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Gysling S, Morgan H, Ifesemen OS, West D, Conibear J, Navani N, O'Dowd EL, Baldwin DR, Humes D, Hubbard R. The Impact of COVID-19 on Lung Cancer Incidence in England: Analysis of the National Lung Cancer Audit 2019 and 2020 Rapid Cancer Registration Datasets. Chest 2023; 163:1599-1607. [PMID: 36640995 PMCID: PMC9833851 DOI: 10.1016/j.chest.2023.01.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 12/20/2022] [Accepted: 01/05/2023] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has caused significant disruption to health-care services and delivery worldwide. The impact of the pandemic and associated national lockdowns on lung cancer incidence in England have yet to be assessed. RESEARCH QUESTION What was the impact of the first year of the COVID-19 pandemic on the incidence and presentation of lung cancer in England? STUDY DESIGN AND METHODS In this retrospective observational study, incidence rates for lung cancer were calculated from The National Lung Cancer Audit Rapid Cancer Registration Datasets for 2019 and 2020, using midyear population estimates from the Office of National Statistics as the denominators. Rates were compared using Poisson regression according to time points related to national lockdowns in 2020. RESULTS Sixty-four thousand four hundred fifty-seven patients received a diagnosis of lung cancer across 2019 (n = 33,088) and 2020 (n = 31,369). During the first national lockdown, a 26% reduction in lung cancer incidence was observed compared with the equivalent calendar period of 2019 (adjusted incidence rate ratio [IRR], 0.74; 95% CI, 0.71-0.78). This included a 23% reduction in non-small cell lung cancer (adjusted IRR, 0.77; 95% CI, 0.74-0.81) and a 45% reduction in small cell lung cancer (adjusted IRR, 0.55; 95% CI, 0.46-0.65) incidence. Thereafter, incidence rates almost recovered to baseline, without overcompensation (adjusted IRR, 0.96; 95% CI, 0.94-0.98). INTERPRETATION The incidence rates of lung cancer in England fell significantly by 26% during the first national lockdown in 2020 and did not compensate later in the year.
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Affiliation(s)
- Savannah Gysling
- Lifespan and Population Health, University of Nottingham, Nottingham, England.
| | - Helen Morgan
- Lifespan and Population Health, University of Nottingham, Nottingham, England
| | | | - Douglas West
- Department of Thoracic Surgery, University Hospitals Bristol and Weston NHS Trust, Bristol, England
| | - John Conibear
- Department of Clinical Oncology, Barts Health NHS Trust, London, England
| | - Neal Navani
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, England; Department of Thoracic Medicine, University College London Hospitals NHS Trust, London, England
| | - Emma Louise O'Dowd
- Department of Respiratory Medicine, Nottingham University Hospitals NHS Trust, City Hospital, Nottingham, England
| | - David R Baldwin
- Department of Respiratory Medicine, Nottingham University Hospitals NHS Trust, City Hospital, Nottingham, England
| | - David Humes
- Gastrointestinal Surgery, Gastrointestinal and Liver Theme, National Institute for Health Research Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham School of Medicine, Queen's Medical Centre, Nottingham, England
| | - Richard Hubbard
- Lifespan and Population Health, University of Nottingham, Nottingham, England; Department of Respiratory Medicine, Nottingham University Hospitals NHS Trust, City Hospital, Nottingham, England
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Youssef F, Jackson A, Virely-Carr H, Hossain T, Yanni F, Trotter M, Zanotti D, Catton J, Welch N, Humes D, Vohra R, Parsons SL. OGC P12 Maintaining high volume oesophagagogastric resections during the COVID-19 pandemic: a single centres experience utilising the independent sector. Br J Surg 2022. [DOI: 10.1093/bjs/znac404.175] [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: 12/13/2022]
Abstract
Abstract
Background
With many resources redirected to care for the those affected by the COVID-19 pandemic, the NHS faced unprecedented pressure to maintain oesophagogastric (OG) cancer resectional services. Our institution along with many tertiary units across the country were faced with limited access to essential critical care beds. The implementation of emergency contracts between the NHS and the independent sector (IS) allowed our unit to maintain a high volume resectional service by utilising the resources of a local private hospital with HDU/ ITU provision. We began operating within the IS shortly after the first UK lockdown in March 2020, and continued through till February 2022. During this period, we continued operating at our tertiary unit (TU) albeit at a reduced capacity. This study aimed to evaluate the surgical outcomes of patients undergoing major OG resectional surgery between the two sites.
Methods
This retrospective study included all patients who underwent major OG resectional surgery (including GIST) from March 2020-February 2022. Operation type and site were identified using OPCS-4 clinical codes and combined with National OG Cancer Audit (NOGCA) data to compare basic patient demographics, length of stay, complication rates, COVID infection rates and 90-day mortality. Descriptive and statistical analysis between the two operating sites was performed.
Results
A total of 204 major OG resections were undertaken, 44% (89) at our TU;57 oesophagectomies and 32 gastrectomies, with 56% (115) at a local IS hospital;86 oesophagectomies and 29 gastrectomies. Additionally, 13 (6.4%) open and close procedures were performed across both sites. Median patient age was similar, 69 (45–86) years at our TU v. 68 (38–85) years at the IS site. A higher proportion of ASA 3 patients (46%) were operated on at our TU. No difference in median length of stay was observed; TU= 8 (1–93) days v. IS =9 (3–69) days, this included all patients who were repatriated to the TU. Higher complication rates seemed to occur in patients operated at the IS site v. the TU though these did not reach statistical significance; 18 (15.7%) patients suffered an anastomotic leak v. 9 (10.1%) respectively (p= 0.246). 21 (18.3%) v. 13 (14.6%) patients suffered a major respiratory (p=0.487) and 4 (3.5%) v. 1 (1.1%) a major cardiac (p=0.281) complication. There were no cases of COVID infection within 30 days of primary procedure at the IS site, with 2 cases within the TU cohort. Our 90-day mortality rates were similar (IS= 4.54% v. TU=5.32%), p=0.661.
Conclusions
Our study demonstrates that resection of patients with OG cancer is feasible in an independent sector hospital if supported by critical care. It allowed a high-volume tertiary unit to continue offering potentially curative surgery to patients whose treatment options would have otherwise been limited to oncological therapy only. Long term survival data compared to non-resecting trusts is required to determine whether this approach was superior. When considering future pandemic planning, we have demonstrated the value of this model in maintaining major OG resectional services.
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Affiliation(s)
- Fady Youssef
- Nottingham University Hospitals NHS Trust , Nottingham , United Kingdom
| | - Andrew Jackson
- Nottingham University Hospitals NHS Trust , Nottingham , United Kingdom
| | | | - Tanvir Hossain
- Nottingham University Hospitals NHS Trust , Nottingham , United Kingdom
| | - Fady Yanni
- Nottingham University Hospitals NHS Trust , Nottingham , United Kingdom
| | - Martin Trotter
- Nottingham University Hospitals NHS Trust , Nottingham , United Kingdom
| | - Daniela Zanotti
- Nottingham University Hospitals NHS Trust , Nottingham , United Kingdom
| | - James Catton
- Nottingham University Hospitals NHS Trust , Nottingham , United Kingdom
| | - Neil Welch
- Nottingham University Hospitals NHS Trust , Nottingham , United Kingdom
| | - David Humes
- Nottingham University Hospitals NHS Trust , Nottingham , United Kingdom
| | - Ravi Vohra
- Nottingham University Hospitals NHS Trust , Nottingham , United Kingdom
| | - Simon L Parsons
- Nottingham University Hospitals NHS Trust , Nottingham , United Kingdom
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Torkington J, Harries R, O'Connell S, Knight L, Islam S, Bashir N, Watkins A, Fegan G, Cornish J, Rees B, Cole H, Jarvis H, Jones S, Russell I, Bosanquet D, Cleves A, Sewell B, Farr A, Zbrzyzna N, Fiera N, Ellis-Owen R, Hilton Z, Parry C, Bradbury A, Wall P, Hill J, Winter D, Cocks K, Harris D, Hilton J, Vakis S, Hanratty D, Rajagopal R, Akbar F, Ben-Sassi A, Francis N, Jones L, Williamson M, Lindsey I, West R, Smart C, Ziprin P, Agarwal T, Faulkner G, Pinkney T, Vimalachandran D, Lawes D, Faiz O, Nisar P, Smart N, Wilson T, Myers A, Lund J, Smolarek S, Acheson A, Horwood J, Ansell J, Phillips S, Davies M, Davies L, Bird S, Palmer N, Williams M, Galanopoulos G, Rao PD, Jones D, Barnett R, Tate S, Wheat J, Patel N, Rahmani S, Toynton E, Smith L, Reeves N, Kealaher E, Williams G, Sekaran C, Evans M, Beynon J, Egan R, Qasem E, Khot U, Ather S, Mummigati P, Taylor G, Williamson J, Lim J, Powell A, Nageswaran H, Williams A, Padmanabhan J, Phillips K, Ford T, Edwards J, Varney N, Hicks L, Greenway C, Chesters K, Jones H, Blake P, Brown C, Roche L, Jones D, Feeney M, Shah P, Rutter C, McGrath C, Curtis N, Pippard L, Perry J, Allison J, Ockrim J, Dalton R, Allison A, Rendell J, Howard L, Beesley K, Dennison G, Burton J, Bowen G, Duberley S, Richards L, Giles J, Katebe J, Dalton S, Wood J, Courtney E, Hompes R, Poole A, Ward S, Wilkinson L, Hardstaff L, Bogden M, Al-Rashedy M, Fensom C, Lunt N, McCurrie M, Peacock R, Malik K, Burns H, Townley B, Hill P, Sadat M, Khan U, Wignall C, Murati D, Dhanaratne M, Quaid S, Gurram S, Smith D, Harris P, Pollard J, DiBenedetto G, Chadwick J, Hull R, Bach S, Morton D, Hollier K, Hardy V, Ghods M, Tyrrell D, Ashraf S, Glasbey J, Ashraf M, Garner S, Whitehouse A, Yeung D, Mohamed SN, Wilkin R, Suggett N, Lee C, Bagul A, McNeill C, Eardley N, Mahapatra R, Gabriel C, Datt P, Mahmud S, Daniels I, McDermott F, Nodolsk M, Park L, Scott H, Trickett J, Bearn P, Trivedi P, Frost V, Gray C, Croft M, Beral D, Osborne J, Pugh R, Herdman G, George R, Howell AM, Al-Shahaby S, Narendrakumar B, Mohsen Y, Ijaz S, Nasseri M, Herrod P, Brear T, Reilly JJ, Sohal A, Otieno C, Lai W, Coleman M, Platt E, Patrick A, Pitman C, Balasubramanya S, Dickson E, Warman R, Newton C, Tani S, Simpson J, Banerjee A, Siddika A, Campion D, Humes D, Randhawa N, Saunders J, Bharathan B, Hay O. Incisional hernia following colorectal cancer surgery according to suture technique: Hughes Abdominal Repair Randomized Trial (HART). Br J Surg 2022; 109:943-950. [PMID: 35979802 PMCID: PMC10364691 DOI: 10.1093/bjs/znac198] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 05/09/2022] [Accepted: 05/13/2022] [Indexed: 11/14/2022]
Abstract
BACKGROUND Incisional hernias cause morbidity and may require further surgery. HART (Hughes Abdominal Repair Trial) assessed the effect of an alternative suture method on the incidence of incisional hernia following colorectal cancer surgery. METHODS A pragmatic multicentre single-blind RCT allocated patients undergoing midline incision for colorectal cancer to either Hughes closure (double far-near-near-far sutures of 1 nylon suture at 2-cm intervals along the fascia combined with conventional mass closure) or the surgeon's standard closure. The primary outcome was the incidence of incisional hernia at 1 year assessed by clinical examination. An intention-to-treat analysis was performed. RESULTS Between August 2014 and February 2018, 802 patients were randomized to either Hughes closure (401) or the standard mass closure group (401). At 1 year after surgery, 672 patients (83.7 per cent) were included in the primary outcome analysis; 50 of 339 patients (14.8 per cent) in the Hughes group and 57 of 333 (17.1 per cent) in the standard closure group had incisional hernia (OR 0.84, 95 per cent c.i. 0.55 to 1.27; P = 0.402). At 2 years, 78 patients (28.7 per cent) in the Hughes repair group and 84 (31.8 per cent) in the standard closure group had incisional hernia (OR 0.86, 0.59 to 1.25; P = 0.429). Adverse events were similar in the two groups, apart from the rate of surgical-site infection, which was higher in the Hughes group (13.2 versus 7.7 per cent; OR 1.82, 1.14 to 2.91; P = 0.011). CONCLUSION The incidence of incisional hernia after colorectal cancer surgery is high. There was no statistical difference in incidence between Hughes closure and mass closure at 1 or 2 years. REGISTRATION NUMBER ISRCTN25616490 (http://www.controlled-trials.com).
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Adiamah A, Crooks C, Hammond J, Jepsen P, West J, Humes D. Moynihan Prize 2 Cholecystectomy in patients with cirrhosis: a population-based cohort study from England. Br J Surg 2022. [DOI: 10.1093/bjs/znac246.006] [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: 11/07/2022]
Abstract
Abstract
Introduction
There is an increased risk of cholelithiasis in patients with liver cirrhosis irrespective of the underling aetiology. Cholecystectomy is the recommended definitive treatment for symptomatic gallstones. However, in patients with cirrhosis the postoperative outcomes after cholecystectomy are not fully defined. This population-based cohort study aimed to determine postoperative outcomes after emergency and elective cholecystectomy in patients with cirrhosis.
Methods
Linked electronic healthcare data from England were used to identify all patients undergoing cholecystectomy between January 2000 and December 2017. Length of stay (LOS), 30-day re-admission, case fatality and the odds ratio (OR) of 90-day mortality were calculated for patients with and without cirrhosis, adjusting for age, sex and co-morbidity using logistic regression.
Results
Of the total 69141 eligible patients who underwent a cholecystectomy, 511 (0.74%) had cirrhosis. In patients without cirrhosis 86.55% underwent a laparoscopic procedure compared with 57.53% in patients with cirrhosis (p<0.0001). LOS was longer in those with cirrhosis (3 IQR 1–8days vs 1 IQR 1–3days, p<0.0001). The 30-day re-admission rate was greater in patients with cirrhosis, 36.79% compared with 14.95% in those without cirrhosis. The 90-day case fatality after elective cholecystectomy in patients with and without cirrhosis was 2.79% and 0.43%; and 12.82% and 2.39% following emergency cholecystectomy. This equated to a 3-fold (OR 3.22 (95%-CI 1.72–6.02)) and a 4-fold (OR 4.52 (95%-CI 2.46–8.33)) increased odds of death at 90-days following elective and emergency cholecystectomy after adjusting for confounders.
Conclusion
Patients with cirrhosis undergoing cholecystectomy have an increased 90-day risk of postoperative mortality, which is significantly worse after emergency procedures.
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Affiliation(s)
- Alfred Adiamah
- National Institute for Health Research Nottingham Digestive Diseases Biomedical Research Unit, E Floor West Block, QMC Campus, Nottingham University Hospitals NHS Trust , Nottingham , UK , NG7 2UH
| | - Colin Crooks
- National Institute for Health Research Nottingham Digestive Diseases Biomedical Research Unit, E Floor West Block, QMC Campus, Nottingham University Hospitals NHS Trust , Nottingham , UK , NG7 2UH
| | - John Hammond
- Division of Hepatobiliary and Transplant surgery, Freeman Hospital. Freeman Rd , High Heaton, Newcastle upon Tyne , UK NE7 7DN
| | - Peter Jepsen
- Department of Hepatology and Gastroenterology, Aarhus University Hospital , Aarhus , Denmark
| | - Joe West
- Population and Lifespan sciences, School of Medicine, University of Nottingham , Clinical Sciences Building, City Hospital, Nottingham , UK , NG5 1PB
| | - David Humes
- National Institute for Health Research Nottingham Digestive Diseases Biomedical Research Unit, E Floor West Block, QMC Campus, Nottingham University Hospitals NHS Trust , Nottingham , UK , NG7 2UH
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Jackson A, James E, Vohra R, Humes D, Parsons S. TU1.5 Endoscopic electroporation for inoperable oesophagogastric cancer: Preliminary results from a phase II clinical trial (The VECTOR Trial). Br J Surg 2022. [DOI: 10.1093/bjs/znac248.005] [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: 11/06/2022]
Abstract
Abstract
Aims
Electrochemotherapy (ECT) combines the use of low-dose chemotherapy with reversible electroporation to increase intracellular uptake of chemotherapeutic agents and improve tumoral cytotoxicity. Although a well-established treatment modality in primary skin and cutaneous metastases, the effects of ECT in the treatment of advanced oesophagogastric cancer are unknown. Development of the endoVE/ePORE system now allows endoscopic delivery of ECT.
We aim to recruit thirty patients to the VECTOR trial to assess the efficacy of endoscopic ECT in the local treatment of inoperable oesophagogastric cancer.
Methods
The study began recruitment in March 2020. Patients undergo a single treatment of endoscopic ECT alongside a dose of intravenous Bleomycin. Validated dysphagia and QoL scores (Ogilvie, EORTC QLQ-C30/ OES18) are used to assess symptomatic response to treatment. Local tumour response is assessed with interval gastroscopy and cross-sectional imaging.
Results
Six males and one female with a mean age of 71 years (41–88) have received endoscopic ECT.Four patients had received oncological therapy prior to enrolment. The mean procedural time was 22 minutes.All patients were discharged within 24 hours of treatment.Over 50% of patients reported significant improvements in their dysphagia score at 6-week follow-up with concomitant improvement in their QoL metrics.
Conclusions
Early experience of endoscopic ECT is safe, well tolerated and can be performed in the endoscopy suite with sedation and analgesia. Improvements in patients’ symptomatology are promising and may indicate this as an alternative to stenting.We are yet to demonstrate favourable tumour response on follow up imaging and endoscopy.Careful patient selection is key to negate post procedural complications.
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Abstract
UNLABELLED The aim of surgical training across the 10 surgical specialties is to produce competent day 1 consultants. Progression through training in the UK is assessed by the Annual Review of Competency Progression (ARCP). OBJECTIVE This study aimed to examine variation in ARCP outcomes within surgical training and identify differences in outcomes between specialties. DESIGN A national cohort study using data from the UK Medical Education Database was performed. ARCP outcome was the primary outcome measure. Multilevel ordinal regression analyses were performed, with ARCP outcomes nested within trainees. PARTICIPANTS Higher surgical trainees (ST3-ST8) from nine UK surgical specialties were included (vascular surgery was excluded due to insufficient data). All surgical trainees across the UK with an ARCP outcome between 2010 and 2017 were included. RESULTS Eight thousand two hundred and twenty trainees with an ARCP outcome awarded between 2010 and 2017 were included, comprising 31 788 ARCP outcomes. There was substantial variation in the proportion of non-standard outcomes recorded across specialties with general surgery trainees having the highest proportion of non-standard outcomes (22.5%) and urology trainees the fewest (12.4%). After adjustment, general surgery trainees were 1.3 times more likely to receive a non-standard ARCP outcome compared with trainees in trauma and orthopaedics (T&O) (OR 1.33, 95% CI 1.21 to 1.45, p=0.001). Urology trainees were 36% less likely to receive a non-standard outcome compared with T&O trainees (OR 0.64, 95% CI 0.54 to 0.75, p<0.001). Female trainees and older age were associated with non-standard outcomes (OR 1.11, 95% CI 1.02 to 1.22, p=0.020; OR 1.04, 95% CI 1.03 to 1.05, p<0.001). CONCLUSION There is wide variation in the training outcome assessments across surgical specialties. General surgery has higher rates of non-standard outcomes compared with other surgical specialties. Across all specialties, female sex and older age were associated with non-standard outcomes.
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Affiliation(s)
- Carla Hope
- Division of Graduate Entry Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Jonathan Lund
- Division of Medical Sciences and Graduate Entry Medicine, University of Nottingham, Derby, UK
| | - Gareth Griffiths
- Department of Vascular Surgery, Ninewells Hospital and Medical School, Dundee, UK
| | - David Humes
- NIHR Nottingham Biomedical Research Centre (BRC), Nottingham University, Nottingham, UK
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Hope C, Humes D, Griffiths G, Lund J. Personal Characteristics Associated with Progression in Trauma and Orthopaedic Specialty Training: A Longitudinal Cohort Study. J Surg Educ 2022; 79:253-259. [PMID: 34326034 DOI: 10.1016/j.jsurg.2021.06.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 03/22/2021] [Accepted: 06/30/2021] [Indexed: 06/13/2023]
Abstract
AIM To identify demographic factors, including protected characteristics, and training specific factors which predict a nonstandard Annual Review of Competency Progression (ARCP) outcome during Trauma and Orthopedic Specialty training in the United Kingdom (UK). METHOD A longitudinal cohort study using data from UKMED was performed. ARCP outcome was the primary outcome measure. Multilevel univariate and multiple ordinal regression analyses were performed using STATA v 15. RESULTS Two thousand five hundred and ten Trauma and Orthopedic surgery trainees (ST3-ST8) with an ARCP outcome between 2010 and 2017 were included, comprising 11,011 ARCP outcomes. Eighty five percent (2130/2510) of trainees were male. Eighty two percent of outcomes were satisfactory. Female trainees had a 26% increased risk of nonstandard outcome (OR 1.26 95% CI 1.10-1.44) after adjusting for other factors. Older age at ARCP was associated with an increased risk of nonstandard ARCP outcome (OR 1.04 95% CI 1.03-1.06). International medical graduates had a 34% decreased risk of nonstandard outcome compared to UK graduates (OR 0.66 95% CI 0.54-0.81). Less than full time training was not associated with risk of a nonstandard ARCP outcome (OR 0.92 95% CI 0.76-1.12). CONCLUSION Female sex and older age at ARCP were significantly associated with nonstandard ARCP outcomes in Trauma and Orthopedic surgery, while international medical graduation was protective.
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Affiliation(s)
- Carla Hope
- Division of Medical Sciences and Graduate Entry Medicine, University of Nottingham, Royal Derby Hospital, Derby, United Kingdom.
| | - David Humes
- National Institute for Health Research Nottingham Digestive Diseases Biomedical Research Unit, QMC Campus, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom; Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, United Kingdom; Nottingham Digestive Diseases Centre, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | | | - Jonathan Lund
- Division of Medical Sciences and Graduate Entry Medicine, University of Nottingham, Royal Derby Hospital, Derby, United Kingdom
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Seehra J, Bailey J, Chapman C, Morling J, Humes D, Banerjea A. EP.TU.333FIT stratification in the COVID era - Is it safe for rectal bleeding? Br J Surg 2021. [PMCID: PMC8574348 DOI: 10.1093/bjs/znab311.043] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Aims Faecal Immunochemical Tests (FIT) are increasingly used for stratification of colorectal cancer risk in symptomatic patients. FIT is not currently recommended for use in patients with rectal bleeding, but recent studies have reported its safe use. We report our experiences of FIT in patients presenting with rectal bleeding during the COVID-19 pandemic. Methods Patients referred to NUH NHS Trust with rectal bleeding from 15/04/20-15/08/20 were invited to complete a postal-based FIT (OC-Sensor). Demographics, symptoms, investigations and results were recorded. Outcomes were retrospectively reviewed using an electronic hospital system. Result 344 patients were invited to participate, with 301 (87.5%) returning FITs in accordance with testing protocol. 36 patients declined to be seen, 4 were considered not fit for investigation, and 4 had incomplete records. 257 patients were included in the final analysis with 10 CRC detected (3.9%). Rectal bleeding (257, 100%) was the most common presenting symptom followed by change in bowel habit (133, 51.8%). 10 CRC were diagnosed (3.9%). 2 CRC were detected with FIT <4 µg Hb / g faeces (2/137, 1.5%) and 8 were detected >100 µg Hb / g faeces (8/45, 17.8%). FIT result was significantly associated with CRC diagnosis (p < 0.0001). 4 with CRC had anaemia (4/53, 7.5%), 1 had thrombocytosis (1/12, 8.3%). Conclusions FIT missed 20% of CRC in this patient group with the application of a very low threshold (<4 µg Hb / g faeces). Both cancers missed by FIT were detectable on digital rectal examination, emphasising the importance of this examination in primary care.
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Affiliation(s)
| | - James Bailey
- Nottingham University Hospitals NHS Trust
- School of Medicine, University of Nottingham
| | | | - Joanne Morling
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham
| | - David Humes
- Nottingham University Hospitals NHS Trust
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham
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Lewis-Lloyd C, Brewer H, Hall C, Adiamah A, Humes D. EP.TU.601Improving extended venous thromboembolism prophylaxis prescription compliance at discharge for colorectal cancer resection patients. Br J Surg 2021. [DOI: 10.1093/bjs/znab311.082] [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: 11/12/2022]
Abstract
Abstract
Aims
Extended venous thromboembolism prophylaxis (exVTEp) is used to reduce venous thromboembolism (VTE) incidence following colorectal cancer (CRC) resection. Within our tertiary care centre patients undergoing CRC resection should receive an electronic VTE risk assessment (eVTE) within 24 hours and exVTEp at discharge, compliance targets set at 95%. Our aim was to improve absolute compliance rates of exVTEp prescription at discharge following CRC surgery.
Methods
Data were collected prospectively on CRC resection patients pre and post an educational intervention for doctors during surgical induction, with posters placed in key areas highlighting discharge exVTEp importance. Patients discharged between August-December 2019 served as pre-intervention and those between December 2019-March 2020 as post-intervention cohorts. Time periods reflected junior doctor rotating periods within the country’s healthcare system thus providing more comparable data sets. The service evaluation was registered within the Trust (19-562Q)
Results
Of 80 pre-intervention and 40 post-intervention eligible patients: 81.25% vs. 92.68% received exVTEp at discharge, 70.19% vs. 72.34% had a valid eVTE and 32.50% vs. 36.59% had exVTEp recorded in the post-operative note. Those missing exVTEp documentation in the post-operative plan were significantly less likely to receive exVTEp at discharge with an 80% decrease in exVTEp prescription compared to patients with exVTEp documented within the post-operative note (unadjusted-OR 0.2051, 95%CI 0.0431-0.9773; p = 0.0276).
Conclusions
Educational and visual interventions have shown improvement in exVTEp prescription at discharge. Despite suboptimal eVTE scores true service quality in delivering exVTEp is high. The relationship between exVTEp post-operative instruction and exVTEp prescription needs further investigation.
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Affiliation(s)
- Christopher Lewis-Lloyd
- Gastrointestinal Surgery, Nottingham Digestive Diseases Centre and National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Queen's Medical Centre, Nottingham, United Kingdom
- Nottingham Colorectal Service, Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Nottingham, United Kingdom
| | - Hilary Brewer
- Nottingham Colorectal Service, Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Nottingham, United Kingdom
| | - Craig Hall
- Division of Surgery, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Alfred Adiamah
- Gastrointestinal Surgery, Nottingham Digestive Diseases Centre and National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Queen's Medical Centre, Nottingham, United Kingdom
- Nottingham Colorectal Service, Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Nottingham, United Kingdom
| | - David Humes
- Gastrointestinal Surgery, Nottingham Digestive Diseases Centre and National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Queen's Medical Centre, Nottingham, United Kingdom
- Nottingham Colorectal Service, Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Nottingham, United Kingdom
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Jackson A, Ng O, Bharathan B, Simpson A, Humes D, Parsons S. SP4.2.2 The hidden harm of conservative management in emergency general surgery during the COVID-19 pandemic. Br J Surg 2021. [PMCID: PMC8574452 DOI: 10.1093/bjs/znab361.098] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
Aims
Appendicitis, biliary disease and abscesses make up almost half of the emergency general surgery (EGS) workload. Our aim was to establish whether the shift towards non-operative management during the COVID-19 pandemic for these conditions has led to adverse patient outcomes.
Methods
Patient data were analysed from a prospective EGS database at a large UK tertiary centre. Patients were grouped by admission date into quarters (January-March, April-June, July-September, October-December) and compared with the corresponding time period from the preceding year.
Results
EGS saw 8226 and 7589 patients in 2019 and 2020 respectively. Following the first lockdown EGS admissions fell by 31%. Operative management of appendicitis fell from nearly 100% in 2019 to 32.9% and 54.7% in two of the four study periods. Complicated appendicitis was more common in 2020 leading to a 50% rise in length of stay (LOS), 4.5 days average. 30 day readmissions increased by 228% (n = 7, 2019 v n = 16, 2020). Biliary disease was managed conservatively with 11 patients undergoing percutaneous drainage from Apr-Dec 2020.Very few patients received emergency cholecystectomy in 2019 or 2020 due to institution preference. Readmission rates and LOS remained similar between years. Fewer abscesses were seen and operated on in 2020 with similar readmission rates and LOS between years.
Conclusions
Non-operative management and delays in presentation of appendicitis during the pandemic has had an adverse effect on patient outcomes. The rise in more complex cases has led to higher readmission rates and longer lengths of stay. The outcomes for biliary disease and abscesses remained unchanged.
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Affiliation(s)
| | - Oliver Ng
- Nottingham University Hospitals NHS Trust
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11
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Affiliation(s)
- C. Hope
- Division of Medical Sciences and Graduate Entry Medicine, University of Nottingham, Derby, DE22 3NE UK
| | - J.‑J. Reilly
- Queen’s Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH UK
| | | | - J. Lund
- Division of Medical Sciences and Graduate Entry Medicine, University of Nottingham, Derby, DE22 3NE UK
| | - D. Humes
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK
- Nottingham Digestive Diseases Centre, School of Medicine, University of Nottingham, Nottingham, UK
- National Institute for Health Research Nottingham Digestive Diseases Biomedical Research Unit, Nottingham University Hospitals NHS Trust, E Floor West Block, QMC Campus, Nottingham, NG7 2UH UK
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12
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Hope C, Lund J, Griffiths G, Humes D. O46 Differences in ARCP outcome by surgical specialty: a longitudinal cohort study. Br J Surg 2021. [DOI: 10.1093/bjs/znab282.051] [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]
Abstract
Abstract
Introduction
Surgical training in the UK is comprised of ten specialties: cardiothoracic, general, neurosurgery, oral and maxillofacial (OMFS), otolaryngology, paediatric, plastic, trauma and orthopaedics, urology and vascular surgery. Progression through training is assessed by the Annual Review of Competency Progression (ARCP). The aim is to examine ARCP outcomes within UK surgical specialty training and identify differences between specialties.
Method
A longitudinal cohort study using data from United Kingdom Medical Education Database (UKMED) was performed across surgical specialities. ARCP outcome was the primary outcome measure. Multi-level univariate and multiple ordinal regression analyses were performed.
Result
8,220 trainees with an ARCP outcome between 2010 and 2017 were included, comprising 31,788 ARCP outcomes. There was substantial variation in the proportion of non-standard outcomes across specialties with general surgery trainees having the highest proportion of non-standard outcomes (22.5%) and urology trainees the fewest 12.4%. After adjustment, general surgery trainees were 1.3 times more likely to receive a non-standard outcome compared to T&O trainees (OR 1.33 95% CI 1.21–1.45). Urology trainees were 36% less likely to receive a non-standard outcome compared to T&O trainees (OR 0.64 95% CI 0.54–0.75). Female trainees and older age were associated with non-standard outcomes (OR 1.11 95% CI 1.02–1.22; OR 1.04 95% CI 1.03–1.05).
Conclusion
There is wide variation in the outcomes of surgical ARCP’s across specialties. General surgery has higher rates of non-standard ARCP outcomes compared to other surgical specialities. Across all specialities, female sex and older age were associated with non-standard outcomes. Further studies are required to explore these associations.
Take-home Message
There is significant variation in ARCP outcomes between specialities. Women and older trainees receive significantly more non-standard outcomes.
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Affiliation(s)
- C Hope
- Division of Medical Sciences and Graduate Entry Medicine, University of Nottingham, Royal Derby Hospital, Derby, UK
| | - J Lund
- Division of Medical Sciences and Graduate Entry Medicine, University of Nottingham, Royal Derby Hospital, Derby, UK
| | | | - D Humes
- National Institute for Health Research Nottingham Digestive Diseases Biomedical Research Unit, E Floor West Block, QMC Campus, Nottingham University Hospitals NHS Trust, Nottingham NG7 2UH, UK
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13
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Yessayan L, Sohaney R, Puri V, Wagner B, Riddle A, Dickinson S, Napolitano L, Heung M, Humes D, Szamosfalvi B. Regional citrate anticoagulation "non-shock" protocol with pre-calculated flow settings for patients with at least 6 L/hour liver citrate clearance. BMC Nephrol 2021; 22:244. [PMID: 34215201 PMCID: PMC8249839 DOI: 10.1186/s12882-021-02443-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 05/28/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Regional citrate anticoagulation (RCA) for the prevention of clotting of the extracorporeal blood circuit during continuous kidney replacement therapy (CKRT) has been employed in limited fashion because of the complexity and complications associated with certain protocols. Hypertonic citrate infusion to achieve circuit anticoagulation results in variable systemic citrate- and sodium load and increases the risk of citrate accumulation and hypernatremia. The practice of "single starting calcium infusion rate for all patients" puts patients at risk for clinically significant hypocalcemia if filter effluent calcium losses exceed replacement. A fixed citrate to blood flow ratio, personalized effluent and pre-calculated calcium infusion dosing based on tables derived through kinetic analysis enable providers to use continuous veno-venous hemo-diafiltration (CVVHDF)-RCA in patients with liver citrate clearance of at least 6 L/h. METHODS This was a single-center prospective observational study conducted in intensive care unit patients triaged to be treated with the novel pre-calculated CVVHDF-RCA "Non-shock" protocol. RCA efficacy outcomes were time to first hemofilter loss and circuit ionized calcium (iCa) levels. Safety outcomes were surrogate of citrate accumulation (TCa/iCa ratio) and the incidence of acid-base and electrolyte complications. RESULTS Of 53 patients included in the study, 31 (59%) had acute kidney injury and 12 (22.6%) had the diagnosis of cirrhosis at the start of CVVHDF-RCA. The median first hemofilter life censored for causes other than clotting exceeded 70 h. The cumulative incidence of hypernatremia (Na > 148 mM), metabolic alkalosis (HCO3- > 30 mM), hypocalcemia (iCa < 0.9 mM) and hypercalcemia (iCa > 1.5 mM) were 1/47 (1%), 0/50 (0%), 1/53 (2%), 1/53 (2%) respectively and were not clinically significant. The median (25th-75th percentile) of the highest TCa/iCa ratio for every 24-h interval on CKRT was 1.99 (1.91-2.13). CONCLUSIONS The fixed citrate to blood flow ratio, as opposed to a titration approach, achieves adequate circuit iCa (< 0.4 mm/L) for any hematocrit level and plasma flow. The personalized dosing approach for calcium supplementation based on pre-calculated effluent calcium losses as opposed to the practice of "one starting dose for all" reduces the risk of clinically significant hypocalcemia. The fixed flow settings achieve clinically desirable steady state systemic electrolyte levels.
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Affiliation(s)
- Lenar Yessayan
- Division of Nephrology, Department of Medicine, University of Michigan, 3914 Taubman Center, 1500 E. Medical Center Dr. 5364, Ann Arbor, MI, 48109-5364, USA.
| | - Ryann Sohaney
- Division of Nephrology, Department of Medicine, University of Michigan, 3914 Taubman Center, 1500 E. Medical Center Dr. 5364, Ann Arbor, MI, 48109-5364, USA
| | - Vidhit Puri
- Division of Nephrology, Department of Medicine, University of Michigan, 3914 Taubman Center, 1500 E. Medical Center Dr. 5364, Ann Arbor, MI, 48109-5364, USA
| | - Benjamin Wagner
- Division of Nephrology, Department of Medicine, University of Michigan, 3914 Taubman Center, 1500 E. Medical Center Dr. 5364, Ann Arbor, MI, 48109-5364, USA
| | - Amy Riddle
- Division of Nephrology, Department of Medicine, University of Michigan, 3914 Taubman Center, 1500 E. Medical Center Dr. 5364, Ann Arbor, MI, 48109-5364, USA
| | - Sharon Dickinson
- Division of Acute Care Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Lena Napolitano
- Division of Acute Care Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Michael Heung
- Division of Nephrology, Department of Medicine, University of Michigan, 3914 Taubman Center, 1500 E. Medical Center Dr. 5364, Ann Arbor, MI, 48109-5364, USA
| | - David Humes
- Division of Nephrology, Department of Medicine, University of Michigan, 3914 Taubman Center, 1500 E. Medical Center Dr. 5364, Ann Arbor, MI, 48109-5364, USA
| | - Balazs Szamosfalvi
- Division of Nephrology, Department of Medicine, University of Michigan, 3914 Taubman Center, 1500 E. Medical Center Dr. 5364, Ann Arbor, MI, 48109-5364, USA.
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14
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Catton J, Banerjea A, Gregory S, Hall C, Crooks C, Lewis-Lloyd C, Marshall A, Humes D. 335 Planned Surgery in the COVID-19 Pandemic: A Prospective Cohort Study from Nottingham. Br J Surg 2021. [PMCID: PMC8135862 DOI: 10.1093/bjs/znab134.054] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Introduction Globally planned surgical procedures were deferred during the current COVID-19 pandemic. We aim to report planned urgent and cancer case outcomes during the pandemic using a multi-disciplinary prioritisation group. Method Prospective cohort of patients prioritised by a multi-disciplinary COVID Surgery group undergoing urgent or cancer surgery at a NHS Trust from 1st March-30th April 2020. 30-day post-operative rates of PCR positive and suspected COVID-19 infections, 30-day mortality and COVID-19 related deaths are reported. Results During the period, 597 patients underwent surgery, median age 65-years (interquartile range 54-74) of which 86% (514/597) had a cancer diagnosis. 61% (362/597) had surgery at the NHS Trust whilst 39% (234/597) had surgery at Independent Sector hospitals. The COVID-19 incidence in the East Midlands was 193.7 per 100,000 population. 30-days following surgery, 1.3% (8/597) tested COVID-19 positive with all cases at the NHS site. 30-day mortality was 0.7% (4/597). Mortality following PCR positive COVID-19 diagnosis was 25% (2/8). Including PCR positive and suspected cases 3.0% (18/597) developed COVID-19 infection, 1.3% at the independent site compared to 4.1% at the NHS Trust (p = 0.047). Conclusions Rates of COIVD-19 infection in the post-operative period were low especially in the Independent Sector site. Mortality following a post-operative diagnosis of COVID-19 was high.
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Affiliation(s)
- J Catton
- Division of Surgery, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - A Banerjea
- Division of Surgery, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - S Gregory
- Division of Surgery, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - C Hall
- Division of Surgery, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - C Crooks
- Nottingham Digestive Diseases Centre and National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Queen's Medical Centre, Nottingham, United Kingdom
| | - C Lewis-Lloyd
- Division of Surgery, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
- Nottingham Digestive Diseases Centre and National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Queen's Medical Centre, Nottingham, United Kingdom
| | - A Marshall
- Division of Surgery, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - D Humes
- Division of Surgery, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
- Nottingham Digestive Diseases Centre and National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Queen's Medical Centre, Nottingham, United Kingdom
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15
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Song Y, Ye Y, Su SH, Stephens A, Cai T, Chung MT, Han M, Newstead MW, Yessayan L, Frame D, Humes D, Singer BH, Kurabayashi K. A digital protein microarray for COVID-19 cytokine storm monitoring. Lab Chip 2021; 21:331-343. [PMID: 33211045 PMCID: PMC7855944 DOI: 10.1039/d0lc00678e] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Despite widespread concern regarding cytokine storms leading to severe morbidity in COVID-19, rapid cytokine assays are not routinely available for monitoring critically ill patients. We report the clinical application of a digital protein microarray platform for rapid multiplex quantification of cytokines from critically ill COVID-19 patients admitted to the intensive care unit (ICU) at the University of Michigan Hospital. The platform comprises two low-cost modules: (i) a semi-automated fluidic dispensing/mixing module that can be operated inside a biosafety cabinet to minimize the exposure of the technician to the virus infection and (ii) a 12-12-15 inch compact fluorescence optical scanner for the potential near-bedside readout. The platform enabled daily cytokine analysis in clinical practice with high sensitivity (<0.4 pg mL-1), inter-assay repeatability (∼10% CV), and rapid operation providing feedback on the progress of therapy within 4 hours. This test allowed us to perform serial monitoring of two critically ill patients with respiratory failure and to support immunomodulatory therapy using the selective cytopheretic device (SCD). We also observed clear interleukin-6 (IL-6) elevations after receiving tocilizumab (IL-6 inhibitor) while significant cytokine profile variability exists across all critically ill COVID-19 patients and to discover a weak correlation between IL-6 to clinical biomarkers, such as ferritin and C-reactive protein (CRP). Our data revealed large subject-to-subject variability in patients' response to COVID-19, reaffirming the need for a personalized strategy guided by rapid cytokine assays.
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Affiliation(s)
- Yujing Song
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI, 48109, United States
| | - Yuxuan Ye
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI, 48109, United States
| | - Shiuan-Haur Su
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI, 48109, United States
| | - Andrew Stephens
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI, 48109, United States
| | - Tao Cai
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI, 48109, United States
| | - Meng-Ting Chung
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI, 48109, United States
| | - Meilan Han
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI, 48109, United States
| | - Michael W. Newstead
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI, 48109, United States
| | - Lenar Yessayan
- Department of Internal Medicine, Division of Nephrology, University of Michigan, Ann Arbor, MI, 48109, United States
| | - David Frame
- Department of Clinical Pharmacy, College of Pharmacy, University of Michigan, Ann Arbor, MI, 48109, United States
| | - David Humes
- Department of Internal Medicine, Division of Nephrology, University of Michigan, Ann Arbor, MI, 48109, United States
| | - Benjamin H. Singer
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI, 48109, United States
- Michigan Center for Integrative Research in Critical Care, University of Michigan, Ann Arbor, MI, 48109, United States
| | - Katsuo Kurabayashi
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI, 48109, United States
- Department of Electrical Engineering and Computer Science, University of Michigan, Ann Arbor, MI, 48109, United States
- Michigan Center for Integrative Research in Critical Care, University of Michigan, Ann Arbor, MI, 48109, United States
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Szamosfalvi B, Puri V, Sohaney R, Wagner B, Riddle A, Dickinson S, Napolitano L, Heung M, Humes D, Yessayan L. Regional Citrate Anticoagulation Protocol for Patients with Presumed Absent Citrate Metabolism. Kidney360 2020; 2:192-204. [PMID: 35373034 PMCID: PMC8740983 DOI: 10.34067/kid.0005342020] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 12/18/2020] [Indexed: 02/04/2023]
Abstract
Background Regional citrate anticoagulation (RCA) is not recommended in patients with shock or severe liver failure. We designed a protocol with personalized precalculated flow settings for patients with absent citrate metabolism that abrogates risk of citrate toxicity, and maintains neutral continuous KRT (CKRT) circuit calcium mass balance and normal systemic ionized calcium levels. Methods A single-center prospective cohort study of patients in five adult intensive care units triaged to the CVVHDF-RCA "Shock" protocol. Results Of 31 patients included in the study, 30 (97%) had AKI, 16 (52%) had acute liver failure, and five (16%) had cirrhosis at the start of CKRT. The median lactate was 5 mmol/L (interquartile range [IQR], 3.2-10.7), AST 822 U/L (IQR, 122-2950), ALT 352 U/L (IQR, 41-2238), total bilirubin 2.7 mg/dl (IQR, 1.0-5.1), and INR two (IQR, 1.5-2.6). The median first hemofilter life censored for causes other than clotting exceeded 70 hours. The cumulative incidence of hypernatremia (Na >148 mM), metabolic alkalosis (HCO3- >30 mM), and hypophosphatemia (P<2 mg/dl) were one out of 26 (4%), zero out of 30 (0%), and one out of 30 (3%), respectively, and were not clinically significant. Mild hypocalcemia occurred in the first 4 hours in two out of 31 patients, and corrected by hour 6 with no additional Ca supplementation beyond the per-protocol administered Ca infusion. The maximum systemic total Ca (tCa; mM)/ionized Ca (iCa; mM) ratio never exceeded 2.5. Conclusions The Shock protocol can be used without contraindications and is effective in maintaining circuit patency with a high, fixed ACDA infusion rate to blood flow ratio. Keeping single-pass citrate extraction on the dialyzer >0.75 minimizes the risk of citrate toxicity even in patients with absent citrate metabolism. Precalculated, personalized dosing of the initial Ca-infusion rate from a table on the basis of the patient's albumin level and the filter effluent flow rate maintains neutral CKRT circuit calcium mass balance and a normal systemic iCa level.
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Affiliation(s)
- Balazs Szamosfalvi
- Division of Nephrology, Department of Medicine, University of Michigan, Ann Arbor, Michigan
| | - Vidhit Puri
- Division of Nephrology, Department of Medicine, University of Michigan, Ann Arbor, Michigan
| | - Ryann Sohaney
- Division of Nephrology, Department of Medicine, University of Michigan, Ann Arbor, Michigan
| | - Benjamin Wagner
- Division of Nephrology, Department of Medicine, University of Michigan, Ann Arbor, Michigan
| | - Amy Riddle
- Division of Nephrology, Department of Medicine, University of Michigan, Ann Arbor, Michigan
| | - Sharon Dickinson
- Division of Acute Care Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Lena Napolitano
- Division of Acute Care Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Michael Heung
- Division of Nephrology, Department of Medicine, University of Michigan, Ann Arbor, Michigan
| | - David Humes
- Division of Nephrology, Department of Medicine, University of Michigan, Ann Arbor, Michigan
| | - Lenar Yessayan
- Division of Nephrology, Department of Medicine, University of Michigan, Ann Arbor, Michigan
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17
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Yessayan L, Szamosfalvi B, Napolitano L, Singer B, Kurabayashi K, Song Y, Westover A, Humes D. Treatment of Cytokine Storm in COVID-19 Patients With Immunomodulatory Therapy. ASAIO J 2020; 66:1079-1083. [PMID: 33136592 PMCID: PMC10660617 DOI: 10.1097/mat.0000000000001239] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [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] [Indexed: 01/08/2023] Open
Abstract
Observational evidence suggests that excessive inflammation with cytokine storm may play a critical role in development of acute respiratory distress syndrome (ARDS) in COVID-19. We report the emergency use of immunomodulatory therapy utilizing an extracorporeal selective cytopheretic device (SCD) in two patients with elevated serum interleukin (IL)-6 levels and refractory COVID-19 ARDS requiring extracorporeal membrane oxygenation (ECMO). The two patients were selected based on clinical criteria and elevated levels of IL-6 (>100 pg/ml) as a biomarker of inflammation. Once identified, emergency/expanded use permission for SCD treatment was obtained and patient consented. Six COVID-19 patients (four on ECMO) with severe ARDS were also screened with IL-6 levels less than 100 pg/ml and were not treated with SCD. The two enrolled patients' PaO2/FiO2 ratios increased from 55 and 58 to 200 and 192 at 52 and 50 hours, respectively. Inflammatory indices also declined with IL-6 falling from 231 and 598 pg/ml to 3.32 and 116 pg/ml, respectively. IL-6/IL-10 ratios also decreased from 11.8 and 18 to 0.7 and 0.62, respectively. The two patients were successfully weaned off ECMO after 17 and 16 days of SCD therapy, respectively. The results observed with SCD therapy on these two critically ill COVID-19 patients with severe ARDS and elevated IL-6 is encouraging. A multicenter clinical trial is underway with an FDA-approved investigational device exemption to evaluate the potential of SCD therapy to effectively treat COVID-19 intensive care unit patients.
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Affiliation(s)
- Lenar Yessayan
- Division of Nephrology, Department of Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Balazs Szamosfalvi
- Division of Nephrology, Department of Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Lena Napolitano
- Division of Acute Care Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Benjamin Singer
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Katsuo Kurabayashi
- Department of Mechanical Engineering
- Department of Electrical Engineering and Computer Science
| | | | - Angela Westover
- Division of Nephrology, Department of Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - David Humes
- Division of Nephrology, Department of Medicine, University of Michigan, Ann Arbor, Michigan, USA
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18
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Hope C, Reilly JJ, Griffiths G, Lund J, Humes D. Factors Associated with Attrition and Performance Throughout Surgical Training: A Systematic Review and Meta-Analysis. World J Surg 2020; 45:429-442. [PMID: 33104833 PMCID: PMC7773620 DOI: 10.1007/s00268-020-05844-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2020] [Indexed: 11/18/2022]
Abstract
Background Attrition within surgical training is a challenge. In the USA, attrition rates are as high as 20–26%. The factors predicting attrition are not well known. The aim of this systematic review is to identify factors that influence attrition or performance during surgical training. Method The review was performed in line with PRISMA guidelines and registered with the Open Science Framework (OSF). Medline, EMBASE, PubMed and the Cochrane Central Register of Controlled Trials were searched for articles. Risk of bias was assessed using the Newcastle–Ottawa scale. Pooled estimates were calculated using random effects meta-analyses in STATA version 15 (Stata Corp Ltd). A sensitivity analysis was performed including only multi-institutional studies. Results The searches identified 3486 articles, of which 31 were included, comprising 17,407 residents. Fifteen studies were based on multi-institutional data and 16 on single-institutional data. Twenty-nine of the studies are based on US residents. The pooled estimate for overall attrition was 17% (95% CI 14–20%). Women had a significantly higher pooled attrition than men (24% vs 16%, p < 0.001). Some studies reported Hispanic residents had a higher attrition rate than non-Hispanic residents. There was no increased risk of attrition with age, marital or parental status. Factors reported to affect performance were non-white ethnicity and faculty assessment of clinical performance. Childrearing was not associated with performance. Conclusion Female gender is associated with higher attrition in general surgical residency. Longitudinal studies of contemporary surgical cohorts are needed to investigate the complex multi-factorial reasons for failing to complete surgical residency. Electronic supplementary material The online version of this article (10.1007/s00268-020-05844-0) contains supplementary material, which is available to authorised users.
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Affiliation(s)
- Carla Hope
- Division of Medical Sciences and Graduate Entry Medicine, University of Nottingham, Derby, DE22 3NE, UK.
| | - John-Joe Reilly
- Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, UK
| | | | - Jon Lund
- Division of Medical Sciences and Graduate Entry Medicine, University of Nottingham, Derby, DE22 3NE, UK
| | - David Humes
- Division of Epidemiology and Public Health, Nottingham Digestive Diseases Centre, School of Medicine, University of Nottingham, Nottingham, UK.,National Institute for Health Research Nottingham Digestive Diseases Biomedical Research Unit, Nottingham University Hospitals NHS Trust, E Floor West Block, QMC Campus, Nottingham, NG7 2UH, UK
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19
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Steadman J, Humes D, Dhingsa R, Walter C. The accuracy of CT tumour staging of colon cancer. Eur J Surg Oncol 2018. [DOI: 10.1016/j.ejso.2018.01.499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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20
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Steadman J, Humes D, Walter C, Dhingsa R. Consistency of Endoscopic Tattooing of Colonic Malignancies in a UK Centre. Int J Surg 2017. [DOI: 10.1016/j.ijsu.2017.08.174] [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: 11/15/2022]
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21
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Kooiman J, Seth M, Nallamothu BK, Heung M, Humes D, Gurm HS. Association between acute kidney injury and in-hospital mortality in patients undergoing percutaneous coronary interventions. Circ Cardiovasc Interv 2016; 8:e002212. [PMID: 26047992 DOI: 10.1161/circinterventions.114.002212] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Acute kidney injury (AKI) post percutaneous coronary intervention (PCI) is associated with increased mortality but both death and AKI share common risk factors. Moreover, the effect of a high contrast dose, a known modifiable risk factor for AKI, on mortality is unknown. The aim of our study was to analyze the association between AKI and in-hospital mortality post PCI after adjustment for confounding by common risk factors. METHODS AND RESULTS This study was performed using a regional registry of all patients undergoing PCI in Michigan. Primary end points were AKI (serum creatinine increase >0.5 mg/dL) and all-cause in-hospital mortality. Propensity matching was performed, with each AKI patient matched to 4 controls. Attributable risk fraction and the exposed index number of AKI for mortality were calculated within the propensity-matched cohort. Between 2010 and 2013, 92 317 patients underwent PCI, of whom 2141 (2.3%) developed AKI. We matched 1371/2141 patients with AKI to 5484 controls. AKI was strongly associated with mortality (odds ratio=12.52, 95% confidence interval 9.29-16.86) in the propensity-matched cohort. The attributable risk fraction for mortality of AKI was 31.4% (95% confidence interval 26.8%-37.5%), and one death could be prevented for every 9 cases of AKI successfully avoided. The independent impact of a high contrast dose at time of PCI on in-hospital mortality risk was weak (adjusted odds ratio 1.19, 95% confidence interval 0.97-1.45). CONCLUSIONS Nearly one-third of the in-hospital mortality post PCI is attributable to AKI. Preventing 9 cases of AKI could potentially prevent one death. These study findings stress the need for developing effective AKI preventive strategies beyond minimization of contrast dose.
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Affiliation(s)
- Judith Kooiman
- From the Department of Thrombosis and Hemostasis and Department of Nephrology, Leiden University Medical Center, The Netherlands (J.K.); Division of Cardiovascular Medicine (M.S., B.K.N., H.S.G.) and Division of Nephrology (M.H., D.H.), Department of Internal Medicine, University of Michigan, Ann Arbor, MI; and VA Ann Arbor Healthcare System, MI (B.K.N., H.S.G.)
| | - Milan Seth
- From the Department of Thrombosis and Hemostasis and Department of Nephrology, Leiden University Medical Center, The Netherlands (J.K.); Division of Cardiovascular Medicine (M.S., B.K.N., H.S.G.) and Division of Nephrology (M.H., D.H.), Department of Internal Medicine, University of Michigan, Ann Arbor, MI; and VA Ann Arbor Healthcare System, MI (B.K.N., H.S.G.)
| | - Brahmajee K Nallamothu
- From the Department of Thrombosis and Hemostasis and Department of Nephrology, Leiden University Medical Center, The Netherlands (J.K.); Division of Cardiovascular Medicine (M.S., B.K.N., H.S.G.) and Division of Nephrology (M.H., D.H.), Department of Internal Medicine, University of Michigan, Ann Arbor, MI; and VA Ann Arbor Healthcare System, MI (B.K.N., H.S.G.)
| | - Michael Heung
- From the Department of Thrombosis and Hemostasis and Department of Nephrology, Leiden University Medical Center, The Netherlands (J.K.); Division of Cardiovascular Medicine (M.S., B.K.N., H.S.G.) and Division of Nephrology (M.H., D.H.), Department of Internal Medicine, University of Michigan, Ann Arbor, MI; and VA Ann Arbor Healthcare System, MI (B.K.N., H.S.G.)
| | - David Humes
- From the Department of Thrombosis and Hemostasis and Department of Nephrology, Leiden University Medical Center, The Netherlands (J.K.); Division of Cardiovascular Medicine (M.S., B.K.N., H.S.G.) and Division of Nephrology (M.H., D.H.), Department of Internal Medicine, University of Michigan, Ann Arbor, MI; and VA Ann Arbor Healthcare System, MI (B.K.N., H.S.G.)
| | - Hitinder S Gurm
- From the Department of Thrombosis and Hemostasis and Department of Nephrology, Leiden University Medical Center, The Netherlands (J.K.); Division of Cardiovascular Medicine (M.S., B.K.N., H.S.G.) and Division of Nephrology (M.H., D.H.), Department of Internal Medicine, University of Michigan, Ann Arbor, MI; and VA Ann Arbor Healthcare System, MI (B.K.N., H.S.G.).
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Humes D, Spiller RC. Colonic diverticular disease: medical treatments for acute diverticulitis. BMJ Clin Evid 2016; 2016:0405. [PMID: 26854496 PMCID: PMC4745836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
INTRODUCTION Diverticula (mucosal outpouchings through the wall of the colon) are rare before the age of 40 years, after which prevalence increases steadily and reaches over 25% by 60 years. However, only 10% to 25% of affected people will develop symptoms such as lower abdominal pain. Recurrent symptoms are common, and 5% of people with diverticula eventually develop complications such as perforation, obstruction, haemorrhage, fistulae, or abscesses. METHODS AND OUTCOMES We conducted a systematic overview, aiming to answer the following clinical question: What are the effects of medical treatments for acute diverticulitis? We searched: Medline, Embase, The Cochrane Library, and other important databases up to August 2014 (Clinical Evidence overviews are updated periodically; please check our website for the most up-to-date version of this overview). RESULTS At this update, searching of electronic databases retrieved 193 studies. After deduplication and removal of conference abstracts, 75 records were screened for inclusion in the overview. Appraisal of titles and abstracts led to the exclusion of 37 studies and the further review of 38 full publications. Of the 38 full articles evaluated, four systematic reviews and one RCT were added at this update. We performed a GRADE evaluation for two PICO combinations CONCLUSIONS In this systematic overview, we categorised the efficacy for one comparison based on information about the effectiveness and safety of medical treatment (mesalazine, antibiotics [any] only) versus placebo or no treatment.
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Affiliation(s)
- David Humes
- Department of Surgery, University of Nottingham, Nottingham, UK
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Abdul Sultan A, West J, Stephansson O, Grainge MJ, Tata LJ, Fleming KM, Humes D, Ludvigsson JF. Defining venous thromboembolism and measuring its incidence using Swedish health registries: a nationwide pregnancy cohort study. BMJ Open 2015; 5:e008864. [PMID: 26560059 PMCID: PMC4654387 DOI: 10.1136/bmjopen-2015-008864] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To accurately define venous thromboembolism (VTE) in the routinely collected Swedish health registers and quantify its incidence in and around pregnancy. STUDY DESIGN Cohort study using data from the Swedish Medical Birth Registry (MBR) linked to the National Patient Registry (NPR) and the Swedish Prescribed Drug Register (PDR). SETTING Secondary care centres, Sweden. PARTICIPANT 509,198 women aged 15-44 years who had one or more pregnancies resulting in a live birth or stillbirth between 2005 and 2011. MAIN OUTCOME MEASURE To estimate the incidence rate (IR) of VTE in and around pregnancy using various VTE definitions allowing direct comparison with other countries. RESULTS The rate of VTE varied based on the VTE definition. We found that 43% of cases first recorded as outpatient were not accompanied by anticoagulant prescriptions, whereas this proportion was much lower than those cases first recorded in the inpatient register (9%). Using our most inclusive VTE definition, we observed higher rates of VTE compared with previously published data using similar methodology. These reduced by 31% (IR=142/100,000 person-years; 95% CI 132 to 153) and 22% (IR=331/100,000 person-years; 95% CI 304 to 361) during the antepartum and postpartum periods, respectively, using a restrictive VTE definition that required anticoagulant prescriptions associated with diagnosis, which were more in line with the existing literature. CONCLUSIONS We found that including VTE codes without treatment confirmation risks the inclusion of false-positive cases. When defining VTE using the NPR, anticoagulant prescription information should therefore be considered particularly for cases recorded in an outpatient setting.
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Affiliation(s)
- Alyshah Abdul Sultan
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
- Nottingham Digestive Diseases Biomedical Research Unit, University of Nottingham, Queens Medical Center, UK
| | - Joe West
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK
| | - Olof Stephansson
- Department of Medicine, Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Matthew J Grainge
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK
| | - Laila J Tata
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK
| | - Kate M Fleming
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK
| | - David Humes
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK
| | - Jonas F Ludvigsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
- Department of Paediatrics, Örebro University Hospital, Örebro, Sweden
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Humes D, Smith JK, Spiller RC. Colonic diverticular disease. Am Fam Physician 2011; 84:1163-1164. [PMID: 22085672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Humes D, Smith JK, Spiller RC. Colonic diverticular disease. BMJ Clin Evid 2011; 2011:0405. [PMID: 21401970 PMCID: PMC3275154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
INTRODUCTION Diverticula (mucosal outpouching through the wall of the colon) are rare before the age of 40 years, after which prevalence increases steadily and reaches over 25% by 60 years. However, only 10% to 25% of affected people will develop symptoms such as lower abdominal pain. Recurrent symptoms are common, and 5% of people with diverticula eventually develop complications such as perforation, obstruction, haemorrhage, fistulae, or abscesses. METHODS AND OUTCOMES We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of: treatments for uncomplicated diverticular disease; treatments to prevent complications; and treatments for acute diverticulitis? We searched: Medline, Embase, The Cochrane Library, and other important databases up to May 2010 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). RESULTS We found 16 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. CONCLUSIONS In this systematic review we present information relating to the effectiveness and safety of the following interventions: antispasmodics, elective surgery, increasing fibre intake with bran or ispaghula husk, lactulose, medical treatment, mesalazine, methylcellulose, rifaximin, and surgery.
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Affiliation(s)
- David Humes
- Department of Surgery, University of Nottingham, Nottingham, UK
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Humes D, Simpson J, Spiller RC. Colonic diverticular disease. BMJ Clin Evid 2007; 2007:0405. [PMID: 19454119 PMCID: PMC2943810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
INTRODUCTION Diverticula (mucosal outpouching through the wall of the colon) affect over 5% of adults aged 40 years and older, but only 10-25% of affected people will develop symptoms such as lower abdominal pain. Recurrent symptoms are common, and 5% of people with diverticula eventually develop complications such as perforation, obstruction, haemorrhage, fistulae, or abscesses. METHODS AND OUTCOMES We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of: treatments for uncomplicated diverticular disease; treatments to prevent complications; and treatments for acute diverticulitis? We searched: Medline, Embase, The Cochrane Library and other important databases up to July 2006 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). RESULTS We found 13 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. CONCLUSIONS In this systematic review we present information relating to the effectiveness and safety of the following interventions: antispasmodics, bran, elective surgery, increasing fibre intake, ispaghula husk, lactulose, medical treatment, mesalazine, methylcellulose, rifaximin, surgery.
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Affiliation(s)
- David Humes
- Department of Surgery, University of Nottingham, Nottingham, UK
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Humes D, Speake WJ, Simpson J. Appendicitis. BMJ Clin Evid 2007; 2007:0408. [PMID: 19454096 PMCID: PMC2943782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
INTRODUCTION Potential causes of appendicitis include faecoliths, lymphoid hyperplasia, and caecal carcinoma, all of which can lead to obstruction of the appendix lumen. The lifetime risk is approximately 7-9% in the USA, making appendicectomy the most common abdominal surgical emergency. Mortality from acute appendicitis is less than 0.3%, but rises to 1.7% after perforation. METHODS AND OUTCOMES We conducted a systematic review and aimed to answer the following clinical question: What are the effects of treatments for acute appendicitis? We searched: Medline, Embase, The Cochrane Library and other important databases up to November 2006 (BMJ Clinical evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). RESULTS We found 10 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. CONCLUSIONS In this systematic review we present information relating to the effectiveness and safety of the following interventions: antibiotics, laparoscopic surgery, ligation, open surgery, stump inversion, surgery.
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Dhawan V, Tiranathanagul K, Lou L, Borschel G, Tziampazis E, Buffington D, Zhang W, Humes D, Brown D. Successful use of an In Vivo Model of Spontaneous Angiogenesis as a Vascular Interface for an Implantable Bioartificial Hemofilter. J Reconstr Microsurg 2006. [DOI: 10.1055/s-2006-955133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Lytle IF, Dhawan V, Tiranathanagul K, Lou L, Borschel G, Tziampazis E, Buffington D, Zhang WX, Humes D, Brown D. An implantable bioartificial hemofilter: Ultrafiltrate volume depends on vascular density and collecting fiber surface area. J Am Coll Surg 2006. [DOI: 10.1016/j.jamcollsurg.2006.05.237] [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: 11/29/2022]
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Humes D, Lobo DN. Removal of a rectal foreign body by using a Foley catheter passed through a rigid sigmoidoscope. Gastrointest Endosc 2005; 62:610. [PMID: 16185979 DOI: 10.1016/s0016-5107(05)01575-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2005] [Accepted: 03/23/2005] [Indexed: 12/10/2022]
Affiliation(s)
- David Humes
- Section of Surgery, University Hospital, Queen's Medical Center, Nottingham, United Kingdom
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Abstract
The present anatomical and clinical literature is not detailed enough for a clear understanding of the three-dimensional anatomy of the trapezium. It lacks descriptions of identifiable landmarks needed for the interpretation of two-dimensional radiographs. Fifty dry cadaver trapezia were assessed and an extended surface anatomy described. New consistent landmarks were described and the tubercle of the trapezium was redefined. The incidence of the salient osteological features in Caucasian trapezia was recorded.
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Affiliation(s)
- D Humes
- From the Department of Orthopaedics, King's College Hospital, Denmark Hill, London SE5 9RS, UK
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Pressman P, Larson DB, Lyons JS, Humes D. Impact of religious belief on psychological distress. Psychosomatics 1992; 33:470. [PMID: 1461975 DOI: 10.1016/s0033-3182(92)71958-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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