Publications
419 results found
GlobalSurg Collaborative, 2020, Global variation in anastomosis and end colostomy formation following left-sided colorectal resection, BJS Open, Vol: 3, Pages: 403-414, ISSN: 2474-9842
BackgroundEnd colostomy rates following colorectal resection vary across institutions in high‐income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left‐sided colorectal resection.MethodsThis study comprised an analysis of GlobalSurg‐1 and ‐2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left‐sided colorectal resection within discrete 2‐week windows. Countries were grouped into high‐, middle‐ and low‐income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model.ResultsIn total, 1635 patients from 242 hospitals in 57 countries undergoing left‐sided colorectal resection were included: 113 (6·9 per cent) from low‐HDI, 254 (15·5 per cent) from middle‐HDI and 1268 (77·6 per cent) from high‐HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low‐ compared with middle‐ and high‐HDI settings. The association with colostomy use in low‐HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P
Jani C, Marshall DC, Singh H, et al., 2020, Trends in lung cancer mortality between 2001 and 2017: An observational study in USA and EU., Annual Meeting of the American-Society-of-Clinical-Oncology (ASCO), Publisher: LIPPINCOTT WILLIAMS & WILKINS, ISSN: 0732-183X
Shalhoub J, Lawton R, Hudson J, et al., 2020, Graduated compression stockings as an adjuvant to pharmaco-thromboprophylaxis in elective surgical patients (GAPS study): a randomised controlled trial, BMJ: British Medical Journal, Vol: 369, ISSN: 0959-535X
Objectives: Does the use of GCS offer any adjuvant benefit when pharmaco-thromboprophylaxis is used for VTE prophylaxis?Design: Open, multicentre, randomised, controlled, non-inferiority trial.Setting:Seven National Health Service tertiary hospitals in the United Kingdom.Participants: 1905 elective surgical inpatients, aged >18 years assessed as being at moderate or high risk of VTE were eligible and consented to participate. Intervention: Participants were randomly assigned (1:1) to receive either low molecular weight heparin (LMWH) pharmaco-thromboprophylaxis alone or LMWH pharmaco-thromboprophylaxis and graduated compression stockings (GCS).Outcome measures: The primary endpoint was a combination of imaging confirmed asymptomatic and symptomatic lower limb deep vein thrombosis and/or symptomatic pulmonary embolism within 90 days of surgery. Secondary outcome measures were quality of life, compliance with stockings and LMWH, GCS-related lower limb complications, bleeding complications, adverse reactions to LMWH, and all-cause mortality.Results: Between May 2016 and January 2019, 1905 participants were randomised, of which 1858 were included in the intention-to-treat analysis (17 identified as ineligible post-randomisation and 30 did not undergo surgery). A primary-outcome event occurred in 16/937 (1.7%) patients in the LMWH alone arm compared to 13/921 (1.4%) in the LMWH and GCS arm. The risk difference between LMWH and LMWH and GCS was 0.30% (95% confidence interval [CI} -0.65% to 1.26%). As the 95% CI did not cross the non-inferiority margin of 3.5% (p-value <0.001 for non-inferiority), LMWH alone was confirmed as being non-inferior.Conclusions: For elective surgical patients at moderate or high risk of VTE, administration of pharmaco-thromboprophylaxis alone is non-inferior to a combination of pharmaco-thromboprophylaxis and graduated compression stockings. These findings indicate that graduated compression stockings may be unnecessary in most elective su
Davies A, Onida S, Shalhoub J, et al., 2020, Rapid Response to: Clinical features of covid-19, BMJ: British Medical Journal, ISSN: 0959-535X
Benson RA, Forsythe R, Bosanquet D, et al., 2020, The COvid-19 vascular sERvice (COVER) study: an international vascular and endovascular research network (VERN) collaborative study Assessing the provision, practice, and outcomes of vascular surgery during the COVID-19 pandemic, European Journal of Vascular and Endovascular Surgery, ISSN: 1078-5884
Salim S, Locci R, Martin G, et al., 2020, Short- and long-term outcomes in isolated penetrating aortic ulcer disease, Journal of Vascular Surgery, Vol: 72, Pages: 84-91, ISSN: 0741-5214
BACKGROUND: The optimum management of isolated penetrating aortic ulceration (PAU), with no associated intramural hematoma or aortic dissection is not clear. We evaluate the short- and long-term outcomes in isolated PAU to better inform management strategies. METHODS: We conducted a retrospective review of 43 consecutive patients (mean age, 72.2 years; 26 men) with isolated PAU (excluding intramural hematoma/aortic dissection) managed at a single tertiary vascular unit between November 2007 and April 2019. Twenty-one percent had PAU of the arch, 62% of the thoracic aorta, and 17% of the abdominal aorta. Conservative and surgical groups were analyzed separately. Primary outcomes included mortality, PAU progression, and interventional complications. RESULTS: Initially, 67% of patients (29/43) were managed conservatively; they had significantly smaller PAU neck widths (P = .04), PAU depths (P = .004), and lower rates of associated aneurysmal change (P = .004) compared with those initially requiring surgery. Four patients (4/29) initially managed conservatively eventually required surgical management at a mean time interval of 49.75 months (range, 9.03-104.33 months) primarily owing to aneurysmal degeneration. Initially, 33% of patients (14/43) underwent surgical management; 7 of the 14 procedures were urgent. Of the 18 patients, 17 eventually managed with surgical intervention had an endovascular repair; 2 of the 17 endovascular cases involved supra-aortic debranching, six used scalloped, fenestrated, or chimney stents. The overall long-term mortality was 30% (mean follow-up, 48 months; range, 0-136 months) with no significant difference between the conservatively and surgically managed groups (P = .98). No aortic-related deaths were documented during follow-up in those managed conservatively. There was no in-hospital mortality after surgical repair. Of these 18 patients, two required reintervention within 30 days for t
Goodall R, Salciccioli J, Davies A, et al., 2019, Trends in peripheral arterial disease incidence and mortality in EU15+ countries 1990-2017, European Journal of Vascular and Endovascular Surgery, Vol: 58, Pages: e564-e567, ISSN: 1078-5884
Saratzis A, Joshi S, Benson RA, et al., 2019, Acute Kidney Injury (AKI) in Aortic Intervention: Findings From the Midlands Aortic Renal Injury (MARI) Cohort Study, European Journal of Vascular and Endovascular Surgery, ISSN: 1078-5884
Onida S, Tan MKH, Kafeza M, et al., 2019, Metabolic phenotyping in venous disease: The need for standardization, Journal of Proteome Research, Vol: 18, Pages: 3809-3820, ISSN: 1535-3893
Venous thromboembolism (VTE), chronic venous disease (CVD), and venous leg ulceration (VLU) are clinical manifestations of a poorly functioning venous system. Though common, much is unknown of the pathophysiology and progression of these conditions. Metabolic phenotyping has been employed to explore mechanistic pathways involved in venous disease. A systematic literature review was performed: full text, primary research articles on the applications of nuclear magnetic resonance spectroscopy (NMR) and mass spectrometry (MS) in human participants and animals were included for qualitative synthesis. Seventeen studies applying metabolic phenotyping to venous disease were identified: six on CVD, two on VLU, and nine on VTE; both animal (n = 6) and human (n = 10) experimental designs were reported, with one study including both. NMR, MS, and MS imaging were employed to characterize serum, plasma, urine, wound fluid, and tissue. Metabolites found to be upregulated in CVD included lipids, branched chain amino acids (BCAA), glutamate, taurine, lactate, and myo-inositol identified in vein tissue. Upregulated metabolites in VLU included lactate, BCAA, lysine, 3-hydroxybutyrate, and glutamate identified in wound fluid and ulcer biopsies. VTE cases were associated with reduced carnitine levels, upregulated aromatic amino acids, 3-hydroxybutyrate, BCAA, and lipids in plasma, serum, thrombus, and vein wall; kynurenine and tricarboxylic acid pathway dysfunction were reported. Future research should focus on targeted studies with internal and external validation.
Al-Khayatt B, Salciccioli J, Marshall D, et al., 2019, Trends in incidence and mortality from atrial fibrillation across europe, 1990-2017, ESC Congress / World Congress of Cardiology, Publisher: OXFORD UNIV PRESS, Pages: 3535-3535, ISSN: 0195-668X
Goodall R, Shalhoub J, Davies A, 2019, A qualitative, small group study assessing junior medical students' perceptions of vascular surgery, International Surgical Congress of the Association-of-Surgeons-of-Great-Britain-and-Ireland (ASGBI), Publisher: Wiley, Pages: 102-102, ISSN: 0007-1323
Goodall R, Langridge B, Lane T, et al., 2019, A systematic review of the use of neuromuscular electrical stimulation in individuals with diabetic foot disease, International Surgical Congress of the Association-of-Surgeons-of-Great-Britain-and-Ireland (ASGBI), Publisher: Wiley, Pages: 44-44, ISSN: 0007-1323
Sau A, Al-Aidarous S, Howard J, et al., 2019, Optimum lesion set and predictors of outcome in persistent atrial fibrillation ablation: a meta-regression analysis, Europace, Vol: 21, Pages: 1176-1184, ISSN: 1099-5129
AIMS: Ablation of persistent atrial fibrillation (PsAF) has been performed by many techniques with varying success rates. This may be due to ablation techniques, patient demographics, comorbidities, and trial design. We conducted a meta-regression of studies of PsAF ablation to elucidate the factors affecting atrial fibrillation (AF) recurrence. METHODS AND RESULTS : Databases were searched for prospective studies of PsAF ablation. A meta-regression was performed. Fifty-eight studies (6767 patients) were included. Complex fractionated atrial electrogram (CFAE) ablation reduced freedom from AF by 8.9% [95% confidence interval (CI) -15 to -2.3, P = 0.009). Left atrial appendage [LAA isolation (three study arms)] increased freedom from AF by 39.5% (95% CI 9.1-78.4, P = 0.008). Posterior wall isolation (PWI) (eight study arms) increased freedom from AF by 19.4% (95% CI 3.3-38.1, P = 0.017). Linear ablation or ganglionated plexi ablation resulted in no significant effect on freedom from AF. More extensive ablation increased intraprocedural AF termination; however, intraprocedural AF termination was not associated with improved outcomes. Increased left atrial diameter was associated with a reduction in freedom from AF by 4% (95% CI -6.8% to -1.1%, P = 0.007) for every 1 mm increase in diameter. CONCLUSION : Linear ablation, PWI, and CFAE ablation improves intraprocedural AF termination, but such termination does not predict better long-term outcomes. Study arms including PWI or LAA isolation in the lesion set were associated with improved outcomes in terms of freedom from AF; however, further randomized trials are required before these can be routinely recommended. Left atrial size is the most important marker of AF chronicity influencing outcomes.
Saratzis A, Jaspers NEM, Gwilym B, et al., 2019, Observational study of the medical management of patients with peripheral artery disease, British Journal of Surgery, Vol: 106, Pages: 1168-1177, ISSN: 0007-1323
BackgroundPrevious research has suggested that patients with peripheral artery disease (PAD) are not offered adequate risk factor modification, despite their high cardiovascular risk. The aim of this study was to assess the cardiovascular profiles of patients with PAD and quantify the survival benefits of target‐based risk factor modification.MethodsThe Vascular and Endovascular Research Network (VERN) prospectively collected cardiovascular profiles of patients with PAD from ten UK vascular centres (April to June 2018) to assess practice against UK and European goal‐directed best medical therapy guidelines. Risk and benefits of risk factor control were estimated using the SMART‐REACH model, a validated cardiovascular prediction tool for patients with PAD.ResultsSome 440 patients (mean(s.d.) age 70(11) years, 24·8 per cent women) were included in the study. Mean(s.d.) cholesterol (4·3(1·2) mmol/l) and LDL‐cholesterol (2·7(1·1) mmol/l) levels were above recommended targets; 319 patients (72·5 per cent) were hypertensive and 343 (78·0 per cent) were active smokers. Only 11·1 per cent of patients were prescribed high‐dose statin therapy and 39·1 per cent an antithrombotic agent. The median calculated risk of a major cardiovascular event over 10 years was 53 (i.q.r. 44–62) per cent. Controlling all modifiable cardiovascular risk factors based on UK and European guidance targets (LDL‐cholesterol less than 2 mmol/l, systolic BP under 140 mmHg, smoking cessation, antiplatelet therapy) would lead to an absolute risk reduction of the median 10‐year cardiovascular risk by 29 (20–38) per cent with 6·3 (4·0–9·3) cardiovascular disease‐free years gained.ConclusionThe medical management of patients with PAD in this secondary care cohort was suboptimal. Controlling modifiable risk factors to guideline‐based targets would confer significant patient benefit.
Llwyd Gwilym B, Saratzis A, Benson R, et al., 2019, Study protocol for the Groin wound Infection after Vascular Exposure (GIVE) audit and multicentre cohort study, International Journal of Surgery Protocols, Vol: 16, Pages: 9-13, ISSN: 2468-3574
IntroductionSurgical site infections (SSI) following groin incision for arterial exposure are commonplace and a significant cause of morbidity and mortality following major arterial surgery. Published incidence varies considerably. The primary aim of GIVE will be to compare individual units’ practice with established guidelines from The National Institute for Health and Care Excellence (NICE). Secondary aims will be to describe the contemporary rate of SSI in patients undergoing groin incision for arterial exposure, to identify risk factors for groin wound infection, to examine the value of published tools in the prediction of SSI, to identify areas of equipoise which could be examined in future efficacy/effectiveness trials and to compare UK SSI rates with international centres.Methodsand analysisThis international, multicentre, prospective observational study will be delivered via the Vascular and Endovascular Research Network (VERN). Participating centres will identify all patients undergoing clean emergency or elective groin incision(s) for arterial intervention during a consecutive 3-month period. Follow up data will be captured at 90 days after surgery. SSIs will be defined according as per the Centres for Disease Control and Prevention (CDC) criteria. Data will be gathered centrally using an anonymised electronic data collection tool or secure email transfer.Ethics and disseminationThis study will be registered as a clinical audit at all participating UK centres; research ethics approval is not required. National leads will oversee the appropriate registration and approvals in countries outside the UK as required. Site specific reports of SSI rates will be provided to each participating centre. Study results will be disseminated locally at each site, publicised on social media and submitted for peer-reviewed publication.
Langridge B, Goodall R, Onida S, et al., 2019, Venous thromboembolism prevention in lower limb trauma – Can we do better?, Phlebology, Vol: 34, Pages: 291-293, ISSN: 0268-3555
Taha MA, Lane T, Shalhoub J, et al., 2019, Endovenous stenting in chronic venous disease secondary to iliac vein obstruction, Italian Journal of Vascular and Endovascular Surgery, Vol: 26, Pages: 89-99, ISSN: 1824-4777
Endovenous stenting has become the treatment of choice for chronic (thrombotic or non-thrombotic) venous obstructive iliac disease. This review aims to focus on the role of venous stents in the management of chronic conditions affecting the deep venous systems of the lower limbs. In addition, the review provides an overview on chronic venous outflow obstructive diseases.
Lawton R, Babber A, Braithwaite B, et al., 2019, A multicenter randomized controlled study to evaluate whether neuromuscular electrical stimulation improves the absolute walking distance in patients with intermittent claudication compared with best available treatment, Journal of Vascular Surgery, Vol: 69, Pages: 1567-1573, ISSN: 0741-5214
Objective:To assess the clinical efficacy of an NMES device to improve the absolute walking distance (AWD) in patients with IC, as an adjunct to the local standard care available at the study sites compared to local standard care alone.Methods:An open, multicentre, randomised controlled trial including eight participating centres in England. Sites are equally distributed between those that provide SET programmes and those that do not. Patients with IC meeting the inclusion and exclusion criteria, and providing consent will be randomised, depending on the centre type, to either NMES and locally available standard care or standard care alone. The primary endpoint, AWD, will be measured at 3 months (the end of the intervention period) by treadmill testing. Secondary outcomes include quality of life assessment, compliance with the interventions, economic evaluation of the NMES device, and lower limb haemodynamic measures to further the understanding of underlying mechanisms. Recruitment is due to commence in February 2018 and will continue for a total of 15 months. The NESIC trial is funded by the UK Efficacy and Mechanism Evaluation (EME) Programme, Medical Research Council (MRC) and National Institute for Health Research (NIHR) partnership. ISRCTN 18242823.
Salciccioli JD, Komorowski M, Shalhoub J, et al., 2019, Global Trends in Sepsis Mortality Between 2001 and 2015: A Comparative Analysis of Administrative Sepsis Definitions, International Conference of the American-Thoracic-Society, Publisher: AMER THORACIC SOC, ISSN: 1073-449X
Goodall R, Langridge B, Onida S, et al., 2019, Current status of non-invasive perfusion assessment in individuals with diabetic foot ulceration, Journal of Vascular Surgery, Vol: 69, Pages: 315-317, ISSN: 0741-5214
Thomas HS, Weiser TG, Drake TM, et al., 2019, Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy, British Journal of Surgery, Vol: 106, Pages: E103-E112, ISSN: 1365-2168
Background: The World Health Organization (WHO) Surgical Safety Checklist has fostered safepractice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aimof this study was to evaluate reported checklist use in emergency settings and examine the relationshipwith perioperative mortality in patients who had emergency laparotomy.Methods: In two multinational cohort studies, adults undergoing emergency laparotomy were comparedwith those having elective gastrointestinal surgery. Relationships between reported checklist use andmortality were determined using multivariable logistic regression and bootstrapped simulation.Results: Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. Afteradjusting for patient and disease factors, checklist use before emergency laparotomy was more commonin countries with a high Human Development Index (HDI) (2455 of 2741, 89⋅6 per cent) comparedwith that in countries with a middle (753 of 1242, 60⋅6 per cent; odds ratio (OR) 0⋅17, 95 per cent c.i. 0⋅14to 0⋅21, P < 0⋅001) or low (363 of 860, 42⋅2 per cent; OR 0⋅08, 0⋅07 to 0⋅10, P < 0⋅001) HDI. Checklistuse was less common in elective surgery than for emergency laparotomy in high-HDI countries (riskdifference −9⋅4 (95 per cent c.i. −11⋅9 to −6⋅9) per cent; P < 0⋅001), but the relationship was reversed inlow-HDI countries (+12⋅1 (+7⋅0 to +17⋅3) per cent; P < 0⋅001). In multivariable models, checklist use wasassociated with a lower 30-day perioperative mortality (OR 0⋅60, 0⋅50 to 0⋅73; P < 0⋅001). The greatestabsolute benefit was seen for emergency surgery in low- and middle-HDI countries.Conclusion: Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.
Salciccioli JD, Marshall DC, Shalhoub J, et al., 2018, Respiratory disease mortality in the United Kingdom compared with EU15+ countries in 1985-2015: observational study, BMJ, Vol: 363, ISSN: 0959-8138
OBJECTIVE: To compare age standardised death rates for respiratory disease mortality between the United Kingdom and other countries with similar health system performance. DESIGN: Observational study. SETTING: World Health Organization Mortality Database, 1985-2015. PARTICIPANTS: Residents of the UK, Austria, Belgium, Denmark, Finland, France, Germany, Greece, Ireland, Italy, Luxembourg, the Netherlands, Portugal, Spain, Sweden, Australia, Canada, the United States, and Norway (also known as EU15+ countries). MAIN OUTCOME MEASURES: Mortality from all respiratory disease and infectious, neoplastic, interstitial, obstructive, and other respiratory disease. Differences between countries were tested over time by mixed effect regression models, and trends in subcategories of respiratory related diseases assessed by a locally weighted scatter plot smoother. RESULTS: Between 1985 and 2015, overall mortality from respiratory disease in the UK and EU15+ countries decreased for men and remained static for women. In the UK, the age standardised death rate (deaths per 100 000 people) for respiratory disease mortality in the UK fell from 151 to 89 for men and changed from 67 to 68 for women. In EU15+ countries, the corresponding changes were from 108 to 69 for men and from 35 to 37 in women. The UK had higher mortality than most EU15+ countries for obstructive, interstitial, and infectious subcategories of respiratory disease in both men and women. CONCLUSION: Mortality from overall respiratory disease was higher in the UK than in EU15+ countries between 1985 and 2015. Mortality was reduced in men, but remained the same in women. Mortality from obstructive, interstitial, and infectious respiratory disease was higher in the UK than in EU15+ countries.
Nwabuo CC, Aghaji QN, Philips B, et al., 2018, Trends in mortality from valvular heart disease in Europe from 2001-2015., American Heart Association, Publisher: American Heart Association, Pages: 1-2, ISSN: 0009-7322
Introduction: Deaths from cardiovascular diseases such as heart failure and coronary artery disease have been declining in developed countries over the last decade. However, mortality trends from valvular heart disease (VHD) are less well known.Hypothesis: We evaluated regional and sex-specific temporal trends in VHD mortality among European Union (EU) member nations using data from the World Health Organization (WHO) mortality database.Methods: We performed a temporal analysis of the WHO mortality database between 2001 and 2015. Mortality data for non-rheumatologic VHD were obtained using corresponding ICD-10 medical diagnosis lists. We included in our analysis all EU nations with documented high-usability data as assessed by WHO. We computed age-standardized death rates (ASDR) using the world standard population. We assessed temporal trends in VHD ASDRs between countries. We compared trends using Joinpoint regression analysis.Results: In men, the median ASDR increased to 3.73 deaths / 100,000 population (IQR 2.36 - 4.97) in 2015 from 2.56 deaths / 100,000 population (IQR 1.33 - 3.11) in 2001. In women, median ASDR increased to 3.10 deaths / 100,000 population (IQR 1.83 - 4.27) in 2015 from 2.32 deaths / 100,000 population (IQR 0.84 - 2.87). Slovenia had the highest present day (2015) ASDR for males and females (8.46 deaths/100,000 and 6.94 deaths/100,0000, respectively). The lowest ASDR in males was observed in Romania with 1.00 death/100,000, whereas the lowest ASDR for females was observed in Romania as well as Lithuania was 0.86 deaths/100,000.Conclusions: In contrast to well-documented declining mortality from other CVD conditions, we identified small but increasing mortality rates from valvular heart disease across EU member nations. We observed geographic variations in mortality rates and small but important differences by gender.
Yang D, Salciccioli J, Marshall D, et al., 2018, Trends in mortality from malignant melanoma: an observational study of the World Health Organisation mortality database from 1985 to 2015, National-Cancer-Research-Institute (NCRI) Cancer Conference, Publisher: Springer Nature [academic journals on nature.com], Pages: 14-14, ISSN: 0007-0920
Milinis K, Shalhoub J, Coupland A, et al., 2018, The effectiveness of graduated compression stockings for prevention of venous thromboembolism in orthopedic and abdominal surgery patients requiring extended pharmacological thromboprophylaxis, Journal of vascular surgery. Venous and lymphatic disorders, Vol: 6, Pages: 766-777.e2, ISSN: 2213-3348
Objectives: There is an increasing evidence base to support the use of extended pharmacological thromboprophylaxis in selected surgical patients to prevent venous thromboembolism (VTE). The benefit of graduated compression stockings (GCS) in addition to extended pharmacological thromboprophylaxis is unclear. The aim of this study was to systematically review the evidence relating to the effectiveness of using GCS in conjunction with extended pharmacological thromboprophylaxis to prevent VTE in surgical patients.Methods: A literature search of MEDLINE, Embase, Cochrane Library and clinicaltrials.gov databases was performed in accordance with PRISMA guidelines in April 2017. The review protocol was published on PROSPERO (CRD42017062655). Randomized controlled trials (RCTs) were eligible if one of the study arms included patients receiving extended pharmacological thromboprophylaxis alone (> 21 days) or in conjunction with GCS. Data on deep vein thrombosis (DVT), pulmonary embolism (PE), and VTE-related death were compiled. Pooled proportions of the VTE rates were determined using random-effects meta-analysis.Results: The systematic search identified 1291 studies, of which 19 studies were eligible for inclusion. No RCT directly compared extended pharmacological thromboprophylaxis alone with GCS plus extended pharmacological thromboprophylaxis. A total of 9824 patients from 16 RCTs were treated with extended pharmacological thromboprophylaxis, of whom 0.81% (95% CI 0.5-1.20) were diagnosed with symptomatic DVT and 0.2% (95% 0.12-0.36%) with PE. Three trials included 337 patients who received extended pharmacological thromboprophylaxis in conjunction with GCS. In this group, 1.61% (95% CI 0.03-5.43) had symptomatic DVT with no reported PEs. Similar VTE rates were observed when studies in orthopedic and abdominal surgery were analyzed separately.Conclusions: There is insufficient evidence to recommend GCS in conjunction with extended pharmacological prophylaxis to prev
Ferreira-Martins J, Howard J, Al-Khayatt BM, et al., 2018, Outcomes of paroxysmal AF ablation studies are affected more by study design and patient mix than ablation technique, Journal of Cardiovascular Electrophysiology, Vol: 29, Pages: 1471-1479, ISSN: 1045-3873
Objective: We tested whether ablation methodology and study design can explain the varying outcomes in terms of AF-free survival at 1 year.Background:There have been numerous paroxysmal AF ablation trials, which are heterogeneous in their use of different ablation techniques and study design. A useful approach to understanding how these factors influence outcome is to dismantle the trials into individual arms and reconstitute them as a large meta-regression.Methods: Data was collected from 66 studies (6941 patients). With freedom from AF as the dependent variable, we performed meta-regression using the individual study arm as the unit.Results: Success rates did not change regardless of the technique used to produce pulmonary vein isolation. Neither were adjunctive lesion sets associated with any improvement in outcome.Studies that included more males and fewer hypertensive patients were found more likely to report better outcomes. ECG method selected to assess outcome also plays an important role. Outcomes were worse in studies that used regular telemonitoring (by 23%, p<0.001) or in patients who had implantable loop recorders (by 21%, p=0.006), rather than less thorough periodic Holter monitoring.Conclusions: Outcomes of AF ablation studies involving pulmonary vein isolation are not affected by the technologies used to produce PVI. Neither do adjunctive lesion sets change the outcome. Achieving high success rates in these studies appears to be dependent more on patient mix and on the thoroughness of AF detection protocols. This should be carefully considered when quoting success rates of AF ablation procedures which are derived from such studies.
Pitt J, Milanovic K, Coupland A, et al., 2018, A collective adaptive socio-technical system for remote- and self-supervised exercise in the treatment of intermittent claudication, International Symposium on Leveraging Applications of Formal Methods, Verification and Validation, Publisher: Springer Verlag, Pages: 63-78, ISSN: 0302-9743
Vascular surgeons have recognised that the condition of many patients presenting with intermittent claudication and peripheral arterial disease is better treated by physical exercise rather than endovascular or surgical intervention. Such exercise causes pain, though, before and until the health improvements are realised. Therefore, patients experiencing pain tend to stop doing that which causes it, unless they are supervised performing the necessary exercise programmes. However, supervised exercise is an extremely costly and time-consuming use of medical resources.To overcome this series of problems, we propose to develop and deploy a healthcare application which provides patient exercise programmes that are both centrally organised and remotely supervised by a health practitioner, and self-organized and self-supervised by the patients themselves. This demands that two dimensions of adaptation should be addressed: adaptation prompted by the health practitioner as the patient group improves and meets programme targets; and adaptation prompted from within the patient group enabling them to manage their own community effectively and sustainably.This position paper explores this application from the perspective of engineering a collective adaptive system for a mobile healthcare application, providing both remote- and self-supervised exercise. This requires, on the one hand, converging recent technological advances in sensors and mobile devices, audio and video connectivity, and social computing; with, on the other hand, innovative value-sensitive and user-centric design methodologies, together with formal methods for interaction and interface design and specification. The ultimate ambition is to create a ‘win-win-win’ situation in which the benefits of exercise as a treatment, the reduced costs of supervision, and the pro-social incentives to perform the exercise are all derived from computer-supported self-organised collective action.
Li W, Salciccioli JD, Marshall D, et al., 2018, Factors influencing global trends in liver-related mortality - an observational study from 1985 to 2015, Annual Meeting of the American-Association-for-the-Study-of-Liver-Diseases (AASLD) / Liver Meeting, Publisher: Wiley, Pages: 451A-451A, ISSN: 0270-9139
Drake TM, Camilleri-Brennan J, Tabiri S, et al., 2018, Laparoscopy in management of appendicitis in high-, middle-, and low-income countries: a multicenter, prospective, cohort study, Surgical Endoscopy, Vol: 32, Pages: 3450-3466, ISSN: 0930-2794
BackgroundAppendicitis is the most common abdominal surgical emergency worldwide. Differences between high- and low-income settings in the availability of laparoscopic appendectomy, alternative management choices, and outcomes are poorly described. The aim was to identify variation in surgical management and outcomes of appendicitis within low-, middle-, and high-Human Development Index (HDI) countries worldwide.MethodsThis is a multicenter, international prospective cohort study. Consecutive sampling of patients undergoing emergency appendectomy over 6 months was conducted. Follow-up lasted 30 days.Results4546 patients from 52 countries underwent appendectomy (2499 high-, 1540 middle-, and 507 low-HDI groups). Surgical site infection (SSI) rates were higher in low-HDI (OR 2.57, 95% CI 1.33–4.99, p = 0.005) but not middle-HDI countries (OR 1.38, 95% CI 0.76–2.52, p = 0.291), compared with high-HDI countries after adjustment. A laparoscopic approach was common in high-HDI countries (1693/2499, 67.7%), but infrequent in low-HDI (41/507, 8.1%) and middle-HDI (132/1540, 8.6%) groups. After accounting for case-mix, laparoscopy was still associated with fewer overall complications (OR 0.55, 95% CI 0.42–0.71, p < 0.001) and SSIs (OR 0.22, 95% CI 0.14–0.33, p < 0.001). In propensity-score matched groups within low-/middle-HDI countries, laparoscopy was still associated with fewer overall complications (OR 0.23 95% CI 0.11–0.44) and SSI (OR 0.21 95% CI 0.09–0.45).ConclusionA laparoscopic approach is associated with better outcomes and availability appears to differ by country HDI. Despite the profound clinical, operational, and financial barriers to its widespread introduction, laparoscopy could significantly improve outcomes for patients in low-resource environments.
Ravikumar R, Williams KJ, Babber A, et al., 2018, Neuromuscular electrical stimulation (NMES) for the prevention of venous thromboembolism (VTE), Phlebology, Vol: 33, Pages: 367-378, ISSN: 0268-3555
ObjectiveVenous thromboembolism (VTE), encompassing deep vein thrombosis (DVT) and pulmonary embolism (PE), is a significant cause of morbidity and mortality, affecting 1 in 1000 adults per year. Neuromuscular electrical stimulation (NMES) is the transcutaneous application of electrical impulses to elicit muscle contraction, preventing venous stasis. This review aims to investigate the evidence underlying the use of NMES in thromboprophylaxis.MethodsThe Medline and Embase databases were systematically searched, adhering to PRISMA guidelines, for articles relating to electrical stimulation and thromboprophylaxis. Articles were screened according to a priori inclusion and exclusion criteria.ResultsThe search strategy identified 10 randomised controlled trials, which were used in three separate meta-analyses; 5 trials compared NMES to control, favouring NMES (odds ratio (OR) of DVT 0.29, 95%CI 0.13-0.65; P=.003); 3 trials compared NMES to heparin, favouring heparin (OR of DVT 2.00, 95%CI 1.13-3.52; P=.02); 3 trials compared NMES as an adjunct to heparin versus heparin only, demonstrating no significant difference (OR of DVT 0.33, 95%CI 0.10-1.14; P=.08).ConclusionNMES significantly reduces the risk of deep vein thrombosis compared to no prophylaxis. It is inferior to heparin in preventing DVT and there is no evidence for its use as an adjunct to heparin.
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