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Palese MA, Chin CP, Garden EB, Eilender B, Levy M, Ravivarapu KT, Wang D, Freid H, Al-Alao O, Araya JS, LaPointe-Rudow D, Herron D, Chin E, Arvelakis A, Shapiro R, Larenas F, Florman SS. Comparison of Single-Port Robotic Donor Nephrectomy and Laparoscopic Donor Nephrectomy. J Endourol 2024; 38:136-141. [PMID: 38185847 DOI: 10.1089/end.2023.0364] [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: 01/09/2024] Open
Abstract
Purpose: To compare the intra- and postoperative outcomes of single-port robotic donor nephrectomies (SP RDNs) and laparoscopic donor nephrectomies (LDNs). Materials and Methods: We retrospectively reviewed our institutional database for patients who received LDN or SP RDN between September 2020 and December 2022. Donor baseline characteristics, intraoperative outcomes, postoperative outcomes, and recipient renal function were extracted and compared between LDN and SP RDN. SP RDN learning curve analysis based on operative time and graft extraction time was performed using cumulative sum analysis. Results: One hundred forty-four patients underwent LDN and 32 patients underwent SP RDN. LDN and SP RDN had similar operative times (LDN: 190.3 ± 28.0 minutes, SP RDN: 194.5 ± 35.1 minutes, p = 0.3253). SP RDN patients had significantly greater extraction times (LDN: 83.2 ± 40.3 seconds, SP RDN: 204.1 ± 52.2 seconds, p < 0.0001) and warm ischemia times (LDN: 145.1 ± 61.7 seconds, SP RDN: 275.4 ± 65.6 seconds, p < 0.0001). There were no differences in patient subjective pain scores, inpatient opioid usage, or Clavien-Dindo II+ complications. Short- and medium-term postoperative donor and recipient renal function were also similar between the groups. SP RDN graft extraction time and total operative time learning curves were achieved at case 27 and 13, respectively. Conclusion: SP RDN is a safe and feasible alternative to LDN that minimizes postoperative abdominal incisional scars and has a short learning curve. Future randomized prospective clinical trials are needed to confirm the findings of this study and to identify other potential benefits and drawbacks of SP RDNs.
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Affiliation(s)
- Michael A Palese
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Chih Peng Chin
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Evan B Garden
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Benjamin Eilender
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Micah Levy
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Krishna T Ravivarapu
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Daniel Wang
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Hannah Freid
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Osama Al-Alao
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Joseph Sewell Araya
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Dianne LaPointe-Rudow
- Recanati/Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Daniel Herron
- Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Edward Chin
- Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Antonios Arvelakis
- Recanati/Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Ron Shapiro
- Recanati/Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Francisca Larenas
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Sander S Florman
- Recanati/Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Healey EL, McBeth J, Nicholls E, Chew‐Graham CA, Dent S, Foster NE, Herron D, Pincus T, Hartshorne L, Hay EM, Jinks C. The acceptability and feasibility of conducting a randomised controlled trial to test the effectiveness of a walking intervention for older people with persistent musculoskeletal pain in primary care: A mixed methods evaluation of the iPOPP pilot trial. Musculoskeletal Care 2023; 21:1372-1386. [PMID: 37688496 PMCID: PMC10946998 DOI: 10.1002/msc.1815] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 08/24/2023] [Indexed: 09/11/2023]
Abstract
INTRODUCTION Persistent musculoskeletal (MSK) pain is associated with physical inactivity in older people. While walking is an acceptable form of physical activity, the effectiveness of walking interventions in this population has yet to be established. OBJECTIVES To assess the acceptability and feasibility of conducting a randomised controlled trial (RCT) to test the effectiveness of a healthcare assistant-led walking intervention for older people with persistent MSK pain (iPOPP) in primary care. METHODS A mixed method, three arm pilot RCT was conducted in four general practices and recruited patients aged ≥65 years with persistent MSK pain. Participants were randomised in a 1:1:1 ratio to: (i) usual care, (ii) usual care plus a pedometer intervention, or (iii) usual care plus the iPOPP walking intervention. Descriptive statistics were used in an exploratory analysis of the quantitative data. Qualitative data were analysed using thematic analysis. A triangulation protocol was used to integrate the analyses from the mixed methods. RESULTS All pre-specified success criteria were achieved in terms of feasibility (recruitment, follow-up and iPOPP intervention adherence) and acceptability. Triangulation of the data identified the need, in the future, to make the iPOPP training (for intervention deliverers) more patient-centred to better support already active patients and the use of individualised goal setting and improve accelerometry data collection processes to increase the amount of valid data. CONCLUSIONS This pilot trial suggests that the iPOPP intervention and a future full-scale RCT are both acceptable and feasible. The use of a triangulation protocol enabled more robust conclusions about acceptability and feasibility to be drawn.
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Affiliation(s)
| | - John McBeth
- Arthritis Research UK Centre for EpidemiologyThe University of ManchesterManchesterUK
| | - Elaine Nicholls
- School of MedicineKeele UniversityKeeleStaffordshireUK
- Keele Clinical Trials UnitKeele UniversityKeeleStaffordshireUK
| | - Carolyn A. Chew‐Graham
- School of MedicineKeele UniversityKeeleStaffordshireUK
- Midlands Partnership Foundation TrustStaffordStaffordshireUK
| | - Stephen Dent
- School of MedicineKeele UniversityKeeleStaffordshireUK
| | - Nadine E. Foster
- School of MedicineKeele UniversityKeeleStaffordshireUK
- STARS Education and Research AllianceSurgical Treatment and Rehabilitation ServiceThe University of Queensland and Metro North HealthBrisbaneQueenslandAustralia
| | - Daniel Herron
- School of Health, Science and WellbeingStaffordshire UniversityScience Centre BuildingStoke‐on‐TrentUK
| | - Tamar Pincus
- The Faculty for Environment and Life Sciences (FELS)University of SouthamptonUniversity RoadSouthamptonUK
| | - Liz Hartshorne
- Faculty of Medicine & Health SciencesUniversity of NottinghamNottinghamUK
| | - Elaine M. Hay
- School of MedicineKeele UniversityKeeleStaffordshireUK
| | - Clare Jinks
- School of MedicineKeele UniversityKeeleStaffordshireUK
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Burton AE, Lindsay-Wiles I, Herron D, Owen A, Elliott J, Metcalfe A, Diwakar L. Hereditary Angioedema patient experiences of medication use and emergency care. Int Emerg Nurs 2023; 71:101339. [PMID: 37713946 DOI: 10.1016/j.ienj.2023.101339] [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] [Received: 03/28/2023] [Revised: 07/13/2023] [Accepted: 08/08/2023] [Indexed: 09/17/2023]
Abstract
BACKGROUND Hereditary angioedema (HAE) is a rare inherited illness characterised by recurrent swellings. Four percent of HAE attacks are life threatening throat swellings requiring urgent medical intervention. The aim of this study was to gain an in depth understanding of patient experiences of use of treatment and emergency care. METHODS 65 participants completed an online survey including open ended questions about their experiences and/or completed an in-depth interview. Interview participants were asked to share and talk about up to five images that they felt best represented their life experiences with HAE. Data were analysed using reflexive thematic analysis. RESULTS Treatment experiences highlighted the life changing nature of new treatments and benefits for quality of life, but also illustrated common barriers to treatment administration. Emergency care experiences illustrated how throat attacks and fear of their future occurrence could be traumatic. DISCUSSION Findings indicate that HAE patients need psychological support to process fears and negative experiences. In addition, psychological barriers to treatment administration must be addressed to ensure treatment is used effectively. Education for emergency practitioners is also needed to improve emergency treatment and reduce the psychological burden of delayed emergency care.
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Affiliation(s)
| | | | - Daniel Herron
- Centre for Psychological Research, Staffordshire University, United Kingdom
| | - Alison Owen
- Centre for Psychological Research, Staffordshire University, United Kingdom
| | - Jade Elliott
- Centre for Psychological Research, Staffordshire University, United Kingdom
| | | | - Lavanya Diwakar
- University Hospitals of North Midlands NHS Trust, United Kingdom
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Costello K, Hildebrandt T, Michaelides A, Herron D, Sysko R. An exploratory structural equation modelling (ESEM) of the Eating Disorders Examination Questionnaire (EDE-Q) in bariatric patients. Clin Obes 2023; 13:e12595. [PMID: 37188327 PMCID: PMC10524968 DOI: 10.1111/cob.12595] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 04/12/2023] [Accepted: 04/25/2023] [Indexed: 05/17/2023]
Abstract
Several studies in clinical and non-clinical populations indicate differences between rationally and empirically derived subscales for the Eating Disorder Examination Questionnaire (EDE-Q), including samples of patients seeking bariatric surgery. This study aimed to use exploratory structural equation modelling (ESEM) to estimate the factor structure of the EDE-Q and assess for the additive value of alternative measurement of eating disorder symptoms. Adolescents and adults completed the EDE-Q and a psychiatric evaluation prior to bariatric surgery. Data from 330 participants were analysed using the original four-factor and modified three-factor structure of the EDE-Q using both confirmatory factor analysis (CFA) and exploratory structural equation modelling (ESEM). Age, ethnicity, and body mass index were examined as covariates in the best fitting model, and model subscales used to generate a predictive model of clinician screened DSM-5 eating disorder diagnoses for criterion validity. A CFA of the four-factor EDE-Q provided poor model fit for a pre-surgical bariatric population, but the three-factor EDE-Q and an ESEM of the four-factor EDE-Q provided excellent model fit. The Eating Concern subscale of the four-factor ESEM model significantly predicted eating disorder diagnosis and was positively correlated with age. Our results suggest the ESEM derived factors of the EDE-Q offered some improvements to the original empirically derived factor structure, as subscale scores based on the original items and cross-loading items yielded an adequate prediction of clinician diagnoses.
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Affiliation(s)
- Kayla Costello
- Eating and Weight Disorders Program, Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Tom Hildebrandt
- Eating and Weight Disorders Program, Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY
| | | | - Daniel Herron
- Garlock Division of General Surgery, Icahn School of Medicine at Mount Sinai, 5 East 98th Street, 3rd Fl, New York, NY, 10029, USA
| | - Robyn Sysko
- Eating and Weight Disorders Program, Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY
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Runacres J, Herron D. Designing Inclusive Qualitative Research with Carers of People Living with Dementia: Methodological Insights. Healthcare (Basel) 2023; 11:2125. [PMID: 37570366 PMCID: PMC10419147 DOI: 10.3390/healthcare11152125] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 07/17/2023] [Accepted: 07/24/2023] [Indexed: 08/13/2023] Open
Abstract
The support provided by carers of people living with dementia results in savings for the UK economy; however, providing this care has a significant impact on carers. Supports are needed to ensure that carers can continue to provide care, and carers should be involved in the generation of the evidence necessary to develop such support. However, this relies on their ability to meaningfully engage with research, yet current data collection methods create obstacles to engagement. In this paper, we aim to provide a critical examination of approaches to qualitative data collection with carers and produce recommendations for the design of inclusive research. First, different approaches to qualitative data collection are discussed and appraised. Following this, a case study of inclusive research is presented, illustrating how carers can be facilitated to engage in research. Finally, recommendations for inclusive research are offered, including the collection of data without the cared-for person present, building additional care into a study design, providing 'incidental funds,' offering sustenance and remuneration, and undertaking research in a neutral space. These recommendations are designed to facilitate the involvement of carers in research and promote the use of more varied or multifaceted methods to develop the current evidence base.
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Affiliation(s)
- Jessica Runacres
- Department of Midwifery and Allied Health, Staffordshire University, Staffordshire ST4 2DE, UK
| | - Daniel Herron
- Department of Psychology, Staffordshire University, Staffordshire ST4 2DE, UK;
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Herron D, Runacres J. The Support Priorities of Older Carers of People Living with Dementia: A Nominal Group Technique Study. Healthcare (Basel) 2023; 11:1998. [PMID: 37510439 PMCID: PMC10379206 DOI: 10.3390/healthcare11141998] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 07/06/2023] [Accepted: 07/07/2023] [Indexed: 07/30/2023] Open
Abstract
The aim of this study was to understand the support priorities of older (65+ years old) carers of people living with dementia. Two nominal group technique focus groups were carried out with older carers of people living with dementia. Twelve carers participated across two focus groups. Participants individually identified support priorities, and through several steps, reached a consensus to produce a ranked list of support priorities. The results consisted of two lists (one list per group), which when combined made up 15 support priorities. These priorities are presented alongside their overall and mean ranking. The authors did not refine these priorities after the focus groups, however, as there was overlap between priorities across the two liststhe results benefited from being themed. These overarching themes consisted of prioritising the carers' holistic needs; having a sense of belonging; support needs to be accessible and timely; support to meet the wellbeing and personhood of the person living with dementia; and understanding and training for the wider community. These results have highlighted support priorities, developed by older carers, that services and organisations can use to better inform the support and services that older carers receive.
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Affiliation(s)
- Daniel Herron
- Department of Psychology, Staffordshire University, Stoke-on-Trent ST4 2DF, UK
| | - Jessica Runacres
- Department of Midwifery and Allied Health, Staffordshire University, Stafford ST18 0YB, UK
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Hawarden A, Bullock L, Chew-Graham CA, Herron D, Hider S, Jinks C, Erandie Ediriweera De Silva R, Machin A, Paskins Z. Incorporating FRAX into a nurse-delivered integrated care review: a multi-method qualitative study. BJGP Open 2023; 7:BJGPO.2022.0146. [PMID: 36746471 PMCID: PMC10354387 DOI: 10.3399/bjgpo.2022.0146] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 01/17/2023] [Accepted: 01/30/2023] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND People with inflammatory rheumatological conditions (IRCs) are at increased risk of common comorbidities including osteoporosis. AIM To explore the barriers to and facilitators of implementing nurse-delivered fracture risk assessments in primary care, in the context of multimorbidity reviews for people with IRCs. DESIGN & SETTING A multi-method qualitative study in primary care. METHOD As part of a process evaluation in a pilot trial, semi-structured interviews were conducted with 20 patients, two nurses, and three GPs. Twenty-four patient-nurse INCLUDE review consultations were audiorecorded and transcribed. A framework analysis was conducted using the Theoretical Domains Framework (TDF). RESULTS Nurses reported positive views about the value of the Fracture Risk Assessment Tool (FRAX) and they felt confident to deliver the assessments following training. Barriers to implementation, as identified by TDF, particularly related to the domains of knowledge, skills, professional roles, and environmental context. GPs reported difficulty keeping up to date with osteoporosis guidelines and voiced differing opinions about whether fracture risk assessment was the role of primary or secondary care. Lack of integration of FRAX into IT systems was a barrier to use. GPs and nurses had differing views about the nurse role in communicating risk and acting on FRAX findings; for example, explanations of the FRAX result and action needed were limited. Patients reported limited understanding of FRAX outcomes. CONCLUSION The findings suggest that, with appropriate training including risk communication, practice nurses are likely to be confident to play a key role in conducting fracture risk assessments, but further work is needed to address the barriers identified.
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Affiliation(s)
| | | | | | - Daniel Herron
- Department of Psychology, School of Health, Science and Wellbeing, Staffordshire University, Staffordshire, UK
| | - Samantha Hider
- School of Medicine, Keele University, Keele, UK
- Haywood Academic Rheumatology Centre, Midlands Partnership NHS Foundation Trust, Staffordshire, UK
| | - Clare Jinks
- School of Medicine, Keele University, Keele, UK
| | - Risni Erandie Ediriweera De Silva
- School of Medicine, Keele University, Keele, UK
- Department of Family Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | | | - Zoe Paskins
- School of Medicine, Keele University, Keele, UK
- Haywood Academic Rheumatology Centre, Midlands Partnership NHS Foundation Trust, Staffordshire, UK
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8
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Wilson J, Nachev P, Herron D, McNally N, Williams B, Rees G. Examining patient benefit. Future Healthc J 2023; 10:90-92. [PMID: 37786506 PMCID: PMC10538683 DOI: 10.7861/fhj.2022-0128] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
Healthcare policy, clinical practice and clinical research all declare patient benefit as their avowed aim. Yet, the conceptual question of what exactly constitutes patient benefit has received much less attention than the practical means of realising it. Currently, three key areas of conceptual unclarity make the achieved, real-world impact hard to quantify and disconnect it from the magnitude of the practical endeavour: (1) the distinction between objective and subjective benefit, (2) the relation between individual and population measures of benefit, and (3) the optimal measurement of benefit in research studies. A philosophical understanding of wellbeing is required to clarify these problems. Adopting a rigorous philosophical framework makes apparent that the differing goals of clinicians, researchers and research funders may make differing conceptions of patient benefit appropriate. A framework is proposed for developing rigour in methods for specifying and measuring patient benefit, and for matching benefit measures to different contexts.
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Affiliation(s)
| | | | - Daniel Herron
- University College Hospitals NHS Foundation Trust, London, UK
| | - Nick McNally
- University College London/University College Hospitals, London, UK
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Gardner J, Herron D, McNally N, Williams B. Advancing the digital and computational capabilities of healthcare providers: A qualitative study of a hospital organisation in the NHS. Digit Health 2023; 9:20552076231186513. [PMID: 37456124 PMCID: PMC10345922 DOI: 10.1177/20552076231186513] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 06/20/2023] [Indexed: 07/18/2023] Open
Abstract
Objective Healthcare systems require transformation to meet societal challenges and projected health demands. Digital and computational tools and approaches are fundamental to this transformation, and hospitals have a key role to play in their development and implementation. This paper reports on a study with the objective of exploring the challenges encountered by hospital leaders and innovators as they implement a strategy to become a data-driven hospital organisation. In doing so, this paper provides guidance to future leaders and innovators seeking to build computational and digital capabilities in complex clinical settings. Methods Interviews were undertaken with 42 participants associated with a large public hospital organisation within England's National Health Service. Using the concept of institutional readiness as an analytical framework, the paper explores participants' perspectives on the organisation's capacity to support the development of, and benefit from, digital and computational approaches. Results Participants' accounts reveal a range of specific institutional readiness criteria relating to organisational vision, technical capability, organisational agility, and talent and skills that, when met, enhance the organisations' capacity to support the development and implementation of digital and computational tools. Participant accounts also reveal challenges relating to these criteria, such as unrealistic expectations and the necessary prioritisation of clinical work in resource-constrained settings. Conclusions The paper identifies a general set of institutional readiness criteria that can guide future hospital leaders and innovators aiming to improve their organisation's digital and computational capability. The paper also illustrates the challenges of pursuing digital and computational innovation in resource-constrained hospital environments.
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Affiliation(s)
- John Gardner
- School of Social Sciences, Monash University, Melbourne, Australia
| | | | | | - Bryan Williams
- Institute of Cardiovascular Sciences, University College London, London, UK
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10
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Engleitner H, Jha A, Pinilla MS, Nelson A, Herron D, Rees G, Friston K, Rossor M, Nachev P. GeoSPM: Geostatistical parametric mapping for medicine. Patterns (N Y) 2022; 3:100656. [PMID: 36569555 PMCID: PMC9768692 DOI: 10.1016/j.patter.2022.100656] [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] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 07/01/2022] [Accepted: 11/11/2022] [Indexed: 12/13/2022]
Abstract
The characteristics and determinants of health and disease are often organized in space, reflecting our spatially extended nature. Understanding the influence of such factors requires models capable of capturing spatial relations. Drawing on statistical parametric mapping, a framework for topological inference well established in the realm of neuroimaging, we propose and validate an approach to the spatial analysis of diverse clinical data-GeoSPM-based on differential geometry and random field theory. We evaluate GeoSPM across an extensive array of synthetic simulations encompassing diverse spatial relationships, sampling, and corruption by noise, and demonstrate its application on large-scale data from UK Biobank. GeoSPM is readily interpretable, can be implemented with ease by non-specialists, enables flexible modeling of complex spatial relations, exhibits robustness to noise and under-sampling, offers principled criteria of statistical significance, and is through computational efficiency readily scalable to large datasets. We provide a complete, open-source software implementation.
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Affiliation(s)
- Holger Engleitner
- UCL Queen Square Institute of Neurology, University College London, London WC1N 3BG, UK
- Corresponding author
| | - Ashwani Jha
- UCL Queen Square Institute of Neurology, University College London, London WC1N 3BG, UK
| | - Marta Suarez Pinilla
- UCL Queen Square Institute of Neurology, University College London, London WC1N 3BG, UK
| | - Amy Nelson
- UCL Queen Square Institute of Neurology, University College London, London WC1N 3BG, UK
| | - Daniel Herron
- Research & Development, NIHR University College London Hospitals Biomedical Research Centre, London W1T 7DN, UK
| | - Geraint Rees
- UCL Queen Square Institute of Neurology, University College London, London WC1N 3BG, UK
| | - Karl Friston
- UCL Queen Square Institute of Neurology, University College London, London WC1N 3BG, UK
| | - Martin Rossor
- UCL Queen Square Institute of Neurology, University College London, London WC1N 3BG, UK
| | - Parashkev Nachev
- UCL Queen Square Institute of Neurology, University College London, London WC1N 3BG, UK
- Corresponding author
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Carruthers R, Straw I, Ruffle JK, Herron D, Nelson A, Bzdok D, Fernandez-Reyes D, Rees G, Nachev P. Representational ethical model calibration. NPJ Digit Med 2022; 5:170. [PMID: 36333390 PMCID: PMC9636204 DOI: 10.1038/s41746-022-00716-4] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 10/19/2022] [Indexed: 11/06/2022] Open
Abstract
Equity is widely held to be fundamental to the ethics of healthcare. In the context of clinical decision-making, it rests on the comparative fidelity of the intelligence - evidence-based or intuitive - guiding the management of each individual patient. Though brought to recent attention by the individuating power of contemporary machine learning, such epistemic equity arises in the context of any decision guidance, whether traditional or innovative. Yet no general framework for its quantification, let alone assurance, currently exists. Here we formulate epistemic equity in terms of model fidelity evaluated over learnt multidimensional representations of identity crafted to maximise the captured diversity of the population, introducing a comprehensive framework for Representational Ethical Model Calibration. We demonstrate the use of the framework on large-scale multimodal data from UK Biobank to derive diverse representations of the population, quantify model performance, and institute responsive remediation. We offer our approach as a principled solution to quantifying and assuring epistemic equity in healthcare, with applications across the research, clinical, and regulatory domains.
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Affiliation(s)
- Robert Carruthers
- Department of Computer Science, University College London, London, UK.
| | - Isabel Straw
- UCL Queen Square Institute of Neurology, University College London, London, UK
| | - James K Ruffle
- UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Daniel Herron
- Research and Development, NIHR University College London Hospitals Biomedical Research Centre, London, UK
| | - Amy Nelson
- UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Danilo Bzdok
- Department of Biomedical Engineering, Faculty of Medicine, McGill University, Montreal, Canada
| | | | - Geraint Rees
- UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Parashkev Nachev
- UCL Queen Square Institute of Neurology, University College London, London, UK.
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Chin CP, Garden E, Levy M, Ravivarapu K, Al-Alao O, Sewell Araya J, Florman S, Arvelakis A, Herron D, Chin E, Palese M. MP36-15 ROBOTIC SINGLE-PORT VERSUS LAPAROSCOPIC DONOR NEPHRECTOMY: AN INSTITUTIONAL ANALYSIS. J Urol 2022. [DOI: 10.1097/ju.0000000000002590.15] [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: 11/25/2022]
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Nelson AP, Gray RJ, Ruffle JK, Watkins HC, Herron D, Sorros N, Mikhailov D, Cardoso MJ, Ourselin S, McNally N, Williams B, Rees GE, Nachev P. Deep forecasting of translational impact in medical research. Patterns 2022; 3:100483. [PMID: 35607619 PMCID: PMC9122964 DOI: 10.1016/j.patter.2022.100483] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 01/10/2022] [Accepted: 03/04/2022] [Indexed: 11/26/2022]
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Engleitner H, Jha A, Herron D, Nelson A, Rees G, McNally N, Williams B, Nachev P. Enrolment in clinical research at UCLH and geographically distributed indices of deprivation. Wellcome Open Res 2021. [DOI: 10.12688/wellcomeopenres.17300.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Healthcare should be judged by its equity as well as its quality. Both aspects depend not only on the characteristics of service delivery but also on the research and innovation that ultimately shape them. Conducting a fully-inclusive evaluation of the relationship between enrolment in primary research studies at University College London Hospitals NHS Trust and indices of deprivation, here we demonstrate a quantitative approach to evaluating equity in healthcare research and innovation. We surveyed the geographical locations, aggregated into Lower Layer Super Output Areas (LSOAs), of all England-resident UCLH patients registered as enrolled in primary clinical research studies. We compared the distributions of ten established indices of deprivation across enrolled and non-enrolled areas within Greater London and within a distance-matched subset across England. Bayesian Poisson regression models were used to examine the relation between deprivation and the volume of enrolment standardized by population density and local disease prevalence. A total of 54593 enrolments covered 4401 LSOAs in Greater London and 10150 in England, revealing wide geographical reach. The distributions of deprivation indices were similar between enrolled and non-enrolled areas, exhibiting median differences from 0.26% to 8.73%. Across Greater London, enrolled areas were significantly more deprived on most indices, including the Index of Multiple Deprivation; across England, a more balanced relationship to deprivation emerged. Regression analyses of enrolment volumes yielded weak biases, in favour of greater deprivation for most indices, with little modulation by local disease prevalence. Primary clinical research at UCLH has wide geographical reach. Areas with enrolled patients show similar distributions of established indices of deprivation to those without, both within Greater London, and across distance-matched areas of England. We illustrate a robust approach to quantifying an important aspect of equity in clinical research and provide a flexible set of tools for replicating it across other institutions.
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Kaski D, Herron D, Nachev P. Deconstructing Dizziness. Front Neurol 2021; 12:664107. [PMID: 33995260 PMCID: PMC8116527 DOI: 10.3389/fneur.2021.664107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 04/06/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Diego Kaski
- Department of Clinical and Motor Neurosciences, Institute of Neurology, University College London, London, United Kingdom
| | - Daniel Herron
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom
| | - Parashkev Nachev
- Department of Brain Repair & Rehabilitation, Institute of Neurology, University College London, London, United Kingdom
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Abstract
Background and aims The rapid setting up of research during the COVID-19 pandemic led to changes in ways of working within research organisations. The aim of this study was to examine the experiences of staff involved in the research review and set-up system at a large NHS and university partnership in the UK through the lens of boundary theory. Methods We carried out a rapid qualitative appraisal based on telephone interviews (n=25) to explore how staff experienced the research review and set-up system during the pandemic. Results In light of the pressures created by the pandemic, the boundaries established to set up distinct groups and responsibilities were modified to allow for different ways of working. Some of the new structures and processes were seen positively and brought groups that previously worked at a distance closer together. Conclusions The reconceptualisation of relations within the research system during the pandemic added more fluidity to ways of working within the research office and contributed to closer working interactions and an expanded team ethos.
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Affiliation(s)
| | | | - Nick McNally
- research UCLH/UC, NIHR UCLH Biomedical Research Centre, London, UK
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Herron D, Chew-Graham CA, Hider S, Machin A, Paskins Z, Cooke K, Desilva EE, Jinks C. Acceptability of nurse-led reviews for inflammatory rheumatological conditions: A qualitative study. J Comorb 2021; 11:26335565211002402. [PMID: 33912472 PMCID: PMC8047946 DOI: 10.1177/26335565211002402] [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] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 12/24/2020] [Accepted: 02/05/2021] [Indexed: 11/17/2022]
Abstract
Background: People with inflammatory rheumatological conditions (IRCs), are at increased risk of comorbidities such as cardiovascular disease, osteoporosis, anxiety and depression. The INCLUDE pilot trial evaluated a nurse-delivered review of people with IRCs which sought to identify and initiate management of comorbid conditions. Aim: A nested qualitative study was undertaken to examine the acceptability of the INCLUDE review. Methods: A qualitative interview-based design in UK primary care settings. A purposive sample of 20 patients who attended an INCLUDE review, were interviewed. Inductive thematic analysis was undertaken. Themes were agreed through multidisciplinary team discussion and mapped onto constructs of the Theoretical Framework of Acceptability (TFA). Results: Six themes mapped onto six of the seven TFA constructs. Patients reported the review to be effective by identifying and initiating management of previously unrecognised comorbid conditions. Some participants reported barriers to following recommendations, such as lifestyle modifications or taking more medication. Conclusion: A nurse-delivered review to identify comorbidities is acceptable to patients with IRCs. The TFA provided a novel analytical lens.
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Affiliation(s)
- Daniel Herron
- School of Life Sciences and Education, Science Centre, Staffordshire University, Stoke-on-Trent, UK
| | - Carolyn A Chew-Graham
- Primary Care Centre Versus Arthritis, School of Medicine, David Weatherall Building, Keele University, Keele, UK.,Midlands Partnership NHS Foundation Trust, Stafford, UK
| | - Samantha Hider
- Primary Care Centre Versus Arthritis, School of Medicine, David Weatherall Building, Keele University, Keele, UK.,Haywood Academic Rheumatology Centre, Midlands Partnership Foundation Trust, Stafford, UK
| | - Annabelle Machin
- Primary Care Centre Versus Arthritis, School of Medicine, David Weatherall Building, Keele University, Keele, UK
| | - Zoe Paskins
- Primary Care Centre Versus Arthritis, School of Medicine, David Weatherall Building, Keele University, Keele, UK.,Haywood Academic Rheumatology Centre, Midlands Partnership Foundation Trust, Stafford, UK
| | - Kendra Cooke
- Keele Clinical Trials Unit, School of Medicine, David Weatherall Building, Keele University, Keele, UK
| | - Erandie Ediriweera Desilva
- Primary Care Centre Versus Arthritis, School of Medicine, David Weatherall Building, Keele University, Keele, UK.,Family Medicine Unit, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Clare Jinks
- Primary Care Centre Versus Arthritis, School of Medicine, David Weatherall Building, Keele University, Keele, UK
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18
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Hider SL, Bucknall M, Jinks C, Cooke K, Cooke K, Desilva EE, Finney AG, Healey EL, Herron D, Machin AR, Mallen CD, Wathall S, Chew-Graham CA. A pilot study of a nurse-led integrated care review (the INCLUDE review) for people with inflammatory rheumatological conditions in primary care: feasibility study findings. Pilot Feasibility Stud 2021; 7:9. [PMID: 33407943 PMCID: PMC7786467 DOI: 10.1186/s40814-020-00750-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 05/28/2020] [Accepted: 12/15/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND People with inflammatory rheumatological conditions such as rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, polymyalgia rheumatica and giant cell arteritis are at an increased risk of common comorbidities including cardiovascular disease, osteoporosis and mood problems, leading to increased morbidity and mortality. Identifying and treating these problems could lead to improved patient quality of life and outcomes. Despite these risks being well-established, patients currently are not systematically targeted for management interventions for these morbidities. This study aimed to assess the feasibility of conducting a randomised controlled trial (RCT) of a nurse-led integrated care review in primary care to identify and manage these morbidities. METHODS A pilot cluster RCT was delivered across four UK general practices. Patients with a diagnostic Read code for one of the inflammatory rheumatological conditions of interest were recruited by post. In intervention practices (n = 2), eligible patients were invited to attend the INCLUDE review. Outcome measures included health-related quality of life (EQ-5D-5L), patient activation, self-efficacy and treatment burden. A sample (n = 24) of INCLUDE review consultations were audio-recorded and assessed against a fidelity checklist. RESULTS 453/789 (57%) patients responded to the invitation, although 114/453 (25%) were excluded as they either did not fulfil eligibility criteria or failed to provide full written consent. In the intervention practices, uptake of the INCLUDE review was high at 72%. Retention at 3 and 6 months both reached pre-specified success criteria. Participants in intervention practices had more primary care contacts than controls (mean 29 vs 22) over the 12 months, with higher prescribing of all relevant medication classes in participants in intervention practices, particularly so for osteoporosis medication (baseline 29% vs 12 month 46%). The intervention was delivered with fidelity, although potential areas for improvement were identified. CONCLUSIONS The findings of this pilot study suggest it is feasible to deliver an RCT of the nurse-led integrated care (INCLUDE) review in primary care. A significant morbidity burden was identified. Early results suggest the INCLUDE review was associated with changes in practice. Lessons have been learnt around Read codes for patient identification and refining the nurse training. TRIAL REGISTRATION ISRCTN, ISRCTN12765345.
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Affiliation(s)
- Samantha L Hider
- School of Primary, Community and Social Care, Keele University, Keele, Staffordshire, ST5 5BG, UK. .,Haywood Academic Rheumatology Centre, Midlands Partnership Foundation Trust, Stoke on Trent, Staffordshire, ST6 7AG, UK.
| | - Milica Bucknall
- School of Primary, Community and Social Care, Keele University, Keele, Staffordshire, ST5 5BG, UK.,Keele Clinical Trials Unit, Keele University, Stoke on Trent, UK
| | - Clare Jinks
- School of Primary, Community and Social Care, Keele University, Keele, Staffordshire, ST5 5BG, UK.,National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) West Midlands, Keele, Stoke on Trent, Staffordshire, UK
| | - Kelly Cooke
- Haywood Academic Rheumatology Centre, Midlands Partnership Foundation Trust, Stoke on Trent, Staffordshire, ST6 7AG, UK
| | - Kendra Cooke
- Keele Clinical Trials Unit, Keele University, Stoke on Trent, UK
| | - Erandie Ediriweera Desilva
- School of Primary, Community and Social Care, Keele University, Keele, Staffordshire, ST5 5BG, UK.,Family Medicine Unit, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Andrew G Finney
- School of Primary, Community and Social Care, Keele University, Keele, Staffordshire, ST5 5BG, UK.,School of Nursing and Midwifery, Keele University, Clinical Education Centre, University Hospitals of North Midlands NHS Trust, Royal Stoke University Hospital, Stoke-on-Trent, ST4 6QG, UK
| | - Emma L Healey
- School of Primary, Community and Social Care, Keele University, Keele, Staffordshire, ST5 5BG, UK
| | - Daniel Herron
- School of Primary, Community and Social Care, Keele University, Keele, Staffordshire, ST5 5BG, UK
| | - Annabelle R Machin
- School of Primary, Community and Social Care, Keele University, Keele, Staffordshire, ST5 5BG, UK
| | - Christian D Mallen
- School of Primary, Community and Social Care, Keele University, Keele, Staffordshire, ST5 5BG, UK.,National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) West Midlands, Keele, Stoke on Trent, Staffordshire, UK.,Midlands Partnership Foundation Trust, Stafford, Staffordshire, ST16 3SR, UK
| | - Simon Wathall
- School of Primary, Community and Social Care, Keele University, Keele, Staffordshire, ST5 5BG, UK
| | - Carolyn A Chew-Graham
- School of Primary, Community and Social Care, Keele University, Keele, Staffordshire, ST5 5BG, UK.,National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) West Midlands, Keele, Stoke on Trent, Staffordshire, UK.,Midlands Partnership Foundation Trust, Stafford, Staffordshire, ST16 3SR, UK
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Affiliation(s)
- Sebastian Crutch
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, UK
| | | | | | | | - Martin Rossor
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, UK
- NIHR UCLH Biomedical Research Centre, London, UK
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20
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Hawarden AW, Paskins Z, Desilva EE, Herron D, Machin A, Jinks C, Hider S, Chew-Graham C. P193 Experiences of delivering a nurse-led fracture risk assessment for patients with inflammatory rheumatological conditions in primary care. Rheumatology (Oxford) 2020. [DOI: 10.1093/rheumatology/keaa111.188] [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: 11/14/2022] Open
Abstract
Abstract
Background
The INCLUDE (INtegrating and improving Care for patients with infLammatory rheUmatological DisordErs in the community) pilot trial aimed to evaluate the feasibility and acceptability of a nurse-delivered review in primary care for people with inflammatory rheumatological conditions (IRCs), to identify and manage common comorbidities including anxiety and depression, cardiovascular and fracture risk. We report analysis of data focusing on the fracture risk assessment component of the review.
Methods
Ethical approvals obtained. Semi-structured interviews were conducted to explore experiences of participating in INCLUDE, with 20 patients, the two nurses delivering the intervention and three General Practitioners (GPs) within participating practices. 24 consenting patients had their INCLUDE review recorded for fidelity checking. Selected extracts were played within some interviews to stimulate discussion (tape-assisted recall). Extracts from recorded consultations relating to fracture risk assessment were transcribed and coded. Interviews were digitally recorded, with consent, transcribed and anonymised. Thematic analysis of the interview data was followed by mapping to the Theoretical Domains Framework (TDF).
Results
Findings mapped to 10/14 TDF domains relating to knowledge, skills, social/professional role and identity, beliefs about capabilities, optimism, beliefs about consequences, reinforcement, intentions, memory attention and decision processes and environmental context/resources. GPs and nurses identified a lack of knowledge and skills in relation to the identification and management of osteoporosis, due to lack of exposure and repeated changes in clinical guidance. GPs reported differing opinions about whether osteoporosis screening was the role of primary or secondary care. GPs and nurses had differing views about the limits of the nurse role in communicating risk. The INCLUDE nurses reported confidence (self-efficacy) in undertaking FRAX assessments. Nurses valued the opportunity to learn new skills and believed that they were improving patient care. They described practical barriers using FRAX including the difficulty navigating between different IT systems. Nurses described uncertainty over when to refer to the GP. Fidelity checks of recorded reviews, showed that FRAX was appropriately calculated for 22/24 patients; whilst INCLUDE nurses introduced the reason for calculating fracture risk, explanations of the meaning of risk were limited, and patients’ understanding was not always checked and queries not responded to; patient interview findings confirmed patients had limited understanding of the meaning of FRAX. Life-style advice related to bone health was given in few consultations.
Conclusion
Screening for fracture risk in people with IRCs in a review consultation is acceptable and feasible, although explanations of the meaning of risk assessment could be improved. Integration of a fracture risk assessment tool within GP software would facilitate risk calculation. More work is needed to understand barriers to risk assessment, including clarity over roles and professional boundaries, and develop management pathways to optimise management of fracture risk in people with IRCs.
Disclosures
A.W. Hawarden None. Z. Paskins None. E. Ediriweera Desilva None. D. Herron None. A. Machin None. C. Jinks None. S. Hider None. C. Chew-Graham None.
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Affiliation(s)
- Ashley W Hawarden
- Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Stoke on Trent, UNITED KINGDOM
- Haywood Academic Rheumatology Centre, Midlands Partnership NHS Foundation Trust, Stoke on Trent, UNITED KINGDOM
| | - Zoe Paskins
- Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Stoke on Trent, UNITED KINGDOM
- Haywood Academic Rheumatology Centre, Midlands Partnership NHS Foundation Trust, Stoke on Trent, UNITED KINGDOM
| | - Erandie Ediriweera Desilva
- Family Medicine Unit, Faculty of Medicine, University of Colombo, SRI LANKA
- Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Stoke on Trent, UNITED KINGDOM
| | - Daniel Herron
- University of Derby Online Learning, University of Derby, Derby, UNITED KINGDOM
| | - Anabelle Machin
- Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Stoke on Trent, UNITED KINGDOM
| | - Clare Jinks
- Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Stoke on Trent, UNITED KINGDOM
| | - Samantha Hider
- Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Stoke on Trent, UNITED KINGDOM
- Haywood Academic Rheumatology Centre, Midlands Partnership NHS Foundation Trust, Stoke on Trent, UNITED KINGDOM
| | - Carolyn Chew-Graham
- Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Stoke on Trent, UNITED KINGDOM
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Wilson J, Herron D, Nachev P, McNally N, Williams B, Rees G. The Value of Data: Applying a Public Value Model to the English National Health Service. J Med Internet Res 2020; 22:e15816. [PMID: 32217501 PMCID: PMC7148544 DOI: 10.2196/15816] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 11/14/2019] [Accepted: 12/15/2019] [Indexed: 12/01/2022] Open
Abstract
Research and innovation in biomedicine and health care increasingly depend on electronic data. The emergence of data-driven technologies and associated digital transformations has focused attention on the value of such data. Despite the broad consensus of the value of health data, there is less consensus on the basis for that value; thus, the nature and extent of health data value remain unclear. Much of the existing literature presupposes that the value of data is to be understood primarily in financial terms, and assumes that a single financial value can be assigned. We here argue that the value of a dataset is instead relational; that is, the value depends on who wants to use it and for what purposes. Moreover, data are valued for both nonfinancial and financial reasons. Thus, it may be more accurate to discuss the values (plural) of a dataset rather than the singular value. This plurality of values opens up an important set of questions about how health data should be valued for the purposes of public policy. We argue that public value models provide a useful approach in this regard. According to public value theory, public value is created, or captured, to the extent that public sector institutions further their democratically established goals, and their impact on improving the lives of citizens. This article outlines how adopting such an approach might be operationalized within existing health care systems such as the English National Health Service, with particular focus on actionable conclusions.
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Affiliation(s)
- James Wilson
- Department of Philosophy, University College London, London, United Kingdom
| | - Daniel Herron
- Research & Development, UCL Hospitals/UCL Biomedical Research Centre, London, United Kingdom
| | - Parashkev Nachev
- Institute of Neurology, University College London, London, United Kingdom
| | - Nick McNally
- Research & Development, UCL Hospitals/UCL Biomedical Research Centre, London, United Kingdom
| | - Bryan Williams
- UCL Institute of Cardiovascular Sciences, University College London, London, United Kingdom
| | - Geraint Rees
- Institute of Cognitive Neuroscience, University College London, London, United Kingdom.,Faculty of Life Sciences, University College London, London, United Kingdom.,Wellcome Trust Centre for Neuroimaging, University College London, London, United Kingdom
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King NA, Meknat A, Guevara DE, Alawwa G, Herron D, Fernandez-Ranvier G. Efficacy of Bariatric Surgery Among Adolescent Patients with Super-Obesity. Bariatr Surg Pract Patient Care 2020. [DOI: 10.1089/bari.2019.0056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Neil A. King
- Department of Surgery, Mount Sinai Medical Center, New York, New York
| | - Aryan Meknat
- Department of Surgery, Mount Sinai Medical Center, New York, New York
- Department of Surgery, Brookdale University Hospital, Brooklyn, New York
| | | | - Ghayth Alawwa
- Department of Surgery, Mount Sinai Medical Center, New York, New York
| | - Daniel Herron
- Department of Surgery, Mount Sinai Medical Center, New York, New York
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Fernandez-Ranvier G, Meknat A, Guevara DE, Alenazi N, Ruiz H, Ritondale O, Alsanea O, Kini S, Herron D. The Role of Bariatric Surgery in Patients with Obesity and Type 1 Diabetes Mellitus. Bariatr Surg Pract Patient Care 2020. [DOI: 10.1089/bari.2019.0058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Affiliation(s)
- Gustavo Fernandez-Ranvier
- Division of Metabolic, Endocrine and Minimally Invasive Surgery, Department of Surgery, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Aryan Meknat
- Division of Metabolic, Endocrine and Minimally Invasive Surgery, Department of Surgery, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Daniela E. Guevara
- Division of Metabolic, Endocrine and Minimally Invasive Surgery, Department of Surgery, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Naif Alenazi
- Department of Surgery, Prince Mohammed Bin Abdulaziz Hospital, Riyadh, Saudi Arabia
| | - Hugo Ruiz
- Division of Metabolic and Bariatric Surgery, Department of Surgery, Hospital Alejandro Posadas, El Palomar, Buenos Aires, Argentina
| | - Otto Ritondale
- Division of Metabolic and Bariatric Surgery, Department of Surgery, Hospital Alejandro Posadas, El Palomar, Buenos Aires, Argentina
| | | | - Subhash Kini
- Division of Metabolic, Endocrine and Minimally Invasive Surgery, Department of Surgery, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Daniel Herron
- Division of Metabolic, Endocrine and Minimally Invasive Surgery, Department of Surgery, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, New York
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24
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Affiliation(s)
- Parashkev Nachev
- 1University College Hospitals NHS Trust, 235 Euston Rd, Bloomsbury, London, NW1 2BU UK.,2Institute of Neurology, UCL, London, WC1N 3BG UK
| | - Daniel Herron
- NIHR UCLH Biomedical Research Centre, Research & Development, Maple House Suite A 1st Floor, 149 Tottenham Court Road, London, W1T 7DN UK
| | - Nick McNally
- NIHR UCLH Biomedical Research Centre, Research & Development, Maple House Suite A 1st Floor, 149 Tottenham Court Road, London, W1T 7DN UK
| | - Geraint Rees
- 2Institute of Neurology, UCL, London, WC1N 3BG UK.,NIHR UCLH Biomedical Research Centre, Research & Development, Maple House Suite A 1st Floor, 149 Tottenham Court Road, London, W1T 7DN UK.,4Faculty of Life Sciences, UCL, London, WC1E 6BT UK
| | - Bryan Williams
- 1University College Hospitals NHS Trust, 235 Euston Rd, Bloomsbury, London, NW1 2BU UK.,NIHR UCLH Biomedical Research Centre, Research & Development, Maple House Suite A 1st Floor, 149 Tottenham Court Road, London, W1T 7DN UK.,5UCL Institute of Cardiovascular Sciences, UCL, London, WC1E 6BT UK
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25
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Beitner M, Herron D, Birnbaum A, Meknat A. A250 A case of food intolerance after sleeve gastrectomy. Surg Obes Relat Dis 2019. [DOI: 10.1016/j.soard.2019.08.195] [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: 11/27/2022]
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26
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Tabrizian P, Giacca M, Prigoff J, Tran B, Holzner ML, Chin E, Palese M, Herron D, Arvelakis A, Rudow DL, Florman S, Shapiro R. Renal Safety of Intravenous Ketorolac Use After Donor Nephrectomy. Prog Transplant 2019; 29:283-286. [PMID: 31185805 DOI: 10.1177/1526924819855360] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION The benefit and short-term safety of ketorolac have been established in previous studies however, the risk of bleeding and long-term renal impairment in patients undergoing donor nephrectomy remain unclear. We report our experience at a high-volume transplant center. METHOD Between January 1996 and January 2014, 862 consecutive patients underwent laparoscopic donor nephrectomy. Exclusion criteria included nonsteroidal anti-inflammatory drug allergy, asthma, bleeding disorders, long-term opioid use, intraoperative blood loss >700 mL, peptic ulcer disease, bleeding diathesis, and baseline creatinine greater than 1.9 mg/dL. Intravenous ketorolac was administered within 30 minutes following the surgical procedure at a dose of 15 to 30 mg every 6 hours. Patients were categorized into 2 groups according to the administration of ketorolac after surgery. Differences between the groups were analyzed. Primary outcomes were changes in serum creatinine and hemoglobin levels. Poor outcome was defined as postsurgical complications. RESULTS During this time, 469 (55.3%) received ketorolac. The mean donor age was 39 years, and 360 (42.5%) were male. Left kidneys were procured in 82%. Operative time averaged 210 minutes and warm ischemia time117 seconds. Baseline demographic and operative outcomes were comparable in both groups. No statistically significant differences were found between the ketorolac group and the nonketorolac group in preoperative and postoperative hemoglobin levels and serum creatinine at 1 week, 1 year, and 5 years (P = .6). Ketorolac use was not associated with increased perioperative morbidity (P = NS). CONCLUSION The use of intravenous ketorolac in patients undergoing donor nephrectomy was not associated with an increased risk of bleeding or renal impairment.
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Affiliation(s)
- Parissa Tabrizian
- 1 Recanati/Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Massimo Giacca
- 1 Recanati/Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jake Prigoff
- 1 Recanati/Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Benjamin Tran
- 1 Recanati/Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Matthew L Holzner
- 1 Recanati/Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Edward Chin
- 2 Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Michael Palese
- 2 Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Daniel Herron
- 2 Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Antonios Arvelakis
- 1 Recanati/Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Dianne LaPointe Rudow
- 1 Recanati/Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sander Florman
- 1 Recanati/Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ron Shapiro
- 1 Recanati/Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Machin AR, Hider SL, Jinks C, Herron D, Paskins Z, Cooke K, Chew-Graham CA. E059 Development of a nurse-led integrated care review based in primary care to identify and improve the management of co-morbidities in patients with inflammatory rheumatological conditions: the INCLUDE study. Rheumatology (Oxford) 2019. [DOI: 10.1093/rheumatology/kez110.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Annabelle R Machin
- Research Institute, Primary Care and Health Sciences, Keele University, Staffordshire, UNITED KINGDOM
| | - Samantha L Hider
- Research Institute, Primary Care and Health Sciences, Keele University, Haywood Academic Rheumatology Centre, Midlands Partnership Foundation Trust, Staffordshire, UNITED KINGDOM
| | - Clare Jinks
- Research Institute, Primary Care and Health Sciences, Keele University, Staffordshire, UNITED KINGDOM
| | - Daniel Herron
- Research Institute, Primary Care and Health Sciences, Keele University, Staffordshire, UNITED KINGDOM
| | - Zoe Paskins
- Research Institute, Primary Care and Health Sciences, Keele University, Haywood Academic Rheumatology Centre, Midlands Partnership Foundation Trust, Staffordshire, UNITED KINGDOM
| | - Kendra Cooke
- Keele Clinical Trials Unit, David Weatherall Building, Keele University, Staffordshire, UNITED KINGDOM
| | - Carolyn A Chew-Graham
- Research Institute, Primary Care and Health Sciences, Keele University, Staffordshire, West Midlands CLAHRC, UNITED KINGDOM
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Hider SL, Bucknall M, Cooke K, Cooke K, Finney AG, Goddin D, Healey EL, Hennings S, Herron D, Jinks C, Lewis M, Machin A, Mallen C, Wathall S, Chew-Graham CA. The INCLUDE study: INtegrating and improving Care for patients with infLammatory rheUmatological DisordErs in the community; identifying multimorbidity: Protocol for a pilot randomized controlled trial. J Comorb 2018; 8:2235042X18792373. [PMID: 30191145 PMCID: PMC6088485 DOI: 10.1177/2235042x18792373] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Patients with inflammatory rheumatic conditions such as rheumatoid arthritis, polymyalgia rheumatica and ankylosing spondylitis are at increased risk of common comorbidities such as cardiovascular disease, osteoporosis and anxiety and depression which lead to increased morbidity and mortality. These associated morbidities are often un-recognized and under-treated. While patients with other long-term conditions such as diabetes are invited for routine reviews in primary care, which may include identification and management of co-morbidities, at present this does not occur for patients with inflammatory conditions, and thus, opportunities to diagnose and optimally manage these comorbidities are missed. Objective To evaluate the feasibility and acceptability of a nurse-led integrated care review (the INtegrating and improving Care for patients with infLammatory rheUmatological DisordErs in the community (INCLUDE) review) for people with inflammatory rheumatological conditions in primary care. Design A pilot cluster randomized controlled trial will be undertaken to test the feasibility and acceptability of a nurse-led integrated primary care review for identification, assessment and initial management of common comorbidities including cardiovascular disease, osteoporosis and anxiety and depression. A process evaluation will be undertaken using a mixed methods approach including participant self-reported questionnaires, a medical record review, an INCLUDE EMIS template, intervention fidelity checking using audio-recordings of the INCLUDE review consultation and qualitative interviews with patient participants, study nurses and study general practitioners (GPs). Discussion Success of the pilot study will be measured against the engagement, recruitment and study retention rates of both general practices and participants. Acceptability of the INCLUDE review to patients and practitioners and treatment fidelity will be explored using a parallel process evaluation. Trial Registration ISRCTN12765345.
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Affiliation(s)
- Samantha L Hider
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, UK.,Haywood Academic Rheumatology Centre, Haywood Hospital, Stoke-on-Trent, UK
| | - Milica Bucknall
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, UK.,Keele Clinical Trials Unit, Keele University, Keele, UK
| | - Kelly Cooke
- Haywood Academic Rheumatology Centre, Haywood Hospital, Stoke-on-Trent, UK
| | - Kendra Cooke
- Keele Clinical Trials Unit, Keele University, Keele, UK
| | - Andrew G Finney
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, UK.,School of Nursing and Midwifery, Keele University, Keele UK.,Clinical Education Centre, University Hospitals of North Midlands NHS Trust, Stoke on Trent UK
| | - Dave Goddin
- Keele Clinical Trials Unit, Keele University, Keele, UK
| | - Emma L Healey
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, UK.,WM CLAHRC National Institute of Health Research Collaborations for Leadership in Applied Health Research and Care West Midlands, UK
| | | | - Daniel Herron
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, UK
| | - Clare Jinks
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, UK.,WM CLAHRC National Institute of Health Research Collaborations for Leadership in Applied Health Research and Care West Midlands, UK
| | - Martyn Lewis
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, UK.,Keele Clinical Trials Unit, Keele University, Keele, UK
| | - Annabelle Machin
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, UK
| | - Christian Mallen
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, UK.,WM CLAHRC National Institute of Health Research Collaborations for Leadership in Applied Health Research and Care West Midlands, UK
| | - Simon Wathall
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, UK
| | - Carolyn A Chew-Graham
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, UK.,WM CLAHRC National Institute of Health Research Collaborations for Leadership in Applied Health Research and Care West Midlands, UK
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Hariri K, Guevara D, Dong M, Edwards E, Kini S, Herron D, Fernandez-Ranvier G. Why Are Patients Readmitted? An Analysis of Common Adverse Events Leading to Readmission, Re-intervention, or Reoperation After Bariatric Surgery. Surg Obes Relat Dis 2017. [DOI: 10.1016/j.soard.2017.09.129] [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: 11/25/2022]
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Hariri K, Guevara D, Dong M, Edwards E, Kini S, Fernandez-Ranvier G, Herron D. Ketorolac Use Shortens Hospital Length of Stay after Bariatric Surgery: Single Center 5-year Experience. Surg Obes Relat Dis 2017. [DOI: 10.1016/j.soard.2017.09.296] [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: 11/28/2022]
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Yoon J, Sherman J, Argiroff A, Chin E, Herron D, Inabnet W, Kini S, Nguyen S. Laparoscopic Sleeve Gastrectomy and Gastric Bypass for The Aging Population. Obes Surg 2017; 26:2611-2615. [PMID: 26983631 DOI: 10.1007/s11695-016-2139-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [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: 01/05/2023]
Abstract
BACKGROUND Laparoscopic Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) are the two most common bariatric surgeries for treating morbid obesity. The purpose of this study is to determine differences in outcomes from RYGB or SG between patients ages ≥ 60 years and < 60 years. METHODS A retrospective review of patients who underwent RYGB and SG at our institution from 01/2008 to 05/2012 was conducted. Forty patients from each group (≥60 years and < 60 years) were matched based on gender, body mass index (BMI), co-morbidities, and type of bariatric surgery performed, and their charts were reviewed up to 1 year post-operatively. Primary end points measured were mean length of stay, operative time, incidence of complications, and readmissions in the first post-operative year. A secondary end point measured was percent total weight loss (%TWL) and excess weight loss (%EWL). RESULTS There were no significant differences between group < 60 and group ≥ 60 in operative time (210 vs. 229 min; p = 0.177), in-hospital post-operative complication rates (2.5 vs. 5 %; p = 1.0), long-term complication rates (2.5 vs. 10 %; p = 0.359), and 30-day readmission rates (2.5 vs. 12.5 %; p = 0.2). Patients in group < 60 had shorter lengths of stay (2.2 vs. 2.7 days; p = 0.031), but this difference is not clinically significant. Both groups achieved similar %TWL (21.4 vs. 20.5 %; p = 0.711) and %EWL (50.6 vs. 50.7 %; p = 0.986). CONCLUSIONS Advanced age (≥60 years) is not a significant predictor of a worse outcome for SG and RYGB.
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Affiliation(s)
- James Yoon
- Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Jingjing Sherman
- Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Alexandra Argiroff
- Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Edward Chin
- Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Daniel Herron
- Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - William Inabnet
- Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Subhash Kini
- Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Scott Nguyen
- Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Gorkovenko K, Tigwell GW, Norrie CS, Waite M, Herron D. ShopComm: Community-Supported Online Shopping for Older Adults. Stud Health Technol Inform 2017; 242:175-182. [PMID: 28873796] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The United Kingdom has an ageing population whose members experience significant life transitions as they grow older, for example, losing mobility due to deteriorating health. For these adults, digital technology has the potential to sustain their independence and improve their quality of life. However older adults can be reluctant to use digital solutions. In this paper, we review a local charity providing a grocery shopping service for older adults who are unable to go themselves. We explore how older adults perceive the benefits and drawbacks of both physical and digital shopping. Using these insights, we designed ShopComm to enable and support older adults with mobility impairments to shop online.
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Affiliation(s)
| | | | | | - Miriam Waite
- Duncan of Jordanstone College of Art & Design, University of Dundee
| | - Daniel Herron
- Duncan of Jordanstone College of Art & Design, University of Dundee
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Abstract
One hundred and eighty children undergoing CT examination were randomly allocated to receive meglumine diatrizoate, iohexol, or iopamidol as their i.v. contrast agent. Minor side effects were detected in 85% of children receiving meglumine diatrizoate, in 18% of those receiving iohexol, and in 36% of those receiving iopamidol. Because many of these minor side effects cause patient motion or delay scanning after contrast medium injection, they potentially degrade image quality. These findings are an indication for the use of low osmolarity contrast agents for i.v. use in pediatric CT imaging.
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Quinn S, Herron D, Menzies R, Scott L, Black R, Zhou Y, Waller A, Humphris G, Freeman R. The Video Interaction Guidance approach applied to teaching communication skills in dentistry. Eur J Dent Educ 2016; 20:94-101. [PMID: 25891196 DOI: 10.1111/eje.12146] [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] [Subscribe] [Scholar Register] [Accepted: 03/16/2015] [Indexed: 06/04/2023]
Abstract
PURPOSE To examine dentists' views of a novel video review technique to improve communication skills in complex clinical situations. MATERIALS AND METHODS Dentists (n = 3) participated in a video review known as Video Interaction Guidance to encourage more attuned interactions with their patients (n = 4). Part of this process is to identify where dentists and patients reacted positively and effectively. Each dentist was presented with short segments of video footage taken during an appointment with a patient with intellectual disabilities and communication difficulties. Having observed their interactions with patients, dentists were asked to reflect on their communication strategies with the assistance of a trained VIG specialist. RESULTS Dentists reflected that their VIG session had been insightful and considered the review process as beneficial to communication skills training in dentistry. They believed that this technique could significantly improve the way dentists interact and communicate with patients. The VIG sessions increased their awareness of the communication strategies they use with their patients and were perceived as neither uncomfortable nor threatening. DISCUSSION The VIG session was beneficial in this exploratory investigation because the dentists could identify when their interactions were most effective. Awareness of their non-verbal communication strategies and the need to adopt these behaviours frequently were identified as key benefits of this training approach. One dentist suggested that the video review method was supportive because it was undertaken by a behavioural scientist rather than a professional counterpart. CONCLUSION Some evidence supports the VIG approach in this specialist area of communication skills and dental training.
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Affiliation(s)
- S Quinn
- Dental Health Services Research Unit, University of Dundee, Dundee, UK
| | - D Herron
- School of Computing, University of Dundee, Dundee, UK
| | - R Menzies
- School of Computing, University of Dundee, Dundee, UK
| | - L Scott
- School of Computing, University of Dundee, Dundee, UK
| | - R Black
- School of Computing, University of Dundee, Dundee, UK
| | - Y Zhou
- School of Medicine, University of St Andrews, St Andrews, UK
| | - A Waller
- School of Computing, University of Dundee, Dundee, UK
| | - G Humphris
- School of Medicine, University of St Andrews, St Andrews, UK
| | - R Freeman
- Dental Health Services Research Unit, University of Dundee, Dundee, UK
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Palese M, Pak J, Chin E, Gin G, Herron D, Lerner S, Rudow DL, Arvelakis A, Ames S, Benvenisty A, Shapiro R, Florman S. V8-04 ROBOTIC-ASSISTED VERSUS LAPAROSCOPIC LIVING DONOR NEPHRECTOMY: A 12-STEP COMPARISON OF SURGICAL TECHNIQUE. J Urol 2016. [DOI: 10.1016/j.juro.2016.02.747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Morelli MP, Overman MJ, Dasari A, Kazmi SMA, Mazard T, Vilar E, Morris VK, Lee MS, Herron D, Eng C, Morris J, Kee BK, Janku F, Deaton FL, Garrett C, Maru D, Diehl F, Angenendt P, Kopetz S. Characterizing the patterns of clonal selection in circulating tumor DNA from patients with colorectal cancer refractory to anti-EGFR treatment. Ann Oncol 2015; 26:731-736. [PMID: 25628445 PMCID: PMC4374387 DOI: 10.1093/annonc/mdv005] [Citation(s) in RCA: 188] [Impact Index Per Article: 20.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Revised: 12/16/2014] [Accepted: 12/17/2014] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION KRAS and EGFR ectodomain-acquired mutations in patients with metastatic colorectal cancer (mCRC) have been correlated with acquired resistance to anti-EGFR monoclonal antibodies (mAbs). We investigated the frequency, co-occurrence, and distribution of acquired KRAS and EGFR mutations in patients with mCRC refractory to anti-EGFR mAbs using circulating tumor DNA (ctDNA). PATIENTS AND METHODS Sixty-two post-treatment plasma and 20 matching pretreatment archival tissue samples from KRAS (wt) mCRC patients refractory to anti-EGFR mAbs were evaluated by high-sensitivity emulsion polymerase chain reaction for KRAS codon 12, 13, 61, and 146 and EGFR 492 mutations. RESULTS Plasma analyses showed newly detectable EGFR and KRAS mutations in 5/62 [8%; 95% confidence interval (CI) 0.02-0.18] and 27/62 (44%; 95% CI 0.3-0.56) samples, respectively. KRAS codon 61 and 146 mutations were predominant (33% and 11%, respectively), and multiple EGFR and/or KRAS mutations were detected in 11/27 (41%) cases. The percentage of mutant allele reads was inversely correlated with time since last treatment with EGFR mAbs (P = 0.038). In the matching archival tissue, these mutations were detectable as low-allele-frequency clones in 35% of patients with plasma mutations after treatment with anti-EGFR mAbs and correlated with shorter progression-free survival (PFS) compared with the cases with no new mutations (3.0 versus 8.0 months, P = 0.0004). CONCLUSION Newly detected KRAS and/or EGFR mutations in plasma ctDNA from patients refractory to anti-EGFR treatment appear to derive from rare, pre-existing clones in the primary tumors. These rare clones were associated with shorter PFS in patients receiving anti-EGFR treatment. Multiple simultaneous mutations in KRAS and EGFR in the ctDNA and the decline in allele frequency after discontinuation of anti-EGFR therapy in a subset of patients suggest that several resistance mechanisms can co-exist and that relative clonal burdens may change over time. Monitoring treatment-induced genetic alterations by sequencing ctDNA could identify biomarkers for treatment screening in anti-EGFR-refractory patients.
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Affiliation(s)
- M P Morelli
- Department of Gastrointestinal Medical Oncology
| | - M J Overman
- Department of Gastrointestinal Medical Oncology
| | - A Dasari
- Department of Gastrointestinal Medical Oncology
| | - S M A Kazmi
- Department of Gastrointestinal Medical Oncology
| | - T Mazard
- Department of Gastrointestinal Medical Oncology
| | - E Vilar
- Department of Gastrointestinal Medical Oncology; Clinical Cancer Prevention
| | - V K Morris
- Department of Gastrointestinal Medical Oncology
| | - M S Lee
- Department of Gastrointestinal Medical Oncology
| | - D Herron
- Department of Gastrointestinal Medical Oncology
| | - C Eng
- Department of Gastrointestinal Medical Oncology
| | - J Morris
- Investigational Cancer Therapeutics
| | - B K Kee
- Department of Gastrointestinal Medical Oncology
| | | | - F L Deaton
- Department of Gastrointestinal Medical Oncology
| | - C Garrett
- Department of Gastrointestinal Medical Oncology
| | - D Maru
- Pathology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - F Diehl
- Sysmex Inostics, Hamburg, Germany
| | | | - S Kopetz
- Department of Gastrointestinal Medical Oncology.
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Zhou Y, Black R, Freeman R, Herron D, Humphris G, Menzies R, Quinn S, Scott L, Waller A. Applying the Verona coding definitions of emotional sequences (VR-CoDES) in the dental context involving patients with complex communication needs: An exploratory study. Patient Educ Couns 2014; 97:180-187. [PMID: 25085550 DOI: 10.1016/j.pec.2014.07.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Revised: 07/01/2014] [Accepted: 07/13/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVE The VR-CoDES has been previously applied in the dental context. However, we know little about how dental patients with intellectual disabilities (ID) and complex communication needs express their emotional distress during dental visits. This is the first study explored the applicability of the VR-CoDES to a dental context involving patients with ID. METHODS Fourteen dental consultations were video recorded and coded using the VR-CoDES, assisted with the additional guidelines for the VR-CoDES in a dental context. Both inter- and intra-coder reliabilities were checked on the seven consultations where cues were observed. RESULTS Sixteen cues (eight non-verbal) were identified within seven of the 14 consultations. Twenty responses were observed (12 reducing space) with four multiple responses. Cohen's Kappa were 0.76 (inter-coder) and 0.88 (intra-coder). CONCLUSION With the additional guidelines, cues and responses were reliably identified. Cue expression was exhibited by non-verbal expression of emotion with people with ID in the literature. Further guidance is needed to improve the coding accuracy on multiple providers' responses and to investigate potential impacts of conflicting responses on patients. PRACTICE IMPLICATIONS The findings provided a useful initial step towards an ongoing exploration of how healthcare providers identify and manage emotional distress of patients with ID.
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Affiliation(s)
- Yuefang Zhou
- School of Medicine, University of St Andrews, St Andrews, UK.
| | - Rolf Black
- School of Computing, University of Dundee, Dundee, UK
| | - Ruth Freeman
- School of Dentistry, University of Dundee, Dundee, UK
| | - Daniel Herron
- School of Computing, University of Dundee, Dundee, UK
| | - Gerry Humphris
- School of Medicine, University of St Andrews, St Andrews, UK
| | | | - Sandra Quinn
- School of Dentistry, University of Dundee, Dundee, UK
| | - Lesley Scott
- School of Computing, University of Dundee, Dundee, UK
| | - Annalu Waller
- School of Computing, University of Dundee, Dundee, UK
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Omana JJ, Nguyen SQ, Herron D, Kini S. Comparison of comorbidity resolution and improvement between laparoscopic sleeve gastrectomy and laparoscopic adjustable gastric banding. Surg Endosc 2010; 24:2513-7. [PMID: 20339873 DOI: 10.1007/s00464-010-0995-0] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2009] [Accepted: 11/15/2009] [Indexed: 12/19/2022]
Abstract
BACKGROUND This study aimed to compare the rates for resolution and improvement of common comorbidities between laparoscopic sleeve gastrectomy (LSG) and laparoscopic adjustable gastric banding. The comorbid conditions included were type 2 diabetes mellitus (DM), hypertension (HTN), hyperlipidemias (LPD), degenerative joint disease (DJD), gastroesophageal reflux disease (GERD), obstructive sleep apnea (OSA), and asthma. METHODS A retrospective chart review of the patients who underwent LSG or laparoscopic adjustable gastric banding at our institution from July 2004 to July 2007 was performed. The resolution of comorbidities was determined via patient-completed questionnaires and objective data. RESULTS Of the 123 patients (29 men and 94 women) reviewed, 49 had undergone LSG, and 74 had undergone laparoscopic adjustable gastric banding. The mean preoperative body mass index (BMI) was 52 kg/m(2) for the LSG patients and 44 kg/m(2) for the laparoscopic adjustable gastric banding patients. The overall percentages of excess weight loss (%EWL) were respectively 50.6 and 40.3% (P = 0.03) during mean follow-up periods of 15 and 17 months. There was a greater resolution or improvement of DM after LSG (100% vs 46%), HTN (78% vs 48%), and LPD (87% vs. 50%) than after laparoscopic adjustable gastric banding. Other comorbidities resolved or improved at a similar rate. CONCLUSIONS Although both LSG and laparoscopic adjustable gastric banding resulted in postoperative improvement or resolution of comorbidities associated with obesity, LSG statistically showed a significantly higher rate of resolution or improvement of DM, HTN, and LPD. There was no significant difference between the groups for DJD, GERD, OSA, or asthma.
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Affiliation(s)
- Juan J Omana
- Division of Laparoscopic Surgery, Department of Surgery, Mount Sinai Medical Center, New York, NY, USA
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Abstract
Natural orifice transluminal endoscopic surgery (NOTES) is an experimental surgical approach. Several intra-abdominal procedures have been successfully performed in animals and humans although the long-term safety is still unknown. Potential advantages are reduction of wound-related complications, reduced postoperative pain, improved cosmesis, and short recovery time. This study aimed to measure the overall perception among health care workers and medical students. Materials: A brief 9-item survey was created to measure the perception among health care workers and medical students. A total of 120 surveys were completed. Results: Overall, 15% had a favorable perception, 29% had an unfavorable perception, and 55% were undecided. A total of 40% considered the possibility of avoiding wound-related complications the most appealing advantage, whereas 54% cited unknown safety as the most concerning possible disadvantage. Current occupation, previous knowledge, and affiliation to the surgical department influenced the overall perception. Conclusion: Most health care workers and medical students in our sample were undecided in their perception of NOTES.
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Affiliation(s)
| | | | | | - Subhash Kini
- Mount Sinai School of Medicine, New York, NY, USA
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Chandler A, Wei W, Herron D, Anderson E, Yao J, Ng C. SU-FF-I-07: The Effects of Temporal Sub-Sampling On Estimates of CT Perfusion Parameters in Abdominal Tissues. Med Phys 2009. [DOI: 10.1118/1.3181126] [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: 11/07/2022] Open
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Nguyen NT, Hinojosa M, Mailey B, Herron D, Champion K. A case study from the advanced bariatric life support initiative: pulmonary embolism after laparoscopic gastric bypass. Obes Surg 2007; 17:1257-60. [PMID: 18074503 DOI: 10.1007/s11695-007-9215-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Pulmonary embolism is the leading cause of death after bariatric surgery and represents one of the many potential life-threatening conditions after bariatric surgery. The Advanced Bariatric Life Support (ABLS) initiative was developed to teach practising bariatric surgeons, emergency physicians, and allied health professionals the need for accurate and timely diagnosis and management of life-threatening bariatric surgery complications. This case study was derived from the ABLS file and discusses the difficulty in differentiating between two major complications after gastric bypass--pulmonary embolism vs leak. Accurate diagnosis and expeditious treatment are of utmost importance to prevent death associated with these serious bariatric surgical complications.
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Affiliation(s)
- Ninh T Nguyen
- Department of Surgery, University of California Irvine Medical Center, Orange, CA 92868, USA.
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Bardaro SJ, Gagner M, Consten E, Inabnet WB, Herron D, Dakin G, Pomp A. Routine cholecystectomy during laparoscopic biliopancreatic diversion with duodenal switch is not necessary. Surg Obes Relat Dis 2007; 3:549-53. [PMID: 17903779 DOI: 10.1016/j.soard.2007.05.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2006] [Revised: 05/09/2007] [Accepted: 05/12/2007] [Indexed: 11/28/2022]
Abstract
BACKGROUND Similar to gastric bypass patients, a regimen of ursodeoxycholic acid in the immediate postoperative period might obviate the need for routine cholecystectomy. Routine cholecystectomy has been recommended for patients who undergo biliopancreatic diversion (BPD), because of the high prevalence of gallstones in the obese patient and presumed development of gallstones postoperatively. We have considered elective cholecystectomy only if gallbladder disease were present. The aim of this study was to assess the need for cholecystectomy in the postoperative period in such patients. METHODS In this retrospective study, the data from 219 patients who had undergone BPD with duodenal switch (BPD/DS), from January 1999 to January 2003, were analyzed. We performed a 150-cm alimentary limb and 100-cm common channel BPD/DS. The patients received 600 mg ursodeoxycholic acid orally daily for 6 months. The following data were recorded: demographics, medical history, medication, weight loss, diagnostic evaluation, and operative and pathologic data. RESULTS Of the 219 patients who underwent surgery, 59 were men (26.9%) and 160 women were (73.1%) (mean age 41.7 years, mean body mass index 55.7 kg/m(2)). The mean follow-up was 30 months (range 12-48). Of the 219 patients, 57 (19.6%) underwent cholecystectomy: 28 (12.7%) preoperatively, 10 (4.5%) simultaneously, and 19 (8.7%) postoperatively. Simultaneous cholecystectomy was performed when the patient had a history of colic episodes with gallbladder disease (disclosed by preoperative ultrasonography). The postoperative cholecystectomy pathology reports showed cholecystitis in only 7 patients. CONCLUSION The results of our study have shown that the incidence of postoperative cholecystectomy in BPD/DS patients is low, and cholecystitis is rare. Routine cholecystectomy in BPD/DS patients is no longer recommended.
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Affiliation(s)
- Sergio Jose Bardaro
- New York-Presbyterian Hospital, New York, New York; Weill Medical College of Cornell University, New York, New York 10021, USA
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Hazzan D, Chin EH, Steinhagen E, Kini S, Gagner M, Pomp A, Herron D. Laparoscopic bariatric surgery can be safe for treatment of morbid obesity in patients older than 60 years. Surg Obes Relat Dis 2007; 2:613-6. [PMID: 17138231 DOI: 10.1016/j.soard.2006.09.009] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2006] [Revised: 09/14/2006] [Accepted: 09/18/2006] [Indexed: 01/12/2023]
Abstract
BACKGROUND Previous reports have questioned the safety of bariatric surgery in older patients. The aim of this study was to quantify the perioperative morbidity and mortality of older patients undergoing laparoscopic bariatric procedures at our institution. METHODS A retrospective chart review of all laparoscopic bariatric procedures performed from February 1999 to September 2005 was performed to identify patients at Mount Sinai Medical Center who were older than 60 years at surgery. RESULTS We identified 55 patients (36 women and 19 men). The mean age was 61.5 years (range 60-70), and the mean body mass index was 46.2 kg/m2 (range 38.1-61.0). Of the 55 patients, 33 (60%) had undergone laparoscopic Roux-en-Y gastric bypass, 9 (16%) laparoscopic gastric banding, 7 (13%) laparoscopic biliopancreatic diversion with duodenal switch, 3 (5.5%) laparoscopic revisional surgery, and 3 (5.5%) laparoscopic sleeve gastrectomy. The mean operative time was 2.3 hours (range 1.1-5.5). No patients required conversion to open surgery, and no perioperative mortality occurred within 30 days. The morbidity rate was 7.3% (n = 4). One patient developed an anastomotic bleed that was treated conservatively, and another patient developed an empyema that was successfully drained with a chest tube. That patient also developed a urinary tract infection, and another patient had a wound infection. The mean length of stay was 2.8 days (range 1-14). CONCLUSIONS In a carefully selected patient population in a medical center with appropriate experience, laparoscopic bariatric surgery can be performed safely with low morbidity and mortality in the elderly population.
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Affiliation(s)
- David Hazzan
- Division of Laparoscopic Surgery, Department of Surgery, Mount Sinai School of Medicine, New York, New York, USA
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Abstract
Previous investigators have suggested that laparoscopic splenectomy should be the procedure of choice for the treatment of benign hematologic disorders unresponsive to medical therapy. To evaluate the safety and utility of laparoscopic splenectomy for a variety of splenic disorders, we reviewed our collective experience at 2 institutions. We studied our 8-year experience by retrospective chart review. Patient demographic data, splenic pathology, intraoperative events, concomitant procedures, and all adverse perioperative events were recorded. A total of 131 patients had laparoscopic splenectomy, and there were 8 conversions to open surgery. Pathology included 63 with idiopathic thrombocytopenic purpura (ITP), 23 malignancies, 12 thrombotic thrombocytopenic purpura (TTP), 10 autoimmune hemolytic anemia (AIHA), and 23 others. Accessory spleens were noted in 21 patients (16%). Concomitant surgical procedures included 12 hepatic biopsies, 4 distal pancreatectomies, 4 cholecystectomies, and 7 others. Mean operative time was 170 minutes. There were 16 major complications in 16 patients and 2 deaths. Median postoperative length of stay was 3 days. Conversions, due mostly to bleeding, are related to splenic pathology and medical comorbidity and are not temporally related to surgical experience (learning curve). The morbidity, mortality, and conversion rates were low. Laparoscopic splenectomy permits an appropriate abdominal exploration and is associated with a short hospital stay. It is the procedure of choice for most indications for splenectomy.
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Affiliation(s)
- Alfons Pomp
- Department of Surgery, Weill Medical College of Cornell University, New York, NY 10021, USA.
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Faria SC, Tamm EP, DuBrow R, David C, Loyer E, Herron D, Sawaf Y, Ball G, Silverman PM, Charnsangavej C. Use of thin-section, multidetector row helical CT images for coronal oblique reformations for optimal visualization of structures in the hepatoduodenal ligament. ACTA ACUST UNITED AC 2004; 29:231-8. [PMID: 15290952 DOI: 10.1007/s00261-003-0106-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Multidetector row computed tomography (CT) can acquire abdominal images of unprecedented thinness in a single breath-hold. This study investigated whether acquiring source axial images at 1.25 mm as opposed to 2.5 mm would result in a perceptible difference in image quality for coronal oblique reformations. Similarly, the hypothesis that a slice pitch of 3:1 would be superior to 6:1 was evaluated. Twenty-nine CT studies were retrospectively evaluated. The images were divided into four groups: 1.25-mm axial images, pitch 3:1; 2.5-mm axial images, pitch 3:1; 1.25-mm axial images, pitch 6:1; and 2.5-mm axial images, pitch 6:1. Three radiologists evaluated by consensus the coronal oblique reformations for overall image quality and image quality of structures in the hepatoduodenal ligament and of nodal groups. Use of 1.25-mm rather than of 2.5-mm source axial images resulted in statistically significant better scores for overall image quality and visualization of the hepatic artery, portal vein, pancreatic duct, and nodal groups. However, a pitch of 3:1 rather than of 6:1 did not result in significant differences in ratings of image quality. Use of 1.25-mm rather than of 2.5-mm source axial images improves image quality when creating coronal oblique reformations for abdominal anatomy.
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Affiliation(s)
- S C Faria
- Department of Radiology, Division of Diagnostic Imaging, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Boulevard, Box 57, Houston, TX 77030, USA
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Szekely A, Jacobsen T, D'Amico S, Devescovi A, Andonova E, Herron D, Lu CC, Pechmann T, Pléh C, Wicha N, Federmeier K, Gerdjikova I, Gutierrez G, Hung D, Hsu J, Iyer G, Kohnert K, Mehotcheva T, Orozco-Figueroa A, Tzeng A, Tzeng O, Arévalo A, Vargha A, Butler AC, Buffington R, Bates E. A new on-line resource for psycholinguistic studies. J Mem Lang 2004; 51:247-250. [PMID: 23002322 PMCID: PMC3446821 DOI: 10.1016/j.jml.2004.03.002] [Citation(s) in RCA: 206] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Picture naming is a widely used technique in psycholinguistic studies. Here, we describe new on-line resources that our project has compiled and made available to researchers on the world wide web at http://crl.ucsd.edu/~aszekely/ipnp/. The website provides access to a wide range of picture stimuli and related norms in seven languages. Picture naming norms, including indices of name agreement and latency, for 520 black-and-white drawings of common objects and 275 concrete transitive and intransitive actions are presented. Norms for age-of-acquisition, word-frequency, familiarity, goodness-of-depiction, and visual complexity are included. An on-line database query system can be used to select a specific range of stimuli, based on parameters of interest for a wide range of studies on healthy and clinical populations, as well as studies of language development.
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Biertho L, Steffen R, Ricklin T, Horber FF, Pomp A, Inabnet WB, Herron D, Gagner M. Laparoscopic gastric bypass versus laparoscopic adjustable gastric banding. J Am Coll Surg 2003; 197:536-44; discussion 544-5. [PMID: 14522318 DOI: 10.1016/s1072-7515(03)00730-0] [Citation(s) in RCA: 141] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Indications for and results of laparoscopic adjustable gastric banding (LAGB) and laparoscopic gastric bypass (LGB) are still controversial, especially between Europe and the United States. The recent availability of gastric bandings in the United States made it necessary to compare the two techniques. STUDY DESIGN We compared a series of 456 LGB to a series of 805 LAGB performed in two different institutions. Body mass index (BMI), complication rate, mortality, and excess weight loss (EWL) after 3, 6, 12, and 18 months were obtained. A Fischer's exact test and a Student t test with covariance analysis were used for statistical analysis. RESULTS Results are expressed as a mean +/- standard deviation, comparing LGB with LAGB. Preoperative BMI was 49.4 +/- 8.3 kg/m(2) versus 42.2 +/- 4.9 kg/m(2) (p = 0.0001), respectively. Perioperative major complication rates were 2.0% versus 1.3% (NS), and the early postoperative major complication rates were 4.2% versus 1.7% (p = 0.02), respectively. Mortality rate was 0.4% versus 0% (NS), respectively. The global EWL was 36.3% for LGB versus 14.7% for LAGB at 3 months (p < 0.0001), 51.6% versus 21.9% at 6 months (p < 0.0001), 67.0% versus 33.3% at 12 months (p < 0.0001), and 74.6% versus 40.4% at 18 months (p < 0.0001), respectively. Longterm followup for the LAGB group showed an EWL of 47% at 2 years, 56% at 3 years, and 58% at 4 years. Patients were sorted after their preoperative BMI (30 to 40, 40 to 50, and 50 to 60 kg/m(2)). The EWL at 3, 6, 12, and 18 months was statistically superior in the LGB group, for any BMI ranges. CONCLUSIONS These data suggest that LGB provides a higher EWL at 18 months, compared with LAGB, and this was true for any preoperative BMI range. It is associated with a higher early postoperative complication rate.
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Affiliation(s)
- Laurent Biertho
- The Mount Sinai School of Medicine, Department of Surgery, Division of Minimally Invasive Surgery, New York, NY, USA
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Abstract
Biliopancreatic diversion with duodenal switch (BPD-DS) is a well-known emerging open procedure that appears to be as effective as other bariatric operations and has been shown to provide excellent long-term weight loss. Therefore we looked at the safety and efficacy of the laparoscopic BPD-DS procedure compared to open BPD-DS in superobese patients (body mass index >60). A retrospective study of 54 superobese patients (body mass index >60) was carried out from July 1999 to June 2001: laparoscopic BPD-DS in 26 patients and open BPD-DS in 28 patients. Median preoperative body weight was 189.8 kg (range 155.1 to 271.2 kg) in the laparoscopic BPD-DS group and 196.5 kg (range 160.3 to 298.9 kg) in the open BPD-DS group. Median body mass index was 66.9 kg/m(2) in the laparoscopic group and 68.9 kg/m(2) in the open group. The two groups were compared by means of the unpaired t test, which yielded the following results: Major morbidity occurred in six patients (23%) in the laparoscopic BPD-DS group and in five patients (17%) in the open BPD-DS group (P = 0.63). There were two deaths in the laparoscopic BPD-DS group (7.6% mortality) and one death (3.5% mortality) in the open BPD-DS group (P = 0.51). Preoperative comorbidity was improved in eight patients in the laparoscopic BPD-DS group and two patients in the open BPD-DS group (P < 0.02). Laparoscopic BPD-DS is a technically feasible procedure that results in effective weight loss similar to the open procedure. However, both open and laparoscopic BPD-DS procedures are associated with appreciable morbidity and mortality in the superobese population. Additional studies are needed to determine the best surgical treatment for superobesity.
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Affiliation(s)
- Won-Woo Kim
- Division of Laparoscopic Surgery, Director, Minimally Invasive Surgery Center, Mount Sinai School of Medicine, One Gustave L. Levy Place, P.O. Box 1103, 10029, New York, NY
| | - Michel Gagner
- Division of Laparoscopic Surgery, Director, Minimally Invasive Surgery Center, Mount Sinai School of Medicine, One Gustave L. Levy Place, P.O. Box 1103, 10029, New York, NY.
| | - Subhash Kini
- Division of Laparoscopic Surgery, Director, Minimally Invasive Surgery Center, Mount Sinai School of Medicine, One Gustave L. Levy Place, P.O. Box 1103, 10029, New York, NY
| | - William B Inabnet
- Division of Laparoscopic Surgery, Director, Minimally Invasive Surgery Center, Mount Sinai School of Medicine, One Gustave L. Levy Place, P.O. Box 1103, 10029, New York, NY
| | - Terri Quinn
- Division of Laparoscopic Surgery, Director, Minimally Invasive Surgery Center, Mount Sinai School of Medicine, One Gustave L. Levy Place, P.O. Box 1103, 10029, New York, NY
| | - Daniel Herron
- Division of Laparoscopic Surgery, Director, Minimally Invasive Surgery Center, Mount Sinai School of Medicine, One Gustave L. Levy Place, P.O. Box 1103, 10029, New York, NY
| | - Alfons Pomp
- Division of Laparoscopic Surgery, Director, Minimally Invasive Surgery Center, Mount Sinai School of Medicine, One Gustave L. Levy Place, P.O. Box 1103, 10029, New York, NY
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Muir SR, MacAskill MR, Herron D, Goelz H, Anderson TJ, Jones RD. EMMA--an eye movement measurement and analysis system. Australas Phys Eng Sci Med 2003; 26:18-24. [PMID: 12854621 DOI: 10.1007/bf03178692] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
A system has been developed for stimulation, recording and analysis of a wide range of eye movements. Eye movements are stimulated with an LED bar or a video projector under the control of a PC. The eye movements are measured using a scleral reflection technique (IRIS instrument), and sampled and stored on a PC. A range of tests have been developed to measure saccadic and smooth pursuit eye movements. A variety of tools have been developed to assist in the analysis of the data. Several research studies have ably demonstrated the utility and versatility of the system.
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Affiliation(s)
- S R Muir
- Department of Medical Physics and Bioengineering, Christchurch Hospital.
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Gagner M, Gentileschi P, de Csepel J, Kini S, Patterson E, Inabnet WB, Herron D, Pomp A. Laparoscopic reoperative bariatric surgery: experience from 27 consecutive patients. Obes Surg 2002; 12:254-60. [PMID: 11975224 DOI: 10.1381/096089202762552737] [Citation(s) in RCA: 141] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND 10 to 25% of patients undergoing bariatric surgery will require a revision, either for unsatisfactory weight loss or for complications. Reoperation is associated with a higher morbidity and has traditionally been done in open fashion. The purpose of this study was to determine the safety and efficacy of reoperative surgery using a laparoscopic approach. METHODS A retrospective review of medical records over a 22-month period was conducted. 27 consecutive obesity surgery patients, who had undergone a laparoscopic revision, were identified. 26 of the 27 patients were women. The average age was 40.3 years (range 20 to 58 years) and average original preoperative body mass index (BMI) was 51.6 kg/m2 (range 42 to 66.5). The 27 primary bariatric operations consisted of vertical banded gastroplasty (12), gastric band placement (9) and gastric bypass (6). 17 of them were open procedures. After the primary surgery, the lowest average BMI was 37.6 kg/m2 (range 21 to 52), which increased to 42.7 kg/m2 (range 29 to 56) before reoperation. 24 of the 27 reoperations were indicated for insufficient weight loss. On average, revision was undertaken 52 months after the primary procedure (range 12 to 240 months). RESULTS 24 of the 27 laparoscopic reoperations were conversions to a gastric bypass. A second reoperation was indicated for insufficient weight loss on four occasions. In one case, conversion to open surgery was required. The average operative time was 232 +/- 18.5 minutes (range 120 to 480) and length of hospital stay was 3.7 days (range 1 to 9). 22% percent of patients (6) experienced complications, including pneumothorax, gastric remnant dilation, gastrojejunostomy stenosis, port-site hernia and protein malnutrition. There was no mortality in the study. The average BMI was 35.9 kg/m2 (range 27 to 45.5) 8 months after surgery (range 1 to 22 months). Compared with a preoperative BMI of 42.7 kg/m2, the weight loss was statistically significant (p < 0.001). CONCLUSION Our results compare favorably with those reported for open reoperative bariatric surgery. A laparoscopic approach may be considered a feasible and safe alternative to an open operation.
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Affiliation(s)
- Michel Gagner
- Division of Laparoscopic Surgery, Mount Sinai School of Medicine, New York, NY, USA.
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