1
|
Tandon D, Curlewis K, Vusirikala A, Subramanian P, Patel A. The impact of electronic pathways and digital systems on neck of femur fracture outcomes globally: a systematic review. Ann R Coll Surg Engl 2023; 105:685-691. [PMID: 36927067 PMCID: PMC10618033 DOI: 10.1308/rcsann.2022.0152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
Abstract
INTRODUCTION Electronic pathways (e-pathways) and digital systems are novel interventions with several uses in healthcare, ranging from clinical decision support systems to checklists for care delivery. Their application in the management of neck of femur (NOF) fractures is evolving and they may play a key role in facilitating improvements in care delivery. The primary aim of this review was to outline the impact of e-pathways/digital systems on NOF fracture outcomes. METHODS A systematic literature search was performed using the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines. A total of 698 citations were evaluated, of which 38 passed the inclusion/exclusion criteria. Six studies were then finalised following full-text review. Heterogenous data meant a narrative synthesis was undertaken. Risk of bias for each paper was assessed using the Downs and Black scale. RESULTS A statistically significant improvement was demonstrated for time to theatre (3/6 studies), length of hospital stay (2/6 studies) and secondary fracture prevention (2/6 studies). Although postoperative delirium and mortality improved with the introduction of e-pathways/digital systems, statistical significance was not achieved. No outcome measures were adversely affected. CONCLUSIONS This systematic review of the literature demonstrates that e-pathways and digital systems are promising novel interventions, displaying a significant positive impact on several NOF fracture outcomes. Owing to the novel nature of e-pathways and digital systems in orthopaedics, a limited number of studies were identified for review, each with variable study design. More high quality homogenous prospective cohort studies with a standardised primary outcome measure are required for more definitive conclusions of efficacy to be drawn.
Collapse
Affiliation(s)
| | - K Curlewis
- Royal Free London NHS Foundation Trust, UK
| | - A Vusirikala
- Royal National Orthopaedic Hospital NHS Trust, UK
| | | | - A Patel
- University College London, UK
- Royal Free London NHS Foundation Trust, UK
| |
Collapse
|
2
|
Laurent E, Saleh M, Vusirikala A, Castillo T, Kuzhupilly R, Fahmy A, Tsekes D. 741 Restarting Elective Orthopaedic Surgery During The COVID-19 Pandemic: Experiences and Patient Outcomes. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.1007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Aim
The COVID-19 pandemic resulted in postponing all non-urgent elective surgeries from April 2020. As we emerged from the first peak, restarting non-urgent services such as elective orthopaedic surgery was important for patients with chronic debilitating conditions. Our hospital successfully restarted orthopaedic surgery during the pandemic to help improve the quality of life of patients. This study describes the development of local protocols and pathways to allow for a safe restart of elective orthopaedic surgery in a COVID-19 free site. It presents the morbidity and mortality outcomes of those patients.
Method
This is a prospective cohort study evaluating all patients undergoing non-emergency orthopaedic procedures through a COVID-19 free pathway in a DGH from 18th May – 10th July 2020. 104 patients were identified, and their outcomes analysed during the 2 weeks following their surgery.
Results
No patients developed COVID-19 in the 2-weeks post-operative period. There were no ITU admissions or in-hospital deaths. 22(21.15%) out of 104 patients developed 23 complications within 2 weeks of surgery. These included: TIA, PE, AF, superficial wound infection, oozy wound and post-operative anaemia. They all made full recovery. There was no statistical difference in the development of complications for age (< 70; >70), gender, BMI, or ASA grades.
Conclusions
This study describes a roadmap to setting up a protocolised elective operating service for orthopaedic surgery. It has shown that standardised protocols in a COVID-19 free site, pre-operative COVID-19 testing and adherence to national guidelines on self-isolation prior to surgery can help prevent COVID-19 infection and its related risks post-operatively.
Collapse
Affiliation(s)
- E Laurent
- Basildon and Thurrock University Hospital, Basildon, United Kingdom
| | - M Saleh
- Basildon and Thurrock University Hospital, Basildon, United Kingdom
| | - A Vusirikala
- Basildon and Thurrock University Hospital, Basildon, United Kingdom
| | - T Castillo
- Basildon and Thurrock University Hospital, Basildon, United Kingdom
| | - R Kuzhupilly
- Basildon and Thurrock University Hospital, Basildon, United Kingdom
| | - A Fahmy
- Basildon and Thurrock University Hospital, Basildon, United Kingdom
| | - D Tsekes
- Basildon and Thurrock University Hospital, Basildon, United Kingdom
| |
Collapse
|
3
|
Vusirikala A, Thomas T, Bhala N, Tahrani AA, Thomas GN, Nirantharakumar K. Impact of obesity and metabolic health status in the development of non-alcoholic fatty liver disease (NAFLD): A United Kingdom population-based cohort study using the health improvement network (THIN). BMC Endocr Disord 2020; 20:96. [PMID: 32605642 PMCID: PMC7325099 DOI: 10.1186/s12902-020-00582-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 06/22/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND With the obesity epidemic reaching crisis levels, there has been attention around those who may be resilient to the effects of obesity, termed metabolically healthy obesity (MHO), who initially present without associated metabolic abnormalities. Few longitudinal studies have explored the relationship between MHO and non-alcoholic fatty liver disease (NAFLD), which we address using over 4 million primary care patient records. METHODS A retrospective population-based longitudinal cohort was conducted using The Health Improvement Network (THIN) database incorporating adults with no history of NAFLD or alcohol excess at baseline. Individuals were classified according to BMI category and metabolic abnormalities (diabetes, hypertension and dyslipidaemia). Diagnosis of NAFLD during follow-up was the primary outcome measure. NAFLD was identified by Read codes. RESULTS During a median follow-up period of 4.7 years, 12,867 (0.3%) incident cases of NAFLD were recorded in the cohort of 4,121,049 individuals. Compared to individuals with normal weight and no metabolic abnormalities, equivalent individuals who were overweight, or obese were at significantly greater risk of incident NAFLD (Adjusted HR 3.32 (95%CI 2.98-3.49), and 6.92 (6.40-7.48, respectively). Metabolic risk factors further increased risk, including in those with normal weight and 1 (2.27, 1.97-2.61) or = < 2 (2.39, 1.99-2.87) metabolic abnormalities. CONCLUSIONS MHO individuals are at greater risk of developing NAFLD compared to those with normal weight. This finding supports that the MHO phenotype is a temporary state, and weight must be considered a risk factor even before other risk factors develop. Being normal weight with metabolic abnormalities was also associated with risk of NAFLD.
Collapse
Affiliation(s)
- A Vusirikala
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - T Thomas
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
- Translational Gastroenterology Unit, University of Oxford, Oxford, UK
- Kennedy Institute of Rheumatology, University of Oxford, Oxford, UK
- Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK
| | - N Bhala
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
- Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - A A Tahrani
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
- Department of Diabetes and Endocrinology, University Hospitals Birmingham, Birmingham, UK
- Centre for Endocrinology, Diabetes and Metabolism (CEDAM), Birmingham Health Partners, Birmingham, UK
| | - G N Thomas
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
| | - K Nirantharakumar
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK.
| |
Collapse
|
4
|
Vusirikala A, Ben-Shlomo Y, Kuh D, Stafford M, Cooper R, Morgan GS. Mid-life social participation and physical performance at age 60-64: evidence from the 1946 British Birth Cohort Study. Eur J Public Health 2019; 29:986-992. [PMID: 30726911 DOI: 10.1093/eurpub/ckz005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Previous studies linking social activity and disability have been limited by focussing on self-reported physical performance in older adults (>65). We examined whether social participation in mid-life is associated with objective and subjective measures of physical performance in older age. METHODS Participants of the Medical Research Council National Survey of Health and Development reported their involvement in social activities at ages 43 and 60-64 years; frequency of such involvement was classified into thirds. Physical performance was measured at age 60-64 using: grip strength; standing balance; chair rises; timed get-up-and-go; self-reported physical function from the Short Form-36. Multivariable regression was used to examine longitudinal associations between social participation and each physical performance measure. We also investigated whether change in social participation between 43 and 60-64 was associated with each outcome. RESULTS In fully adjusted models, higher frequency of social participation at 43 was associated with faster chair rise (1.42 repetitions/min, 95% CI 0.45-2.39) and timed get-up-and-go speed (2.47 cm/s, 95% CI 0.27-4.67) and lower likelihood of self-report limitations (OR of low physical function 0.67, 95% CI 0.50-0.91) at 60-64 compared with low frequency. Better performance in objectively measured outcomes was observed only if higher social participation persisted over time whereas lower odds of self-reported limitations were found in all groups when compared to those with persistently low participation (ORs 0.43-0.56, all P≤0.02). CONCLUSION Our findings suggest that associations between higher levels of social participation in mid-life and better physical performance exist only if this social participation persists through to older age.
Collapse
Affiliation(s)
- A Vusirikala
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Y Ben-Shlomo
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - D Kuh
- Medical Research Council Unit for Lifelong Health and Ageing at University College London (UCL), UK
| | - M Stafford
- Medical Research Council Unit for Lifelong Health and Ageing at University College London (UCL), UK
| | - R Cooper
- Medical Research Council Unit for Lifelong Health and Ageing at University College London (UCL), UK
| | - G S Morgan
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| |
Collapse
|
5
|
Miras AD, Herring R, Vusirikala A, Shojaee-Moradi F, Jackson NC, Chandaria S, Jackson SN, Goldstone AP, Hakim N, Patel AG, Umpleby AM, Le Roux CW. Measurement of hepatic insulin sensitivity early after the bypass of the proximal small bowel in humans. Obes Sci Pract 2016; 3:95-98. [PMID: 28392935 PMCID: PMC5358071 DOI: 10.1002/osp4.76] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 09/14/2016] [Accepted: 09/17/2016] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE Unlike gastric banding or sleeve gastrectomy procedures, intestinal bypass procedures, Roux-en-Y gastric bypass in particular, lead to rapid improvements in glycaemia early after surgery. The bypass of the proximal small bowel may have weight loss and even caloric restriction-independent glucose-lowering properties on hepatic insulin sensitivity. In this first human mechanistic study, we examined this hypothesis by investigating the early effects of the duodeno-jejunal bypass liner (DJBL; GI Dynamics, USA) on the hepatic insulin sensitivity by using the gold standard euglycaemic hyperinsulinaemic clamp methodology. METHOD Seven patients with obesity underwent measurement of hepatic insulin sensitivity at baseline, 1 week after a low-calorie liquid diet and after a further 1 week following insertion of the DJBL whilst on the same diet. RESULTS Duodeno-jejunal bypass liner did not improve the insulin sensitivity of hepatic glucose production beyond the improvements achieved with caloric restriction. CONCLUSIONS Caloric restriction may be the predominant driver of early increases in hepatic insulin sensitivity after the endoscopic bypass of the proximal small bowel. The same mechanism may be at play after Roux-en-Y gastric bypass and explain, at least in part, the rapid improvements in glycaemia.
Collapse
Affiliation(s)
- A D Miras
- Section of Investigative Medicine, Division of Diabetes, Endocrinology and Metabolism Imperial College London London UK
| | - R Herring
- CEDAR Centre Royal Surrey County Hospital Guildford Surrey UK
| | | | - F Shojaee-Moradi
- Diabetes and Metabolic Medicine, Faculty of Health and Medical Sciences University of Surrey Guildford UK
| | - N C Jackson
- Diabetes and Metabolic Medicine, Faculty of Health and Medical Sciences University of Surrey Guildford UK
| | | | - S N Jackson
- Diabetes Complications Research Centre, UCD Conway Institute University College Dublin Dublin Ireland
| | - A P Goldstone
- Centre for Neuropsychopharmacology, Computational, Cognitive and Clinical Neuroimaging Laboratory, Division of Brain Sciences Imperial College London London UK
| | - N Hakim
- Faculty of Medicine, Department of Surgery and Cancer Imperial College London London UK
| | - A G Patel
- Hepatobiliary and minimal access surgery King's College Hospital NHS Foundation Trust London UK
| | - A M Umpleby
- Diabetes and Metabolic Medicine, Faculty of Health and Medical Sciences University of Surrey Guildford UK
| | - C W Le Roux
- Section of Investigative Medicine, Division of Diabetes, Endocrinology and Metabolism Imperial College London London UK; Diabetes Complications Research Centre, UCD Conway Institute University College Dublin Dublin Ireland
| |
Collapse
|
6
|
Vusirikala A, Livermore L, Bojanic S. The wide reaching effect of increasing emergency theatre capacity - the impact on chronic subdural haematoma patient pathway. Int J Surg 2016. [DOI: 10.1016/j.ijsu.2016.08.306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
7
|
Miras AD, Al-Najim W, Jackson SN, McGirr J, Cotter L, Tharakan G, Vusirikala A, le Roux CW, Prechtl CG, Scholtz S. Psychological characteristics, eating behavior, and quality of life assessment of obese patients undergoing weight loss interventions. Scand J Surg 2014; 104:10-7. [PMID: 25053582 DOI: 10.1177/1457496914543977] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND AIMS Bariatric surgery is the most effective treatment for obesity. However, not all patients have similar weight loss following surgery and many researchers have attributed this to different pre-operative psychological, eating behavior, or quality-of-life factors. The aim of this study was to determine whether there are any differences in these factors between patients electing to have bariatric surgery compared to less invasive non-surgical weight loss treatments, between patients choosing a particular bariatric surgery procedure, and to identify whether these factors predict weight loss after bariatric surgery. MATERIAL AND METHODS This was a prospective study of 90 patients undergoing gastric bypass, vertical sleeve gastrectomy, or adjustable gastric banding and 36 patients undergoing pharmacotherapy or lifestyle interventions. All patients completed seven multi-factorial psychological, eating behavior, and quality-of-life questionnaires prior to choosing their weight loss treatment. Questionnaire scores, baseline body mass index, and percent weight loss at 1 year after surgical interventions were recorded. RESULTS AND CONCLUSIONS Surgical patients were younger, had a higher body mass index, and obesity had a higher impact on their quality of life than on non-surgical patients, but they did not differ in the majority of eating behavior and psychological parameters studied. Patients opting for adjustable gastric banding surgery were more anxious, depressed, and had more problems with energy levels than those choosing vertical sleeve gastrectomy, and more work problems compared to those undergoing gastric bypass. Weight loss after bariatric surgery was predicted by pre-operative scores of dietary restraint, disinhibition, and pre-surgery energy levels. The results of this study generate a number of hypotheses that can be explored in future studies and accelerate the development of personalized weight loss treatments.
Collapse
Affiliation(s)
- A D Miras
- Section of Investigative Medicine, Division of Diabetes, Endocrinology & Metabolism, Imperial College London, Hammersmith Hospital, London, UK
| | - W Al-Najim
- Metabolic Medicine Research Unit, Imperial College London, Charing Cross Hospital, London, UK
| | - S N Jackson
- Metabolic Medicine Research Unit, Imperial College London, Charing Cross Hospital, London, UK Diabetes Complications Research Centre, UCD Conway Institute, School of Medicine and Medical Science, University College Dublin, Dublin, Ireland
| | - J McGirr
- Metabolic Medicine Research Unit, Imperial College London, Charing Cross Hospital, London, UK
| | - L Cotter
- Metabolic Medicine Research Unit, Imperial College London, Charing Cross Hospital, London, UK
| | - G Tharakan
- Section of Investigative Medicine, Division of Diabetes, Endocrinology & Metabolism, Imperial College London, Hammersmith Hospital, London, UK
| | - A Vusirikala
- Metabolic Medicine Research Unit, Imperial College London, Charing Cross Hospital, London, UK
| | - C W le Roux
- Metabolic Medicine Research Unit, Imperial College London, Charing Cross Hospital, London, UK Diabetes Complications Research Centre, UCD Conway Institute, School of Medicine and Medical Science, University College Dublin, Dublin, Ireland
| | - C G Prechtl
- Metabolic Medicine Research Unit, Imperial College London, Charing Cross Hospital, London, UK
| | - S Scholtz
- Metabolic Medicine Research Unit, Imperial College London, Charing Cross Hospital, London, UK
| |
Collapse
|