772
Treating disease can be considered a combat between curative therapies and pathological afflictions. As such, the action of achieving a cure can be likened to successfully waging war on sickness and bodily disorders. Surgical Philosophy applies the core principles derived from Sun Tzu's timeless book Art of War to combating disease through surgery. Its goal is to offer principles, strategies and leadership guidelines for surgeons at all levels and other healthcare practitioners who carry out interventional procedures for the ultimate aim of defeating illness and enhancing the care of patients. In providing a novel and exciting perspective on this ancient text, the book will also be of interest to students of leadership, Eastern philosophy and Chinese history. The book follows eleven sections of the Art of War. Each section reflects the messages in the Art of War, but with a modern surgical point of view. In the book, the role of the surgeon is equivalent to that of a leader or military commander, and the lessons offered in the Art of War are expanded to identify surgical principles and practice.
Galassi FM, Ashrafian H, 2015, Has the diagnosis of a stroke been overlooked in the symptoms of Julius Caesar?, NEUROLOGICAL SCIENCES, Vol: 36, Pages: 1521-1522, ISSN: 1590-1874
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- Citations: 9
Bower G, Athanasiou T, Isla AM, et al., 2015, Bariatric surgery and nonalcoholic fatty liver disease, European Journal of Gastroenterology & Hepatology, Vol: 27, Pages: 755-768, ISSN: 0954-691X
The rising prevalence of nonalcoholic fatty liver disease (NAFLD) is associated with the increasing global pandemic of obesity. These conditions cluster with type II diabetes mellitus and the metabolic syndrome to result in obesity-associated liver disease. The benefits of bariatric procedures on diabetes and the metabolic syndrome have been recognized for some time, and there is now mounting evidence to suggest that bariatric procedures improve liver histology and contribute to the beneficial resolution of NAFLD in obese patients. These beneficial effects derive from a number of weight-dependent and weight-independent mechanisms including surgical BRAVE actions (bile flow changes, restriction of stomach size, anatomical gastrointestinal rearrangement, vagal manipulation, enteric hormonal modulation) and subsequent effects such as reduced lipid intake, adipocytokine secretion, modulation of gut flora, improvements in insulin resistance and reduced inflammation. Here, we review the clinical investigations on bariatric procedures for NAFLD, in addition to the mounting mechanistic data supporting these findings. Elucidating the mechanisms by which bariatric procedures may resolve NAFLD can help enhance surgical approaches for metabolic hepatic dysfunction and also contribute toward developing the next generation of therapies aimed at reducing the burden of obesity-associated liver disease.
Ashrafian H, Toma T, Rowland SP, et al., 2015, Bariatric Surgery or Non-Surgical Weight Loss for Obstructive Sleep Apnoea? A Systematic Review and Comparison of Meta-analyses, OBESITY SURGERY, Vol: 25, Pages: 1239-1250, ISSN: 0960-8923
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- Citations: 99
Kidher E, Jarral OA, Harling L, et al., 2015, NR2 antibody is associated with quality of life in aortic valve replacement., Asian Cardiovasc Thorac Ann, Vol: 23, Pages: 690-700
BACKGROUND: The relationship between the potential brain injury biomarker N-methyl-D-aspartate receptor antibody and quality of life has never been assessed. METHODS: We measured serum N-methyl-D-aspartate receptor antibody levels preoperatively in patients undergoing aortic valve replacement. Quality of life was scored using the Short Form-36 and European Quality of Life 5-Dimensions questionnaires pre- and postoperatively. We analyzed the antibody levels as a continuous variable and as a dichotomous variable with 1.8 ng mL(-1) as the cutoff. RESULTS: Fifty-two patients (15 females) with a mean age of 71 ± 8.4 years were recruited for this study. Forty-eight (92%) patients attended the follow-up visit (405 ± 161 days). No mortality or severe neurological event was recorded. In both quality-of-life instruments, the low antibody level group (n = 35) had significantly better scores than the high antibody level group (n = 17) preoperatively. Postoperatively, the scores for both groups improved; however, the low antibody level group continued to score significantly better in most of the physical and mental health domains (p = 0.04 to <0.001). Multiple regression analyses revealed that antibody level and the 1.8 ng mL(-1) cutoff were independently related to quality of life (pre- and postoperatively). CONCLUSIONS: Higher N-methyl-D-aspartate receptor antibody levels in aortic valve replacement patients are independently related to poorer quality of life pre- and postoperatively.
Pannick S, Beveridge I, Ashrafian H, et al., 2015, A stepped wedge, cluster controlled trial of an intervention to improve safety and quality on medical wards: the HEADS-UP study protocol, BMJ Open, Vol: 5, ISSN: 2044-6055
Introduction The majority of preventable deaths in healthcare are due to errors on general wards. Staff perceptions of safety correlate with patient survival, but effectively translating ward teams’ concerns into tangibly improved care remains problematic. The Hospital Event Analysis Describing Significant Unanticipated Problems (HEADS-UP) trial evaluates a structured, multidisciplinary team briefing, capturing safety threats and adverse events, with rapid feedback to clinicians and service managers. This is the first study to rigorously assess a simpler intervention for general medical units, alongside an implementation model applicable to routine clinical practice.Methods/analysis 7 wards from 2 hospitals will progressively incorporate the intervention into daily practice over 14 months. Wards will adopt HEADS-UP in a pragmatic sequence, guided by local clinical enthusiasm. Initial implementation will be facilitated by a research lead, but rapidly delegated to clinical teams. The primary outcome is excess length of stay (a surplus stay of 24 h or more, compared to peer institutions’ Healthcare Resource Groups-predicted length of stay). Secondary outcomes are 30-day readmission or excess length of stay; in-hospital death or death/readmission within 30 days; healthcare-acquired infections; processes of escalation of care; use of traditional incident-reporting systems; and patient safety and teamwork climates. HEADS-UP will be analysed as a stepped wedge cluster controlled trial. With 7840 patients, using best and worst case predictions, the study would achieve between 75% and 100% power to detect a 2–14% absolute risk reduction in excess length of stay (two-sided p<0.05). Regression analysis will use generalised linear mixed models or generalised estimating equations, and a time-to-event regression model. A qualitative analysis will evaluate facilitators and barriers to HEADS-UP implementation and impact.Ethics and dissemination Participating in
Pannick S, Davis R, ashrafian H, et al., 2015, Effects of interdisciplinary team care interventions on general medical wards. A systematic review., JAMA Internal Medicine, Vol: 175, Pages: 1288-1298, ISSN: 2168-6114
Importance Improving the quality of health care for general medical patients is a priority, but the organization of general medical ward care receives less scrutiny than the management of specific diseases. Optimizing teams’ performance improves patient outcomes in other settings, and interdisciplinary practice is a major target for improvement efforts. However, the effect of interdisciplinary team interventions on general medical ward care has not been systematically reviewed.Objectives To describe the range of objective patient outcomes used in studies of general medical ward interdisciplinary team care, and to evaluate the performance of interdisciplinary interventions against them.Evidence Review We searched EMBASE, MEDLINE, and PsycINFO from January 1, 1998, through December 31, 2013, for interdisciplinary team care interventions in adult general medical wards using an objective patient outcome measure. Reference lists of included articles were also searched. The last search was conducted on January 29, 2014, and the narrative and statistical analysis was conducted through December 1, 2014. Study quality was assessed using the Cochrane Effective Practice and Organization of Care group’s tool.Findings Thirty of 6934 articles met the selection criteria. The studies included 66 548 patients, with a mean age of 63 years. Nineteen of 30 (63%) studies reported length of stay, readmission, or mortality rate as their primary outcome, or did not specify the primacy of their outcomes. The most commonly reported objective patient outcomes were length of stay (23 of 30 [77%]), complications of care (10 of 30 [33%]), in-hospital mortality rate (8 of 30 [27%]), and 30-day readmission rate (8 of 30 [27%]). Of 23 interventions, 16 (70%) had no effect on length of stay, 12 of 15 (80%) did not reduce readmissions, and 14 of 15 (93%) did not affect mortality. Five of 10 (50%) interventions reduced complications of care. In an exploratory quantitative analysis, the
Ashrafian H, Galassi FM, Harling L, 2015, Medusa's Head and Ancient Aristotelian Biology, JAMA PSYCHIATRY, Vol: 72, Pages: 625-625, ISSN: 2168-622X
Aziz O, Albeyatti A, Derias M, et al., 2015, A CASE-CONTROLLED STUDY DEMONSTRATING THAT CHANGES ASSOCIATED WITH RECTAL ANASTOMOTIC LEAKAGE ARE DETECTABLE WITHIN 48 HOURS OF SURGERY, 2nd Digestive-Disorders-Federation Conference, Publisher: BMJ PUBLISHING GROUP, Pages: A152-A152, ISSN: 0017-5749
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