91 results found
Mamidanna R, Ni Z, Anderson O, et al., 2016, Surgeon Volume and Cancer Esophagectomy, Gastrectomy, and Pancreatectomy: A Population-based Study in England, Annals of Surgery, Vol: 263, Pages: 727-732, ISSN: 1528-1140
Objective: The aim of the study was to assess whether there is a proficiency curve-like relationship between surgeon volume and operative mortality and determine the minimum surgeon volume for optimum operative mortality.Background: The inverse relationship between hospital volume and operative mortality is well-established for esophageal, gastric, and pancreatic cancer. The recommended minimum surgeon volumes are however uncertain.Methods: We retrieved data on esophagectomies, gastrectomies, and pancreatectomies for cancer from the NHS Hospital Episodes Statistics database from April 2000 to March 2010. We defined mortality as in-hospital death within 30 days of surgery. We determined whether there was a proficiency curve relationship by inspecting surgeon volume-mortality graphs after adjusting for patient age, sex, socioeconomic, and comorbidity indices. We then statistically determined the minimum surgeon volume that produced a mortality rate insignificantly different from the optimum of the curve.Results: Sixteen thousand five hundred seventy-two esophagectomies, 12,622 gastrectomies, and 9116 pancreatectomies were examined. Surgeon volume ranged from 2 to 29 esophagectomies, from 1 to 14 gastrectomies, and from 2 to 31 pancreatectomies per surgeon per year. We demonstrated a proficiency relationship between surgeon volume and mortality in esophageal, gastric, and pancreatic cancer surgery. Each additional case of esophagectomy, gastrectomy, and pancreatectomy would reduce 30-day mortality odds by 3.4%, 7.2%, and 4.1%, respectively. However, as surgeon volume increased, mortality rate continued to improve. Therefore, we were unable to recommend minimum surgeon volume.Conclusions: Mortality after resections for esophageal, gastric, and pancreatic cancer falls as surgeon volume rises up to 30 cases. Within this range, we did not demonstrate any statistical threshold that could be recommended as a minimum volume target.
Anderson O, Carr R, Harbinson M, et al., 2016, Development and validation of a lipase nasogastric tube position test, BMJ Open Gastroenterology, Vol: 2, ISSN: 2054-4774
BackgroundNasogastric tube position should be checked every day by either aspirate pH or chest radiography to prevent fatal misplaced feeding into the lungs. Many patients do not have acidic gastric aspirates and require daily chest radiographs. We developed and validated a lipase test that was compatible with non-acidic gastric aspirates.MethodsWe conducted evaluations of diagnostic test accuracy at a teaching hospital in development and validation stages. Development: We collected gastric and lung aspirates from 34 consecutive patients. We measured pH and human gastric lipase activity in the laboratory. These data helped us develop the lipase test. Ingenza Ltd (Roslin, Scotland) created tributyrin-coated pH test paper, which human gastric lipase converted into butyric acid, thus correcting false negatives. Validation: We tested nasogastric feeding tube aspirates from 36 consecutive patients with pH and lipase tests, using chest radiography or trial by use as the reference standard.ResultsDevelopment: We demonstrated human gastric lipase activity in the non-acidic stomach aspirates. Validation: The accuracy of the lipase test (sensitivity 97.2%, specificity 100%) was significantly better than pH (sensitivity 65.7%, specificity 100%, p<0.05).ConclusionsWhen nasogastric tube stomach aspirates were not acidic and pH was falsely negative, the lipase test showed a true positive and was significantly more accurate.
Anderson O, Hanna GB, 2015, Effectiveness of the CareCentre (R) at improving contact precautions: randomized simulation and clinical evaluations, Journal of Hospital Infection, Vol: 92, Pages: 332-336, ISSN: 1532-2939
BackgroundBedside hygiene is important to reduce healthcare-associated infection rates. The CareCentre® is an end-of-hospital-bed table, housing: alcohol-based hand rub, gloves, aprons, waste bin, and an ergonomic writing surface.AimTo determine the effectiveness of the CareCentre at improving bedside hygiene.MethodsIn the randomized cross-over simulation evaluation, 20 participants used the CareCentre and standard conditions to perform common bedside tasks. In the randomized cross-over clinical evaluation, nine pairs of acute adult hospital ward bays received CareCentres and standard conditions for one week each. Researchers measured adherence to the World Health Organization's ‘my five moments for hand hygiene’ and donning and disposing of gloves and aprons at the bedside.FindingsAdherence to hand hygiene guidelines improved from 48% to 67% (P = 0.04) in the simulation and from 14% to 40% (P < 0.001) in the clinical evaluation. Donning and disposing of gloves at the bedside improved from 19% to 79% (P < 0.001) in the simulation and from 30% to 65% (P = 0.014) in the clinical evaluation. Donning and disposing of aprons at the bedside improved from 14% to 78% (P < 0.001) in the simulation and from 10% to 53% (P = 0.180) in the clinical evaluation.ConclusionThe CareCentre improved bedside hygiene and might help reduce healthcare-associated infection rates as part of a multimodal strategy.
Johnston M, Arora S, Anderson O, et al., 2015, Escalation of care in surgery: a systematic risk assessment to prevent avoidable harm in hospitalized patients, Annals of Surgery, Vol: 261, Pages: 831-838, ISSN: 0003-4932
Objective: To systematically risk assess and analyze the escalation of care process in surgery so as to identify problems and provide recommendations for intervention.Background: The ability to escalate care appropriately when managing deteriorating patients is a hallmark of surgical competence and safe postoperative care. Healthcare-Failure-Mode-Effects-Analysis (HFMEA) is a methodology adapted from safety-critical industries, which allows for hazardous process failures to be prospectively identified and solutions to be recommended.Methods: Forty-two hours of ethnographic observations on surgical wards in 3 London hospitals (phase 1) formed the basis of an escalation process diagram. A risk-assessment survey identified failures associated with process steps and attributed hazard scores (phase 2). Patient safety and clinical risk experts validated hazard scores through a group consensus meeting (phase 3). Hazardous failures were taken forward to multidisciplinary HFMEA where cause analysis was applied and interventions were recommended (phase 4).Results: Observations identified 33 steps in the escalation process. The risk-assessment survey (30 surgical staff members, 100% response) and expert consensus group identified 18 hazardous failures associated with these steps. The HFMEA team identified 3 adequately controlled failures; therefore, 15 were subjected to cause analysis. Outdated communication technology, understaffing, and hierarchical barriers were identified as root causes of failure. Participants recommended interventions based on these findings including defined escalation protocols, human factors education, enhanced communication technology, and improved clinical supervision.Conclusions: Failures in the escalation process amenable to intervention were systematically identified. This mapping of the escalation process will allow tailored interventions to enhance surgical training and patient safety.
Ahmed K, Anderson O, Jawad M, et al., 2015, Design and validation of the surgical ward round assessment tool: a quantitative observational study, AMERICAN JOURNAL OF SURGERY, Vol: 209, Pages: 682-688, ISSN: 0002-9610
Johnston M, Arora S, Anderson O, et al., 2015, Uncovering Failures in the Recognition and Management of Post-Operative Complications: a Systematic Risk Assessment of a Safety-Critical Process, International Surgical Congress of the Association-of-Surgeons-of-Great-Britain-and-Ireland (ASGBI), Publisher: WILEY-BLACKWELL, Pages: 87-87, ISSN: 0007-1323
Mamidanna R, Ni Z, Anderson O, et al., 2014, Surgeon caseload and oesophagectomy, gastrectomy and pancreatectomy for cancer: a population based study, Annual Meeting of the Association-of-Upper-Gastrointestinal-Surgeons-of-Great-Britain-and-Ireland, Publisher: WILEY-BLACKWELL, Pages: 5-5, ISSN: 0007-1323
Norris B, West J, Anderson O, et al., 2014, Taking ergonomics to the bedside - A multi-disciplinary approach to designing safer healthcare, APPLIED ERGONOMICS, Vol: 45, Pages: 629-638, ISSN: 0003-6870
West J, Matthews E, Anderson O, 2013, Designing Out Medical Error (DOME), University-of-Minnesota's Design of Medical Devices (DMD) Conference, Publisher: ASME, ISSN: 1932-6181
West J, Matthews E, Anderson O, 2013, Designing Out Medical Error (DOME) (poster), Design of Medical Devices
Anderson A, Davis R, Hanna G, et al., 2013, Surgical adverse events: A systematic review, ISQUA
Anderson O, 2012, The enzymatic nasogastric tube position test (oral presentation), National Nurses Nutrition Group (NNNG)
Anderson O, West J, Walker S, et al., 2012, A continuum of Design for Patient Safety research (oral presentation), International Society of Quality and Safety in Healthcare (ISQua), Geneva, Switzerland
Anderson O, Brodie A, Vincent CA, et al., 2012, A Systematic Proactive Risk Assessment of Hazards in Surgical Wards A Quantitative Study, ANNALS OF SURGERY, Vol: 255, Pages: 1086-1092, ISSN: 0003-4932
Anderson O, West J, Davey G, et al., 2012, The CareCentre™: a cluster-randomised crossover clinical trial (oral presentation), Association of Surgeons of Great Britain and Ireland (ASGBI), Liverpool, UK
Anderson O, Shamsi A, Mahroof A, et al., 2012, Improving the accuracy of respiratory rate measurement and documentation (poster), Association of Surgeons of Great Britain and Ireland (ASGBI), Liverpool, UK
Anderson O, Davis R, Hanna GB, et al., 2012, Surgical adverse events: a systematic review (oral presentation), Association of Surgeons of Great Britain and Ireland (ASGBI), Liverpool, UK
Davis R, Anderson O, Vincent C, et al., 2012, Predictors of hospitalized patients' intentions to prevent healthcare harm: A cross sectional survey, INTERNATIONAL JOURNAL OF NURSING STUDIES, Vol: 49, Pages: 407-415, ISSN: 0020-7489
Anderson O, 2012, Designing Out Medical Error (oral presentation), Clinical Human Factors Group Seminar, Nottingham Univeristy Hospitals NHS Trust, UK
Anderson O, Carr R, Briggs M, et al., 2012, Human gastric lipase augmentation of nasogastric tube aspirate pH tests (oral presentation), London Deanery South-East Thames Surgical Research Symposium, Maidstone, UK
Anderson O, West J, Hanna GB, et al., 2012, Designing Out Medical Errors (exhibition), Pontio Centre, Bangor, Wales
Boyce N, 2012, War on error (3rd party publication), The Lancet, Vol: 379
Anderson O, Buckle P, Hanna GB, 2012, Ergonomic risk assessment of nasogastric tube placement and implications for design and training (oral presentation), International Ergonomics Association 18th World Congress, Recife, Brazil
de Lange C, 2012, Designs for eradicating medical mistakes (3rd party publication), New Scientist
Anderson O, West J, Davey G, et al., 2012, Designing Out Medical Error (exhibition)., Royal College of Surgeons of England, Hunterian Museum. London, UK
Anderson O, Boshier PR, Hanna GB, 2012, Interventions designed to prevent healthcare bed-related injuries in patients., Cochrane Database Syst Rev, Vol: 1
BACKGROUND: Every patient in residential healthcare has a bed. Falling out of bed is associated with preventable patient harm. Various interventions to prevent injury are available. Bed rails are the most common intervention designed to prevent patients falling out of bed; however, their effectiveness is uncertain and bed rail entrapment can also result in injuries. OBJECTIVES: To assess the effectiveness of interventions designed to prevent patient injuries and falls from their beds. SEARCH METHODS: We searched the Cochrane Injuries Group Specialised Register, Cochrane Central Register of Controlled Trials 2010, Issue 2 (The Cochrane Library), MEDLINE (Ovid), EMBASE (Ovid), CINAHL (EBSCO), ISOI Web of Science and Web-based trials registers (all to December 2010) as well as reference lists. SELECTION CRITERIA: Randomised controlled trials of interventions designed to prevent patient injuries from their beds which were conducted in hospitals, nursing care facilities or rehabilitation units were eligible for inclusion. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed the risk of bias and extracted data from the included studies. Authors contacted investigators to obtain missing information. MAIN RESULTS: Two studies met the inclusion criteria, involving a total of 22,106 participants. One study tested low height beds and the other tested bed exit alarms. Both studies used standard care for their control group and both studies were conducted in hospitals. No study investigating bed rails met the inclusion criteria. Due to the clinical heterogeneity of the interventions in the included studies pooling of data and meta-analysis was inappropriate, and so the results of the studies are described.A single cluster randomised trial of low height beds in 18 hospital wards, including 22,036 participants, found no significant reduction in the frequency of patient injuries due to their beds (there were no injuries in either group), patient falls in the bedr
Anderson O, Shamsi A, Mahroof A, et al., 2012, Improving the accuracy of respiratory rate measurement and documentation (poster presentation), Imperial College London Surgery & Cancer Research Student Symposium
Anderson O, Carr R, Briggs M, et al., 2012, Human gastric lipase augmentation of nasogastric tube aspirate pH tests (oral presentation), Society of Academic & Research Surgery (SARS)
Anderson O, Buckle P, Hanna G, 2012, Ergonomic risk assessment of nasogastric tube placement and implications for design and training, WORK-A JOURNAL OF PREVENTION ASSESSMENT & REHABILITATION, Vol: 41, Pages: 4689-4691, ISSN: 1051-9815
Anderson A, Davis R, Hanna G, et al., 2012, Surgical adverse events: a systematic review
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