177 results found
Koller KR, Wilson A, Normolle DP, et al., 2021, Dietary fibre to reduce colon cancer risk in Alaska Native people: the Alaska FIRST randomised clinical trial protocol., BMJ Open, Vol: 11, Pages: 1-9, ISSN: 2044-6055
INTRODUCTION: Diet, shown to impact colorectal cancer (CRC) risk, is a modifiable environmental factor. Fibre foods fermented by gut microbiota produce metabolites that not only provide food for the colonic epithelium but also exert regulatory effects on colonic mucosal inflammation and proliferation. We describe methods used in a double-blinded, randomised, controlled trial with Alaska Native (AN) people to determine if dietary fibre supplementation can substantially reduce CRC risk among people with the highest reported CRC incidence worldwide. METHODS AND ANALYSES: Eligible patients undergoing routine screening colonoscopy consent to baseline assessments and specimen/data collection (blood, urine, stool, saliva, breath and colon mucosal biopsies) at the time of colonoscopy. Following an 8-week stabilisation period to re-establish normal gut microbiota post colonoscopy, study personnel randomise participants to either a high fibre supplement (resistant starch, n=30) or placebo (digestible starch, n=30) condition, repeating stool sample collection. During the 28-day supplement trial, each participant consumes their usual diet plus their supplement under direct observation. On day 29, participants undergo a flexible sigmoidoscopy to obtain mucosal biopsy samples to measure the effect of the supplement on inflammatory and proliferative biomarkers of cancer risk, with follow-up assessments and data/specimen collection similar to baseline. Secondary outcome measures include the impact of a high fibre supplement on the oral and colonic microbiome and biofluid metabolome. ETHICS AND DISSEMINATION: Approvals were obtained from the Alaska Area and University of Pittsburgh Institutional Review Boards and Alaska Native Tribal Health Consortium and Southcentral Foundation research review bodies. A data safety monitoring board, material transfer agreements and weekly study team meetings provide regular oversight throughout the study. Study findings will first be shared with AN
Beatty JW, Clarke JM, Sounderajah V, et al., 2021, Impact of the COVID-19 pandemic on emergency adult surgical patients and surgical services: an international multi-center cohort study and department survey., Annals of Surgery, ISSN: 0003-4932
OBJECTIVES: The PREDICT study aimed to determine how the COVID-19 pandemic affected surgical services and surgical patients and to identify predictors of outcomes in this cohort. BACKGROUND: High mortality rates were reported for surgical patients with COVID-19 in the early stages of the pandemic. However, the indirect impact of the pandemic on this cohort is not understood, and risk predictors are yet to be identified. METHODS: PREDICT is an international longitudinal cohort study comprising surgical patients presenting to hospital between March and August 2020, conducted alongside a survey of staff redeployment and departmental restructuring. A subgroup analysis of 3176 adult emergency patients, recruited by 55 teams across 18 countries is presented. RESULTS: Among adult emergency surgical patients, all-cause in-hospital mortality (IHM) was 3 6%, compared to 15 5% for those with COVID-19. However, only 14 1% received a COVID-19 test on admission in March, increasing to 76 5% by July.Higher Clinical Frailty Scale scores (CFS >7 aOR 18 87), ASA grade above 2 (aOR 4 29), and COVID-19 infection (aOR 5 12) were independently associated with significantly increased IHM.The peak months of the first wave were independently associated with significantly higher IHM (March aOR 4 34; April aOR 4 25; May aOR 3 97), compared to non-peak months.During the study, UK operating theatre capacity decreased by a mean of 63 6% with a concomitant 27 3% reduction in surgical staffing. CONCLUSION: The first wave of the COVID-19 pandemic significantly impacted surgical patients, both directly through co-morbid infection and indirectly as shown by increasing mortality in peak months, irrespective of COVID-19 status.Higher CFS scores and ASA grades strongly predict outcomes in surgical patients and are an important risk assessment tool during the pandemic.
Mason SE, Manoli E, Alexander JL, et al., 2021, Lipidomic profiling of colorectal lesions for real-time tissue recognition and risk-stratification using rapid evaporative ionisation mass spectrometry., Annals of Surgery, ISSN: 0003-4932
OBJECTIVE: Rapid Evaporative Ionisation Mass Spectrometry (REIMS) is a metabolomic technique analysing tissue metabolites, which can be applied intra-operatively in real-time. The objective of this study was to profile the lipid composition of colorectal tissues using REIMS, assessing its accuracy for real-time tissue recognition and risk-stratification. SUMMARY BACKGROUND DATA: Metabolic dysregulation is a hallmark feature of carcinogenesis, however it remains unknown if this can be leveraged for real-time clinical applications in colorectal disease. METHODS: Patients undergoing colorectal resection were included, with carcinoma, adenoma and paired-normal mucosa sampled. Ex vivo analysis with REIMS was conducted using monopolar diathermy, with the aerosol aspirated into a Xevo G2S QToF mass spectrometer. Negatively charged ions over 600-1000m/z were used for univariate and multivariate functions including linear discriminant analysis. RESULTS: 161 patients were included, generating 1013 spectra. Unique lipidomic profiles exist for each tissue type, with REIMS differentiating samples of carcinoma, adenoma and normal mucosa with 93 1% accuracy and 96 1% negative predictive value for carcinoma. Neoplasia (carcinoma or adenoma) could be predicted with 96 0% accuracy and 91 8% negative predictive value. Adenomas can be risk-stratified by grade of dysplasia with 93 5% accuracy, but not histological subtype. The structure of 61 lipid metabolites was identified, revealing that during colorectal carcinogenesis there is progressive increase in relative abundance of phosphatidylglycerols, sphingomyelins and mono-unsaturated fatty acid containing phospholipids. CONCLUSIONS: The colorectal lipidome can be sampled by REIMS and leveraged for accurate real-time tissue recognition, in addition to risk-stratification of colorectal adenomas. Unique lipidomic features associated with carcinogenesis are described.
Van Den Heede K, Chidambaram S, Winter Beatty J, et al., 2021, The PanSurg-PREDICT Study: endocrine surgery during the COVID-19 pandemic, World Journal of Surgery, Vol: 45, Pages: 2315-2324, ISSN: 0364-2313
BACKGROUND: In the midst of the COVID-19 pandemic, patients have continued to present with endocrine (surgical) pathology in an environment depleted of resources. This study investigated how the pandemic affected endocrine surgery practice. METHODS: PanSurg-PREDICT is an international, multicentre, prospective, observational cohort study of emergency and elective surgical patients in secondary/tertiary care during the pandemic. PREDICT-Endocrine collected endocrine-specific data alongside demographics, COVID-19 and outcome data from 11-3-2020 to 13-9-2020. RESULTS: A total of 380 endocrine surgery patients (19 centres, 12 countries) were analysed (224 thyroidectomies, 116 parathyroidectomies, 40 adrenalectomies). Ninety-seven percent were elective, and 63% needed surgery within 4 weeks. Eight percent were initially deferred but had surgery during the pandemic; less than 1% percent was deferred for more than 6 months. Decision-making was affected by capacity, COVID-19 status or the pandemic in 17%, 5% and 7% of cases. Indication was cancer/worrying lesion in 61% of thyroidectomies and 73% of adrenalectomies and calcium 2.80 mmol/l or greater in 50% of parathyroidectomies. COVID-19 status was unknown at presentation in 92% and remained unknown before surgery in 30%. Two-thirds were asked to self-isolate before surgery. There was one COVID-19-related ICU admission and no mortalities. Consultant-delivered care occurred in a majority (anaesthetist 96%, primary surgeon 76%). Post-operative vocal cord check was reported in only 14% of neck endocrine operations. Both of these observations are likely to reflect modification of practice due to the pandemic. CONCLUSION: The COVID-19 pandemic has affected endocrine surgical decision-making, case mix and personnel delivering care. Significant variation was seen in COVID-19 risk mitigation measures. COVID-19-related complications were uncommon. This analysis demonstrates the safety of endocrine surgery during this
Cardiothoracic Interdisciplinary Research Network and COVIDSurg Collaborative, 2021, Early outcomes and complications following cardiac surgery in patients testing positive for coronavirus disease 2019: An international cohort study., Journal of Thoracic and Cardiovascular Surgery, Vol: 162, Pages: e355-e372, ISSN: 0022-5223
BackgroundHeterogeneous access to clinical learning opportunities and inconsistency in teaching is a common source of dissatisfaction among medical students. This was exacerbated during the COVID‐19 pandemic, with limited exposure to patients for clinical teaching.MethodsWe conducted a proof‐of‐concept study at a London teaching hospital using mixed reality (MR) technology (HoloLens2™) to deliver a remote access teaching ward round.ResultsStudents unanimously agreed that use of this technology was enjoyable and provided teaching that was otherwise inaccessible. The majority of participants gave positive feedback on the MR (holographic) content used (n = 8 out of 11) and agreed they could interact with and have their questions answered by the clinician leading the ward round (n = 9). Quantitative and free text feedback from students, patients and faculty members demonstrated that this is a feasible, acceptable and effective method for delivery of clinical education.DiscussionWe have used this technology in a novel way to transform the delivery of medical education and enable consistent access to high‐quality teaching. This can now be integrated across the curriculum and will include remote access to specialist clinics and surgery. A library of bespoke MR educational resources will be created for future generations of medical students and doctors to use on an international scale.
Lam K, Purkayastha S, Kinross JM, 2021, The ethical digital surgeon, Journal of Medical Internet Research, Vol: 23, Pages: 1-3, ISSN: 1438-8871
This viewpoint explores the ethical and regulatory consequences of the digital transformation of the operating room. Surgical robotics is undergoing significant change and future advances will center around the capture and use of data. The consequences of creating this surgical data pipeline must be understood and digital surgical systems must prioritize the safeguarding of patient data. Moreover, data protection laws and frameworks must adapt to the changing nature of surgical data. Finally, digital surgeons must understand changing data legislation and best practice on data governance to act as guardians not only for their own but also for their patients’ data.
Harewood R, Disney R, Kinross J, et al., 2021, Medication use and risk of proximal colon cancer: a systematic review of prospective studies with narrative synthesis and meta-analysis, CANCER CAUSES & CONTROL, Pages: 1-15, ISSN: 0957-5243
PurposeEvidence of differences in the etiology of, and poorer survival from, proximal colon compared to the distal colorectum, necessitates research into its risk factors. This systematic review summarizes the evidence on medication use and proximal colon cancer risk.MethodsMEDLINE and EMBASE were searched for prospective studies investigating nine medication groups, namely non-steroidal anti-inflammatory drugs (NSAIDs), exogenous hormones, i.e., hormone replacement therapy (HRT) or oral contraceptives (OCs), statins, proton pump inhibitors, anti-hypertensives, metformin (an antidiabetic), antidiarrheals or laxatives, and the risk of proximal colon cancer. Narrative synthesis and meta-analyses, using random effects models to estimate risk ratios (RRs) and 95% confidence intervals (CIs), were conducted.ResultsTwenty nine publications investigating NSAIDs (n = 13), exogenous hormones [HRT (n = 9) or OCs (n = 4)] statins (n = 5), anti-hypertensives (n = 1), and metformin (n = 1) were included. Summary RRs reported a protective effect of aspirin use (RR 0.80, 95% CI 0.73–0.89) but no associations between HRT (RR 0.92, 95% CI 0.83–1.02), OC (RR 1.06, 95% CI 0.98–1.14) or statin use (RR 0.94, 95% CI 0.67–1.31), and proximal colon cancer incidence compared to never/non-use. One study on metformin and one on anti-hypertensives reported no association. Sources of between-study heterogeneity included study design, period of exposure ascertainment, exposure source, and exposure comparison, but this exploration was hindered by the small numbers of studies.ConclusionDespite some studies on NSAID or HRT use, evidence on the impact of a range of medications on proximal colon cancer risk is limited. This highlights the need for more research to inform chemoprevention strategies.
Reynolds IS, O'Connell E, Fichtner M, et al., 2021, An insight into the driver mutations and molecular mechanisms underlying mucinous adenocarcinoma of the rectum., Diseases of the Colon and Rectum, Vol: 64, Pages: 677-688, ISSN: 0012-3706
BACKGROUND: Mucinous adenocarcinoma of the rectum accounts for 10% of all rectal cancers and has an impaired response to neoadjuvant chemoradiotherapy and worse overall survival. To date, insufficient genomic research has been performed on this histological subtype. OBJECTIVE: This study aims to define the mismatch repair deficiency rate and the driver mutations underpinning mucinous adenocarcinoma of the rectum and to compare it with rectal adenocarcinoma not otherwise specified. DESIGN: Immunohistochemistry and sequencing were performed on tumor samples from our tumor biobank. SETTINGS: This study was conducted across 2 tertiary referral centers. PATIENTS: Patients with mucinous adenocarcinoma and rectal adenocarcinoma not otherwise specified who underwent rectal resection between 2008 and 2018 were included. MAIN OUTCOME MEASURES: Mismatch repair status was performed by immunohistochemical staining. Mutations in the panel of oncogenes and tumor suppressor genes were determined by sequencing on the MiSeq V3 platform. RESULTS: The study included 33 patients with mucinous adenocarcinoma of the rectum and 100 patients with rectal adenocarcinoma not otherwise specified. Those with mucinous adenocarcinoma had a mismatch repair deficiency rate of 12.1% compared to 2.0% in the adenocarcinoma not otherwise specified cohort (p = 0.04). Mucinous adenocarcinoma and adenocarcinoma not otherwise specified rectal tumors had similar mutation frequencies in most oncogenes and tumor suppressor genes. No difference was found in the KRAS mutation rate (50.0% vs 37.1%, p = 0.29) or BRAF mutation rate (6.7% vs 3.1%, p = 0.34) between the cohorts. No difference was found between the cohorts regarding recurrence-free (p = 0.29) or overall survival (p = 0.14). LIMITATIONS: The major limitations of this study were the use of formalin-fixed, paraffin-embedded tissue over fresh-frozen tissue and the small number of patients included, in particular, in the mucinous rectal cohort. CONCLUSIONS
Van den Heede K, Chidambaram S, Beatty JW, et al., 2021, The PanSurg-PREDICT study: endocrine surgery during the COVID-19 pandemic (Apr, 10.1007/s00268-021-06099-z, 2021), World Journal of Surgery, Pages: 1-1, ISSN: 0364-2313
Kinross JM, Mason SE, Mylonas G, et al., 2021, Next-generation robotics in gastrointestinal surgery (vol 17, pg 430, 2020), NATURE REVIEWS GASTROENTEROLOGY & HEPATOLOGY, Vol: 18, Pages: 589-589, ISSN: 1759-5045
Barker GF, Pechlivanis A, Bello AT, et al., 2021, Aa022 a high-fiber low-fat diet increases fecal levels of lithocholic acid derivative 3-ketocholanic acid, Digestive Disease Week, Publisher: W B SAUNDERS CO-ELSEVIER INC, Pages: S393-S394, ISSN: 0016-5085
Vaghela U, Rabinowicz S, Bratsos P, et al., 2021, Using a secure continually updating web-source processing pipeline supporting a Real-time data synthesis and analysis of scientific literature: development and validation study, Journal of Medical Internet Research, Vol: 23, ISSN: 1438-8871
Background: The scale and quality of the global scientific response to the COVID-19 pandemic have unquestionably saved lives. However, the COVID-19 pandemic has also triggered an unprecedented “infodemic”; the velocity and volume of data production have overwhelmed many key stakeholders such as clinicians and policy makers, as they have been unable to process structured and unstructured data for evidence-based decision making. Solutions that aim to alleviate this data synthesis–related challenge are unable to capture heterogeneous web data in real time for the production of concomitant answers and are not based on the high-quality information in responses to a free-text query.Objective: The main objective of this project is to build a generic, real-time, continuously updating curation platform that can support the data synthesis and analysis of a scientific literature framework. Our secondary objective is to validate this platform and the curation methodology for COVID-19–related medical literature by expanding the COVID-19 Open Research Dataset via the addition of new, unstructured data.Methods: To create an infrastructure that addresses our objectives, the PanSurg Collaborative at Imperial College London has developed a unique data pipeline based on a web crawler extraction methodology. This data pipeline uses a novel curation methodology that adopts a human-in-the-loop approach for the characterization of quality, relevance, and key evidence across a range of scientific literature sources.Results: REDASA (Realtime Data Synthesis and Analysis) is now one of the world’s largest and most up-to-date sources of COVID-19–related evidence; it consists of 104,000 documents. By capturing curators’ critical appraisal methodologies through the discrete labeling and rating of information, REDASA rapidly developed a foundational, pooled, data science data set of over 1400 articles in under 2 weeks. These articles provide COVID-19&ndas
Sivananthan A, Machin M, Zijlstra G, et al., 2021, A grassroots junior doctor communication network in response to the COVID-19 pandemic: a service evaluation, BMJ Open Quality, Vol: 10, ISSN: 2399-6641
BackgroundCOVID-19 was declared a worldwide pandemic on 11th March 2020. Imperial NHS Trust provides 1412 inpatient beds staffed by 1200 junior doctors and faced a large burden of COVID-19 admissions.Local problemA survey of doctors revealed only 20% felt confident that they would know to whom they could raise concerns and that most were getting information from a combination of informal work discussions, trust emails, social media and medical literature. MethodsThis quality improvement project was undertaken aligning with SQUIRE 2.0© guidelines. Through an iterative process, a digital network; ICON (Imperial Covid cOmmunications Network) using existing smartphone technologies was developed. Concerns were collated from the junior body (Google Form®) and convey them to the leadership team (vertical - bottom up) and improve communication from leadership to the junior body (vertical - top down using WhatsApp and Zoom®). Quantitative analysis on engagement with the network (members of the group and number of issues raised) and qualitative assessment (thematic analysis on issues) was undertaken.ResultsMembership of the ICON WhatsApp group peaked at 780 on 17th May 2020. 197 concerns were recorded via the Google Form® system between 20th March and 14th June 2020. There were five overarching themes; organisational and logistics; clinical strategy concerns; staff safety and wellbeing; clinical (COVID-19) and patient care; and facilities. 94.4% of members agreed ICON was helpful in receiving updates and 88.9% agreed ICON improved collaboration. ConclusionsThis work demonstrates that a coordinated network, utilising existing smartphone technologies and a novel communications structure, can improve collaboration between senior leadership and junior doctors. Such a network could play an important role during times of pressure in a healthcare system.
Capece D, D'Andrea D, Begalli F, et al., 2021, Enhanced triacylglycerol catabolism by Carboxylesterase 1 promotes aggressive colorectal carcinoma., Journal of Clinical Investigation, ISSN: 0021-9738
The ability to adapt to low-nutrient microenvironments is essential for tumor-cell survival and progression in solid cancers, such as colorectal carcinoma (CRC). Signaling by the NF-κB transcription-factor pathway associates with advanced disease stages and shorter survival in CRC patients. NF-κB has been shown to drive tumor-promoting inflammation, cancer-cell survival and intestinal epithelial cell (IEC) dedifferentiation in mouse models of CRC. However, whether NF-κB affects the metabolic adaptations that fuel aggressive disease in CRC patients is unknown. Here, we identified carboxylesterase 1 (CES1) as an essential NF-κB-regulated lipase linking obesity-associated inflammation with fat metabolism and adaptation to energy stress in aggressive CRC. CES1 promoted CRC-cell survival via cell-autonomous mechanisms that fuel fatty-acid oxidation (FAO) and prevent the toxic build-up of triacylglycerols. We found that elevated CES1 expression correlated with worse outcomes in overweight CRC patients. Accordingly, NF-κB drove CES1 expression in CRC consensus molecular subtype (CMS)4, associated with obesity, stemness and inflammation. CES1 was also upregulated by gene amplifications of its transcriptional regulator, HNF4A, in CMS2 tumors, reinforcing its clinical relevance as a driver of CRC. This subtype-based distribution and unfavourable prognostic correlation distinguished CES1 from other intracellular triacylglycerol lipases and suggest CES1 could provide a route to treat aggressive CRC.
Denning M, Goh ET, Tan B, et al., 2021, Determinants of burnout and other aspects of psychological well-being in healthcare workers during the Covid-19 pandemic: A multinational cross-sectional study, PLOS ONE, Vol: 16, ISSN: 1932-6203
Manoli E, Mason S, Ford L, et al., 2021, Validation of ultrasonic harmonic scalpel for real-time tissue identification using rapid evaporative ionization mass spectrometry, Analytical Chemistry, Vol: 93, Pages: 5906-5916, ISSN: 0003-2700
In this study, we integrate rapid evaporative ionization mass spectrometry (REIMS) with the Harmonic scalpel, an advanced laparoscopic surgical instrument that utilizes ultrasound energy to dissect and coagulate tissues. It provides unparalleled manipulation capability to surgeons and has superseded traditional electrosurgical tools particularly in abdominal surgery, but is yet to be validated with REIMS. The REIMS platform coupled with the Harmonic device was shown to produce tissue-specific lipid profiles through the analysis of porcine tissues in both negative and positive ionization modes. Comparison with other methods of electrosurgical dissection, such as monopolar electrosurgery and CO2 laser, showed spectral differences in the profile dependent on the energy device used. The Harmonic device demonstrated major spectral differences in the phospholipid region of m/z 600–1000 compared with the monopolar electrosurgical and CO2 laser-generated spectra. Within the Harmonic REIMS spectra, high intensities of diglycerides and triglycerides were observed. In contrast, monopolar electrosurgical and laser spectra demonstrated high abundances of glycerophospholipids. The Harmonic scalpel was able to differentiate between the liver, muscle, colon, and small intestine, demonstrating 100% diagnostic accuracy. The validation of the Harmonic device–mass spectrometry combination will allow the platform to be used safely and robustly for real-time in vivo surgical tissue identification in a variety of clinical applications.
Vaghela U, Rabinowicz S, Bratsos P, et al., 2021, Using a secure, continually updating, web source processing pipeline to support the real-time data synthesis and analysis of scientific literature: development and validation study, Publisher: JMIR Publications
Background:The scale and quality of the global scientific response to the COVID-19 pandemic have unquestionably saved lives. However, the COVID-19 pandemic has also triggered an unprecedented “infodemic”; the velocity and volume of data production have overwhelmed many key stakeholders such as clinicians and policy makers, as they have been unable to process structured and unstructured data for evidence-based decision making. Solutions that aim to alleviate this data synthesis–related challenge are unable to capture heterogeneous web data in real time for the production of concomitant answers and are not based on the high-quality information in responses to a free-text query.Objective:The main objective of this project is to build a generic, real-time, continuously updating curation platform that can support the data synthesis and analysis of a scientific literature framework. Our secondary objective is to validate this platform and the curation methodology for COVID-19–related medical literature by expanding the COVID-19 Open Research Dataset via the addition of new, unstructured data.Methods:To create an infrastructure that addresses our objectives, the PanSurg Collaborative at Imperial College London has developed a unique data pipeline based on a web crawler extraction methodology. This data pipeline uses a novel curation methodology that adopts a human-in-the-loop approach for the characterization of quality, relevance, and key evidence across a range of scientific literature sources.Results:REDASA (Realtime Data Synthesis and Analysis) is now one of the world’s largest and most up-to-date sources of COVID-19–related evidence; it consists of 104,000 documents. By capturing curators’ critical appraisal methodologies through the discrete labeling and rating of information, REDASA rapidly developed a foundational, pooled, data science data set of over 1400 articles in under 2 weeks. These articles provide COVID-19–re
Lam K, Iqbal F, Purkayastha S, et al., 2021, A protocol for a Delphi study investigating the ethical and data governance issues of artificial intelligence in surgery, JMIR Research Protocols, Vol: 10, ISSN: 1929-0748
Background: The rapid uptake of digital technology into the operating room has the potential to improve patient outcomes, increase efficiency of the use of operating rooms, and allow surgeons to progress quickly up learning curves. These technologies are, however, dependent on huge amounts of data, and the consequences of their mismanagement are significant. While the field of artificial intelligence ethics is able to provide a broad framework for those designing and implementing these technologies into the operating room, there is a need to determine and address the ethical and data governance challenges of using digital technology in this unique environment.Objective: The objectives of this study are to define the term digital surgery and gain expert consensus on the key ethical and data governance issues, barriers, and future research goals of the use of artificial intelligence in surgery.Methods: Experts from the fields of surgery, ethics and law, policy, artificial intelligence, and industry will be invited to participate in a 4-round consensus Delphi exercise. In the first round, participants will supply free-text responses across 4 key domains: ethics, data governance, barriers, and future research goals. They will also be asked to provide their understanding of the term digital surgery. In subsequent rounds, statements will be grouped, and participants will be asked to rate the importance of each issue on a 9-point Likert scale ranging from 1 (not at all important) to 9 (critically important). Consensus is defined a priori as a score of 7 to 9 by 70% of respondents and 1 to 3 by less than 30% of respondents. A final online meeting round will be held to discuss inclusion of statements and draft a consensus document.Results: Full ethical approval has been obtained for the study by the local research ethics committee at Imperial College, London (20IC6136). We anticipate round 1 to commence in January 2021.Conclusions: The results of this study will define the t
Jimenez B, Abellona MRU, Drymousis P, et al., 2021, Neuroendocrine neoplasms: identification of novel metabolic circuits of potential diagnostic utility, Cancers, Vol: 13, ISSN: 2072-6694
The incidence of neuroendocrine neoplasms (NEN) is increasing, but established biomarkers have poor diagnostic and prognostic accuracy. Here, we aim to define the systemic metabolic consequences of NEN and to establish the diagnostic utility of proton nuclear magnetic resonance spectroscopy (1H-NMR) for NEN in a prospective cohort of patients through a single-centre, prospective controlled observational study. Urine samples of 34 treatment-naïve NEN patients (median age: 59.3 years, range: 36–85): 18 had pancreatic (Pan) NEN, of which seven were functioning; 16 had small bowel (SB) NEN; 20 age- and sex-matched healthy control individuals were analysed using a 600 MHz Bruker 1H-NMR spectrometer. Orthogonal partial-least-squares-discriminant analysis models were able to discriminate both PanNEN and SBNEN patients from healthy control (Healthy vs. PanNEN: AUC = 0.90, Healthy vs. SBNEN: AUC = 0.90). Secondary metabolites of tryptophan, such as trigonelline and a niacin-related metabolite were also identified to be universally decreased in NEN patients, while upstream metabolites, such as kynurenine, were elevated in SBNEN. Hippurate, a gut-derived metabolite, was reduced in all patients, whereas other gut microbial co-metabolites, trimethylamine-N-oxide, 4-hydroxyphenylacetate and phenylacetylglutamine, were elevated in those with SBNEN. These findings suggest the existence of a new systems-based neuroendocrine circuit, regulated in part by cancer metabolism, neuroendocrine signalling molecules and gut microbial co-metabolism. Metabonomic profiling of NEN has diagnostic potential and could be used for discovering biomarkers for these tumours. These preliminary data require confirmation in a larger cohort.
Zakka K, Chidambaram S, Mansour S, et al., 2021, SARS-CoV-2 and obesity: "CoVesity"-a pandemic within a pandemic, Obesity Surgery, Vol: 31, Pages: 1745-1754, ISSN: 0960-8923
Individuals who are overweight or suffering from obesity are in a chronic state of low-grade inflammation, making them particularly susceptible to developing severe forms of respiratory failure. Studies conducted in past pandemics link obesity with worse health outcomes. This population is thus of particular concern within the context of the COVID-19 pandemic, considering the cessation of obesity management services. This systematic review highlights  the reciprocal link between the obesity and COVID-19 pandemics,  obesity as a risk factor for more severe disease in past pandemics,  potential mechanisms that make individual’s suffering from obesity more susceptible to severe disease and higher viral load, and  the need to safely resume bariatric services as recommended by expert guidelines, in order to mitigate the health outcomes of an already vulnerable population.
Herzig DO, Ogilvie JW, Chudzinski A, et al., 2020, Assessment of a circular powered stapler for creation of anastomosis in left-sided colorectal surgery: A prospective cohort study, INTERNATIONAL JOURNAL OF SURGERY, Vol: 84, Pages: 140-146, ISSN: 1743-9191
Tan BYQ, Kanneganti A, Lim LJH, et al., 2020, Burnout and Associated Factors Among Health Care Workers in Singapore During the COVID-19 Pandemic, Journal of the American Medical Directors Association (JAMDA): long-term care: management, applied research and clinical issues, Vol: 21, Pages: 1751-1758.e5, ISSN: 1525-8610
OBJECTIVES: The strain on health care systems due to the COVID-19 pandemic has led to increased psychological distress among health care workers (HCWs). As this global crisis continues with little signs of abatement, we examine burnout and associated factors among HCWs. DESIGN: Cross-sectional survey study. SETTING AND PARTICIPANTS: Doctors, nurses, allied health professionals, administrative, and support staff in 4 public hospitals and 1 primary care service in Singapore 3 months after COVID-19 was declared a global pandemic. METHODS: Study questionnaire captured demographic and workplace environment information and comprised 3 validated instruments, namely the Oldenburg Burnout Inventory (OLBI), Safety Attitudes Questionnaire (SAQ), and Hospital Anxiety and Depression Scale (HADS). Multivariate mixed model regression analyses were used to evaluate independent associations of mean OLBI-Disengagement and -Exhaustion scores. Further subgroup analysis was performed among redeployed HCWs. RESULTS: Among 11,286 invited HCWs, 3075 valid responses were received, giving an overall response rate of 27.2%. Mean OLBI scores were 2.38 and 2.50 for Disengagement and Exhaustion, respectively. Burnout thresholds in Disengagement and Exhaustion were met by 79.7% and 75.3% of respondents, respectively. On multivariate regression analysis, Chinese or Malay ethnicity, HADS anxiety or depression scores ≥8, shifts lasting ≥8 hours, and being redeployed were significantly associated with higher OLBI mean scores, whereas high SAQ scores were significantly associated with lower scores. Among redeployed HCWs, those redeployed to high-risk areas in a different facility (offsite) had lower burnout scores than those redeployed within their own work facility (onsite). A higher proportion of HCWs redeployed offsite assessed their training to be good or better compared with those redeployed onsite. CONCLUSIONS AND IMPLICATIONS: Every level of the health care workforce is suscepti
Diederen K, Li JV, Donachie GE, et al., 2020, Exclusive enteral nutrition mediates gut microbial and metabolic changes that are associated with remission in children with Crohn's disease, Scientific Reports, Vol: 10, ISSN: 2045-2322
A nutritional intervention, exclusive enteral nutrition (EEN) can induce remission in patients with pediatric Crohn's disease (CD). We characterized changes in the fecal microbiota and metabolome to identify the mechanism of EEN. Feces of 43 children were collected prior, during and after EEN. Microbiota and metabolites were analyzed by 16S rRNA gene amplicon sequencing and NMR. Selected metabolites were evaluated in relevant model systems. Microbiota and metabolome of patients with CD and controls were different at all time points. Amino acids, primary bile salts, trimethylamine and cadaverine were elevated in patients with CD. Microbiota and metabolome differed between responders and non-responders prior to EEN. EEN decreased microbiota diversity and reduced amino acids, trimethylamine and cadaverine towards control levels. Patients with CD had reduced microbial metabolism of bile acids that partially normalized during EEN. Trimethylamine and cadaverine inhibited intestinal cell growth. TMA and cadaverine inhibited LPS-stimulated TNF-alpha and IL-6 secretion by primary human monocytes. A diet rich in free amino acids worsened inflammation in the DSS model of intestinal inflammation. Trimethylamine, cadaverine, bile salts and amino acids could play a role in the mechanism by which EEN induces remission. Prior to EEN, microbiota and metabolome are different between responders and non-responders.
Clarke J, Murray A, Markar S, et al., 2020, A new geographic model of care to manage the post-COVID-19 elective surgery aftershock in England: a retrospective observational study, BMJ Open, Vol: 10, Pages: 1-9, ISSN: 2044-6055
Objectives The suspension of elective surgery during the COVID pandemic is unprecedented and has resulted in record volumes of patients waiting for operations. Novel approaches that maximise capacity and efficiency of surgical care are urgently required. This study applies Markov Multiscale Community Detection (MMCD), an unsupervised graph-based clustering framework, to identify new surgical care models based on pooled waiting lists delivered across an expanded network of surgical providers. DesignRetrospective observational study using Hospital Episode Statistics.SettingPublic and private hospitals providing surgical care to National Health Service (NHS) patients in England. ParticipantsAll adult patients resident in England undergoing NHS-funded planned surgical procedures between 1st April 2017 and 31st March 2018. Main outcome measuresThe identification of the most common planned surgical procedures in England (High Volume Procedures – HVP) and proportion of low, medium and high-risk patients undergoing each HVP. The mapping of hospitals providing surgical care onto optimised groupings based on patient usage data.ResultsA total of 7,811,891 planned operations were identified in 4,284,925 adults during the one-year period of our study. The 28 most common surgical procedures accounted for a combined 3,907,474 operations (50.0% of the total). 2,412,613 (61.7%) of these most common procedures involved ‘low risk’ patients. Patients travelled an average of 11.3 km for these procedures. Based on the data, MMCD partitioned England into 45, 16 and 7 mutually exclusive and collectively exhaustive natural surgical communities of increasing coarseness. The coarser partitions into 16 and 7 surgical communities were shown to be associated with balanced supply and demand for surgical care within communities.ConclusionsPooled waiting lists for low risk elective procedures and patients across integrated, expanded natural surgical community networks have the pot
Mason SE, Scott AJ, Markar SR, et al., 2020, Insights from a global snapshot of the change in elective colorectal practice due to the COVID-19 pandemic, PLoS One, Vol: 15, Pages: 1-13, ISSN: 1932-6203
BackgroundThere is a need to understand the impact of COVID-19 on colorectal cancer care globally and determine drivers of variation.ObjectiveTo evaluate COVID-19 impact on colorectal cancer services globally and identify predictors for behaviour change.DesignAn online survey of colorectal cancer service change globally in May and June 2020.ParticipantsAttending or consultant surgeons involved in the care of patients with colorectal cancer.Main outcome measuresChanges in the delivery of diagnostics (diagnostic endoscopy), imaging for staging, therapeutics and surgical technique in the management of colorectal cancer. Predictors of change included increased hospital bed stress, critical care bed stress, mortality and world region.Results191 responses were included from surgeons in 159 centers across 46 countries, demonstrating widespread service reduction with global variation. Diagnostic endoscopy was reduced in 93% of responses, even with low hospital stress and mortality; whilst rising critical care bed stress triggered complete cessation (p = 0.02). Availability of CT and MRI fell by 40–41%, with MRI significantly reduced with high hospital stress. Neoadjuvant therapy use in rectal cancer changed in 48% of responses, where centers which had ceased surgery increased its use (62 vs 30%, p = 0.04) as did those with extended delays to surgery (p<0.001). High hospital and critical care bed stresses were associated with surgeons forming more stomas (p<0.04), using more experienced operators (p<0.003) and decreased laparoscopy use (critical care bed stress only, p<0.001). Patients were also more actively prioritized for resection, with increased importance of co-morbidities and ICU need.ConclusionsThe COVID-19 pandemic was associated with severe restrictions in the availability of colorectal cancer services on a global scale, with significant variation in behaviours which cannot be fully accounted for by hospital burden or mortality.
Lam K, Clarke J, Purkayastha S, et al., 2020, Uptake and accessibility of surgical robotics in England, International Journal of Medical Robotics and Computer Assisted Surgery, Vol: 17, Pages: 1-7, ISSN: 1478-5951
BackgroundThe distribution, utilisation and accessibility of surgical robotics in England is unknown.MethodsA nationwide Freedom of Information (FOI) request was sent to all acute National Health Service (NHS) trusts. Accessibility was assessed for 32 843 Lower Super Output Areas in England.ResultsAll 149 acute NHS trusts responded to the FOI request. Sixty‐one robots are distributed between 48 trusts. The number of robots and robotic procedures has increased annually. Urological procedures comprise 84.2% of robotic procedures. Procedure volume varies between robotic centres ranging from 1 to 683 in 2018. Over 2.4 million people have a travel time of over 1 hour to their nearest robotic centre.DiscussionNational accessibility to robotic services and case volumes are variable and does not represent good value for the NHS. A national robotic surgery registry could improve the quality of robotic surgery and is needed to dynamically assess national provision of this technology.
Denning M, Goh ET, Scott A, et al., 2020, What has been the impact of Covid-19 on Safety Culture? A case study from a large metropolitan teaching hospital, International Journal of Environmental Research and Public Health, Vol: 17, Pages: 1-14, ISSN: 1660-4601
Covid-19 has placed an unprecedented demand on healthcare systems worldwide. A positive safety culture is associated with improved patient safety and in turn patient outcomes. To date, no study has evaluated the impact of Covid-19 on safety culture. The Safety Attitudes Questionnaire (SAQ) was used to investigate safety culture at a large UK healthcare trust during Covid-19. Findings were compared with baseline data from 2017. Incident reporting from the year preceding the pandemic was also examined. SAQ scores of doctors and 'other clinical staff', were relatively higher than the nursing group. During Covid-19, on univariate regression analysis, female gender, age 40-49 years, non-white ethnicity, and nursing job role were all associated with lower SAQ scores. Training and support for redeployment were associated with higher SAQ scores. On multivariate analysis, non-disclosed gender (-0.13), non-disclosed ethnicity (-0.11), nursing role (-0.15), and support (0.29) persisted to significance. A significant decrease (p<0.003) was seen in error reporting after the onset of the Covid-19 pandemic. This is the first study to investigate SAQ during Covid-19. Differences in SAQ scores were observed during Covid-19 between professional groups when compared to baseline. Reductions in incident reporting were also seen. These changes may reflect perception of risk, changes in volume or nature of work. High-quality support for redeployed staff may be associated with improved safety perception during future pandemics.
Markar SR, Clarke J, Kinross J, et al., 2020, Practice patterns of diagnostic upper gastrointestinal endoscopy during the initial COVID-19 outbreak in England., The Lancet Gastroenterology and Hepatology, Vol: 5, Pages: 804-805, ISSN: 2468-1253
Zakka K, Erridge S, Chidambaram S, et al., 2020, Electrocautery, diathermy, and surgical energy devices: are surgical teams at risk during the COVID-19 pandemic?, Annals of Surgery, Vol: 272, Pages: e257-e262, ISSN: 0003-4932
OBJECTIVE: The aim of the study was to provide a rapid synthesis of available data to identify the risk posed by utilizing surgical energy devices intraoperatively due to the generation of surgical smoke, an aerosol. Secondarily it aims to summarize methods to minimize potential risk to operating room staff. SUMMARY BACKGROUND DATA: Continuing operative practice during the coronavirus disease-19 (COVID-19) pandemic places the health of operating theatre staff at potential risk. SARS-CoV2 is transmitted through inhaled droplets and aerosol particles, thus posing an inhalation threat even at considerable distance. Surgical energy devices generate an aerosol of biological particular matter during use. The risk to healthcare staff through use of surgical energy devices is unknown. METHODS: This review was conducted utilizing a rapid review methodology to enable efficient generation and dissemination of information useful for concurrent clinical practice. RESULTS: There are conflicting stances on the use of energy devices and laparoscopy by different surgical governing bodies and societies. There is no definitive evidence that aerosol generated by energy devices may carry active SARS-CoV2 virus. However, investigations of other viruses have demonstrated aerosolization through energy devise use. Measures to reduce potential transmission include appropriate personal protective equipment, evacuation and filtration of surgical plume, limiting energy device use if appropriate, and adjusting endoscopic and laparoscopic practice (low CO2 pressures, evacuation through ultrafiltration systems). CONCLUSIONS: The risk of transmission of SARS-CoV2 through aerosolized surgical smoke associated with energy device use is not fully understood, however transmission is biologically plausible. Caution and appropriate measures to reduce risk to healthcare staff should be implemented when considering intraoperative use of energy devices.
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