Publications
419 results found
Marshall DC, Goodson RJ, Xu Y, et al., 2018, Trends in mortality from pneumonia in the Europe Union: a temporal analysis of the European Detailed Mortality Database between 2001-2014, Respiratory Research, Vol: 19, ISSN: 1465-9921
BackgroundPneumonia is responsible for approximately 230 000 deaths in Europe, annually.Comprehensive and comparable reports on pneumonia mortality trends across theEuropean Union (EU) are lacking.MethodsAn temporal analysis of national mortality statistics to compare trends in pneumoniaage-standardised death rates (ASDR) of EU countries between 2001-2014 wasperformed. International Classification of Diseases version 10 (ICD-10) codes wereused to extract data from the World Health Organisation European Detailed MortalityDatabase and trends were analysed using Joinpoint regression.ResultsMedian pneumonia mortality across the EU for the last recorded observation was 19.8 /100 000 and 6.9 / 100 000 for males and females, respectively. Mortality was higher inmales across all EU counties, most notably in Estonia and Lithuania where the ratio ofmale to female ASDR was 4.0 and 3.7, respectively. Gender mortality differences werelowest in the UK and Demark with ASDR ratios of 1.1 and 1.5, respectively.Pneumonia mortality across all countries decreased by a median of 31.0% over theobservation period. Countries that demonstrated an increase in pneumonia mortalitywere Poland (males +33.1%, females +10.2%), and Lithuania (males +6.0%).ConclusionsMortality from pneumonia is improving in most EU countries, however substantialvariation in trends remains between countries and between genders.
Sung Y, Spagou K, Kafeza M, et al., 2018, Deep vein thrombosis exhibits characteristic serum and vein wall metabolic phenotypes in the inferior vena cava ligation mouse model, European Journal of Vascular and Endovascular Surgery, Vol: 55, Pages: 703-713, ISSN: 1078-5884
Deep vein thrombosis (DVT) is a major health problem, responsible for significant morbidity and mortality, and imposes a heavy economic burden to healthcare systems (1). Although most events resolve without complication through spontaneous lysis and recanalization, DVT can be complicated with life-threatening pulmonary embolism (2), while approximately one third of DVT patients develop post-thrombotic syndrome with swelling, pain, skin changes and/or venous ulceration (3).Treatment with anticoagulation prevents further thrombus extension, protects from pulmonary embolism and reduces the risk of chronic lower limb complications. Importantly, unnecessary treatment can result in bleeding. Therefore, accurate and reliable DVT diagnosis is essential. Currently, diagnosis relies on subjective clinical examination and ultrasound imaging (4). A number of biological markers have been investigated with variable results. D-dimer, the most widely used biomarker, is sensitive but lacks specificity (5, 6). Ongoing research efforts target the utility of alternative blood diagnostic biomarkers able to accurately diagnose DVT, guide length and type of treatment, and potentially identify patients who may benefit from more aggressive therapies than standard anticoagulation. New molecular technologies and methods have entered the scientific arena, offering the opportunity to revisit this important clinical need. Metabolic profiling has emerged as a new approach to investigate complex metabolic disease and enable precision medicine. Metabolomics is the comprehensive and systematic identification of the small molecules present in differential abundance in biofluids and are affected by various factors such as diet, lifestyle, genetics, disease, environmental factors and medications. Metabolic profiling approaches to characterizing the metabolome can be either targeted or untargeted. In targeted approaches specific metabolites, representative of suspected biological pathways, are analysed
Milinis K, Thapar A, Shalhoub J, et al., 2018, Antithrombotic Therapy Following Venous Stenting: International Delphi Consensus, Journal of Vascular Surgery, Vol: 67, Pages: 1633-1633, ISSN: 0741-5214
Lee MJ, National Research Collaborative, Association of Surgeons in Training Collaborative Consensus Group, et al., 2018, Recognising contributions to work in research collaboratives: Guidelines for standardising reporting of authorship in collaborative research, International Journal of Surgery, Vol: 52, Pages: 355-360, ISSN: 1743-9191
BackgroundTrainee research collaboratives (TRCs) have been revolutionary changes to the delivery of high-quality, multicentre research. The aim of this study was to define common roles in the conduct of collaborative research, and map these to academic competencies as set out by General Medical Council (GMC) in the United Kingdom. This will support trainers and assessors when judging academic achievements of those involved in TRC projects, and supports trainees by providing guidance on how to fulfil their role in these studies.MethodsA modified Delphi process was followed. Electronic discussion with key stakeholders was undertaken to identify and describe common roles. These were refined and mapped to GMC educational domains and International Committee of Medical Journal Editors authorship (ICJME) guidelines. The resulting roles and descriptions were presented to a face-to-face consensus meeting for voting. The agreed roles were then presented back to the electronic discussion group for approval.ResultsElectronic discussion generated six common roles. All of these were agreed in face-to-face meetings, where two further roles identified and described. All eight roles required skills that map to part of the academic requirements for surgical training in the UK.DiscussionThis paper presents a standardised framework for reporting authorship in collaborative group authored research publications. Linkage of collaborator roles to the ICMJE guidelines and GMC academic competency guidelines will facilitate incorporation into relevant training curricular and journal publication policies.
Li N, Marshall DC, Sykes M, et al., 2018, Systematic review of methods for quantifying teamwork in the operating theatre, BJS Open, Vol: 2, Pages: 42-51, ISSN: 2474-9842
Background:Teamwork in the operating theatre is becoming increasingly recognized as a major factor in clinical outcomes. Many tools have been developed to measure teamwork. Most fall into two categories: self‐assessment by theatre staff and assessment by observers. A critical and comparative analysis of the validity and reliability of these tools is lacking.Methods:MEDLINE and Embase databases were searched following PRISMA guidelines. Content validity was assessed using measurements of inter‐rater agreement, predictive validity and multisite reliability, and interobserver reliability using statistical measures of inter‐rater agreement and reliability. Quantitative meta‐analysis was deemed unsuitable.Results:Forty‐eight articles were selected for final inclusion; self‐assessment tools were used in 18 and observational tools in 28, and there were two qualitative studies. Self‐assessment of teamwork by profession varied with the profession of the assessor. The most robust self‐assessment tool was the Safety Attitudes Questionnaire (SAQ), although this failed to demonstrate multisite reliability. The most robust observational tool was the Non‐Technical Skills (NOTECHS) system, which demonstrated both test–retest reliability (P > 0·09) and interobserver reliability (Rwg = 0·96).Conclusion:Self‐assessment of teamwork by the theatre team was influenced by professional differences. Observational tools, when used by trained observers, circumvented this.
Milinis K, Thapar A, Shalhoub J, et al., 2018, Antithrombotic therapy following venous stenting: international Delphi consensus, European Journal of Vascular and Endovascular Surgery, Vol: 55, Pages: 537-544, ISSN: 1078-5884
Objective/backgroundDeep venous stenting is increasingly used in the treatment of deep venous obstruction; however, there is currently no consensus regarding post-procedural antithrombotic therapy. The aim of the present study was to determine the most commonly used antithrombotic regimens and facilitate global consensus.MethodsAn electronic survey containing three clinical scenarios on venous stenting for non-thrombotic iliac vein lesions, acute deep vein thrombosis (DVT), and post-thrombotic syndrome was distributed to five societies whose members included vascular surgeons, interventional radiologists, and haematologists. The results of the initial survey (phase 1) were used to produce seven consensus statements, which were distributed to the respondents for evaluation in the second round (phase 2), along with the results of phase 1. Consensus was defined a priori as endorsement or rejection of a statement by ≥ 67% of respondents.ResultsPhase 1 was completed by 106 experts, who practiced in 78 venous stenting centres in 28 countries. Sixty-one respondents (58% response rate) completed phase 2. Five of seven statements met the consensus criteria. Anticoagulation was the preferred treatment during the first 6–12 months following venous stenting for a compressive iliac vein lesion. Low molecular weight heparin was the antithrombotic agent of choice during the first 2–6 weeks. Lifelong anticoagulation was recommended after multiple DVTs. Discontinuation of anticoagulation after 6–12 months was advised following venous stenting for a single acute DVT. No agreement was reached regarding the role of long-term antiplatelet therapy.ConclusionsConsensus existed amongst respondents regarding anticoagulant therapy following venous stenting. At present, there is no consensus regarding the role of antiplatelet agents in this context.
Sun R, Marshall DC, Sykes MC, et al., 2018, The impact of improving teamwork on patient outcomes in surgery: a systematic review, International Journal of Surgery, Vol: 53, Pages: 171-177, ISSN: 1743-9191
BackgroundThe aviation industry pioneered formalised crew training in order to improve safety and reduce consequences of non-technical error. This formalised training has been successfully adapted and used to in the field of surgery to improve post-operative patient outcomes. The need to implement teamwork training as an integral part of a surgical programme is increasingly being recognised. We aim to systematically review the impact of surgical teamwork training on post-operative outcomes.MethodsTwo independent researchers systematically searched MEDLINE and Embase in accordance with PRISMA guidelines. Studies were screened and subjected to inclusion/exclusion criteria. Study characteristics and outcomes were reported and analysed.ResultsOur initial search identified 2720 articles. Following duplicate removal, title and abstract screening, 107 full text articles were analysed. Eight articles met our inclusion criteria. Overall, three articles supported a positive effect of good teamwork on post-operative patient outcomes. We identified key areas in study methodology that can be improved upon, including small cohort size, lack of unified training programme, and short training duration, should future studies be designed and implemented in this field.ConclusionAt present, there is insufficient evidence to support the hypothesis that teamwork training interventions improve patient outcomes. We believe that non-significant and conflicting results can be attributed to flaws in methodology and non-uniform training methods. With increasing amounts of evidence in this field, we predict a positive association between teamwork training and patient outcomes will come to light.
Salciccioli JD, Marshall DC, Maruthappu M, et al., 2017, Deaths from respiratory disease in the uk compared to eu15+ countries: an observational analysis of national mortality statistics, 1985 – 2013, Winter Meeting of the British-Thoracic-Society, Publisher: BMJ PUBLISHING GROUP, Pages: A75-A75, ISSN: 0040-6376
Stather P, Mascara F, on Behalf of the Vascular and Endovascular Research Network VERN, 2017, Cardiovascular risk reduction in referrals to outpatient vascular clinics, Annals of The Royal College of Surgeons of England, Vol: 100, Pages: 194-198, ISSN: 0035-8843
IntroductionPatients with peripheral arterial disease (PAD), aneurysmal disease (AD) or carotid atherosclerosis are at high cardiovascular risk, necessitating secondary cardiovascular protection. The aim of this study was to determine compliance with cardiovascular risk reduction guidelines in new patients referred to vascular clinics.MethodsA multicentre collaborative national observational audit of new patients referred to eight tertiary general vascular clinics over a three-month period in England and Wales was conducted by the Vascular and Endovascular Research Network (VERN). Referral letters, case notes and investigations were reviewed by local investigators, and data analysed by VERN.ResultsA total of 656 patients were included in the study: 73.2% had PAD, 23.2% had AD and 3.7% had carotid atherosclerosis. A third (37.5%) were current smokers, two-thirds (61.7%) were on antiplatelet therapy and two-thirds (61.5%) were on statin therapy. Smoking was more prevalent in the PAD cohort (PAD 41.4%, AD 27.5%, p=0.003). However, more PAD patients were on antiplatelet therapy (PAD 63.9%, AD 53.3%, p=0.024). Both antiplatelet and statin prescription significantly increased with the number of cardiovascular risk factors. Patients with a previous cardiac or cerebrovascular history were more likely to have stopped smoking, and to be on antiplatelet and statin therapy (p<0.0001 for each). Overall, 47.3% of patients were on both antiplatelet and statin therapy, and 28.9% were on antiplatelet and statin therapy and not smoking.ConclusionsThis study highlights deficiencies in cardiovascular risk minimisation in patients with established vascular disease. Patients with concomitant cardiac or cerebrovascular disease were more likely to be on best medical therapy.
Glasbey J, Sinclair P, Mohan H, et al., 2017, 40-4-40: educational and economic outcomes of a free, international surgical training event, Postgraduate Medical Journal, Vol: 93, Pages: 730-735, ISSN: 0032-5473
Purpose of study To demonstrate a model for delivery of an international surgical training event, and demonstrate its educational and economic outcomes.Study design The Association of Surgeons in Training (ASiT) ran a course series on 16 January 2016 across the UK and Ireland. A mandatory, self-reported, online questionnaire collected delegate feedback, using 5-point Likert Scales, and a NetPromoter feedback tool. Precourse and postcourse matched questionnaires were collected for ‘Foundation Skills in Surgery’ (FSS) courses. Paired economic analysis was performed. Statistical analysis was carried out using RStudio (V.3.1.1 Boston, Massachusetts, USA).Results Forty courses were held across the UK and Ireland (65.0% technical, 35.0% non-technical), with 184 faculty members. Of 570 delegates, 529 fully completed the feedback survey (92.8% response rate); 56.5% were male. The median age was 26 years (range: 18–67 years). The mean overall course NetPromoter Score was 8.7 out of 10. On logistic regression high NetPromoter Score was associated with completing a Foundation Skills in Surgery course (R=0.44, OR: 1.49, p=0.025) and having clear learning outcomes (R=0.72, OR: 2.04, p=0.029) but not associated with specialty, course style or teaching style. For Foundation Skills in Surgery courses, delegates reported increased commitment to a career in surgery (p<0.001), confidence with basic surgical skills (p<0.001) and confidence with assisting in theatre (p<0.001). A comparable cost saving of £231,462.37 was calculated across the 40 courses.Conclusion The ASiT ‘40-4-40’ event demonstrated the diversity and depth of surgical training, with 40 synchronous technical and non-technical courses, demonstrable educational benefit and a significant cost saving to surgical trainees.
Humm G, Harries RL, Derbyshire LF, et al., 2017, Teaching ‘Foundation Skills in Surgery’: Evaluating the Association of Surgeons in Training Course, Bulletin of the Royal College of Surgeons of England, ISSN: 1473-6357
Kafeza M, Shalhoub J, Salooja N, et al., 2017, Systematic Review of Clinical Prediction Scores for Deep Vein Thrombosis, Phlebology, Vol: 32, Pages: 516-531, ISSN: 0268-3555
Objective:Diagnosis of Deep Vein Thrombosis (DVT) remains a challenging problem. Various clinical prediction rules have been developed in order to improve diagnosis and decision-making in relation to DVT. The purpose of this review is to summarise the available clinical scores and describe their applicability and limitations.Methods:A systematic search of PubMed, MEDLINE and EMBASE databases was conducted in accordance with PRISMA guidance using the keywords: clinical score, clinical prediction rule, risk assessment, clinical probability, pretest probability, diagnostic score and MeSH terms: “Venous Thromboembolism/diagnosis” OR “Venous Thrombosis/diagnosis”. Both development and validation studies were eligible for inclusion.Results:The search strategy returned a total of 2036 articles, of which 102 articles met a priori criteria for inclusion. Eight different diagnostic scores were identified. The development of these scores differs in respect of the population included (hospital inpatients, hospital outpatients or primary care patients), the exclusion criteria, the inclusion of distal DVT and the use of D-dimer. The reliability and applicability of the scores in the context of specific subgroups (inpatients, cancer patients, elderly patients, and those with recurrent DVT) remains controversial.Conclusion:Detailed knowledge of the development of the various clinical prediction scores for DVT is essential in understanding the power, generalisability and limitations of these clinical tools.
Lim C, Shalhoub J, Davies AH, 2017, Deep venous procedures performed in the National Health Service in England between 2005 and 2015, European Journal of Vascular and Endovascular Surgery, Vol: 54, Pages: 487-494, ISSN: 1532-2165
ObjectivesRecent advances in imaging technology and endovenous interventions have revolutionised the management of specific groups of patients with deep venous pathology. This study aimed to examine data published by Hospital Episode Statistics (HES) to assess trends in the number of endovascular and open surgical deep venous procedures performed in National Health Service (NHS) hospitals in England between 2005 and 2015.Materials and methodsThe main diagnosis of deep venous thrombosis (DVT), and total number of primary open and percutaneous procedures for deep venous pathology for patients admitted to the NHS hospitals in England from 2005 to 2015 were retrieved from the HES database and analysed.ResultsAn overall declining trend in the annual number of admissions for a primary diagnosis of DVT was observed (linear regression r2 = 0.9, p < .0001). The number of open surgical procedures for removal of thrombus remained largely unchanged (range 26–70); the frequency of percutaneous procedures increased steadily over the study period (range 0–311). The number of open surgical procedures relating to the vena cava fell between 2005 and 2009, and remained around 50 per year thereafter. Annual numbers of cases of deep venous bypass (range 17–33) and venous valve surgery (range 8–47) remained similar in trend over this period. The number of vena cava stent (range 0–405), other venous stent (range 0–316), and percutaneous venoplasty (range 0–972) procedures increased over the first 5 years of the study period.ConclusionsThere is an increasing trend in relation to endovenous procedures but not open surgery, being carried out for deep venous pathology in the last decade in NHS hospitals in England. Despite a number of limitations with HES, the increase in the number of endovenous procedures shown is likely to have significant implications for the provision of care and healthcare resources for patients with deep venous pathology.
Albazde O, Shalhoub J, Davies A, 2017, The effect of supervised exercise on biomarker levels in individuals with peripheral arterial disease - a systematic review, International Congress of the Association-of-Surgeons-of-Great-Britain-and-Ireland, Publisher: WILEY, Pages: 82-82, ISSN: 0007-1323
Anwar MA, Adesina-Georgiadis KN, Spagou K, et al., 2017, A comprehensive characterisation of the metabolic profile of varicose veins; implications in elaborating plausible cellular pathways for disease pathogenesis, Scientific Reports, Vol: 7, ISSN: 2045-2322
Metabolic phenotypes reflect both the genetic and environmental factors which contribute to the development of varicose veins (VV). This study utilises analytical techniques to provide a comprehensive metabolic picture of VV disease, with the aim of identifying putative cellular pathways of disease pathogenesis. VV (n = 80) and non-VV (n = 35) aqueous and lipid metabolite extracts were analysed using 600 MHz 1H Nuclear Magnetic Resonance spectroscopy and Ultra-Performance Liquid Chromatography Mass Spectrometry. A subset of tissue samples (8 subjects and 8 controls) were analysed for microRNA expression and the data analysed with mirBase (www.mirbase.org). Using Multivariate statistical analysis, Ingenuity pathway analysis software, DIANALAB database and published literature, the association of significant metabolites with relevant cellular pathways were understood. Higher concentrations of glutamate, taurine, myo-inositol, creatine and inosine were present in aqueous extracts and phosphatidylcholine, phosphatidylethanolamine and sphingomyelin in lipid extracts in the VV group compared with non-VV group. Out of 7 differentially expressed miRNAs, spearman correlation testing highlighted correlation of hsa-miR-642a-3p, hsa-miR-4459 and hsa-miR-135a-3p expression with inosine in the vein tissue, while miR-216a-5p, conversely, was correlated with phosphatidylcholine and phosphatidylethanolamine. Pathway analysis revealed an association of phosphatidylcholine and sphingomyelin with inflammation and myo-inositol with cellular proliferation.
Langley SR, Willeit K, Didangelos A, et al., 2017, EXTRACELLULAR MATRIX PROTEOMICS IDENTIFIES MOLECULAR SIGNATURE OF SYMPTOMATIC CAROTID PLAQUES, Annual Conference of the British-Cardiovascular-Society (BCS), Publisher: BMJ PUBLISHING GROUP, Pages: A137-A137, ISSN: 1355-6037
Saratzis A, Dattani N, Brown A, et al., 2017, Multi-centre study on cardiovascular risk management in patients undergoing AAA surveillance, European Journal of Vascular and Endovascular Surgery, Vol: 54, Pages: 116-122, ISSN: 1532-2165
BackgroundThe risk of cardiovascular events and death in patients with abdominal aortic aneurysms (AAA) is high. Screening has been introduced to reduce AAA related mortality; however, after AAA diagnosis, cardiovascular modification may be as important to patient outcomes as surveillance. The aim of this study was to assess cardiovascular risk reduction in patients with small AAA.MethodsInstitutional approval was granted for The Vascular and Endovascular Research Network (VERN) to retrospectively collect data pertaining to cardiovascular risk reduction from four tertiary vascular units in England. Patients with small AAA (January 2013–December 2015) were included. Demographic details, postcode, current medications, and smoking status were recorded using a bespoke electronic database and analysed. In a secondary analysis VERN contacted all AAA screening units in England and Wales to assess their current protocols relating to CV protection.ResultsIn total, 1053 patients were included (mean age 74 ± 9 years, all men). Of these, 745 patients (70.8%) had been prescribed an antiplatelet agent and 787 (74.7%) a statin. Overall, only 666 patients (63.2%) were prescribed both a statin and antiplatelet. Two hundred and sixty eight patients (32.1%) were current smokers and the proportion of patients who continued to smoke decreased with age. Overall, only 401 patients (48.1%) were prescribed a statin, antiplatelet, and had stopped smoking. In the secondary analysis 38 AAA screening units (84% national coverage) replied. Thirty-one units (82%) suggest changes to the patient's prescription; however, none monitor compliance with these recommendations or assess whether the general practitioner has been made aware of the AAA diagnosis or prescription advice.ConclusionMany patients with small AAA are not prescribed an antiplatelet/statin, and still smoke cigarettes, and therefore remain at high risk of cardiovascular morbidity and mortality. National guidance to ensure
Shalhoub J, Norrie J, Baker C, et al., 2017, Graduated compression stockings as an adjunct to low dose low molecular weight heparin in venous thromboembolism prevention in surgery– a multi-centre randomised controlled trial, European Journal of Vascular and Endovascular Surgery, Vol: 53, Pages: 880-885, ISSN: 1532-2165
Background:The evidence base upon which current global venous thromboembolism (VTE) prevention recommendations have been made is not optimal. The cost of purchasing and applying Graduated Compression Stockings (GCS) in surgical patients is considerable and has been estimated at £63.1 million each year in England alone.Objective:To determine whether low dose low molecular weight heparin (LMWH) alone is non-inferior to a combination of GCS and low dose LMWH for the prevention of VTE.Methods:A randomised controlled Graduated compression as an Adjunct to Pharmacoprophylaxis in Surgery (GAPS) Trial [ISRCTN 13911492] will randomise adult elective surgical patients identified as being at moderate and high risk for VTE to receive either the current ‘standard’ combined thromboprophylactic LMWH with GCS mechanical thromboprophylaxis, or thromboprophylactic LMWH pharmacoprophylaxis alone. To show non-inferiority (3.5% non-inferiority margin) for the primary endpoint of all VTE within 90 days, 2236 patients are required. Recruitment will be from seven UK centres. Secondary outcomes include quality of life, compliance with stockings and LMWH, overall mortality, and GCS or LMWH-related complications (including bleeding).Recruitment commenced in April 2016 with the seven UK centres coming ‘on-line’ in a staggered fashion. Recruitment will be over a total of 18 months. The GAPS trial is funded by the National Institute for Health Research Health Technology Assessment in the UK [14/140/61].
Langley SR, Willeit K, Didangelos A, et al., 2017, Extracellular matrix proteomics identifies molecular signature of symptomatic carotid plaques, Journal of Clinical Investigation, Vol: 127, Pages: 1546-1560, ISSN: 0021-9738
BACKGROUND: The identification of patients with high-risk atherosclerotic plaques prior to the manifestation of clinical events remains challenging. Recent findings question histology- and imaging-based definitions of the "vulnerable plaque," necessitating an improved approach for predicting onset of symptoms. METHODS: We performed a proteomics comparison of the vascular extracellular matrix and associated molecules in human carotid endarterectomy specimens from 6 symptomatic versus 6 asymptomatic patients to identify a protein signature for high-risk atherosclerotic plaques. Proteomics data were integrated with gene expression profiling of 121 carotid endarterectomies and an analysis of protein secretion by lipid-loaded human vascular smooth muscle cells. Finally, epidemiological validation of candidate biomarkers was performed in two community-based studies. RESULTS: Proteomics and at least one of the other two approaches identified a molecular signature of plaques from symptomatic patients that comprised matrix metalloproteinase 9, chitinase 3-like-1, S100 calcium binding protein A8 (S100A8), S100A9, cathepsin B, fibronectin, and galectin-3-binding protein. Biomarker candidates measured in 685 subjects in the Bruneck study were associated with progression to advanced atherosclerosis and incidence of cardiovascular disease over a 10-year follow-up period. A 4-biomarker signature (matrix metalloproteinase 9, S100A8/S100A9, cathepsin D, and galectin-3-binding protein) improved risk prediction and was successfully replicated in an independent cohort, the SAPHIR study. CONCLUSION: The identified 4-biomarker signature may improve risk prediction and diagnostics for the management of cardiovascular disease. Further, our study highlights the strength of tissue-based proteomics for biomarker discovery. FUNDING: UK: British Heart Foundation (BHF); King's BHF Center; and the National Institute for Health Research Biomedical Research Center based at Guy's and St Th
Nepogodiev D, Chapman SJ, Kolias AG, et al., 2017, The effect of trainee research collaboratives in the UK, Lancet Gastroenterology and Hepatology, Vol: 2, Pages: 247-248, ISSN: 2468-1253
Shalhoub J, Marshall DC, Ippolito K, et al., 2017, Perspectives on procedure-based assessments: a thematic analysis of semistructured interviews with 10 UK surgical trainees, BMJ OPEN, Vol: 7, ISSN: 2044-6055
Objectives: The introduction of competency-based training has necessitated development and implementation of accompanying mechanisms for assessment. Procedure based assessments (PBAs) are an example of workplace-based assessments that are used to examine focal competencies in the workplace. The primary objective was to understand surgical trainees’ perspective on the value of PBA.Design: Semi-structured interviews with 10 surgical trainees individually interviewed to explore their views. Interviews were audio-recorded and transcribed, following this they were open and axial coded. Thematic analysis was then performed.Results: Semi-structured interviews yielded several topical and recurring themes. In trainees’ experience the use of PBAs as a summative tool limits their educational value. Trainees reported a lack of support from seniors and variation in the usefulness of the tool based on stage of training. Concerns related to the validity of PBAs for evaluating trainees’ performance with reports of ‘gaming’ the system and trainees completing their own assessments. Trainees’ did identify the significant value of PBAs when used correctly. Benefits included the identification of additional learning opportunities, standardisation of assessment and their role in providing a measure of progress.Conclusions: The UK surgical trainees interviewed identified both limitations and benefits to PBAs, however we would argue based on their responses and our experience that their use as a summative tool limits their formative use as an educational opportunity. PBAs should either be used exclusively to support learning or solely used as a summative tool, if so further work is needed to audit, validate and standardise them for this purpose.
Marshall D, Salciccioli J, Goodson RJ, et al., 2017, The association between sodium fluctuations and mortality in surgical patients requiring intensive care, Journal of Critical Care, Vol: 40, Pages: 63-68, ISSN: 1557-8615
Purpose: Serum sodium derangement is the most common electrolyte disturbance amongst patients admitted to intensive care. This study aims to validate the association between dysnatraemia and serum sodium fluctuation with mortality in surgical intensive care patients.Method: We performed a retrospective analysis of the Medical Information Mart for Intensive Care (MIMIC-II) database. Dysnatraemia was defined as a sodium concentration outside physiologic range (135–145 mmol/L) and subjects were categorized by severity of dysnatraemia and sodium fluctuation. Univariate and multivariable logistic regression was used to test for associations between sodium fluctuations and mortality. Results: We identified 8600 subjects, 39% female with a median age of 66 years for analysis. Subjects with dysnatraemia were more likely to be dead at 28-days (17% vs 7%; p<0.001). There was a significant association between sodium fluctuation and mortality at 28-days (adjusted OR per 1 mmol/L change: 1.10 (95% CI 1.08-1.12; p <0.001)) even in patients who remained normotraemic during their ICU stay (1.12 (95% CI 1.09-1.16; p<0.001))Conclusions: This observational study validates previous findings of an association between serum sodium fluctuations and mortality in surgical intensive care patients. This association was also present in subjects who remained normonatraemic throughout their ICU admission.
GlobalSurg Collaborative, Shalhoub J, 2016, Determinants of morbidity and mortality following emergency abdominal surgery in children in low-income and middle-income countries, BMJ Global Health, Vol: 1, ISSN: 2059-7908
Background Child health is a key priority on the global health agenda, yet the provision of essential and emergency surgery in children is patchy in resource-poor regions. This study was aimed to determine the mortality risk for emergency abdominal paediatric surgery in low-income countries globally.Methods Multicentre, international, prospective, cohort study. Self-selected surgical units performing emergency abdominal surgery submitted prespecified data for consecutive children aged <16 years during a 2-week period between July and December 2014. The United Nation's Human Development Index (HDI) was used to stratify countries. The main outcome measure was 30-day postoperative mortality, analysed by multilevel logistic regression.Results This study included 1409 patients from 253 centres in 43 countries; 282 children were under 2 years of age. Among them, 265 (18.8%) were from low-HDI, 450 (31.9%) from middle-HDI and 694 (49.3%) from high-HDI countries. The most common operations performed were appendectomy, small bowel resection, pyloromyotomy and correction of intussusception. After adjustment for patient and hospital risk factors, child mortality at 30 days was significantly higher in low-HDI (adjusted OR 7.14 (95% CI 2.52 to 20.23), p<0.001) and middle-HDI (4.42 (1.44 to 13.56), p=0.009) countries compared with high-HDI countries, translating to 40 excess deaths per 1000 procedures performed.Conclusions Adjusted mortality in children following emergency abdominal surgery may be as high as 7 times greater in low-HDI and middle-HDI countries compared with high-HDI countries. Effective provision of emergency essential surgery should be a key priority for global child health agendas.
Goodson R, Marshall D, Salciccioli J, et al., 2016, The Association between sodium fluctuations and mortality in surgical patients requiring intensive care, International Journal of Surgery, Vol: 36, Pages: S32-S32, ISSN: 1743-9191
Sun R, Sykes M, Marshall D, et al., 2016, The impact of improving teamwork on patient outcomes in surgery: a systematic review, International Journal of Surgery, Vol: 36, Pages: S35-S36, ISSN: 1743-9191
Aim: To systematically review available literature assessing the effect of surgical teamwork on post-operative patient outcomes across a variety of surgical specialties.Methods: Two independent researchers systematically searched Medline and EMBASE in accordance with PRISMA guidelines. Studies were screened for relevance, then subjected to inclusion and exclusion criteria. Study characteristics and outcomes were reported and discussed qualitatively.Results: Following PRISMA guidelines, our initial search identified 2519 articles. 105 articles remained after duplicate removal and screening. 11 articles were fully reviewed following addition of exclusion and inclusion criteria. Six studies adopted the use of teamwork training intervention; three studies assessed outcomes based on the familiarity of teams, and two studies correlated teamwork quality with patient outcome. Overall, seven papers demonstrated a positive effect of teamwork on patient outcomes, of which five were significant. Two papers found mixed improvements and deteriorations, two papers found no correlation. There exists considerable heterogeneity in methodology, study characteristics and design.Conclusions: The positive effect of teamwork on surgical patient outcome is overall supported. Insignificant and opposing results are likely due to inadequate methodology and study design. Common reasons identified are cohort size, lack of a validated training programme, length of training and follow-up time, and non-randomization.
Salciccioli JD, Marshall DC, Komorowsk M, et al., 2016, ESICM LIVES 2016: part one : Milan, Italy. 1-5 October 2016, Intensive Care Medicine Experimental, Vol: 4, ISSN: 2197-425X
Sivakumar S, Taccone FS, Desai KA, et al., 2016, ESICM LIVES 2016: part two : Milan, Italy. 1-5 October 2016, Intensive Care Medicine Experimental, Vol: 4, ISSN: 2197-425X
Williams KJ, Ravikumar R, Gaweesh AS, et al., 2016, A Review of the Evidence to Support Neuromuscular Electrical Stimulation in the Prevention and Management of Venous Disease, Advances in Experimental Medicine and Biology, Vol: 906, Pages: 377-386, ISSN: 0065-2598
INTRODUCTION: The prevention and management of venous disease is a therapeutic challenge. Movement of blood through the venous system is augmented by the action of muscles on the deep veins, and can be achieved through the application of electrical current. The efficacy of currently available clinical devices for this purpose is unknown, and is investigated here. METHODS: A literature search of the EMBASE and Medline databases was performed, and studies were included if they were full text articles, written in english, pertaining to venous disease and neuromuscular electrical stimulation (NMES). RESULTS: NMES devices increase venous haemodynamic parameters such as peak velocity and volume flow. Studies report them to be non-inferior to intermittent pneumatic compression. They are effective in the prevention of venous thromboembolism, though inferior to low molecular weight heparin. NMES can reduce symptoms of chronic venous disease. DISCUSSION: NMES is an important tool in the prevention and management of venous disease, and avoids the significant risks associated with heparin administration. Data explored here is heterogenous in device, protocol, and reported end-points, therefore should be interpreted with care. Long term effects of treatment with NMES have not been explored.
Li MM, Shalhoub J, Davies AH, et al., 2016, Guidance on Feedback of Outcome Data to Improve Performance in Vascular Surgery, British Journal of Hospital Medicine, Vol: 77, ISSN: 1750-8460
Feedback of performance data is a well-established method of performance improvement in the health-care setting, although guidance has been limited in the context of surgical performance. This article outlines how optimal feedback can be achieved using surgeon outcome data.
Nepogodiev D, National Surgical Research Collaborative, Shalhoub J, 2016, UK surgical trainees will continue to support European research collaboration, The Lancet, Vol: 388, Pages: 459-460, ISSN: 0140-6736
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