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Starsmore K, Lopez-Villalobos N, Shalloo L, Egan M, Burke J, Lahart B. Animal factors that affect enteric methane production measured using the GreenFeed monitoring system in grazing dairy cows. J Dairy Sci 2024; 107:2930-2940. [PMID: 37977449 DOI: 10.3168/jds.2023-23915] [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: 06/30/2023] [Accepted: 10/31/2023] [Indexed: 11/19/2023]
Abstract
Similar to all dairy systems internationally, pasture-based dairy systems are under increasing pressure to reduce their greenhouse gas (GHG) emissions. Ireland and New Zealand are 2 countries operating predominantly pasture-based dairy production systems where enteric CH4 contributes 23% and 36% of total national emissions, respectively. Ireland currently has a national commitment to reduce 51% of total GHG emissions by 2030 and 25% from agriculture by 2030, as well as striving to achieve climate neutrality by 2050. New Zealand's national commitment is to reduce 10% of methane emissions by 2030 and between 24% and 47% reduction in methane emissions by 2050. To achieve these reductions, factors that affect enteric methane (CH4) production in a pasture-based system need to be investigated. The objective of this study was to assess the relationship between enteric CH4 and other animal traits (feed intake, metabolic liveweight, energy corrected milk yield, milk urea concentration, and body condition score [BCS]) in a grazing dairy system. Enteric CH4 emissions were measured on 45 late lactation (213.8 ± 29 d after calving) grazing Holstein-Friesian and Holstein-Friesian × Jersey crossbred cows (lactation number 3.01 ± 1.65, 538.64 ± 59.37 kg live weight, and 3.14 ± 0.26 BCS) using GreenFeed monitoring equipment for 10 wk. There was a training period for the cows to use the GreenFeed of 3 wk before the 10-wk study period. The average enteric CH4 produced in the study was 352 g ± 45.7 g per day with an animal to animal coefficient of variation of 13%. Dry matter intake averaged 16.6 kg ± 2.23 kg per day, while milk solids (fat plus protein) averaged 1.62 kg ± 0.29 kg per day. A multiple linear regression model indicated that each one unit increase in energy corrected milk yield, metabolic liveweight and milk urea concentration, resulted in an increase in enteric CH4 production per day by 3.9, 1.74, and 1.38 g, respectively. Although each one unit increase in BCS resulted in a decrease in 39.03 g CH4 produced per day. When combined, these factors explained 47% of the variation in CH4 production, indicating that there is a large proportion of variation not included in the model. The repeatability of the CH4 measurements was 0.66 indicating that cows are relatively consistently exhibiting the same level of CH4 throughout the study. Therefore, enteric CH4 production is suitable for phenotyping.
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Affiliation(s)
- K Starsmore
- Teagasc, Animal and Grassland Research and Innovation Centre, Moorepark, Fermoy Co. Cork, Ireland P31 P302; Massey University, Palmerston North, Manawatu, New Zealand 4442.
| | | | - L Shalloo
- Teagasc, Animal and Grassland Research and Innovation Centre, Moorepark, Fermoy Co. Cork, Ireland P31 P302
| | - M Egan
- Teagasc, Animal and Grassland Research and Innovation Centre, Moorepark, Fermoy Co. Cork, Ireland P31 P302
| | - J Burke
- Massey University, Palmerston North, Manawatu, New Zealand 4442
| | - B Lahart
- Teagasc, Animal and Grassland Research and Innovation Centre, Moorepark, Fermoy Co. Cork, Ireland P31 P302
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El-Sayed C, Yiu A, Burke J, Vaughan-Shaw PG, Todd J, Lin P, Kasmani Z, Munsch C, Rooshenas L, Campbell M, Bach SP. Correction to: Measures of performance and proficiency in robotic assisted surgery: a systematic review. J Robot Surg 2024; 18:163. [PMID: 38578548 DOI: 10.1007/s11701-024-01864-3] [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: 04/06/2024]
Affiliation(s)
- Charlotte El-Sayed
- Robotics and Digital Surgery Initiative, Royal College of Surgeons England, London, England, UK.
- NHSE Technology Enhanced Learning, London, UK.
- Institute of Cancer and Genomics, University of Birmingham, Birmingham, UK.
| | - A Yiu
- Guys' and St Thomas NHS Foundation Trust, London, UK
| | - J Burke
- Leeds Institute Medical Research, University of Leeds, Leeds, UK
| | | | - J Todd
- Worcestershire Acute Hospitals NHS Trust, Worcester, UK
| | - P Lin
- Worcestershire Acute Hospitals NHS Trust, Worcester, UK
| | - Z Kasmani
- Worcestershire Acute Hospitals NHS Trust, Worcester, UK
| | - C Munsch
- NHSE Technology Enhanced Learning, London, UK
| | - L Rooshenas
- Population Health Science, Bristol Medical School, University of Bristol, Bristol, UK
| | - M Campbell
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - S P Bach
- Robotics and Digital Surgery Initiative, Royal College of Surgeons England, London, England, UK
- Institute of Cancer and Genomics, University of Birmingham, Birmingham, UK
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3
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Sheng Z, Laloo R, Lewis S, Giwa L, Burke J, Brennan PA, Ellis R. The hidden costs of the intercollegiate membership of the Royal College of surgeons examinations: Can trainees afford it? Surgeon 2024:S1479-666X(24)00018-0. [PMID: 38368193 DOI: 10.1016/j.surge.2024.02.003] [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: 12/02/2023] [Revised: 02/07/2024] [Accepted: 02/08/2024] [Indexed: 02/19/2024]
Abstract
BACKGROUND The Intercollegiate Membership of the Royal College of Surgeons (MRCS) examination is a mandatory requirement for higher specialty surgical training in the UK. However, there is a significant economic impact on trainees which raises the question of whether the costs of this exam hinder surgical career progression. This study explores the burden of these exams on trainees. METHODS A 37-point questionnaire was distributed to all trainees who were preparing for or have sat MRCS examinations. Univariate analyses included the cost of the preparatory resources, extra hours worked to pay for these and the examinations, and the number of annual leave (AL) days taken to prepare. Pearson correlation coefficients were used to identify possible correlation between monetary expenditure and success rate. RESULTS On average, trainees (n = 145) spent £332.54, worked 31.2 h in addition to their rostered hours, and used 5.8 AL days to prepare for MRCS Part A. For MRCS Part B/ENT, trainees spent on average £682.92, worked 41.7 extra hours, and used 5 AL days. Overall, the average trainee spent 5-9% of their salary and one-fifth of their AL allowance to prepare for the exams. There was a positive correlation between number of attempts and monetary expenditure on Part A preparation (r(109)=0.536, p < 0.001). CONCLUSIONS There is a considerable financial and social toll of the MRCS examination on trainees. Reducing this is crucial to tackle workforce challenges that include trainee retention and burnout. Further studies exploring study habits can help reform study budget policies to ease this pressure on trainees.
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Affiliation(s)
- Ziyan Sheng
- Nottingham University Hospitals NHS Trust, Nottingham, NG5 1PB, United Kingdom.
| | - Ryan Laloo
- Association of Surgeons in Training (ASiT), Royal College of Surgeons of England, London, WC2A 3PE, United Kingdom.
| | - Sophie Lewis
- Association of Surgeons in Training (ASiT), Royal College of Surgeons of England, London, WC2A 3PE, United Kingdom.
| | - Lola Giwa
- Association of Surgeons in Training (ASiT), Royal College of Surgeons of England, London, WC2A 3PE, United Kingdom.
| | - Josh Burke
- Association of Surgeons in Training (ASiT), Royal College of Surgeons of England, London, WC2A 3PE, United Kingdom.
| | - Peter A Brennan
- Department of Maxillo-Facial Surgery, Queen Alexandra Hospital, Portsmouth, PO6 3LY, United Kingdom.
| | - Ricky Ellis
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, AB25 2ZD, United Kingdom.
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Thaventhiran A, McKnight G, Clements JM, Barlow E, Pegna V, Dovell G, Nally D, Burke J. The Association of Surgeons in Training (ASiT) Consensus Statement on Major Trauma Training in the UK. Ann R Coll Surg Engl 2024; 106:123-130. [PMID: 36748795 PMCID: PMC10830340 DOI: 10.1308/rcsann.2022.0151] [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] [Accepted: 11/21/2022] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION Since the establishment of the Major Trauma Networks in 2012, it is estimated that an extra 1,600 lives have been saved across England. Although the delivery of trauma care has improved significantly, the provision of trauma training has not and remains fragmented. The Association of Surgeons in Training (ASiT), an independent organisation run by trainees, is dedicated to excellence in surgical training within the United Kingdom (UK) and Republic of Ireland (ROI). The aim of this study was to develop a consensus statement representing the views of the ASiT on the future of trauma surgery training. METHODS A modified nominal group technique was used in five stages: 1, scoping exercise; 2, virtual consultation; 3, nominal group consensus meeting; 4, virtual feedback from stakeholders; and 5, virtual confirmation by the ASiT Council. The design and reporting of the consensus followed best practice methodology for consensus research. RESULTS Overall, 62 participants gave 90 statements across stages 1-3. Eleven key themes were identified, all of which met the consensus of the ASiT Council. The key findings were widespread support for increased exposure to trauma for medical students and early surgical trainees as well as an increased use of simulation methods and improved focus on non-technical skills within trauma surgery. CONCLUSIONS This study sets out the position of the ASiT on the future of trauma surgery training and how training in major trauma surgery in the UK and ROI could be improved.
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Affiliation(s)
| | | | - JM Clements
- The Association of Surgeons in Training, Royal College of Surgeons of England, UK
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5
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El-Sayed C, Yiu A, Burke J, Vaughan-Shaw P, Todd J, Lin P, Kasmani Z, Munsch C, Rooshenas L, Campbell M, Bach SP. Measures of performance and proficiency in robotic assisted surgery: a systematic review. J Robot Surg 2024; 18:16. [PMID: 38217749 DOI: 10.1007/s11701-023-01756-y] [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: 10/03/2023] [Accepted: 11/07/2023] [Indexed: 01/15/2024]
Abstract
Robotic assisted surgery (RAS) has seen a global rise in adoption. Despite this, there is not a standardised training curricula nor a standardised measure of performance. We performed a systematic review across the surgical specialties in RAS and evaluated tools used to assess surgeons' technical performance. Using the PRISMA 2020 guidelines, Pubmed, Embase and the Cochrane Library were searched systematically for full texts published on or after January 2020-January 2022. Observational studies and RCTs were included; review articles and systematic reviews were excluded. The papers' quality and bias score were assessed using the Newcastle Ottawa Score for the observational studies and Cochrane Risk Tool for the RCTs. The initial search yielded 1189 papers of which 72 fit the eligibility criteria. 27 unique performance metrics were identified. Global assessments were the most common tool of assessment (n = 13); the most used was GEARS (Global Evaluative Assessment of Robotic Skills). 11 metrics (42%) were objective tools of performance. Automated performance metrics (APMs) were the most widely used objective metrics whilst the remaining (n = 15, 58%) were subjective. The results demonstrate variation in tools used to assess technical performance in RAS. A large proportion of the metrics are subjective measures which increases the risk of bias amongst users. A standardised objective metric which measures all domains of technical performance from global to cognitive is required. The metric should be applicable to all RAS procedures and easily implementable. Automated performance metrics (APMs) have demonstrated promise in their wide use of accurate measures.
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Affiliation(s)
- Charlotte El-Sayed
- RCS England/HEE Robotics Research Fellow, University of Birmingham, Birmingham, United Kingdom.
| | - A Yiu
- RCS England/HEE Robotics Research Fellow, University of Birmingham, Birmingham, United Kingdom
| | - J Burke
- RCS England/HEE Robotics Research Fellow, University of Birmingham, Birmingham, United Kingdom
| | - P Vaughan-Shaw
- RCS England/HEE Robotics Research Fellow, University of Birmingham, Birmingham, United Kingdom
| | - J Todd
- RCS England/HEE Robotics Research Fellow, University of Birmingham, Birmingham, United Kingdom
| | - P Lin
- RCS England/HEE Robotics Research Fellow, University of Birmingham, Birmingham, United Kingdom
| | - Z Kasmani
- RCS England/HEE Robotics Research Fellow, University of Birmingham, Birmingham, United Kingdom
| | - C Munsch
- RCS England/HEE Robotics Research Fellow, University of Birmingham, Birmingham, United Kingdom
| | - L Rooshenas
- RCS England/HEE Robotics Research Fellow, University of Birmingham, Birmingham, United Kingdom
| | - M Campbell
- RCS England/HEE Robotics Research Fellow, University of Birmingham, Birmingham, United Kingdom
| | - S P Bach
- RCS England/HEE Robotics Research Fellow, University of Birmingham, Birmingham, United Kingdom
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Fleming CA, Ali O, Clements JM, Hirniak J, King M, Mohan HM, Nally DM, Burke J. Surgical trainee experience and opinion of robotic surgery in surgical training and vision for the future: a snapshot study of pan-specialty surgical trainees. J Robot Surg 2022; 16:1073-1082. [PMID: 34826106 PMCID: PMC8616984 DOI: 10.1007/s11701-021-01344-y] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 11/21/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND Robotic surgery is well established across multiple surgical specialities in the United Kingdom (UK) and Republic of Ireland (ROI). We aimed to elucidate current surgical trainee experience of and attitudes to robotic surgery in a surgical training programme across the UK and ROI to determine the future role of robotic surgery in international surgical training programmes. Methods: A pan-specialty trainee cross-sectional study was performed on behalf of the Association of Surgeons in Training (ASiT) using mixed-methodology. Round 1: a digital questionnaire was disseminated to all ASiT members. Round 2: 'live-polling' was performed prior to and following the Robotic Surgery plenary session convened at the ASiT 2020 International Conference (Birmingham). Data analysis was performed using a combination of quantitative and qualitative methods. RESULTS Three hundred and four responses were analysed (n = 244 digital questionnaire, n = 60 live-polling). Overall, 73.8% (n = 180) of trainees would value greater access to robotic surgery training. 73.4% (n = 179) believed that robotic surgery was important for the future of their desired specialty and 77.2% (n = 156) believed it should be incorporated into formal surgical training. Qualitative analysis identified that trainees believe that robotic training should have a formal role in surgical training. Perceived disadvantages of robotic surgery experience in surgical training included expense and the current impact of consultant robotic learning curves on training. CONCLUSION Current surgical trainees desire greater access to robotic surgery in surgical training. Robotic surgery is developing an increasing role in current surgical practice and it is important that it is introduced in a timely, evidence-based fashion to surgical trainees at an appropriate stage of training.
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Affiliation(s)
- Christina A Fleming
- Association of Surgeon in Training Council, London, UK. .,Department of Colorectal Surgery, Mater Misericordiae University Hospital, Dublin 7, Dublin, Ireland.
| | - Oroog Ali
- Association of Surgeon in Training Council, London, UK.,Queen Elizabeth Hospital, Gateshead, UK
| | - Joshua M Clements
- Association of Surgeon in Training Council, London, UK.,Belfast City Hospital, Belfast, Northern Ireland
| | - Johnathan Hirniak
- Association of Surgeon in Training Council, London, UK.,St George's University of London, London, UK
| | - Martin King
- Association of Surgeon in Training Council, London, UK.,Causeway Hospital, Coleraine, Northern Ireland
| | - Helen M Mohan
- Association of Surgeon in Training Council, London, UK.,St. Vincent's University Hospital, Dublin 4, Dublin, Ireland
| | - Deirdre M Nally
- Association of Surgeon in Training Council, London, UK.,Department of Colorectal Surgery, Mater Misericordiae University Hospital, Dublin 7, Dublin, Ireland
| | - Josh Burke
- Association of Surgeon in Training Council, London, UK.,St. James's Teaching Hospital Trust, Leeds, UK
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Collins J, Khetrapal P, Sridhar A, Hung A, Ghazi A, Slack M, Bishop S, Wang Y, Maier-Hein L, Anvari M, Nakawala H, Garcia P, Jarc A, Bano S, Nathan A, Percy E, Burke J, Stoyanov D, Kelly J. Digital transformation of surgical services with a focus on patient wearables. EUR UROL SUPPL 2022. [DOI: 10.1016/s2666-1683(22)02189-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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8
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Aldoori J, Burke J, Robson A, Al-Attar A, Giwa L, O'Regan D, Peter M. 126 The Theatre Training Checklist: A Toolkit to Improve Operative Training. Br J Surg 2022. [DOI: 10.1093/bjs/znac040.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Aim
The operating theatre is expensive, costing approximately £1200 per hour to run. It is a crucial learning environment for many different trainees: anaesthetists, surgeons, operation department practitioners, etc. For individuals to achieve their training requirements, the operating theatre as a training environment must be shared between all trainees, requiring excellent teamwork and leadership. This could be improved by the adoption of innovative training strategies.
Method
The Theatre Training Checklist is a simple framework that aims to facilitate awareness, understanding, coordination and cooperation of training for all team members. It is a practical strategy that can be adopted in any setting. Usually, trainers discuss informally with their trainees about their individual skills, experience, expectations and what is achievable in a theatre list. However, there is currently limited opportunity to discuss this between different disciplines and the wider team. This tool aims to refine communication, optimize training, manage expectations, and ensure equity across the board.
Results
The checklist is completed at the start of the list during the theatre brief. It identifies all trainees and their specific needs within the operating theatre session to the whole team. An agreed strategy is developed on how to achieve identified training goals. Feedback undertaken from the MDT after local trailing of the checklist has been positive.
Conclusions
The toolkit is available for use and consists of the checklist tool and an instructional video. The checklist is being piloted in some centres and we hope to have the opportunity to present some early findings to the ASiT Innovation Summit.
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Affiliation(s)
- J. Aldoori
- Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - J. Burke
- Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - A. Robson
- Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - A. Al-Attar
- Health Education North West, Manchester, United Kingdom
| | - L. Giwa
- Royal Free London NHS Foundation Trust, London, United Kingdom
| | - D. O'Regan
- Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - M. Peter
- Calderdale and Huddersfield NHS Foundation Trust, Huddersfield, United Kingdom
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9
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Aldoori J, Robson A, Al-Attar A, Burke J, Giwa L, O'Regan D, Peter M. P-EGS11 The Theatre Training Checklist: A Toolkit to Revive Post Pandemic Operative Training. Br J Surg 2021. [PMCID: PMC9383165 DOI: 10.1093/bjs/znab430.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background The COVID-19 pandemic has had a significant negative impact on operative surgical training, with trainee logbook numbers reduced by more than 50% compared to 2019. The operating theatre is expensive, costing approximately £1200 per hour to run. It is a crucial learning environment for many different trainees: anaesthetists, surgeons, operation department practitioners and surgical first assistants. For individuals to achieve their training requirements, the operating theatre as a training environment must be shared between all trainees. This requires excellent teamwork and leadership. The recovery phase of the COVID-19 pandemic is a unique opportunity to adopt novel training strategies. Methods The Theatre Training Checklist is a simple framework that aims to facilitate awareness, understanding, coordination and cooperation of training for all members of the team (Figure 1). It is a practical strategy that can be adopted in any setting. Usually, trainers discuss informally with their trainees about their individual Skills, Experience, Expectationsand what is Achievable in a planned theatre list (SEEA). However, there currently is limited opportunity to discuss this between different disciplines and the wider team. This tool aims to refine communication, optimize training, manage expectations and ensure equity across the board. The checklist has been introduced and trialed locally. Results The checklist is completed at the start of the list during the theatre brief. It identifies all trainees and their specific needs within the operating theatre session to the whole team. An agreed strategy is developed on how to achieve identified training goals (figure 2). Sometimes it may not be possible to allow a trainee to perform a particular procedure. However, other opportunities for training in theatre exist, such as: patient positioning, choice of equipment, types of techniques, discussions around consenting and complications etc. Feedback undertaken from the multiprofessional team after local trialing of the checklist has been positive. Conclusions The Theatre Training Checklist aims to create dialogue and shared understanding of training needs among all parties within the operating theatre. The Theatre Training Checklist Toolkit is available for use and consists of the checklist tool and an instructional video. The Theatre Training checklist is being piloted in some centers and we hope to have the opportunity to present some early findings at AUGIS 2021.
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Affiliation(s)
- Joanna Aldoori
- Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Andrew Robson
- Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Adam Al-Attar
- Health Education North West, Manchester, United Kingdom
| | - Josh Burke
- Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Lolade Giwa
- Royal Free London NHS Foundation Trust, London, United Kingdom
| | - David O'Regan
- Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Mark Peter
- Calderdale and Huddersfield NHS Foundation Trust, Huddersfield, United Kingdom
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10
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Penugonda M, Walsh J, Barry JJ, Govern RM, Bradley D, Bolger M, English G, Moore J, Nolan N, Treacy E, Burke J, Dwyer N, Gallagher D, Macken S, McCaffrey S, Moloney S, Murphy R, Murray M, Hanlon EO. 231 ESTABLISHING AN INTERVENTIONS BUNDLE TO IMPROVE INPATIENT CARE FOR PATIENTS WITH PARKINSON’S DISEASE: A MULTIDISCIPLINARY QUALITY IMPROVEMENT PROJECT. Age Ageing 2021. [DOI: 10.1093/ageing/afab219.231] [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: 02/25/2023] Open
Abstract
Abstract
Background
Patients with Parkinson’s (PwP) are at a higher risk of complications once admited to hospital compared to their age-matched peers. Medication mismanagement is a well-known obstacle, which puts PwP at risk of sub-optimal treatment leading to an unnecessary deterioration of baseline and potentially increases risk of adverse sequelae.
Methods
Retrospective electronic patient records (EPR)/chart review of 47 admissions was conducted, across three hospital sites.
Data attaining to correct prescribing of medication on admission and discharge, prescribing of contraindicated medications, reasons for medication lapses and complications of inpatient stay were collected. EPR of 17 patients’ were reviewed to assess if Parkinson’s disease (PD) medication administrations occurred within 30 minutes of patient schedule, as recommended by NICE guidelines. Key areas for improvement were identified based on the results.
Results
47 charts (30 Males, 17 Females) with mean age 72 (range:57–90), were reviewed. Average number of co-morbidities:4.5 and Clinical Frailty Scale ranged 5–9 (n = 30). LOS averaged 12.4 days and 43% of patients had ≥2 hospital admissions in the preceeding year.
38% (17/44) of admissions correctly documented patient specific medication times. Only 48% of patients (n = 638) received their medications within 30 minutes of the scheduled time. 47% (22/47) experienced complications attributable to PD. Contraindicated medications were noted in 5 cases. 84% of discharging prescriptions did not mention timing of PD medication and 3 prescriptions had errors with regards to dosage/omission of medication.
Conclusion
We implemented across two sites: 1) Care protocol flag in patient’s chart highlighting simple avoidable complications. 2) Laminated over the bed signpost alerting ‘time critical medication’. 3) ‘Time critical medication’ stickers in drug kardex 4) Education sessions for Medical, Nursing and Ward staff. 6) Establishing out of hours access to PD medications and protocols for NPO/poor swallow. We plan to reassess significance of efforts post intervention.
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Affiliation(s)
| | - J Walsh
- St. Luke's General Hospital , Kilkenny, Ireland
| | - J J Barry
- St. Michael's Hospital , Dublin, Ireland
| | - R M Govern
- St. Luke's General Hospital , Kilkenny, Ireland
| | - D Bradley
- St. James Hospital , Dublin, Ireland
| | - M Bolger
- St. Luke's General Hospital , Kilkenny, Ireland
| | - G English
- St. Luke's General Hospital , Kilkenny, Ireland
| | - J Moore
- St. Luke's General Hospital , Kilkenny, Ireland
| | - N Nolan
- St. Luke's General Hospital , Kilkenny, Ireland
| | - E Treacy
- St. Luke's General Hospital , Kilkenny, Ireland
| | - J Burke
- St. Michael's Hospital , Dublin, Ireland
| | - N Dwyer
- St. Michael's Hospital , Dublin, Ireland
| | | | - S Macken
- St. Michael's Hospital , Dublin, Ireland
| | | | - S Moloney
- St. Michael's Hospital , Dublin, Ireland
| | - R Murphy
- St. Michael's Hospital , Dublin, Ireland
| | - M Murray
- St. Michael's Hospital , Dublin, Ireland
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McGurn A, Peterson S, Burke J, Chen E. 162: An initiative to improve quality of care in CF patients with Burkholderia by eliminating cohort segregation. J Cyst Fibros 2021. [DOI: 10.1016/s1569-1993(21)01587-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
Abstract
Aims
In response to the COVID-19 pandemic and the cancellation of elective surgery, the Independent sector (IS) has been utilised to provide COVID-light sites. On average operative log book numbers have been reduced by 50% due to a reduction in operative exposure. The Four Educational Bodies continue to support training within the independent sector. This study aimed to qualitatively assess access and barriers to UK surgical training in the Independent Sector.
Methods
A snap-shot online survey was distributed to ASIT members of all training specialities and grades between 21/10/2020-11/11/2020 . Data measures included participant demographics, frequency of access, participation in training opportunities including outpatient clinic, theatre lists and endoscopy and any barriers encountered. A mixture of Likert scale and short answer questions were utilised.
Results
249 complete responses representing all grades and specialities were included in the final analysis (34.29% CST and 56.3% HST). 35.7% of trainees reported access to the IS. 22.9% had access to at least one operating list whilst 70.3% had none. Access to outpatient clinics and endoscopy was negligible. 75% of trainees ‘strongly agreed’ that when access was achievable, it was beneficial to their training. Multiple barriers were identified including Human Resource requirements and local service provision.
Conclusions
Within the sample, access to the IS has been poor. There is wide variation in barriers to access across the 4 nations and IS providers. Trainees and Trainers should maximise training opportunities in the IS. Where barriers exist, they should be reported to local Training Programme Directors.
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13
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Murray V, Burke J, Hughes M, Schofield C, Young A. 1020 Delay to Surgery in Acute Perforated and Ischaemic Gastrointestinal Pathology. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Introduction
Patients with acute abdominal pathology requiring emergency laparotomy who experience a delay to theatre have an increased risk of morbidity, mortality, and complications. The timeline between symptom onset and operation is ill-defined with international variance in assessment and management. This systematic review aims to define where delays to surgery occur and assess the evidence for previous interventions.
Method
A systematic review was performed searching MEDLINE and EMBASE databases (January 1st 2005 to May 6th 2020). All studies assessing the impact of time to theatre in patients with acute abdominal pathology requiring emergency laparotomy were considered.
Results
Eighty-five results were assessed to include 19 papers in the analysis. Fifteen unique timepoints were identified in the patient pathway between symptom onset and operation which could be classified into four distinct phases. Time from admission to theatre (1 to 72 hours), and mortality rate (10.6-74.5%) varied greatly between studies. Mean time to surgery was significantly higher in deceased patients compared to survivors. Delays were related to imaging, diagnosis, decision-making, theatre availability and staffing. Four of five interventional studies showed a reduced mortality following introduction of an acute laparotomy pathway.
Conclusions
There is wide variation in the definition and measurement of time delays prior to emergency surgery with few studies exploring interventions. Given the heterogenous nature of the patient population and pathologies, an assessment and management framework from onset of symptoms to operation is proposed. This could be incorporated into national mortality prediction and audit tools and assist in the assessment of interventions.
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Affiliation(s)
- V Murray
- University of Leeds, Leeds, United Kingdom
| | - J Burke
- St. James’s University Hospital, Leeds, United Kingdom
| | - M Hughes
- St. James’s University Hospital, Leeds, United Kingdom
| | - C Schofield
- St. James’s University Hospital, Leeds, United Kingdom
| | - A Young
- St. James’s University Hospital, Leeds, United Kingdom
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14
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Arshad S, Gallivan E, Skinner H, Burke J, Young A. 1289 Gender Representation in The Authorship of Surgical Journals. Br J Surg 2021. [DOI: 10.1093/bjs/znab258.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Introduction
Despite the increase in female doctors graduating from medical schools internationally, gender disparity in surgery remains. This disparity is also evident in academic surgery. This study aims to quantify the extent of gender disparity in the authorship of articles in major surgical journals.
Method
The Top 10 Surgical Journals were identified using SCImago Journal Rank indicator. Authorship details for papers published in 2019 were collected. Authors were assigned as female, male or unknown using Gender API software (Gender API, Germany). For each journal, the percentage of first author, last author, corresponding author and all authors split by gender was interrogated. Gender differences by publication type were also identified.
Results
9 of the 10 journals had full names publicly available. Overall, 2414 manuscripts were interrogated which included 16,277 number of authors. Respectively, females and males accounted for 29.8% [22.9-34.9%] (N = 655) and 62.4% [56.3-70.2%] (N = 1419) of first authors, 20.6% [11.8-27.1%] (N = 453) and 74.2% [65.6-84.1%] (N = 1706) of last authors, 23.9% [14.9-29.6%] (N = 510) and 69.9% [60.5-79.3%] (N = 2341) of corresponding authors and in total 27% [19.4-31.6%] (N = 4298) and 65.5% [58.6-73.4%] (N = 9982) of all authors. The wide range in these results could be a result of various factors.
Conclusions
This study has identified a gender imbalance in authorship positions, with the greatest difference observed in the most senior author position. Whether this is reflective of the current disparity observed in senior academic surgery positions or due to gender discrimination is unclear.
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Affiliation(s)
- S Arshad
- School of Medicine, University of Leeds, Leeds, United Kingdom
| | - E Gallivan
- School of Medicine, University of Leeds, Leeds, United Kingdom
| | - H Skinner
- St James’s University Hospital, Leeds, United Kingdom
| | - J Burke
- St James’s University Hospital, Leeds, United Kingdom
| | - A Young
- Department of pancreatic surgery, St James’s University Hospital, Leeds, United Kingdom
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15
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Misbert E, Hughes M, Burke J, Schofield C, Young A. 1308 Investigating the Use of a Novel Pre-Hospital Triage Tool for Acute Abdominal Surgical Emergencies – A Two-Phase Single Centre Cohort Study. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.530] [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: 11/15/2022]
Abstract
Abstract
Background
Despite the recent improvements in mortality in patients undergoing emergency laparotomy(EL) within the UK, delay to theatre continues to be associated with increased mortality. This study aimed to assess if patients requiring urgent surgical intervention for acute abdominal surgical pathology could be identified in the pre-hospital setting.
Method
A two-phase, single-centre, cohort study was performed. Phase 1 retrospectively investigated patients who underwent emergency laparotomy between 01/01/2019-31/12/2019 at Leeds Teaching Hospital Trust (LTHT) through the NELA database. Phase 2 prospectively assessed NEWS2 for all patients presenting to LTHT Surgical Admissions Unit with abdominal pain between 01/01/2020-31/01/2020.
Results
Phase 1: 45 patients were coded through NELA and confirmed through operation note review as undergoing EL for gastrointestinal perforation. 66%(n = 30) were assessed by the ambulance service and 80% (n = 24) had a NEWS2 of 3 or greater. Phase 2: 319 patients were assessed in SAU/ED, of which 69 initially treated by the ambulance service. 30% (n = 21) of these patients had an initial NEWS2 of 3 or above. Sensitivity of a NEWS2 score of >/3 in predicting the need for immediate surgical intervention including EL was 95%(95%CI, 74-99) and specificity was 95% (95%CI, 83-99) with a PPV of 86%(95%CI 67-95) and NPV of 98% (95%CI, 87-99).
Conclusions
A NEWS2 score of >/3 predicts the need for emergency surgical intervention including laparotomy for gastrointestinal perforation with reasonable sensitivity in this cohort. A pre-hospital triage tool for patients presenting with abdominal pain could utilise NEWS2 as an adjunct to decision-making in an acute abdominal pathway.
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Affiliation(s)
- E Misbert
- Leeds Teaching Hospital Trust, Leeds, United Kingdom
| | - M Hughes
- Leeds Teaching Hospital Trust, Leeds, United Kingdom
| | - J Burke
- Leeds Teaching Hospital Trust, Leeds, United Kingdom
| | - C Schofield
- Leeds Teaching Hospital Trust, Leeds, United Kingdom
| | - A Young
- Leeds Teaching Hospital Trust, Leeds, United Kingdom
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16
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Kowal M, Bolton W, Van Duren B, Burke J, Jayne D. 389 Impact of Surgical Drain Output Monitoring on Patient Outcomes in Gastrointestinal Surgery: A Systematic Review. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Aim
Surgical drains are widely utilised in Gastrointestinal Surgery to prevent intra-abdominal collections and identify post-operative complications. Surgical drain monitoring ranges from simple output measurements through to specific analysis for constituents such as amylase. This systematic review aimed to determine whether surgical drain monitoring can detect post-operative complications and impact on patient outcomes.
Method
A systematic review was performed, and the following databases searched between 02/03/20 and 26/04/20: MEDLINE, EMBASE, The Cochrane Library and Clinicaltrials.gov. All studies describing surgical drain monitoring of output and content in adult patients undergoing gastrointestinal surgery were considered. Other invasive methods of intra-abdominal sampling were excluded.
Results
The search returned 396 articles. Following abstract review, 383 were excluded and 13 articles were included for full review. The studies were classified according to speciality: Oesophagogastric (1), Pancreatic (6), Hepatobiliary (2), Colorectal (3) and Emergency General Surgery (1). Post-operative monitoring of amylase and bilirubin decreased the incidence of post-operative complications (pancreatic fistulas, intra-abdominal infections, surgical site infections), length of stay and mortality rate in Pancreatic and Hepatobiliary Surgery. Testing of drain contents following Colorectal Surgery can aid anastomotic leak and the detection of peritonitis, however this did not confer any improvement in patient outcome. Surgical drain monitoring did not improve patient outcomes in Oesophagogastric Surgery.
Conclusions
Surgical drain monitoring has established advantages in the post-operative care for patients undergoing Gastrointestinal Surgery. Enhanced surgical drain monitoring involving the testing of drain amylase, bilirubin, lactate, and cytokines may improve detection of complications in the immediate post-operative period.
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Affiliation(s)
- M Kowal
- The John Goligher Colorectal Surgery Unit, St. James’s University Hospital, Leeds Teaching Hospital Trust, Leeds, United Kingdom
- University of Leeds, Leeds, United Kingdom
| | - W Bolton
- The John Goligher Colorectal Surgery Unit, St. James’s University Hospital, Leeds Teaching Hospital Trust, Leeds, United Kingdom
- University of Leeds, Leeds, United Kingdom
| | - B Van Duren
- University of Leeds, Leeds, United Kingdom
- Leeds Institute of Rheumatic & Musculoskeletal Medicine, Leeds, United Kingdom
| | - J Burke
- The John Goligher Colorectal Surgery Unit, St. James’s University Hospital, Leeds Teaching Hospital Trust, Leeds, United Kingdom
- University of Leeds, Leeds, United Kingdom
| | - D Jayne
- The John Goligher Colorectal Surgery Unit, St. James’s University Hospital, Leeds Teaching Hospital Trust, Leeds, United Kingdom
- University of Leeds, Leeds, United Kingdom
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17
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Misbert E, Hughes M, Burke J, Schofield C, Young A. 1404 NELA Risk Mortality Scores from Admission to Theatre in Emergency Gastrointestinal Perforation – A Retrospective Cohort Study. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Background
Patients with acute abdominal pathology requiring emergency laparotomy who experience a delay to theatre have an increased risk of morbidity, mortality and complications. The aim of this study was to assess delay, from symptom onset to theatre in patients with gastrointestinal perforation and its effect on perioperative risk.
Method
A single-centre retrospective study was performed in the Leeds Trust Hospitals, UK investigating the NELA database for patients requiring emergency laparotomy for perforated gastrointestinal viscus who presented to the acute surgical unit or emergency department between 1st February 2018 and 31st January 2020.
Results
101 patients met the inclusion criteria (47% F and 53% M), mean age 59 [21-91]. 37% of patients’ NELA scores worsened from admission to pre-op (median change of + 5.9% IQR 1.3-11.5]), 14% stayed the same and 49% improved (median change of -4.4%[IQR 0.4-9.1]) 3% had their NELA score documented at the time of consent. 18% did not wait for a CT report or went straight to theatre. Mean time from admission to scan report was 9.3 hours (0.9-22.0). Median time from symptom onset to presentation (2 days [IQR 1-13]) was greater in patients with an Index of Multiple Deprivation Decile of 1-5, (n = 64, median 2 days [IQR 1-6]) compared to those in deciles 6-10, (n = 37, median 1 day[IQR 1-3]), p = 0.097.
Conclusions
NELA mortality risk score changes from presentation to surgery in patients with acute gastrointestinal perforation requiring emergency laparotomy. There is suggestion that delay in symptom onset to presentation may correlate with Index of Multiple Deprivation Decile.
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Affiliation(s)
- E Misbert
- Leeds Teaching Hospital Trust, Leeds, United Kingdom
| | - M Hughes
- Leeds Teaching Hospital Trust, Leeds, United Kingdom
| | - J Burke
- Leeds Teaching Hospital Trust, Leeds, United Kingdom
| | - C Schofield
- Leeds Teaching Hospital Trust, Leeds, United Kingdom
| | - A Young
- Leeds Teaching Hospital Trust, Leeds, United Kingdom
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18
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Nelson J, Perkins S, Holmes A, Hirschl J, Chopra Z, Medlin R, Fung C, Korley F, Burke J. 296 A Bayesian Approach to Predicting Outcomes During the Initial COVID-19 Outbreak. Ann Emerg Med 2021. [PMCID: PMC8536276 DOI: 10.1016/j.annemergmed.2021.09.309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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19
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Zosimas D, Lykoudis PM, Strano G, Burke J, Al-Cerhan E, Shatkar V. Bilirubin is a specific marker for the diagnosis of acute appendicitis. Exp Ther Med 2021; 22:1056. [PMID: 34434270 DOI: 10.3892/etm.2021.10490] [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: 09/27/2020] [Accepted: 01/19/2021] [Indexed: 11/05/2022] Open
Abstract
Total serum bilirubin and other biochemical parameters have been associated with acute appendicitis, mainly in complicated cases. The present study aimed to evaluate the role of biochemical parameters in the diagnosis of acute appendicitis, and to further investigate the role of bilirubin as a diagnostic marker irrespective of the severity of the pathology. All recorded cases of appendicectomies in a 1-year period in a single institution were reviewed. The median values of white cell count, C-reactive protein and total serum bilirubin on admission were associated with final histology, and their respective rates of abnormal and normal values were compared between patients who were proven to have negative histology and patients who were proven to have acute appendicitis. A total of 300 patients were studied. Median total serum bilirubin, white cell count and C-reactive protein on admission were significantly associated with acute appendicitis (P<0.001). Respective rates of normal and abnormal values were significantly associated with final histology (P<0.001). Total serum bilirubin demonstrated higher specificity (0.88) but lower sensitivity (0.26) and diagnostic accuracy (0.40) for acute appendicitis. In conclusion, total serum bilirubin on admission should be considered in the diagnostic workup to confirm rather than exclude appendicitis, without focusing on subgroups of specific severity of the disease. White cell count and C-reactive protein may also contribute to the diagnostic work-up, although with limited accuracy.
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Affiliation(s)
- Dimitrios Zosimas
- Department of General Surgery, Queen's Hospital, Barking, Havering and Redbridge University Hospitals NHS Trust, Romford RM7 0AG, UK
| | - Panagis M Lykoudis
- Division of Surgery and Interventional Science, University College London, London WC1E 6BT, UK
| | - Giuseppe Strano
- Department of General Surgery, Queen's Hospital, Barking, Havering and Redbridge University Hospitals NHS Trust, Romford RM7 0AG, UK
| | - Josh Burke
- Department of General Surgery, Queen's Hospital, Barking, Havering and Redbridge University Hospitals NHS Trust, Romford RM7 0AG, UK
| | - Eyad Al-Cerhan
- Department of General Surgery, Queen's Hospital, Barking, Havering and Redbridge University Hospitals NHS Trust, Romford RM7 0AG, UK
| | - Veeranna Shatkar
- Department of General Surgery, Queen's Hospital, Barking, Havering and Redbridge University Hospitals NHS Trust, Romford RM7 0AG, UK
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20
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Holzgang M, Koenemann N, Skinner H, Burke J, Smith A, Young A. Discrimination in the surgical discipline: an international European evaluation (DISDAIN). BJS Open 2021; 5:6311489. [PMID: 34189560 PMCID: PMC8242223 DOI: 10.1093/bjsopen/zrab050] [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: 03/16/2021] [Accepted: 05/04/2021] [Indexed: 11/16/2022] Open
Abstract
Background Negative workplace experiences (NWPEs), such as gender discrimination, bullying, sexual harassment and ethnic discrimination, are concerns in today’s surgical society. These negative experiences potentially impair surgeons’ performance and might impact patient care or outcomes negatively. This study aimed to assess the experience of NWPEs across the European surgical workforce. Methods A prospective online 34-point questionnaire was designed using a combination of Likert scale, multiple-choice and short-answer questions. Invitations were distributed through surgical associations via email/social media between 1 September and 15 November 2019. Data were analysed using non-parametric methods. Results Some 840 complete responses were included in the analysis. The distribution across genders and stage of surgical training was even. Of the respondents, 20 per cent (168 respondents) considered quitting their job, 4.5 per cent (38) took time off and 0.5% (4) left surgery due to NWPEs; 12.9 per cent of females and 4.4 per cent of males experienced some form of physical harassment. Females and those in training were significantly more likely to experience or witness gender discrimination and sexual harassment. Just over half of the respondents (448) did not report negative experiences, with most of these (375 respondents) being unaware of whom to report to. Nearly a fifth of respondents felt that NWPEs influenced patient care or outcomes negatively. Conclusion NWPEs were frequent, especially among females and those in training. While a substantial proportion of respondents experienced physical harassment, many individuals were unaware of how to raise concerns. Adverse effects on patient outcomes, surgical training and workforce retention indicate a need for urgent action.
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Affiliation(s)
- M Holzgang
- Department of General Surgery, St. James's University Hospital, Leeds Teaching Hospital Trust, Leeds, UK.,UVCM (Visceral Medicine and Surgery), Inselspital Bern, Bern, Switzerland
| | - N Koenemann
- Department of Trauma Surgery, Orthopaedics, Plastic and Hand Surgery, Augsburg University Hospital, Augsburg, Germany
| | - H Skinner
- Department of General Surgery, St. James's University Hospital, Leeds Teaching Hospital Trust, Leeds, UK
| | - J Burke
- Department of General Surgery, St. James's University Hospital, Leeds Teaching Hospital Trust, Leeds, UK
| | - A Smith
- Department of General Surgery, St. James's University Hospital, Leeds Teaching Hospital Trust, Leeds, UK
| | - A Young
- Department of General Surgery, St. James's University Hospital, Leeds Teaching Hospital Trust, Leeds, UK
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21
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Elkadi H, Dodd E, Bolton W, Poulton T, Burke J, Jayne D. 524 Anaesthetic Use and Packing in Subcutaneous Abscess Management: A Retrospective Before and After Analysis Within A Two-Cycle Audit. Br J Surg 2021. [PMCID: PMC8135932 DOI: 10.1093/bjs/znab134.445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Introduction In the United Kingdom, there are no widely used guidelines within the management of subcutaneous abscesses by incision and drainage (I&D) to direct the use of local anaesthesia (LA) vs genal anaesthesia (GA); or the use of wound packing vs no packing. Method Two cohorts of patients undergoing I&D procedures were retrospectively identified from attendance records over a 3.5-month period. The first cohort was between 16th October 2018 to 31st January 2019. The second cohort of patients was during the COVID-19 pandemic following the introduction of new RCS guidance (intervention) between 29th March 2020 and 15th June 2020. Results Seventy-one patients before and 63 after the intervention were included. There were significantly more procedures performed under LA after the introduction of the intervention (n = 52; 82.5%) vs before (n = 4; 5.6%) p < 0.0001. The incidence of wound packing decreased after the intervention (n = 43; 68.3% vs n = 62; 87.3%) p = 0.00452. Conclusions The results demonstrate that during the pandemic, change in practice resulted in more subcutaneous abscesses being treated with LA. The majority of abscesses were packed in both cohorts although the incidence declined after the intervention. Future research should explore the patient satisfaction regarding pain management and the abscess recurrence rate.
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Affiliation(s)
- H Elkadi
- The John Golligher Colorectal Surgery Unit St. James’s University Hospital, Leeds, United Kingdom
| | - E Dodd
- The John Golligher Colorectal Surgery Unit St. James’s University Hospital, Leeds, United Kingdom
| | - W Bolton
- Leeds Institute of Medical Research, Leeds, United Kingdom
| | - T Poulton
- The Faculty of Medicine and Health University of Leeds, Leeds, United Kingdom
| | - J Burke
- Leeds Institute of Medical Research, Leeds, United Kingdom
| | - D Jayne
- Leeds Institute of Medical Research, Leeds, United Kingdom
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22
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Franco C, Sawhney R, Burke J, Aruparayil N, Chauhan M, Bolton W, Mishra A, Valdastri P, Jayne D. P15: EVALUATING THE INTERNATIONAL USABILITY OF A LOW-COST LAPAROSCOPIC TRAINER IN LOW- AND HIGH-INCOME SETTINGS. Br J Surg 2021. [DOI: 10.1093/bjs/znab117.100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Introduction
Limited access to equipment and trained personnel restrict the adoption of laparoscopic surgery globally. There are a wide range of laparoscopic trainers available; however, most of these are not affordable. We propose an ultra-low-cost laparoscopic trainer (Lap-Pack), designed for portability, ease of assembly and compatibility with smart devices. The study aims to evaluate the usability of Lap-Pack as a training tool in low- and high-income settings.
Method
An international usability study was conducted in India and the UK in 2019. The participants (n=60), consisting of senior surgeons (n=18), junior trainees (n=20) and medical students (n=22), were asked to complete two tasks using Lap-Pack. Participants then scored Lap-Pack in a 25-point questionnaire, including a pre-established Face-Validity Criteria and four major evaluation categories – Usability, Camera, View, Material.
Result
Lap-Pack scored highly in Face-Validity with a combined mean score of 4.63 (95%CI: 4.31, 4.95, p <0.05) of a possible 6. In both cohorts, the Usability and Camera categories scored highest, with combined values respectively of 6.10 (95%CI: 6.01, 6.19, p <0.05) and 6.09 (95%CI: 5.88, 6.31, p <0.05) of a possible 7. For both centres, the highest-scoring individual criteria were its light weight and portability.
Conclusion
Overall, Lap-Pack was received positively by medical students and consultants alike, suggesting it is a suitable device for development of skills as part of a larger laparoscopic training curriculum. Its ease of assembly, portability and versatility show promise of increasing access to training opportunities worldwide.
Take-home message
Lap-Pack is an ultra-low-cost, portable laparoscopic simulator featuring compatibility with smart devices designed to help increase access to laparoscopic training worldwide. An international usability study found medical students, junior trainees and senior surgeons rated its usability and camera features highly, suggesting its employability as a laparoscopic training tool on a global scale.
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Affiliation(s)
- C Franco
- University of Leeds, Maulana Azad Medical College
| | - R Sawhney
- University of Leeds, Maulana Azad Medical College
| | - J Burke
- University of Leeds, Maulana Azad Medical College
| | - N Aruparayil
- University of Leeds, Maulana Azad Medical College
| | - M Chauhan
- University of Leeds, Maulana Azad Medical College
| | - W Bolton
- University of Leeds, Maulana Azad Medical College
| | - A Mishra
- University of Leeds, Maulana Azad Medical College
| | - P Valdastri
- University of Leeds, Maulana Azad Medical College
| | - D Jayne
- University of Leeds, Maulana Azad Medical College
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23
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Fleming CA, Ali O, Clements JM, Hirniak J, King M, Mohan HM, Nally DM, Burke J. Pan-specialty access to robotic surgery in surgical training. Br J Surg 2021; 108:e245-e246. [PMID: 33822004 DOI: 10.1093/bjs/znab107] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 02/09/2021] [Accepted: 02/28/2021] [Indexed: 01/19/2023]
Affiliation(s)
- C A Fleming
- Association of Surgeons in Training Council, London, UK.,Mater Misericordiae University Hospital, Dublin, Ireland
| | - O Ali
- Association of Surgeons in Training Council, London, UK.,Queen Elizabeth Hospital, Gateshead, UK
| | - J M Clements
- Association of Surgeons in Training Council, London, UK.,Belfast City Hospital, Belfast, UK
| | - J Hirniak
- Association of Surgeons in Training Council, London, UK.,St George's Hospital, University of London, UK
| | - M King
- Association of Surgeons in Training Council, London, UK.,Causeway Hospital, Coleraine, UK
| | - H M Mohan
- Association of Surgeons in Training Council, London, UK.,St Vincent's University Hospital, Dublin, Ireland
| | - D M Nally
- Association of Surgeons in Training Council, London, UK.,Mater Misericordiae University Hospital, Dublin, Ireland
| | - J Burke
- Association of Surgeons in Training Council, London, UK.,St James's Teaching Hospital Trust, Leeds, UK
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24
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Affiliation(s)
| | - Josh Burke
- Association of Surgeons in Training, London, UK
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25
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26
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27
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Peckham-Cooper A, Coe PO, Clarke RW, Burke J, Lee MJ. The role of cholecystostomy drains in the management of acute cholecystitis during the SARS-CoV-2 pandemic. What can we expect? Br J Surg 2020; 107:e447. [PMID: 32749699 PMCID: PMC7436907 DOI: 10.1002/bjs.11907] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 06/17/2020] [Indexed: 12/18/2022]
Affiliation(s)
| | - P O Coe
- Leeds Teaching Hospitals NHS Trust
| | - R W Clarke
- Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust
| | - J Burke
- Leeds Teaching Hospitals NHS Trust
| | - M J Lee
- Sheffield Teaching Hospitals NHS Foundation Trust
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28
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McLean KA, Ahmed WUR, Akhbari M, Claireaux HA, English C, Frost J, Henshall DE, Khan M, Kwek I, Nicola M, Rehman S, Varghese S, Drake TM, Bell S, Nepogodiev D, McLean KA, Drake TM, Glasbey JC, Borakati A, Drake TM, Kamarajah S, McLean KA, Bath MF, Claireaux HA, Gundogan B, Mohan M, Deekonda P, Kong C, Joyce H, Mcnamee L, Woin E, Burke J, Khatri C, Fitzgerald JE, Harrison EM, Bhangu A, Nepogodiev D, Arulkumaran N, Bell S, Duthie F, Hughes J, Pinkney TD, Prowle J, Richards T, Thomas M, Dynes K, Patel M, Patel P, Wigley C, Suresh R, Shaw A, Klimach S, Jull P, Evans D, Preece R, Ibrahim I, Manikavasagar V, Smith R, Brown FS, Deekonda P, Teo R, Sim DPY, Borakati A, Logan AE, Barai I, Amin H, Suresh S, Sethi R, Bolton W, Corbridge O, Horne L, Attalla M, Morley R, Robinson C, Hoskins T, McAllister R, Lee S, Dennis Y, Nixon G, Heywood E, Wilson H, Ng L, Samaraweera S, Mills A, Doherty C, Woin E, Belchos J, Phan V, Chouari T, Gardner T, Goergen N, Hayes JDB, MacLeod CS, McCormack R, McKinley A, McKinstry S, Milligan W, Ooi L, Rafiq NM, Sammut T, Sinclair E, Smith M, Baker C, Boulton APR, Collins J, Copley HC, Fearnhead N, Fox H, Mah T, McKenna J, Naruka V, Nigam N, Nourallah B, Perera S, Qureshi A, Saggar S, Sun L, Wang X, Yang DD, Caroll P, Doyle C, Elangovan S, Falamarzi A, Perai KG, Greenan E, Jain D, Lang-Orsini M, Lim S, O'Byrne L, Ridgway P, Van der Laan S, Wong J, Arthur J, Barclay J, Bradley P, Edwin C, Finch E, Hayashi E, Hopkins M, Kelly D, Kelly M, McCartan N, Ormrod A, Pakenham A, Hayward J, Hitchen C, Kishore A, Martins T, Philomen J, Rao R, Rickards C, Burns N, Copeland M, Durand C, Dyal A, Ghaffar A, Gidwani A, Grant M, Gribbon C, Gruhn A, Leer M, Ahmad K, Beattie G, Beatty M, Campbell G, Donaldson G, Graham S, Holmes D, Kanabar S, Liu H, McCann C, Stewart R, Vara S, Ajibola-Taylor O, Andah EJE, Ani C, Cabdi NMO, Ito G, Jones M, Komoriyama A, Patel P, Titu L, Basra M, Gallogly P, Harinath G, Leong SH, Pradhan A, Siddiqui I, Zaat S, Ali A, Galea M, Looi WL, Ng 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Livesey C, McLachlan G, Mohammad M, Pranesh N, Richards C, Ross F, Sajid M, Brooke M, Francombe J, Gresly J, Hutchinson S, Kerrigan K, Matthews E, Nur S, Parsons L, Sandhu A, Vyas M, White F, Zulkifli A, Zuzarte L, Al-Mousawi A, Arya J, Azam S, Yahaya AA, Gill K, Hallan R, Hathaway C, Leptidis I, McDonagh L, Mitrasinovic S, Mushtaq N, Pang N, Peiris GB, Rinkoff S, Chan L, Christopher E, Farhan-Alanie MMH, Gonzalez-Ciscar A, Graham CJ, Lim H, McLean KA, Paterson HM, Rogers A, Roy C, Rutherford D, Smith F, Zubikarai G, Al-Khudairi R, Bamford M, Chang M, Cheng J, Hedley C, Joseph R, Mitchell B, Perera S, Rothwell L, Siddiqui A, Smith J, Taylor K, Wright OW, Baryan HK, Boyd G, Conchie H, Cox L, Davies J, Gardner S, Hill N, Krishna K, Lakin F, Scotcher S, Alberts J, Asad M, Barraclough J, Campbell A, Marshall D, Wakeford W, Cronbach P, D'Souza F, Gammeri E, Houlton J, Hall M, Kethees A, Patel R, Perera M, Prowle J, Shaid M, Webb E, Beattie S, Chadwick M, El-Taji O, Haddad S, Mann M, Patel M, Popat K, Rimmer L, Riyat H, Smith H, Anandarajah C, Cipparrone M, Desai K, Gao C, Goh ET, Howlader M, Jeffreys N, Karmarkar A, Mathew G, Mukhtar H, Ozcan E, Renukanthan A, Sarens N, Sinha C, Woolley A, Bogle R, Komolafe O, Loo F, Waugh D, Zeng R, Crewe A, Mathias J, Mills A, Owen A, Prior A, Saunders I, Baker A, Crilly L, McKeon J, Ubhi HK, Adeogun A, Carr R, Davison C, Devalia S, Hayat A, Karsan RB, Osborne C, Scott K, Weegenaar C, Wijeyaratne M, Babatunde F, Barnor-Ahiaku E, Beattie G, Chitsabesan P, Dixon O, Hall N, Ilenkovan N, Mackrell T, Nithianandasivam N, Orr J, Palazzo F, Saad M, Sandland-Taylor L, Sherlock J, Ashdown T, Chandler S, Garsaa T, Lloyd J, Loh SY, Ng S, Perkins C, Powell-Chandler A, Smith F, Underhill R. Perioperative intravenous contrast administration and the incidence of acute kidney injury after major gastrointestinal surgery: prospective, multicentre cohort study. Br J Surg 2020; 107:1023-1032. [PMID: 32026470 DOI: 10.1002/bjs.11453] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 09/21/2019] [Accepted: 11/08/2019] [Indexed: 01/14/2023]
Abstract
BACKGROUND This study aimed to determine the impact of preoperative exposure to intravenous contrast for CT and the risk of developing postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery. METHODS This prospective, multicentre cohort study included adults undergoing gastrointestinal resection, stoma reversal or liver resection. Both elective and emergency procedures were included. Preoperative exposure to intravenous contrast was defined as exposure to contrast administered for the purposes of CT up to 7 days before surgery. The primary endpoint was the rate of AKI within 7 days. Propensity score-matched models were adjusted for patient, disease and operative variables. In a sensitivity analysis, a propensity score-matched model explored the association between preoperative exposure to contrast and AKI in the first 48 h after surgery. RESULTS A total of 5378 patients were included across 173 centres. Overall, 1249 patients (23·2 per cent) received intravenous contrast. The overall rate of AKI within 7 days of surgery was 13·4 per cent (718 of 5378). In the propensity score-matched model, preoperative exposure to contrast was not associated with AKI within 7 days (odds ratio (OR) 0·95, 95 per cent c.i. 0·73 to 1·21; P = 0·669). The sensitivity analysis showed no association between preoperative contrast administration and AKI within 48 h after operation (OR 1·09, 0·84 to 1·41; P = 0·498). CONCLUSION There was no association between preoperative intravenous contrast administered for CT up to 7 days before surgery and postoperative AKI. Risk of contrast-induced nephropathy should not be used as a reason to avoid contrast-enhanced CT.
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Chimalakonda A, Burke J, Cheng L, Strnad J, Catlett I, Patel A, Shen J, Girgis I, Banerjee S, Throup J. AB0026 SELECTIVE INHIBITION OF TYROSINE KINASE 2 WITH AN ORAL AGENT, BMS-986165, COMPARED WITH JANUS KINASE INHIBITORS. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.4598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:BMS-986165 is an oral, selective inhibitor of tyrosine kinase 2 (TYK2) with a unique mode of binding to the pseudokinase domain of the enzyme rather than the active site within the kinase domain. This unique mode of binding provides high functional selectivity for TYK2 versus other tyrosine kinases (TYKs) in cellular and other in vitro assays.1This approach may provide robust efficacy with a differentiated safety profile due to decreased off-target activity on other kinases. In a 12-week, placebo-controlled Phase 2 trial in patients with moderate to severe plaque psoriasis,2BMS-986165 had a favorable safety profile, and 67%–75% of patients achieved Psoriasis Area and Severity Index 75 (PASI 75) after 12 weeks at doses ≥3 mg twice daily versus 7% with placebo. BMS-986165 is currently under investigation in multiple autoimmune disorders such as psoriatic arthritis, psoriasis, and systemic lupus erythematosus.Objectives:To understand the selectivity of BMS-986165 compared with JAK inhibitors, such as tofacitinib (Tofa), upadacitinib (Upa), and baricitinib (Bari), at clinically relevant doses and plasma concentrations.Methods:In vitro whole blood assays were developed to measure the activity of common pairings of JAKs (JAK 1/3, JAK2/2, and TYK2/JAK2) and concentrations providing half-maximal inhibition (IC50) for BMS-986165, Tofa, Upa, and Bari were determined. The whole blood IC50values were plotted against pharmacokinetic profiles of these agents at approved doses and/or doses evaluated in their respective Phase 2/3 trials. The time that concentrations were >IC50and projected average daily inhibition were evaluated.Results:At clinically relevant doses and exposures, BMS-986165 plasma concentrations were higher than the TYK2 whole blood IC50value for a considerable part of the dosing interval. Additionally, the maximal plasma concentration (Cmax) of BMS-986165 was approximately >9- to 18-fold lower than the JAK 1/3 whole blood IC50value and >52- to >109-fold lower than JAK2/2 whole blood IC50, indicating lack of meaningful inhibition of the JAK 1-3 pathways by BMS-986165 at therapeutic doses. At clinically relevant doses, projected Cmaxvalues of Tofa, Upa, and Bari were many-fold lower than TYK2 IC50, indicating minimal or no meaningful inhibition of the TYK2 pathway. As expected, Tofa, Upa, and Bari had varying degrees of inhibition against JAK1/3 (daily average inhibition range: 70%–94%) and JAK2/2 pathways (daily average inhibition range: 24%–67%) at clinically relevant doses and exposures.Conclusion:These results demonstrate the high TYK2 functional selectivity of BMS-986165 at clinically relevant doses and plasma concentrations compared with Tofa, Upa, and Bari and indicate that BMS-986165 is in a different class compared with JAK 1–3 inhibitors. Ongoing studies in psoriasis and other conditions may confirm the expected safety of BMS-986165 based on the above results. The daily average inhibition of JAK1 and JAK2 likely explains some common laboratory observations and adverse events reported for the JAK1–3 inhibitors.References:[1]Burke JR et al.Sci Transl Med. 2019 Jul 24;11(502); eaaw1736.[2]Papp K et al.N Engl J Med. 2018;379(14):1313-1321.Acknowledgments:This study was sponsored by Bristol-Myers Squibb. Editorial assistance was provided by Peloton Advantage, LLC, an OPEN Health company, Parsippany, NJ, and was funded by Bristol-Myers Squibb.Disclosure of Interests:Anjaneya Chimalakonda Shareholder of: Bristol-Myers Squibb, Employee of: Bristol-Myers Squibb, James Burke Shareholder of: Bristol-Myers Squibb, Employee of: Bristol-Myers Squibb, Lihong Cheng Shareholder of: Bristol-Myers Squibb, Employee of: Bristol-Myers Squibb, Joann Strnad Shareholder of: Bristol-Myers Squibb, Employee of: Bristol-Myers Squibb, Ian Catlett Shareholder of: Bristol-Myers Squibb, Employee of: Bristol-Myers Squibb, Aditya Patel Shareholder of: Bristol-Myers Squibb, Employee of: Bristol-Myers Squibb, Jun Shen Shareholder of: Bristol-Myers Squibb, Employee of: Bristol-Myers Squibb, Ihab Girgis Shareholder of: Bristol-Myers Squibb, Employee of: Bristol-Myers Squibb, Subhashis Banerjee Shareholder of: AbbVie, Bristol-Myers Squibb, Lily, Pfizer, Employee of: Bristol-Myers Squibb (current); AbbVie, Lily, Pfizer (past), John Throup Shareholder of: Bristol-Myers Squibb, Employee of: Bristol-Myers Squibb
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Gleeson M, Kentwell M, Meiser B, Do J, Nevin S, Taylor N, Barlow-Stewart K, Kirk J, James P, Scott CL, Williams R, Gamet K, Burke J, Murphy M, Antill YC, Pearn A, Pachter N, Ebzery C, Poplawski N, Friedlander M, Tucker KM. The development and evaluation of a nationwide training program for oncology health professionals in the provision of genetic testing for ovarian cancer patients. Gynecol Oncol 2020; 158:431-439. [PMID: 32451123 DOI: 10.1016/j.ygyno.2020.05.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 01/21/2020] [Accepted: 05/03/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND BRCA1/2 mutation status has increasing relevance for ovarian cancer treatments, making traditional coordination of genetic testing by genetic services unsustainable. Consequently alternative models of genetic testing have been developed to improve testing at the initial diagnosis for all eligible women. METHODS A training module to enable mainstreamed genetic testing by oncology healthcare professionals was developed by genetic health professionals. Oncology healthcare professionals completed questionnaires before and 12 months post-training to assess perceived skills, competence and barriers to their coordinating genetic testing for women with high-grade non-mucinous epithelial ovarian cancer. Genetic health professionals were surveyed 12 months post-training to assess perceived barriers to implementation of mainstreaming. RESULTS 185 oncology healthcare professionals were trained in 42 workshops at 35 Australasian hospitals. Of the 273 tests ordered by oncology healthcare professionals post-training, 241 (93.1%) met national testing guidelines. The number of tests ordered by genetic health professionals reduced significantly (z = 45.0, p = 0.008). Oncology healthcare professionals' perceived barriers to mainstreamed testing decreased from baseline to follow-up (t = 2.39, p = 0.023), particularly perceived skills, knowledge and attitudes. However, only 58% reported either 'always' or 'nearly always' having ordered BRCA testing for eligible patients at 12 months, suggesting oncology healthcare professionals' perceived barriers were not systematically addressed through training. CONCLUSIONS Oncology healthcare professionals have demonstrated a willingness to be involved in the provision of genetic testing in a mainstreaming model. If oncology services are to hold responsibility for coordinating genetic testing, their readiness will require understanding of barriers not addressed by training alone to inform future intervention design.
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Affiliation(s)
- M Gleeson
- Hunter Family Cancer Service, Newcastle, Australia.
| | - M Kentwell
- Parkville Familial Cancer Clinic, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Australia; The Royal Women's Hospital, Oncology and Dysplasia, Melbourne, Australia
| | - B Meiser
- Prince of Wales Clinical School, UNSW Sydney, Australia
| | - J Do
- Prince of Wales Clinical School, UNSW Sydney, Australia
| | - S Nevin
- Prince of Wales Clinical School, UNSW Sydney, Australia
| | - N Taylor
- The Cancer Council New South Wales, Sydney and Faculty of Health Science, University of Sydney, Australia
| | | | - J Kirk
- Familial Cancer Service, Westmead Hospital, Sydney Medical School, University of Sydney and Centre for Cancer Research, The Westmead Institute for Medical Research, Australia
| | - P James
- Parkville Familial Cancer Clinic, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Australia
| | - C L Scott
- Parkville Familial Cancer Clinic, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Australia; Department of Obstetrics and Gynaecology and Department of Medical Biology, University of Melbourne, Australia
| | - R Williams
- Prince of Wales Clinical School, UNSW Sydney, Australia; Hereditary Cancer Centre, Prince of Wales Hospital, Sydney, Australia
| | - K Gamet
- Genetic Health Service NZ Northern Hub, Auckland City Hospital, Auckland, New Zealand
| | - J Burke
- Tasmanian Clinical Genetics Service, Royal Hobart Hospital, Hobart, Australia
| | - M Murphy
- Parkville Familial Cancer Clinic, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Australia; Bendigo Health Cancer Centre, Bendigo, Australia
| | - Y C Antill
- Parkville Familial Cancer Clinic, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Australia; Familial Cancer Centre, Monash Health, Victoria, Australia
| | - A Pearn
- Genetic Services of Western Australia, King Edward Memorial Hospital, Perth, Australia
| | - N Pachter
- Genetic Services of Western Australia, King Edward Memorial Hospital, Perth, Australia; School of Medicine, University of Western Australia, Perth, Australia
| | - C Ebzery
- Genetic Health Queensland, Royal Brisbane and Women's Hospital, Queensland, Australia
| | - N Poplawski
- Adult Genetics Unit, Royal Adelaide Hospital, Adelaide and School of Medicine, University of Adelaide, Australia
| | - M Friedlander
- Dept Medical Oncology, Prince of Wales Hospital, Sydney, Australia
| | - K M Tucker
- Prince of Wales Clinical School, UNSW Sydney, Australia; Hereditary Cancer Centre, Prince of Wales Hospital, Sydney, Australia
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Winichayakul S, Beechey-Gradwell Z, Muetzel S, Molano G, Crowther T, Lewis S, Xue H, Burke J, Bryan G, Roberts N. In vitro gas production and rumen fermentation profile of fresh and ensiled genetically modified high–metabolizable energy ryegrass. J Dairy Sci 2020; 103:2405-2418. [DOI: 10.3168/jds.2019-16781] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 11/14/2019] [Indexed: 11/19/2022]
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Affiliation(s)
- R W Storherr
- (Division of Food, Food and Drug Administration, Department of Health, Education, and Welfare, Washington 25, D.C.)
| | - J Burke
- (Division of Food, Food and Drug Administration, Department of Health, Education, and Welfare, Washington 25, D.C.)
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Brause AR, Trucksess MW, Thomas FS, Page SW, Burke J, Tanner A, Hammack S, Woodward BB, Post S, Simmons D, Cherix G, Kennedy M, Lewis S, English N, Coppola ED, Kline L, Coopersmith A, Foos JF, Eisele TA, Krueger DA, Hofsommer HJ, MacDonald S, Hesford F, Lea A, Symonds P, Martin G, Acar J, Eksi A, Ardenghi R, Weiss J, Lee B, Woidich H. Determination of Patulin in Apple Juice by Liquid Chromatography: Collaborative Study. J AOAC Int 2020. [DOI: 10.1093/jaoac/79.2.451] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
An AOAC International-International Union of Pure and Applied Chemistry-International Fruit Juice Union (AOAC-IUPAC-IFJU) collaborative study was conducted to evaluate a liquid chromatographic (LC) procedure for determination of patulin in apple juice. Patulin is a mold metabolite found naturally in rotting apples. Patulin is extracted with ethyl acetate, treated with sodium carbonate solution, and determined by reversed-phase LC with UV detection at 254 or 276 nm. Water, water-tetrahydrofuran, or water-acetonitrile was used as mobile phase. Levels determined in spiked test samples were 20, 50,100, and 200 μg/L. A test sample naturally contaminated at 31 μg/L was also included. Twenty-two collaborators in 10 countries analyzed 12 test samples of apple juice. Recoveries averaged 96%, with a range of 91-108%. Repeatability relative standard deviations (RSDr) ranged from 10.9 to 53.8%. The reproducibility relative standard deviation (RSDR) ranged from 15.1 to 68.8%. The LC method for determination of patulin in apple juice has been adopted first action by AOAC INTERNATIONAL.
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Affiliation(s)
- Allan R Brause
- Analytical Chemical Services of Columbia, Inc., 9151 Rumsey Rd, Columbia, MD 21045
| | - Mary W Trucksess
- U.S. Food and Drug Administration, Center for Food Safety and Applied Nutrition, 200 C St, SW, Washington, DC 20204
| | - Frederick S Thomas
- U.S. Food and Drug Administration, Center for Food Safety and Applied Nutrition, 200 C St, SW, Washington, DC 20204
| | - Samuel W Page
- U.S. Food and Drug Administration, Center for Food Safety and Applied Nutrition, 200 C St, SW, Washington, DC 20204
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Eisele TA, Adadevoh K, Anderson G, Brause A, Briesmeister D, Burke J, Cherix G, Ellis C, Hendricks S, Ho CT, Huang CJ, Iuliano T, Kline L, Knapp C, Krueger D, Terwel L. Determination of D-Malic Acid in Apple Juice by Liquid Chromatography: Collaborative Study. J AOAC Int 2020. [DOI: 10.1093/jaoac/79.1.50] [Citation(s) in RCA: 4] [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: 11/13/2022]
Abstract
Abstract
Eleven laboratories collaboratively studied a liquid chromatographic (LC) method for determination of D-malic acid in apple juice. The mobile phase consisted of 16 mM L-valine and 8 mM copper acetate adjusted to pH 5.5 with NaOH. The UV detector was set at 330 nm, and a single reversed-phase LC column was used. Seven paired samples containing various amounts of D-malic acid ranging from 0 to 188 mg/100 mL of 12 Brix pasteurized apple juice were tested by each collaborator. Repeatability and reproducibility coefficients of variation ranged from 1.0 to 3.5% and 7.7 to 11.7%, respectively, within the range of 26 to 188 mg D-malic acid/100 mL of 12 Brix apple juice. The collabora tive study results demonstrated that the method could quantitate the economic adulteration of ap ple juice with DL-malic acid at lower levels than those reported with previous methods. The LC method for determination of D-malic acid in apple juice has been adopted first action by AOAC INTERNATIONAL.
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Affiliation(s)
- Thomas A Eisele
- Tree Top, Inc., Technical Center, PO Box 248, Selah, WA 98942
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ABEYSEKERA N, Brailsford G, Burke J, Mallett A, Jose M. SAT-097 HEREDITARY RENAL CANCER PREDISPOSING SYNDROMES IN TASMANIA. Kidney Int Rep 2019. [DOI: 10.1016/j.ekir.2019.05.124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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McLean K, Glasbey J, Borakati A, Brooks T, Chang H, Choi S, Goodson R, Nielsen M, Pronin S, Salloum N, Sewart E, Vanniasegaram D, Drake T, Gillies M, Harrison E, Chapman S, Khatri C, Kong C, Claireaux H, Bath M, Mohan M, McNamee L, Kelly M, Mitchell H, Fitzgerald J, Bhangu A, Nepogodiev D, Antoniou I, Dean R, Davies N, Trecarten S, Henderson I, Holmes C, Wylie J, Shuttleworth R, Jindal A, Hughes F, Gouda P, Fleck R, Hanrahan M, Karunakaran P, Chen J, Sykes M, Sethi R, Suresh S, Patel P, Patel M, Varma R, Mushtaq J, Gundogan B, Bolton W, Khan T, Burke J, Morley R, Favero N, Adams R, Thirumal V, Kennedy E, Ong K, Tan Y, Gabriel J, Bakhsh A, Low J, Yener A, Paraoan V, Preece R, Tilston T, Cumber E, Dean S, Ross T, McCance E, Amin H, Satterthwaite L, Clement K, Gratton R, Mills E, Chiu S, Hung G, Rafiq N, Hayes J, Robertson K, Dynes K, Huang H, Assadullah S, Duncumb J, Moon R, Poo S, Mehta J, Joshi K, Callan R, Norris J, Chilvers N, Keevil H, Jull P, Mallick S, Elf D, Carr L, Player C, Barton E, Martin A, Ratu S, Roberts E, Phan P, Dyal A, Rogers J, Henson A, Reid N, Burke D, Culleton G, Lynne S, Mansoor S, Brennan C, Blessed R, Holloway C, Hill A, Goldsmith T, Mackin S, Kim S, Woin E, Brent G, Coffin J, Ziff O, Momoh Z, Debenham R, Ahmed M, Yong C, Wan J, Copley H, Raut P, Chaudhry F, Nixon G, Dorman C, Tan R, Kanabar S, Canning N, Dolaghan M, Bell N, McMenamin M, Chhabra A, Duke K, Turner L, Patel T, Chew L, Mirza M, Lunawat S, Oremule B, Ward N, Khan M, Tan E, Maclennan D, McGregor R, Chisholm E, Griffin E, Bell L, Hughes B, Davies J, Haq H, Ahmed H, Ungcharoen N, Whacha C, Thethi R, Markham R, Lee A, Batt E, Bullock N, Francescon C, Davies J, Shafiq N, Zhao J, Vivekanantham S, Barai I, Allen J, Marshall D, McIntyre C, Wilson H, Ashton A, Lek C, Behar N, Davis-Hall M, Seneviratne N, Esteve L, Sirakaya M, Ali S, Pope S, Ahn J, Craig-McQuaide A, Gatfield W, Leong S, Demetri A, Kerr A, Rees C, Loveday J, Liu S, Wijesekera M, Maru D, Attalla M, Smith N, Brown D, Sritharan P, Shah A, Charavanamuttu V, Heppenstall-Harris G, Ng K, Raghvani T, Rajan N, Hulley K, Moody N, Williams M, Cotton A, Sharifpour M, Lwin K, Bright M, Chitnis A, Abdelhadi M, Semana A, Morgan F, Reid R, Dickson J, Anderson L, McMullan R, Ahern N, Asmadi A, Anderson L, Boon Xuan JL, Crozier L, McAleer S, Lees D, Adebayo A, Das M, Amphlett A, Al-Robeye A, Valli A, Khangura J, Winarski A, Ali A, Woodward H, Gouldthrope C, Turner M, Sasapu K, Tonkins M, Wild J, Robinson M, Hardie J, Heminway R, Narramore R, Ramjeeawon N, Hibberd A, Winslow F, Ho W, Chong B, Lim K, Ho S, Crewdson J, Singagireson S, Kalra N, Koumpa F, Jhala H, Soon W, Karia M, Rasiah M, Xylas D, Gilbert H, Sundar-Singh M, Wills J, Akhtar S, Patel S, Hu L, Brathwaite-Shirley C, Nayee H, Amin O, Rangan T, Turner E, McCrann C, Shepherd R, Patel N, Prest-Smith J, Auyoung E, Murtaza A, Coates A, Prys-Jones O, King M, Gaffney S, Dewdney C, Nehikhare I, Lavery J, Bassett J, Davies K, Ahmad K, Collins A, Acres M, Egerton C, Cheng K, Chen X, Chan N, Sheldon A, Khan S, Empey J, Ingram E, Malik A, Johnstone M, Goodier R, Shah J, Giles J, Sanders J, McLure S, Pal S, Rangedara A, Baker A, Asbjoernsen C, Girling C, Gray L, Gauntlett L, Joyner C, Qureshi S, Mogan Y, Ng J, Kumar A, Park J, Tan D, Choo K, Raman K, Buakuma P, Xiao C, Govinden S, Thompson O, Charalambos M, Brown E, Karsan R, Dogra T, Bullman L, Dawson P, Frank A, Abid H, Tung L, Qureshi U, Tahmina A, Matthews B, Harris R, O'Connor A, Mazan K, Iqbal S, Stanger S, Thompson J, Sullivan J, Uppal E, MacAskill A, Bamgbose F, Neophytou C, Carroll A, Rookes C, Datta U, Dhutia A, Rashid S, Ahmed N, Lo T, Bhanderi S, Blore C, Ahmed S, Shaheen H, Abburu S, Majid S, Abbas Z, Talukdar S, Burney L, Patel J, Al-Obaedi O, Roberts A, Mahboob S, Singh B, Sheth S, Karia P, Prabhudesai A, Kow K, Koysombat K, Wang S, Morrison P, Maheswaran Y, Keane P, Copley P, Brewster O, Xu G, Harries P, Wall C, Al-Mousawi A, Bonsu S, Cunha P, Ward T, Paul J, Nadanakumaran K, Tayeh S, Holyoak H, Remedios J, Theodoropoulou K, Luhishi A, Jacob L, Long F, Atayi A, Sarwar S, Parker O, Harvey J, Ross H, Rampal R, Thomas G, Vanmali P, McGowan C, Stein J, Robertson V, Carthew L, Teng V, Fong J, Street A, Thakker C, O'Reilly D, Bravo M, Pizzolato A, Khokhar H, Ryan M, Cheskes L, Carr R, Salih A, Bassiony S, Yuen R, Chrastek D, Rosen O'Sullivan H, Amajuoyi A, Wang A, Sitta O, Wye J, Qamar M, Major C, Kaushal A, Morgan C, Petrarca M, Allot R, Verma K, Dutt S, Chilima C, Peroos S, Kosasih S, Chin H, Ashken L, Pearse R, O'Loughlin R, Menon A, Singh K, Norton J, Sagar R, Jathanna N, Rothwell L, Watson N, Harding F, Dube P, Khalid H, Punjabi N, Sagmeister M, Gill P, Shahid S, Hudson-Phillips S, George D, Ashwood J, Lewis T, Dhar M, Sangal P, Rhema I, Kotecha D, Afzal Z, Syeed J, Prakash E, Jalota P, Herron J, Kimani L, Delport A, Shukla A, Agarwal V, Parthiban S, Thakur H, Cymes W, Rinkoff S, Turnbull J, Hayat M, Darr S, Khan U, Lim J, Higgins A, Lakshmipathy G, Forte B, Canning E, Jaitley A, Lamont J, Toner E, Ghaffar A, McDowell M, Salmon D, O'Carroll O, Khan A, Kelly M, Clesham K, Palmer C, Lyons R, Bell A, Chin R, Waldron R, Trimble A, Cox S, Ashfaq U, Campbell J, Holliday R, McCabe G, Morris F, Priestland R, Vernon O, Ledsam A, Vaughan R, Lim D, Bakewell Z, Hughes R, Koshy R, Jackson H, Narayan P, Cardwell A, Jubainville C, Arif T, Elliott L, Gupta V, Bhaskaran G, Odeleye A, Ahmed F, Shah R, Pickard J, Suleman Y, North A, McClymont L, Hussain N, Ibrahim I, Ng G, Wong V, Lim A, Harris L, Tharmachandirar T, Mittapalli D, Patel V, Lakhani M, Bazeer H, Narwani V, Sandhu K, Wingfield L, Gentry S, Adjei H, Bhatti M, Braganza L, Barnes J, Mistry S, Chillarge G, Stokes S, Cleere J, Wadanamby S, Bucko A, Meek J, Boxall N, Heywood E, Wiltshire J, Toh C, Ward A, Shurovi B, Horth D, Patel B, Ali B, Spencer T, Axelson T, Kretzmer L, Chhina C, Anandarajah C, Fautz T, Horst C, Thevathasan A, Ng J, Hirst F, Brewer C, Logan A, Lockey J, Forrest P, Keelty N, Wood A, Springford L, Avery P, Schulz T, Bemand T, Howells L, Collier H, Khajuria A, Tharakan R, Parsons S, Buchan A, McGalliard R, Mason J, Cundy O, Li N, Redgrave N, Watson R, Pezas T, Dennis Y, Segall E, Hameed M, Lynch A, Chamberlain M, Peck F, Neo Y, Russell G, Elseedawy M, Lee S, Foster N, Soo Y, Puan L, Dennis R, Goradia H, Qureshi A, Osman S, Reeves T, Dinsmore L, Marsden M, Lu Q, Pitts-Tucker T, Dunn C, Walford R, Heathcote E, Martin R, Pericleous A, Brzyska K, Reid K, Williams M, Wetherall N, McAleer E, Thomas D, Kiff R, Milne S, Holmes M, Bartlett J, Lucas de Carvalho J, Bloomfield T, Tongo F, Bremner R, Yong N, Atraszkiewicz B, Mehdi A, Tahir M, Sherliker G, Tear A, Pandey A, Broyd A, Omer H, Raphael M, Chaudhry W, Shahidi S, Jawad A, Gill C, Fisher IH, Adeleja I, Clark I, Aidoo-Micah G, Stather P, Salam G, Glover T, Deas G, Sim N, Obute R, Wynell-Mayow W, Sait M, Mitha N, de Bernier G, Siddiqui M, Shaunak R, Wali A, Cuthbert G, Bhudia R, Webb E, Shah S, Ansari N, Perera M, Kelly N, McAllister R, Stanley G, Keane C, Shatkar V, Maxwell-Armstrong C, Henderson L, Maple N, Manson R, Adams R, Semple E, Mills M, Daoub A, Marsh A, Ramnarine A, Hartley J, Malaj M, Jewell P, Whatling E, Hitchen N, Chen M, Goh B, Fern J, Rogers S, Derbyshire L, Robertson D, Abuhussein N, Deekonda P, Abid A, Harrison P, Aildasani L, Turley H, Sherif M, Pandey G, Filby J, Johnston A, Burke E, Mohamud M, Gohil K, Tsui A, Singh R, Lim S, O'Sullivan K, McKelvey L, O'Neill S, Roberts H, Brown F, Cao Y, Buckle R, Liew Y, Sii S, Ventre C, Graham C, Filipescu T, Yousif A, Dawar R, Wright A, Peters M, Varley R, Owczarek S, Hartley S, Khattak M, Iqbal A, Ali M, Durrani B, Narang Y, Bethell G, Horne L, Pinto R, Nicholls K, Kisyov I, Torrance H, English W, Lakhani S, Ashraf S, Venn M, Elangovan V, Kazmi Z, Brecher J, Sukumar S, Mastan A, Mortimer A, Parker J, Boyle J, Elkawafi M, Beckett J, Mohite A, Narain A, Mazumdar E, Sreh A, Hague A, Weinberg D, Fletcher L, Steel M, Shufflebotham H, Masood M, Sinha Y, Jenvey C, Kitt H, Slade R, Craig A, Deall C, Reakes T, Chervenkoff J, Strange E, O'Bryan M, Murkin C, Joshi D, Bergara T, Naqib S, Wylam D, Scotcher S, Hewitt C, Stoddart M, Kerai A, Trist A, Cole S, Knight C, Stevens S, Cooper G, Ingham R, Dobson J, O'Kane A, Moradzadeh J, Duffy A, Henderson C, Ashraf S, McLaughin C, Hoskins T, Reehal R, Bookless L, McLean R, Stone E, Wright E, Abdikadir H, Roberts C, Spence O, Srikantharajah M, Ruiz E, Matthews J, Gardner E, Hester E, Naran P, Simpson R, Minhas M, Cornish E, Semnani S, Rojoa D, Radotra A, Eraifej J, Eparh K, Smith D, Mistry B, Hickling S, Din W, Liu C, Mithrakumar P, Mirdavoudi V, Rashid M, Mcgenity C, Hussain O, Kadicheeni M, Gardner H, Anim-Addo N, Pearce J, Aslanyan A, Ntala C, Sorah T, Parkin J, Alizadeh M, White A, Edozie F, Johnston J, Kahar A, Navayogaarajah V, Patel B, Carter D, Khonsari P, Burgess A, Kong C, Ponweera A, Cody A, Tan Y, Ng A, Croall A, Allan C, Ng S, Raghuvir V, Telfer R, Greenhalgh A, McKerr C, Edison M, Patel B, Dear K, Hardy M, Williams P, Hassan S, Sajjad U, O'Neill E, Lopes S, Healy L, Jamal N, Tan S, Lazenby D, Husnoo S, Beecroft S, Sarvanandan T, Weston C, Bassam N, Rabinthiran S, Hayat U, Ng L, Varma D, Sukkari M, Mian A, Omar A, Kim J, Sellathurai J, Mahmood J, O'Connell C, Bose R, Heneghan H, Lalor P, Matheson J, Doherty C, Cullen C, Cooper D, Angelov S, Drislane C, Smith A, Kreibich A, Palkhi E, Durr A, Lotfallah A, Gold D, Mckean E, Dhanji A, Anilkumar A, Thacoor A, Siddiqui Z, Lim S, Piquet A, Anderson S, McCormack D, Gulati J, Ibrahim A, Murray S, Walsh S, McGrath A, Ziprin P, Chua E, Lou C, Bloomer J, Paine H, Osei-Kuffour D, White C, Szczap A, Gokani S, Patel K, Malys M, Reed A, Torlot G, Cumber E, Charania A, Ahmad S, Varma N, Cheema H, Austreng L, Petra H, Chaudhary M, Zegeye M, Cheung F, Coffey D, Heer R, Singh S, Seager E, Cumming S, Suresh R, Verma S, Ptacek I, Gwozdz A, Yang T, Khetarpal A, Shumon S, Fung T, Leung W, Kwang P, Chew L, Loke W, Curran A, Chan C, McGarrigle C, Mohan K, Cullen S, Wong E, Toale C, Collins D, Keane N, Traynor B, Shanahan D, Yan A, Jafree D, Topham C, Mitrasinovic S, Omara S, Bingham G, Lykoudis P, Miranda B, Whitehurst K, Kumaran G, Devabalan Y, Aziz H, Shoa M, Dindyal S, Yates J, Bernstein I, Rattan G, Coulson R, Stezaker S, Isaac A, Salem M, McBride A, McFarlane H, Yow L, MacDonald J, Bartlett R, Turaga S, White U, Liew W, Yim N, Ang A, Simpson A, McAuley D, Craig E, Murphy L, Shepherd P, Kee J, Abdulmajid A, Chung A, Warwick H, Livesey A, Holton P, Theodoreson M, Jenkin S, Turner J, Entwisle J, Marchal S, O'Connor S, Blege H, Aithie J, Sabine L, Stewart G, Jackson S, Kishore A, Lankage C, Acquaah F, Joyce H, McKevitt K, Coffey C, Fawaz A, Dolbec K, O'Sullivan D, Geraghty J, Lim E, Bolton L, FitzPatrick D, Robinson C, Ramtoola T, Collinson S, Grundy L, McEnhill P, Harbhajan Singh G, Loughran D, Golding D, Keeling R, Williams R, Whitham R, Yoganathan S, Nachiappan R, Egan R, Owasil R, Kwan M, He A, Goh R, Bhome R, Wilson H, Teoh P, Raji K, Jayakody N, Matthams J, Chong J, Luk C, Greig R, Trail M, Charalambous G, Rocke A, Gardiner N, Bulley F, Warren N, Brennan E, Fergurson P, Wilson R, Whittingham H, Brown E, Khanijau R, Gandhi K, Morris S, Boulton A, Chandan N, Barthorpe A, Maamari R, Sandhu S, McCann M, Higgs L, Balian V, Reeder C, Diaper C, Sale T, Ali H, Archer C, Clarke A, Heskin J, Hurst P, Farmer J, O'Flynn L, Doan L, Shuker B, Stott G, Vithanage N, Hoban K, Nesargikar P, Kennedy H, Grossart C, Tan E, Roy C, Sim P, Leslie K, Sim D, Abul M, Cody N, Tay A, Woon E, Sng S, Mah J, Robson J, Shakweh E, Wing V, Mills H, Li M, Barrow T, Balaji S, Jordan H, Phillips C, Naveed H, Hirani S, Tai A, Ratnakumaran R, Sahathevan A, Shafi A, Seedat M, Weaver R, Batho A, Punj R, Selvachandran H, Bhatt N, Botchey S, Khonat Z, Brennan K, Morrison C, Devlin E, Linton A, Galloway E, McGarvie S, Ramsay N, McRobbie H, Whewell H, Dean W, Nelaj S, Eragat M, Mishra A, Kane T, Zuhair M, Wells M, Wilkinson D, Woodcock N, Sun E, Aziz N, Ghaffar MKA. Critical care usage after major gastrointestinal and liver surgery: a prospective, multicentre observational study. Br J Anaesth 2019; 122:42-50. [PMID: 30579405 DOI: 10.1016/j.bja.2018.07.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 07/19/2018] [Accepted: 07/23/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Patient selection for critical care admission must balance patient safety with optimal resource allocation. This study aimed to determine the relationship between critical care admission, and postoperative mortality after abdominal surgery. METHODS This prespecified secondary analysis of a multicentre, prospective, observational study included consecutive patients enrolled in the DISCOVER study from UK and Republic of Ireland undergoing major gastrointestinal and liver surgery between October and December 2014. The primary outcome was 30-day mortality. Multivariate logistic regression was used to explore associations between critical care admission (planned and unplanned) and mortality, and inter-centre variation in critical care admission after emergency laparotomy. RESULTS Of 4529 patients included, 37.8% (n=1713) underwent planned critical care admissions from theatre. Some 3.1% (n=86/2816) admitted to ward-level care subsequently underwent unplanned critical care admission. Overall 30-day mortality was 2.9% (n=133/4519), and the risk-adjusted association between 30-day mortality and critical care admission was higher in unplanned [odds ratio (OR): 8.65, 95% confidence interval (CI): 3.51-19.97) than planned admissions (OR: 2.32, 95% CI: 1.43-3.85). Some 26.7% of patients (n=1210/4529) underwent emergency laparotomies. After adjustment, 49.3% (95% CI: 46.8-51.9%, P<0.001) were predicted to have planned critical care admissions, with 7% (n=10/145) of centres outside the 95% CI. CONCLUSIONS After risk adjustment, no 30-day survival benefit was identified for either planned or unplanned postoperative admissions to critical care within this cohort. This likely represents appropriate admission of the highest-risk patients. Planned admissions in selected, intermediate-risk patients may present a strategy to mitigate the risk of unplanned admission. Substantial inter-centre variation exists in planned critical care admissions after emergency laparotomies.
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Zosimas D, Lykoudis PM, Burke J, Strano G, Leung P, Shatkar V. Postoperative outcomes in laparoscopic appendicectomies with histopathologically normal appendix. Ann Ital Chir 2019; 90:72-77. [PMID: 30467271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
AIM Although still debatable, appendicectomy during laparoscopy in patients with abdominal pain is often performed even if the appendix seems normal. The study's aim is to compare the postoperative outcomes of laparoscopic appendicectomies with appendix proven to be histologically normal to those with proven appendicitis, adding evidence on whether a normal appendix should be removed. METHODS All consecutive patients who underwent laparoscopic appendicectomy in a one-year period in a single centre were retrospectively studied. Comparison was attempted between patients with negative and positive histology with regards to their postoperative outcomes (length of stay and postoperative complications). RESULTS Out of 134 patients included in the study, ten patients developed postoperative complications (7.5%), 42 patients had negative histology (31.3%), 92 patients had positive histology (68.7%) and six (14.3%) and four patients (4.3%) respectively from each group developed post-operative complications. No statistically significant difference was found regarding morbidity, length of stay and Clavien-Dindo grading of complications between the two groups. DISCUSSION Morbidity and length of stay in laparoscopic appendicectomy with normal appendix are not inferior to those with histologically confirmed appendicitis and thus should not be disregarded when considering a routine appendicectomy. CONCLUSION The final decision to remove a normal appendix in laparoscopy for abdominal pain should be based on the individual clinical scenario and surgeon's experience. KEY WORDS Acute appendicitis, Histology, Length of Stay, Morbidity.
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De K, Kasliwal MM, Ofek EO, Moriya TJ, Burke J, Cao Y, Cenko SB, Doran GB, Duggan GE, Fender RP, Fransson C, Gal-Yam A, Horesh A, Kulkarni SR, Laher RR, Lunnan R, Manulis I, Masci F, Mazzali PA, Nugent PE, Perley DA, Petrushevska T, Piro AL, Rumsey C, Sollerman J, Sullivan M, Taddia F. A hot and fast ultra-stripped supernova that likely formed a compact neutron star binary. Science 2018; 362:201-206. [PMID: 30309948 DOI: 10.1126/science.aas8693] [Citation(s) in RCA: 6] [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] [Received: 12/31/2017] [Accepted: 07/26/2018] [Indexed: 11/02/2022]
Abstract
Compact neutron star binary systems are produced from binary massive stars through stellar evolution involving up to two supernova explosions. The final stages in the formation of these systems have not been directly observed. We report the discovery of iPTF 14gqr (SN 2014ft), a type Ic supernova with a fast-evolving light curve indicating an extremely low ejecta mass (≈0.2 solar masses) and low kinetic energy (≈2 × 1050 ergs). Early photometry and spectroscopy reveal evidence of shock cooling of an extended helium-rich envelope, likely ejected in an intense pre-explosion mass-loss episode of the progenitor. Taken together, we interpret iPTF 14gqr as evidence for ultra-stripped supernovae that form neutron stars in compact binary systems.
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Affiliation(s)
- K De
- Cahill Centre for Astrophysics, California Institute of Technology, 1200 East California Boulevard, Pasadena, CA 91125, USA.
| | - M M Kasliwal
- Cahill Centre for Astrophysics, California Institute of Technology, 1200 East California Boulevard, Pasadena, CA 91125, USA
| | - E O Ofek
- Department of Particle Physics and Astrophysics, Faculty of Physics, The Weizmann Institute of Science, Rehovot 76100, Israel
| | - T J Moriya
- Division of Theoretical Astronomy, National Astronomical Observatory of Japan, National Institutes of Natural Sciences, 2-21-1 Osawa, Mitaka, Tokyo 181-8588, Japan
| | - J Burke
- Las Cumbres Observatory, 6740 Cortona Drive, Suite 102, Goleta, CA 93117, USA.,Department of Physics, University of California, Santa Barbara, CA 93106, USA
| | - Y Cao
- Department of Astronomy, University of Washington, Box 351580, Seattle, WA 98195, USA
| | - S B Cenko
- Astrophysics Science Division, NASA Goddard Space Flight Center, Mail Code 661, Greenbelt, MD 20771, USA.,Joint Space-Science Institute, University of Maryland, College Park, MD 20742, USA
| | - G B Doran
- Jet Propulsion Laboratory, California Institute of Technology, Pasadena, CA 91109, USA
| | - G E Duggan
- Cahill Centre for Astrophysics, California Institute of Technology, 1200 East California Boulevard, Pasadena, CA 91125, USA
| | - R P Fender
- Department of Physics, Astrophysics, University of Oxford, Denys Wilkinson Building, Oxford OX1 3RH, UK
| | - C Fransson
- Oskar Klein Centre, Department of Astronomy, Stockholm University, 106 91 Stockholm, Sweden
| | - A Gal-Yam
- Department of Particle Physics and Astrophysics, Faculty of Physics, The Weizmann Institute of Science, Rehovot 76100, Israel
| | - A Horesh
- Racah Institute of Physics, The Hebrew University of Jerusalem, Jerusalem 91904, Israel
| | - S R Kulkarni
- Cahill Centre for Astrophysics, California Institute of Technology, 1200 East California Boulevard, Pasadena, CA 91125, USA
| | - R R Laher
- Infrared Processing and Analysis Center, California Institute of Technology, MS 100-22, Pasadena, CA 91125, USA
| | - R Lunnan
- Oskar Klein Centre, Department of Astronomy, Stockholm University, 106 91 Stockholm, Sweden
| | - I Manulis
- Department of Particle Physics and Astrophysics, Faculty of Physics, The Weizmann Institute of Science, Rehovot 76100, Israel
| | - F Masci
- Infrared Processing and Analysis Center, California Institute of Technology, MS 100-22, Pasadena, CA 91125, USA
| | - P A Mazzali
- Astrophysics Research Institute, Liverpool John Moores University, Liverpool L3 5RF, UK.,Max-Planck-Institut für Astrophysik, Karl-Schwarzschild-Str. 1, D-85748 Garching bei München, Germany
| | - P E Nugent
- Lawrence Berkeley National Laboratory, Berkeley, California 94720, USA.,Department of Astronomy, University of California, Berkeley, CA, 94720, USA
| | - D A Perley
- Astrophysics Research Institute, Liverpool John Moores University, Liverpool L3 5RF, UK
| | - T Petrushevska
- Oskar Klein Centre, Department of Physics, Stockholm University, 106 91 Stockholm, Sweden.,Centre for Astrophysics and Cosmology, University of Nova Gorica, Vipavska 11c, 5270 Ajdovščina, Slovenia
| | - A L Piro
- The Observatories of the Carnegie Institution for Science, 813 Santa Barbara Street, Pasadena, CA 91101, USA
| | - C Rumsey
- Astrophysics Group, Cavendish Laboratory, 19 J J Thomson Avenue, Cambridge CB3 0HE, UK
| | - J Sollerman
- Oskar Klein Centre, Department of Astronomy, Stockholm University, 106 91 Stockholm, Sweden
| | - M Sullivan
- Department of Physics and Astronomy, University of Southampton, Southampton SO17 1BJ, UK
| | - F Taddia
- Oskar Klein Centre, Department of Astronomy, Stockholm University, 106 91 Stockholm, Sweden
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Beare S, Meglioli A, Burke J, Bandhoe N, Gallardo JL. Saving Women's Lives in Latin America and the Caribbean: Improving Cervical Cancer Screening and Treatment Quality and Access. J Glob Oncol 2018. [DOI: 10.1200/jgo.18.60200] [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
Background and context: It is the third leading cause of cancer deaths among females in Latin America and the Caribbean, and yet cervical cancer is almost entirely preventable and treatable. In a region where many lack even basic access to quality sexual and reproductive healthcare, screening and treatment services for HPV and cervical cancer are far from universally available. International Planned Parenthood Federation/Western Hemisphere Region (IPPF/WHR) and its member associations (MAs) are working to reverse this trend, identifying and bridging local gaps in access and services wherever possible. Aim: IPPF/WHR and its MAs seek to improve both providers' ability to deliver - and women's ability to access - quality cervical cancer screening and treatment through institutional capacity building, the introduction of new technologies, advocacy and community awareness efforts. Strategy/Tactics: 1) Increase cervical cancer services by training providers in the provision of low cost, high capacity screening and treatment methods, including visual inspection with acetic acid (VIA), HC2 and HPV DNA screening technologies, and a single-visit approach (SVA) to treatment using cryotherapy, thermocoagulation and LEEP. 2) Educate populations and increase demand for cervical cancer services by implementing public awareness campaigns and community information, education and communication (IEC) activities promoting the importance of early detection and treatment. 3) Improve and standardize clinical protocols and referral pathways by advocating among and collaborating with key decision-makers and local ministries of health. Program/Policy process: MAs are implementing small-scale pilot studies to incorporate VIA, HC2 and HPV DNA screening and new treatment to provide even greater numbers of women with potentially life-saving diagnostics and care in Belize, Honduras, El Salvador and Bolivia. As leading clinical experts and advocates, several MAs are also working with public sector counterparts to refine two-way referral pathways, standardize screening protocols and clinical guidelines, and to ensure data quality and collection. A range of Caribbean MAs have also been trained in the use of VIA, cryo and LEEP. Outcomes: From 2016 to 2017, MAs from Belize, Grenada, Suriname, and several additional Caribbean countries who received training in VIA and other screening and treatment techniques saw an average 7% increase in the number of direct cervical cancer services provided. MAs from Belize, Bolivia and Honduras also contributed to updated national cervical cancer protocols. What was learned: An effective national response to cervical cancer requires the support and collaboration of civil society organizations, which can deliver direct services and play a catalytic role in advancing technical recommendations and policy dialogue. Countries should continue to improve the quality of VIA services, until more advanced screening technologies become available and can be scaled up.
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Affiliation(s)
- S. Beare
- International Planned Parenthood Federation/Western Hemisphere Region, New York, NY
| | - A. Meglioli
- International Planned Parenthood Federation/Western Hemisphere Region, New York, NY
| | - J. Burke
- Belize Family Life Association, Belize City, Belize
| | - N. Bandhoe
- Stichting Lobi Health Center, Paramaribo, Suriname
| | - J. López Gallardo
- Centro de Investigación, Educación y Servicios, La Paz, Plurinational State of Bolivia
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Wasilewski A, Serventi J, Ibegbu C, Burke J, Wychowski T, Mohile N. P01.008 Feasibility of a structured tumor related epilepsy education intervention in adult gliomas. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy139.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- A Wasilewski
- University of Rochester, Rochester, NY, United States
| | - J Serventi
- University of Rochester, Rochester, NY, United States
| | - C Ibegbu
- University of Rochester, Rochester, NY, United States
| | - J Burke
- University of Rochester, Rochester, NY, United States
| | - T Wychowski
- University of Rochester, Rochester, NY, United States
| | - N Mohile
- University of Rochester, Rochester, NY, United States
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Hemminger L, Ibegbu C, Serventi J, Burke J, Occhiogrosso J, Mohile N. P01.016 Caregiver Burden and Distress in Newly Diagnosed Gliomas: A Prospective Analysis. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy139.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- L Hemminger
- University of Rochester Medical Center, Rochester, NY, United States
| | - C Ibegbu
- University of Rochester Medical Center, Rochester, NY, United States
| | - J Serventi
- University of Rochester Medical Center, Rochester, NY, United States
| | - J Burke
- University of Rochester Medical Center, Rochester, NY, United States
| | - J Occhiogrosso
- University of Rochester Medical Center, Rochester, NY, United States
| | - N Mohile
- University of Rochester Medical Center, Rochester, NY, United States
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Ledowski T, Burke J, Hruby J. Surgical pleth index: prediction of postoperative pain and influence of arousal. Br J Anaesth 2018; 117:371-4. [PMID: 27543532 DOI: 10.1093/bja/aew226] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2016] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND There are conflicting reports concerning the outcome after anaesthesia guided by the surgical pleth index (SPI; GE Healthcare, Helsinki, Finland). One potential explanation may be the lack of evidence for the selection of SPI cut-off values. The aim of this trial was to investigate the correlation between SPI, arousal, and postoperative pain and to define a cut-off value for SPI to predict moderate-to-severe pain. METHODS After obtaining ethical approval and written informed consent, 70 patients undergoing non-emergency surgery were enrolled. Data relating to SPI, heart rate, mean arterial pressure, and state entropy were recorded every 10 s for the last 10 min of surgery (state entropy <60 at all times). Subsequently, recordings continued during the phase of arousal. After recovery room admission, pain scores (numerical rating scale 0-10) were obtained every 3 min for 15 min. RESULTS Data from 65 patients were analysed. Receiver-operating characteristic curve analysis revealed an optimal intraoperative cut-off SPI value of 30 to discriminate between numerical rating scale scores 0-3 and 4-10. For this value, the negative and positive predictive values to discriminate between numerical rating scale scores 0-3 and 4-10 were 50 and 89.7%, respectively. The SPI was significantly affected by arousal, and SPI scores obtained during this phase were not predictive of postoperative pain. CONCLUSIONS Surgical pleth index values are predictive of postoperative pain only if obtained before patient arousal. In contrast to previous studies, a relatively low SPI, >30, appears to predict pain with a high positive predictive value and may therefore be suggested for future studies of SPI-guided anaesthesia. CLINICAL TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry: ACTRN12615000804583.
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Affiliation(s)
- T Ledowski
- School of Medicine and Pharmacology, University of Western Australia, Level 2 Royal Perth Hospital MRF Building, Rear 50 Murray Street, Perth, WA 6000, Australia Department of Anaesthesia and Pain Medicine, Royal Perth Hospital, Perth, WA, Australia
| | - J Burke
- Faculty of Medicine, Christian-Albrechts-University Kiel, Kiel, Germany
| | - J Hruby
- Department of Anaesthesia, Armadale Health Services, Perth, WA, Australia
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Skinner H, Burke J, Young A, Smith A. Management of acute cholecystitis in a tertiary centre – room for improvement. Int J Surg 2018. [DOI: 10.1016/j.ijsu.2018.05.284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Burke J, Houtouras A, Knowles C, Sadigh P. Pedicled, innervated vastus lateralis (PIVL) flap for abdominal wall incisional hernia following kidney transplant and its proposed use in large lateralised incisional hernia - A new application for an established technique. Int J Surg 2018. [DOI: 10.1016/j.ijsu.2018.05.086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Zosimas D, Lykoudis PM, Pilavas A, Burke J, Leung P, Strano G, Shatkar V. Open versus laparoscopic appendicectomy in acute appendicitis: results of a district general hospital. S AFR J SURG 2018; 56:59-62. [PMID: 30010266] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Despite multiple studies comparing the two methods, the real advantages of laparoscopic appendicectomy (LA) compared to open appendicectomy (OA) are still unclear. Purpose of the current study was to compare the results between the two techniques in a district general hospital. METHODS The electronic records of all patients who underwent OA or LA in a one year period were reviewed retrospectively. The comparative data points assessed included age, gender, overall complications, length of stay and Clavien-Dindo Classification of Surgical Complications, including the rates of the main types of complications. RESULTS 300 patients were included in the study. 166 patients underwent OA and 134 patients LA. Postoperative complications were documented in 26 patients (8.7%). LA was employed predominantly in female patients (p = 0.004) and in older patients (p = 0.0015) and was associated with significantly more negative appendicectomies than OA (p = 0.002). No statistically significant difference was noted with regards to the length of hospital stay (p = 0.577), overall postoperative morbidity (p = 0.543) and grading of complications (p = 0.460). Finally, following comparison of the incidence of specific types of complications, only wound infections were significantly different, in favour of LA. CONCLUSION LA is safe and effective, however, besides the lower incidence of wound sepsis, demonstrates no clear advantage over OA. The selection between OA and LA should thus be tailored to the clinical scenario and the surgeon's preference.
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Affiliation(s)
- D Zosimas
- Department of General Surgery, Queen's Hospital, Romford, Essex, UK
| | | | - A Pilavas
- Department of General Surgery, Queen's Hospital, Romford, Essex, UK
| | - J Burke
- Department of General Surgery, Queen's Hospital, Romford, Essex, UK
| | - P Leung
- Department of General Surgery, Queen's Hospital, Romford, Essex, UK
| | - G Strano
- Department of General Surgery, Queen's Hospital, Romford, Essex, UK
| | - V Shatkar
- Department of General Surgery, Queen's Hospital, Romford, Essex, UK
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Sadigh P, Burke J, Nikkhah D, Sammartino C, Puliatti C, Sivaprakasam R, Knowles C. 'Abdominal reanimation' and massive flank hernias: Moving towards a more functional reconstruction. J Plast Reconstr Aesthet Surg 2018; 71:941-943. [PMID: 29426810 DOI: 10.1016/j.bjps.2018.01.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Accepted: 01/21/2018] [Indexed: 10/18/2022]
Affiliation(s)
- Parviz Sadigh
- Department of Plastic Reconstructive Surgery, The Royal London Hospital, Bart's Health NHS Trust, London, UK.
| | - Josh Burke
- National Centre for Bowel Research & Surgical Innovation, London, UK
| | - Dariush Nikkhah
- Department of Plastic Reconstructive Surgery, The Royal London Hospital, Bart's Health NHS Trust, London, UK
| | - Cinzia Sammartino
- Department of Renal Transplantation, The Royal London Hospital, Bart's Health NHS Trust, London, UK
| | - Carmelo Puliatti
- Department of Renal Transplantation, The Royal London Hospital, Bart's Health NHS Trust, London, UK
| | - Rajesh Sivaprakasam
- Department of Renal Transplantation, The Royal London Hospital, Bart's Health NHS Trust, London, UK
| | - Charles Knowles
- National Centre for Bowel Research & Surgical Innovation, London, UK
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Siegert S, Singer C, Molho E, Burke J, Liang G. Effects of once-daily valbenazine on Tardive Dyskinesia by body region. Parkinsonism Relat Disord 2018. [DOI: 10.1016/j.parkreldis.2017.11.087] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Zosimas D, Lykoudis PM, Pilavas A, Burke J, Leung P, Strano G, Shatkar V. Open versus laparoscopic appendicectomy in acute appendicitis: results of a District General Hospital. S AFR J SURG 2018. [DOI: 10.17159/2078-5151/2018/v56n2a2392] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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49
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Randall M, Filiaci V, McMeekin D, Yashar C, Mannel R, Salani R, DiSilvestro P, Burke J, Rutherford T, Spirtos N, Cho J, Kim J, Anderson P, Brewster W, Small W, Carney M, Aghajanian C, Miller D. A Phase 3 Trial of Pelvic Radiation Therapy Versus Vaginal Cuff Brachytherapy Followed by Paclitaxel/Carboplatin Chemotherapy in Patients with High-Risk, Early-Stage Endometrial Cancer: A Gynecology Oncology Group Study. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.09.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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50
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Zhang T, Harrison M, O'Donnell P, Alva A, Hahn N, Appleman L, Cetnar J, Burke J, Fleming M, Milowsky M, Mortazavi A, Shore N, Schmidt E, Kresja C, Chen T, Bitman B, Izumi R, Hamdy A, George D. Phase 2 study of pembrolizumab alone or combined with acalabrutinib in platinum-refractory metastatic urothelial carcinoma (mUC). Ann Oncol 2017. [DOI: 10.1093/annonc/mdx371.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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