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Kwan JY, Stocco F, Scott DJA, Bailey MA, Coughlin PA. Assessment of internet-based information on statin therapy. Eur J Cardiovasc Nurs 2024; 23:115-121. [PMID: 37367216 DOI: 10.1093/eurjcn/zvad061] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 06/21/2023] [Accepted: 06/23/2023] [Indexed: 06/28/2023]
Abstract
AIMS The use of statin therapy is deemed to be controversial by mainstream media. Patients increasingly source medical information from the internet, and the use of statins is no exception. This study aims to determine the quality and educational content of statin-focused information on the internet and YouTube. METHODS AND RESULTS 'Statin' was searched on Google, Yahoo!, Bing, and YouTube. The first 50 results obtained from each search engine and the first 20 YouTube videos were screened by two assessors. Websites were assessed using the Flesch Reading Ease (FRE) score, University of Michigan Consumer Health Website Evaluation Checklist, and a customized scoring system evaluating statin-focused content for quality. Videos were scored using the Journal of the American Medical Association (JAMA) benchmark criteria, Global Quality Score (GQS), and the customized scoring system. Websites scored a median FRE score of 57.5 [interquartile range (IQR) 52.1-62.3], median Michigan score of 36 (IQR 32-41.5), and median content score of 5 (IQR 3.75-7). Good interobserver agreement was demonstrated [Michigan score interobserver coefficient correlation (ICC) = 0.968; content score ICC = 0.944]. Videos scored a median JAMA score of 2, median GQS score of 2.5, and median content score of 2.5. Good interobserver agreement was demonstrated (JAMA ICC = 0.746; GQS ICC = 0.874; content score ICC = 0.946). CONCLUSION Quality and readability of statin-focused online information are poor. Healthcare professionals should be aware of the limitations of the current available sources and design online resources that are accurate and patient-friendly.
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Affiliation(s)
- Jing Yi Kwan
- The Leeds Vascular Institute, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Great George Street, Leeds LS1 3EX, UK
- The Leeds Institute of Cardiovascular & Metabolic Medicine, School of Medicine, University of Leeds, Woodhouse Lane, Leeds LS2 9JT, UK
| | - Fabio Stocco
- The Leeds Vascular Institute, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Great George Street, Leeds LS1 3EX, UK
- The Leeds Institute of Cardiovascular & Metabolic Medicine, School of Medicine, University of Leeds, Woodhouse Lane, Leeds LS2 9JT, UK
| | - David J A Scott
- The Leeds Vascular Institute, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Great George Street, Leeds LS1 3EX, UK
| | - Marc A Bailey
- The Leeds Vascular Institute, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Great George Street, Leeds LS1 3EX, UK
- The Leeds Institute of Cardiovascular & Metabolic Medicine, School of Medicine, University of Leeds, Woodhouse Lane, Leeds LS2 9JT, UK
| | - Patrick A Coughlin
- The Leeds Vascular Institute, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Great George Street, Leeds LS1 3EX, UK
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Davies H, Safdar NZ, Yi Kwan J, Jain K, Sciberras P, Hurlow A, Po Tam SK, Coughlin P, Mees BME, Scott DJA. End of Life Care for Unplanned Vascular Admissions. Ann Vasc Surg 2024; 99:280-289. [PMID: 37852363 DOI: 10.1016/j.avsg.2023.08.024] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 08/13/2023] [Accepted: 08/16/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND Unplanned vascular admissions have a high mortality. Previous studies have indicated that end of life care (EoLC) among this group of patients is low but there exist limited data on EoLC in the United Kingdom. The aim of this study was to evaluate the quality and predictors of EoLC for unplanned vascular admissions to a tertiary center in the United Kingdom. METHODS This was a retrospective single-center cohort study of unplanned vascular surgery admissions from August 1, 2019 to January 22, 2020. Data on patient demographics, markers of quality of palliative care, mortality, and cause of death of unplanned admission to the vascular surgery department were collected from hospital and general practitioner records and evaluated against EoLC to evaluate predictors and efficacy of EoLC. Quality of palliative care markers included documentation of preferred place of death and care priorities, time spent in hospital and the intensive care unit toward the end of life, and realization of documented care objectives. EoLC input was defined as a dedicated palliative care consultation (PCC) by a palliative care professional, medical doctor, surgeon, or advanced care practitioner. We also conducted a subgroup analysis of patients within this group with chronic limb-threatening ischemia (CLTI), diabetic foot, and ruptured aortic aneurysms, as all patients in this group should be offered EoLC according to international guidelines. RESULTS One-hundred and fifty patients were included. Median age at presentation was 70.5 years, and the cohort consisted of mostly men (72%). CLTI (31%) was the most common reason for admission. Surgical intervention was carried out in 60% of patients. Two-year mortality was 36%, and pneumonia (22%) was the most common cause of death. Seven percent of patients received PCC, which occurred a median of 10 days before death. Only a minority of patients had preferred place of care/death (14%), care priorities (37%), and family involvement during advance care planning (17%) documented in their notes; 29% of patients had Recommended Summary Plan for Emergency Care and Treatment forms in place. A diagnosis of left ventricular systolic dysfunction, chronic kidney disease, and increasing age predicted Recommended Summary Plan for Emergency Care and Treatment form completion. Patients with PCC were more likely to have advance care planning, but this did not translate into improvements in the other markers of quality of palliative and, consequently, EoLC. CONCLUSIONS EoLC was insufficient and of low quality despite a high mortality in this group. Clinical guidelines and pathways are needed to ensure these patients are considered for EoLC and those with CLTI, diabetic foot sepsis or ruptured abdominal aortic aneurysms are offered it by default. Further research is needed to help identify vascular patients who would benefit from EoLC earlier to improve quality at end of life.
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Affiliation(s)
- Henry Davies
- Leeds Vascular Institute, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
| | | | - Jing Yi Kwan
- Leeds Vascular Institute, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Kinshuk Jain
- School of Medicine, University of Leeds, Leeds, UK
| | - Peter Sciberras
- Hull Royal Infirmary, Hull University Teaching Hospitals NHS Trust, Hull, UK
| | - Adam Hurlow
- Department of Palliative Care, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Sharon Ka Po Tam
- Department of Anaesthetics, University of Leicester Teaching Hospitals NHS Trust, Leicester, UK
| | - Patrick Coughlin
- Leeds Vascular Institute, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Barend M E Mees
- Department of Vascular Surgery, Maastricht University Medical Center, Maastricht, Netherlands
| | - D Julian A Scott
- Leeds Vascular Institute, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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3
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Kwan JY, Davies H, Puppala S, Bailey MA. Images in Vascular Medicine: Idiopathic internal mammary artery aneurysms. Vasc Med 2023:1358863X231210294. [PMID: 38133888 DOI: 10.1177/1358863x231210294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Affiliation(s)
- Jing Yi Kwan
- Leeds Vascular Institute, Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Leeds, UK
- Leeds Institute of Cardiovascular and Metabolic Medicine, LIGHT Building, University of Leeds, Leeds, UK
| | - Henry Davies
- Leeds Vascular Institute, Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Leeds, UK
- Leeds Institute of Cardiovascular and Metabolic Medicine, LIGHT Building, University of Leeds, Leeds, UK
| | - Sapna Puppala
- Department of Interventional Vascular Radiology, Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Leeds, UK
| | - Marc A Bailey
- Leeds Vascular Institute, Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Leeds, UK
- Leeds Institute of Cardiovascular and Metabolic Medicine, LIGHT Building, University of Leeds, Leeds, UK
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4
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Stocco F, Kwan JY, Sood M, Scott DJA, Bailey MA, Coughlin PA. Assessment of Available Online Website and YouTube Resources for Patients with Abdominal Aortic Aneurysms. Ann Vasc Surg 2023; 96:176-185. [PMID: 37169249 DOI: 10.1016/j.avsg.2023.04.031] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 03/26/2023] [Accepted: 04/29/2023] [Indexed: 05/13/2023]
Abstract
BACKGROUND Over the last decade, patients have displayed a greater tendency to search for online information related to their health before seeking advice from a clinician. This study aims to determine the current quality and educational content of online patient information for abdominal aortic aneurysms (AAAs). METHODS In March 2022, the 3 most popular search engines by market shares (Google, Yahoo!, and Bing) and the video platform YouTube were interrogated for the term "abdominal aortic aneurysm". Validated scoring tools were used to assess quality and readability of the top 50 results for each search engine and to evaluate reliability and educational quality of the first 20 YouTube videos returned by the search. A custom-made scoring system was used to assess content. RESULTS Forty-five unique websites were analysed, 29% of which held Health on the Net certification. Median Flesch-Kincaid Reading Ease (interquartile range [IQR]) was 56.4 (50.4-62.75), with the average website falling under the "difficult to read" category. Median Michigan score (IQR) was 38.5 (32-43.5), reflecting "weak" quality. Websites with a higher content-specific score had a significantly higher median Michigan score. Sixty percent of websites discussed benefits and risks related to AAA treatment, and only 31% discussed advantages and disadvantages of open versus endovascular treatment. No websites mentioned the volume-outcome relationship in aneurysm surgery. Eight unique YouTube videos were assessed. Median Journal of the American Medical Association score (IQR) was 2 (2-2.25). Median Global Quality Score score (IQR) was 3 (2-4). Median content score was 1 (0-2). CONCLUSIONS The current average online information on AAA is of 'weak' quality and 'difficult' (i.e., above the standard reading ability of a 13- to 15-year-old) readability. Healthcare providers should focus on the provision of better AAA-focused patient information (e.g., appropriately referenced, regularly reviewed, and limiting advertisements where possible). The involvement of patient advisory groups during resource development is highly recommended.
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Affiliation(s)
- Fabio Stocco
- The Leeds Vascular Institute, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Jing Yi Kwan
- The Leeds Vascular Institute, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Mehak Sood
- The Leeds Vascular Institute, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - D Julian A Scott
- The Leeds Vascular Institute, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Marc A Bailey
- The Leeds Vascular Institute, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK; The Leeds Institute of Cardiovascular & Metabolic Medicine, School of Medicine, University of Leeds, Leeds, UK.
| | - Patrick A Coughlin
- The Leeds Vascular Institute, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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5
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Heinz J, Walshaw J, Kwan JY, Long J, Carradice D, Totty J, Kontouli KM, Lainas P, Hitchman L, Smith G, Huo B, Guadalajara H, Garcia-Olmo D, Sharma D, Biyani CS, Tomlinson J, Loubani M, Galli R, Lathan R, Chetter I, Yiasemidou M. PRESS survey: PREvention of surgical site infection-a global pan-specialty survey of practice protocol. Front Surg 2023; 10:1251444. [PMID: 37818209 PMCID: PMC10560728 DOI: 10.3389/fsurg.2023.1251444] [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: 07/01/2023] [Accepted: 08/15/2023] [Indexed: 10/12/2023] Open
Abstract
Background Surgical site infections (SSI) complicate up to 40% of surgical procedures, leading to increased patient morbidity and mortality. Previous research identified disparities in SSI prevention guidelines and clinical practices across different institutions. The study aims to identify variations in SSI prevention practices within and between specialties and financial systems and provide a representation of existing SSI preventative measures to help improve the standardization of SSI prevention practices. Methods This collaborative cross-sectional survey will be aimed at pan-surgical specialties internationally. The study has been designed and will be reported in line with the CROSS and CHERRIES standards. An international study steering committee will design and internally validate the survey in multiple consensus-based rounds. This will be based on SSI prevention measures outlined in the CDC (2017), WHO (2018), NICE (2019), Wounds UK (2020) and the International Surgical Wound Complications Advisory Panel (ISWCAP) guidelines. The questionnaire will include demographics, SSI surveillance, preoperative, peri-operative and postoperative SSI prevention. Data will be collected on participants' surgical specialty, operative grade, of practice and financial healthcare system of practice. The online survey will be designed and disseminated using QualtricsXM Platform™ through national and international surgical colleges and societies, in addition to social media and snowballing. Data collection will be open for 3 months with reminders, and raking will be used to ascertain the sample. Responses will be analyzed, and the chi-square test used to evaluate the impact of SSI prevention variables on responses. Discussion Current SSI prevention practice in UK Vascular surgery varies considerably, with little consensus on many measures. Given the inconsistency in guidelines on how to prevent SSIs, there is a need for standardization. This survey will investigate the disparity in SSI preventative measures between different surgical fields and countries.
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Affiliation(s)
- J Heinz
- Clinical Sciences Centre, Hull York Medical School, Hull, United Kingdom
- Academic Vascular Surgical Unit, Hull University Teaching Hospitals NHS Trust, Hull, United Kingdom
| | - J Walshaw
- Clinical Sciences Centre, Hull York Medical School, Hull, United Kingdom
- Academic Vascular Surgical Unit, Hull University Teaching Hospitals NHS Trust, Hull, United Kingdom
- Department of Health Sciences, University of York, York, United Kingdom
| | - J Y Kwan
- Leeds Vascular Institute, Leeds Teachings Hospitals NHS Trust, Leeds, United Kingdom
| | - J Long
- Clinical Sciences Centre, Hull York Medical School, Hull, United Kingdom
- Academic Vascular Surgical Unit, Hull University Teaching Hospitals NHS Trust, Hull, United Kingdom
| | - D Carradice
- Clinical Sciences Centre, Hull York Medical School, Hull, United Kingdom
- Academic Vascular Surgical Unit, Hull University Teaching Hospitals NHS Trust, Hull, United Kingdom
| | - J Totty
- Clinical Sciences Centre, Hull York Medical School, Hull, United Kingdom
- Department of Plastic and Reconstructive Surgery, Hull University Teaching Hospitals NHS Trust, Hull, United Kingdom
| | - K M Kontouli
- Department of Mathematics, University of Ioannina, Ioannina, Greece
| | - P Lainas
- Department of Digestive Surgery, Metropolitan Hospital, HEAL Academy, Athens, Greece
- Department of Minimally Invasive Digestive Surgery, Antoine-Béclère Hospital, Partis-Saclay University, Clamart, France
| | - L Hitchman
- Clinical Sciences Centre, Hull York Medical School, Hull, United Kingdom
- Academic Vascular Surgical Unit, Hull University Teaching Hospitals NHS Trust, Hull, United Kingdom
| | - G Smith
- Clinical Sciences Centre, Hull York Medical School, Hull, United Kingdom
- Academic Vascular Surgical Unit, Hull University Teaching Hospitals NHS Trust, Hull, United Kingdom
| | - B Huo
- Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - H Guadalajara
- Department of Surgery, Hospital Universitario Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Madrid, Spain
| | - D Garcia-Olmo
- Department of Surgery, Hospital Universitario Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Madrid, Spain
| | - D Sharma
- Department of Surgery, Government NSCB Medical College, Jabalpur, India
| | - C S Biyani
- Department of Urology, St James University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - J Tomlinson
- Trauma and Orthopedics, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - M Loubani
- Department of Cardiothoracic Surgery, Hull University Teaching Hospitals NHS Trust, Hull, United Kingdom
| | - R Galli
- Department of Surgery, Cantonal Hospital Baselland, Liestal, Switzerland
| | - R Lathan
- Clinical Sciences Centre, Hull York Medical School, Hull, United Kingdom
- Academic Vascular Surgical Unit, Hull University Teaching Hospitals NHS Trust, Hull, United Kingdom
- Department of Health Sciences, University of York, York, United Kingdom
| | - I Chetter
- Clinical Sciences Centre, Hull York Medical School, Hull, United Kingdom
- Academic Vascular Surgical Unit, Hull University Teaching Hospitals NHS Trust, Hull, United Kingdom
| | - M Yiasemidou
- Clinical Sciences Centre, Hull York Medical School, Hull, United Kingdom
- Department of General Surgery, Bradford Teaching Hospitals NHS Trust, Bradford, United Kingdom
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6
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McClean A, Huo B, Kwan JY, Long J, Walshaw J, Mesri M, Francis N, Arulampalam TH, Chetter I, Yiasemidou M. The impact of the European Association of Endoscopic Surgery research grant scheme-a mixed qualitative quantitative methodology study protocol. Front Surg 2023; 10:1197103. [PMID: 37405059 PMCID: PMC10315820 DOI: 10.3389/fsurg.2023.1197103] [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: 03/30/2023] [Accepted: 05/31/2023] [Indexed: 07/06/2023] Open
Abstract
Background The European Association of Endoscopic Surgery (EAES) is a surgical society who promotes the development and expansion of minimally invasive surgery to surgeons and surgical trainees. It does so through its activities in education, training, and research. The EAES research committee aims to promote the highest quality clinical research in endoscopic and minimally invasive surgery. They have provided grant funding since 2009 in education, surgery, and basic science. Despite the success and longevity of the scheme, the academic and non-academic impact of the research funding scheme has not been evaluated. Aims The primary aim of this project is to assess the short, long term academic and real world impact of the EAES funding scheme. The secondary aims are to identify barriers and facilitators for achieving good impact. Methods This will be a mixed qualitative and quantitative study. Semi-structured interviews will be performed with previous grant recipients. The questions for the interviews will be selected after a consensus is achieved amongst the members of the steering committee of this project. The responses will be transcribed and thematic analysis will be applied. The results of the thematic analysis will be used to populate a questionnaire which will be disseminated to grant recipients. This study is kindly funded by the EAES. Discussion The first question this project is expected to answer is whether the EAES research funding scheme had a significant positive impact on research output, career progression but also non-academic output such as change in clinical guidelines, healthcare quality and cost-effectiveness improvement. This project however is also expected to identify facilitators and barriers to successful completion of projects and to achieving high impact. This will inform EAES and the rest of the surgical and academic communities as to how clinicians would like to be supported when conducting research. There should also be a positive and decisive change towards removing factors that hinder the timely and successful completion of projects.
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Affiliation(s)
- Adam McClean
- Clinical Fellow General Surgery, Bradford Teaching Hospitals, Bradford, United Kingdom
| | - Bright Huo
- Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Jing Yi Kwan
- NIHR Academic Clinical Fellow, Vascular Surgery, Leeds Teaching Hospitals, Leeds, United Kingdom
| | - Judith Long
- Research Manager, Academic Vascular Surgical Unit, Hull University Teaching Hospitals NHS Trust, Hull, United Kingdom
| | - Josephine Walshaw
- Department of Health Research, University of York, York, United kingdom
| | - Mina Mesri
- Department of Medicine, Hull York MedicalSchool, York, United kingdom
| | - Nader Francis
- Consultant Colorectal Surgeon, Department of Surgery, Yeovil District Hospital NHS Foundation Trust, Honorary Professor of Surgery UCL, Yeovil, United Kingdom
| | - Tan H. Arulampalam
- Consultant Colorectal Surgeon, ICENI Centre, Colchester Hospital University NHS Foundation Trust, Colchester, Essex, United Kingdom
| | - Ian Chetter
- Professor of Surgery, Hull University Teaching Hospital, Hull, United Kingdom
| | - Marina Yiasemidou
- Department of Medicine, NIHR Academic Clinical Lecturer in General Surgery, Hull York Medical School, Hull, United Kingdom
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7
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Kwan JY, Lainas P, Banks P, Jimenez De Veciana A, Said H, Mehrem A, Debbarma M, Matthews M, Etim G, Biyani CS, Rajpal S, Phillipson M, Palit V, Renwick P, Yiasemidou M. Five-Year results of a multi-specialty induction course for surgical training. Front Surg 2023; 10:1198696. [PMID: 37405057 PMCID: PMC10315573 DOI: 10.3389/fsurg.2023.1198696] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 05/30/2023] [Indexed: 07/06/2023] Open
Abstract
Background The Essential Surgical Skills Course (ESSC) is a multi-specialty induction "boot camp" style course that has been run successfully for five years. The aim of the current paper is to create an accurate guide for the replication of the course by other teams and assess the course's fitness for purpose, through the survey feedback provided by trainees. Methods The course's fitness for purpose was assessed through cumulative five-year survey feedback from trainees. This observational study describes the design and process of content adjustment according to feedback. Results The course its five-year span offered twelve different procedural skills in four different specialties. Feedback for each session was persistently >8/10. Key themes identified as beneficial include teacher-to-trainee ratio (often 1:1), teaching style, course structure and responsiveness. Conclusions The ESSC was found to be fit for purpose for the induction of trainees into surgical training. The key factors contributing to the success of the course include the structured method of curriculum design, outstanding teaching delivery methods, teacher-to-trainee ratio, the availability of appropriate faculty and infrastructure and the willingness to learn from trainee feedback and adjust the content of the course accordingly. It acts as a paradigm for courses aimed to prepare surgical trainees for a "step-up" in their careers.
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Affiliation(s)
- Jing Yi Kwan
- Department of Vascular Surgery, Leeds Teaching Hospitals, Leeds, United Kingdom
| | - Panagiotis Lainas
- Department of Digestive Surgery, Metropolitan Hospital, HEAL Academic, Athens, Greece
- Department of Minimally Invasive Digestive Surgery, Antoine-Beclere Hospital, Paris-Saclay University, Clamart, France
| | - Philippa Banks
- Department of General Surgery, Bradford Teaching Hospitals, Bradford, United Kingdom
| | | | - Hagar Said
- School of Medicine, University of York, York, United Kingdom
| | - Anna Mehrem
- Department of General Surgery, Bradford Teaching Hospitals, Bradford, United Kingdom
| | - Manash Debbarma
- Department of Urology, Mid Yorkshire Hospitals NHS Trust, Wakefield, United Kingdom
| | - Melissa Matthews
- School of Medicine, Hull York Medical School, Hull, United Kingdom
| | - Gloria Etim
- School of Medicine, Hull York Medical School, Hull, United Kingdom
| | | | - Sanjay Rajpal
- Department of Urology, Airedale General Hospital, Airedale, United Kingdom
| | - Mark Phillipson
- Department of Orthopaedics, Leeds Teaching Hospitals, Leeds, United Kingdom
| | - Victor Palit
- Department of Urology, Leeds Teaching Hospitals, Leeds, United Kingdom
| | - Paul Renwick
- Department of Vascular Surgery, Hull University Teaching Hospitals, Hull, United Kingdom
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8
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Walshaw J, Huo B, McClean A, Gajos S, Kwan JY, Tomlinson J, Biyani CS, Dimashki S, Chetter I, Yiasemidou M. Innovation in gastrointestinal surgery: the evolution of minimally invasive surgery-a narrative review. Front Surg 2023; 10:1193486. [PMID: 37288133 PMCID: PMC10242011 DOI: 10.3389/fsurg.2023.1193486] [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: 03/24/2023] [Accepted: 05/04/2023] [Indexed: 06/09/2023] Open
Abstract
Background Minimally invasive (MI) surgery has revolutionised surgery, becoming the standard of care in many countries around the globe. Observed benefits over traditional open surgery include reduced pain, shorter hospital stay, and decreased recovery time. Gastrointestinal surgery in particular was an early adaptor to both laparoscopic and robotic surgery. Within this review, we provide a comprehensive overview of the evolution of minimally invasive gastrointestinal surgery and a critical outlook on the evidence surrounding its effectiveness and safety. Methods A literature review was conducted to identify relevant articles for the topic of this review. The literature search was performed using Medical Subject Heading terms on PubMed. The methodology for evidence synthesis was in line with the four steps for narrative reviews outlined in current literature. The key words used were minimally invasive, robotic, laparoscopic colorectal, colon, rectal surgery. Conclusion The introduction of minimally surgery has revolutionised patient care. Despite the evidence supporting this technique in gastrointestinal surgery, several controversies remain. Here we discuss some of them; the lack of high level evidence regarding the oncological outcomes of TaTME and lack of supporting evidence for robotic colorectalrectal surgery and upper GI surgery. These controversies open pathways for future research opportunities with RCTs focusing on comparing robotic to laparoscopic with different primary outcomes including ergonomics and surgeon comfort.
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Affiliation(s)
- Josephine Walshaw
- Academic Vascular Surgical Unit, Hull University Teaching Hospitals NHS Trust, Hull, United Kingdom
| | - Bright Huo
- Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Adam McClean
- Department of General Surgery, Bradford Teaching Hospitals NHS Trust, Bradford, United Kingdom
| | - Samantha Gajos
- Emergency Medicine Department, York and Scarborough Teaching Hospitals NHS Foundation Trust, York, United Kingdom
| | - Jing Yi Kwan
- Department of General Surgery, Bradford Teaching Hospitals NHS Trust, Bradford, United Kingdom
- Department of Vascular Surgery, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - James Tomlinson
- Department of Spinal Surgery, SheffieldTeaching Hospitals, Sheffield, United Kingdom
| | - Chandra Shekhar Biyani
- Department of Vascular Surgery, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Safaa Dimashki
- Department of General Surgery, Bradford Teaching Hospitals NHS Trust, Bradford, United Kingdom
| | - Ian Chetter
- Academic Vascular Surgical Unit, Hull University Teaching Hospitals NHS Trust, Hull, United Kingdom
| | - Marina Yiasemidou
- NIHR Academic Clinical Lecturer General Surgery, University of Hull, Hull, United Kingdom
- Hull York Medical School, University of York, York, United Kingdom
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9
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Davies H, Vleugels MJ, Kwan JY, Aerden A, Wyld L, Fawcett LE, Anthony R, Khan A, Wallace T, Van Den Beuken-Van Everdingen M, Schurink GW, Mees BME, Scott DJA. End of Life Care and Advance Care Planning for Outpatients with Inoperable Aortic Aneurysms. J Vasc Surg 2023:S0741-5214(23)01041-8. [PMID: 37076107 DOI: 10.1016/j.jvs.2023.04.015] [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: 10/29/2022] [Revised: 04/07/2023] [Accepted: 04/08/2023] [Indexed: 04/21/2023]
Abstract
OBJECTIVE A significant proportion of patients with abdominal and thoracic aortic aneurysms (AA) do not proceed to intervention after reaching treatment threshold diameter due to a combination of poor cardiovascular reserve, frailty and aortic morphology. This patient cohort has a high mortality, however, until this study, there exist no studies on the end of life care conservatively managed patients receive. DESIGN This is a retrospective multicentre cohort study of 220 conservatively managed AA patients referred to Leeds Vascular Institute (UK) and Maastricht University Medical Centre (Netherlands) for intervention between 2017 and 2021. METHODS Demographic details, mortality, cause of death, advance care planning and palliative care outcomes were analysed to examine predictors of palliative care referral and efficacy of palliative care consultation. RESULTS A total of 1506 AA patients were seen over this time period, giving a non-intervention rate of 15%. There was a 3-year mortality rate of 55%, a median survival of 364 days and rupture was the reported cause of death in 18% of the decedents. Median follow up was 34 months. Only 8% of all patients and 16% of decedents received palliative care consultation, which took place a median of 3.5 days before death. Patients over 81 years of age were more likely to have advance care planning. Only 5% and 23% of conservatively managed patients had documentation of preferred place of death and care priorities respectively. Patients with palliative care consultation were more likely to have these in place. CONCLUSION Only a small proportion of conservatively treated patients had advance care planning and this was far below international guidelines on end of life care for adults, which recommend it for each of these patients. Pathways and guidance should be implemented to ensure patients not offered AA intervention receive end of life care and advance care planning.
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Affiliation(s)
- Henry Davies
- Leeds Vascular Institute, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Great George Street, Leeds, LS1 3EX, UK.
| | - Marie-José Vleugels
- Department of Vascular Surgery, Maastricht University Medical Center, Maastricht, Netherlands
| | - Jing Yi Kwan
- Leeds Vascular Institute, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Great George Street, Leeds, LS1 3EX, UK
| | - Alexander Aerden
- Department of Vascular Surgery, Maastricht University Medical Center, Maastricht, Netherlands
| | - Lucy Wyld
- Palliative Care, Leeds Teaching Hospitals NHS Trust, Great George Street, Leeds, LS1 3EX, UK
| | - Lee-Ellen Fawcett
- Proactive Care of Older People Going to Have Surgery Service, Leeds Teaching Hospitals NHS Trust, Great George Street, Leeds, LS1 3EX, UK
| | - Rebecca Anthony
- Proactive Care of Older People Going to Have Surgery Service, Leeds Teaching Hospitals NHS Trust, Great George Street, Leeds, LS1 3EX, UK
| | - Assad Khan
- Leeds Vascular Institute, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Great George Street, Leeds, LS1 3EX, UK
| | - Tom Wallace
- Leeds Vascular Institute, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Great George Street, Leeds, LS1 3EX, UK
| | | | - Geert Willem Schurink
- Department of Vascular Surgery, Maastricht University Medical Center, Maastricht, Netherlands
| | - Barend M E Mees
- Department of Vascular Surgery, Maastricht University Medical Center, Maastricht, Netherlands
| | - D Julian A Scott
- Leeds Vascular Institute, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Great George Street, Leeds, LS1 3EX, UK
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10
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Kwan JY, Tang SH, Davies H, Sood M, Sucharitkul PP, Wallace T, Scott DJA, Coughlin PA, Bailey MA. Analyzing Sex Differences in Intensity of Cardiovascular Disease Prevention Medications in Patients With Abdominal Aortic Aneurysms-A Single-Center Cross-Sectional Study. Ann Vasc Surg 2023; 90:67-76. [PMID: 36460174 DOI: 10.1016/j.avsg.2022.10.024] [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] [Received: 08/29/2022] [Revised: 10/08/2022] [Accepted: 10/22/2022] [Indexed: 12/02/2022]
Abstract
BACKGROUND Patients with abdominal aortic aneurysm (AAA) are at a significant risk of cardiovascular events, similar to that of patients who have already experienced a major cardiac event. The European Society for Vascular Society AAA guidelines suggest that antiplatelet therapy and lipid-lowering therapy (LLT) should be considered in all patients with AAA. This study explores the overall prevalence and intensity of antithrombotic therapy and LLT, and lipid profile monitoring in a single center AAA surveillance cohort alongside any sex differences. METHODS This was a retrospective, single center, cross-sectional study of 614 patients enrolled in the AAA surveillance program of a tertiary vascular surgery unit. All patients undergoing at least 1 surveillance scan from January 1, 2018, to December 31, 2020, were assessed. Electronic hospital records linked to real-time primary care records were interrogated for data on demographics, comorbidities, antiplatelet and LLT prescriptions, and serum cholesterol laboratory results. An analysis of covariance test was used to account for the effects of confounding comorbidities. RESULTS Twenty-one percent of patients were not on antithrombotic therapy, and 20% of patients were not on LLT which reflects a group of patients receiving sub-optimal clinical care. In total, 47% of the cohort were on low/moderate intensity statin therapy which reflects a group of patients where care can be improved upon. Female sex was independently associated with a reduced likelihood of being prescribed LLT (P = 0.008, eta squared (ηp2) = 0.012, small effect size) but not antithrombotic therapy (P = 0.202). Fewer women underwent low-density lipoprotein cholesterol (LDL-C) monitoring (mean difference 9%, P = 0.040) and achieved the European Society of Cardiology-European Atherosclerosis Society- LDL-C target of <1.4 mmol/L (mean difference 9%, P = 0.040). CONCLUSIONS Overall, there is room for improvement in these aspects of cardiovascular risk prevention for both sexes. Sex differences in the prescription of LLT, the prevalence of lipid profile monitoring, and likelihood of achieving LDL-C targets exist among patients with AAA, with a lower prevalence in women.
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Affiliation(s)
- Jing Yi Kwan
- The Leeds Vascular Institute, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK; The Leeds Institute of Cardiovascular & Metabolic Medicine, School of Medicine, University of Leeds, Leeds, UK
| | - Steve Hm Tang
- The Leeds Vascular Institute, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Henry Davies
- The Leeds Vascular Institute, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK; The Leeds Institute of Cardiovascular & Metabolic Medicine, School of Medicine, University of Leeds, Leeds, UK
| | - Mehak Sood
- The Leeds Institute for Medical Education, School of Medicine, University of Leeds, Leeds, UK
| | - Penelope Pj Sucharitkul
- The Leeds Vascular Institute, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK; The Leeds Institute for Medical Education, School of Medicine, University of Leeds, Leeds, UK
| | - Tom Wallace
- The Leeds Vascular Institute, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - D Julian A Scott
- The Leeds Vascular Institute, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Patrick A Coughlin
- The Leeds Vascular Institute, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Marc A Bailey
- The Leeds Vascular Institute, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK; The Leeds Institute of Cardiovascular & Metabolic Medicine, School of Medicine, University of Leeds, Leeds, UK.
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11
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Davies H, Vleugels MJ, Kwan JY, Aerden A, Wyld L, Mees B, Scott DJA. SP11.6 End of Life Care and Advance Care Planning for Outpatients with Inoperable Abdominal Aortic Aneurysms – A Retrospective Cohort Study. Br J Surg 2022. [DOI: 10.1093/bjs/znac247.125] [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: 11/05/2022]
Abstract
Abstract
Introduction
A proportion of patients with aortic aneurysms (AA) do not proceed to intervention after reaching treatment threshold diameter due to a combination of poor cardiovascular reserve, frailty and aortic morphology. This patient cohort has a high mortality, however, there exist no studies on the palliative care (PC) and advance care planning (ACP) they receive following discharge from the clinic.
Methods
We conducted a multicentre cohort study of 220 conservatively managed AA patients referred to centres in Leeds and the Maastricht for intervention between 2017 and 2021, from a combined total of 1506 patients - a non-intervention rate of 15%. Demographic details, mortality, cause of death, ACP and PC outcomes were analysed to examine predictors of PC referral and consultation efficacy.
Results
There was a 3-year mortality rate of 60%. Rupture was the reported cause of death in 17% of the decedents. Only 9% of all patients received PC referrals - a median of 3.5 days before death. Patients over 80 were more likely to have PCCs. Almost half of the decedents were readmitted to hospital before death and 37% died in hospital. Only 5% of patients had a documented preferred place of death. Patients with PCCs were more likely to have preferred place of death and care priorities documented.
Conclusion
Only a small proportion of conservatively treated patients with AAs had ACP, far below 2019 NICE end-of-life care guidance. It is also far below the level offered to oncology patients. Pathways and guidance should be implemented to ensure patients not offered AA intervention are offered end-of-life care and ACP.
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Affiliation(s)
- Henry Davies
- Leeds Vascular Institute , Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust
| | - Marie-José Vleugels
- Department of Vascular Surgery, Maastricht University Medical Center , Maastricht , the Netherlands
| | - Jing Yi Kwan
- Leeds Vascular Institute , Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust
| | - Alexander Aerden
- Department of Vascular Surgery, Maastricht University Medical Center , Maastricht , the Netherlands
| | - Lucy Wyld
- Palliative Care, Leeds Teaching Hospitals NHS Trust
| | - Barend Mees
- Department of Vascular Surgery, Maastricht University Medical Center , Maastricht , the Netherlands
| | - D Julian A Scott
- Leeds Vascular Institute , Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust
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12
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Kwan JY, Noor M. Clozapine‐induced pulmonary embolism in a patient with no pre‐existing risk factors: A case report. Clin Case Rep 2022; 10:e05497. [PMID: 35340632 PMCID: PMC8933634 DOI: 10.1002/ccr3.5497] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 02/11/2022] [Indexed: 12/17/2022] Open
Abstract
We report the case of a 51‐year‐old Caucasian woman who developed a pulmonary embolism in the absence of any pre‐existing risk factors for VTE, 3 weeks following clozapine initiation for treatment resistant paranoid schizophrenia. She was initially misdiagnosed and treated for suspected COVID‐19 infection.
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Affiliation(s)
- Jing Yi Kwan
- Lynfield Mount Hospital Bradford District Care Trust Bradford UK
| | - Maha Noor
- Lynfield Mount Hospital Bradford District Care Trust Bradford UK
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13
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14
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Kwan JY. HA coatings in implant dentistry--hype, hysteria, and clinical reality. Implant Soc 1993; 3:1-16. [PMID: 8117789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
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15
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Kwan JY. The ailing implant. J Calif Dent Assoc 1991; 19:51-6. [PMID: 1726435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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16
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Kwan JY. Implant maintenance. J Calif Dent Assoc 1991; 19:45-9. [PMID: 1726434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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17
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Douglass GL, Shanelec DA, Detsch SG, Zablotsky MH, Kwan JY, Rempfer RK, Bartlett ML. Periodontics. J Calif Dent Assoc 1991; 19:49-55. [PMID: 1713621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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18
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Kwan JY, Zablotsky MH, Meffert RM. Implant maintenance using a modified ultrasonic instrument. J Dent Hyg 1990; 64:422, 424-5, 430. [PMID: 2098488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
With the increasing number of implants in place, oral hygiene and maintenance are imperative because implants are susceptible to plaque accumulation and calculus formation. This case study evaluated a modification of the common ultrasonic tip to remove calcified deposits on implant abutments and prostheses, and also evaluated ultrastructural changes on polished titanium. A modified "plastic" ultrasonic instrument was found to be clinically effective and efficient. This instrument, unlike a metal ultrasonic tip on an ultrastructural level, produced no irreversible changes on the evaluated commercially pure titanium test strip. The preliminary results of this modification of an ultrasonic instrument show promise for its use as an implant maintenance modality.
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Affiliation(s)
- J Y Kwan
- USAF Hospital Mather, Mather AFB, California
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Kwan JY, Meffert RM. HA coatings in implant dentistry. Implant Soc 1990; 1:2-4. [PMID: 1963554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- J Y Kwan
- USAF Hospital Mather/SGD, Mather AFB California
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Kwan JY, Morris RW. The Bridgend modification of the Manley ventilator. Anaesthesia 1986; 41:679-80. [PMID: 3460367 DOI: 10.1111/j.1365-2044.1986.tb13111.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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