70 results found
Bakri NAC, Kwasnicki R, Khan N, et al., 2022, Impact of axillary lymph node dissection and sentinel lymph node biopsy on upper-limb morbidity in breast cancer patients: Systematic review and meta-analysis, Publisher: SPRINGER, Pages: 92-93, ISSN: 1068-9265
Marcus HJ, Bennett A, Chari A, et al., 2022, IDEAL-D Framework for Device Innovation A Consensus Statement on the Preclinical Stage, ANNALS OF SURGERY, Vol: 275, Pages: 73-79, ISSN: 0003-4932
Lee A, Kwasnicki R, Hasaan K, et al., 2021, Outcome reporting in therapeutic mammaplasty: a systematic review, BJS Open, Vol: 5, Pages: 1-12, ISSN: 2474-9842
BackgroundTherapeutic mammaplasty (TM) is an oncological procedure which combines tumour resection with breast reduction and mastopexy techniques. Previous systematic reviews have demonstrated the oncological safety of TM but reporting of critically important outcomes such as quality of life, aesthetic and functional outcomes are limited, piecemeal or inconsistent. This systematic review aims to identify all outcomes reported in clinical studies of TM to facilitate development of a Core Outcome Set.MethodsMedline, EMBASE, CINAHL and Web of Science were searched from inception to 5 August 2020. Included studies reported clinical outcomes following TM for adult women. Two authors independently screened articles for eligibility. Data was extracted regarding the outcome definition and classification type (e.g., oncologic, quality of life, etc), time of outcome reporting and measurement tools. ResultsOf 5709 de-duplicated records, 148 were included in the narrative synthesis. The majority of studies (n=102, 68.9 per cent) reported measures of survival and/or recurrence; approximately three-quarters (n=75, 73.5 per cent) had less than 5 years follow-up. Aesthetic outcome was reported in half of studies (n=75, 50.7 per cent) using mainly subjective, non-validated measurement tools. The time-point at which aesthetic assessment was conducted was highly variable, and only defined in 48 (64.0 per cent) studies and none included a pre-operative baseline for comparison. Few studies reported quality of life (n=30, 20.3 per cent), functional outcomes (n=5, 3.4 per cent) or resource use (n=28, 18.9 per cent).ConclusionsGiven the oncological equivalence of TM and mastectomy, treatment decisions are often driven by aesthetic and functional outcomes, which are infrequently and inconsistently reported with non-validated measurement tools.PROSPERO: CRD42020200365
Che Bakri NA, Kwasnicki RM, Dhillon K, et al., 2021, ASO visual abstract: objective assessment of postoperative morbidity following breast cancer treatments with wearable activity monitors: The "BRACELET" study., Annals of Surgical Oncology, Vol: 28, Pages: 1-1, ISSN: 1068-9265
Kwasnicki R, Noakes A, Banhidy N, et al., 2021, Quantifying the Limitations of Clinical and Technology-Based Flap Monitoring Strategies Using A Systematic Recurrent Themes Analysis, Publisher: OXFORD UNIV PRESS, ISSN: 0007-1323
Che Bakri NA, Kwasnicki RM, Dhillon K, et al., 2021, ASO author reflections: Improving management of upper limb complications after breast cancer treatments, Annals of Surgical Oncology, ISSN: 1068-9265
Che Bakri NA, Kwasnicki R, Dhillon K, et al., 2021, Objective assessment of post-operative morbidity following breast cancer treatments with wearable activity monitors, Annals of Surgical Oncology, Vol: 28, Pages: 5597-5606, ISSN: 1068-9265
BackgroundCurrent validated tools to measure upper limb dysfunction after breast cancer treatment, such as questionnaires, are prone to recall bias and do not enable comparisons between patients. This study aimed to test the feasibility of wearable activity monitors (WAMs) for achieving a continuous, objective assessment of functional recovery by measuring peri-operative physical activity (PA).MethodsA prospective, single-center, non-randomized, observational study was conducted. Patients undergoing breast and axillary surgery were invited to wear WAMs on both wrists in the peri-operative period and then complete upper limb function (DASH) and quality-of-life (EQ-5D-5L) questionnaires. Statistical analyses were performed to determine the construct validity and concurrent validity of WAMs.ResultsThe analysis included 39 patients with a mean age of 55 ± 13.2 years. Regain of function on the surgically treated side was observed to be an increase of arm activity as a percentage of preoperative levels, with the greatest increase observed between the postoperative days 1 and 2. The PA was significantly greater on the side not treated by surgery than on the surgically treated side after week 1 (mean PA, 75.8% vs. 62.3%; p < 0.0005) and week 2 (mean PA, 91.6% vs. 77.4%; p < 0.005). Subgroup analyses showed differences in recovery trends between different surgical procedures. Concurrent validity was demonstrated by a significant negative moderate correlation between the PA and DASH questionnaires (R = −0.506; p < 0.05).ConclusionThis study demonstrated the feasibility and validity of WAMs to objectively measure postoperative recovery of upper limb function after breast surgery, providing a starting point for personalized rehabilitation through early detection of upper limb physical morbidity.
Kwasnicki R, Noakes A, Banhidy N, et al., 2021, Quantifying the limitations of clinical and technology-based flap monitoring strategies using a systematic thematic analysis, Plastic and Reconstructive Surgery Global Open, Vol: 7, ISSN: 2169-7574
Aims: Multiple techniques exist to monitor free flap viability postoperatively, varying with practicaland personal preference, yet the limitations of each technique remain unquantified. Thissystematic review aims to identify the most commonly reported limitations of these techniques inclinical practice.Methods: A systematic review was conducted according to PRISMA guidelines using MEDLINE,EMBASE and Web of Science with search criteria for postoperative free flap monitoringtechniques. Search results were independently screened using defined criteria by two authorsand a senior clinician. Limitations of the techniques found in the discussion section of eligiblepapers were recorded and categorised using thematic analysis.Results: A total of 4699 records were identified. 2210 articles met the eligibility criteria and weresubsequently reviewed, with 195 papers included in the final analysis. The most frequentlyreported limitations of clinical monitoring were: interpretation requiring expertise (25% of relatedpapers), unsuitability for buried flaps (21%), and lack of quantitative/objective values (19%). Fornon-invasive technologies: lack of quantitative/objective values (21%), cost (16%) andinterpretation requiring expertise (13%). For invasive technologies: application requiring expertise(25%), equipment design and malfunction (13%) and cost (13%).Conclusions: This is the first systematic review to quantify the limitations of different flapmonitoring techniques as reported in the literature. This information may enhance the choice inmonitoring strategy for a reconstructive service and inform the development and refinement ofnew flap monitoring technologies.
Che Bakri NA, Kwasnicki R, Dhillon K, et al., 2021, Improving management of upper limb complications after breast cancer treatments, Annals of Surgical Oncology, ISSN: 1068-9265
Lee A, Kwasnicki R, Leff D, 2021, Outcomes and outcome measures reported in clinical studies of therapeutic mammaplasty: a systematic review protocol, BMJ Open, Vol: 11, ISSN: 2044-6055
ntroduction Therapeutic mammaplasty (TM) is an oncological procedure which combines tumour resection with breast reduction and mastopexy techniques. Previous systematic reviews have demonstrated oncological safety of TM, but poor and inconsistent reporting of quality-of-life, aesthetic and functional outcomes, often with non-validated measurement tools. Moreover, there is a paucity of patient-reported outcome measures. Standardisation of outcome reporting is required to enable study results to be compared and combined, for example, through core outcome set (COS) development. This systematic review aims to comprehensively describe the outcomes reported in clinical studies of TM, their respective outcome measures and the time points at which they were evaluated. The overall objective is to facilitate the development of a COS for TM.Methods and analysis A systematic review of clinical studies evaluating outcomes following TM will be completed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The following electronic databases have been searched from inception to 5 August 2020: Ovid MEDLINE, Embase, CINAHL and Web of Science. Primary outcomes will include the number of reported outcomes of various types (clinical, aesthetic, functional, quality-of-life and cost-effectiveness), whether these are patient-reported or clinician-reported, how outcomes are defined and the outcome measurement tool(s) used. The time point(s) at which outcomes were measured will be a secondary outcome. No studies will be excluded on the basis of methodological quality in order to generate a comprehensive list of reported outcomes and outcome measures; hence, risk of bias assessment is not required. The data will be described narratively. This protocol has been reported in line with PRISMA-Protocols.Ethics and dissemination This study does not involve human or animal participants, hence ethical approval is not required. The findings will be p
Dawidziuk A, Ngadimin C, Kwasnicki R, et al., 2021, The Effectiveness of a Two-Day Conference in Improving Plastic Surgery Knowledge and Skills of Medical Students and Junior Doctors, Publisher: OXFORD UNIV PRESS, ISSN: 0007-1323
Ngadimin C, Rai A, Ngaage LM, et al., 2021, Emergencies in Plastic Surgery - The Impact of a One-Day Conference on Medical Students' Confidence, Publisher: OXFORD UNIV PRESS, ISSN: 0007-1323
Joshi M, Archer S, Morbi A, et al., 2021, Short-Term Wearable Sensors for In-Hospital Medical and Surgical Patients: Mixed Methods Analysis of Patient Perspectives, JMIR Perioperative Medicine, Vol: 4, Pages: e18836-e18836
<jats:sec> <jats:title>Background</jats:title> <jats:p>Continuous vital sign monitoring using wearable sensors may enable early detection of patient deterioration and sepsis.</jats:p> </jats:sec> <jats:sec> <jats:title>Objective</jats:title> <jats:p>This study aimed to explore patient experiences with wearable sensor technology and carry out continuous monitoring through questionnaire and interview studies in an acute hospital setting.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>Patients were recruited for a wearable sensor study and were asked to complete a 9-item questionnaire. Patients responses were evaluated using a Likert scale and with continuous variables. A subgroup of surgical patients wearing a Sensium Vital Sign Sensor was invited to participate in semistructured interviews. The Sensium wearable sensor measures the vital signs: heart rate, respiratory rate, and temperature. All interview data were subjected to thematic analysis.</jats:p> </jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>Out of a total of 500 patients, 453 (90.6%) completed the questionnaire. Furthermore, 427 (85.4%) patients agreed that the wearable sensor was comfortable, 429 (85.8%) patients agreed to wear the patch again when in hospital, and 398 (79.6%) patients agreed to wear the patch at home. Overall, 12 surgical patients consented to the interviews. Five main themes of interest to patients emerged from the interviews: (1) centralized monitoring, (2) enhanced feelings of patient safety, (3) impact on nursing staff, (4) comfort and usability, and (5) future use and views on technology.</jats:p> </jats:sec> <jats:sec> <jat
Geoghegan L, Kwasnicki RM, Henton JM, et al., 2021, REDUCING VENOUS CONGESTION FOLLOWING LOWER LIMB RECONSTRUCTION WITH ISOMETRIC CALF EXERCISES: A PROSPECTIVE CLINICAL STUDY, Publisher: OXFORD UNIV PRESS, ISSN: 0007-1323
Joshi M, Archer S, Morbi A, et al., 2021, Short-Term Wearable Sensors for In-Hospital Medical and Surgical Patients: Mixed Methods Analysis of Patient Perspectives, JMIR Perioperative Medicine, ISSN: 2561-9128
Kwasnicki R, Chen C-M, Noakes A, et al., 2021, Developing a wearable sensor for continuous tissue oxygenation monitoring: a proof of concept study, Journal of Reconstructive Microsurgery Open, Vol: 6, Pages: e11-e19, ISSN: 2377-0813
Objective Technologies facilitating continuous free tissue flap monitoring such as near infrared spectroscopy (NIRS) have been shown to improve flap salvage rates. However, the size and associated costs of such technology create a barrier to wider implementation. The aim of this study was to develop and validate a wearable sensor for continuous tissue oxygenation monitoring.Materials and Methods A forearm ischemia model was designed by using a brachial pressure cuff inflation protocol. Twenty healthy subjects were recruited. The forearm tissue oxygenation of each subject was monitored throughout the pressure cuff protocol by using a new optical sensor (Imperial College London), and a gold standard tissue spectrometry system (O2C, Medizintecknik, LEA, Germany). Data were processed to allow quantitative deoxygenation episode comparisons between inflations and sensor modalities.Results The correlation between O2C and optical sensor oxygenation measurements was moderate (average R = 0.672, p < 0.001). Incremental increases in cuff inflation duration resulted in a linear increase in deoxygenation values with both O2C and optical sensors, with significant differences recorded on consecutive inflations (wall shear rate, p < 0.005). The presence or absence of pulsatile blood flow was correctly determined throughout by both sensor modalities.Conclusion This study demonstrates the ability of a small optical sensor to detect and quantify tissue oxygenation changes and assess the presence of pulsatile blood flow. Low power, miniaturized electronics make the device capable of deployment in a wearable form which may break down the barriers for implementation in postoperative flap monitoring.
Anastasova S, SpeharDélèze A, Kwasnicki RM, et al., 2020, Electrochemical monitoring of subcutaneous tissue pO2 fluctuations during exercise using a semi‐implantable needle electrode, Electroanalysis, Vol: 32, Pages: 2393-2403, ISSN: 1040-0397
Semi‐implantable needle oxygen electrodes were used for forearm subcutaneous monitoring in human subjects undertaking high intensity cycling and fist clenching exercise. pO2 variations in the range between 40 and 100 mm Hg oxygen were seen. Superimposed on these were paradoxical rises in subcutaneous pO2, of up to 100 mm Hg which paralleled the scale of the exercise. This was indicative of increased blood flow through skin. Triton X‐100 incorporated into the sensor polyurethane membranes helped to give faster responses and reduced the possibility of biofouling and drift. The sterilizable system, free from internal electrolyte film appears promising for future clinical monitoring.
Kwasnicki R, Paton C, Burgin J, et al., 2020, Pulse Oximetry for Diagnosing Acute Limb Ischaemia: A Systematic Review, International Surgical Conference of the Association-of-Surgeons-in-Training, Publisher: WILEY, Pages: 198-198, ISSN: 0007-1323
Kwasnicki RM, Burgin J, Paton C, et al., 2020, The Use of Pulse Oximetry for the Diagnosis of Vascular Disruption Following Limb Trauma, International Surgical Conference of the Association-of-Surgeons-in-Training, Publisher: WILEY, Pages: 195-196, ISSN: 0007-1323
Kwasnicki R, Khan N, Cairns A, et al., 2020, BRACELET Study: Breast Recovery After Axillary Node Clearance - Evaluating Limbs with E-Technology, 21st Annual Meeting of the American-Society-of-Breast-Surgeons (ASBS), Publisher: SPRINGER, Pages: S469-S470, ISSN: 1068-9265
Geoghegan L, Kwasnicki RM, Henton JMD, et al., 2020, Investigating Lower Limb Hemodynamics during Flap Training Regimens and Patient-led Isometric Contraction Protocols, PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN, Vol: 8, ISSN: 2169-7574
Geoghegan L, Kwasnicki R, Henton J, et al., 2020, Investigating Lower Limb Flap Hemodynamics During Flap Training Regimens and Patient Led Isometric Contraction Protocols: A Prospective Clinical Study, Plastic and Reconstructive Surgery Global Open, ISSN: 2169-7574
Kwasnicki RM, Cato LD, Geoghegan L, et al., 2020, Supportive technology in collaborative research: proposing the STiCR framework, ANNALS OF THE ROYAL COLLEGE OF SURGEONS OF ENGLAND, Vol: 102, Pages: 3-8, ISSN: 0035-8843
Darwood A, McCanny J, Kwasnicki R, et al., 2019, The design and evaluation of a novel low-cost portable ventilator, ANAESTHESIA, Vol: 74, Pages: 1406-1415, ISSN: 0003-2409
Chen C-M, Kwasnicki RM, Curto VF, et al., 2019, Tissue oxygenation sensor and an active in vitro phantom for sensor Validation, IEEE Sensors Journal, Vol: 19, Pages: 8233-8240, ISSN: 1530-437X
A free flap is a tissue reconstruction procedure where healthy tissue is harvested to cover up vital structures after wound debridement. Microvascular anastomoses are carried out to join the arteries and veins of the flap with recipient vessels near the target site. Continuous monitoring is required to identify the flap failure and enable early intervention to salvage the flap. Although there are medical instruments that can assist surgeons in monitoring flap viability, high upfront costs and time-consuming data interpretation have hindered the use of such technologies in practice. Surgeons still rely largely on the clinical examination to monitor flaps after operations. This paper presents a low-cost, low-power (6.6 mW), and miniaturized Hamlyn StO 2 (tissue oxygen saturation) sensor that can be embodied as a plaster and attached to a flap for real-time monitoring. Similar to the design of oxygen saturation (SpO 2 /SaO 2 ) sensors, the Hamlyn StO 2 sensor was designed based on photoplethysmography (PPG), but with a different target of quantifying tissue perfusion rather than capturing pulsatile flow. To understand the spectral response to oxygenation/deoxygenation and vascular flow, an active in vitro silicone phantom was developed. The new sensor was validated using the silicone phantom and compared with a commercially available photospectroscopy and laser Doppler machine (O2C, LEA, Germany). In addition, in vivo experiments were conducted using a brachial pressure cuff forearm ischemia model. The experiment results have shown a high correlation between the proposed sensor and the O2C machine (r = 0.672 and p <; 0.001), demonstrating the potential value of the of the proposed low-cost sensor in post-operative free flap monitoring.
optiFLAPP Collaborative, Gardiner MD, Giblin V, et al., 2019, Variation in the perioperative care of women undergoing abdominal-based microvascular breast reconstruction in the United Kingdom (The optiFLAPP Study), Journal of Plastic, Reconstructive and Aesthetic Surgery, Vol: 72, Pages: 35-42, ISSN: 0007-1226
INTRODUCTION: Abdominal-based microvascular breast reconstruction constitutes approximately one-fifth of reconstructions following mastectomy for breast cancer. Enhanced recovery after surgery (ERAS) protocols have been implemented to improve patient care. The aim of this project was to identify variation in the perioperative care of women undergoing microvascular breast reconstruction to inform development of an ERAS protocol. METHODS: Surveys were developed for plastic surgeons, anaesthetists and the lead clinician for breast reconstruction at each unit. These assessed most aspects of perioperative care. A team of medical student collaborators was identified. This team created a list of surgeons and anaesthetists in the United Kingdom by unit. REDCap was used to record their responses. RESULTS: Nineteen (19/39, 49%) lead clinicians, 83 (83/134, 62%) plastic surgeons and 71 (71/100, 71%) anaesthetists from units across the UK completed the surveys. Marked variation was identified in the clinician responses when compared with the national and international guidelines. This variation covered many aspects of patient care including antibiotic and fluid prescribing, surgical technique, post-operative care and recording of patient outcomes. CONCLUSIONS: The optiFLAPP national practice survey has demonstrated variation in the perioperative care of women undergoing abdominal-based microvascular breast reconstruction. We propose a large prospective audit to assess current protocols and support development of randomised controlled trials.
Kwasnicki RM, Din AH, Hettiaratchy S, 2018, The use of pulse oximetry to diagnose limb ischaemia, JOURNAL OF PLASTIC RECONSTRUCTIVE AND AESTHETIC SURGERY, Vol: 71, Pages: 1823-1825, ISSN: 1748-6815
Normahani P, Kwasnicki R, Bicknell C, et al., 2018, Wearable sensor technology efficacy in peripheral vascular disease (wSTEP): a randomized controlled trial, Annals of Surgery, Vol: 268, Pages: 1113-1118, ISSN: 1528-1140
OBJECTIVE: To evaluate the effect of using wearable activity monitors (WAMs) in patients with intermittent claudication (IC) within a single-center randomized controlled trial. BACKGROUND: WAMs allow users to set daily activity targets and monitor their progress. They may offer an alternative treatment to supervised exercise programs (SEPs) for patients with IC. METHODS: Thirty-seven patients with IC were recruited and randomized into intervention or control group. The intervention consisted of a feedback-enabled, wrist-worn activity monitor (WAM) in addition to access to SEP. The control group was given access to SEP only. The outcome measures were maximum walking distance (MWD), claudication distance (CD), and quality of life as measured by the VascuQol questionnaire. Participants were assessed upon recruitment, and at 3, 6, and 12 months. RESULTS: Patients in the WAM group showed significant improvement in MWD at 3 and 6 months (80-112 m, to 178 m; P < 0.001), which was sustained at 12 months. The WAM group also increased CD (40 vs 110 m; P < 0.001) and VascuQol score (4.7 vs 5.8; P = 0.004). The control group saw a temporary increase in VascuQol score at 6 months (4.5 vs 4.7; P = 0.028), but no other improvements in MWD or CD were observed. Significantly higher improvements in MWD were seen in the WAM group compared with that in the control group at 6 months (82 vs -5 m; P = 0.009, r = 0.47) and 12 months (69 vs 7.5 m; P = 0.011, r = 0.52). CONCLUSIONS: The study demonstrates the significant, sustained benefit of WAM-led technologies for patients with IC. This potentially resource-sparing intervention is likely to provide a valuable adjunct or alternative to SEP.
Geoghegan L, Kwasnicki RM, Kanabar S, et al., 2018, A systematic recurrent theme analysis of the reported limitations of facial electromyography, Annals of Medicine and Surgery, Vol: 33, Pages: 1-6, ISSN: 2049-0801
BackgroundAdvances in digital technology hold promise in expanding the clinical and consumer applications of facial electromyography (EMG) through thedevelopment of wireless pervasive systems capable of operating in a nonclinical environment. This systematic review aims to appraise the most commonly reported limitations of the technology in clinical research and practice.MethodsA systematic search for clinical facial EMG literature was performed using MEDLINE, EMBASE, PsychINFO and CINAHL. No language limits were applied. Search results were screened using defined criteria by two authors with disagreements resolved by a third. Practical limitations in the technology, as reported by the authors, were recorded and characterised using recurrent theme analysis.ResultsA total of 4,983 records were identified. Of those, 1,061 articles met eligibility criteria and were subsequently reviewed. In the medical domain, the most common area of application was in psychosocial studies (28% of medical studies); in the surgical domain monitoring of facial nerve integrity was the most common application of facial electromyography (27% of surgical studies). Collectively, the three most commonly reported limitations were motion artefact (13.7%), inter-subject variability in response and anatomy (13.1%), and muscle crosstalk (12.0%).ConclusionsThis is the first study to evaluate the limitations of facial EMG using a systematic analysis of author reports. Highlighting technology limitations in this non-biased manner raises awareness to users key issues and reliably informs the development of future systems.
Kwasnicki RM, Cross GW, Geoghegan L, et al., 2018, A lightweight sensing platform for monitoring sleep quality and posture: a simulated validation study, EUROPEAN JOURNAL OF MEDICAL RESEARCH, Vol: 23, ISSN: 0949-2321
BackgroundThe prevalence of self-reported shoulder pain in the UK has been estimated at 16%. This has been linked with significant sleep disturbance. It is possible that this relationship is bidirectional, with both symptoms capable of causing the other. Within the field of sleep monitoring, there is a requirement for a mobile and unobtrusive device capable of monitoring sleep posture and quality. This study investigates the feasibility of a wearable sleep system (WSS) in accurately detecting sleeping posture and physical activity.MethodsSixteen healthy subjects were recruited and fitted with three wearable inertial sensors on the trunk and forearms. Ten participants were entered into a ‘Posture’ protocol; assuming a series of common sleeping postures in a simulated bedroom. Five participants completed an ‘Activity’ protocol, in which a triphasic simulated sleep was performed including awake, sleep and REM phases. A combined sleep posture and activity protocol was then conducted as a ‘Proof of Concept’ model. Data were used to train a posture detection algorithm, and added to activity to predict sleep phase. Classification accuracy of the WSS was measured during the simulations.ResultsThe WSS was found to have an overall accuracy of 99.5% in detection of four major postures, and 92.5% in the detection of eight minor postures. Prediction of sleep phase using activity measurements was accurate in 97.3% of the simulations. The ability of the system to accurately detect both posture and activity enabled the design of a conceptual layout for a user-friendly tablet application.ConclusionsThe study presents a pervasive wearable sensor platform, which can accurately detect both sleeping posture and activity in non-specialised environments. The extent and accuracy of sleep metrics available advances the current state-of-the-art technology. This has potential diagnostic implications in musculoskeletal pathology and with the addition of aler
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