Publications
60 results found
Athanasiou T, Patel V, Darzi A, 2023, Patient Reported Outcomes and Quality of Life in Surgery, ISBN: 9783031275968
This book provides a guide to the assessment of quality of life and patient reported outcomes measures in general surgery. The rapidly emerging field helps contextualise patients and helps the decision-making process within health economics, bedside medicine, public health, and health policy. All subspecialties of general surgery are covered, as well as the core principles of quality of life. The book aims to demonstrate how clinicians and policymakers can easily get access to a single source of patient reported outcomes measures and quality of life evidence to help them make the best-informed decisions in the field of general surgery. This book is relevant to healthcare managers, doctors, allied health professionals, healthcare scientists, consultants, healthcare economists, and medical statisticians working in healthcare.
Al Ani M, Garas G, Hollingshead J, et al., 2022, Which electronic health record system should we use? A systematic review, Medical Principles and Practice, Vol: 31, Pages: 342-351, ISSN: 1011-7571
The UK government had intended to introduce a comprehensive EHRs system in England by 2020. These EHRs would run across primary, secondary, and social care linking data in a single digital platform. This systematic review's objectives were to identify studies that compare EHRs in terms of direct comparison between systems and evaluate them using System and Software Quality Requirements and Evaluation (SQuaRE) ISO/IEC 25010. A systematic review was performed by searching EMBASE and Ovid MEDLINE databases between 1974 and April 2021. All original studies that appraised EHR systems and their providers were included. The main outcome measures were EHR system comparison and SQuaRE's eight characteristics: functional suitability, performance efficiency, compatibility, usability, reliability, security, maintainability, and portability. A total of 724 studies were identified using the search criteria. After review of titles and abstracts, this was filtered down to 40 studies as per exclusion and inclusion criteria set out in our study selection. Seven studies compared more than one EHR. The following number of studies looked at the various aspects of the SQuaRE respectively. Nineteen studies addressed functional suitability, n=18 performance efficiency, n=12 compatibility, n=25 usability, n=6 reliability, n=2 security, n=16 maintainability, and n=13 portability. Epic was the most studied EHR system and one of the most implemented vendors in the USA market, and one of the top ten in UK. It is difficult to assess which is the most advantageous EHR system currently available when looking at them in accordance with SQuaRE's eight characteristics for software evaluation.
Patel VM, Haunschild R, Bornmann L, et al., 2021, A call for governments to pause Twitter censorship: using Twitter data as social-spatial sensors of COVID-19/SARS-CoV-2 research diffusion, SCIENTOMETRICS, Vol: 126, Pages: 3193-3207, ISSN: 0138-9130
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- Citations: 5
Sounderajah V, Patel V, Varatharajan L, et al., 2020, Are disruptive innovations recognised in the healthcare literature? A systematic review, BMJ Innovations, Vol: 7, Pages: 208-216, ISSN: 2055-8074
The study aims to conduct a systematic review to characterise the spread and use of the concept of ‘disruptive innovation’ within the healthcare sector. We aim to categorise references to the concept over time, across geographical regions and across prespecified healthcare domains. From this, we further aim to critique and challenge the sector-specific use of the concept. PubMed, Medline, Embase, Global Health, PsycINFO, Maternity and Infant Care, and Health Management Information Consortium were searched from inception to August 2019 for references pertaining to disruptive innovations within the healthcare industry. The heterogeneity of the articles precluded a meta-analysis, and neither quality scoring of articles nor risk of bias analyses were required. 245 articles that detailed perceived disruptive innovations within the health sector were identified. The disruptive innovations were categorised into seven domains: basic science (19.2%), device (12.2%), diagnostics (4.9%), digital health (21.6%), education (5.3%), processes (17.6%) and technique (19.2%). The term has been used with increasing frequency annually and is predominantly cited in North American (78.4%) and European (15.2%) articles. The five most cited disruptive innovations in healthcare are ‘omics’ technologies, mobile health applications, telemedicine, health informatics and retail clinics. The concept ‘disruptive innovation’ has diffused into the healthcare industry. However, its use remains inconsistent and the recognition of disruption is obscured by other types of innovation. The current definition does not accommodate for prospective scouting of disruptive innovations, a likely hindrance to policy makers. Redefining disruptive innovation within the healthcare sector is therefore crucial for prospectively identifying cost-effective innovations.
Bornmann L, Haunschild R, Patel VM, 2020, Are papers addressing certain diseases perceived where these diseases are prevalent? The proposal to use Twitter data as social-spatial sensors, PLoS One, Vol: 15, ISSN: 1932-6203
We propose to use Twitter data as social-spatial sensors. This study deals with the question whether research papers on certain diseases are perceived by people in regions (worldwide) that are especially concerned by these diseases. Since (some) Twitter data contain location information, it is possible to spatially map the activity of Twitter users referring to certain papers (e.g., dealing with tuberculosis). The resulting maps reveal whether heavy activity on Twitter is correlated with large numbers of people having certain diseases. In this study, we focus on tuberculosis, human immunodeficiency virus (HIV), and malaria, since the World Health Organization ranks these diseases as the top three causes of death worldwide by a single infectious agent. The results of the social-spatial Twitter maps (and additionally performed regression models) reveal the usefulness of the proposed sensor approach. One receives an impression of how research papers on the diseases have been perceived by people in regions that are especially concerned by these diseases. Our study demonstrates a promising approach for using Twitter data for research evaluation purposes beyond simple counting of tweets.
Patel V, Haunschild R, Bornmann L, 2020, Altmetrics as Social-Spatial Sensors, The state of altmetrics: a tenth anniversary celebration, Editors: Konkiel, London, UK, Publisher: Altmetric, Pages: 20-23
Garas G, Cingolani I, Patel V, et al., 2020, Surgical innovation in the era of global surgery: a network analysis, Annals of Surgery, Vol: 271, Pages: 868-874, ISSN: 0003-4932
OBJECTIVE: To present a novel network-based framework for the study of collaboration in surgery and demonstrate how this can be used in practice to help build and nurture collaborations that foster innovation. BACKGROUND: Surgical innovation is a social process that originates from complex interactions among diverse participants. This has led to the emergence of numerous surgical collaboration networks. What is still needed is a rigorous investigation of these networks and of the relative benefits of various collaboration structures for research and innovation. METHODS: Network analysis of the real-world innovation network in robotic surgery. Hierarchical mixed-effect models were estimated to assess associations between network measures, research impact and innovation, controlling for the geographical diversity of collaborators, institutional categories, and whether collaborators belonged to industry or academia. RESULTS: The network comprised of 1700 organizations and 6000 links. The ability to reach many others along few steps in the network (closeness centrality), forging a geographically diverse international profile (network entropy), and collaboration with industry were all shown to be positively associated with research impact and innovation. Closed structures (clustering coefficient), in which collaborators also collaborate with each other, were found to have a negative association with innovation (P < 0.05 for all associations). CONCLUSIONS: In the era of global surgery and increasing complexity of surgical innovation, this study highlights the importance of establishing open networks spanning geographical boundaries. Network analysis offers a valuable framework for assisting surgeons in their efforts to forge and sustain collaborations with the highest potential of maximizing innovation and patient care.
Garas G, Cingolani I, Patel V, et al., 2019, Evaluating the implications of Brexit for research collaboration and policy: A network analysis and simulation study, BMJ Open, Vol: 9, Pages: 1-11, ISSN: 2044-6055
Objective To evaluate the role of the European Union (EU) as a research collaborator in the United Kingdom (UK)’s success as a global leader in healthcare research and innovation and quantify the impact that Brexit may have. Design Network and regression analysis of scientific collaboration, followed by simulation models based on alternative scenarios. Setting International real world collaboration network among all countries involved in robotic surgical research and innovation.Participants 772 organisations from industry and academia nested within 56 countries and connected through 2,397 collaboration links.Main outcome measures Research impact measured through citations, innovation value measured through the innovation index, and an array of attributes of social networks to measure brokerage and geographical entropy at national and international levels.Results Globally, the UK ranks third in robotic surgical innovation, and the EU constitutes its prime collaborator. Brokerage opportunities and collaborators’ geographical diversity are associated with a country’s research impact (c=211.320 and 244.527, respectively;p-value<0·01) and innovation (c=18.819 and 30.850, respectively;p-value<0·01). Replacing EU collaborators with United States (US)’ ones is the only strategy that could benefit the UK, but on the condition that US collaborators are chosen among the top-performing ones, which is likely to be very difficult and costly, at least in the short term. Conclusions This study suggests what has long been argued, namely that the UK-EU research partnership has been mutually beneficial and that its continuation represents the best possible outcome for both negotiating parties. However, the uncertainties raised by Brexit necessitate looking beyond the EU for potential research partners. In the short-term, the UK’s best strategy might be to try and maintain its academic links with the EU. In the longer-term, strategic r
Patel VM, Panzarasa P, Ashrafian H, et al., 2019, Collaborative patterns, authorship practices and scientific success in biomedical research: a network analysis., Journal of the Royal Society of Medicine, Vol: 112, Pages: 245-257, ISSN: 1758-1095
OBJECTIVE: To investigate the relationship between biomedical researchers' collaborative and authorship practices and scientific success. DESIGN: Longitudinal quantitative analysis of individual researchers' careers over a nine-year period. SETTING: A leading biomedical research institution in the United Kingdom. PARTICIPANTS: Five hundred and twenty-five biomedical researchers who were in employment on 31 December 2009. MAIN OUTCOME MEASURES: We constructed the co-authorship network in which nodes are the researchers, and links are established between any two researchers if they co-authored one or more articles. For each researcher, we recorded the position held in the co-authorship network and in the bylines of all articles published in each three-year interval and calculated the number of citations these articles accrued until January 2013. We estimated maximum likelihood negative binomial panel regression models. RESULTS: Our analysis suggests that collaboration sustained success, yet excessive co-authorship did not. Last positions in non-alphabetised bylines were beneficial for higher academic ranks but not for junior ones. A professor could witness a 20.57% increase in the expected citation count if last-listed non-alphabetically in one additional publication; yet, a lecturer suffered from a 13.04% reduction. First positions in alphabetised bylines were positively associated with performance for junior academics only. A lecturer could experience a 8.78% increase in the expected citation count if first-listed alphabetically in one additional publication. While junior researchers amplified success when brokering among otherwise disconnected collaborators, senior researchers prospered from socially cohesive networks, rich in third-party relationships. CONCLUSIONS: These results help biomedical scientists shape successful careers and research institutions develop effective assessment and recruitment policies that will ultimately sustain the quality of biomedical r
Patel V, lovegrove C, 2017, Role of the surgeon, Introduction to Surgery for Students, Editors: Fisher, Ahmed, Dasgupta, Publisher: Springer, Pages: 41-48, ISBN: 9783319432090
In recent years, the role of the surgeon has come under much scrutiny as a consequence of investigations into professional practice. A positive working environment has been shown to promote workers’ motivation and happiness, increasing productivity and reporting of problems as a knock-on effect. This is affected by a wide range of factors, ranging from individual actions to group-work and institutional regulation on a larger scale. This chapter will examine the role of the surgeon in different settings, considering interactions with the workforce and subsequent effects on patient care.
Athanasiou T, Patel V, Garas G, et al., 2016, Mentoring perception, scientific collaboration and research performance: is there a ‘gender gap’ in academic medicine? An Academic Health Science Centre perspective, Postgraduate Medical Journal, Vol: 92, Pages: 581-256, ISSN: 1469-0756
OBJECTIVES: The 'gender gap' in academic medicine remains significant and predominantly favours males. This study investigates gender disparities in research performance in an Academic Health Science Centre, while considering factors such as mentoring and scientific collaboration. MATERIALS AND METHODS: Professorial registry-based electronic survey (n=215) using bibliometric data, a mentoring perception survey and social network analysis. Survey outcomes were aggregated with measures of research performance (publications, citations and h-index) and measures of scientific collaboration (authorship position, centrality and social capital). Univariate and multivariate regression models were constructed to evaluate inter-relationships and identify gender differences. RESULTS: One hundred and four professors responded (48% response rate). Males had a significantly higher number of previous publications than females (mean 131.07 (111.13) vs 79.60 (66.52), p=0.049). The distribution of mentoring survey scores between males and females was similar for the quality and frequency of shared core, mentor-specific and mentee-specific skills. In multivariate analysis including gender as a variable, the quality of managing the relationship, frequency of providing corrective feedback and frequency of building trust had a statistically significant positive influence on number of publications (all p<0.05). CONCLUSIONS: This is the first study in healthcare research to investigate the relationship between mentoring perception, scientific collaboration and research performance in the context of gender. It presents a series of initiatives that proved effective in marginalising the gender gap. These include the Athena Scientific Women's Academic Network charter, new recruitment and advertisement strategies, setting up a 'Research and Family Life' forum, establishing mentoring circles for women and projecting female role models.
Patel VM, Ashrafian H, Uzoho C, et al., 2016, Leadership behaviours and healthcare research performance: prospective correlational study, Postgraduate Medical Journal, Vol: 92, Pages: 663-669, ISSN: 1469-0756
OBJECTIVES: The aims of the study were to determine whether differences in leadership self-perception/behaviour in healthcare researchers may influence research performance and to evaluate whether certain leadership characteristics are associated with enhanced leadership efficiency in terms of motivation, effectiveness and satisfaction. DESIGN AND PARTICIPANTS: All Faculty of Medicine Professors at Imperial College London (n=215) were sent the Multifactor Leadership Questionnaire (MLQ) Self form as a means of evaluating self-perception of leadership behaviours. MAIN OUTCOME MEASURES: For each professor, we extracted objective research performance measures (total number of publications, total number of citations and h index) from 1 January 2007 to 31 December 2009. The MLQ measured three leadership outcomes, which included motivation, effectiveness and satisfaction. Regression analysis was used to determine associations. RESULTS: A total number of 90 responses were received, which equated to a 42% response rate. There were no significant correlations between transformational, transactional or passive/avoidant leadership behaviours and any of the research performance measures. The five transformational leadership behaviours (ie, idealised attributes (IA), idealised behaviours (IB), inspirational motivation (IM), intellectual stimulation (IS), individual consideration (IC)) were highly significant predictors of leadership outcomes, extra effort (all B>0.404, SE=0.093-0.146, p<0.001), effectiveness (IA, IM, IS, IC B>0.359, SE=0.093-0.146, p<0.001; IB B=0.233, SE=0.103, p=0.026) and satisfaction (IA, IM, IS, IC B>0.483, SE=0.086-0.139, p<0.001; IB B=0.296, SE=0.101, p=0.004). Similarly, contingent reward was a significant predictor of extra effort (B=0.400, SE=0.123, p=0.002), effectiveness (B=0.353, SE=0.113, p=0.002) and satisfaction (B=0.326, SE=0.114, p=0.005). CONCLUSIONS: This study demonstrates that transformational leadership and contingent rewa
Athanasiou T, Patel V, Garas G, et al., 2016, Mentoring perception and academic performance: an Academic Health Science Centre survey, Postgraduate Medical Journal, Vol: 92, Pages: 597-602, ISSN: 1469-0756
Purpose To determine the association between professors' self-perception of mentoring skills and their academic performance.Design Two hundred and fifteen professors from Imperial College London, the first Academic Health Science Centre (AHSC) in the UK, were surveyed. The instrument adopted was the Mentorship Skills Self-Assessment Survey. Statement scores were aggregated to provide a score for each shared core, mentor-specific and mentee-specific skill. Univariate and multivariate regression analyses were used to evaluate their relationship with quantitative measures of academic performance (publications, citations and h-index).Results There were 104 professors that responded (response rate 48%). There were no statistically significant negative correlations between any mentoring statement and any performance measure. In contrast, several mentoring survey items were positively correlated with academic performance. The total survey score for frequency of application of mentoring skills had a statistically significant positive association with number of publications (B=0.012, SE=0.004, p=0.006), as did the frequency of acquiring mentors with number of citations (B=1.572, SE=0.702, p=0.030). Building trust and managing risks had a statistically significant positive association with h-index (B=0.941, SE=0.460, p=0.047 and B=0.613, SE=0.287, p=0.038, respectively).Conclusions This study supports the view that mentoring is associated with high academic performance. Importantly, it suggests that frequent use of mentoring skills and quality of mentoring have positive effects on academic performance. Formal mentoring programmes should be considered a fundamental part of all AHSCs’ configuration.
Jarral OA, Kidher E, Patel VM, et al., 2016, Quality of life after intervention on the thoracic aorta, EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY, Vol: 49, Pages: 369-389, ISSN: 1010-7940
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- Citations: 19
Ibrahim M, Fanshawe A, Patel V, et al., 2014, What factors influence British medical students' career intentions?, MEDICAL TEACHER, Vol: 36, Pages: 1064-1072, ISSN: 0142-159X
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- Citations: 44
Kidher E, Patel VM, Nihoyannopoulos P, et al., 2014, Aortic stiffness is related to the ischemic brain injury biomarker N-methyl-D-aspartate receptor antibody levels in aortic valve replacement, Neurology Research International, Vol: 2014, ISSN: 2090-1860
Background. Aortic stiffness changes the flow pattern of circulating blood causing microvascular damage to different end-organ tissues, such as brain cells. The relationship between aortic stiffness measured by pulse wave velocity (PWV) and serum ischemic brain injury biomarker N-methyl-D-aspartate receptor antibody (NR2Ab) levels in aortic valve replacement has not been assessed. Methods. Patients undergoing aortic valve replacement (AVR) for aortic stenosis (AS) had their PWV and NR2Ab serum levels measured preoperatively. We analyzed PWV and NR2Ab in two ways: (1) as continuous variables using the actual value and (2) as dichotomous variables (PWV-norm and PWV-high groups) and (NR2Ab-low and NR2Ab-high groups). Results. Fifty-six patients ( years) were included in this study. The NR2Ab level (ng/mL) was significantly higher in the PWV-high group () than in PWV-norm group (; median versus , resp., ). NR2Ab level was positively associated with PWV and negatively associated with male gender. Multiple regression revealed PWV independently related to NR2Ab level, and PWV cut-off was associated with a 7.23 times increase in the likelihood of having high NR2Ab (>1.8 ng/mL). Conclusion. Higher PWV in patients with surgical aortic stenosis is associated with higher levels of the ischemic brain biomarker NR2Ab.
Sabharwal S, Gauher S, Kyriacou S, et al., 2014, Quality assessment of guidelines on thromboprophylaxis in orthopaedic surgery, BONE & JOINT JOURNAL, Vol: 96B, Pages: 19-23, ISSN: 2049-4394
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- Citations: 7
Sabharwal S, Gauher S, Kyriacou S, et al., 2014, Quality assessment of guidelines on thromboprophylaxis in orthopaedic surgery., Bone Joint J, Vol: 96-B, Pages: 19-23
We evaluated the quality of guidelines on thromboprophylaxis in orthopaedic surgery by examining how they adhere to validated methodological standards in their development. A structured review was performed for guidelines that were published between January 2005 and April 2013 in medical journals or on the Internet. A pre-defined computerised search was used in MEDLINE, Scopus and Google to identify the guidelines. The AGREE II assessment tool was used to evaluate the quality of the guidelines in the study. Seven international and national guidelines were identified. The overall methodological quality of the individual guidelines was good. 'Scope and Purpose' (median score 98% interquartile range (IQR)) 86% to 98%) and 'Clarity of Presentation' (median score 90%, IQR 90% to 95%) were the two domains that received the highest scores. 'Applicability' (median score 68%, IQR 45% to 75%) and 'Editorial Independence' (median score 71%, IQR 68% to 75%) had the lowest scores. These findings reveal that although the overall methodological quality of guidelines on thromboprophylaxis in orthopaedic surgery is good, domains within their development, such as 'Applicability' and 'Editorial Independence', need to be improved. Application of the AGREE II instrument by the authors of guidelines may improve the quality of future guidelines and provide increased focus on aspects of methodology used in their development that are not robust.
Sabharwal S, Patel V, Nijjer SS, et al., 2013, Guidelines in cardiac clinical practice: evaluation of their methodological quality using the AGREE II instrument, JOURNAL OF THE ROYAL SOCIETY OF MEDICINE, Vol: 106, Pages: 315-322, ISSN: 0141-0768
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- Citations: 33
Elliott JA, Patel VM, Kirresh A, et al., 2013, Fast-track laparoscopic bariatric surgery: a systematic review., Updates Surg, Vol: 65, Pages: 85-94, ISSN: 2038-131X
This study aimed to systematically evaluate the evidence-based literature on fast-track laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic adjustable gastric banding (LAGB) to determine the feasibility and safety of fast-track laparoscopic bariatric surgery. A literature search of PubMed, EMBASE and Cochrane Library using the MeSH terms "bariatric surgery", "ambulatory surgical procedures" and related terms as keywords was performed. The study included articles that reported on intended next-day discharge for LRYGB and same-day discharge for LAGB. Data were extracted on study design and size, patient demographics, patient-selection criteria, patient preparation, perioperative management, operative details, clinical outcomes, and follow-up. The review included 13 studies classified as level 3b or 4 evidence. There were seven studies that investigated LAGB, five studies investigated LRYGB and one study detailed outcomes from both LRYGB and LAGB. Next-day discharge rate ranged from 81 to 100 % for LRYGB. Same-day discharge rate ranged from 76 to 98 % for LAGB. In LRYGB and LAGB complication, re-admission and mortality rates (≤10.5, ≤7.5, ≤0.1 %, respectively) were comparable with the conventional perioperative care. From our results, the fast-track management of patients undergoing LRYGB and LAGB is feasible. With careful patient selection and preparation within high-volume centres, and application of care pathways including close outpatient follow-up, outcomes for fast-track bariatric procedures can compare favourably with those reported in the literature for standard management, but with decreased cost. However, further studies from independent researchers are required to determine the safety of a generalised adoption of this approach outside of dedicated bariatric units, and to formally demonstrate the cost-benefit of fast-track bariatric surgery.
Patel VM, Ashrafian H, Almoudaris A, et al., 2013, Measuring academic performance for healthcare researchers with the H index: which search tool should be used?, Medical Principles and Practice, Vol: 22, Pages: 178-183, ISSN: 1011-7571
Objectives: To compare H index scores for healthcare researchers returned by Google Scholar, Web of Science and Scopus databases, and to assess whether a researcher’s age, country of institutional affiliation and physician status influences calculations. Subjects and Methods: One hundred and ninety-five Nobel laureates in Physiology and Medicine from 1901 to 2009 were considered. Year of first and last publications, total publications and citation counts, and the H index for each laureate were calculated from each database. Cronbach’s alpha statistics was used to measure the reliability of H index scores between the databases. Laureate characteristic influence on the H index was analysed using linear regression. Results: There was no concordance between the databases when considering the number of publications and citations count per laureate. The H index was the most reliably calculated bibliometric across the three databases (Cronbach’s alpha = 0.900). All databases returned significantly higher H index scores for younger laureates (p < 0.0001). Google Scholar and Web of Science returned significantly higher H index for physician laureates (p = 0.025 and p = 0.029, respectively). Country of institutional affiliation did not influence the H index in any database. Conclusion: The H index appeared to be the most consistently calculated bibliometric between the databases for Nobel laureates in Physiology and Medicine. Researcher-specific characteristics constituted an important component of objective research assessment. The findings of this study call to question the choice of current and future academic performance databases.
Patel VM, Ashrafian H, Bornmann L, et al., 2013, Enhancing the <i>h</i> index for the objective assessment of healthcare researcher performance and impact, JOURNAL OF THE ROYAL SOCIETY OF MEDICINE, Vol: 106, Pages: 19-29, ISSN: 0141-0768
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- Citations: 15
Ahmed K, Ashrafian H, Harling L, et al., 2013, Safety of training and assessment in operating theatres - a systematic review and meta-analysis, PERFUSION-UK, Vol: 28, Pages: 76-87, ISSN: 0267-6591
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- Citations: 4
Jaffer OS, Lung PFC, Bosanac D, et al., 2012, Acoustic radiation force impulse quantification: repeatability of measurements in selected liver segments and influence of age, body mass index and liver capsule-to-box distance, BRITISH JOURNAL OF RADIOLOGY, Vol: 85, Pages: E858-E863, ISSN: 0007-1285
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- Citations: 44
Garas G, Ibrahim A, Ashrafian H, et al., 2012, Evidence-Based Surgery: Barriers, Solutions, and the Role of Evidence Synthesis, WORLD JOURNAL OF SURGERY, Vol: 36, Pages: 1723-1731, ISSN: 0364-2313
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- Citations: 41
Verma AR, Patel VM, Mikhail S, et al., 2012, An unusual presentation of late oesophagojejunal anastomotic leak after total D2 gastrectomy., Ann R Coll Surg Engl, Vol: 94, Pages: e106-e108
Oesophagojejunal anastomotic leak usually presents in the early post-operative period with abdominal pain and sepsis. We report a case of late anastomotic leak presenting as epigastric pain with hyperamylasaemia and discuss the differential diagnosis.
Okabayashi K, Ashrafian H, Hasegawa H, et al., 2012, Body mass index category as a risk factor for colorectal adenomas: a systematic review and meta-analysis, Am J Gastroenterol, Vol: 107, Pages: 1175-1186, ISSN: 0002-9270
OBJECTIVES: The association between increasing body weight and colorectal adenoma prevalence has been suggested to follow a similar pattern to excess weight and colorectal cancer, although the magnitude of this relationship has not been validated. The objective of this study was to quantify the association and dose-response relationship between body mass index (BMI) and colorectal adenoma prevalence in clinical trials. METHODS: We systematically reviewed 23 studies (168,201 participants), which compared the prevalence of colorectal adenomas according to World Health Organization BMI categories. We assessed the effects of each BMI category on colorectal adenomas where odds ratio (OR) was used as a surrogate for effect size, and applied multivariate meta-analysis as a method of sensitivity analysis to evaluate the robustness of our findings and to analyze adenoma prevalence by multiple BMI categories simultaneously to assess for a dose-response relationship. Heterogeneity and publication bias were assessed. RESULTS: Subjects with a BMI of >/=25 had a significantly higher prevalence of colorectal adenomas (OR=1.24 (95% confidence interval (CI): 1.16-1.33), P<0.01) when compared with those with BMI<25. Multivariate meta-analysis also confirmed a positive association between higher BMI categories and the prevalence of colorectal adenoma (BMI: 25-30 vs. BMI<25; OR=1.21 (95% CI: 1.07-1.38), P<0.01; BMI>/=30 vs. BMI<25; OR=1.32 (95% CI: 1.18-1.48), P<0.01) and revealed a dose-response relationship. CONCLUSIONS: The positive association between obesity and colorectal adenoma prevalence demonstrates an underlying dose-response relationship according to BMI. Colorectal centers may benefit from the timely screening of obese patients for colorectal adenomas in addition to clarifying the biological role of adiposity on colorectal tumor initiation and progression.
Fovos A, Jarral O, Patel V, et al., 2012, Does Heller's myotomy provide superior clinical outcome in comparison to botulinum toxin injection for treatment of achalasia? Best evidence topic (BET), INTERNATIONAL JOURNAL OF SURGERY, Vol: 10, Pages: 120-123, ISSN: 1743-9191
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- Citations: 8
Ashrafian H, Patel VM, Skapinakis P, et al., 2011, Nobel Prizes in Medicine: are clinicians out of fashion?, JOURNAL OF THE ROYAL SOCIETY OF MEDICINE, Vol: 104, Pages: 387-389, ISSN: 0141-0768
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- Citations: 5
Kirresh A, Patel VM, Warren OJ, et al., 2011, A framework to establish a mentoring programme in surgery, LANGENBECKS ARCHIVES OF SURGERY, Vol: 396, Pages: 811-817, ISSN: 1435-2443
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- Citations: 5
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