Publications
419 results found
Groin wound Infection after Vascular Exposure Study Group, Shalhoub J, 2021, Groin wound infection after vascular exposure (GIVE) multicentre cohort study, International Wound Journal, Vol: 18, Pages: 164-175, ISSN: 1742-4801
Background: Surgical site infections (SSIs) of groin wounds are a common and potentially preventable cause of morbidity, mortality and healthcare costs in vascular surgery. Our aim was to define the contemporaneous rate of groin SSIs, determine clinical sequelae, and identify risk factors for SSI.Method:An international multicentre prospective observational cohort study of consecutive patients undergoing groin incision for femoral vessel access in vascular surgery was undertaken over 3 months, follow up was 90 days. The primary outcome was incidence of groin wound SSI.Results:1337 groin incisions (1039 patients) from 37 centres were included. 115 groin incisions (8.6%) developed SSI, of which 62 (4.6%) were superficial. Patients who developed an SSI had a significantly longer length of hospital stay (6 vs 5 days, p=0.005), a significantly higher rate of post-operative acute kidney injury (19.6% vs 11.7%, p=0.018), with no significant difference in 90-day mortality. Female sex, Body Mass Index≥30kg/m2, ischaemic heart disease, aqueous betadine skin preparation, bypass/patch use (vein, xenograft or prosthetic) and increased operative time were independent predictors of SSI. Conclusion:Groin infections which are clinically apparent to the treating vascular unit are frequent and their development carries significant clinical sequelae. Risk factors include modifiable and non-modifiable variables.
Normahani P, Shalhoub J, Narayanan S, 2021, A Guytonian explanation for hemodynamic responses to interventions in superficial venous disease, Phlebology, Vol: 36, Pages: 245-250, ISSN: 0268-3555
Background:We thank Franceschi et al for their letter entitled “Transmural pressure for conceptualisation of chronic venous insufficiency management” regarding our paper wherein we have repurposed a Guytonian model of systemic venous return to explain the hemodynamic changes that occur in lower limb venous disease.1,2 This model was developed using the non-thrombotic iliac vein lesion (NIVL) as the basis for the hemodynamic response.Franceschi et al have raised queries in their communication that in our model, we have suggested venous stenting, compression therapy and superficial ablation as treatment options for the NIVL. Their concern is that superficial venous ablation will raise transmural pressures within the deep venous compartment, with a worsening of venous compliance, transmission of the higher pressures to the microcirculation leading to trophic changes of venous stasis, as well as recurrences.It is important to state at the outset that we do not advocate superficial venous ablation as a treatment for an NIVL. The NIVL has been used by us purely to develop the model for venous return, not to suggest one form of therapy or another for superficial venous disease. A detailed explanation of the responses to different interventions for superficial venous disease based on our model is now presented to address the issues raised.
Gwilym B, Dovell G, Dattani N, et al., 2021, Systematic review and meta-analysis of wound adjuncts for the prevention of groin wound surgical site infection in arterial surgery, European Journal of Vascular and Endovascular Surgery, Vol: 61, Pages: 636-646, ISSN: 1078-5884
Review methodsThis review was undertaken according to established international reporting guidelines and was registered prospectively with the International prospective register of systematic reviews (CRD42020185170). The MEDLINE, EMBASE, and CENTRAL databases were searched using pre-defined search terms without date restriction. Randomised controlled trials (RCTs) and observational studies recruiting patients with non-infected groin incisions for arterial exposure were included; SSI rates and other outcomes were captured. Interventions reported in two or more studies were subjected to meta-analysis.ResultsThe search identified 1 532 articles. Seventeen RCTs and seven observational studies, reporting on 3 747 patients undergoing 4 130 groin incisions were included. A total of seven interventions and nine outcomes were reported upon. Prophylactic closed incision negative pressure wound therapy (ciNPWT) reduced groin SSIs compared with standard dressings (odds ratio [OR] 0.34, 95% CI 0.23 – 0.51; p < .001, GRADE strength of evidence: moderate). Local antibiotics did not reduce groin SSIs (OR 0.60 95% CI 0.30 – 1.21 p = .15, GRADE strength: low). Subcuticular sutures (vs. transdermal sutures or clips) reduced groin SSI rates (OR 0.33, 95% CI 0.17 – 0.65, p = .001, GRADE strength: low). Wound drains, platelet rich plasma, fibrin glue, and silver alginate dressings did not show any significant effect on SSI rates.ConclusionThere is evidence that ciNPWT and subcuticular sutures reduce groin SSI in patients undergoing arterial vascular interventions involving a groin incision. Local antibiotics did not reduce groin wound SSI, although the strength of this evidence is lower. No other interventions demonstrated a significant effect.
Benson R, Nandhra S, Shalhoub J, 2021, Outcomes of vascular and endovascular interventions performed during the COronaVIrus Disease 2019 (COVID-19) pandemic: The Vascular and Endovascular Research Network (VERN) COvid-19 Vascular sERvice (COVER) Tier 2 study, Annals of Surgery, Vol: 273, Pages: 630-635, ISSN: 0003-4932
Objective: The aim of the COVER Study is to identify global outcomes and decision making for vascular procedures during the pandemic.Background data: During its initial peak, there were many reports of delays to vital surgery and the release of several guidelines advising later thresholds for vascular surgical intervention for key conditions.Methods: An international multi-centre observational study of outcomes following open and endovascular interventions.Results: In an analysis of 1,103 vascular intervention (57 centres in 19 countries), 71.6% were elective or scheduled procedures. Mean age was 67 ± 14 years (75.6% male). Suspected or confirmed COVID-19 infection was documented in 4.0%. Overall, in-hospital mortality was 11.0%. (aortic interventions mortality 15.2% [23/151], amputations 12.1% [28/232], carotid interventions 10.7% [11/103], lower limb revascularisations 9.8% [51/521]). Chronic obstructive pulmonary disease (Odds ratio [OR] 2.02, 95% CI 1.30-3.15) and active lower respiratory tract infection due to any cause (OR 24.94, 95% CI 12.57-241.70) ware associated with mortality, whereas elective or scheduled cases were lower risk (OR 0.4, 95% CI 0.22-0.73 and 0.60, 95% CI 0.45-0.98 respectively. After adjustment, antiplatelet (Odds Ratio [OR] 0.503, 95% Confidence Interval [CI]:0.273 - 0.928) and oral anticoagulation (OR 0.411, 95% CI: 0.205 - 0.824) were linked to reduced risk of in-hospital mortality.Conclusions: Mortality following vascular interventions during this period was unexpectedly high. Suspected or confirmed COVID-19 cases were uncommon. Therefore an alternative cause e.g. recommendations for delayed surgery, should be considered. The vascular community must anticipate longer term implications for survival.Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.
COVIDSurg Collaborative, GlobalSurg Collaborative, 2021, SARS-CoV-2 vaccination modelling for safe surgery to save lives: data from an international prospective cohort study., British Journal of Surgery, ISSN: 0007-1323
Machin M, Salim S, Tan M, et al., 2021, Surgical and non-surgical approaches in the management of lower limb post-thrombotic syndrome, Expert Review of Cardiovascular Therapy, Vol: 19, Pages: 191-200, ISSN: 1477-9072
Introduction: Post-thrombotic syndrome (PTS) is a common lifelong condition affecting up to 50% of those suffering from deep vein thrombosis (DVT). PTS compromises function and quality of life with subsequent venous ulceration in up to 29% of those affected.Areas covered: A literature review of surgical and non-surgical approaches in the prevention and treatment of PTS was undertaken. Notable areas include the use of percutaneous endovenous interventions and the use of graduated compression stockings (GCS) after acute proximal DVT.Expert opinion: In patients with acute iliofemoral DVT, we think it is important to have a frank conversation with the patient about catheter-directed thrombolysis, aiming to reduce the severity of PTS experienced. We advocate ultrasound-accelerated thrombolysis with adjunctive procedures, such as deep venous stenting for proximal iliofemoral DVT. For patients with isolated femoral DVT, we believe that anticoagulation and GCS should be recommended. In patients with established PTS, we recommend GCS for symptomatic relief. We recommend that patients engage in regular exercise where possible with the prospect of gaining symptomatic relief. For those with severe PTS that has a significant effect on quality of life, we discuss the patient’s case at a multi-disciplinary team meeting to plan for endovenous intervention.
DeLago A, Singh H, Rupal A, et al., 2021, Intracerebral Hemorrhage Across the United States: Incidence and Mortality Trends From 1990 to 2017, Publisher: LIPPINCOTT WILLIAMS & WILKINS, ISSN: 0039-2499
Normahani P, Anwar IY, Courtney A, et al., 2021, Factors associated with infrainguinal bypass graft patency at 1-year; a retrospective analysis of a single centre experience, Perfusion (United Kingdom), Vol: 37, Pages: 276-283, ISSN: 1477-111X
Introduction:The aim of this study was to identify factors associated with primary graft patency 1 year following open lower limb revascularisation (LLR) at a tertiary referral vascular service.Methods:A retrospective analysis of patients undergoing infra-inguinal bypass surgery between January 2016 and May 2017 at a tertiary vascular centre (St Mary’s Hospital, London) was performed. Data regarding patient demographics, comorbidities, type of operation and post-operative anti-thrombotic strategy were collected. Quality of run-off score was assessed from pre-operative imaging.Results:Seventy-seven cases were included in the analysis. Overall, the primary patency rate at 1-year was 63.6% (n = 49/77) and the secondary patency rate was 67.5% (n = 52/77). Independent variables with statistically significant inferior patency rates at 1-year were (1) bypasses with below knee targets (p = 0.0096), (2) chronic limb threatening ischaemia indication (p = 0.038), (3) previous ipsilateral revascularisation (p < 0.001) and (4) absence of hypertension history (p = 0.041). There was also a trend towards significance for American Society of Anesthesiologists (ASA) grade (p = 0.06). Independent variables with log-rank test p values of <0.1 were included in a Cox proportional hazards model. The only variable with a statistically significant impact on primary patency rates was previous open or endovascular ipsilateral revascularisation (HR 2.44 (1.04–5.7), p = 0.04).Conclusion:At 1-year follow-up, previous ipsilateral revascularisation was the most significant factor in affecting patency rates. Patients in this subgroup should therefore be deemed high-risk, which should be reflected in the informed consent and peri-operative management.
Al-Khayatt B, Salciccioli J, Marshall D, et al., 2021, Paradoxical impact of socioeconomic factors on outcome of atrial fibrillation in Europe: trends in incidence and mortality from atrial fibrillation, European Heart Journal, Vol: 42, Pages: 847-857, ISSN: 0195-668X
Aims: To understand the changing trends in Atrial Fibrillation (AF) incidence and mortality acrossEurope from 1990 to 2017, and how socioeconomic factors and sex differences play a role.Methods and Results: We performed a temporal analysis of data from the 2017 Global Burden ofDisease Database for 20 countries across Europe using Joinpoint regression analysis. Age-adjustedincidence, mortality and mortality to incidence ratios (MIRs) to approximate case fatality rate arepresented. Incidence and mortality trends were heterogenous throughout Europe, with Austria,Denmark and Sweden experiencing peaks in incidence in the middle of the study period. Mortalityrates were higher in wealthier countries with the highest being Sweden for both men and women (8.83and 8.88 per 100,000, respectively) in 2017. MIRs were higher in women in all countries studied,with the disparity increasing the most over time in Germany (43.6% higher in women versus men in1990 to 74.5% higher in women in 2017).Conclusion: AF incidence and mortality across Europe did not show a general trend, but uniquepatterns for some nations were observed. Higher mortality rates were observed in wealthier countries,potentially secondary to a survivor effect where patients survive long enough to suffer from AF andits complications. Outcomes for women with AF were worse than men, represented by higher MIRs.This suggests there is widespread healthcare inequality between the sexes across Europe, or that thereare biological differences between them in terms of their risk of adverse outcomes from AF
Jani CT, Singh H, Al Omari O, et al., 2021, A comparison of the burden of leukemia amongst European Union 15+countries, 1990-2019, Congress of the European-Society-for-Medical-Oncology (ESMO), Publisher: ELSEVIER, Pages: S784-S784, ISSN: 0923-7534
Hanbury GH, Jani CT, Al Omari O, et al., 2021, Trends in disease burden from hepatocellular carcinoma: An observational study of European union 15+countries, Congress of the European-Society-for-Medical-Oncology (ESMO), Publisher: ELSEVIER, Pages: S827-S827, ISSN: 0923-7534
Rajkumar C, Cook C, Shalhoub J, et al., 2020, Technical considerations facilitating right-sided axillary artery access for transcatheter aortic valve replacement using the Edwards Sapien 3 and Ultra valves, Catheterization and Cardiovascular Interventions, Vol: 96, Pages: E747-E754, ISSN: 1522-1946
Trans-Axillary Transcatheter Aortic Valve Replacement (TAVR) has become established as the safest arterial approach when femoral arterial anatomy is unfavourable. Although a left sided axillary approach is generally preferred, patient specific factors may require use of the right axillary artery. In this case series we describe procedural modifications which are required to overcome the challenge of restricted space in the ascending aorta for in-situ valve preparation of balloon-expandable valve systems when a right sided trans-Axillary approach is taken. These steps permit implantation of both the Edwards LifeSciences Sapien 3 and Ultra prostheses via the right trans-Axillary approach, allowing patients a greater range of valve options when this arterial route is required for TAVR.
Normahani P, Shalhoub J, Narayanan S, 2020, Repurposing the systemic venous return model for conceptualisation of chronic venous insufficiency and its management, Phlebology, Vol: 35, Pages: 749-751, ISSN: 0268-3555
Yang D, Salciccioli J, Marshall D, et al., 2020, Trends in malignant melanoma mortality in 31 countries from 1985 to 2015, British Journal of Dermatology, Vol: 183, Pages: 1056-1064, ISSN: 0007-0963
BackgroundMalignant melanoma (MM) causes the highest absolute number of deaths among skin cancers. An up‐to‐date analysis of international MM mortality trends is required for assessing the burden of disease, and may support the assessment of the effectiveness of new diagnostic, therapeutic and preventative strategies.ObjectivesTo report MM mortality trends between 1985 and 2015 using the World Health Organization (WHO) Mortality Database.Materials and methodsWe used country‐level MM mortality data from the WHO Mortality Database for all countries with high usability death registration data. Mortality trends were described using Joinpoint regression modelling.ResultsThirty‐one countries met the inclusion criteria. All countries, except the Czech Republic, demonstrated increased age‐standardized death rates (ASDRs) in males over the observation period. More countries exhibited decreased or stable MM mortality in females. The median mortality rate for 2013–2015 was 2·57 deaths per 100 000 for males and 1·55 per 100 000 for females. Australia and Norway had the highest ASDRs for males (5·72 per 100 000 and 4·55 per 100 000, respectively). Norway and Slovenia had the highest ASDRs for females (3·02 per 100 000 and 2·58 per 100 000, respectively). MM mortality was greater for males than females in all countries, with sex disparity increasing across the period. Disparity in mortality between older and younger cohorts in several countries was also found.ConclusionsAn overall increase in MM mortality over the past 30 years was observed. However, there was notable variation in mortality trends between countries, as well as between males and females, and between different age groups.What is already known about this topic?Malignant melanoma (MM) has the highest mortality among skin cancers.The majority of MM cases can be attributed to known, modifiable risk factors.The incidence of MM is reported to have increased over past decade
Shalhoub J, Lawton R, Gohel M, et al., 2020, Compression stockings in addition to low-molecular-weight heparin to prevent venous thromboembolism in surgical inpatients requiring pharmacoprophylaxis: the GAPS non-inferiority RCT, Health Technology Assessment, Vol: 24, Pages: 1-117, ISSN: 1366-5278
BackgroundPatients admitted to hospital for surgery are at increased risk of venous thromboembolism (VTE). Pharmaco-thromboprophylaxis and mechanical prophylaxis (usually graduated compression stockings (GCS) or intermittent pneumatic compression) has been shown to reduce the incidence of VTE. The evidence base supporting The National Institute for Health and Care Excellence recommendation for the use of graduated compression stockings for VTE prevention in the UK has recently been challenged. It is unclear if the risks and costs associated with graduated compression stockings are justified for deep vein thrombosis (DVT) prevention in moderate and high risk elective surgical inpatients receiving low dose low-molecular-weight heparin (LMWH) pharmaco-thromboprophylaxis..Objective(s)The primary objective was to compare the VTE rate in elective surgical inpatients at moderate and high risk for VTE receiving either; graduated compression stockings and low dose low molecular weight heparin (standard care), or low dose low molecular weight heparin alone (intervention).DesignA pragmatic, multicentre, prospective, non-inferiority, randomised controlled trial (RCT).SettingSecondary care National Health Service (NHS hospitals. in the UKParticipantsPatients aged ≥ 18 years, assessed as moderate or high risk of VTE according to the NHS England VTE Risk Assessment Tool (or the Trust equivalent based on this form), who were not contraindicated to LMWH or GCS were deemed eligible to take part.InterventionsParticipants were randomised 1:1 to either LMWH or LMWH and GCS.Main outcome measuresThe primary outcome measure was VTE up to 90 days after surgery. A combined endpoint of duplex ultrasound-proven new lower-limb DVT (symptomatic or asymptomatic) plus imaging confirmed symptomatic pulmonary embolism (PE). Secondary outcomes included, quality of life, compliance with GCS and LMWH during admission, and all-cause mortality.Results1905 participants underwent randomisation and 185
Benson R, Nandra S, on behalf of the Vascular and Endovascular Research Network, et al., 2020, Study protocol for COvid-19 Vascular sERvice (COVER) study: The impact of the COVID-19 pandemic on the provision, practice and outcomes of vascular surgery, PLoS One, ISSN: 1932-6203
BackgroundThe novel Coronavirus Disease 2019 (COVID-19) pandemic is having a profound impact on global healthcare. Shortages in staff, operating theatre space and intensive care beds has led to a significant reduction in the provision of surgical care. Even vascular surgery, often insulated from resource scarcity due to its status as an urgent specialty, has limited capacity due to the pandemic. Furthermore, many vascular surgical patients are elderly with multiple comorbidities putting them at increased risk of COVID-19 and its complications. There is an urgent need to investigate the impact on patients presenting to vascular surgeons during the COVID-19 pandemic.Methods and AnalysisThe COvid-19 Vascular sERvice (COVER) study has been designed to investigate the worldwide impact of the COVID-19 pandemic on vascular surgery, at both service provision and individual patient level. COVER is running as a collaborative study through the Vascular and Endovascular Research Network (VERN), an independent, international vascular research collaborative with the support of numerous national and international organisations). The study has 3 ‘Tiers’: Tier 1 is a survey of vascular surgeons to capture longitudinal changes to the provision of vascular services within their hospital; Tier 2 captures data on vascular and endovascular procedures performed during the pandemic; and Tier 3 will capture any deviations to patient management strategies from pre-pandemic best practice. Data submission and collection will be electronic using online survey tools (Tier 1: SurveyMonkey® for service provision data) and encrypted data capture forms (Tiers 2 and 3: REDCap® for patient level data). Tier 1 data will undergo real-time serial analysis to determine longitudinal changes in practice, with country-specific analyses also performed. The analysis of Tier 2 and Tier 3 data will occur on completion of the study as per the pre-specified statistical analysis plan.
Parvez A, Salciccioli J, DeLago A, et al., 2020, Abstract 13795: Race and gender differences in mortality from atrial fibrillation in the United States: 1999 to 2018, American Heart Association Scientific Sessions 2020, Publisher: Lippincott, Williams & Wilkins, ISSN: 0009-7322
Goodall R, Armstrong A, Hughes W, et al., 2020, Trends in decubitus ulcer disease burden in European Union 15+ countries 1990-2017, Plastic and Reconstructive Surgery Global Open, Vol: 8, Pages: 1-9, ISSN: 2169-7574
BackgroundDecubitus ulcers (DU) are a common pathology with significant morbidity and financial implications for health services globally. This study aims to compare the burden of DU across European Union (EU) 15+ countries between 1990-2017.MethodsAge-standardised incidence, mortality and disability-adjusted life-years (DALYs) rates per 100,000 were extracted from the Global Burden of Disease Study online data repository for EU15+ countries (a group of 19 countries with comparable health expenditure, including the United States, Canada, the United Kingdom and Australia). Joinpoint regression analysis was used to describe trends. ResultsThe incidence of DU increased between 1990-2017 in 15 of 19 EU15+ countries for both males and females. Mortality from DU decreased over the time period analysed in the majority of EU15+ countries: only in Denmark, Finland and Germany were increasing mortality rates observed. Decreasing DALY rates were generally observed, with the largest decreases observed in Ireland for males and females. Denmark and Germany were the only countries to demonstrate unfavourable trends in mortality, incidence and DALYs between 1990-2017 for males and females. The United States, the Netherlands and France were the only EU15+ countries in which improving disease burden was identified between 1990-2017 for all parameters assessed.ConclusionIncidence of DU is increasing in EU15+ countries, whereas mortality rates and DALYs are improving. The trends in disease burden in Denmark and Germany have followed contrasting and unfavourable trends. investigation into these trends is called for.
Hughes W, Goodall R, Salciccioli J, et al., 2020, Trends in lower limb amputation incidence in European Union 15+ Countries 1990-2017, European Journal of Vascular and Endovascular Surgery, Vol: 60, Pages: 602-612, ISSN: 1078-5884
Objective: Lower extremity amputation (LEA) carries significant mortality, morbidity and health economic burden. In the Westernworld,it most commonly results from complications of peripheral arterial occlusive disease (PAOD) or diabetic foot disease. Incidence of PAOD has declined in Europe,the United States and parts of Australasia.We aimed to assess trends in LEA incidence in European Union (EU15+) countries for the years 1990 to 2017. Design: Observational study using data obtained from the 2017 Global Burden of Disease (GBD) study. Materials: GBD Results Tool: http://ghdx.healthdata.org/gbd-results-too. Methods: Age-standardised incidence rates (ASIRs) for LEA (stratified into toe amputation,and LEA proximal to toes) were extracted from the GBD Results Tool for EU15+ countries foreach ofthe years 1990-2017.Trends were analysed using Join point regression analysis. Results: Between 1990 and 2017, variable trends in the incidence of LEA were observedin EU15+ countries. For LEAs proximal to toes, increasing trends were observed in 6 of 19 countries anddecreasing trends in 9 of 19 countries, with 4 countries showing varying trendsbetween sexes. For toe amputation, increasing trends were observed in 8 of 19 countries and decreasing trends in 8 of 19 countries for both sexes, with 3 countries showing varying trendsbetween sexes. Australia hadthe highest ASIRs for both sexes in all LEAs at all time 6 points, with steadily increasing trends. The USA observed the greatest reduction all LEAsin both sexes over the time periodanalysed (LEAs proximal to toes: females -22.93%, males -29.76%; toe amputation: females -29.93%, males -32.67%). The greatest overall increase in incidence was observed in Australia. Conclusions: Variable trends in LEA incidence were observed across EU15+ countries. These trends do not reflect previously observed reductions in incidence of PAO Dover the same t
Benson RA, The VERN COVER study collaborative, Shalhoub J, 2020, Global impact of the first coronavirus disease 2019 (COVID-19) pandemic wave on vascular services, British Journal of Surgery, Vol: 107, Pages: 1396-1400, ISSN: 0007-1323
This online structured survey has demonstrated the global impact of the COVID‐19 pandemic on vascular services. The majority of centres have documented marked reductions in operating and services provided to vascular patients. In the months during recovery from the resource restrictions imposed during the pandemic peaks, there will be a significant vascular disease burden awaiting surgeons.
Al-Balah A, Goodall R, Salciccioli JD, et al., 2020, Mortality from abdominal aortic aneurysm: trends in European Union 15+countries from 1990 to 2017, British Journal of Surgery, Vol: 107, Pages: 1459-1467, ISSN: 0007-1323
BackgroundThis observational study assessed trends in abdominal aortic aneurysm (AAA) death rates in European Union (EU) 15+ countries for the years 1990 to 2017.MethodsAge‐standardized death rates (ASDRs) were extracted from the Global Burden of Disease Study Global Health Data Exchange. Trends were analysed using joinpoint regression analysis.ResultsBetween 1990 and 2017, ASDRs from AAA decreased in all 19 EU15+ countries for women, and in 18 of 19 countries for men. Increasing AAA mortality was observed only for men in Greece (+5·3 per cent). The largest relative decreases in ASDR between 1990 and 2017 were observed in Australia (men –65·6 per cent, women –50·4 per cent) and Canada (men –60·8 per cent, women –48·6 per cent). Over the 28‐year interval, the smallest decreases in ASDR for women were noted in Greece (–2·3 per cent) and in Italy (–2·5 per cent). In 2017, the highest mortality rates were observed in the UK for both men and women (7·5 per 100 000 and 3·7 per 100 000 respectively). The lowest ASDR was observed in Portugal for men (2·8 per 100 000) and in Spain for women (1·0 per 100 000). ASDRs for AAA in 2017 were higher for men than women in all 19 EU15+ countries. The most recent trends demonstrated increasing AAA ASDRs in 14 of 19 countries for both sexes; the increases were relatively small compared with the improvements in the preceding years.ConclusionThis observational study identified decreasing mortality from AAA across EU15+ countries since 1990. The most recent trends demonstrated relatively small increases in AAA mortality across the majority of EU15+ countries since 2012.
Dattani N, Shalhoub J, Nandhra S, et al., 2020, Reducing the risk of venous thromboembolism following superficial endovenous treatment: a UK and Republic of Ireland consensus study, Phlebology, Vol: 35, Pages: 706-714, ISSN: 0268-3555
ObjectivesVenous thromboembolism is a potentially fatal complication of superficial endovenous treatment. Proper risk assessment and thromboprophylaxis could mitigate this hazard; however, there are currently no evidence-based or consensus guidelines. This study surveyed UK and Republic of Ireland vascular consultants to determine areas of consensus.MethodsA 32-item survey was sent to vascular consultants via the Vascular and Endovascular Research Network (phase 1). These results generated 10 consensus statements which were redistributed (phase 2). ‘Good’ and ‘very good’ consensus were defined as endorsement/rejection of statements by >67% and >85% of respondents, respectively.ResultsForty-two consultants completed phase 1. This generated seven statements regarding risk factors mandating peri-procedural pharmacoprophylaxis and three statements regarding specific pharmacoprophylaxis regimes. Forty-seven consultants completed phase 2. Regarding venous thromboembolism risk factors mandating pharmacoprophylaxis, ‘good’ and ‘very good’ consensus was achieved for 5/7 and 2/7 statements, respectively. Regarding specific regimens, ‘very good’ consensus was achieved for 3/3 statements.ConclusionsThe main findings from this study were that there was ‘good’ or ‘very good’ consensus that patients with any of the seven surveyed risk factors should be given pharmacoprophylaxis with low-molecular-weight heparin. High-risk patients should receive one to two weeks of pharmacoprophylaxis rather than a single dose.
Jani C, Marshall D, Goodall R, et al., 2020, Persistent sex-differences in lung cancer mortality between 2001 and 2017 in the US and EU, ESMO Virtual Congress, Publisher: Elsevier, Pages: S1036-S1037, ISSN: 0923-7534
BackgroundThe lung is the most common site of cancer and has the highest worldwide cancer-related mortality. Advancements in lung cancer screening, new therapeutics, and guideline driven care over the past two decades have resulted in improvements in mortality. Few studies have reported on lung cancer trends in the 21st century. This study assessed the difference between lung cancer mortality by gender in the United States (US) and European Union (EU).MethodsWe utilized the World Health Organization (WHO) Mortality Database for European mortality data and Center for Disease Control (CDC) Wonder database for US mortality data. We extracted lung cancer mortality data from 2000 to 2017 based on ICD 10 system. Crude mortality rates were dichotomized by sex and reported by year. We computed Age Standardized Death Rates (ASDRs) per 100,000 population using the World Standard Population (and USA standard population for CDC mortality). We computed the ratio of male to female mortality over the observation period.ResultsWe analyzed data from a total of 26 EU countries and the US, of which 6 countries had data till 2017, 12 till 2016, 7 till 2015 and 2 till 2014. All countries had greater mortality in men compared to women in all years. All countries had an overall decrease in the ratio of male-to-female mortality over the observation period. Specifically, in 2000, the median male-to-female mortality was 5.35 (IQR 3.65, 6.06) and for the most recent observation the median male-to-female mortality ratio was 2.26 (1.92, 4.05). The countries with the greatest current disparity in lung cancer mortality were Lithuania (5.51), Latvia (5.00), and Bulgaria (4.4). The countries with the smallest difference in mortality between sexes were Sweden (1.1), Denmark (1.13), United Kingdom (1.39). The median percentage change for all countries was – 44.45 (-50.44, - 30.56). The countries with the greatest percentage change were Spain (- 55.19), Belgium (-55.18), Cyprus (-53.64). The cou
Goodall R, Langridge B, Lane T, et al., 2020, A narrative review of the use of neuromuscular electrical stimulation in individuals with diabetic foot ulceration, International Journal of Lower Extremity Wounds, Vol: 19, Pages: 242-250, ISSN: 1534-7346
This review aims to summarise the evidence reported on the use of neuromuscular electrical stimulation (NMES) in individuals with diabetic foot ulceration (DFU).A systematic search of EMBASE and MEDLINE databases was performed in February 2019, using search terms relating to the domains DFU and NMES. All primary evidence assessing outcomes of NMES in DFU were included. Of 344 references obtained from database searching, seven met the inclusion criteria and included a total of 140 participants, 77 of whom had DFU. All included studies used prospective designs. Two studies demonstrated improvements in chronic ulcer healing with NMES use, however in each study, only three of the included participants had DFU and subgroup analyses based on ulcer aetiology was omitted. The remaining five studies were produced by the same research group and positive effects of NMES (in combination with heat therapy) on DFU healing were consistently demonstrated. They reported significantly better healing rates with NMES in DFU than in non-diabetic wounds of a similar grade (Healing rate: 70.0±32.3% in DFU vs. 38.4±22.3% in non diabetic ulcers (p<0.01)). These studies did not provide data assessing the isolated effects of NMES without concomitant heat exposure. Data on device tolerability and compliance were lacking. The existing data supports a potential role for NMES in individuals with DFU, however the identified studies inadequately controlled for confounding and were underpowered. Given the significant morbidity and mortality associated with DFU, higher quality evidence is needed to assess the adjunctive role for NMES in this group.
Jani CT, Salciccioli I, Marshall DC, et al., 2020, Trends in breast cancer mortality between 2001 and 2017: An observational study in EU and UK, ESMO Virtual Congress, Publisher: Elsevier, Pages: S369-S369, ISSN: 0923-7534
Li W, Kemos P, Salciccioli J, et al., 2020, Socioeconomic factors associated with liver-related mortality from 1985 to 2015 in 36 developed countries, Clinical Gastroenterology and Hepatology, Vol: 19, Pages: 1698-1707.e13, ISSN: 1542-3565
Background & AimsThere is increasing disparity in liver-related mortality worldwide. Although there are many biologic and lifestyle risk factors for liver-related mortality, the effects of inequalities in social and economic determinants of health have received little attention. We investigated changes in liver-related mortality from 1985 through 2015 in 36 countries, using 4 international health and economic databases, and searched for socioeconomic factors that might influence these trends.MethodsWe collected information on sex- and country-specific liver-related mortality from countries with designated high usability data from the World Health Organization mortality database. We obtained data on alcohol consumption per capita, percentage of adults with body mass index greater than 30kg/m2, health expenditure per capita, gross domestic product per capita, Gini index, national unemployment estimates and diabetes prevalence from the World Health Organization global health observatory data repository, the World Bank database, and the International Diabetes Federation. We examined changes in mortality using Joinpoint regression analysis. Univariate analysis and a mixed-effects linear model were used to identify factors associated with liver-related mortality.ResultsFrom 1985 to 2015, mean liver-related deaths per 100,000 persons increased in men, from 23.8 to 26.1, and women, from 9.7 to 11.9. Increased liver-related mortality was associated with male sex, high level of alcohol consumption, obesity, and indicators of national wealth and government health expenditure gross domestic product or government expenditure on health.ConclusionsIn addition to established risk factors for liver mortality, this study identified addressable economic factors associated with liver-related mortality trends. Healthcare professionals and policy makers may wish to consider these factors to reduce liver-related mortality.
Goodall R, Ellauzi J, Tan K, et al., 2020, A systematic review of the impact of foot-care education on self-efficacy and self-care in patients with diabetes, European Journal of Vascular and Endovascular Surgery, Vol: 60, Pages: 282-292, ISSN: 1078-5884
Objectives: Assess the evidence supporting the impact of patient foot-care education on self-efficacy, self-care behaviour and self-care knowledge in individuals with diabetes.Design: Systematic review registered prospectively on the PROSPERO database (CRD42019106171).Materials and Methods: Ovid EMBASE and MEDLINE databases were searched from 1946 to end of March 2019, using search terms related to the domains diabetic foot, patient education, self-efficacy, self-care behaviour and self-care knowledge. All included studies were prospective, randomised controlled trials that assessed foot-care education interventions in individuals with diabetes and recorded an outcome related to self-efficacy, self-care behaviour and/or self-care knowledge.Results: 13 randomised controlled trials were included, reporting on a total of 3,948 individuals. The risk of bias was high or unclear in 11 of the 13 included studies, and low in 2 studies. Both the education-interventions delivered, and the outcome assessment tools used were heterogenous across included studies: meta-analysis was therefore not performed. Eight of 11 studies identified significantly better foot self-care behaviour scores in individuals randomised to education compared with controls. Self-efficacy scores were significantly better in education groups in four of five studies reporting this primary outcome. Foot-care knowledge was significantly better in intervention versus control in three of seven studies. In general, studies assessing secondary end-points including quality of life and ulcer/amputation incidence tended not to identify significant clinical improvements.Conclusion: The available evidence is of inadequate quality to reliably conclude that foot-care education has a positive impact on foot self-care behaviour and self-efficacy in individuals with diabetes. Quality data supporting accompanying benefits on quality of life or ulcer/amputation incidence are also lacking and should be considered as an impor
Rolls A, Sudarsanam A, Luo X, et al., 2020, COVID-19 and vascular surgery at a Central London teaching hospital, British Journal of Surgery, Vol: 107, Pages: e311-e312, ISSN: 0007-1323
Tan K, Goodall R, Hughes W, et al., 2020, A methodological assessment of diabetic foot syndrome clinical practice guidelines, European Journal of Vascular and Endovascular Surgery, Vol: 60, Pages: 274-281, ISSN: 1078-5884
Objectives: Diabetic foot syndrome (DFS) contributes to significant morbidity in diabetic patients. Diagnostic and therapeutic approaches to DFS may be summarised in clinical practice guidelines (CPGs) to aid clinical practice but may only benefit patients if the CPG is of high quality. This study determines the methodological quality of DFS CPGs using a validated assessment tool to identify CPGs adequate for use in clinical practice.Methods: Medline, EMBASE and CPG databases were searched to 31st May 2019. Reference lists were also searched. Full text English evidence-based DFS CPGs were included. CPGs based on expert consensus, guideline summaries or only available if purchased were excluded. Four reviewers independently assessed methodological quality using Appraisal of Guidelines for Research and Evaluation II instrument. An overall guideline assessment scaled score of ≥80% was considered of adequate quality to recommend use.Results: 16 CPGs were identified. Good inter-reviewer reliability (ICC 0.985, 95% CI 0.980-0.989) was achieved. Poor scores were noted in domains 2 (stakeholder involvement), 5 (applicability), and 6 (editorial independence). Significant methodological heterogeneity was observed in all domains with the most noted in domain 6 (mean scaled score 43.2±32.1%). Four CPGs achieved overall assessment scores of ≥80%.Conclusion: Four CPGs were considered adequate for clinical practice based on methodological quality. However, elements of methodological quality were still lacking, and all CPGs showed areas for improvement, potentially through increased multidisciplinary team involvement and trial application of recommendations. Methodological rigour may be improved using structured approaches with validated CPG creation tools in the future. Future work should also assess recommendation accuracy using available validated assessment tools.
Dattani N, Shalhoub J, Nandhra S, et al., 2020, Corrigendum to Reducing the risk of venous thromboembolism following superficial endovenous treatment: A UK and Republic of Ireland consensus study, Phlebology, Vol: 35, Pages: 844-844, ISSN: 0268-3555
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