21 results found
Gaba K, Morris D, Halliday A, et al., 2021, Improving Quality of Carotid Interventions: Identifying Hospital-Level Structural Factors that can Improve Outcomes, ANNALS OF VASCULAR SURGERY, Vol: 72, Pages: 589-600, ISSN: 0890-5096
Gaba KA, Halliday A, Bulbulia R, et al., 2021, Procedural Risks of Carotid Intervention in 19,000 Patients, ANNALS OF VASCULAR SURGERY, Vol: 70, Pages: 326-331, ISSN: 0890-5096
McGlone ER, Carey I, Velickovic V, et al., 2020, Bariatric surgery for patients with type 2 diabetes mellitus requiring insulin: Clinical outcome and cost-effectiveness analyses, PLoS Medicine, Vol: 17, Pages: 1-22, ISSN: 1549-1277
BackgroundAlthough bariatric surgery is well established as an effective treatment for patients with obesity and type 2 diabetes mellitus (T2DM), there exists reluctance to increase its availability for patients with severe T2DM. The aims of this study were to examine the impact of bariatric surgery on T2DM resolution in patients with obesity and T2DM requiring insulin (T2DM-Ins) using data from a national database and to develop a health economic model to evaluate the cost-effectiveness of surgery in this cohort when compared to best medical treatment (BMT).Methods and findingsClinical data from the National Bariatric Surgical Registry (NBSR), a comprehensive database of bariatric surgery in the United Kingdom, were extracted to analyse outcomes of patients with obesity and T2DM-Ins who underwent primary bariatric surgery between 2009 and 2017. Outcomes for this group were combined with data sourced from a comprehensive literature review in order to develop a state-transition microsimulation model to evaluate cost-effectiveness of bariatric surgery versus BMT for patients over a 5-year time horizon. The main outcome measure for the clinical study was insulin cessation at 1-year post-surgery: relative risks (RR) summarising predictive factors were determined, unadjusted, and after adjusting for variables including age, initial body mass index (BMI), duration of T2DM, and weight loss. Main outcome measures for the economic evaluation were total costs, total quality-adjusted life years (QALYs), and incremental cost-effectiveness ratio (ICER) at willingness-to-pay threshold of GBP£20,000.A total of 2,484 patients were eligible for inclusion, of which 1,847 had 1-year follow-up data (mean age of 51 years, mean initial BMI 47.2 kg/m2, and 64% female). 67% of patients no longer required insulin at 1-year postoperatively: these rates persisted for 4 years. Roux-en-Y gastric bypass (RYGB) was associated with a higher rate of insulin cessation (71.7%) than sleeve gastr
Mastoridis S, Chana P, Singh M, et al., 2020, Endoscopic vacuum therapy (EVT) in the management of oesophageal perforations and post-operative leaks, MINIMALLY INVASIVE THERAPY & ALLIED TECHNOLOGIES, Vol: 31, Pages: 380-388, ISSN: 1364-5706
Mastoridis S, Shalaby S, Chana P, et al., 2020, Endoscopic Vacuum Therapy (EVT) for Oesophageal Perforations and Leaks: The Oxford Experience, International Surgical Conference of the Association-of-Surgeons-in-Training, Publisher: WILEY, Pages: 49-49, ISSN: 0007-1323
Faiella G, Parand A, Franklin BD, et al., 2018, Expanding healthcare failure mode and effect analysis: A composite proactive risk analysis approach, RELIABILITY ENGINEERING & SYSTEM SAFETY, Vol: 169, Pages: 117-126, ISSN: 0951-8320
Chana P, Joy M, Casey N, et al., 2017, Cohort analysis of outcomes in 69 490 emergency general surgical admissions across an international benchmarking collaborative, BMJ Open, Vol: 7, ISSN: 2044-6055
Objective This study aims to use the Dr Foster Global Comparators Network (GC) database to examine differences in outcomes following high-risk emergency general surgery (EGS) admissions in participating centres across 3 countries and to determine whether hospital infrastructure factors can be linked to the delivery of high-quality care.Design A retrospective cohort analysis of high-risk EGS admissions using GC's international administrative data set.Setting 23 large hospitals in Australia, England and the USA.Methods Discharge data for a cohort of high-risk EGS patients were collated. Multilevel hierarchical logistic regression analysis was performed to examine geographical and structural differences between GC hospitals.Results 69 490 patients, admitted to 23 centres across Australia, England and the USA from 2007 to 2012, were identified. For all patients within this cohort, outcomes defined as: 7-day and 30-day inhospital mortality, readmission and length of stay appeared to be superior in US centres. A subgroup of 19 082 patients (27%) underwent emergency abdominal surgery. No geographical differences in mortality were seen at 7 days in this subgroup. 30-day mortality (OR=1.47, p<0.01) readmission (OR=1.42, p<0.01) and length of stay (OR=1.98, p<0.01) were worse in English units. Patient factors (age, pathology, comorbidity) were significantly associated with worse outcome as were structural factors, including low intensive care unit bed ratios, high volume and interhospital transfers. Having dedicated EGS teams cleared of elective commitments with formalised handovers was associated with shorter length of stay.Conclusions Key factors that influence outcomes were identified. For patients who underwent surgery, outcomes were similar at 7 days but not at 30 days. This may be attributable to better infrastructure and resource allocation towards EGS in the US and Australian centres.
Johnston MJ, Arora S, Pucher PH, et al., 2016, Improving Escalation of Care A Double-blinded Randomized Controlled Trial, ANNALS OF SURGERY, Vol: 263, Pages: 421-426, ISSN: 0003-4932
Objective: This study aimed to determine whether an intervention could improve the escalation of care skills of junior surgeons.Summary Background Data: Escalation of care involves the recognition, communication, and response to patient deterioration until a satisfactory outcome has been achieved. Although failure to escalate care can lead to increased morbidity and mortality, there is no formal training in how to perform this vital process safely.Methods: This randomized controlled trial recruited postgraduate year (PGY)-1 and PGY-2 surgeons to participate in 2 scenarios involving simulated patients requiring escalation of care. A control group performed both scenarios before receiving the intervention; the intervention group received the educational intervention before their second scenario. Scenarios were video recorded and rated by 2 independent, blinded assessors using validated scales to measure patient assessment, communication, management and nontechnical skills of participants, and the number of medical errors they detected.Results: A total of 33 PGY-1 and PGY-2 surgeons, all with equivalent skill at baseline, participated. Postintervention, the intervention group demonstrated significantly better patient assessment (P < 0.001), communication (P < 0.001), and nontechnical skills (P < 0.001). They also detected more medical errors (P < 0.05).Conclusions: Teaching junior surgeons a systematic approach to escalation of care improved multiple core skills required to maintain patient safety and avoid preventable harm.
Chana P, Burns EM, Arora S, et al., 2016, A Systematic Review of the Impact of Dedicated Emergency Surgical Services on Patient Outcomes, Annals of Surgery, Vol: 263, Pages: 20-27, ISSN: 1528-1140
Chana P, Casey N, Chang D, et al., 2015, The delivery of high-risk emergency general surgery across the dr foster global comparators network: an examination of international outcomes, 2nd Digestive-Disorders-Federation Conference, Publisher: BMJ PUBLISHING GROUP, Pages: A48-A48, ISSN: 0017-5749
Introduction The Dr Foster Global Comparators Network (GC) aims to improve quality in healthcare by promoting inter-hospital collaboration through sharing of outcome data and benchmarking standards.This study aims to utilise the GC database to establish whether geographical differences in outcomes exist following high-risk emergency general surgery (EGS) admissions, whilst determining if structural differences between healthcare systems can be linked to high-quality care.Method Discharge data for a cohort of EGS patients were collated using a pre-determined protocol. Hierarchical logistic regression analysis was performed to examine geographical and structural differences between GC hospitals.Results 69,490 patients, admitted to 23 centres across Australia, England and the USA with high-risk EGS diagnoses from 2007–2012 were identified. Outcomes including: seven/thirty-day mortality, readmission and length of stay were all superior in the USA.19,082 patients (27%) underwent emergency abdominal surgery. No geographical differences in mortality were seen at seven-days in this subgroup. Thirty-day mortality (OR = 1.47) readmission (OR = 1.42) and length of stay (OR = 1.98) were all worse in the UK.Across this cohort, patient factors, (age, pathology and co-morbidity) were significantly associated with worse outcome as were structural factors including: low ITU bed ratios, high unit volume and inter-hospital transfers. Having dedicated EGS teams cleared of elective commitments with formalised handover of patients was associated with shorter length of stay.Conclusion Post-operative outcomes were similar at seven but not at thirty-days. This may be attributable to better infrastructure and resource allocation towards EGS in the US. The costs associated with this healthcare gain were not measured.
Crowther N, Kahvo M, Chana P, 2015, Improving the management of acute pancreatitis in a district general hospital., BMJ Qual Improv Rep, Vol: 4, ISSN: 2050-1315
Acute pancreatitis is a common problem seen in the United Kingdom, with an incidence of 56.6 per 100,000 population.[1,2,3] Optimising management has been shown to reduce mortality and morbidity, and the British Society of Gastroenterology (BSG) published revised guidelines in 2005 to standardise treatment for this potentially life threatening condition. The aim of this quality improvement project was to investigate and improve the initial management of acute pancreatitis in patients presenting to the Great Western Hospital (GWH) in Swindon between November 2012 and July 2013. Patients presenting to the surgical team during this time with a diagnosis of acute pancreatitis were identified for the initial data collection. Notes were prospectively reviewed and data collected allowing a comparison between management in GWH against BSG guidelines. Following this stage, a pro forma based on the 2005 guidelines was created and implemented, with the aim of raising awareness and standardising care among surgical staff. Following implementation of the pro forma, data collection was repeated between May and June 2013 to assess the impact of the intervention. Results revealed an improvement from 93% to 100% of patients receiving the correct diagnosis within 24 hours of presentation. Severity stratification within 48 hours of diagnosis improved from 75% to 88% and identification of aetiology also improved from 64% to 74%. The implementation of an acute pancreatitis management protocol and education of junior surgical staff has been shown to improve compliance with BSG guidelines at the GWH, and ultimately aims to improves patient care and outcomes.
Chana P, Johnston MJ, Pullyblank AM, et al., 2014, Identifying Organizational Failures in Emergency General Surgical Admissions in the United Kingdom: A Healthcare Failure Mode Effect Analysis, Annual Clinical Congress of the American-College-of-Surgeons, Publisher: ELSEVIER SCIENCE INC, Pages: S92-S92, ISSN: 1072-7515
Blencowe NS, Chana P, Whistance RN, et al., 2014, Outcome Reporting in Neoadjuvant Surgical Trials: A Systematic Review of the Literature and Proposals for New Standards, JNCI-JOURNAL OF THE NATIONAL CANCER INSTITUTE, Vol: 106, ISSN: 0027-8874
We describe a rare case of a leiomyosarcoma in the inguinal canal in a patient presenting clinically with an inguinal hernia. The clinical details, histological findings and surgical management are reviewed.
Kahvo M, Crowther N, Chana P, 2013, Management of Acute Pancreatitis: A Prospective Audit, 17th Annual Scientific Meeting of the Association-of-Upper-Gastrointestinal-Surgeons-of-Great-Britain-and-Ireland (AUGIS), Publisher: WILEY-BLACKWELL, Pages: 22-22, ISSN: 0007-1323
Blencowe NS, Chana P, Whistance RN, et al., 2013, The need for consensus, consistency and integrated outcome reporting in trials of neoadjuvant treatment and surgery for GI cancer: A systematic review of the literature and proposals for new standards, International Surgical Congress of the Association-of-Surgeons-of-Great-Britain-and-Ireland (ASGBI), Publisher: WILEY-BLACKWELL, Pages: 131-131, ISSN: 0007-1323
Blencowe NS, Chana P, Whistance RN, et al., 2013, Short term and surrogate outcomes in surgical oncology: The need for core outcome sets, Joint Meeting of the Section-of-Surgery of the Royal-Society-of-Medicine / Annual Meeting of the Society-of-Academic-and-Research-Surgery, Publisher: WILEY-BLACKWELL, Pages: 62-62, ISSN: 0007-1323
Warbrick-Smith J, Chana P, Hewes J, 2012, Herniation of the liver via an incisional abdominal wall defect., BMJ Case Rep, Vol: 2012
Herniation of the liver through an anterior abdominal wall incisional defect has rarely been described. An 81-year-old man presented to our surgical team with acute right upper quadrant abdominal pain. He had undergone coronary artery bypass grafting via a median sternotomy 7 years previously. Examination revealed gallbladder tenderness and a non-tender incisional epigastric hernia. Cholecystitis was confirmed on ultrasound. A CT scan revealed a knuckle of liver (segment II/III) herniating through an upper midline anterior abdominal wall incisional defect.
Chana P, Chadwick MA, Pullyblank AM, 2012, Achieving abdominal closure following emergency laparotomy in patients with connective tissue disorders, ANNALS OF THE ROYAL COLLEGE OF SURGEONS OF ENGLAND, Vol: 94, Pages: 212-213, ISSN: 0035-8843
Fysh T, Thompson J, Chana P, et al., 2010, Making endovascular aneurysm repair (EVAR) cost-effective, 45th Congress of the European-Society-for-Surgical-Research, Publisher: WILEY-BLACKWELL, Pages: S4-S4, ISSN: 0007-1323
Chana P, 2009, Advances in the medical treatment of Parkinson's disease, Publisher: ELSEVIER SCI LTD, Pages: S7-S7, ISSN: 1353-8020
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