2024

Automating incidence and prevalence analysis in open cohorts (2024)

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Type of publication:
Journal article

Author(s):
Cockburn N.; Hammond B.; Gani I.; Cusworth S.; Acharya A.; Gokhale K.; Thayakaran R.; Crowe F.; Minhas S.; *Smith W.P.; Taylor B.; Nirantharakumar K.; Chandan J.S.;

Citation:
BMC medical research methodology. 24(1) (pp 144), 2024. Date of Publication: 04 Jul 2024.

Abstract:
MOTIVATION: Data is increasingly used for improvement and research in public health, especially administrative data such as that collected in electronic health records. Patients enter and exit these typically open-cohort datasets non-uniformly; this can render simple questions about incidence and prevalence time-consuming and with unnecessary variation between analyses. We therefore developed methods to automate analysis of incidence and prevalence in open cohort datasets, to improve transparency, productivity and reproducibility of analyses. IMPLEMENTATION: We provide both a code-free set of rules for incidence and prevalence that can be applied to any open cohort, and a python Command Line Interface implementation of these rules requiring python 3.9 or later. GENERAL FEATURES: The Command Line Interface is used to calculate incidence and point prevalence time series from open cohort data. The ruleset can be used in developing other implementations or can be rearranged to form other analytical questions such as period prevalence. AVAILABILITY: The command line interface is freely available from https://github.com/THINKINGGroup/analogy_publication .

Link to full-text [open access - no password required]

Patients' Preferences for Cytoreductive Treatments in Newly Diagnosed Metastatic Prostate Cancer: The IP5-MATTER Study (2024)

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Type of publication:
Journal article

Author(s):
Connor M.J.; Genie M.; Dudderidge T.; Wu H.; Sukumar J.; Beresford M.; Bianchini D.; Goh C.; Horan G.; Innominato P.; Khoo V.; Klimowska-Nassar N.; Madaan S.; Mangar S.; McCracken S.; Ostler P.; Paisey S.; Robinson A.; Rai B.; Sarwar N.; *Srihari N.; Jayaprakash K.T.; Varughese M.; Winkler M.; Ahmed H.U.; Watson V.

Citation:
European Urology Oncology. (no pagination), 2024. Date of Publication: 2024.

Abstract:
Background and objective: Cytoreductive treatments for patients diagnosed with de novo synchronous metastatic hormone-sensitive prostate cancer (mHSPC) confer incremental survival benefits over systemic therapy, but these may lead to added toxicity and morbidity. Our objective was to determine patients' preferences for, and trade-offs between, additional cytoreductive prostate and metastasis-directed interventions. Method(s): A prospective multicentre discrete choice experiment trial was conducted at 30 hospitals in the UK between December 3, 2020 and January 25, 2023 (NCT04590976). The individuals were eligible for inclusion if they were diagnosed with de novo synchronous mHSPC within 4 mo of commencing androgen deprivation therapy and had performance status 0-2. A discrete choice experiment instrument was developed to elicit patients' preferences for cytoreductive prostate radiotherapy, prostatectomy, prostate ablation, and stereotactic ablative body radiotherapy to metastasis. Patients chose their preferred treatment based on seven attributes. An error-component conditional logit model was used to estimate the preferences for and trade-offs between treatment attributes. Key findings and limitations: A total of 352 patients were enrolled, of whom 303 completed the study. The median age was 70 yr (interquartile range [IQR] 64-76) and prostate-specific antigen was 94 ng/ml (IQR 28-370). Metastatic stages were M1a 10.9% (33/303), M1b 79.9% (242/303), and M1c 7.6% (23/303). Patients preferred treatments with longer survival and progression-free periods. Patients were less likely to favour cytoreductive prostatectomy with systemic therapy (Coef. -0.448; [95% confidence interval {CI} -0.60 to -0.29]; p < 0.001), unless combined with metastasis-directed therapy. Cytoreductive prostate radiotherapy or ablation with systemic therapy, number of hospital visits, use of a "day-case" procedure, or addition of stereotactic ablative body radiotherapy did not impact treatment choice. Patients were willing to accept an additional cytoreductive treatment with 10 percentage point increases in the risk of urinary incontinence and fatigue to gain 3.4 mo (95% CI 2.8-4.3) and 2.7 mo (95% CI 2.3-3.1) of overall survival, respectively. Conclusions and clinical implications: Patients are accepting of additional cytoreductive treatments for survival benefit in mHSPC, prioritising preservation of urinary function and avoidance of fatigue. Patient Summary: We performed a large study to ascertain how patients diagnosed with advanced (metastatic) prostate cancer at their first diagnosis made decisions regarding additional available treatments for their prostate and cancer deposits (metastases). Treatments would not provide cure but may reduce cancer burden (cytoreduction), prolong life, and extend time without cancer progression. We reported that most patients were willing to accept additional treatments for survival benefits, in particular treatments that preserved urinary function and reduced fatigue.

Link to full-text [open access - no password required]

Dedicated anticoagulation management protocols in fragility femoral fracture care - a source of significant variance and limited effectiveness in improving time to surgery: The hip and femoral fracture anticoagulation surgical timing evaluation (HASTE) study

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Type of publication:
Journal article

Author(s):
Farhan-Alanie M.M.; Dixon J.; Irvine S.; Walker R.; Eardley W.G.P.; Smith M.; Yoong A.; Lim J.W.; Yousef O.; McDonald S.; Chileshe C.; Ramus C.; Clements C.; Barrett L.; Rockall O.; Geetala R.; Islam S.U.; Nasar A.; Almond K.; Hassan L.F.Y.; Brand R.B.; Yawar B.; Gilmore C.; McAuley D.; Khan W.; Subramanian P.; Ahluwalia A.; Ozbek L.; Awasthi P.; Sheikh H.; Barkley S.; Ardolino T.; Denning A.; Thiruchandran G.; Fraig H.; Salim O.; Iqbal R.; Guy S.; Hogg J.; Bagshaw O.; Asmar S.; Mitchell S.; Quek F.; Fletcher J.; French J.; Graham S.; Sloper P.; Sadique H.; Matera V.; Sohail Z.; Leong J.W.; Issa F.; Greasley L.; Marsden S.; Parry L.; Mannan S.; Zaheen H.; Moriarty P.; Manning W.; Morris T.; Brockbanks C.; Ward P.; Pearce K.; McMenemy L.; Mahmoud M.; Kieffer W.; Lal A.; Collis J.; Chandrasekaran K.; Foxall-Smith M.; Raad M.; Kempshall P.; Cheuk J.; Leckey S.; Gupta R.; Engelke D.; Kemp M.; Venkatesan A.; Hussain A.; Simons M.; Raghavendra R.M.; Rohra S.; Deo S.; Vasarhelyi F.; Thelwall C.; Cullen K.; Al-Obaidi B.; Fell A.; Thaumeen A.; Dadabhoy M.; Ali M.; Ijaz S.; Lin D.; Khan B.; Alsonbaty M.; Lebe M.; Millan R.K.; Imam S.; Theobald E.; Cormack J.; Sharoff L.; Eardley W.; Jeyapalan R.; Alcock L.; Clayton J.; Bates N.; Mahmoud Y.; Osborne A.; Ralhan S.; Carpenter C.; Ahmad M.; Ravi S.M.; Konbaz T.; Lloyd T.; Sheikh N.; Swealem A.; Soroya E.; Rayan F.; Ward T.; Vasireddy A.; Clarke E.; Sikdar O.; Smart Y.W.; Windley J.; Ilagan B.; Brophy E.; Joseph S.; Lowery K.; Jamjoom A.; Ismayl G.; Aujla R.; Sambhwani S.; Ramasamy A.; Khalaf A.; Ponugoti N.; Teng W.H.; Masud S.; Otoibhili E.; Clarkson M.; Nafea M.; Sarhan M.; Hanna S.; Kelly A.; Curtis A.; Gourbault L.; Tarhini M.; Platt N.; Fleming T.; Pemmaraju G.; Choudri M.J.; Burahee A.; Hassan L.; Hamid L.; Loveday D.; Edres K.; Schankat K.; Granger L.; Goodbun M.; Parikh S.; Johnson-Lynn S.; Griffiths A.; Rai A.; Chandler H.; Guiot L.; Appleyard T.; Robinson K.; Fong A.; Watts A.; Stedman T.; Walton V.; Inman D.; Liaw F.; Hadfield J.; McGovern J.; Baldock T.; White J.; Seah M.; Jacob N.; Ali Z.H.; Goff T.; Sanalla A.; Gomati A.; Nordin L.; Hassan E.; Ramadan O.; Teoh K.H.; Baskaran D.; Ngwayi J.; Abbakr L.; Blackmore N.; Mansukhani S.; Guryel E.; Harper A.; Cashman E.; Brooker J.; Pack L.; Regan N.; *Wagner W.; *Selim A.; *Archer D.; *McConaghie G.; *Patel R.; *Gibson W.; Pasapula C.S.; Youssef H.; Aziz M.A.; Subhash S.; Banaszkiewicz P.; Elzawahry A.; Neo C.; Wei N.; Bhaskaran A.; Sharma A.; Factor D.; Shahin F.; Shields D.; Ferreira C.D.F.; Jeyakumar G.; Liao Q.; Sinnerton R.; Ashwood N.; Sarhan I.; Ker A.; Phelan S.; Paxton J.; McAuley J.; Moulton L.; Mohamed A.; Dias A.; Ho B.; Francis D.; Miller S.; Phillips J.; Jones R.; Arthur C.; Oag E.; Thutoetsile K.; Bell K.; Milne K.; Whitefield R.; Patel K.; Singh A.; Morris G.; Parkinson D.; Patil A.; Hamid H.; Syam K.; *Singh R.; *Menon D.; *Crooks S.; Borland S.; Rohman A.; Nicholson A.; Smith B.; Hafiz N.; Kolhe S.; Waites M.; Piper D.; Westacott D.; Grimshaw J.; Bott A.; Berry A.; Battle J.; Flannery O.; Iyengar K.P.; Thakur A.W.; Yousef M.; Bansod V.; El-nahas W.; Dawe E.; Oladeji E.; Federer S.; Trompeter A.; Pritchard A.; Shurovi B.; Jordan C.; Little M.; Sivaloganathan S.; Shaunak S.; Watters H.; Luck J.; Zbaeda M.; Frasquet-Garcia A.; Warner C.; Telford J.; Rooney J.; Attwood J.; Wilson F.; Panagiotopoulos A.; Keane C.; Scott H.; Mazel R.; Maggs J.; Skinner E.; McMunn F.; Lau J.; Ravikumar K.; Thakker D.; Gill M.; McCarthy P.; Fossey G.; Shah S.; McAlinden G.; McGoldrick P.; O'Brien S.; Patil S.; Millington A.; Umar H.; Sehdev S.; Dyer-Hill T.; Yu Kwan T.; Tanagho A.; Hagnasir A.; White T.; Bano C.; Kissin E.; Ghani R.; Thomas P.S.W.; McMullan M.; Walmsley M.; Elgendy M.; Winstanley R.; Round J.; Baxter M.; Thompson E.; Hogan K.; Youssef K.; Fetouh S.; Hopper G.P.; Simpson C.; Warren C.; Waugh D.; Nair G.; Ballantyne A.; Blacklock C.; O'Connell C.; Toland G.; McIntyre J.; Ross L.; Badge R.; Loganathan D.; Turner I.; Ball M.; Maqsood S.; Deierl K.; Beer A.; Tan A.C.W.; Mackinnon T.; Gade V.; Gill J.; Yu San K.; Archunan M.W.; Shaikh M.; Ugbah O.; Uwaoma S.; Pillai A.; Nath U.; Rohan

Citation:
Injury. 55(8) (no pagination), 2024. Article Number: 111686. Date of Publication: August 2024. [epub ahead of print]

Abstract:
Introduction: Approximately 20 % of femoral fragility fracture patients take anticoagulants, typically warfarin or Direct Oral AntiCoagulant (DOAC). These can impact timing of surgery affecting patient survival. Due to several possible approaches and numerous factors to consider in the preoperative workup of anticoagulated patients, potential for variations in clinical practice exist. Some hospitals employ dedicated anticoagulation management protocols to address this issue, and to improve time to surgery. This study aimed to determine the proportion of hospitals with such protocols, compare protocol guidance between hospitals, and evaluate the effectiveness of protocols in facilitating prompt surgery. Method(s): Data was prospectively collected through a collaborative, multicentre approach involving hospitals across the UK. Femoral fragility fracture patients aged >=60 years and admitted to hospital between 1st May to 31st July 2023 were included. Information from dedicated anticoagulation management protocols were collated on several domains relating to perioperative care including administration of reversal agents and instructions on timing of surgery as well as others. Logistic regression was used to evaluate effects of dedicated protocols on time to surgery. Result(s): Dedicated protocols for management of patients taking warfarin and DOACs were present at 41 (52.6 %) and 43 (55.1 %) hospitals respectively. For patients taking warfarin, 39/41 (95.1 %) protocols specified the dose of vitamin k and the most common was 5 milligrams intravenously (n=21). INR threshold values for proceeding to surgery varied between protocols; 1.5 (n=28), 1.8 (n=6), and 2 (n=6). For patients taking DOACs, 35/43 (81.4 %) and 8/43 (18.6 %) protocols advised timing of surgery based on renal function and absolute time from last dose respectively. Analysis of 10,197 patients from 78 hospitals showed fewer patients taking DOACs received surgery within 36 h of admission at hospitals with a dedicated protocol compared to those without (adjusted OR 0.73, 95% CI 0.54-0.99, p=0.040), while there were no differences among patients taking warfarin (adjusted OR 1.64, 95% CI 0.75-3.57, p=0.219). Conclusion(s): Around half of hospitals employed a dedicated anticoagulation management protocol for femoral fragility fracture patients, and substantial variation was observed in guidance between protocols. Dedicated protocols currently being used at hospitals were ineffective at improving the defined targets for time to surgery.

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Shropshire's military, NHS, and volunteer community collaborate to provide an innovative training course for medical registrars (2024)

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Type of publication:
Conference abstract

Author(s):
*Eardley K.; *Mackintosh A.; *Wood G.;

Citation:
Future Healthcare Journal. Conference: The future of medicine. RCP annual conference. Regent's Park, London United Kingdom. 11(Supplement) (no pagination), 2024. Article Number: 100046. Date of Publication: April 2024.

Abstract:
Introduction: The position of Medical Registrar is one of the most important for the delivery of safe and effective emergency care in the acute hospital. It is also one of the most challenging physically and mentally. Health Education England West Midland's School of Medicine commissioned Shrewsbury & Telford Hospital NHS Trust (SATH) to deliver a 3-day residential course specifically designed to cover a wide range of competencies and clinical skills, but specifically to help equip the medical registrar with strategies to better manage the complexity, the cognitive load, and psychological stress of the role in a fun and interactive way. Material(s) and Method(s): The course was codesigned by SATH Volunteers, 202 Multi-role Medical Regiment (202MMR), NHS England OP COURAGE, SATH Clinical Simulation team, and RCP Chief Registrar. Feedback during the course meant that delegate's individual learning needs were identified and addressed in Course. Faculty provided feedback in person and a survey monkey was sent to the delegates on completion of the course. Results and discussion: The following course was delivered to 16 Internal Medicine Year 3 doctors. Deteriorating Patient Clinical Simulation Course: Delegates managed simulated clinical scenarios of deteriorating patients. Complexity called upon prioritisation, delegation, escalation, and communication skills. Simulated relatives were used calling on skills of breaking bad news, duty of candour, best interests' decision making, and providing compassionate end of life care. Human Factors Course: 202MMR Army Reservists and permanent staff delivered a course utilising the Centre of Army Leadership training packages. Using several engaging activities, the delegates gained a greater understanding of self and how their emotions, behaviours, and perceptions play an important role in their ability to be a safe and effective clinician, leader, and follower. Hospital Cardiac Arrest Clinical Simulation Course: All scenarios led onto cardiac arrest and included additional complexity requiring discussion with relatives including breaking bad news and making end of life decisions. Mental health session: This session provided a safe space for the delegates to talk about their experiences working in the NHS. Sustaining mental health and coping strategies and concepts were explored. Written feedback from the delegates was very positive and included: 'It was the best simulation course I have ever attended'. 'Role play by volunteers from the community was a unique experience which I have not observed in previous such training. This provided excellent opportunity to receive feedback on various aspects of our performance'. 'Focus on teamwork, leadership and followership is rarely spoken about in other training. Very dynamic and engaging'. 'Training in army barracks with command tasks correlating with leadership, teamwork and human factors. Interactive sessions, everyone was involved, valued, and listened'. 'The arrest scenarios were much truer to life than ALS courses eg relatives, debrief, bleed, thrombolysis'. 'Very useful feedback. Great to have the opportunity to try this before starting on the reg rota. Hugely appreciated thank you'. Conclusion(s): Utilising the skills and experiences of the NHS, military, and wider community significantly enhances the quality of clinical simulation and human factors training for the medical registrar.

Link to full-text [open access - no password required]

Patients' Preferences for Cytoreductive Treatments in Newly Diagnosed Metastatic Prostate Cancer: The IP5-MATTER Study (2024)

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Type of publication:
Journal article

Author(s):
Connor, Martin J; Genie, Mesfin; Dudderidge, Tim; Wu, Hangjian; Sukumar, Johanna; Beresford, Mark; Bianchini, Diletta; Goh, Chee; Horan, Gail; Innominato, Pasquale; Khoo, Vincent; Klimowska-Nassar, Natalia; Madaan, Sanjeev; Mangar, Stephen; McCracken, Stuart; Ostler, Peter; Paisey, Sangeeta; Robinson, Angus; Rai, Bhavan; Sarwar, Naveed; *Srihari, Narayanan; Jayaprakash, Kamal Thippu; Varughese, Mohini; Winkler, Mathias; Ahmed, Hashim U; Watson, Verity.

Citation:
European Urology Oncology. 2024 Jul 06. [epub ahead of print]

Abstract:
BACKGROUND AND OBJECTIVE: Cytoreductive treatments for patients diagnosed with de novo synchronous metastatic hormone-sensitive prostate cancer (mHSPC) confer incremental survival benefits over systemic therapy, but these may lead to added toxicity and morbidity. Our objective was to determine patients' preferences for, and trade-offs between, additional cytoreductive prostate and metastasis-directed interventions. METHODS: A prospective multicentre discrete choice experiment trial was conducted at 30 hospitals in the UK between December 3, 2020 and January 25, 2023 (NCT04590976). The individuals were eligible for inclusion if they were diagnosed with de novo synchronous mHSPC within 4 mo of commencing androgen deprivation therapy and had performance status 0-2. A discrete choice experiment instrument was developed to elicit patients' preferences for cytoreductive prostate radiotherapy, prostatectomy, prostate ablation, and stereotactic ablative body radiotherapy to metastasis. Patients chose their preferred treatment based on seven attributes. An error-component conditional logit model was used to estimate the preferences for and trade-offs between treatment attributes. KEY FINDINGS AND LIMITATIONS: A total of 352 patients were enrolled, of whom 303 completed the study. The median age was 70 yr (interquartile range [IQR] 64-76) and prostate-specific antigen was 94 ng/ml (IQR 28-370). Metastatic stages were M1a 10.9% (33/303), M1b 79.9% (242/303), and M1c 7.6% (23/303). Patients preferred treatments with longer survival and progression-free periods. Patients were less likely to favour cytoreductive prostatectomy with systemic therapy (Coef. -0.448; [95% confidence interval {CI} -0.60 to -0.29]; p < 0.001), unless combined with metastasis-directed therapy. Cytoreductive prostate radiotherapy or ablation with systemic therapy, number of hospital visits, use of a "day-case" procedure, or addition of stereotactic ablative body radiotherapy did not impact treatment choice. Patients were willing to accept an additional cytoreductive treatment with 10 percentage point increases in the risk of urinary incontinence and fatigue to gain 3.4 mo (95% CI 2.8-4.3) and 2.7 mo (95% CI 2.3-3.1) of overall survival, respectively. CONCLUSIONS AND CLINICAL IMPLICATIONS: Patients are accepting of additional cytoreductive treatments for survival benefit in mHSPC, prioritising preservation of urinary function and avoidance of fatigue. PATIENT SUMMARY: We performed a large study to ascertain how patients diagnosed with advanced (metastatic) prostate cancer at their first diagnosis made decisions regarding additional available treatments for their prostate and cancer deposits (metastases). Treatments would not provide cure but may reduce cancer burden (cytoreduction), prolong life, and extend time without cancer progression. We reported that most patients were willing to accept additional treatments for survival benefits, in particular treatments that preserved urinary function and reduced fatigue.

Link to full-text [open access - no password required]

A Systematic Review and Meta-Analysis of the Outcomes of Reconstruction with Vascularised vs Non-Vascularised Bone Graft after Surgical Resection of Primary Malignant and Non-Malignant Bone Tumors (2024)

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Type of publication:
Systematic Review

Author(s):
*Patel, R; McConaghie, G; Khan, M M; Gibson, W; Singh, R; Banerjee, R.

Citation:
Acta Chirurgiae Orthopaedicae et Traumatologiae Cechoslovaca. 91(3):143-150, 2024.

Abstract:
PURPOSE OF THE STUDY: Vascularised bone grafting (VBG) and non-vascularised bone grafting (NVBG) are crucial biological reconstructive procedures extensively employed in the management of bone tumours. The principal aim of this study is to conduct a comparative analysis of the post-resection outcomes associated with the utilisation of vascularised and non-vascularised bone grafts. MATERIAL AND METHODS: A comprehensive and systematic literature review spanning the years 2013 to 2023 was meticulously executed, utilising prominent online databases including PubMed/Medline, Google Scholar, and Cochrane Library. Inclusion criteria were restricted to comparative articles that specifically addressed outcomes pertaining to defect restoration following bone tumour resection via vascularised and non-vascularised bone grafting techniques. The quality of research methodologies was assessed using the Oxford Quality Scoring System for randomised trials and the Newcastle Ottawa Scale for non-randomised comparative studies. Data analysis was conducted using SPSS version 24. Key outcome measures encompassed the Musculoskeletal Tumour Society Score (MSTS), bone union duration, and the incidence of post-operative complications. RESULTS: This analysis incorporated four clinical publications, enrolling a total of 178 participants (comprising 92 males and 86 females), with 90 patients subjected to VBG and 88 to NVBG procedures. The primary endpoints of interest encompassed MSTS scores and bone union durations. Although no statistically significant distinction was observed in the complication rates between the two cohorts, it is noteworthy that VBG exhibited a markedly superior bone union rate (P<0.001). CONCLUSIONS: Our systematic evaluation revealed that VBG facilitates expedited bone union, thereby contributing to accelerated patient recovery. Notably, complication rates and functional outcomes were comparable between the VBG and NVBG groups. Moreover, the correlation between bone union duration and functional scores following VBG and NVBG merits further investigation.

Automating incidence and prevalence analysis in open cohorts (2024)

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Type of publication:
Journal article

Author(s):
Cockburn, Neil; Hammond, Ben; Gani, Illin; Cusworth, Samuel; Acharya, Aditya; Gokhale, Krishna; Thayakaran, Rasiah; Crowe, Francesca; Minhas, Sonica; *Smith, William Parry; Taylor, Beck; Nirantharakumar, Krishnarajah; Chandan, Joht Singh.

Citation:
BMC Medical Research Methodology. 24(1):144, 2024 Jul 04.

Abstract:
MOTIVATION: Data is increasingly used for improvement and research in public health, especially administrative data such as that collected in electronic health records. Patients enter and exit these typically open-cohort datasets non-uniformly; this can render simple questions about incidence and prevalence time-consuming and with unnecessary variation between analyses. We therefore developed methods to automate analysis of incidence and prevalence in open cohort datasets, to improve transparency, productivity and reproducibility of analyses. IMPLEMENTATION: We provide both a code-free set of rules for incidence and prevalence that can be applied to any open cohort, and a python Command Line Interface implementation of these rules requiring python 3.9 or later. GENERAL FEATURES: The Command Line Interface is used to calculate incidence and point prevalence time series from open cohort data. The ruleset can be used in developing other implementations or can be rearranged to form other analytical questions such as period prevalence. AVAILABILITY: The command line interface is freely available from https://github.com/THINKINGGroup/analogy_publication

Link to full-text [open access - no password required]

REPAIRS Delphi: A UK and Ireland Consensus Statement on the Management of Infected Arterial Pseudoaneurysms Secondary to Groin Injecting Drug Use (2024)

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Type of publication:
Journal article

Author(s):
MacLeod C.S.; Nagy J.; Radley A.; Khan F.; Rae N.; Wilson M.S.J.; Suttie S.A.; Munro E.N.; Flett M.M.; Hussey K.; Wolf B.; W R.; Wallace D.; Vesey A.T.; McCaslin J.; Wong P.; Tenna A.; Badger S.; Harrison G.; Ghosh J.; Al-Khaffaf H.; Torella F.; McBride R.; Drinkwater S.; Antoniou G.A.; Bhasin N.; Pradhan A.; Smith G.; Coughlin P.; Brar R.; Peach G.; Kulkarni S.; Brooks M.; Wijesinghe L.; McCune K.; Hopper N.; Cowan A.; Hunter I.; Mittapalli D.; Garnham A.; *Jones S.; Rajagopalan S.; Tiwari A.; Imray C.; Atwal A.; Bahia S.; Jones K.G.; Handa A.; Bowbrick G.; Nordon I.; Button M.; Rudarakanchana N.; D'Souza R.; Tai N.; Moxey P.; Bicknell C.; Gibbs R.; Zayed H.; Saratzis A.; Kannan R.; Batchelder A.; Chong P.L.; Rowlands T.; Hildebrand D.; Thapar A.; Chaudhuri A.; Howard A.; Metcalfe M.; Al-Jundi W.; Sayer G.; Lewis D.; Sohrabi S.; Woolgar J.; Fligelstone L.; Davies H.; Hill S.; Fulton G.; Moneley D.; McDonnell C.; Martin Z.; Dowdall J.; Tierney S.; Walsh S.; Medani M.; Gosi G.

Citation:
European Journal of Vascular and Endovascular Surgery. (no pagination), 2024 [epub ahead of print]

Abstract:
Objective: Consensus guidelines on the optimal management of infected arterial pseudoaneurysms secondary to groin injecting drug use are lacking. This pathology is a problem in the UK and globally, yet operative management options remain contentious. This study was designed to establish consensus to promote better management of these patients, drawing on the expert experience of those in a location with a high prevalence of illicit drug use. Method(s): A three round modified Delphi was undertaken, systematically surveying consultant vascular surgeons in the UK and Ireland using an online platform. Seventy five vascular surgery units were invited to participate, with one consultant providing the unit consensus practice. Round one responses were thematically analysed to generate statements for round two. These statements were evaluated by participants using a five point Likert scale. Consensus was achieved at a threshold of 70% or more agreement or disagreement. Those statements not reaching consensus were assessed and modified for round three. The results of the Delphi process constituted the consensus statement. Result(s): Round one received 64 (86%) responses, round two 59 (79%) responses, and round three 62 (83%) responses; 73 (97%) of 75 units contributed. Round two comprised 150 statements and round three 24 statements. Ninety one statements achieved consensus agreement and 15 consensus disagreement. The Delphi statements covered sequential management of these patients from diagnosis and imaging, antibiotics and microbiology, surgical approach, wound management, follow up, and additional considerations. Pre-operative imaging achieved consensus agreement (97%), with computerised tomography angiography being the modality of choice (97%). Ligation and debridement without arterial reconstruction was the preferred approach at initial surgical intervention (89%). Multidisciplinary management, ensuring holistic care and access to substance use services, also gained consensus agreement. Conclusion(s): This comprehensive consensus statement provides a strong insight into the standard of care for these patients.

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Global 30-day morbidity and mortality of surgery for perforated peptic ulcer: GRACE study (2024)

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Type of publication:
Journal article

Author(s):
Abouelazayem, Mohamed; Jain, Rajesh; Wilson, Michael S J; Martinino, Alessandro; Balasubaramaniam, Vignesh; Biffl, Walter; Coccolini, Federico; *Riera, Manel; Wadhawan, Himanshu; Wazir, Ishaan; Abderaouf, Bettahar; Abramov, Daniil; Abu Jayyab, Mustafa A; Al-Shami, Khayry; Alfarwan, Ahmad; Alhajami, Faris M; Alkaseek, Akram; Alozairi, Ous; Ammar, Ahmed Siddique; Atar, Burak; Baatarjav, Gan-Erdene; Bains, Lovenish; Bakri, Ashraf; Bayramov, Nuru; Bhojwani, Rajesh; Brachini, Gioia; Calini, Giacomo; Campanelli, Michela; Cheng, Shi Yu; Choudhary, Charan Singh; Chowdhury, Sharfuddin; Colak, Elif; Das, Jayanta Kumar; Dawani, Surrendar; Donmez, Turgut; Elzayat, Ibrahim; Erdene, Sarnai; Faizi, Tashaba Qaiser; Frountzas, Maximos; Gafsi, Besma; Gentileschi, Paolo; Guler, Mert; Gupta, Gaurav; Harkati, Nour Elhouda; Harris, Matthew; Hasan, Doaa M; Irowa, Omorodion Omoruyi; Jafferi, Salman; Jain, Sumita Agarwal; Jun Han, Lai; Kandiboyina, Satyanarayana Murthy; Karabulut, Mehmetu; Khamees, Almu'atasim; Khan, Shahzeb; Khan, Madiha Masood; Khaw, Cheng Jing; Kisielewski, Michal; Klib, Mohamad; Kosir, Jurij A; Krawczyk, Wiktor Jan; Lisi, Giorgio; Makama, Jerry Godfrey; Maqbool, Baila; Marques, Claudia Neves; Meric, Serhat; Mietla, Mateusz Przemyslaw; Ads, Alaa Mohamed; Muhumuza, Joshua; Mulita, Francesk; Mustafayeva, Matanat; Omar, Mohammed A; Omarov, Taryel; Pathak, Akshant Anil; Paul, Ratnadeep; Pavone, Giovanna; Podda, Mauro; Raja Ram, Novinth Kumar; Rauf, Fatima; Rauf, Sidra; Safy, Ahmed Mohamed; Sandag, Erdene; Sanli, Ahmet Necati; Siddiqui, Adeela Z; Sotiropoulou, Maria; Talib, Vikash; Tatar, Cihad; Thota, Anuroop; Tokocin, Merve; Tolat, Aditya; Uchikov, Petar Angelov; Valenzuela, Jose I; Venkatappa, Sunil Kumar; Verras, Georgios-Ioannis; Vlahovic, Ivan; Zreeg, Dafer Abdulhakim S; Cardoso, Victor Roth; Gkoutos, Georgios V; Singhal, Rishi; Mahawar, Kamal.

Citation:
Surgical Endoscopy. 2024 Jun 17.

Abstract:
BACKGROUND: There is little international data on morbidity and mortality of surgery for perforated peptic ulcer (PPU). This study aimed to understand the global 30-day morbidity and mortality of patients
undergoing surgery for PPU and to identify variables associated with these. METHOD: We performed an international study of adults (>= 18 years) who underwent surgery for PPU from 1st January 2022 to 30th June 2022. Patients who were treated conservatively or had an underlying gastric cancer were excluded. Patients were divided into subgroups according to age (<= 50 and > 50 years) and time from onset of symptoms to hospital presentation (<= 24 and > 24 h). Univariate and Multivariate analyses were carried out to identify factors associated with higher 30-day morbidity and mortality. RESULTS: 1874 patients from 159 centres across 52 countries were included. 78.3% (n = 1467) of the patients were males and the median (IQR) age was 49 years (25). Thirty-day morbidity and mortality were 48.5% (n = 910) and 9.3% (n = 174) respectively. Median (IQR) hospital stay was 7 (5) days. Open surgery was performed in 80% (n = 1505) of the cohort. Age > 50 years [(OR = 1.7, 95% CI 1.4-2), (OR = 4.7, 95% CI 3.1-7.6)], female
gender [(OR = 1.8, 95% CI 1.4-2.3), (OR = 1.9, 95% CI 1.3-2.9)], shock on admission [(OR = 2.1, 95% CI 1.7-2.7), (OR = 4.8, 95% CI 3.2-7.1)], and acute kidney injury [(OR = 2.5, 95% CI 1.9-3.2), (OR = 3.9), 95% CI
2.7-5.6)] were associated with both 30-day morbidity and mortality. Delayed presentation was associated with 30-day morbidity [OR = 1.3, 95% CI 1.1-1.6], but not mortality. CONCLUSIONS: This study showed that surgery for PPU was associated with high 30-day morbidity and mortality rate. Age, female gender, and signs of shock at presentation were associated with both 30-day morbidity and mortality.

Five historical innovations that have shaped modern otolaryngological surgery (2024)

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Type of publication:
Journal article

Author(s):
*Patel R; Acharya R; *Shah S; Desai C; Raveshia D; *Panesar H; Patel N; Mcconaghie G; Cain DC; *Parmar D; Banerjee R; Singh R

Citation:
Journal of Perioperative Practice. 17504589241244996, 2024 Jun 03.

Abstract:
Throughout history, many innovations have contributed to the development of modern otolaryngological surgery, improving patient outcomes and expanding the range of treatment options available to patients. This article explores five key historical innovations that have shaped modern otolaryngological surgery: Operative Microscope, Hopkins Rigid Endoscope, Laryngeal Nerve monitoring, Cochlear implants and Laser surgery. The selection of innovations for inclusion in this article was meticulously determined through expert consensus and an extensive literature review. We will review the development, impact and significance of each innovation, highlighting their contributions to the field of otolaryngological surgery and their ongoing relevance in contemporary and perioperative practice.