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Chalmers KA, Cousins SE, Blazeby JM. Randomized controlled trials comparing gastric bypass, gastric band, and sleeve gastrectomy: A systematic review examining validity and applicability to wider clinical practice. Obes Rev 2024; 25:e13718. [PMID: 38346786 DOI: 10.1111/obr.13718] [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: 02/15/2023] [Revised: 01/17/2024] [Accepted: 01/17/2024] [Indexed: 04/18/2024]
Abstract
Consideration of how applicable the results of surgical trials are to clinical practice is important to inform decision-making. Randomized controlled trials comparing at least two surgical interventions (of gastric bypass, gastric band, and sleeve gastrectomy) for severe and complex obesity were examined using the PRagmatic Explanatory Continuum Indicator Summary-2 tool, to consider how applicable the trial results are to clinical practice, and the Risk of Bias 2 tool, to examine validity. MEDLINE, Embase, and CENTRAL databases were searched for studies published between November 2013 and June 2021, and 15 were identified. Using the PRagmatic Explanatory Continuum Indicator Summary-2 tool, three were classified as pragmatic, with good applicability to clinical practice. Ten had more explanatory domains but did include some pragmatic characteristics, and two were predominantly explanatory. This was due to some trial design features that would not be considered applicable to the wider clinical setting, including being single-centered, having prescribed intervention delivery methods, and intensive follow-up regimens. Only two trials had low risk of bias, of which one was considered pragmatic. Three had high risk of bias. Overall, few trials in bariatric surgery are pragmatic with low risk of bias. Well-designed pragmatic trials are needed to inform practice and reduce research waste.
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Affiliation(s)
- Katy A Chalmers
- National Institute of Health and Care Research (NIHR) Biomedical Research Centre at University Hospitals Bristol NHS Foundation Trust and the University of Bristol, Surgical Innovation Theme and the Medical Research Council ConDuCT-II Hub for Trials Methodology Research, Bristol Centre for Surgical Research, Population Health Sciences, Bristol Medical School, Bristol, UK
| | - Sian E Cousins
- National Institute of Health and Care Research (NIHR) Biomedical Research Centre at University Hospitals Bristol NHS Foundation Trust and the University of Bristol, Surgical Innovation Theme and the Medical Research Council ConDuCT-II Hub for Trials Methodology Research, Bristol Centre for Surgical Research, Population Health Sciences, Bristol Medical School, Bristol, UK
| | - Jane M Blazeby
- National Institute of Health and Care Research (NIHR) Biomedical Research Centre at University Hospitals Bristol NHS Foundation Trust and the University of Bristol, Surgical Innovation Theme and the Medical Research Council ConDuCT-II Hub for Trials Methodology Research, Bristol Centre for Surgical Research, Population Health Sciences, Bristol Medical School, Bristol, UK
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Fairhurst K, Potter S, Blazeby JM, Avery KNL. Recommendations for optimising pilot and feasibility work in surgery. Pilot Feasibility Stud 2024; 10:64. [PMID: 38637818 PMCID: PMC11025276 DOI: 10.1186/s40814-024-01489-1] [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: 11/15/2022] [Accepted: 03/26/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND Surgical trials are recognised as inherently challenging. Pilot and feasibility studies (PAFS) are increasingly acknowledged as a key method to optimise the design and conduct of randomised trials but remain limited in surgery. We used a mixed methods approach to develop recommendations for how surgical PAFS could be optimised. METHODS The findings from a quantitative analysis of funded surgical PAFS over a 10-year period and in-depth qualitative interviews with surgeons, methodologists and funders were triangulated and synthesised with available methodological guidance on PAFS. RESULTS The synthesis informed the development of an explanatory model describing root causes and compounding challenges that contribute to how and why surgical PAFS is not currently optimised. The four root causes identified include issues relating to (i) understanding the full scope of PAFS; (ii) design and conduct of PAFS; (iii) reporting of PAFS; and (iv) lack of appreciation of the value of PAFS by all stakeholder groups. Compounding challenges relate to both cultural issues and access to and interpretation of available methodological PAFS guidance. The study findings and explanatory model were used to inform the development of a practical guidance tool for surgeons and study teams to improve research practice. CONCLUSIONS Optimisation of PAFS in surgery requires a cultural shift in research practice amongst funders, academic institutions, regulatory bodies and journal editors, as well as amongst surgeons. Our 'Top Tips' guidance tool offers an accessible framework for surgeons designing PAFS. Adoption and utilisation of these recommendations will optimise surgical PAFS, facilitating successful and efficient future surgical trials.
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Affiliation(s)
- K Fairhurst
- Centre for Surgical Research, Medical Research Council ConDuCT-II Hub for Trials Methodology Research and Biomedical Research Centre, Department of Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Clifton, Bristol, BS8 2PS, UK.
| | - S Potter
- Centre for Surgical Research, Medical Research Council ConDuCT-II Hub for Trials Methodology Research and Biomedical Research Centre, Department of Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Clifton, Bristol, BS8 2PS, UK
| | - J M Blazeby
- Centre for Surgical Research, Medical Research Council ConDuCT-II Hub for Trials Methodology Research and Biomedical Research Centre, Department of Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Clifton, Bristol, BS8 2PS, UK
| | - K N L Avery
- Centre for Surgical Research, Medical Research Council ConDuCT-II Hub for Trials Methodology Research and Biomedical Research Centre, Department of Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Clifton, Bristol, BS8 2PS, UK
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Akhtar K, Alkhaffaf B, Ariyarathenam A, Avery K, Barham P, Bateman A, Beard C, Berrisford R, Blazeby JM, Blencowe N, Boddy A, Bowrey D, Bracey T, Brierley RC, Briton K, Byrne J, Catton J, Chaparala R, Clark SK, Clarke T, Cooke J, Couper G, Culliford L, Dawson H, Deans C, Donovan JL, Ekblad C, Elliott J, Exon D, Falk S, Farooq N, Garfield K, Gaunt DM, Gill F, Goldin R, Gravani A, Hanna G, Hayes S, Heys R, Hindmarsh C, Hollinghurst S, Hollingworth W, Hollowood A, Houlihan R, Howes B, Howie L, Humphreys L, Hutton D, Jarvis R, Jepson M, Kandiyali R, Kaur S, Kaye P, Kelly J, King A, Kirwin J, Krysztopik R, Lamb P, Lang A, Lee V, Maitland S, Mapstone N, Melia G, Metcalfe C, Melhado R, Moure-Fernandez A, Nair B, Nicklin J, Noble F, Noble SM, O’Connell A, Palmer S, Parsons S, Pursnani K, Rea N, Reed F, Rice C, Richards C, Rogers C, Sanders G, Save V, Shaw C, Schiller M, Schranz R, Shetty V, Shirkey B, Singleton J, Skipworth R, Smith J, Streets C, Titcomb D, Turner P, Ubhi S, Underwood T, Vinod C, Vohra R, Ward EM, Warman R, Welch N, Wheatley T, White K, Wickens RA, Wilkerson P, Williams A, Williams R, Wilmshurst N, Wong NACS. Laparoscopic or open abdominal surgery with thoracotomy for patients with oesophageal cancer: ROMIO randomized clinical trial. Br J Surg 2024; 111:znae023. [PMID: 38525931 PMCID: PMC10961947 DOI: 10.1093/bjs/znae023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 11/16/2023] [Accepted: 01/10/2024] [Indexed: 03/26/2024]
Abstract
OBJECTIVE This study investigated if hybrid oesophagectomy with minimally invasive gastric mobilization and thoracotomy enabled faster recovery than open surgery. METHODS In eight UK centres, this pragmatic RCT recruited patients for oesophagectomy to treat localized cancer. Participants were randomly allocated to hybrid or open surgery, stratified by centre and receipt of neoadjuvant treatment. Large dressings aimed to mask patients to their allocation for six days post-surgery. The authors present the intention-to-treat analysis of outcome measures from the first 3 months post-randomization, including the primary outcome, the patient-reported physical function scale of the EORTC QLQ-C30, and cost-effectiveness. Current Controlled Trials registration: ISRCTN 59036820 (feasibility study), 10386621 (definitive study). FINDINGS There was no evidence of a difference between hybrid (n = 267) and open (n = 266) surgery in average physical function over 3 months post-randomization: difference in means 2.1, 95% c.i. -2.0 to 6.2, P = 0.3. Complication rates were similar; for example, 88 (34%) participants in the open and 82 (32%) participants in the hybrid surgery groups experienced a pulmonary infection within 30 days. There was no evidence that hybrid surgery was more cost-effective than open surgery at 3 months. CONCLUSIONS Patient-reported physical function in the 3 months post-randomization provided no evidence of a difference in recovery time between hybrid and open surgery, or a difference in cost-effectiveness. Both approaches to surgery were completed safely, with a similar risk of key complications, suggesting that surgeons who have a preference for one of the two approaches need not change their practice.
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Skivington K, Matthews L, Simpson SA, Craig P, Baird J, Blazeby JM, Boyd KA, Craig N, French DP, McIntosh E, Petticrew M, Rycroft-Malone J, White M, Moore L. Reprint of: 'A new framework for developing and evaluating complex interventions: update of Medical Research Council guidance'. Int J Nurs Stud 2024; 154:104705. [PMID: 38564982 DOI: 10.1016/j.ijnurstu.2024.104705] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
The UK Medical Research Council's widely used guidance for developing and evaluating complex interventions has been replaced by a new framework, commissioned jointly by the Medical Research Council and the National Institute for Health Research, which takes account of recent developments in theory and methods and the need to maximise the efficiency, use, and impact of research.
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Affiliation(s)
- Kathryn Skivington
- MRC/CSO Social and Public Health Sciences Unit, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK.
| | - Lynsay Matthews
- MRC/CSO Social and Public Health Sciences Unit, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Sharon Anne Simpson
- MRC/CSO Social and Public Health Sciences Unit, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Peter Craig
- MRC/CSO Social and Public Health Sciences Unit, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Janis Baird
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - Jane M Blazeby
- Medical Research Council ConDuCT-II Hub for Trials Methodology Research and Bristol Biomedical Research Centre, Bristol, UK
| | - Kathleen Anne Boyd
- Health Economics and Health Technology Assessment Unit, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | | | - David P French
- Manchester Centre for Health Psychology, University of Manchester, Manchester, UK
| | - Emma McIntosh
- Health Economics and Health Technology Assessment Unit, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Mark Petticrew
- London School of Hygiene and Tropical Medicine, London, UK
| | | | - Martin White
- Medical Research Council Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Laurence Moore
- MRC/CSO Social and Public Health Sciences Unit, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
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Blazeby JM, Murkin C, Rooshenas L, Elliott D, Avery K, Chalmers K, Cousins S, Pinkney T, Blencowe N, Reeves BC, Smart N. Development and pilot testing of a patient-reported outcome measure to assess symptoms of parastomal hernia. Colorectal Dis 2024; 26:364-370. [PMID: 38177087 DOI: 10.1111/codi.16850] [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: 08/11/2023] [Revised: 11/24/2023] [Accepted: 12/03/2023] [Indexed: 01/06/2024]
Abstract
AIM The aim was to develop and pilot a patient-reported outcome measure (PROM) to assess symptoms of parastomal hernia (PSH). METHODS Standard questionnaire development was undertaken (phases 1-3). An initial list of questionnaire domains was identified from validated colorectal cancer PROMs and from semi-structured interviews with patients with a PSH and health professionals (phase 1). Domains were operationalized into items in a provisional questionnaire, and 'think-aloud' patient interviews explored face validity and acceptability (phase 2). The updated questionnaire was piloted in patients with a stoma who had undergone colorectal surgery and had a computed tomography scan available for review. Patient-reported symptoms were examined in relation to PSH (phase 3). Three sources determined PSH presence: (i) data about PSH presence recorded in hospital notes, (ii) independent expert review of the computed tomography scan and (iii) patient report of being informed of a PSH by a health professional. RESULTS For phase 1, 169 and 127 domains were identified from 70 PROMs and 29 interviews respectively. In phase 2, 14 domains specific to PSH were identified and operationalized into questionnaire items. Think-aloud interviews led to three minor modifications. In phase 3, 44 completed questionnaires were obtained. Missing data were few: 5/660 items. PSH symptom scores associated with PSH presence varied between different data sources. The scale with the most consistent differences between PSH presence and absence and all data sources was the stoma appearance scale. CONCLUSION A PROM to examine the symptoms of PSH has been developed from the literature and views of key informants. Although preliminary testing shows it to be understandable and acceptable it is uncertain if it is sensitive to PSH-specific symptoms and further psychometric testing is needed.
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Affiliation(s)
- Jane M Blazeby
- Population Health Sciences and Bristol Biomedical Research Centre, University of Bristol and University Hospitals Bristol and Weston Foundation Trust, Bristol, UK
| | - Charlotte Murkin
- Population Health Sciences and Bristol Biomedical Research Centre, University of Bristol and University Hospitals Bristol and Weston Foundation Trust, Bristol, UK
| | - Leila Rooshenas
- Population Health Sciences and Bristol Biomedical Research Centre, University of Bristol and University Hospitals Bristol and Weston Foundation Trust, Bristol, UK
| | - Daisy Elliott
- Population Health Sciences and Bristol Biomedical Research Centre, University of Bristol and University Hospitals Bristol and Weston Foundation Trust, Bristol, UK
| | - Kerry Avery
- Population Health Sciences and Bristol Biomedical Research Centre, University of Bristol and University Hospitals Bristol and Weston Foundation Trust, Bristol, UK
| | - Katy Chalmers
- Population Health Sciences and Bristol Biomedical Research Centre, University of Bristol and University Hospitals Bristol and Weston Foundation Trust, Bristol, UK
| | - Sian Cousins
- Population Health Sciences and Bristol Biomedical Research Centre, University of Bristol and University Hospitals Bristol and Weston Foundation Trust, Bristol, UK
| | - Thomas Pinkney
- Birmingham University Hospitals NHS Trust, Birmingham, UK
| | - Natalie Blencowe
- Population Health Sciences and Bristol Biomedical Research Centre, University of Bristol and University Hospitals Bristol and Weston Foundation Trust, Bristol, UK
| | - Barnaby C Reeves
- Population Health Sciences and Bristol Biomedical Research Centre, University of Bristol and University Hospitals Bristol and Weston Foundation Trust, Bristol, UK
| | - Neil Smart
- Royal Devon and Exeter Hospital, Exeter, UK
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Hoffmann C, Avery KNL, Macefield RC, Snelgrove V, Blazeby JM, Hopkins D, Hickey S, Cabral C, Hall J, Gibbison B, Rooshenas L, Williams A, Aning J, Bekker HL, McNair AGK. Real-time monitoring and feedback to improve shared decision-making for surgery (the ALPACA Study): protocol for a mixed-methods study to inform co-development of an inclusive intervention. BMJ Open 2024; 14:e079155. [PMID: 38238045 PMCID: PMC10806516 DOI: 10.1136/bmjopen-2023-079155] [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: 08/23/2023] [Accepted: 12/07/2023] [Indexed: 01/23/2024] Open
Abstract
INTRODUCTION High-quality shared decision-making (SDM) is a priority of health services, but only achieved in a minority of surgical consultations. Improving SDM for surgical patients may lead to more effective care and moderate the impact of treatment consequences. There is a need to establish effective ways to achieve sustained and large-scale improvements in SDM for all patients whatever their background. The ALPACA Study aims to develop, pilot and evaluate a decision support intervention that uses real-time feedback of patients' experience of SDM to change patients' and healthcare professionals' decision-making processes before adult elective surgery and to improve patient and health service outcomes. METHODS AND ANALYSIS This protocol outlines a mixed-methods study, involving diverse stakeholders (adult patients, healthcare professionals, members of the community) and three National Health Service (NHS) trusts in England. Detailed methods for the assessment of the feasibility, usability and stakeholder views of implementing a novel system to monitor the SDM process for surgery automatically and in real time are described. The study will measure the SDM process using validated instruments (CollaboRATE, SDM-Q-9, SHARED-Q10) and will conduct semi-structured interviews and focus groups to examine (1) the feasibility of automated data collection, (2) the usability of the novel system and (3) the views of diverse stakeholders to inform the use of the system to improve SDM. Future phases of this work will complete the development and evaluation of the intervention. ETHICS AND DISSEMINATION Ethical approval was granted by the NHS Health Research Authority North West-Liverpool Central Research Ethics Committee (reference: 21/PR/0345). Approval was also granted by North Bristol NHS Trust to undertake quality improvement work (reference: Q80008) overseen by the Consent and SDM Programme Board and reporting to an Executive Assurance Committee. TRIAL REGISTRATION NUMBER ISRCTN17951423; Pre-results.
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Affiliation(s)
- Christin Hoffmann
- National Institute for Health and Care Research Bristol Biomedical Research Centre, Bristol Centre for Surgical Research, Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, UK
| | - Kerry N L Avery
- National Institute for Health and Care Research Bristol Biomedical Research Centre, Bristol Centre for Surgical Research, Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, UK
| | - Rhiannon C Macefield
- National Institute for Health and Care Research Bristol Biomedical Research Centre, Bristol Centre for Surgical Research, Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, UK
| | | | - Jane M Blazeby
- National Institute for Health and Care Research Bristol Biomedical Research Centre, Bristol Centre for Surgical Research, Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, UK
| | | | - Shireen Hickey
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Christie Cabral
- Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Bristol, UK
| | - Jennifer Hall
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Ben Gibbison
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Leila Rooshenas
- National Institute for Health and Care Research Bristol Biomedical Research Centre, Bristol Centre for Surgical Research, Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, UK
| | | | - Jonathan Aning
- Bristol Urological Institute, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Hilary L Bekker
- Leeds Unit of Complex Intervention Development (LUCID), Leeds Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, UK
- The Research Centre for Patient Involvement (ResCenPI), Department of Public Health, Aarhus Universitet, Central Denmark Region, Denmark
| | - Angus G K McNair
- National Institute for Health and Care Research Bristol Biomedical Research Centre, Bristol Centre for Surgical Research, Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, UK
- North Bristol NHS Trust, Bristol, UK
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7
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King A, Fowler G, Macefield RC, Quek FF, Walker H, Thomas C, Markar S, Blazeby JM, Blencowe NS. A systematic scoping review protocol to summarise and appraise the use of artificial intelligence in the analysis of digital videos of invasive general surgical procedures. Int J Surg Protoc 2023; 27:118-121. [PMID: 38046901 PMCID: PMC10688534 DOI: 10.1097/sp9.0000000000000012] [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: 11/09/2022] [Accepted: 09/28/2023] [Indexed: 12/05/2023] Open
Abstract
Background Intraoperative video recordings are a valuable addition to operative written documentation. However, the review of these videos often requires surgical expertise and takes considerable time. While a large amount of work has been undertaken to understand the role of artificial intelligence (AI) in healthcare more generally, the application of these techniques to automate the analysis of surgical videos is currently unclear. In this systematic scoping review, we sought to give a contemporary overview of the use of AI research in the analysis of digital videos of invasive general surgical procedures. We will describe and summarise the study characteristics, purpose of the applications and stage of development, to ascertain how these techniques might be applied in future research and to identify gaps in current knowledge (e.g. uncertainties about the study methods). Methods Systematic searches will be conducted in OVID Medline and Embase, using terms related to 'artificial intelligence', 'surgery' and 'video' to identify all potentially relevant studies published since 1st January 2012. All primary studies where AI has been applied to the analysis of videos (recorded by conventional digital cameras or laparoscopic or robotic-assisted technology) of general surgical procedures will be included. Data extraction will include study characteristics, governance, details of video datasets and AI models, measures of accuracy, validation and any reported limitations. Ethics and dissemination No ethical approval is required as primary data will not be collected. The results will be disseminated at relevant conferences, on social media and published in a peer-reviewed journal.
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Affiliation(s)
- Anni King
- National Institute for Health Research Bristol Biomedical Research Centre (Surgical Innovation Theme), Centre for Surgical Research, Bristol Medical School: Population Health Sciences, University of Bristol
| | - George Fowler
- National Institute for Health Research Bristol Biomedical Research Centre (Surgical Innovation Theme), Centre for Surgical Research, Bristol Medical School: Population Health Sciences, University of Bristol
- Department of Surgery, North Bristol NHS Trust, Bristol
| | - Rhiannon C. Macefield
- National Institute for Health Research Bristol Biomedical Research Centre (Surgical Innovation Theme), Centre for Surgical Research, Bristol Medical School: Population Health Sciences, University of Bristol
| | - Fang-Fang Quek
- National Institute for Health Research Bristol Biomedical Research Centre (Surgical Innovation Theme), Centre for Surgical Research, Bristol Medical School: Population Health Sciences, University of Bristol
| | - Hamish Walker
- National Institute for Health Research Bristol Biomedical Research Centre (Surgical Innovation Theme), Centre for Surgical Research, Bristol Medical School: Population Health Sciences, University of Bristol
| | - Charlie Thomas
- National Institute for Health Research Bristol Biomedical Research Centre (Surgical Innovation Theme), Centre for Surgical Research, Bristol Medical School: Population Health Sciences, University of Bristol
| | - Sheraz Markar
- Nuffield Department of Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, Oxfordshire, UK
| | - Jane M. Blazeby
- National Institute for Health Research Bristol Biomedical Research Centre (Surgical Innovation Theme), Centre for Surgical Research, Bristol Medical School: Population Health Sciences, University of Bristol
| | - Natalie S. Blencowe
- National Institute for Health Research Bristol Biomedical Research Centre (Surgical Innovation Theme), Centre for Surgical Research, Bristol Medical School: Population Health Sciences, University of Bristol
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Goudswaard LJ, Smith ML, Hughes DA, Taylor R, Lean M, Sattar N, Welsh P, McConnachie A, Blazeby JM, Rogers CA, Suhre K, Zaghlool SB, Hers I, Timpson NJ, Corbin LJ. Using trials of caloric restriction and bariatric surgery to explore the effects of body mass index on the circulating proteome. Sci Rep 2023; 13:21077. [PMID: 38030643 PMCID: PMC10686974 DOI: 10.1038/s41598-023-47030-x] [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: 07/11/2023] [Accepted: 11/08/2023] [Indexed: 12/01/2023] Open
Abstract
Thousands of proteins circulate in the bloodstream; identifying those which associate with weight and intervention-induced weight loss may help explain mechanisms of diseases associated with adiposity. We aimed to identify consistent protein signatures of weight loss across independent studies capturing changes in body mass index (BMI). We analysed proteomic data from studies implementing caloric restriction (Diabetes Remission Clinical trial) and bariatric surgery (By-Band-Sleeve), using SomaLogic and Olink Explore1536 technologies, respectively. Linear mixed models were used to estimate the effect of the interventions on circulating proteins. Twenty-three proteins were altered in a consistent direction after both bariatric surgery and caloric restriction, suggesting that these proteins are modulated by weight change, independent of intervention type. We also integrated Mendelian randomisation (MR) estimates of the effect of BMI on proteins measured by SomaLogic from a UK blood donor cohort as a third line of causal evidence. These MR estimates provided further corroborative evidence for a role of BMI in regulating the levels of six proteins including alcohol dehydrogenase-4, nogo receptor and interleukin-1 receptor antagonist protein. These results indicate the importance of triangulation in interrogating causal relationships; further study into the role of proteins modulated by weight in disease is now warranted.
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Affiliation(s)
- Lucy J Goudswaard
- Population Health Sciences, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK.
- MRC Integrative Epidemiology Unit, Bristol, UK.
- Physiology, Pharmacology & Neuroscience, University of Bristol, Biomedical Sciences Building, University Walk, Bristol, BS8 1TD, UK.
| | - Madeleine L Smith
- Population Health Sciences, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK
- MRC Integrative Epidemiology Unit, Bristol, UK
| | - David A Hughes
- Population Health Sciences, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK
- MRC Integrative Epidemiology Unit, Bristol, UK
| | - Roy Taylor
- Newcastle Magnetic Resonance Centre, Translational and Clinical Research Institute, Newcastle University, Newcastle Upon Tyne, NE4 5PL, UK
| | - Michael Lean
- Human Nutrition, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow, G31 2ER, UK
| | - Naveed Sattar
- School of Cardiovascular and Medical Science, University of Glasgow, Glasgow, G12 8TA, UK
| | - Paul Welsh
- School of Cardiovascular and Medical Science, University of Glasgow, Glasgow, G12 8TA, UK
| | - Alex McConnachie
- Robertson Centre for Biostatistics, School of Health and Wellbeing, University of Glasgow, Glasgow, G12 8QQ, UK
| | - Jane M Blazeby
- Population Health Sciences, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK
| | - Chris A Rogers
- Bristol Medical School, Bristol Trials Centre, University of Bristol, Bristol, BS8 1NU, UK
| | - Karsten Suhre
- Department of Biophysics and Physiology, Weill Cornell Medicine - Qatar, Doha, Qatar
| | - Shaza B Zaghlool
- Department of Biophysics and Physiology, Weill Cornell Medicine - Qatar, Doha, Qatar
| | - Ingeborg Hers
- Physiology, Pharmacology & Neuroscience, University of Bristol, Biomedical Sciences Building, University Walk, Bristol, BS8 1TD, UK
| | - Nicholas J Timpson
- Population Health Sciences, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK
- MRC Integrative Epidemiology Unit, Bristol, UK
| | - Laura J Corbin
- Population Health Sciences, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK
- MRC Integrative Epidemiology Unit, Bristol, UK
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9
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Cousins S, Gormley A, Chalmers K, Campbell MK, Beard DJ, Blencowe NS, Blazeby JM. How do pilot and feasibility studies inform randomised placebo-controlled trials in surgery? A systematic review. BMJ Open 2023; 13:e071094. [PMID: 37989384 PMCID: PMC10660967 DOI: 10.1136/bmjopen-2022-071094] [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: 12/16/2022] [Accepted: 09/28/2023] [Indexed: 11/23/2023] Open
Abstract
INTRODUCTION Randomised controlled trials (RCTs) with a placebo comparator are considered the gold standard study design when evaluating healthcare interventions. These are challenging to design and deliver in surgery. Guidance recommends pilot and feasibility work to optimise main trial design and conduct; however, the extent to which this occurs in surgery is unknown. METHOD A systematic review identified randomised placebo-controlled surgical trials. Articles published from database inception to 31 December 2020 were retrieved from Ovid-MEDLINE, Ovid-EMBASE and CENTRAL electronic databases, hand-searching and expert knowledge. Pilot/feasibility work conducted prior to the RCTs was then identified from examining citations and reference lists. Where studies explicitly stated their intent to inform the design and/or conduct of the future main placebo-controlled surgical trial, they were included. Publication type, clinical area, treatment intervention, number of centres, sample size, comparators, aims and text about the invasive placebo intervention were extracted. RESULTS From 131 placebo surgical RCTs included in the systematic review, 47 potentially eligible pilot/feasibility studies were identified. Of these, four were included as true pilot/feasibility work. Three were original articles, one a conference abstract; three were conducted in orthopaedic surgery and one in oral and maxillofacial surgery. All four included pilot RCTs, with an invasive surgical placebo intervention, randomising 9-49 participants in 1 or 2 centres. They explored the acceptability of recruitment and the invasive placebo intervention to patients and trial personnel, and whether blinding was possible. One study examined the characteristics of the proposed invasive placebo intervention using in-depth interviews. CONCLUSION Published studies reporting feasibility/pilot work undertaken to inform main placebo surgical trials are scarce. In view of the difficulties of undertaking placebo surgical trials, it is recommended that pilot/feasibility studies are conducted, and more are reported to share key findings and optimise the design of main RCTs. PROSPERO REGISTRATION NUMBER CRD42021287371.
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Affiliation(s)
- Sian Cousins
- Surgical Innovation theme, Bristol National Institute for Health and Care Research (NIHR) Biomedical Research Centre; Royal College of Surgeons of England (RCSEng) Bristol Surgical Trials Centre, Centre for Surgical Research, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Katy Chalmers
- Surgical Innovation theme, Bristol National Institute for Health and Care Research (NIHR) Biomedical Research Centre; Royal College of Surgeons of England (RCSEng) Bristol Surgical Trials Centre, Centre for Surgical Research, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Marion K Campbell
- Royal College of Surgeons of England, Aberdeen Surgical Trials Centre; Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - David J Beard
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences; RCSEng Surgical Intervention Trials Unit; NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Natalie S Blencowe
- Surgical Innovation theme, Bristol National Institute for Health and Care Research (NIHR) Biomedical Research Centre; Royal College of Surgeons of England (RCSEng) Bristol Surgical Trials Centre, Centre for Surgical Research, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Jane M Blazeby
- Surgical Innovation theme, Bristol National Institute for Health and Care Research (NIHR) Biomedical Research Centre; Royal College of Surgeons of England (RCSEng) Bristol Surgical Trials Centre, Centre for Surgical Research, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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10
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Chamberlain C, Tammes P, Jones T, Pullyblank A, Blazeby JM, Thackray KE, McPhail S, McNair AGK. Novel methods to define invasive procedures at the end of life were developed to improve quality of end of life care research: a population-based cohort study in colorectal cancer. J Clin Epidemiol 2023; 163:51-61. [PMID: 37659581 DOI: 10.1016/j.jclinepi.2023.08.018] [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: 03/16/2023] [Revised: 07/25/2023] [Accepted: 08/26/2023] [Indexed: 09/04/2023]
Abstract
BACKGROUND Understanding the use of invasive procedures (IPs) at the end of life (EoL) is important to avoid undertreatment and overtreatment, but epidemiologic analysis is hampered by limited methods to define treatment intent and EoL phase. This study applied novel methods to report IPs at the EoL using a colorectal cancer case study. METHODS An English population-based cohort of adult patients diagnosed between 2013 and 2015 was used with follow-up to 2018. Procedure intent (curative, noncurative, diagnostic) by cancer site and stage at diagnosis was classified by two surgeons independently. Joinpoint regression modeled weekly rates of IPs for 36 subcohorts of patients with incremental survival of 0-36 months. EoL phase was defined by a significant IP rate change before death. Zero-inflated Poisson regression explored associations between IP rates and clinical/sociodemographic variables. RESULTS Of 87,731 patients included, 41,972 (48%) died. Nine thousand four hundred ninety two procedures were classified by intent (inter-rater agreement 99.8%). Patients received 502,895 IPs (1.39 and 3.36 per person year for survivors and decedents). Joinpoint regression identified significant increases in IPs 4 weeks before death in those living 3-6 months and 8 weeks before death in those living 7-36 months from diagnosis. Seven thousand nine hundred eight (18.8%) patients underwent IPs at the EoL, with stoma formation the most common major procedure. Younger age, early-stage disease, men, lower comorbidity, those receiving chemotherapy, and living longer from diagnosis were associated with IPs. CONCLUSION Methods to identify and classify IPs at the EoL were developed and tested within a colorectal cancer population. This approach can be now extended and validated to identify potential undertreatment and overtreatment.
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Affiliation(s)
- Charlotte Chamberlain
- National Institute for Health Research Bristol Biomedical Research Centre, Bristol Centre for Surgical Research, Population Health Sciences, Bristol Medical School, University of Bristol, 39 Whatley Road, Clifton, Bristol BS8 2PS, UK; Specialised Services, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Peter Tammes
- National Institute for Health Research Bristol Biomedical Research Centre, Bristol Centre for Surgical Research, Population Health Sciences, Bristol Medical School, University of Bristol, 39 Whatley Road, Clifton, Bristol BS8 2PS, UK; National Disease Registration Service, NHS England, Quarry House, Quarry Hill, Leeds, LS2 7UE
| | - Timothy Jones
- Specialised Services, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK; National Disease Registration Service, NHS England, Quarry House, Quarry Hill, Leeds, LS2 7UE; The National Institute for Health Research Applied Research Collaboration West (NIHR ARC West), Bristol, UK
| | - Anne Pullyblank
- Department of Gastrointestinal Surgery, North Bristol NHS Trust, Southmead Road, Bristol BS10 5NB, UK
| | - Jane M Blazeby
- National Institute for Health Research Bristol Biomedical Research Centre, Bristol Centre for Surgical Research, Population Health Sciences, Bristol Medical School, University of Bristol, 39 Whatley Road, Clifton, Bristol BS8 2PS, UK; Division of Surgery, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Katherine E Thackray
- National Disease Registration Service, NHS England, Quarry House, Quarry Hill, Leeds, LS2 7UE
| | - Sean McPhail
- National Disease Registration Service, NHS England, Quarry House, Quarry Hill, Leeds, LS2 7UE
| | - Angus G K McNair
- National Institute for Health Research Bristol Biomedical Research Centre, Bristol Centre for Surgical Research, Population Health Sciences, Bristol Medical School, University of Bristol, 39 Whatley Road, Clifton, Bristol BS8 2PS, UK; Department of Gastrointestinal Surgery, North Bristol NHS Trust, Southmead Road, Bristol BS10 5NB, UK.
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11
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Coulman KD, Margelyte R, Jones T, Blazeby JM, Macleod J, Owen-Smith A, Parretti H, Welbourn R, Redaniel MT, Judge A. Access to publicly funded weight management services in England using routine data from primary and secondary care (2007-2020): An observational cohort study. PLoS Med 2023; 20:e1004282. [PMID: 37769031 PMCID: PMC10538857 DOI: 10.1371/journal.pmed.1004282] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 08/21/2023] [Indexed: 09/30/2023] Open
Abstract
BACKGROUND Adults living with overweight/obesity are eligible for publicly funded weight management (WM) programmes according to national guidance. People with the most severe and complex obesity are eligible for bariatric surgery. Primary care plays a key role in identifying overweight/obesity and referring to WM interventions. This study aimed to (1) describe the primary care population in England who (a) are referred for WM interventions and (b) undergo bariatric surgery and (2) determine the patient and GP practice characteristics associated with both. METHODS AND FINDINGS An observational cohort study was undertaken using routinely collected primary care data in England from the Clinical Practice Research Datalink linked with Hospital Episode Statistics. During the study period (January 2007 to June 2020), 1,811,587 adults met the inclusion criteria of a recording of overweight/obesity in primary care, of which 54.62% were female and 20.10% aged 45 to 54. Only 56,783 (3.13%) were referred to WM, and 3,701 (1.09% of those with severe and complex obesity) underwent bariatric surgery. Multivariable Poisson regression examined the associations of demographic, clinical, and regional characteristics on the likelihood of WM referral and bariatric surgery. Higher body mass index (BMI) and practice region had the strongest associations with both outcomes. People with BMI ≥40 kg/m2 were more than 6 times as likely to be referred for WM (10.05% of individuals) than BMI 25.0 to 29.9 kg/m2 (1.34%) (rate ratio (RR) 6.19, 95% confidence interval (CI) [5.99,6.40], p < 0.001). They were more than 5 times as likely to undergo bariatric surgery (3.98%) than BMI 35.0 to 40.0 kg/m2 with a comorbidity (0.53%) (RR 5.52, 95% CI [5.07,6.02], p < 0.001). Patients from practices in the West Midlands were the most likely to have a WM referral (5.40%) (RR 2.17, 95% CI [2.10,2.24], p < 0.001, compared with the North West, 2.89%), and practices from the East of England least likely (1.04%) (RR 0.43, 95% CI [0.41,0.46], p < 0.001, compared with North West). Patients from practices in London were the most likely to undergo bariatric surgery (2.15%), and practices in the North West the least likely (0.68%) (RR 3.29, 95% CI [2.88,3.76], p < 0.001, London compared with North West). Longer duration since diagnosis with severe and complex obesity (e.g., 1.67% of individuals diagnosed in 2007 versus 0.34% in 2015, RR 0.20, 95% CI [0.12,0.32], p < 0.001), and increasing comorbidities (e.g., 2.26% of individuals with 6+ comorbidities versus 1.39% with none (RR 8.79, 95% CI [7.16,10.79], p < 0.001) were also strongly associated with bariatric surgery. The main limitation is the reliance on overweight/obesity being recorded within primary care records to identify the study population. CONCLUSIONS Between 2007 and 2020, a very small percentage of the primary care population eligible for WM referral or bariatric surgery according to national guidance received either. Higher BMI and GP practice region had the strongest associations with both. Regional inequalities may reflect differences in commissioning and provision of WM services across the country. Multi-stakeholder qualitative research is ongoing to understand the barriers to accessing WM services and potential solutions. Together with population-wide prevention strategies, improved access to WM interventions is needed to reduce obesity levels.
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Affiliation(s)
- Karen D. Coulman
- Health Economics Bristol, Population Health Sciences, University of Bristol, Bristol, United Kingdom
- National Institute for Health Research Bristol Biomedical Research Centre, Population Health Sciences, University of Bristol, Bristol, United Kingdom
- Centre for Academic Primary Care, Population Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Ruta Margelyte
- The National Institute for Health Research Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom
- Musculoskeletal Research Unit, Translational Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Tim Jones
- Health Economics Bristol, Population Health Sciences, University of Bristol, Bristol, United Kingdom
- The National Institute for Health Research Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom
- Musculoskeletal Research Unit, Translational Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Jane M. Blazeby
- National Institute for Health Research Bristol Biomedical Research Centre, Population Health Sciences, University of Bristol, Bristol, United Kingdom
| | - John Macleod
- National Institute for Health Research Bristol Biomedical Research Centre, Population Health Sciences, University of Bristol, Bristol, United Kingdom
- Centre for Academic Primary Care, Population Health Sciences, University of Bristol, Bristol, United Kingdom
- The National Institute for Health Research Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom
| | - Amanda Owen-Smith
- Health Economics Bristol, Population Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Helen Parretti
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Richard Welbourn
- Department of Upper GI and Bariatric Surgery, Somerset NHS Foundation Trust, Taunton, United Kingdom
| | - Maria Theresa Redaniel
- The National Institute for Health Research Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom
| | - Andy Judge
- Musculoskeletal Research Unit, Translational Health Sciences, University of Bristol, Bristol, United Kingdom
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12
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Elliott D, Ochieng CA, Zahra J, McNair AG, Main BG, Skilton A, Blencowe NS, Cousins S, Paramasivan S, Hoffmann C, Donovan JL, Blazeby JM. What Are Patients Told About Innovative Surgical Procedures? A Qualitative Synthesis of 7 Case Studies in the United Kingdom. Ann Surg 2023; 278:e482-e490. [PMID: 36177849 PMCID: PMC10414150 DOI: 10.1097/sla.0000000000005714] [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] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To investigate how information about innovative surgical procedures is communicated to patients. BACKGROUND Despite the national and international guidance that patients should be informed whether a procedure is innovative and has uncertain outcomes, little is known about current practice. METHODS This qualitative study followed 7 "case studies" of surgical innovation in hospitals across the United Kingdom. Preoperative interviews were conducted with clinician innovators (n=9), preoperative real-time consultations between clinicians and patients were audio-recorded (n=37). Patients were interviewed postoperatively (n=30). Data were synthesized using thematic analytical methods. RESULTS Interviews with clinicians demonstrated strong intentions to inform patients about the innovative nature of the procedure in a neutral manner, although tensions between fully informing patients and not distressing them were raised. In the consultations, only a minority of clinicians actually made explicit statements about, (1) the procedure being innovative, (2) their limited clinical experience with it, (3) the paucity of evidence, and (4) uncertainty/unknown outcomes. Discussions about risks were generalized and often did not relate to the innovative component. Instead, all clinicians optimistically presented potential benefits and many disclosed their own positive beliefs. Postoperative patient interviews revealed that many believed that the procedure was more established than it was and were unaware of the unknown risks. CONCLUSIONS There were contradictions between clinicians' intentions to inform patients about the uncertain outcomes of innovative and their actual discussions with patients. There is a need for communication interventions and training to support clinicians to provide transparent data and shared decision-making for innovative procedures.
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Affiliation(s)
- Daisy Elliott
- Centre for Surgical Research, National Institute for Health Research Bristol and Weston Biomedical Research Centre, Surgical Innovation Theme, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, England
| | - Cynthia A. Ochieng
- Centre for Surgical Research, National Institute for Health Research Bristol and Weston Biomedical Research Centre, Surgical Innovation Theme, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, England
| | - Jesmond Zahra
- Centre for Surgical Research, National Institute for Health Research Bristol and Weston Biomedical Research Centre, Surgical Innovation Theme, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, England
| | - Angus G.K. McNair
- Centre for Surgical Research, National Institute for Health Research Bristol and Weston Biomedical Research Centre, Surgical Innovation Theme, Population Health Sciences, Bristol Medical School, North Bristol NHS Trust, University of Bristol, Bristol, England
| | - Barry G. Main
- Centre for Surgical Research, National Institute for Health Research Bristol and Weston Biomedical Research Centre, Surgical Innovation Theme, Population Health Sciences, Bristol Medical School, University Hospitals Bristol, Weston NHS Foundation Trust, University of Bristol, Bristol, England
| | - Anni Skilton
- Centre for Surgical Research, National Institute for Health Research Bristol and Weston Biomedical Research Centre, Surgical Innovation Theme, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, England
| | - Natalie S. Blencowe
- Centre for Surgical Research, National Institute for Health Research Bristol and Weston Biomedical Research Centre, Surgical Innovation Theme, Population Health Sciences, Bristol Medical School, University Hospitals Bristol, Weston NHS Foundation Trust, University of Bristol, Bristol, England
| | - Sian Cousins
- Centre for Surgical Research, National Institute for Health Research Bristol and Weston Biomedical Research Centre, Surgical Innovation Theme, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, England
| | - Sangeetha Paramasivan
- Centre for Surgical Research, National Institute for Health Research Bristol and Weston Biomedical Research Centre, Surgical Innovation Theme, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, England
| | - Christin Hoffmann
- Centre for Surgical Research, National Institute for Health Research Bristol and Weston Biomedical Research Centre, Surgical Innovation Theme, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, England
| | - Jenny L. Donovan
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, England
| | - Jane M. Blazeby
- Centre for Surgical Research, National Institute for Health Research Bristol and Weston Biomedical Research Centre, Surgical Innovation Theme, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, England
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13
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Campbell MK, Beard DJ, Blazeby JM, Cousins S. Further considerations for placebo controls in surgical trials. Trials 2023; 24:391. [PMID: 37301819 PMCID: PMC10257825 DOI: 10.1186/s13063-023-07417-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 05/25/2023] [Indexed: 06/12/2023] Open
Abstract
The use of invasive placebo controls in surgical trials can be challenging. The ASPIRE guidance, published in the Lancet in 2020, provided advice for the design and conduct of surgical trials with an invasive placebo control. Based on a more recent international expert workshop in June 2022, we now provide further insights into this topic. These include the purpose and design of invasive placebo controls, patient information provision and how findings from these trials may be used to inform decision-making.
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Affiliation(s)
- Marion K Campbell
- Royal College of Surgeons of England (RCSEng) Aberdeen Surgical Trials Centre; Health Services Research Unit, Health Sciences Building, University of Aberdeen, Foresterhill, Aberdeen, UK
| | - David J Beard
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences; RCSEng Surgical Intervention Trials Unit; National Institute for Health and Care Research (NIHR) Oxford Biomedical Research Centre, University of Oxford, Headington, Oxford, UK
| | - Jane M Blazeby
- NIHR Bristol Biomedical Research Centre; RCSEng Bristol Surgical Trials Centre, Bristol Centre for Surgical Research, Population Health Sciences, University of Bristol, BS8 2PS, Bristol, UK
| | - Sian Cousins
- NIHR Bristol Biomedical Research Centre; RCSEng Bristol Surgical Trials Centre, Bristol Centre for Surgical Research, Population Health Sciences, University of Bristol, BS8 2PS, Bristol, UK.
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14
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Donovan JL, Hamdy FC, Lane JA, Young GJ, Metcalfe C, Walsh EI, Davis M, Steuart-Feilding T, Blazeby JM, Avery KNL, Martin RM, Bollina P, Doble A, Doherty A, Gillatt D, Gnanapragasam V, Hughes O, Kockelbergh R, Kynaston H, Paul A, Paez E, Powell P, Rosario DJ, Rowe E, Mason M, Catto JWF, Peters TJ, Wade J, Turner EL, Williams NJ, Oxley J, Staffurth J, Bryant RJ, Neal DE. Patient-Reported Outcomes 12 Years after Localized Prostate Cancer Treatment. NEJM Evid 2023; 2:EVIDoa2300018. [PMID: 38320051 DOI: 10.1056/evidoa2300018] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
Outcomes after Localized Prostate Cancer TreatmentDonovan et al. present the long-term patient-reported outcomes of 1643 randomly assigned participants in the ProtecT (Prostate Testing for Cancer and Treatment) trial. Functional and quality-of-life impacts of prostatectomy, radiotherapy with neoadjuvant androgen deprivation, and active monitoring are described. Over the trial period from 7 to 12 years, generic quality-of-life scores were similar among all groups, with varying degrees of impact on urinary leakage, sexual function, and fecal leakage depending on the treatment group.
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Affiliation(s)
- Jenny L Donovan
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Freddie C Hamdy
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom
| | - J Athene Lane
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- Bristol Trials Centre, Bristol Medical School, University of Bristol, United Kingdom
| | - Grace J Young
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- Bristol Trials Centre, Bristol Medical School, University of Bristol, United Kingdom
| | - Chris Metcalfe
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- Bristol Trials Centre, Bristol Medical School, University of Bristol, United Kingdom
| | - Eleanor I Walsh
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Michael Davis
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Thomas Steuart-Feilding
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Jane M Blazeby
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Kerry N L Avery
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Richard M Martin
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Prasad Bollina
- Department of Urology and Surgery, Western General Hospital, University of Edinburgh, United Kingdom
| | - Andrew Doble
- Department of Urology, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Alan Doherty
- Department of Urology, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - David Gillatt
- Department of Urological Oncology and Robotic Surgery, Macquarie University, Sydney
| | - Vincent Gnanapragasam
- Division of Urology, Department of Surgery and Cambridge Urology Translational Research and Clinical Trials Office, Cambridge, United Kingdom
| | - Owen Hughes
- Department of Urology, Cardiff and Vale University Health Board, Cardiff, United Kingdom
| | - Roger Kockelbergh
- Department of Urology, University Hospitals of Leicester, Leicester, United Kingdom
| | - Howard Kynaston
- Department of Urology, Cardiff and Vale University Health Board, Cardiff, United Kingdom
| | - Alan Paul
- Department of Urology, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Edgar Paez
- Department of Urology, Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | - Phillip Powell
- Department of Urology, Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | - Derek J Rosario
- Academic Urology Unit, University of Sheffield, Sheffield, United Kingdom
| | - Edward Rowe
- Department of Urology, Southmead Hospital and Bristol Urological Institute, Bristol, United Kingdom
| | - Malcolm Mason
- School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - James W F Catto
- Academic Urology Unit, University of Sheffield, Sheffield, United Kingdom
- Academic Urology Unit, Medical School, University of Sheffield, Sheffield, United Kingdom
| | - Tim J Peters
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Julia Wade
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Emma L Turner
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Naomi J Williams
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Jon Oxley
- Department of Cellular Pathology, North Bristol NHS Trust, Bristol, United Kingdom
| | - John Staffurth
- Division of Cancer and Genetics, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Richard J Bryant
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom
| | - David E Neal
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom
- Division of Urology, Department of Surgery and Cambridge Urology Translational Research and Clinical Trials Office, Cambridge, United Kingdom
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15
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Hossaini S, Hoffmann C, Cousins S, Blencowe N, McNair AGK, Blazeby JM, Avery KNL, Potter S, Macefield R. Development of a conceptual framework for reporting modifications in surgical innovation: scoping review. BJS Open 2023; 7:7145934. [PMID: 37104755 PMCID: PMC10139440 DOI: 10.1093/bjsopen/zrad020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 01/20/2023] [Accepted: 01/28/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND Innovative surgical procedures and devices are often modified throughout their development and introduction into clinical practice. A systematic approach to reporting modifications may support shared learning and foster safe and transparent innovation. Definitions of 'modifications', and how they are conceptualized and classified so they can be reported and shared effectively, however, are lacking. This study aimed to explore and summarize existing definitions, perceptions, classifications and views on modification reporting to develop a conceptual framework for understanding and reporting modifications. METHODS A scoping review was conducted in accordance with PRISMA Extension for Scoping Reviews (PRISMA-ScR) guidelines. Targeted searches and two database searches were performed to identify relevant opinion pieces and review articles. Included were articles relating to modifications to surgical procedures/devices. Data regarding definitions, perceptions and classifications of modifications, and views on modification reporting were extracted verbatim. Thematic analysis was undertaken to identify themes, which informed development of the conceptual framework. RESULTS Forty-nine articles were included. Eight articles included systems for classifying modifications, but no articles reported an explicit definition of modifications. Some 13 themes relating to perception of modifications were identified. The derived conceptual framework comprises three overarching components: baseline data about modifications, details about modifications and impact/consequences of modifications. CONCLUSION A conceptual framework for understanding and reporting modifications that occur during surgical innovation has been developed. This is a first necessary step to support consistent and transparent reporting of modifications, to facilitate shared learning and incremental innovation of surgical procedures/devices. Testing and operationalization is now needed to realize the value of this framework.
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Affiliation(s)
- Sina Hossaini
- Department of Population Health Sciences, National Institute for Health and Care Research Bristol Biomedical Research Centre, Bristol Centre for Surgical Research, Bristol Medical School, University of Bristol, Bristol, UK
| | - Christin Hoffmann
- Department of Population Health Sciences, National Institute for Health and Care Research Bristol Biomedical Research Centre, Bristol Centre for Surgical Research, Bristol Medical School, University of Bristol, Bristol, UK
| | - Sian Cousins
- Department of Population Health Sciences, National Institute for Health and Care Research Bristol Biomedical Research Centre, Bristol Centre for Surgical Research, Bristol Medical School, University of Bristol, Bristol, UK
| | - Natalie Blencowe
- Department of Population Health Sciences, National Institute for Health and Care Research Bristol Biomedical Research Centre, Bristol Centre for Surgical Research, Bristol Medical School, University of Bristol, Bristol, UK
- Department of Gastrointestinal Surgery, North Bristol NHS Trust, Bristol, UK
| | - Angus G K McNair
- Department of Population Health Sciences, National Institute for Health and Care Research Bristol Biomedical Research Centre, Bristol Centre for Surgical Research, Bristol Medical School, University of Bristol, Bristol, UK
- Department of Gastrointestinal Surgery, North Bristol NHS Trust, Bristol, UK
| | - Jane M Blazeby
- Department of Population Health Sciences, National Institute for Health and Care Research Bristol Biomedical Research Centre, Bristol Centre for Surgical Research, Bristol Medical School, University of Bristol, Bristol, UK
- Division of Surgery, Bristol Royal Infirmary, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Kerry N L Avery
- Department of Population Health Sciences, National Institute for Health and Care Research Bristol Biomedical Research Centre, Bristol Centre for Surgical Research, Bristol Medical School, University of Bristol, Bristol, UK
| | - Shelley Potter
- Department of Population Health Sciences, National Institute for Health and Care Research Bristol Biomedical Research Centre, Bristol Centre for Surgical Research, Bristol Medical School, University of Bristol, Bristol, UK
- Bristol Breast Care Centre, North Bristol NHS Trust, Bristol, UK
| | - Rhiannon Macefield
- Department of Population Health Sciences, National Institute for Health and Care Research Bristol Biomedical Research Centre, Bristol Centre for Surgical Research, Bristol Medical School, University of Bristol, Bristol, UK
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Zucker BE, Leandro L, Forbes K, Blazeby JM, Chamberlain C. Training surgeons to optimize communication and symptom management in patients with life-limiting conditions: systematic review. BJS Open 2023; 7:zrad015. [PMID: 37104753 PMCID: PMC10129389 DOI: 10.1093/bjsopen/zrad015] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 11/08/2022] [Accepted: 01/22/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND Surgeons routinely care for patients with life-limiting illness, requiring communication and symptom management skills supported by appropriate training. The objective of this study was to appraise and synthesize studies that assessed surgeon-directed training interventions that aimed to optimize communication and symptom management for patients with life-limiting illness. METHODS A PRISMA-concordant systematic review was undertaken. MEDLINE, Embase, Allied and Complementary Medicine Database (AMED), and the Cochrane Central Register of Controlled Trials were searched from inception until October 2022 for studies reporting on the evaluation of surgeon-training interventions intending to improve surgeons' communication or symptom management of patients with life-limiting disease. Data on the design, trainer and patient participants, and the intervention were extracted. Risk of bias was assessed. RESULTS Of 7794 articles, 46 were included. Most studies employed a before-after approach (29 studies) and nine included control groups with five being randomized studies. General surgery was the most frequently included sub-specialty (22 studies). Trainers were described in 25 of 46 studies. Most training interventions aimed to improve communication skills (45 studies) and 13 different training interventions were described. Eight studies reported a measurable improvement in patient care, such as increased documentation of advance care discussions. Most study outcomes focused on surgeons' knowledge (12 studies), skills (21 studies), and confidence/comfort (18 studies) in palliative communication skills. Studies had a high risk of bias. CONCLUSION Whilst interventions exist to improve the training of surgeons managing patients with life-threatening conditions, evidence is limited, and studies measure the direct impact on patient care insufficiently. Improved research is needed to lead to better methods for training surgeons to benefit patients.
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Affiliation(s)
- Benjamin E Zucker
- Population Health Sciences, University of Bristol, Bristol, UK
- Division of Surgery, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Lorna Leandro
- Population Health Sciences, University of Bristol, Bristol, UK
- Division of Surgery, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Karen Forbes
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Jane M Blazeby
- Population Health Sciences, University of Bristol, Bristol, UK
- NIHR Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol, Bristol, UK
| | - Charlotte Chamberlain
- Population Health Sciences, University of Bristol, Bristol, UK
- Department of Palliative Care, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
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17
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Macefield RC, Blazeby JM, Reeves BC, King A, Rees J, Pullyblank A, Avery K. Remote assessment of surgical site infection (SSI) using patient-taken wound images: Development and evaluation of a method for research and routine practice. J Tissue Viability 2023; 32:94-101. [PMID: 36681617 DOI: 10.1016/j.jtv.2023.01.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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: 09/08/2022] [Revised: 12/12/2022] [Accepted: 01/07/2023] [Indexed: 01/11/2023]
Abstract
BACKGROUND/AIM Clinical assessment of wounds for surgical site infection (SSI) after hospital discharge is challenging and resource intensive. Remote assessment using digital images may be feasible and expedite SSI diagnosis. Acceptable and accurate methods for this process are needed. This study developed and evaluated the feasibility, acceptability and usability of a method for patients to capture standardised wound images for remote wound assessment to detect SSI. MATERIALS AND METHODS The work was conducted in two phases. Phase I involved: i) a review of literature to identify key components of photography relevant to taking wound images, ii) development of wound photography instructions for patients and a secure process for transmission of images using electronic survey software and iii) pre-testing of the photography instructions and processing method with a sample of 16 patients using cognitive interviews and observations. Phase II involved a prospective cohort study of 89 patients to evaluate the feasibility, acceptability and usability of the remote method following discharge from hospital after surgery. Quality of the images was assessed by three independent clinical reviewers. RESULTS Some 21 key components for photographing wounds were identified from 11 documents. Of these, 16 were relevant to include in instructions for patients to photograph their wounds. Pre-testing and subsequent iterations improved understanding and ease of use of the instructions and the process for transmitting images. Fifty-two of 89 (58.4%) patients testing the method remotely took an image of their wound(s) and 46/52 (88.5%) successfully transmitted images. When it was possible to ascertain a reason for not taking/transmitting images, this was primarily health problems (n = 7) or lack of time/poor engagement with the study (n = 4) rather than problems relating to technology/competency (n = 2) or practical issues relating to the wound itself (n = 2). Eighty-seven (85.3%) of the 102 images received were evaluated to be of high quality and sufficient to remotely assess SSI by at least two independent reviewers. CONCLUSION A simple, standardised and acceptable method for patients to take and transmit wound images suitable for remote assessment of SSI has been developed and tested and is now available for use in routine clinical care and research.
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Affiliation(s)
- Rhiannon C Macefield
- National Institute for Health and Care Research (NIHR) Bristol Biomedical Research Centre (BRC), Population Health Sciences: Bristol Medical School, University of Bristol, UK.
| | - Jane M Blazeby
- National Institute for Health and Care Research (NIHR) Bristol Biomedical Research Centre (BRC), Population Health Sciences: Bristol Medical School, University of Bristol, UK
| | - Barnaby C Reeves
- Bristol Trials Centre, Bristol Medical School, University of Bristol, UK
| | - Anni King
- National Institute for Health and Care Research (NIHR) Bristol Biomedical Research Centre (BRC), Population Health Sciences: Bristol Medical School, University of Bristol, UK
| | - Jonathan Rees
- Hepatobiliary Surgery, University Hospitals Bristol NHS Foundation Trust, UK; Bristol Medical School, University of Bristol, UK
| | | | - Kerry Avery
- National Institute for Health and Care Research (NIHR) Bristol Biomedical Research Centre (BRC), Population Health Sciences: Bristol Medical School, University of Bristol, UK
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18
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Avery KNL, Wilson N, Macefield R, McNair A, Hoffmann C, Blazeby JM, Potter S. A Core Outcome Set for Seamless, Standardized Evaluation of Innovative Surgical Procedures and Devices (COHESIVE): A Patient and Professional Stakeholder Consensus Study. Ann Surg 2023; 277:238-245. [PMID: 34102667 PMCID: PMC9831031 DOI: 10.1097/sla.0000000000004975] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [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] [Indexed: 01/14/2023]
Abstract
OBJECTIVE To develop a COS, an agreed minimum set of outcomes to measure and report in all studies evaluating the introduction and evaluation of novel surgical techniques. SUMMARY OF BACKGROUND DATA Agreement on the key outcomes to measure and report for safe and efficient surgical innovation is lacking, hindering transparency and risking patient harm. METHODS (I) Generation of a list of outcome domains from published innovation-specific literature, policy/regulatory body documents, and surgeon interviews; (II) Prioritization of identified outcome domains using an international, multi-stakeholder Delphi survey; (III) Consensus meeting to agree the final COS. Participants were international stakeholders, including patients/public, surgeons, device manufacturers, regulators, trialists, methodologists, and journal editors. RESULTS A total of 7972 verbatim outcomes were identified, categorized into 32 domains, and formatted into survey items/questions. Four hundred ten international participants (220 professionals, 190 patients/public) completed at least one round 1 survey item, of which 153 (69.5%) professionals and 116 (61.1%) patients completed at least one round 2 item. Twelve outcomes were scored "consensus in" ("very important" by ≥70% of patients and professionals) and 20 "no consensus." A consensus meeting, involvingcontext: modifications, unexpected disadvantages, device problems, technical procedure completion success, patients' experience relating to the procedure being innovative, surgeons'/operators' experience. Other domains relate to intended benefits, whether the overall desired effect was achieved and expected disadvantages. CONCLUSIONS The COS is recommended for use in all studies before definitive randomized controlled trial evaluation to promote safe, transparent, and efficient surgical innovation.
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Affiliation(s)
- Kerry N L Avery
- National Institute for Health Research Bristol Biomedical Research Centre, Bristol Centre for Surgical Research, Bristol Medical School: Population Health Sciences, University of Bristol, Clifton, Bristol, UK
| | - Nicholas Wilson
- National Institute for Health Research Bristol Biomedical Research Centre, Bristol Centre for Surgical Research, Bristol Medical School: Population Health Sciences, University of Bristol, Clifton, Bristol, UK
| | - Rhiannon Macefield
- National Institute for Health Research Bristol Biomedical Research Centre, Bristol Centre for Surgical Research, Bristol Medical School: Population Health Sciences, University of Bristol, Clifton, Bristol, UK
| | - Angus McNair
- National Institute for Health Research Bristol Biomedical Research Centre, Bristol Centre for Surgical Research, Bristol Medical School: Population Health Sciences, University of Bristol, Clifton, Bristol, UK
- Gastrointestinal Surgery, North Bristol NHS Trust, Bristol, UK
| | - Christin Hoffmann
- National Institute for Health Research Bristol Biomedical Research Centre, Bristol Centre for Surgical Research, Bristol Medical School: Population Health Sciences, University of Bristol, Clifton, Bristol, UK
| | - Jane M Blazeby
- National Institute for Health Research Bristol Biomedical Research Centre, Bristol Centre for Surgical Research, Bristol Medical School: Population Health Sciences, University of Bristol, Clifton, Bristol, UK
- Division of Surgery, Bristol Royal Infirmary, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Shelley Potter
- National Institute for Health Research Bristol Biomedical Research Centre, Bristol Centre for Surgical Research, Bristol Medical School: Population Health Sciences, University of Bristol, Clifton, Bristol, UK
- Bristol Breast Care Centre, North Bristol NHS Trust, Southmead Road, Bristol, UK
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19
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McNair AGK, Hoffmann C, Macefield RC, Elliott D, Blazeby JM, Avery KLN, Potter S. A standardized measurement instrument was recommended for evaluating operator experience in complex healthcare interventions. J Clin Epidemiol 2023; 153:55-65. [PMID: 36228972 DOI: 10.1016/j.jclinepi.2022.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 09/16/2022] [Accepted: 10/03/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE During development of complex surgical innovations, modifications occur to optimize safety and efficacy. Operators' experiences (how professionals feel undertaking the innovation) drive this process but comprehensive overviews of measures of this concept are lacking. This study identified and appraised measures to assess operators' experience of surgical innovation. STUDY DESIGN AND SETTING There were three phases: (1) Literature reviews identified measures of operators' experience and concepts measured were extracted and grouped into domains. (2) Quality appraisal was conducted to assess content validity of identified instruments and was supported by COnsensus-based Standards for the selection of health Measurement Instruments methodology. Self-reported measurement instruments that had underdone formal development were eligible. Content validity was assessed using COnsensus-based Standards for the selection of health Measurement Instruments criteria for good content validity (rated sufficient/insufficient/indeterminate/inconsistent), informed by standards for measurement development and domains identified in phase 1. (3) Instruments determined suitable and of sufficient quality underwent supplemental appraisal in interviews with international multidisciplinary professionals and a focus group. RESULTS Literature reviews identified 16 measurement instruments from 243 studies. Most assessed 'psychological' experiences and 'usability'. No instrument was specifically validated for innovative surgery. Three instruments were rated 'sufficient' (Surgery Task Load Index [SURG-TLX]) or 'indeterminate' (Spielberger State-Trait Anxiety Inventory, Imperial Stress Assessment Tool). Twenty professionals were interviewed (seven female; 15 specialties; six countries) and the focus group included 10 participants (four professionals, six researchers). The SURG-TLX was considered the most relevant, comprehensive, and comprehensible instrument. CONCLUSION The SURG-TLX is preliminarily recommended to measure operators' experiences of innovation. Further work exploring its role and impact on surgical innovation is required.
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Affiliation(s)
- Angus G K McNair
- National Institute for Health and Care Research Bristol Biomedical Research Centre, Bristol Centre for Surgical Research, Population Health Sciences, Bristol Medical School, University of Bristol, 39 Whatley Road, Bristol, BS8 2PS, UK; Department of Gastrointestinal Surgery, North Bristol NHS Trust, Southmead Road, Bristol, BS10 5NB, UK.
| | - Christin Hoffmann
- National Institute for Health and Care Research Bristol Biomedical Research Centre, Bristol Centre for Surgical Research, Population Health Sciences, Bristol Medical School, University of Bristol, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Rhiannon C Macefield
- National Institute for Health and Care Research Bristol Biomedical Research Centre, Bristol Centre for Surgical Research, Population Health Sciences, Bristol Medical School, University of Bristol, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Daisy Elliott
- National Institute for Health and Care Research Bristol Biomedical Research Centre, Bristol Centre for Surgical Research, Population Health Sciences, Bristol Medical School, University of Bristol, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Jane M Blazeby
- National Institute for Health and Care Research Bristol Biomedical Research Centre, Bristol Centre for Surgical Research, Population Health Sciences, Bristol Medical School, University of Bristol, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Kerry L N Avery
- National Institute for Health and Care Research Bristol Biomedical Research Centre, Bristol Centre for Surgical Research, Population Health Sciences, Bristol Medical School, University of Bristol, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Shelley Potter
- National Institute for Health and Care Research Bristol Biomedical Research Centre, Bristol Centre for Surgical Research, Population Health Sciences, Bristol Medical School, University of Bristol, 39 Whatley Road, Bristol, BS8 2PS, UK; Bristol Breast Care Centre, North Bristol NHS Trust, Southmead Road, Bristol, BS10 5NB, UK
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20
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Stokes EA, Harris RA, Dabner L, McKeon HE, Kaur S, Paramasivan S, Realpe A, Elliott D, Batchelor TJ, Dunning J, Shackcloth M, Anikin V, Naidu B, Belcher E, Loubani M, Zamvar V, De Sousa P, Blazeby JM, Rogers CA, Lim E, Wordsworth S. Cost-Effectiveness of Video-Assisted Thoracoscopic Surgery Compared to Open Lobectomy in Patients with Early-Stage Lung Cancer: Findings from the VIOLET Randomised Controlled Trial. Lung Cancer 2022. [DOI: 10.1016/j.lungcan.2022.12.005] [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: 12/23/2022]
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21
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Gilbert A, Piccinin C, Velikova G, Groenvold M, Kuliś D, Blazeby JM, Bottomley A. Linking the European Organisation for Research and Treatment of Cancer Item Library to the Common Terminology Criteria for Adverse Events. J Clin Oncol 2022; 40:3770-3780. [PMID: 35973158 PMCID: PMC9649281 DOI: 10.1200/jco.21.02017] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 03/25/2022] [Accepted: 05/10/2022] [Indexed: 11/26/2022] Open
Abstract
PURPOSE The European Organisation for Research and Treatment of Cancer (EORTC) Item Library is an interactive online platform currently composed of 950 unique items (questions) derived from 67 patient-reported outcome (PRO) questionnaires. PROs complement clinician adverse event (AE) reporting classifications like the Common Terminology Criteria for Adverse Events (CTCAE). This work aims to create a standardized framework using the CTCAE to systematically classify symptomatic AEs from the EORTC Item Library through linking individual items to corresponding AEs. METHODS The EORTC Item Library items were searched for within the CTCAE (v5.0) and linked to an AE if they were described within the AE's title, description, or grading. Symptoms described in EORTC items but not located in the CTCAE were coded as missing symptoms. Other nonsymptom EORTC items, not described within the CTCAE were assigned a non-CTCAE descriptive classification. Further descriptive codes (eg, multiple issues) were allocated to enable descriptive analysis. Two raters independently coded 26.2% (n = 249) of the items. The remaining 701 items were coded by one rater and verified by the second, followed by discussion with two additional raters to reach consensus. RESULTS Overall, 625 (65.8%) EORTC items were linked to 208 different AEs. Three hundred sixty-nine items provide information about non-CTCAE cancer-related issues and were categorized into seven descriptive classifications, including body image; emotional impact of a symptom, diagnosis, or treatment; global health and quality of life; and impact on life and daily activities. Inter-rater agreement for independent coding was 79.1%. Bowel urgency and tenesmus were identified as missing symptoms in CTCAEv5.0. CONCLUSION The EORTC Item Library provides considerable coverage of CTCAE toxicities, along with other complementary issues important to patients with cancer. Using the CTCAE clinical framework to classify symptomatic PRO items may facilitate PRO selection and use in clinical trials and routine care.
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Affiliation(s)
- Alexandra Gilbert
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, United Kingdom
| | | | - Galina Velikova
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, United Kingdom
| | - Mogens Groenvold
- Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Dagmara Kuliś
- Quality of Life Department, EORTC, Brussels, Belgium
| | - Jane M. Blazeby
- National Institute for Health Research Bristol Biomedical Research Centre, Bristol Centre for Surgical Research, Bristol Medical School, University of Bristol, Bristol, United Kingdom
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22
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Conroy EJ, Blazeby JM, Burnside G, Cook JA, Gamble C. Managing clustering effects and learning effects in the design and analysis of randomised surgical trials: a review of existing guidance. Trials 2022; 23:869. [PMID: 36221107 PMCID: PMC9552436 DOI: 10.1186/s13063-022-06743-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 02/28/2022] [Accepted: 09/13/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The complexities associated with delivering randomised surgical trials, such as clustering effects, by centre or surgeon, and surgical learning, are well known. Despite this, approaches used to manage these complexities, and opinions on these, vary. Guidance documents have been developed to support clinical trial design and reporting. This work aimed to identify and examine existing guidance and consider its relevance to clustering effects and learning curves within surgical trials. METHODS A review of existing guidelines, developed to inform the design and analysis of randomised controlled trials, is undertaken. Guidelines were identified using an electronic search, within the Equator Network, and by a targeted search of those endorsed by leading UK funding bodies, regulators, and medical journals. Eligible documents were compared against pre-specified key criteria to identify gaps or inconsistencies in recommendations. RESULTS Twenty-eight documents were eligible (12 Equator Network; 16 targeted search). Twice the number of guidance documents targeted design (n/N=20/28, 71%) than analysis (n/N=10/28, 36%). Managing clustering by centre through design was well documented. Clustering by surgeon had less coverage and contained some inconsistencies. Managing the surgical learning curve, or changes in delivery over time, through design was contained within several documents (n/N=8/28, 29%), of which one provided guidance on reporting this and restricted to early phase studies only. Methods to analyse clustering effects and learning were provided in five and four documents respectively (N=28). CONCLUSIONS To our knowledge, this is the first review as to the extent to which existing guidance for designing and analysing randomised surgical trials covers the management of clustering, by centre or surgeon, and the surgical learning curve. Twice the number of identified documents targeted design aspects than analysis. Most notably, no single document exists for use when designing these studies, which may lead to inconsistencies in practice. The development of a single document, with agreed principles to guide trial design and analysis across a range of realistic clinical scenarios, is needed.
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Affiliation(s)
- Elizabeth J. Conroy
- grid.10025.360000 0004 1936 8470Liverpool Clinical Trials Centre, University of Liverpool, Liverpool, UK
- grid.4991.50000 0004 1936 8948Oxford Clinical Trials Research Unit, Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Windmill Road, Oxford, OX3 7LD UK
| | - Jane M. Blazeby
- grid.5337.20000 0004 1936 7603Centre for Surgical Research, Bristol Biomedical Research Centre, Population Health Sciences, University of Bristol, Bristol, UK
| | - Girvan Burnside
- grid.10025.360000 0004 1936 8470Liverpool Clinical Trials Centre, University of Liverpool, Liverpool, UK
| | - Jonathan A. Cook
- grid.4991.50000 0004 1936 8948Oxford Clinical Trials Research Unit, Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Windmill Road, Oxford, OX3 7LD UK
| | - Carrol Gamble
- grid.10025.360000 0004 1936 8470Liverpool Clinical Trials Centre, University of Liverpool, Liverpool, UK
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23
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Hoffmann C, Kobetic M, Alford N, Blencowe N, Ramirez J, Macefield R, Blazeby JM, Avery KNL, Potter S. Shared Learning Utilizing Digital Methods in Surgery to Enhance Transparency in Surgical Innovation: Protocol for a Scoping Review. JMIR Res Protoc 2022; 11:e37544. [PMID: 36074555 PMCID: PMC9501681 DOI: 10.2196/37544] [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: 02/24/2022] [Revised: 08/11/2022] [Accepted: 08/16/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Surgical innovation can lead to important improvements in patient outcomes. Currently, information and knowledge about novel procedures and devices are disseminated informally and in an unstandardized way (eg, through social media). This can lead to ineffective and inefficient knowledge sharing among surgeons, which can result in the harmful repetition of mistakes and delay in the uptake of promising innovation. Improvements are needed in the way that learning in surgical innovation is shared through the development of novel, real-time methods, informed by a contemporary and comprehensive investigation of existing methods. OBJECTIVE The aim of this scoping review is to explore the application of existing digital methods for training/education and feedback to surgeons in the context of performing invasive surgical procedures. This work will (1) summarize existing methods for shared learning in surgery and how they are characterized and operationalized, (2) examine the impact of their application, and (3) explore their benefits and barriers to implementation. The findings of this scoping review will inform the development of novel, real-time methods to optimize shared learning in surgical innovation. METHODS This study will adhere to the recommended guidelines for conducting scoping reviews. A total of 6 different searches will be conducted within multiple sources (2 electronic databases, journals, social media, gray literature, commercial websites, and snowball searches) to comprehensively identify relevant articles and data. Searches will be limited to articles published in the English language within the last 5 years. Wherever possible, a 2-stage study selection process will be followed whereby the eligibility of articles will be assessed through the title, abstract, and full-text screening independently by 2 reviewers. Inclusion criteria will be articles providing data on (1) fully qualified theater staff involved in performing invasive procedures, (2) one or more methods for shared learning (ie, digital means for training/education and feedback), and (3) qualitative or quantitative evaluations of this method. Data will be extracted (10% double data extraction by an independent reviewer) into a piloted proforma and analyzed using descriptive statistics, narrative summaries, and principles of thematic analysis. RESULTS The study commenced in October 2021 and is planned to be completed in 2023. To date, systematic searches were applied to 2 electronic databases (MEDLINE and Web of Science) and returned a total of 10,093 records. The results of this scoping review will be published as open access in a peer-reviewed journal. CONCLUSIONS This scoping review of methods for shared learning in surgery is, to our knowledge, the most comprehensive and up-to-date investigation that maps current information on this topic. Ultimately, efficient and effective sharing of information and knowledge of novel procedures and devices has the potential to optimize the evaluation of early-phase surgical research and reduce harmful innovation. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/37544.
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Affiliation(s)
- Christin Hoffmann
- National Institute for Health and Care Research, Bristol Biomedical Research Centre, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Matthew Kobetic
- National Institute for Health and Care Research, Bristol Biomedical Research Centre, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Natasha Alford
- National Institute for Health and Care Research, Bristol Biomedical Research Centre, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Natalie Blencowe
- National Institute for Health and Care Research, Bristol Biomedical Research Centre, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- Division of Surgery, Bristol Royal Infirmary, University Hospitals Bristol and Weston National Health Service Foundation Trust, Bristol, United Kingdom
| | - Jozel Ramirez
- National Institute for Health and Care Research, Bristol Biomedical Research Centre, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Rhiannon Macefield
- National Institute for Health and Care Research, Bristol Biomedical Research Centre, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Jane M Blazeby
- National Institute for Health and Care Research, Bristol Biomedical Research Centre, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- Division of Surgery, Bristol Royal Infirmary, University Hospitals Bristol and Weston National Health Service Foundation Trust, Bristol, United Kingdom
| | - Kerry N L Avery
- National Institute for Health and Care Research, Bristol Biomedical Research Centre, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Shelley Potter
- National Institute for Health and Care Research, Bristol Biomedical Research Centre, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- Bristol Breast Care Centre, North Bristol National Health Service Trust, Bristol, United Kingdom
- Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
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24
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Kirkham EN, Jones CS, Higginbotham G, Biggs S, Dewi F, Dixon L, Huttman M, Main BG, Ramirez J, Robertson H, Scroggie DL, Zucker B, Blazeby JM, Blencowe NS, Pathak S. A systematic review of robot-assisted cholecystectomy to examine the quality of reporting in relation to the IDEAL recommendations: systematic review. BJS Open 2022; 6:6770691. [PMID: 36281734 PMCID: PMC9593068 DOI: 10.1093/bjsopen/zrac116] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 07/12/2022] [Accepted: 08/18/2022] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Robotic cholecystectomy (RC) is a recent innovation in minimally invasive gallbladder surgery. The IDEAL (idea, development, exploration, assessment, long-term study) framework aims to provide a safe method for evaluating innovative procedures. This study aimed to understand how RC was introduced, in accordance with IDEAL guidelines. METHODS Systematic searches were used to identify studies reporting RC. Eligible studies were classified according to IDEAL stage and data were collected on general study characteristics, patient selection, governance procedures, surgeon/centre expertise, and outcome reporting. RESULTS Of 1425 abstracts screened, 90 studies were included (5 case reports, 38 case series, 44 non-randomized comparative studies, and 3 randomized clinical trials). Sixty-four were single-centre and 15 were prospective. No authors described their work in the context of IDEAL. One study was classified as IDEAL stage 1, 43 as IDEAL 2a, 43 as IDEAL 2b, and three as IDEAL 3. Sixty-four and 51 provided inclusion and exclusion criteria respectively. Ethical approval was reported in 51 and conflicts of interest in 34. Only 21 reported provision of training for surgeons in RC. A total of 864 outcomes were reported; 198 were used in only one study. Only 30 reported a follow-up interval which, in 13, was 1 month or less. CONCLUSION The IDEAL framework was not followed during the adoption of RC. Few studies were conducted within a research setting, many were retrospective, and outcomes were heterogeneous. There is a need to implement appropriate tools to facilitate the incremental evaluation and reporting of surgical innovation.
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Affiliation(s)
- Emily N Kirkham
- Bristol Centre for Surgical Research, Population Health Sciences, University of Bristol, Bristol, UK
- Musgrove Park Hospital, Taunton, UK
| | - Conor S Jones
- Bristol Centre for Surgical Research, Population Health Sciences, University of Bristol, Bristol, UK
- North Bristol NHS Foundation Trust, Bristol, UK
| | | | - Sarah Biggs
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Ffion Dewi
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Lauren Dixon
- Bristol Centre for Surgical Research, Population Health Sciences, University of Bristol, Bristol, UK
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Marc Huttman
- Bristol Centre for Surgical Research, Population Health Sciences, University of Bristol, Bristol, UK
- University College Hospital, University College London Hospitals NHS Foundation Trust, London, UK
| | - Barry G Main
- Bristol Centre for Surgical Research, Population Health Sciences, University of Bristol, Bristol, UK
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
- Bristol Dental School, University of Bristol, Bristol, UK
- NIHR Bristol Biomedical research centre, Bristol, UK
| | - Jozel Ramirez
- Bristol Centre for Surgical Research, Population Health Sciences, University of Bristol, Bristol, UK
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Harry Robertson
- Bristol Centre for Surgical Research, Population Health Sciences, University of Bristol, Bristol, UK
- Imperial College Healthcare NHS Trust, London
| | - Darren L Scroggie
- Bristol Centre for Surgical Research, Population Health Sciences, University of Bristol, Bristol, UK
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Benjamin Zucker
- Bristol Centre for Surgical Research, Population Health Sciences, University of Bristol, Bristol, UK
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Jane M Blazeby
- Bristol Centre for Surgical Research, Population Health Sciences, University of Bristol, Bristol, UK
- NIHR Bristol Biomedical research centre, Bristol, UK
| | - Natalie S Blencowe
- Bristol Centre for Surgical Research, Population Health Sciences, University of Bristol, Bristol, UK
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
- NIHR Bristol Biomedical research centre, Bristol, UK
| | - Samir Pathak
- Correspondence to: Sami Pathak, St James’s University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK (e-mail: )
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Ochieng CA, Richards H, Zahra J, Cousins S, Elliott D, Wilson N, Paramasivan S, Avery KNL, Mathews J, Main BG, Hinchliffe R, Blencowe NS, Blazeby JM. Qualitative documentary analysis of guidance on information provision and consent for the introduction of innovative invasive procedures including surgeries within NHS organisations' policies in England and Wales. BMJ Open 2022; 12:e059228. [PMID: 36581966 PMCID: PMC9438078 DOI: 10.1136/bmjopen-2021-059228] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE To review guidance, included in written local UK National Health Service (NHS) organisation policies, on information provision and consent for the introduction of new invasive procedures- including surgeries, and devices (IPs/Ds). DESIGN A qualitative documentary analysis of data on patient information provision and consent extracted from policies for the introduction of IP/Ds from NHS organisations in England and Wales. SETTING NHS trusts in England and health boards in Wales, UK. PARTICIPANTS Between December 2017 and July 2018, 150 acute trusts in England and 7 health boards in Wales were approached for their policies for the introduction of new IP/Ds. In total, 123 policies were received, 11 did not fit the inclusion criteria and a further policy was included from a trust website resulting in 113 policies included for review. RESULTS From the 113 policies, 22 did not include any statements on informed consent/information provision or lacked guidance on the information to be provided to patients and were hence excluded. Consequently, 91 written local NHS policies were included in the final dataset. Within the guidance obtained, variation existed on disclosure of the procedure's novelty, potential risks, benefits, uncertainties, alternative treatments and surgeon's experience. Few policies stated that clinicians should discuss the existing evidence associated with a procedure. Additionally, while the majority of policies referred to patients needing written information, this was often not mandated and few policies specified the information to be included. CONCLUSIONS Nearly a fifth of all the policies lacked guidance on information to be provided to patients. There was variability in the policy documents regarding what patients should be told about innovative procedures. Further research is needed to ascertain the information and level of detail appropriate for patients when considering innovative procedures. A core information set including patients' and clinicians' views is required to address variability around information provision/consent for innovative procedures.
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Affiliation(s)
| | - Hollie Richards
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Jesmond Zahra
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Sian Cousins
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Daisy Elliott
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Nicholas Wilson
- Population Health Sciences, University of Bristol, Bristol, UK
| | | | - Kerry N L Avery
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Johnny Mathews
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Barry G Main
- Population Health Sciences, University of Bristol, Bristol, UK
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Robert Hinchliffe
- Population Health Sciences, University of Bristol, Bristol, UK
- North Bristol NHS Trust, Westbury on Trym, UK
| | - Natalie S Blencowe
- Population Health Sciences, University of Bristol, Bristol, UK
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Jane M Blazeby
- Population Health Sciences, University of Bristol, Bristol, UK
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
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Williamson PR, Barrington H, Blazeby JM, Clarke M, Gargon E, Gorst SL, Saldanha IJ, Tunis S. Review finds core outcome set uptake in new studies and systematic reviews needs improvement. J Clin Epidemiol 2022; 150:154-164. [PMID: 35779824 DOI: 10.1016/j.jclinepi.2022.06.016] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [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: 03/30/2022] [Revised: 05/24/2022] [Accepted: 06/24/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To review evidence about the uptake of core outcome sets (COS). A COS is an agreed standardized set of outcomes that should be measured and reported, as a minimum, in all clinical trials in a specific area of health or health care. STUDY DESIGN AND SETTING This article provides an analysis of what is known about the uptake of COS in research. Similarities between COS and outcomes recommended by stakeholders in the evidence ecosystem is reviewed, and actions taken by them to facilitate COS uptake described. RESULTS COS uptake is low in most research areas. Common facilitators relate to trialist awareness and understanding. Common barriers were not including in the development process all specialties who might use the COS, and the lack of recommendations for how to measure the outcomes. Increasingly, COS developers are considering strategies for promoting uptake earlier in the process, including actions beyond traditional dissemination approaches. Overlap between COS and outcomes in regulatory documents and health technology assessments is good. An increasing number and variety of organisations are recommending COS be considered. CONCLUSION We suggest actions for various stakeholders for improving COS uptake. Research is needed to assess the impact of these actions to identify effective evidence-based strategies.
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Affiliation(s)
- P R Williamson
- Department of Health Data Science, University of Liverpool (a member of Liverpool Health Partners), MRC/NIHR Trials Methodology Research Partnership, Liverpool, UK.
| | - H Barrington
- Department of Health Data Science, University of Liverpool (a member of Liverpool Health Partners), MRC/NIHR Trials Methodology Research Partnership, Liverpool, UK
| | - J M Blazeby
- NIHR Bristol Biomedical Research Centre at University Hospitals Bristol NHS Foundation Trust and the University of Bristol, Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, UK
| | - M Clarke
- Northern Ireland Methodology Hub, Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - E Gargon
- Department of Health Data Science, University of Liverpool (a member of Liverpool Health Partners), MRC/NIHR Trials Methodology Research Partnership, Liverpool, UK
| | - S L Gorst
- Department of Health Data Science, University of Liverpool (a member of Liverpool Health Partners), MRC/NIHR Trials Methodology Research Partnership, Liverpool, UK
| | - I J Saldanha
- Center for Evidence Synthesis in Health, Department of Health Services, Policy, and Practice (Primary), Department of Epidemiology (Secondary), Brown University School of Public Health, Providence, Rhode Island, USA
| | - S Tunis
- Center for Evaluation of Value and Risk in Health (CEVR), Tufts Medical Center, Boston Massachusetts, USA
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Wilson N, Macefield RC, Hoffmann C, Edmondson MJ, Miller RL, Kirkham EN, Blencowe NS, McNair AGK, Main BG, Blazeby JM, Avery KNL, Potter S. Identification of outcomes to inform the development of a core outcome set for surgical innovation: a targeted review of case studies of novel surgical devices. BMJ Open 2022; 12:e056003. [PMID: 35487755 PMCID: PMC9058790 DOI: 10.1136/bmjopen-2021-056003] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Outcome selection and reporting in studies of novel surgical procedures and devices lacks standardisation, hindering safe and effective evaluation. A core outcome set (COS) to measure and report in all studies of surgical innovation is needed. We explored outcomes in a specific sample of innovative surgical device case studies to identify outcome domains specifically relevant to innovation to inform the development of a COS. DESIGN A targeted review of 11 purposive selected case studies of innovative surgical devices. METHODS Electronic database searches in PubMed (July 2018) identified publications reporting the introduction and evaluation of each device. Outcomes were extracted and categorised into domains until no new domains were conceptualised. Outcomes specifically relevant to evaluating innovation were further scrutinised. RESULTS 112 relevant publications were identified, and 5926 outcomes extracted. Heterogeneity in study type, outcome selection and reporting was observed across surgical devices. Categorisation of outcomes was performed for 2689 (45.4%) outcomes into five broad outcome domains. Outcomes considered key to the evaluation of innovation (n=66; 2.5%) were further categorised as surgeon/operator experience (n=40; 1.5%), unanticipated events (n=15, 0.6%) and modifications (n=11; 0.4%). CONCLUSION Outcome domains unique to evaluating innovative surgical devices have been identified. Findings have been combined with multiple other data sources relevant to the evaluation of surgical innovation to inform the development of a COS to measure and report in all studies evaluating novel surgical procedures/devices.
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Affiliation(s)
- Nicholas Wilson
- National Institute for Health and Care Research Bristol Biomedical Research Centre, Bristol Centre for Surgical Research, Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, UK
| | - Rhiannon C Macefield
- National Institute for Health and Care Research Bristol Biomedical Research Centre, Bristol Centre for Surgical Research, Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, UK
| | - Christin Hoffmann
- National Institute for Health and Care Research Bristol Biomedical Research Centre, Bristol Centre for Surgical Research, Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, UK
| | - Matthew J Edmondson
- Anaesthetics Department, Musgrove Park Hospital, Somerset NHS Foundation, Taunton, UK
| | - Rachael L Miller
- National Institute for Health and Care Research Bristol Biomedical Research Centre, Bristol Centre for Surgical Research, Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, UK
- Department of Vascular Surgery, North Bristol NHS Trust, Bristol, UK
| | - Emily N Kirkham
- Gloucestershire Hospitals NHS Foundation Trust, Gloucester, UK
| | - Natalie S Blencowe
- National Institute for Health and Care Research Bristol Biomedical Research Centre, Bristol Centre for Surgical Research, Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, UK
- Division of Surgery, Bristol Royal Infirmary, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Angus G K McNair
- National Institute for Health and Care Research Bristol Biomedical Research Centre, Bristol Centre for Surgical Research, Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, UK
- Department of Gastrointestinal Surgery, North Bristol NHS Trust, Bristol, UK
| | - Barry G Main
- National Institute for Health and Care Research Bristol Biomedical Research Centre, Bristol Centre for Surgical Research, Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, UK
- Division of Surgery, Bristol Royal Infirmary, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
- Bristol Dental School, University of Bristol, Bristol, UK
| | - Jane M Blazeby
- National Institute for Health and Care Research Bristol Biomedical Research Centre, Bristol Centre for Surgical Research, Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, UK
- Division of Surgery, Bristol Royal Infirmary, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Kerry N L Avery
- National Institute for Health and Care Research Bristol Biomedical Research Centre, Bristol Centre for Surgical Research, Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, UK
| | - Shelley Potter
- National Institute for Health and Care Research Bristol Biomedical Research Centre, Bristol Centre for Surgical Research, Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, UK
- Bristol Breast Care Centre, North Bristol NHS Trust, Westbury on Trym, UK
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Blazeby JM, Cousins S, Pullyblank A. Safety and transparency in surgical innovation. Br J Hosp Med (Lond) 2022; 83:1-3. [DOI: 10.12968/hmed.2022.0073] [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: 11/11/2022]
Abstract
Advances in healthcare require safe and transparent innovation. Currently in surgery it can be difficult to identify when innovation is occurring because of inconsistent oversight and reporting. New ways of identifying, monitoring and reporting surgical innovation are called for in order to optimise the process.
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Affiliation(s)
- Jane M Blazeby
- Bristol Biomedical Research Centre and Bristol Centre for Surgical Research, Bristol Medical School, University of Bristol, Bristol, UK
| | - Sian Cousins
- Bristol Biomedical Research Centre and Bristol Centre for Surgical Research, Bristol Medical School, University of Bristol, Bristol, UK
| | - Anne Pullyblank
- West of England Academic Health Science Network, part of the AHSN Network, Bristol, UK
- Department of Surgery, North Bristol NHS Trust, Bristol, UK
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Donovan JL, Jepson M, Rooshenas L, Paramasivan S, Mills N, Elliott D, Wade J, Reda D, Blazeby JM, Moghanaki D, Hwang ES, Davies L. Development of a new adapted QuinteT Recruitment Intervention (QRI-Two) for rapid application to RCTs underway with enrolment shortfalls—to identify previously hidden barriers and improve recruitment. Trials 2022; 23:258. [PMID: 35379301 PMCID: PMC8978173 DOI: 10.1186/s13063-022-06187-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 03/19/2022] [Indexed: 11/30/2022] Open
Abstract
Background Many randomised controlled trials (RCTs) struggle to recruit, despite valiant efforts. The QRI (QuinteT Recruitment Intervention) uses innovative research methods to optimise recruitment by revealing previously hidden barriers related to the perceptions and experiences of recruiters and patients, and targeting remedial actions. It was designed to be integrated with RCTs anticipating difficulties at the outset. A new version of the intervention (QRI-Two) was developed for RCTs already underway with enrolment shortfalls. Methods QRIs in 12 RCTs with enrolment shortfalls during 2007–2017 were reviewed to document which of the research methods used could be rapidly applied to successfully identify recruitment barriers. These methods were then included in the new streamlined QRI-Two intervention which was applied in 20 RCTs in the USA and Europe during 2018–2019. The feasibility of the QRI-Two was investigated, recruitment barriers and proposed remedial actions were documented, and the QRI-Two protocol was finalised. Results The review of QRIs from 2007 to 2017 showed that previously unrecognised recruitment barriers could be identified but data collection for the full QRI required time and resources usually unavailable to ongoing RCTs. The streamlined QRI-Two focussed on analysis of screening/accrual data and RCT documents (protocol, patient-information), with discussion of newly diagnosed barriers and potential remedial actions in a workshop with the RCT team. Four RCTs confirmed the feasibility of the rapid application of the QRI-Two. When the QRI-Two was applied to 14 RCTs underway with enrolment shortfalls, an array of previously unknown/underestimated recruitment barriers related to issues such as equipoise, intervention preferences, or study presentation was identified, with new insights into losses of eligible patients along the recruitment pathway. The QRI-Two workshop enabled discussion of the newly diagnosed barriers and potential remedial actions to improve recruitment in collaboration with the RCT team. As expected, the QRI-Two performed less well in six RCTs at the start-up stage before commencing enrolment. Conclusions The QRI-Two can be applied rapidly, diagnose previously unrecognised recruitment barriers, and suggest remedial actions in RCTs underway with enrolment shortfalls, providing opportunities for RCT teams to develop targeted actions to improve recruitment. The effectiveness of the QRI-Two in improving recruitment requires further evaluation. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06187-y.
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Lim E, Batchelor TJP, Dunning J, Shackcloth M, Anikin V, Naidu B, Belcher E, Loubani M, Zamvar V, Harris RA, Dabner L, McKeon HE, Paramasivan S, Realpe A, Elliott D, De Sousa P, Stokes EA, Wordsworth S, Blazeby JM, Rogers CA. Video-Assisted Thoracoscopic or Open Lobectomy in Early-Stage Lung Cancer. NEJM Evid 2022; 1:EVIDoa2100016. [PMID: 38319202 DOI: 10.1056/evidoa2100016] [Citation(s) in RCA: 55] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
Video-Assisted Thoracoscopic Surgery or Open Lobectomy in Early-Stage Lung CancerIn a patient with early-stage lung cancer, is resection by video-assisted thoracoscopic surgery (VATS) versus open resection superior with respect to the postoperative recovery? This question was addressed in a multicenter randomized trial in more than 500 patients. At 5 weeks after surgery, the physical function mean score was 73 in the VATS group and 67 in the open surgery group (function scores range from 0 to 100, with higher scores indicating better function). Of the participants allocated to VATS, 30.7% had serious adverse events after discharge compared with 37.8% of those allocated to open surgery. At 52 weeks, there were no differences in cancer progression-free survival.
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Affiliation(s)
- Eric Lim
- Academic Division of Thoracic Surgery, Royal Brompton and Harefield Hospitals, London
- Imperial College London, London
| | - Tim J P Batchelor
- Thoracic Surgery, Bristol Royal Infirmary, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom
| | - Joel Dunning
- Department of Cardiothoracic Surgery, The James Cook University Hospital, South Tees Hospitals NHS Foundation Trust, Middlesbrough, United Kingdom
| | - Michael Shackcloth
- Department of Thoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Vladimir Anikin
- Academic Division of Thoracic Surgery, Royal Brompton and Harefield Hospitals, London
- Department of Oncology and Reconstructive Surgery, I.M. Sechenov First Moscow State Medical University, Moscow
| | - Babu Naidu
- Department of Thoracic Surgery, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom
| | - Elizabeth Belcher
- Cardiothoracic Surgery, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Mahmoud Loubani
- Department of Cardiothoracic Surgery, Castle Hill Hospital, Hull University Teaching Hospitals, Cottingham, United Kingdom
| | - Vipin Zamvar
- Department of Cardiothoracic Surgery, Edinburgh Royal Infirmary, NHS Lothian, Edinburgh
| | - Rosie A Harris
- Clinical Trials and Evaluation Unit, Bristol Trials Centre, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Lucy Dabner
- Clinical Trials and Evaluation Unit, Bristol Trials Centre, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Holly E McKeon
- Clinical Trials and Evaluation Unit, Bristol Trials Centre, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Sangeetha Paramasivan
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Alba Realpe
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Daisy Elliott
- National Institute for Health Research Bristol Biomedical Research Centre, Surgical Innovation Theme, Centre for Surgical Research, University of Bristol, Bristol, United Kingdom
| | - Paulo De Sousa
- Academic Division of Thoracic Surgery, Royal Brompton and Harefield Hospitals, London
| | - Elizabeth A Stokes
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
- National Institute for Health Research Oxford Biomedical Research Centre, Oxford, United Kingdom
| | - Sarah Wordsworth
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
- National Institute for Health Research Oxford Biomedical Research Centre, Oxford, United Kingdom
| | - Jane M Blazeby
- National Institute for Health Research Bristol Biomedical Research Centre, Surgical Innovation Theme, Centre for Surgical Research, University of Bristol, Bristol, United Kingdom
| | - Chris A Rogers
- Clinical Trials and Evaluation Unit, Bristol Trials Centre, Bristol Medical School, University of Bristol, Bristol, United Kingdom
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Kearney A, Rosala-Hallas A, Rainford N, Blazeby JM, Clarke M, Lane AJ, Gamble C. Increased transparency was required when reporting imputation of primary outcome data in clinical trials. J Clin Epidemiol 2022; 146:60-67. [PMID: 35218883 DOI: 10.1016/j.jclinepi.2022.02.008] [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: 07/26/2021] [Revised: 02/02/2022] [Accepted: 02/17/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To explore the transparency of reporting primary outcome data within randomised controlled trials (RCTs) in the presence of missing data. STUDY DESIGN / Setting: A cohort examination of RCTs published in the four major medical journals (NEJM, JAMA, BMJ, Lancet) in 2013 and the first quarter of 2018. Data was extracted on reporting quality, the number of randomised participants and the number of participants included within the primary outcome analysis with observed or imputed data. RESULTS 91/159 (57%) of the studies analysed from 2013 and 19/46 (41%) from 2018 included imputed data within the primary outcome analysis. Of these, only 13/91 (14%) studies from 2013 and 1/19 (5%) studies from 2018 explicitly reported the number of imputed values in the CONSORT diagram. Results tables included levels of imputed data in 12/91 (13%) studies in 2013 and 4/19 (21%) in 2018. Consequently, identification of imputed data was a time-consuming task requiring extensive cross-referencing of all manuscript elements. CONCLUSION Imputed primary outcome data is poorly reported. Participant flow diagrams frequently reported participant status which does not necessarily correlate to availability of data. We recommended that the number of imputed values are explicitly reported within CONSORT flow diagrams to increase transparency.
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Affiliation(s)
- Anna Kearney
- Department of Health Data Science, University of Liverpool, Liverpool, UK.
| | - Anna Rosala-Hallas
- Liverpool Clinical Trials Centre, University of Liverpool, Liverpool, UK
| | - Naomi Rainford
- Liverpool Clinical Trials Centre, University of Liverpool, Liverpool, UK
| | - Jane M Blazeby
- Bristol Biomedical Research Centre, Population health sciences, University of Bristol, Bristol. UK
| | - Mike Clarke
- Northern Ireland Methodology Hub, Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Athene J Lane
- CONDuCTII Hub for Trials Methodology Research, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Carrol Gamble
- Department of Health Data Science, University of Liverpool, Liverpool, UK; Liverpool Clinical Trials Centre, University of Liverpool, Liverpool, UK
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Scroggie DL, Elliott D, Cousins S, Avery KN, Blazeby JM, Blencowe NS. Understanding stage of innovation of invasive procedures and devices: protocol for a systematic review and thematic analysis. BMJ Open 2022; 12:e057842. [PMID: 35149575 PMCID: PMC8845321 DOI: 10.1136/bmjopen-2021-057842] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
INTRODUCTION Surgical innovation has generally occurred in an unstandardised manner. This has led to unnecessary exposure of patients to harm, research waste and inadequate evidence. The IDEAL (Idea, Development, Exploration, Assessment, Long-term follow-up) Collaboration provided a set of recommendations for evaluating surgical innovations based on their stage of innovation. Despite further refinements and guidance, adoption of the IDEAL recommendations has been slow; an important reason may be that determining the stage of innovation is often difficult. To facilitate evaluation of surgical innovations, there is a need for a detailed insight into what stage of innovation means, and how it can be determined. The aim of this study is to understand the concept of stage of innovation as reported in the literature. METHODS AND ANALYSIS A systematic review is being conducted. Ovid MEDLINE and Embase databases were searched from their inception until July 2021 using an iteratively developed strategy based on the concepts of stage of innovation, invasive procedures or devices and guidance. Articles were included if they described an approach to evaluating surgical innovations in stages, described a method for determining stage of innovation, described indicators of stage of innovation, defined stages or described potential sources of stage-related information. Conference abstracts and non-English language articles were excluded. Other articles were detected from citations within included articles and suggestions from experts in surgical innovation. Data will be extracted regarding approaches to evaluating surgical innovations, methods for determining stage of innovation, indicators of stage of innovation, definitions of stages and potential sources of stage-related information. A thematic analysis will be conducted, and findings summarised in a narrative report. ETHICS AND DISSEMINATION Ethical approval will not be required. This systematic review will be published in a peer-reviewed journal and presented at appropriate conferences. PROSPERO REGISTRATION NUMBER CRD42021270812.
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Affiliation(s)
- Darren L Scroggie
- NIHR Bristol Biomedical Research Centre, Bristol, UK
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Daisy Elliott
- NIHR Bristol Biomedical Research Centre, Bristol, UK
| | - Sian Cousins
- NIHR Bristol Biomedical Research Centre, Bristol, UK
| | | | - Jane M Blazeby
- NIHR Bristol Biomedical Research Centre, Bristol, UK
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Natalie S Blencowe
- NIHR Bristol Biomedical Research Centre, Bristol, UK
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
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Alkhaffaf B, Metryka A, Blazeby JM, Glenny AM, Williamson PR, Bruce IA. How are trial outcomes prioritised by stakeholders from different regions? Analysis of an international Delphi survey to develop a core outcome set in gastric cancer surgery. PLoS One 2022; 16:e0261937. [PMID: 34972165 PMCID: PMC8719722 DOI: 10.1371/journal.pone.0261937] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Accepted: 12/15/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND International stakeholder participation is important in the development of core outcome sets (COS). Stakeholders from varying regions may value health outcomes differently. Here, we explore how region, health income and participant characteristics influence prioritisation of outcomes during development of a COS for gastric cancer surgery trials (the GASTROS study). METHODS 952 participants from 55 countries participating in a Delphi survey during COS development were eligible for inclusion. Recruits were grouped according to region (East or West), country income classification (high and low-to-middle income) and other characteristics (e.g. patients; age, sex, time since surgery, mode of treatment, surgical approach and healthcare professionals; clinical experience). Groups were compared with respect to how they categorised 56 outcomes identified as potentially important to include in the final COS ('consensus in', 'consensus out', 'no consensus'). Outcomes categorised as 'consensus in' or 'consensus out' by all 3 stakeholder groups would be automatically included in or excluded from the COS respectively. RESULTS In total, 13 outcomes were categorised 'consensus in' (disease-free survival, disease-specific survival, surgery-related death, recurrence of cancer, completeness of tumour removal, overall quality of life, nutritional effects, all-cause complications, intraoperative complications, anaesthetic complications, anastomotic complications, multiple organ failure, and bleeding), 13 'consensus out' and 31 'no consensus'. There was little variation in prioritisation of outcomes by stakeholders from Eastern or Western countries and high or low-to-middle income countries. There was little variation in outcome prioritisation within either health professional or patient groups. CONCLUSION Our study suggests that there is little variation in opinion within stakeholder groups when participant region and other characteristics are considered. This finding may help COS developers when designing their Delphi surveys and recruitment strategies. Further work across other clinical fields is needed before broad recommendations can be made.
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Affiliation(s)
- Bilal Alkhaffaf
- Department of Oesophago-Gastric Surgery, Salford Royal Hospital, Salford Royal NHS Foundation Trust, Manchester, United Kingdom
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
- * E-mail:
| | - Aleksandra Metryka
- Paediatric ENT Department, Royal Manchester Children’s Hospital, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Jane M. Blazeby
- Centre for Surgical Research and Bristol NIHR Biomedical Research Centre, University of Bristol, Bristol, United Kingdom
| | - Anne-Marie Glenny
- Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Paula R. Williamson
- MRC North West Hub for Trials Methodology Research, University of Liverpool and a Member of Liverpool Health Partners, Liverpool, United Kingdom
| | - Iain A. Bruce
- Paediatric ENT Department, Royal Manchester Children’s Hospital, Manchester University NHS Foundation Trust, Manchester, United Kingdom
- Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
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Harris A, Butterworth J, Boshier PR, MacKenzie H, Tokunaga M, Sunagawa H, Mavroveli S, Ni M, Mikhail S, Yeh CC, Blencowe NS, Avery KNL, Hardwick R, Hoelscher A, Pera M, Zaninotto G, Law S, Low DE, van Lanschot JJB, Berrisford R, Barham CP, Blazeby JM, Hanna GB. Development of a Reliable Surgical Quality Assurance System for 2-stage Esophagectomy in Randomized Controlled Trials. Ann Surg 2022; 275:121-130. [PMID: 32224728 DOI: 10.1097/sla.0000000000003850] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim was to develop a reliable surgical quality assurance system for 2-stage esophagectomy. This development was conducted during the pilot phase of the multicenter ROMIO trial, collaborating with international experts. SUMMARY OF BACKGROUND DATA There is evidence that the quality of surgical performance in randomized controlled trials influences clinical outcomes, quality of lymphadenectomy and loco-regional recurrence. METHODS Standardization of 2-stage esophagectomy was based on structured observations, semi-structured interviews, hierarchical task analysis, and a Delphi consensus process. This standardization provided the structure for the operation manual and video and photographic assessment tools. Reliability was examined using generalizability theory. RESULTS Hierarchical task analysis for 2-stage esophagectomy comprised fifty-four steps. Consensus (75%) agreement was reached on thirty-nine steps, whereas fifteen steps had a majority decision. An operation manual and record were created. A thirty five-item video assessment tool was developed that assessed the process (safety and efficiency) and quality of the end product (anatomy exposed and lymphadenectomy performed) of the operation. The quality of the end product section was used as a twenty seven-item photographic assessment tool. Thirty-one videos and fifty-three photographic series were submitted from the ROMIO pilot phase for assessment. The overall G-coefficient for the video assessment tool was 0.744, and for the photographic assessment tool was 0.700. CONCLUSIONS A reliable surgical quality assurance system for 2-stage esophagectomy has been developed for surgical oncology randomized controlled trials. ETHICAL APPROVAL 11/NW/0895 and confirmed locally as appropriate, 12/SW/0161, 16/SW/0098.Trial registration number: ISRCTN59036820, ISRCTN10386621.
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Affiliation(s)
- Alexander Harris
- Department of Surgery & Cancer, Imperial College London, United Kingdom
| | - James Butterworth
- Department of Surgery & Cancer, Imperial College London, United Kingdom
| | - Piers R Boshier
- Department of Surgery & Cancer, Imperial College London, United Kingdom
| | - Hugh MacKenzie
- Department of Surgery & Cancer, Imperial College London, United Kingdom
| | - Masanori Tokunaga
- Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, Japan
| | - Hideki Sunagawa
- Department of Gastroenterological Surgery, New Tokyo Hospital, Japan
| | - Stella Mavroveli
- Department of Surgery & Cancer, Imperial College London, United Kingdom
| | - Melody Ni
- Department of Surgery & Cancer, Imperial College London, United Kingdom
| | - Sameh Mikhail
- Department of General Surgery, Faculty of Medicine University of Cairo, Egypt
| | - Chi-Chuan Yeh
- Department of Surgery, National Taiwan University Hospital, Taiwan
| | - Natalie S Blencowe
- Division of Surgery, University Hospitals Bristol NHS Foundation Trust, United Kingdom
- National Institute for Health Research Bristol Biomedical Research Centre, University of Bristol, United Kingdom
| | - Kerry N L Avery
- National Institute for Health Research Bristol Biomedical Research Centre, University of Bristol, United Kingdom
| | - Richard Hardwick
- Upper gastrointestinal Unit, Cambridge University Hospitals NHS Foundation Trust, United Kingdom
| | - Arnulf Hoelscher
- Center for Esophageal and Gastric Surgery, Agaplesion Markus Hospital, Germany
| | - Manuel Pera
- Department of Surgery, Hospital del Mar, Spain
| | | | - Simon Law
- Department of Esophageal and Upper Gastrointestinal Surgery, The University of Hong Kong Queen Mary Hospital, Hong Kong
| | - Donald E Low
- Department of Thoracic Surgery, Virginia Mason Medical Center, Seattle, WA
| | | | - Richard Berrisford
- Department of Surgery, University Hospitals Plymouth NHS Trust, United Kingdom
| | | | - Jane M Blazeby
- Division of Surgery, University Hospitals Bristol NHS Foundation Trust, United Kingdom
- National Institute for Health Research Bristol Biomedical Research Centre, University of Bristol, United Kingdom
| | - George B Hanna
- Department of Surgery & Cancer, Imperial College London, United Kingdom
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Elliott D, Blencowe NS, Cousins S, Zahra J, Skilton A, Mathews J, Paramasivan S, Hoffmann C, McNair AG, Ochieng C, Richards H, Hossaini S, Scroggie DL, Main B, Potter S, Avery K, Donovan J, Blazeby JM. Using qualitative research methods to understand how surgical procedures and devices are introduced into NHS hospitals: the Lotus study protocol. BMJ Open 2021; 11:e049234. [PMID: 34862280 PMCID: PMC8647399 DOI: 10.1136/bmjopen-2021-049234] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 10/05/2021] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION The development of innovative invasive procedures and devices are essential to improving outcomes in healthcare. However, how these are introduced into practice has not been studied in detail. The Lotus study will follow a wide range of 'case studies' of new procedures and/or devices being introduced into NHS trusts to explore what information is communicated to patients, how procedures are modified over time and how outcomes are selected and reported. METHODS AND ANALYSIS This qualitative study will use ethnographic approaches to investigate how new invasive procedures and/or devices are introduced. Consultations in which the innovation is discussed will be audio-recorded to understand information provision practice. To understand if and how procedures evolve, they will be video recorded and non-participant observations will be conducted. Post-operative interviews will be conducted with the innovating team and patients who are eligible for the intervention. Audio-recordings will be audio-recorded, transcribed verbatim and analysed thematically using constant comparison techniques. Video-recordings will be reviewed to deconstruct procedures into key components and document how the procedure evolves. Comparisons will be made between the different data sources. ETHICS AND DISSEMINATION The study protocol has Health Research Authority (HRA) and Health and Care Research Wales approval (Ref 18/SW/0277). Results will be disseminated at appropriate conferences and will be published in peer-reviewed journals. The findings of this study will provide a better understanding of how innovative invasive procedures and/or devices are introduced into practice.
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Affiliation(s)
- Daisy Elliott
- National Institute for Health Research Bristol Biomedical Research Centre, Surgical Innovation Theme, Centre for Surgical Research, University of Bristol, Bristol, UK
| | - Natalie S Blencowe
- National Institute for Health Research Bristol Biomedical Research Centre, Surgical Innovation Theme, Centre for Surgical Research, University of Bristol, Bristol, UK
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Sian Cousins
- National Institute for Health Research Bristol Biomedical Research Centre, Surgical Innovation Theme, Centre for Surgical Research, University of Bristol, Bristol, UK
| | - Jesmond Zahra
- National Institute for Health Research Bristol Biomedical Research Centre, Surgical Innovation Theme, Centre for Surgical Research, University of Bristol, Bristol, UK
| | - Anni Skilton
- National Institute for Health Research Bristol Biomedical Research Centre, Surgical Innovation Theme, Centre for Surgical Research, University of Bristol, Bristol, UK
| | | | - Sangeetha Paramasivan
- National Institute for Health Research Bristol Biomedical Research Centre, Surgical Innovation Theme, Centre for Surgical Research, University of Bristol, Bristol, UK
| | - Christin Hoffmann
- National Institute for Health Research Bristol Biomedical Research Centre, Surgical Innovation Theme, Centre for Surgical Research, University of Bristol, Bristol, UK
| | - Angus Gk McNair
- National Institute for Health Research Bristol Biomedical Research Centre, Surgical Innovation Theme, Centre for Surgical Research, University of Bristol, Bristol, UK
- North Bristol NHS Trust, Bristol, UK
| | - Cynthia Ochieng
- National Institute for Health Research Bristol Biomedical Research Centre, Surgical Innovation Theme, Centre for Surgical Research, University of Bristol, Bristol, UK
| | - Hollie Richards
- National Institute for Health Research Bristol Biomedical Research Centre, Surgical Innovation Theme, Centre for Surgical Research, University of Bristol, Bristol, UK
| | - Sina Hossaini
- National Institute for Health Research Bristol Biomedical Research Centre, Surgical Innovation Theme, Centre for Surgical Research, University of Bristol, Bristol, UK
| | - Darren L Scroggie
- National Institute for Health Research Bristol Biomedical Research Centre, Surgical Innovation Theme, Centre for Surgical Research, University of Bristol, Bristol, UK
| | - Barry Main
- National Institute for Health Research Bristol Biomedical Research Centre, Surgical Innovation Theme, Centre for Surgical Research, University of Bristol, Bristol, UK
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Shelley Potter
- National Institute for Health Research Bristol Biomedical Research Centre, Surgical Innovation Theme, Centre for Surgical Research, University of Bristol, Bristol, UK
| | - Kerry Avery
- National Institute for Health Research Bristol Biomedical Research Centre, Surgical Innovation Theme, Centre for Surgical Research, University of Bristol, Bristol, UK
| | - Jenny Donovan
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Jane M Blazeby
- National Institute for Health Research Bristol Biomedical Research Centre, Surgical Innovation Theme, Centre for Surgical Research, University of Bristol, Bristol, UK
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
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Hoffmann C, Hossaini S, Cousins S, Blencowe N, McNair AGK, Blazeby JM, Avery KNL, Potter S, Macefield R. Reporting Modifications in Surgical Innovation: A Systematic Scoping Review Protocol. Int J Surg Protoc 2021; 25:250-256. [PMID: 34825118 PMCID: PMC8588892 DOI: 10.29337/ijsp.167] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 09/08/2021] [Accepted: 10/07/2021] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Innovation in surgery drives improvements to patient care. New surgical procedures and devices typically undergo a series of modifications as they are developed and refined during their introduction into clinical practice. These changes should ideally be reported and shared between surgeon-innovators to promote efficient, safe and transparent innovation. Currently, agreement on how modifications should be defined, conceptualised and classified, so they can be reported and shared efficiently and transparently, is lacking. The aim of this review is to examine and summarise existing literature on definitions, perceptions and classifications of modifications to surgical procedures/devices, including views on how to measure and report them. The findings will inform future work to standardise reporting and sharing of modifications in surgical innovation. MATERIALS AND METHODS A systematic scoping review will be conducted adhering to PRISMA-ScR guidelines. Included articles will focus on review articles and opinion pieces relevant to modifications to new surgical procedures or devices introduced to clinical practice. Methods to identify relevant literature will include systematic searches in MEDLINE (Ovid version), targeted internet searches (Google Scholar) and snowball searches. A two-stage screening process (titles/abstracts/keywords and full-texts) will use specified exclusion/inclusion criteria to identify eligible articles. Data on how modifications are i) defined, ii) perceived, and iii) classified, and iv) views on how modifications should be measured and reported, will be extracted verbatim. Inductive thematic analysis will be applied to extracted data where appropriate. Results will be presented as a narrative summary including descriptive characteristics of included articles. Findings will inform a preliminary conceptual framework to facilitate the systematic reporting and sharing of modifications to novel procedures and devices. HIGHLIGHTS This work will generate an in-depth understanding of how modifications are currently defined, perceived and classified, and views on how they may be reported, in the context of surgical innovation.Rigorous and comprehensive search methods will be applied to identify a wide range of diverse data sources for inclusion in the review.A summary of existing relevant literature on modifications is a necessary step to inform development of a framework for transparent, real-time reporting and sharing of modifications in future studies of innovative invasive procedures/devices.
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Affiliation(s)
- Christin Hoffmann
- National Institute for Health Research Bristol Biomedical Research Centre (Surgical Innovation Theme), Centre for Surgical Research, Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, UK
| | - Sina Hossaini
- National Institute for Health Research Bristol Biomedical Research Centre (Surgical Innovation Theme), Centre for Surgical Research, Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, UK
| | - Sian Cousins
- National Institute for Health Research Bristol Biomedical Research Centre (Surgical Innovation Theme), Centre for Surgical Research, Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, UK
| | - Natalie Blencowe
- National Institute for Health Research Bristol Biomedical Research Centre (Surgical Innovation Theme), Centre for Surgical Research, Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, UK
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Angus G. K. McNair
- National Institute for Health Research Bristol Biomedical Research Centre (Surgical Innovation Theme), Centre for Surgical Research, Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, UK
- North Bristol NHS Trust, Bristol, UK
| | - Jane M. Blazeby
- National Institute for Health Research Bristol Biomedical Research Centre (Surgical Innovation Theme), Centre for Surgical Research, Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, UK
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Kerry N. L. Avery
- National Institute for Health Research Bristol Biomedical Research Centre (Surgical Innovation Theme), Centre for Surgical Research, Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, UK
| | - Shelley Potter
- National Institute for Health Research Bristol Biomedical Research Centre (Surgical Innovation Theme), Centre for Surgical Research, Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, UK
- North Bristol NHS Trust, Bristol, UK
| | - Rhiannon Macefield
- National Institute for Health Research Bristol Biomedical Research Centre (Surgical Innovation Theme), Centre for Surgical Research, Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, UK
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Matvienko-Sikar K, Avery K, Blazeby JM, Devane D, Dodd S, Egan AM, Gorst SL, Hughes K, Jacobsen P, Kirkham JJ, Kottner J, Mellor K, Millward CP, Patel S, Quirke F, Saldanha IJ, Smith V, Terwee CB, Young AE, Williamson PR. Use of core outcome sets was low in clinical trials published in major medical journals. J Clin Epidemiol 2021; 142:19-28. [PMID: 34715310 DOI: 10.1016/j.jclinepi.2021.10.012] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [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: 08/14/2021] [Revised: 10/08/2021] [Accepted: 10/20/2021] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To examine current practices in late-phase trials published in major medical journals and examine trialists' views about core outcome set (COS) use. STUDY DESIGN AND SETTING A sequential multi-methods study was conducted. We examined late-phase trials published between October 2019 and March 2020 in JAMA, NEJM, The Lancet, BMJ, and Annals of Internal Medicine. The COMET database was searched for COS potentially relevant to trials not reporting using a COS; overlap of trial and COS outcomes was examined. An online survey examined awareness of, and decisions to search for and use a COS. RESULTS Ninety-five trials were examined; 93 (98%) did not report using a COS. Relevant COS were identified for 31 trials (33%). Core outcomes were measured in 9 (23%) studies; all trials measured at least one core outcome. Thirty-one trialists (33%) completed our survey. The most common barrier to COS use was trialist's own outcome preferences and choice (68%). The most common perceived facilitator was awareness and knowledge about COS (90%). CONCLUSION COS use in this cohort of trials was low, even when relevant COS were available. Increased use of COS in clinical trials can improve evaluation of intervention effects and evidence synthesis and reduce research waste.
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Affiliation(s)
| | - Kerry Avery
- NIHR Bristol Biomedical Research Centre at University Hospitals Bristol NHS Foundation Trust and the University of Bristol, Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, UK
| | - Jane M Blazeby
- NIHR Bristol Biomedical Research Centre at University Hospitals Bristol NHS Foundation Trust and the University of Bristol, Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, UK
| | - Declan Devane
- Aras Moyola, School of Nursing and Midwifery, National University of Ireland, Galway, 26 Upper Newcastle, Galway, H91 E3YV, Ireland; Health Research Board Trials Methodology Research Network, National University of Ireland, Galway, Ireland
| | - Susanna Dodd
- Department of Health Data Science, University of Liverpool (a member of Liverpool Health Partners), MRC/NIHR Trials Methodology Research Partnership, Liverpool, UK
| | - Aoife M Egan
- Division of Endocrinology, Diabetes and Metabolism, Mayo Clinic School of Medicine, Rochester, MN, USA
| | - Sarah L Gorst
- Department of Health Data Science, University of Liverpool (a member of Liverpool Health Partners), MRC/NIHR Trials Methodology Research Partnership, Liverpool, UK
| | - Karen Hughes
- Department of Health Data Science, University of Liverpool (a member of Liverpool Health Partners), MRC/NIHR Trials Methodology Research Partnership, Liverpool, UK
| | | | - Jamie J Kirkham
- Centre for Biostatistics, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Jan Kottner
- Charité-Universitätsmedizin Berlin, Institute of Clinical Nursing Science, Berlin, Germany
| | - Katie Mellor
- Centre for Statistics in Medicine, Nuffield Department of Orthopedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Christopher P Millward
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK; Institute of Systems, Molecular & Integrative Biology, University of Liverpool, Liverpool, UK
| | - Smitaa Patel
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Fiona Quirke
- Health Research Board Trials Methodology Research Network, National University of Ireland, Galway, Ireland; College of Medicine, Nursing and Health Sciences, National University of Ireland Galway, Galway, Ireland
| | - Ian J Saldanha
- Department of Health Services, Center for Evidence Synthesis in Health, Policy and Practice, and Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Valerie Smith
- School of Nursing and Midwifery, University of Dublin Trinity College, Ireland
| | - Caroline B Terwee
- Department of Epidemiology and Data Science, Amsterdam UMC, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Amber E Young
- Centre for Surgical Research, Population Health Sciences Bristol Medical School, Bristol, UK
| | - Paula R Williamson
- Department of Health Data Science, University of Liverpool (a member of Liverpool Health Partners), MRC/NIHR Trials Methodology Research Partnership, Liverpool, UK
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Welford P, Blencowe NS, Pardington E, Jones CS, Blazeby JM, Main BG. Systematic review of the introduction, early phase study and evaluation of pyrocarbon proximal interphalangeal joint arthroplasty. PLoS One 2021; 16:e0257497. [PMID: 34665802 PMCID: PMC8525747 DOI: 10.1371/journal.pone.0257497] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 09/02/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND In 2002 a pyrocarbon interphalangeal joint implant was granted Food and Drug Administration approval with limited evidence of effectiveness. It is important to understand device use and outcomes since this implant entered clinical practice in order to establish incremental evidence, appropriate study design and reporting. This systematic review summarised and appraised studies reporting pyrocarbon proximal interphalangeal joint arthroplasty. METHODS Systematic review of MEDLINE, EMBASE, SCOPUS, Web of Science, BIOSIS, CINAHL and CENTRAL from inception to November 2020. All study designs reporting pyrocarbon proximal interphalangeal joint arthroplasty in humans were included. Data extracted included information about study characteristics, patient selection, regulatory (gaining research ethics approval) and governance issues (reporting of conflicting interests), operator and centre experience, technique description and outcome reporting. Descriptive and narrative summaries were reported. RESULTS From 4316 abstracts, 210 full-text articles were screened. A total of 38 studies and 1434 (1-184) patients were included. These consisted of three case reports, 24 case series, 10 retrospective cohort studies and one randomised trial. Inclusion and exclusion criteria were stated in 25 (66%) studies. Most studies (n = 27, 71%) gained research ethics approval to be conducted. Six studies reported conflicting interests. Experience of operating surgeons was reported in nine (24%) and caseload volume in five studies. There was no consensus about the optimal surgical approach. Technical aspects of implant placement were reported frequently (n = 32) but the detail provided varied widely. Studies reported multiple, heterogenous outcomes. The most commonly reported outcome was range of motion (n = 37). CONCLUSIONS This systematic review identified inconsistencies in how studies describing the early use and update of an innovative procedure were reported. Incremental evidence was lacking, risking the implant being adopted without robust evaluation. This review adds to evidence highlighting the need for more rigorous evaluation of how implantable medical devices are used in practice following licencing.
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Affiliation(s)
- Paul Welford
- North Bristol NHS Trust, Bristol, United Kingdom
- Bristol Centre for Surgical Research, Department of Population Health Sciences, Bristol Medical School, Bristol, United Kingdom
| | - Natalie S. Blencowe
- Bristol Centre for Surgical Research, Department of Population Health Sciences, Bristol Medical School, Bristol, United Kingdom
- National Institute for Health Research Biomedical Research Centre at Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom
| | - Emily Pardington
- Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Conor S. Jones
- North Bristol NHS Trust, Bristol, United Kingdom
- Bristol Centre for Surgical Research, Department of Population Health Sciences, Bristol Medical School, Bristol, United Kingdom
| | - Jane M. Blazeby
- Bristol Centre for Surgical Research, Department of Population Health Sciences, Bristol Medical School, Bristol, United Kingdom
- National Institute for Health Research Biomedical Research Centre at Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom
| | - Barry G. Main
- Bristol Centre for Surgical Research, Department of Population Health Sciences, Bristol Medical School, Bristol, United Kingdom
- National Institute for Health Research Biomedical Research Centre at Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom
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Skivington K, Matthews L, Simpson SA, Craig P, Baird J, Blazeby JM, Boyd KA, Craig N, French DP, McIntosh E, Petticrew M, Rycroft-Malone J, White M, Moore L. A new framework for developing and evaluating complex interventions: update of Medical Research Council guidance. BMJ 2021; 374:n2061. [PMID: 34593508 PMCID: PMC8482308 DOI: 10.1136/bmj.n2061] [Citation(s) in RCA: 1269] [Impact Index Per Article: 423.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/09/2021] [Indexed: 11/25/2022]
Affiliation(s)
- Kathryn Skivington
- MRC/CSO Social and Public Health Sciences Unit, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Lynsay Matthews
- MRC/CSO Social and Public Health Sciences Unit, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Sharon Anne Simpson
- MRC/CSO Social and Public Health Sciences Unit, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Peter Craig
- MRC/CSO Social and Public Health Sciences Unit, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Janis Baird
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - Jane M Blazeby
- Medical Research Council ConDuCT-II Hub for Trials Methodology Research and Bristol Biomedical Research Centre, Bristol, UK
| | - Kathleen Anne Boyd
- Health Economics and Health Technology Assessment Unit, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | | | - David P French
- Manchester Centre for Health Psychology, University of Manchester, Manchester, UK
| | - Emma McIntosh
- Health Economics and Health Technology Assessment Unit, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Mark Petticrew
- London School of Hygiene and Tropical Medicine, London, UK
| | | | - Martin White
- Medical Research Council Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Laurence Moore
- MRC/CSO Social and Public Health Sciences Unit, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
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Beard DJ, Campbell MK, Blazeby JM, Carr AJ, Weijer C, Cuthbertson BH, Buchbinder R, Pinkney T, Bishop FL, Pugh J, Cousins S, Harris I, Lohmander LS, Blencowe N, Gillies K, Probst P, Brennan C, Cook A, Farrar-Hockley D, Savulescu J, Huxtable R, Rangan A, Tracey I, Brocklehurst P, Ferreira ML, Nicholl J, Reeves BC, Hamdy F, Rowley SC, Lee N, Cook JA. Placebo comparator group selection and use in surgical trials: the ASPIRE project including expert workshop. Health Technol Assess 2021; 25:1-52. [PMID: 34505829 PMCID: PMC8450778 DOI: 10.3310/hta25530] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 01/09/2023] Open
Abstract
BACKGROUND The use of placebo comparisons for randomised trials assessing the efficacy of surgical interventions is increasingly being considered. However, a placebo control is a complex type of comparison group in the surgical setting and, although powerful, presents many challenges. OBJECTIVES To provide a summary of knowledge on placebo controls in surgical trials and to summarise any recommendations for designers, evaluators and funders of placebo-controlled surgical trials. DESIGN To carry out a state-of-the-art workshop and produce a corresponding report involving key stakeholders throughout. SETTING A workshop to discuss and summarise the existing knowledge and to develop the new guidelines. RESULTS To assess what a placebo control entails and to assess the understanding of this tool in the context of surgery is considered, along with when placebo controls in surgery are acceptable (and when they are desirable). We have considered ethics arguments and regulatory requirements, how a placebo control should be designed, how to identify and mitigate risk for participants in these trials, and how such trials should be carried out and interpreted. The use of placebo controls is justified in randomised controlled trials of surgical interventions provided that there is a strong scientific and ethics rationale. Surgical placebos might be most appropriate when there is poor evidence for the efficacy of the procedure and a justified concern that results of a trial would be associated with a high risk of bias, particularly because of the placebo effect. CONCLUSIONS The use of placebo controls is justified in randomised controlled trials of surgical interventions provided that there is a strong scientific and ethics rationale. Feasibility work is recommended to optimise the design and implementation of randomised controlled trials. An outline for best practice was produced in the form of the Applying Surgical Placebo in Randomised Evaluations (ASPIRE) guidelines for those considering the use of a placebo control in a surgical randomised controlled trial. LIMITATIONS Although the workshop participants involved international members, the majority of participants were from the UK. Therefore, although every attempt was made to make the recommendations applicable to all health systems, the guidelines may, unconsciously, be particularly applicable to clinical practice in the UK NHS. FUTURE WORK Future work should evaluate the use of the ASPIRE guidelines in making decisions about the use of a placebo-controlled surgical trial. In addition, further work is required on the appropriate nomenclature to adopt in this space. FUNDING Funded by the Medical Research Council UK and the National Institute for Health Research as part of the Medical Research Council-National Institute for Health Research Methodology Research programme.
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Affiliation(s)
- David J Beard
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | | | - Jane M Blazeby
- Centre for Surgical Research, NIHR Bristol and Weston Biomedical Research Centre, Population Health Sciences, University of Bristol, Bristol, UK
| | - Andrew J Carr
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Charles Weijer
- Departments of Medicine, Epidemiology and Biostatistics, and Philosophy, Western University, London, ON, Canada
| | - Brian H Cuthbertson
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Rachelle Buchbinder
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Thomas Pinkney
- Academic Department of Surgery, University of Birmingham, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Felicity L Bishop
- Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - Jonathan Pugh
- The Oxford Uehiro Centre for Practical Ethics, University of Oxford, Oxford, UK
| | - Sian Cousins
- Centre for Surgical Research, NIHR Bristol and Weston Biomedical Research Centre, Population Health Sciences, University of Bristol, Bristol, UK
| | - Ian Harris
- Faculty of Medicine, South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - L Stefan Lohmander
- Department of Clinical Sciences Lund, Orthopedics, Clinical Epidemiology Unit, Lund University, Lund, Sweden
| | - Natalie Blencowe
- Centre for Surgical Research, NIHR Bristol and Weston Biomedical Research Centre, Population Health Sciences, University of Bristol, Bristol, UK
| | - Katie Gillies
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Pascal Probst
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | | | - Andrew Cook
- Wessex Institute, University of Southampton, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | | | - Julian Savulescu
- The Oxford Uehiro Centre for Practical Ethics, University of Oxford, Oxford, UK
| | - Richard Huxtable
- Centre for Surgical Research, NIHR Bristol and Weston Biomedical Research Centre, Population Health Sciences, University of Bristol, Bristol, UK
| | - Amar Rangan
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- Department of Health Sciences, University of York, York, UK
| | - Irene Tracey
- Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Peter Brocklehurst
- Birmingham Clinical Trials Unit, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Manuela L Ferreira
- Faculty of Medicine and Health, Institute of Bone and Joint Research, Northern Clinical School, The University of Sydney, Sydney, NSW, Australia
| | - Jon Nicholl
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Barnaby C Reeves
- Clinical Trials Evaluation Unit Bristol Medical School, University of Bristol, Bristol Royal Infirmary, Bristol, UK
| | - Freddie Hamdy
- Nuffield Department of Surgical Sciences, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | | | - Naomi Lee
- Editorial Department, The Lancet, London, UK
| | - Jonathan A Cook
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
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Skivington K, Matthews L, Simpson SA, Craig P, Baird J, Blazeby JM, Boyd KA, Craig N, French DP, McIntosh E, Petticrew M, Rycroft-Malone J, White M, Moore L. Framework for the development and evaluation of complex interventions: gap analysis, workshop and consultation-informed update. Health Technol Assess 2021; 25:1-132. [PMID: 34590577 PMCID: PMC7614019 DOI: 10.3310/hta25570] [Citation(s) in RCA: 144] [Impact Index Per Article: 48.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND The Medical Research Council published the second edition of its framework in 2006 on developing and evaluating complex interventions. Since then, there have been considerable developments in the field of complex intervention research. The objective of this project was to update the framework in the light of these developments. The framework aims to help research teams prioritise research questions and design, and conduct research with an appropriate choice of methods, rather than to provide detailed guidance on the use of specific methods. METHODS There were four stages to the update: (1) gap analysis to identify developments in the methods and practice since the previous framework was published; (2) an expert workshop of 36 participants to discuss the topics identified in the gap analysis; (3) an open consultation process to seek comments on a first draft of the new framework; and (4) findings from the previous stages were used to redraft the framework, and final expert review was obtained. The process was overseen by a Scientific Advisory Group representing the range of relevant National Institute for Health Research and Medical Research Council research investments. RESULTS Key changes to the previous framework include (1) an updated definition of complex interventions, highlighting the dynamic relationship between the intervention and its context; (2) an emphasis on the use of diverse research perspectives: efficacy, effectiveness, theory-based and systems perspectives; (3) a focus on the usefulness of evidence as the basis for determining research perspective and questions; (4) an increased focus on interventions developed outside research teams, for example changes in policy or health services delivery; and (5) the identification of six 'core elements' that should guide all phases of complex intervention research: consider context; develop, refine and test programme theory; engage stakeholders; identify key uncertainties; refine the intervention; and economic considerations. We divide the research process into four phases: development, feasibility, evaluation and implementation. For each phase we provide a concise summary of recent developments, key points to address and signposts to further reading. We also present case studies to illustrate the points being made throughout. LIMITATIONS The framework aims to help research teams prioritise research questions and design and conduct research with an appropriate choice of methods, rather than to provide detailed guidance on the use of specific methods. In many of the areas of innovation that we highlight, such as the use of systems approaches, there are still only a few practical examples. We refer to more specific and detailed guidance where available and note where promising approaches require further development. CONCLUSIONS This new framework incorporates developments in complex intervention research published since the previous edition was written in 2006. As well as taking account of established practice and recent refinements, we draw attention to new approaches and place greater emphasis on economic considerations in complex intervention research. We have introduced a new emphasis on the importance of context and the value of understanding interventions as 'events in systems' that produce effects through interactions with features of the contexts in which they are implemented. The framework adopts a pluralist approach, encouraging researchers and research funders to adopt diverse research perspectives and to select research questions and methods pragmatically, with the aim of providing evidence that is useful to decision-makers. FUTURE WORK We call for further work to develop relevant methods and provide examples in practice. The use of this framework should be monitored and the move should be made to a more fluid resource in the future, for example a web-based format that can be frequently updated to incorporate new material and links to emerging resources. FUNDING This project was jointly funded by the Medical Research Council (MRC) and the National Institute for Health Research (Department of Health and Social Care 73514).
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Affiliation(s)
- Kathryn Skivington
- Medical Research Council/Chief Scientist Office Social and Public Health Sciences Unit, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Lynsay Matthews
- Medical Research Council/Chief Scientist Office Social and Public Health Sciences Unit, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Sharon Anne Simpson
- Medical Research Council/Chief Scientist Office Social and Public Health Sciences Unit, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Peter Craig
- Medical Research Council/Chief Scientist Office Social and Public Health Sciences Unit, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Janis Baird
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - Jane M Blazeby
- Medical Research Council ConDuCT-II Hub for Trials Methodology Research and Bristol Biomedical Research Centre, University of Bristol, Bristol, UK
| | - Kathleen Anne Boyd
- Health Economics and Health Technology Assessment Unit, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | | | - David P French
- Manchester Centre for Health Psychology, University of Manchester, Manchester, UK
| | - Emma McIntosh
- Health Economics and Health Technology Assessment Unit, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Mark Petticrew
- London School of Hygiene and Tropical Medicine, London, UK
| | | | - Martin White
- Medical Research Council Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Laurence Moore
- Medical Research Council/Chief Scientist Office Social and Public Health Sciences Unit, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
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Tabusa H, Blazeby JM, Blencowe N, Callaway M, Daniels IR, Gunning A, Hollingworth W, McNair AG, Murkin C, Pinkney TD, Rogers CA, Smart NJ, Reeves BC. Protocol for the UK cohort study to investigate the prevention of parastomal hernia (the CIPHER study). Colorectal Dis 2021; 23:1900-1908. [PMID: 33686656 DOI: 10.1111/codi.15621] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [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: 11/18/2020] [Revised: 02/23/2021] [Accepted: 03/01/2021] [Indexed: 12/13/2022]
Abstract
AIM Abdominal surgery sometimes necessitates the creation of a stoma, which can cause future complications including parastomal hernia (PSH), an incisional hernia adjacent to and related to the stoma. PSH affects approximately 40% of patients within 2 years of stoma formation. Complications of PSH reduce a patient's quality of life and can be severe (e.g. bowel obstruction). PSHs are difficult to manage and can recur after surgical repair. Therefore, it is very important to prevent a PSH. Surgeons create stomas in different ways and both patient and surgical factors are believed to influence the development of PSH. The aim of the CIPHER study is to investigate the influence of different surgical techniques on the development of PSH. METHOD The UK cohort study to investigate the prevention of parastomal hernia (the CIPHER study) aims to recruit 4000 patients undergoing elective or expedited surgery with the intention of forming an ileostomy or colostomy, irrespective of the primary indication for the planned surgery. For each patient, surgeons will describe their methods of trephine formation, mesh reinforcement of the stoma trephine, use of the stoma as a specimen extraction site and wound closure. The primary outcome will be incident PSH during follow-up, defined as symptoms of PSH (custom-designed questionnaire) and anatomical PSH, ascertained by independent reading of usual care CT scans. Secondary outcomes will include surgical site infection, the Comprehensive Complication Index, quality of life (EQ-5D-5L and SF-12), PSH repair and use of NHS resources. RESULTS Results of the study will be submitted for publication in peer-reviewed journals. All publications relating to the results of CIPHER will use a corporate authorship, 'The CIPHER Study Investigators' with named writing committee members. CONCLUSION The CIPHER study will be the first to investigate detailed surgical methods of stoma formation in a large, representative cohort of patients with a range of primary indications, both cancer and noncancer.
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Affiliation(s)
| | | | | | - Mark Callaway
- University Hospitals Bristol and Weston NHS Trust, Bristol, UK
| | - Ian R Daniels
- Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | | | | | | | | | | | | | - Neil J Smart
- Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
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Alkhaffaf B, Metryka A, Blazeby JM, Glenny AM, Adeyeye A, Costa PM, Diez del Val I, Gisbertz SS, Guner A, Law S, Lee HJ, Li Z, Nakada K, Reim D, Vorwald P, Baiocchi GL, Allum W, Chaudry MA, Griffiths EA, Williamson PR, Bruce IA. Core outcome set for surgical trials in gastric cancer (GASTROS study): international patient and healthcare professional consensus. Br J Surg 2021; 108:znab192. [PMID: 34165555 PMCID: PMC10364901 DOI: 10.1093/bjs/znab192] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 05/04/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Surgery is the primary treatment that can offer potential cure for gastric cancer, but is associated with significant risks. Identifying optimal surgical approaches should be based on comparing outcomes from well designed trials. Currently, trials report different outcomes, making synthesis of evidence difficult. To address this, the aim of this study was to develop a core outcome set (COS)-a standardized group of outcomes important to key international stakeholders-that should be reported by future trials in this field. METHODS Stage 1 of the study involved identifying potentially important outcomes from previous trials and a series of patient interviews. Stage 2 involved patients and healthcare professionals prioritizing outcomes using a multilanguage international Delphi survey that informed an international consensus meeting at which the COS was finalized. RESULTS Some 498 outcomes were identified from previously reported trials and patient interviews, and rationalized into 56 items presented in the Delphi survey. A total of 952 patients, surgeons, and nurses enrolled in round 1 of the survey, and 662 (70 per cent) completed round 2. Following the consensus meeting, eight outcomes were included in the COS: disease-free survival, disease-specific survival, surgery-related death, recurrence, completeness of tumour removal, overall quality of life, nutritional effects, and 'serious' adverse events. CONCLUSION A COS for surgical trials in gastric cancer has been developed with international patients and healthcare professionals. This is a minimum set of outcomes that is recommended to be used in all future trials in this field to improve trial design and synthesis of evidence.
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Affiliation(s)
- B Alkhaffaf
- Department of Oesophago-Gastric Surgery, Salford Royal Hospital, Salford Royal NHS Foundation Trust, Salford, UK
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - A Metryka
- Paediatric Ear, Nose and Throat Department, Royal Manchester Children’s Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - J M Blazeby
- Centre for Surgical Research and Bristol and Weston National Institute for Health Research Biomedical Research Centre, University of Bristol, Bristol, UK
| | - A -M Glenny
- Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - A Adeyeye
- University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - P M Costa
- Cirurgia Geral, Hospital Garcia de Orta, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
| | | | - S S Gisbertz
- Department of Surgery, Cancer Centre, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - A Guner
- Department of General Surgery, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - S Law
- Department of Surgery, University of Hong Kong, Hong Kong, China
| | - H -J Lee
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, South Korea
| | - Z Li
- Peking University Cancer Hospital and Institute, Beijing, China
| | - K Nakada
- Department of Laboratory Medicine, Jikei University School of Medicine, Tokyo, Japan
| | - D Reim
- Department of Surgery, TUM School of Medicine, Munich, Germany
| | - P Vorwald
- Hospital Universitario Fundación Jiménez Diaz, Madrid, Spain
| | - G L Baiocchi
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - W Allum
- Department of Academic Surgery, Royal Marsden NHS Foundation Trust, London, UK
| | - M A Chaudry
- Department of Academic Surgery, Royal Marsden NHS Foundation Trust, London, UK
| | - E A Griffiths
- Department of Upper Gastrointestinal Surgery, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - P R Williamson
- Medical Research Council North West Hub for Trials Methodology Research, University of Liverpool, Liverpool, UK
| | - I A Bruce
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
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Alkhaffaf B, Blazeby JM, Metryka A, Glenny AM, Adeyeye A, Costa PM, Del Val ID, Gisbertz SS, Guner A, Law S, Lee HJ, Li Z, Nakada K, Nuñez RMR, Reim D, Reynolds JV, Vorwald P, Zanotti D, Allum W, Chaudry MA, Griffiths E, Williamson PR, Bruce IA. Methods for conducting international Delphi surveys to optimise global participation in core outcome set development: a case study in gastric cancer informed by a comprehensive literature review. Trials 2021; 22:410. [PMID: 34154641 PMCID: PMC8218463 DOI: 10.1186/s13063-021-05338-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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] [Received: 12/07/2020] [Accepted: 05/21/2021] [Indexed: 01/13/2023] Open
Abstract
Background Core outcome sets (COS) should be relevant to key stakeholders and widely applicable and usable. Ideally, they are developed for international use to allow optimal data synthesis from trials. Electronic Delphi surveys are commonly used to facilitate global participation; however, this has limitations. It is common for these surveys to be conducted in a single language potentially excluding those not fluent in that tongue. The aim of this study is to summarise current approaches for optimising international participation in Delphi studies and make recommendations for future practice. Methods A comprehensive literature review of current approaches to translating Delphi surveys for COS development was undertaken. A standardised methodology adapted from international guidance derived from 12 major sets of translation guidelines in the field of outcome reporting was developed. As a case study, this was applied to a COS project for surgical trials in gastric cancer to translate a Delphi survey into 7 target languages from regions active in gastric cancer research. Results Three hundred thirty-two abstracts were screened and four studies addressing COS development in rheumatoid and osteoarthritis, vascular malformations and polypharmacy were eligible for inclusion. There was wide variation in methodological approaches to translation, including the number of forward translations, the inclusion of back translation, the employment of cognitive debriefing and how discrepancies and disagreements were handled. Important considerations were identified during the development of the gastric cancer survey including establishing translation groups, timelines, understanding financial implications, strategies to maximise recruitment and regulatory approvals. The methodological approach to translating the Delphi surveys was easily reproducible by local collaborators and resulted in an additional 637 participants to the 315 recruited to complete the source language survey. Ninety-nine per cent of patients and 97% of healthcare professionals from non-English-speaking regions used translated surveys. Conclusion Consideration of the issues described will improve planning by other COS developers and can be used to widen international participation from both patients and healthcare professionals. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-021-05338-x.
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Affiliation(s)
- Bilal Alkhaffaf
- Department of Oesophago-Gastric Surgery, Salford Royal Hospital, Salford Royal NHS Foundation Trust, Stott Lane, Manchester, M6 8HD, UK. .,Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.
| | - Jane M Blazeby
- Centre for Surgical Research and Bristol and Weston NIHR Biomedical Research Centre, University of Bristol, Bristol, UK
| | - Aleksandra Metryka
- Paediatric ENT Department, Royal Manchester Children's Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Anne-Marie Glenny
- Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | | | - Paulo Matos Costa
- Hospital Garcia de Orta, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
| | | | - Suzanne S Gisbertz
- Department of Surgery, Cancer Center, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Ali Guner
- Department of General Surgery, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Simon Law
- Department of Surgery, The University of Hong Kong, Hong Kong, China
| | - Hyuk-Joon Lee
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea
| | - Ziyu Li
- Peking University Cancer Hospital and Institute, Beijing, China
| | - Koji Nakada
- Department of Laboratory Medicine, The Jikei University Daisan Hospital, Komae, Japan
| | | | - Daniel Reim
- Department of Surgery, TUM School of Medicine, Munich, Germany
| | - John V Reynolds
- Department of Surgery, Trinity Translational Medicine Institute and St James's Hospital, Dublin, Ireland
| | - Peter Vorwald
- Hospital Universitario Fundación Jiménez Diaz, Madrid, Spain
| | - Daniela Zanotti
- Regional Centre for Oesophago-gastric Surgery, Broomfield Hospital, Chelmsford, UK
| | - William Allum
- Department of Academic Surgery, Royal Marsden NHS Foundation Trust, London, UK
| | - M Asif Chaudry
- Department of Academic Surgery, Royal Marsden NHS Foundation Trust, London, UK
| | - Ewen Griffiths
- Upper GI Unit, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Paula R Williamson
- MRC North West Hub for Trials Methodology Research, University of Liverpool and a member of Liverpool Health Partners, Liverpool, UK
| | - Iain A Bruce
- Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
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Elliott D, Ochieng C, Jepson M, Blencowe NS, Avery KN, Paramasivan S, Cousins S, Skilton A, Hutchinson P, Jayne D, Birchall M, Blazeby JM, Donovan JL, Rooshenas L. 'Overnight, things changed. Suddenly, we were in it': a qualitative study exploring how surgical teams mitigated risks of COVID-19. BMJ Open 2021; 11:e046662. [PMID: 34135048 PMCID: PMC8210660 DOI: 10.1136/bmjopen-2020-046662] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES COVID-19 presents a risk of infection and transmission for operating theatre teams. Guidelines to protect patients and staff emerged and changed rapidly based on expert opinion and limited evidence. This paper presents the experiences and innovations developed by international surgical teams during the early stages of the pandemic to attempt to mitigate risk. DESIGN In-depth, semistructured interviews were audio recorded, transcribed and analysed thematically using methods of constant comparison. PARTICIPANTS 43 participants, including surgeons from a range of specialties (primarily general surgery, otolaryngology, neurosurgery, cardiothoracic and ophthalmology), anaesthetists and those in nursing roles. SETTING The UK, Italy, Spain, the USA, China and New Zealand between March and May 2020. RESULTS Surgical teams sought to mitigate COVID-19 risks by modifying their current practice with an abundance of strategies and innovations. Communication and teamwork played an integral role in how teams adapted, although participants reflected on the challenges of having to improvise in real time. Uncertainties remained about optimal surgical practice and there were significant tensions where teams were forced to balance what was best for patients while contemplating their own safety. CONCLUSIONS The perceptions of risks during a pandemic such as COVID-19 can be complex and context dependent. Management of these risks in surgery must be driven by evidence-based practice resulting from a pragmatic and novel approach to collation of global evidence. The context of surgery has changed dramatically, and surgical teams have developed a plethora of innovations. There is an urgent need for high-quality evidence to inform surgical practice that optimises the safety of both patients and healthcare professionals as the COVID-19 pandemic unfolds.
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Affiliation(s)
- Daisy Elliott
- National Institute for Health Research Bristol Biomedical Research Centre, Surgical Innovation Theme, Centre for Surgical Research, University of Bristol, Bristol, UK
| | - Cynthia Ochieng
- National Institute for Health Research Bristol Biomedical Research Centre, Surgical Innovation Theme, Centre for Surgical Research, University of Bristol, Bristol, UK
| | - Marcus Jepson
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Natalie S Blencowe
- National Institute for Health Research Bristol Biomedical Research Centre, Surgical Innovation Theme, Centre for Surgical Research, University of Bristol, Bristol, UK
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Kerry Nl Avery
- National Institute for Health Research Bristol Biomedical Research Centre, Surgical Innovation Theme, Centre for Surgical Research, University of Bristol, Bristol, UK
| | - Sangeetha Paramasivan
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Sian Cousins
- National Institute for Health Research Bristol Biomedical Research Centre, Surgical Innovation Theme, Centre for Surgical Research, University of Bristol, Bristol, UK
| | - Anni Skilton
- National Institute for Health Research Bristol Biomedical Research Centre, Surgical Innovation Theme, Centre for Surgical Research, University of Bristol, Bristol, UK
| | - Peter Hutchinson
- Division of Neurosurgery, Department of Clinical Neuroscience, University of Cambridge, Cambridge, UK
| | - David Jayne
- Leeds Institute of Medical Research, Level 7 Clinical Sciences Building, St. James's University Hospital, Leeds, UK
| | - Martin Birchall
- Ear Institute, Faculty of Brain Sciences, University College London, London, UK
| | - Jane M Blazeby
- National Institute for Health Research Bristol Biomedical Research Centre, Surgical Innovation Theme, Centre for Surgical Research, University of Bristol, Bristol, UK
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Jenny L Donovan
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Leila Rooshenas
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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Winter H, Willis J, Lang S, Drury K, Heywood J, Bewley J, Blencowe N, Gibbison B, Lazarus R, Bradbury C, Blazeby JM. Building capacity and ensuring equity in clinical trials during the COVID-19 pandemic. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.e13598] [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: 11/20/2022] Open
Abstract
e13598 Background: The impact on cancer outcomes from the Covid-19 pandemic has yet to be determined. Concerns persist on screening, delays in diagnosis, treatment interruptions and outcomes of infection in the immunosuppressed. The need for agile working has been exemplified by establishment of Nightingale Hospitals, staff redeployment and sudden integration of virtual consultations into clinical working. With most cancer clinical trials halted, recruitment into COVID-19 research became essential and embedded into the everyday. Here we present how rapid implementation of COVID-19 randomised clinical trials within an NHS organisation during the pandemic was achieved. Methods: A COVID-19 senior facilitation committee was set up to provide oversight, maximise staff capacity and resource and prioritise studies. Specific strategies to maximise access and clinical trials recruitment for patients including children and those with solid tumours were designed. These included presence of a research nurse at clinical ward rounds and team meetings, the promotion of protocol and informed consent training to all including doctors in the acute settings and weekly research meetings to share-best practice. Reflecting on learnings from this time provide an opportunity to consider how we adjust working for our patients in the future. Results: The integration of research into the everyday working of clinical teams looking after patients with COVID-19 has become the norm. The provision of protocol and informed consent training for all levels of staff and the consideration of all patients for trials during clinical ward rounds and multi-disciplinary meetings, have ensured access to trials has become embedded. The integration of research nurses working, upskilling and prompting clinical colleagues has ensured equity of access and provided a research presence and focus during the busy clinical day. The adoption of cross-disciplinary working, sharing best practice and a culture of commitment and support to the trials ensures no patient is denied the opportunity to participate. Three RTCs opened over 7 weeks. At one site 1904 patients were screened for one of the randomised-controlled trials and over 18% of these patients (351) were recruited and 175 patients declined. Conclusions: The pandemic has had a devastating impact across the UK. However, a coordinated and collaborative multi-disciplinary approach has supported high recruitment and equity of access for patients into COVID-19 trials. Learnings from this work may lead to embedding clinical trials and access to translational research for cancer patients in the future as we recover from the full impact of the pandemic. COVID-19 research has demonstrated how increased recruitment accelerates access and implementation of new innovations and novel drug combinations.The full impact of improved access to cancer research in the future during COVID recovery is worthy of more research.
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Affiliation(s)
- Helen Winter
- Bristol Cancer Institute, Bristol, United Kingdom
| | | | - Stephen Lang
- Bristol Cancer Institute, Bristol, United Kingdom
| | - Kay Drury
- Clinical Trials Unit, Bristol Cancer Institute, Bristol, United Kingdom
| | | | - Jeremy Bewley
- Intensive Care, UHBW NHS Trust, Bristol, United Kingdom
| | | | | | | | | | - Jane M. Blazeby
- National Institute for Health Research Bristol Biomedical Research Centre, Surgical Innovation Theme, Centre for Surgical Research, University of Bristol, Bristol, United Kingdom
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Blazeby JM. Minimally invasive or open oesophagectomy for localized oesophageal cancer: Results of the ROMIO phase 3 randomized controlled trial. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.e16057] [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: 11/20/2022] Open
Abstract
e16057 Background: Patients with localised oesophageal adenocarcinoma or squamous cell cancer are frequently offered surgery, usually with neoadjuvant treatment. Whether minimally invasive surgical approaches are superior to standard open procedures in terms of patient recovery and survival benefit is unclear. Well-designed and well-conducted pragmatic trials are limited. The ROMIO study compared laparoscopic abdominal surgery and thoracotomy (LAO) with open oesophagectomy (OO), to test the hypothesis that LAO allows faster recovery than OO whilst maintaining the survival benefit of surgery. Methods: A pragmatic multi-centre randomised controlled trial (1:1 LAO vs. OO) was conducted in 9 major cancer centres in the UK. Included were patients with localised adenocarcinoma or squamous cell cancer selected by a multi-disciplinary team for oesophagectomy with or without neoadjuvant treatment. Surgery was quality assured by provision of a protocol, pre-operative video assessment of the 40 participating surgeons and intra-operative photographs of key agreed surgical components. The primary outcome was the physical function scale of the EORTC QLQ-C30 assessed during the first 3 months. Results: At enrolment to ROMIO 447 (85%) of 526 participants were male, mean age was 67 years (SD 9), 469 (89%) had an adenocarcinoma, 368 (70%) had a clinically staged T3 or T4a tumour, 295 (56%) had clinically positive nodes, and 438 (83%) underwent neoadjuvant treatment. 263 were randomly allocated to each of the two procedures, with 241 (92%) undergoing their allocated open surgery and 237 (91%) undergoing their allocated LAO (hybrid) surgery. Analyses are underway and this presentation will include the primary outcome measure and other short-term clinical outcomes including key complications and survival during the first 90 days (clinical data >95% complete). Conclusions: ROMIO is the largest multi-centre randomised controlled surgical trial of minimal access versus open surgical approaches for oesophageal cancer. The provision of a surgical quality assessment tool will supplement trial data to provide for the first-time evidence of surgical standards of both approaches. Clinical trial information: ISRCTN10386621.
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Affiliation(s)
- Jane M. Blazeby
- National Institute for Health Research Bristol Biomedical Research Centre, Surgical Innovation Theme, Centre for Surgical Research, University of Bristol, Bristol, United Kingdom
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Lim EKS, Batchelor TJ, Dunning J, Shackcloth M, Anikin V, Naidu B, Belcher E, Loubani M, Zamvar V, Harris RA, Dabner L, Mckeon HE, Paramasivan S, Realpe A, Elliot D, De Sousa P, Blazeby JM, Rogers CA. Video-assisted thoracoscopic versus open lobectomy in patients with early-stage lung cancer: One-year results from a randomized controlled trial (VIOLET). J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.8504] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
8504 Background: Video assisted thoracoscopic surgery (VATS) is a popular access for lung cancer resection. However, there is limited information from RCTs from in-hospital to one-year clinical efficacy, safety and oncologic outcomes of a minimal access approach. Methods: VIOLET is a parallel group multi-center RCT conducted in 9 centers in the United Kingdom that recruited participants with known or suspected (cT1-3, N0-1 and M0) lung cancer (ISRCTN13472721). Trial protocol: https://bmjopen.bmj.com/content/9/10/e029507.info. Results: From July 2015 to February 2019, 503 participants were randomized to VATS (n=247) or open (n=256) lobectomy. Patients allocated to VATS had less pain with a mean difference (MD) in visual analogue score of -0.54 (95%CI -0.99 to -0.10) despite less analgesic consumption (mean ratio 0.90, 95%CI 0.80 to 1.01). After discharge pain was consistent on multiple sub-scales including overall pain (MD -7.19, -10.59 to -3.80), chest pain (MD -4.66, -7.96 to -1.36) and an 18% relative risk (RR) reduction in incision pain (RR 0.82; 0.72 to 0.94) up to one-year. Better functional recovery continued in VATS arm after discharge with better physical function (primary outcome) with MD of 4.65 (1.69 to 7.61; P=0.002) at 5 weeks and overall improvement in global health status with a MD of 4.21 (1.62 to 6.79; P=0.001). In hospital, VATS arm had fewer complications (RR 0.74, 0.66 to 0.84; P<0.001) with no difference in serious adverse events (RR 0.98, 0.59 to 1.63; P=0.948). Median hospital stay was one day shorter in the VATS arm (4 vs 5 days) corresponding to hazard ratio (HR) for discharge of 1.34, 95%CI 1.09 to 1.65; P=0.006). After discharge VATS arm had 19% less serious adverse events (RR 0.81, 0.66 to 1.00; p=0.053) and lower readmission rates (29.0% vs. 35.9% respectively) to one-year. Of those with lymph node disease, 50.9% in the VATS and 45.9% in open arms received adjuvant treatment. There was no difference in the time to uptake of adjuvant chemotherapy (HR 1.12, 0.62 to 2.02; p=0.716). Recurrence with clinical follow up and CT at one-year was similar with 7.7% versus 8.1% in the VATS and open groups respectively. Progression-free survival (HR 0.74, 0.43 to 1.27; p=0.27) and overall survival HR 0.67, 0.32 to 1.40; p=0.282) was not significantly different. Conclusions: VATS lobectomy for lung cancer is associated with less pain, fewer in-hospital complications and shorter hospital stay, achieved without any compromise to early oncologic outcomes nor serious adverse events. Superior functional recovery continues in the post-operative period with improved physical function, lower re-admission rates and no difference in disease-free and overall survival up to one-year. Clinical trial information: ISRCTN13472721.
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Affiliation(s)
| | - Tim J.P. Batchelor
- Thoracic Surgery, Bristol Royal Infirmary, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom
| | - Joel Dunning
- The James Cook University Hospital, South Tees Hospitals NHS Foundation Trust, Middlesbrough, United Kingdom
| | - Michael Shackcloth
- Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, United Kingdom
| | - Vladimir Anikin
- Royal Brompton and Harefield Hospitals, London, United Kingdom
| | - Babu Naidu
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom
| | - Elizabeth Belcher
- John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | | | - Vipin Zamvar
- Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, United Kingdom
| | - Rosie A. Harris
- Bristol Trials Centre (CTEU), Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Lucy Dabner
- Bristol Trials Centre (CTEU), Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Holly E. Mckeon
- Bristol Trials Centre (CTEU), Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Sangeetha Paramasivan
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Alba Realpe
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Daisy Elliot
- National Institute for Health Research Bristol Biomedical Research Centre, Surgical Innovation Theme, Centre for Surgical Research, Bristol, United Kingdom
| | - Paulo De Sousa
- Royal Brompton and Harefield Hospitals, London, United Kingdom
| | - Jane M. Blazeby
- National Institute for Health Research Bristol Biomedical Research Centre, Surgical Innovation Theme, Centre for Surgical Research, University of Bristol, Bristol, United Kingdom
| | - Chris A. Rogers
- Bristol Trials Centre (CTEU), Bristol Medical School, University of Bristol, Bristol, United Kingdom
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Piccinin C, Bottomley A, Velikova G, Groenvold M, Kuliś D, Blazeby JM, Gilbert A. Coverage of symptomatic toxicities from the common terminology criteria for adverse events (CTCAE) framework within the european organization for research and treatment of cancer (EORTC) item library. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.e24117] [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: 11/20/2022] Open
Abstract
e24117 Background: The EORTC Item Library is an online, interactive platform comprised of 950 distinct questions (items) from 67 different EORTC patient-reported outcome (PRO) questionnaires, covering a range of symptomatic toxicities, types of functioning, and impact on quality of life. These PROs provide a patient-centred perspective, complementing clinician adverse event (AE) reporting using classifications like the CTCAE. In order to summarize the coverage of symptomatic toxicities and facilitate the identification of items through use of a standardized framework, a mapping study was carried out, aimed at creating a coding system to classify EORTC items according to the CTCAE and link them to corresponding AEs. Methods: All items were searched for within the CTCAE (v5.0) using a deductive approach. Items were coded as linked if they were described within an AE’s title, description, or grading. Items not suitable for CTCAE coding were inductively assigned a descriptive classification. Descriptive classifications were also applied along with CTCAE codes when they provided additional information. Symptoms described in EORTC items but not located in the CTCAE were coded as missing and additional codes were assigned to highlight EORTC items capturing multiple underlying issues and diagnosis only CTCAE codes. Two raters independently coded 249 items and agreement was calculated. The remaining 701 items were coded by one rater and verified by the second, with a third introduced to discuss any discrepancies until a consensus was reached. Results: Agreement for raters following independent coding was 77.9% for at least one AE per item. In total, 625 (65.8%) items were linked to 208 different AEs. Fatigue was the most commonly linked AE, representing 4.9% of linked AEs. The majority of linked items were associated with one (65.6%) or two (23.5%) AEs, with some linked to three or more (10.9%). Multiple linkage resulted from different symptoms relating to the same issue/diagnosis or one symptom relating to multiple diagnoses. Two symptoms captured by six EORTC items but not found in the CTCAE were identified: bowel urgency and tenesmus. Seven descriptive non-CTCAE classifications emerged, with most of these covering the emotional impact of symptom, diagnosis, or treatment (33.6%) and information/satisfaction with care (31.7%). Nineteen items (2%) were linked to multiple underlying issues, and 43 (4.5%) to diagnosis only CTCAE codes. Conclusions: The EORTC Item Library provides extensive coverage of CTCAE symptomatic toxicities, along with other issues that are important to cancer patients, including emotional well-being and satisfaction with care services. Classifying symptomatic PRO items following the CTCAE clinical framework may facilitate future PRO selection and use in clinical trials and routine care.
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Affiliation(s)
- Claire Piccinin
- European Organisation for Research and Treatment of Cancer, Brussels, Belgium
| | - Andrew Bottomley
- European Organisation for Research and Treatment of Cancer, Brussels, Belgium
| | - Galina Velikova
- Leeds Institute of Medical Research at St James’s, University of Leeds, Leeds, United Kingdom
| | - Mogens Groenvold
- Bispebjerg and Frederiksberg Hospital & University of Copenhagen, Copenhagen, Denmark
| | - Dagmara Kuliś
- European Organisation for Research and Treatment of Cancer, Brussels, Belgium
| | - Jane M. Blazeby
- National Institute for Health Research Bristol Biomedical Research Centre, Bristol Centre for Surgical Research, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Alexandra Gilbert
- Leeds Institute of Medical Research at St James’s, University of Leeds, Leeds, United Kingdom
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50
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Paramasivan S, Davies P, Richards A, Wade J, Rooshenas L, Mills N, Realpe A, Raj JP, Subramani S, Ives J, Huxtable R, Blazeby JM, Donovan JL. What empirical research has been undertaken on the ethics of clinical research in India? A systematic scoping review and narrative synthesis. BMJ Glob Health 2021; 6:e004729. [PMID: 34006518 PMCID: PMC8137180 DOI: 10.1136/bmjgh-2020-004729] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 02/13/2021] [Accepted: 02/24/2021] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION The post-2005 rise in clinical trials and clinical research conducted in India was accompanied by frequent reports of unethical practices, leading to a series of regulatory changes. We conducted a systematic scoping review to obtain an overview of empirical research pertaining to the ethics of clinical trials/research in India. METHODS Our search strategy combined terms related to ethics/bioethics, informed consent, clinical trials/research and India, across nine databases, up to November 2019. Peer-reviewed research exploring ethical aspects of clinical trials/research in India with any stakeholder groups was included. We developed an evidence map, undertook a narrative synthesis and identified research gaps. A consultation exercise with stakeholders in India helped contextualise the review and identify additional research priorities. RESULTS Titles/Abstracts of 9699 articles were screened, full text of 282 obtained and 80 were included. Research on the ethics of clinical trials/research covered a wide range of topics, often conducted with little to no funding. Studies predominantly examined what lay (patients/public) and professional participants (eg, healthcare staff/students/faculty) know about topics such as research ethics or understand from the information given to obtain their consent for research participation. Easily accessible groups, namely ethics committee members and healthcare students were frequently researched. Research gaps included developing a better understanding of the recruitment-informed consent process, including the doctor-patient interaction, in multiple contexts and exploring issues of equity and justice in clinical trials/research. CONCLUSION The review demonstrates that while a wide range of topics have been studied in India, the focus is largely on assessing knowledge levels across different population groups. This is a useful starting point, but fundamental questions remain unanswered about informed consent processes and broader issues of inequity that pervade the clinical trials/research landscape. A priority-setting exercise and appropriate funding mechanisms to support researchers in India would help improve the clinical trials/research ecosystem.
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Affiliation(s)
- Sangeetha Paramasivan
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- University Hospitals Bristol NHS Foundation Trust, NIHR ARC West, Bristol, UK
| | - Philippa Davies
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Medical Research Council (MRC) ConDuCT-II Trials Methodology Hub, Bristol Medical School, University of Bristol, Bristol, UK
| | - Alison Richards
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Medical Research Council (MRC) ConDuCT-II Trials Methodology Hub, Bristol Medical School, University of Bristol, Bristol, UK
| | - Julia Wade
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Leila Rooshenas
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- University Hospitals Bristol NHS Foundation Trust, NIHR ARC West, Bristol, UK
| | - Nicola Mills
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- University Hospitals Bristol NHS Foundation Trust, NIHR ARC West, Bristol, UK
| | - Alba Realpe
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- University Hospitals Bristol NHS Foundation Trust, NIHR ARC West, Bristol, UK
| | - Jeffrey Pradeep Raj
- Department of Clinical Pharmacology, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Supriya Subramani
- Institute of Biomedical Ethics and History of Medicine, University of Zurich, Zurich, Switzerland
| | - Jonathan Ives
- Centre for Ethics in Medicine, University of Bristol, Bristol, UK
| | - Richard Huxtable
- Centre for Ethics in Medicine, University of Bristol, Bristol, UK
| | - Jane M Blazeby
- University Hospitals Bristol NHS Foundation Trust, NIHR ARC West, Bristol, UK
- University Hospitals Bristol NHS Foundation Trust, NIHR Bristol Biomedical Research Centre, Bristol, UK
| | - Jenny L Donovan
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- University Hospitals Bristol NHS Foundation Trust, NIHR ARC West, Bristol, UK
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