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Khan Z, Challand CP, Lee MJ. Management of acute colonic pseudo-obstruction: opportunities to improve care? Ann R Coll Surg Engl 2024. [PMID: 38445579 DOI: 10.1308/rcsann.2024.0017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND Acute colonic pseudo-obstruction (ACPO) is a functional bowel obstruction characterised by colonic dilatation in the absence of mechanical obstruction on imaging. Complications include bowel ischaemia, perforation and death. The aim of this study was to explore outcomes for patients treated for ACPO and to assess adherence to current ACPO treatment guidelines. METHODS This is a retrospective service evaluation and included patients with a diagnosis of ACPO between 1 March 2018 and 31 March 2023. Process measures were identified following discussion with the clinical team from published guidance. Patients were identified using clinical coding and radiological text reports. Cases were eligible for inclusion if they had radiologically confirmed ACPO. Data were collected following review of patient notes into Microsoft Excel. Descriptive analysis was performed with no formal statistical assessment. RESULTS A total of 45 patients were identified, of whom 13 were admitted under general surgery. All patients received admission bloods (n=45). Nearly all patients had computed tomography imaging (43/45, 96%). Only 3/45 (6.7%) of the patients received optimal conservative management (intravenous infusion, nil by mouth, flatus tube, treatment of reversible causes). In all, 11/45 (24%) required further treatment, of whom 7 received this within 72 h. The leading (11/45) complication following diagnosis of ACPO was hospital-acquired pneumonia. Mortality was seen in 9/45. CONCLUSIONS ACPO is often managed remotely by general surgeons. This may impact on the quality of conservative management, and timeliness of endoscopic or pharmacological intervention. Further work is needed to optimise management.
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Affiliation(s)
- Z Khan
- University of Sheffield, UK
- Sheffield Teaching Hospitals, UK
| | | | - M J Lee
- University of Sheffield, UK
- Sheffield Teaching Hospitals, UK
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Jung Y, Lee SH, Lee MJ. Development of reference material for quality control of uranium analysis in marine sediments. Appl Radiat Isot 2023; 200:110979. [PMID: 37586247 DOI: 10.1016/j.apradiso.2023.110979] [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: 04/25/2023] [Revised: 07/28/2023] [Accepted: 08/10/2023] [Indexed: 08/18/2023]
Abstract
Environmental radioactivity monitoring is strengthening due to public concerns over radioactive contamination since the Fukushima nuclear power plant accident. Therefore, various research laboratories, institutes, and universities have been conducting environmental radioactivity surveys around nuclear power plants (NPPs). However, the reliability of the results continues to trigger controversy in society. This study was conducted to develop reference material (RM) for the quality control of 238U and 234U analyses in marine sediments. The RM was prepared according to ISO Guides 31, 34, and 35. A homogeneity test of the marine sediment RM was implemented by analyzing two batch samples from ten bottles using multiple acid digestion and alkali fusion, respectively. We found that the 238U and 234U reference values of the RM were 43.0 ± 1.7 Bq kg-1(k=1) and 41.5 ± 1.9 Bq kg-1(k=1), respectively. This marine sediment RM will be useful for the quality control of analytical methods for similar samples and proficiency tests.
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Affiliation(s)
- Y Jung
- Environmental Radioactivity Safety Team, Korea Research Institute of Standards and Science, 267 Gajeong-ro, Yuseong-gu, Daejeon, 34113, Republic of Korea
| | - S H Lee
- Environmental Radioactivity Safety Team, Korea Research Institute of Standards and Science, 267 Gajeong-ro, Yuseong-gu, Daejeon, 34113, Republic of Korea.
| | - M J Lee
- Environmental Radioactivity Safety Team, Korea Research Institute of Standards and Science, 267 Gajeong-ro, Yuseong-gu, Daejeon, 34113, Republic of Korea
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Lee SH, Jung Y, Lee MJ, Lee CH. Development of metal radioactive liquid reference material for proficiency test. Appl Radiat Isot 2023; 200:110970. [PMID: 37540991 DOI: 10.1016/j.apradiso.2023.110970] [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: 05/31/2023] [Revised: 07/21/2023] [Accepted: 07/31/2023] [Indexed: 08/06/2023]
Abstract
This study developed liquid reference materials containing various metals, to be used for quality assurance of radiation measurements of the most common metallic wastes generated during the operation or decommissioning of nuclear power plants. The liquid reference materials were prepared by assuming the dissolution of stainless-steel using acid and melting of the major metals present in the stainless steel, namely Fe, Ni, Cr, and Mn, along with the standard sources (134Cs, 137Cs, 60Co, 90Sr). The theoretical massic activity of the standard sources added to the samples and the measured reference values of the gamma and beta emitters in the samples were compared, and they showed good agreement within a one-sigma confidence interval (k = 1). Using the developed reference materials, a proficiency test was conducted on three domestic labs, and the results were evaluated using Z-score. While the evaluation results showed good agreement between the reference values and the reported values for 137Cs and 60Co, all participating labs reported lower values than the reference value for 134Cs. For 90Sr, two out of the three labs reported significantly higher values than the reference value. Based on the results of this study, the developed metal radioactive liquid reference material is expected to be registered as certified reference material (CRM) in the future. They will be used as the CRM for measuring and ensuring the quality of radioactive metal waste.
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Affiliation(s)
- S H Lee
- Environmental Radioactivity Safety Team, Korea Research Institute of Standards and Science (KRISS), 267 Gajeong-ro, Yuseong-gu, Daejeon, 34113, Republic of Korea.
| | - Y Jung
- Environmental Radioactivity Safety Team, Korea Research Institute of Standards and Science (KRISS), 267 Gajeong-ro, Yuseong-gu, Daejeon, 34113, Republic of Korea
| | - M J Lee
- Environmental Radioactivity Safety Team, Korea Research Institute of Standards and Science (KRISS), 267 Gajeong-ro, Yuseong-gu, Daejeon, 34113, Republic of Korea
| | - C H Lee
- Nuclear Decommissioning Research Institute (NDRI), 17 Techno 4-ro, Yuseong-gu, Daejeon, 34013, Republic of Korea
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Jung J, Moon SM, Kim DY, Kim SH, Lee WJ, Heo ST, Park JY, Bae S, Lee MJ, Kim B, Park SY, Jeong HW, Kim Y, Kwak YG, Song KH, Park KH, Park SH, Kim YK, Kim ES, Kim HB. Appropriateness of antibiotic use for patients with asymptomatic bacteriuria or urinary tract infection with positive urine culture: a retrospective observational multi-centre study in Korea. J Hosp Infect 2023; 140:79-86. [PMID: 37562596 DOI: 10.1016/j.jhin.2023.07.022] [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: 05/02/2023] [Revised: 07/24/2023] [Accepted: 07/29/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND Antibiotic resistance threatens public health worldwide, and inappropriate use of antibiotics is one of the main causes. AIM To evaluate qualitative use of antibiotics in asymptomatic bacteriuria (ABU) and urinary tract infection (UTI). METHODS Cases of positive urine culture (≥105 colony-forning units/mL) performed in inpatient, outpatient and emergency departments in April 2021 were screened in 26 hospitals in the Republic of Korea. The cases were classified as ABU, lower UTI and upper UTI. The appropriateness of antibiotic use was evaluated retrospectively by infectious disease specialists using quality indicators based on clinical guidelines for ABU and UTI. RESULTS This study included a total of 2697 patients with ABU or UTI. The appropriateness of antibiotic use was assessed in 1157 patients with ABU, and in 677 and 863 patients with lower and upper UTI, respectively. Among the 1157 patients with ABU, 251 (22%) were prescribed antibiotics without appropriate indications. In 66 patients with ABU in which antibiotics were prescribed with appropriate indications, the duration was adequate in only 23 (34.8%) patients. The appropriateness of empirical and definite antibiotics was noted in 527 (77.8%) and 353 (68.0%) patients with lower UTI, and 745 (86.3%) and 583 (78.2%) patients with upper UTI, respectively. The duration of antibiotics was adequate in 321 (61.8%) patients with lower UTI and 576 (78.7%) patients with upper UTI. CONCLUSIONS This nationwide qualitative assessment of antibiotic use in ABU and UTI revealed that antibiotics were often prescribed inappropriately, and the duration of antibiotics was unnecessarily prolonged.
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Affiliation(s)
- J Jung
- Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea
| | - S M Moon
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - D Y Kim
- Division of Infectious Diseases, Department of Internal Medicine, Kyung Hee University Hospital, Kyung Hee University School of Medicine, Seoul, Republic of Korea
| | - S-H Kim
- Division of Infectious Diseases, Samsung Changwon Hospital, Sungkyunkwan University, Changwon, Republic of Korea
| | - W J Lee
- Department of Internal Medicine, Hallym Hospital, Incheon, Republic of Korea
| | - S T Heo
- Division of Infectious Disease, Department of Internal Medicine, Jeju National University College of Medicine, Jeju, Republic of Korea
| | - J Y Park
- Department of Paediatrics, Chung-Ang University Hospital, Seoul, Republic of Korea
| | - S Bae
- Division of Infectious Diseases, Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - M J Lee
- Department of Internal Medicine, Inje University Sanggye Paik Hospital, Seoul, Republic of Korea
| | - B Kim
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - S Y Park
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Republic of Korea; Department of Hospital Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Republic of Korea; Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Republic of Korea; Centres for Digital Health, Yongin Severance Hospital, Yonsei University Health System, Yongin, Republic of Korea
| | - H W Jeong
- Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Republic of Korea; Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Y Kim
- Department of Internal Medicine, Wonkwang University College of Medicine, Iksan, Republic of Korea
| | - Y G Kwak
- Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Republic of Korea
| | - K-H Song
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - K-H Park
- Department of Infectious Diseases, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - S H Park
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Y K Kim
- Department of Internal Medicine, Wonju College of Medicine, Yonsei University, Wonju, Republic of Korea
| | - E S Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - H B Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.
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Park SY, Moon SM, Kim B, Lee MJ, Song KH, Kim ES, Kim TH, Kim HB. Applicability and limitations of quality indicator-based assessment of appropriateness in antimicrobial use: a comparison with expert opinion. J Hosp Infect 2023; 139:93-98. [PMID: 37419187 DOI: 10.1016/j.jhin.2023.06.023] [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: 04/12/2023] [Revised: 06/06/2023] [Accepted: 06/26/2023] [Indexed: 07/09/2023]
Abstract
BACKGROUND The effective implementation of antimicrobial stewardship requires an a-priori assessment of the appropriateness of antimicrobial prescriptions. AIM To evaluate the effectiveness of quality indicators (QIs) in determining the appropriateness of antimicrobial prescriptions compared to that of expert opinions. METHODS The study assessed antimicrobial use in 20 hospitals in Korea, with infectious disease specialists rating the appropriateness based on QIs and expert opinions. The selected QIs were (1) taking two blood cultures, (2) taking cultures from suspected sites of infection, (3) prescribing empirical antimicrobials according to guidelines, and (4) changing from empirical to pathogen-directed therapy for hospitalized patients and (2, 3, and 4) for ambulatory patients. Applicability, compliance with QIs, and agreement between QIs and expert opinions were investigated. FINDINGS Overall, 7999 therapeutic uses of antimicrobials were investigated at the study hospitals. The experts rated 20.5% (1636/7999) as inappropriate use. For hospitalized patients, antimicrobial use was assessed based on all four QIs in 28.8% (1798/6234) of the cases. For ambulatory care patients, only 7.5% (102/1351) of the antimicrobial use cases were assessed using all three QIs. The agreement between expert opinions and all four QIs for hospitalized patients was minimal (κ = 0.332), whereas that between expert opinions and all three QIs for ambulatory patients was weak (κ = 0.598). CONCLUSION QIs have limitations in determining the appropriateness of antimicrobial use, and the degree of agreement with expert opinions was low. Therefore, these QI limitations should be considered when determining the appropriateness of antimicrobial use.
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Affiliation(s)
- S Y Park
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, South Korea; Centres for Digital Health, Yongin Severance Hospital, Yonsei University Health System, Yongin, South Korea
| | - S M Moon
- Division of Infectious Diseases, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
| | - B Kim
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, South Korea
| | - M J Lee
- Department of Internal Medicine, Inje University Sanggye Paik Hospital, Seoul, South Korea
| | - K-H Song
- Division of Infectious Diseases, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
| | - E S Kim
- Division of Infectious Diseases, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
| | - T H Kim
- Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, South Korea.
| | - H B Kim
- Division of Infectious Diseases, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea.
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Jung SY, Lee MJ, Lee SY. Analysis of the Relationship Between Lower leg Muscle Mass and Preservation of Lower Extremity in Patients with Diabetic Foot Ulcer. INT J LOW EXTR WOUND 2023; 22:503-508. [PMID: 34096804 DOI: 10.1177/15347346211024493] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study aimed to determine how the muscle mass of the lower leg affects the preservation of the lower extremities in patients with diabetic foot ulcer. This study analyzed patients with diabetic foot ulcer between January 2014 and June 2018 with a follow-up of at least 2 years. Of these 181 patients whose ulcer is located distal to the metatarsophalangeal joint, which was categorized as grade ≤2 by the Wagner classification were classified into 4 grades: grade 0 (treated without amputation), grade 1 (amputation distal to the metatarsophalangeal joint), grade 2 (Ray, transmetatarsal, Lisfranc, and Chopart amputation), and grade 3 (Syme, below-knee, and above-knee amputation) according to the final amputation degree. The muscles of the lower leg were classified into 4 compartments: anterior, lateral, deep posterior, and superficial posterior. The cross-sectional area and attenuation to estimate the muscle volume and density were measured at the axial image of computed tomography (CT) angiography. No significant differences were observed in the sex ratio and mean age among the grades (P = .966 and .962). The cross-sectional area of the anterior, lateral, and posterior compartments demonstrated no significant differences, but that of the superficial posterior compartment exhibited significant differences among the grades (P < .001). Moreover, the attenuation of the anterior, lateral, and deep posterior compartments showed no significant differences, but that of the posterior compartment showed significant differences among the grades (P = .003). The muscle mass of the superficial posterior compartment of the lower leg could be a good indicator of the preservation of the lower extremity in patients with diabetic foot ulcer. Therefore, a strengthening exercise for the triceps surae and plantaris muscles in the early stage could help preserve as much of the lower extremities as possible.
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Affiliation(s)
- Sung Y Jung
- Department of Orthopedic Surgery, College of Medicine, Dong-A University, Busan, Korea
| | - Myoung J Lee
- Department of Orthopedic Surgery, College of Medicine, Dong-A University, Busan, Korea
| | - Sang Y Lee
- Department of Orthopedic Surgery, College of Medicine, Dong-A University, Busan, Korea
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Briody H, Sheehan M, Hanley M, O'Neill B, Dunne R, Lee MJ, Morrin MM. Biochemically recurrent prostate cancer: rationalisation of the approach to imaging. Clin Radiol 2023; 78:518-524. [PMID: 37085338 DOI: 10.1016/j.crad.2023.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 03/16/2023] [Accepted: 03/17/2023] [Indexed: 04/09/2023]
Abstract
AIM To assess the utility of magnetic resonance imaging (MRI) in addition to the additive benefit of the conventional imaging techniques, computed tomography (CT) and nuclear medicine (NM) bone scintigraphy, for investigation of biochemical recurrence (BCR) post-prostatectomy where access to prostate specific membrane antigen (PSMA) positron-emission tomography (PET)-CT is challenging. MATERIALS AND METHODS Relevant imaging over a 5-year period was reviewed. Ethical approval was granted by the internal review board. All patients with suspected BCR, defined as a PSA ≥0.2 ng/ml on two separate occasions, underwent a retrospective imaging review. This was performed on PACS archive search database in a single centre using search terms "PSA" and "prostatectomy" in the three imaging methods; MRI, CT, and NM bone scintigraphy. All PSMA PET CT performed were recorded. RESULTS One hundred and eighty-five patients were identified. Patients with an MRI pelvis that demonstrated distant metastases (i.e., pelvic bone metastases or lymph node involvement more cranial to the bifurcation of the common iliac arteries) were more likely to have a positive CT and/or NM bone scintigraphy. The Pearson correlation coefficient between the findings of M1 disease at MRI pelvis and the presence of distant metastases at CT thorax, abdomen, pelvis and NM bone scintigraphy was calculated at 0.81 (p<0.01) and 0.91 (p<0.01) respectively. CONCLUSION An imaging strategy based on risk stratification and technique-specific selection criteria leads to more appropriate use of resources, and in turn, increases the yield of conventional imaging methods. MRI prostate findings can be used to predict the additive value of CT/NM bone scintigraphy allowing a more streamlined approach to their use.
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Affiliation(s)
- H Briody
- Department of Medicine, Beaumont Hospital, Dublin, Ireland.
| | - M Sheehan
- Department of Radiology, Beaumont Hospital, Dublin, Ireland
| | - M Hanley
- Department of Radiology, Beaumont Hospital, Dublin, Ireland
| | - B O'Neill
- Department of Radiation Oncology, Beaumont Hospital, Dublin, Ireland
| | - R Dunne
- Department of Radiology, Beaumont Hospital, Dublin, Ireland
| | - M J Lee
- Department of Radiology, Beaumont Hospital, Dublin, Ireland; Royal College of Surgeons in Ireland, Dublin, Ireland
| | - M M Morrin
- Department of Radiology, Beaumont Hospital, Dublin, Ireland; Royal College of Surgeons in Ireland, Dublin, Ireland
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Lee MJ, Folan AM, Baker DM, Blackwell S, Wootton R, Robinson K, Sebastian S, Brown SR, Jones GL, Lobo AJ. A survey of patient informational preferences when choosing between medical and surgical therapy for ulcerative colitis: a sub-study from the DISCUSS project. Colorectal Dis 2023. [PMID: 37237447 DOI: 10.1111/codi.16625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 12/31/2022] [Accepted: 04/01/2023] [Indexed: 05/28/2023]
Abstract
AIM People living with ulcerative colitis (UC) have two broad treatment avenues, namely medical or surgical therapy. The choice between these can depend on patient preference as well as the receipt of relevant information. The aim of this study was to define the informational needs of patients with UC. METHOD A postal survey was designed to capture respondent demographics, treatment experienced within the previous 12 months and informational preferences by rating a long list of items. It was delivered through two hospitals that provide tertiary inflammatory bowel disease services. Descriptive analyses were performed to describe demographics and experiences. Principal component analysis was carried out using a varimax rotation to investigate informational needs. RESULTS A total of 101 responses were returned (20.1% response rate). The median age of respondents was 45 years and the median time since diagnosis was 10 years. Control preferences skewed towards shared (42.6%) or patient-led but clinician-informed (35.6%). Decision regret was low for the population (median 12.5/100, range 0-100). Key informational needs related to medical therapy were benefits and risks of long-term therapy, burden of hospital attendance, reproductive health, need for steroid treatment and impact on personal life. For surgery, these were stoma information, effect on daily life, effect on sexual and reproductive health, risks and benefits and disruption of life due to surgery. CONCLUSION This study has identified key areas for discussion when counselling patients about treatment decisions around medical therapy and surgery for UC.
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Affiliation(s)
- M J Lee
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
- Academic Directorate of General Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - A M Folan
- Department of Psychology, School of Social Sciences, Leeds Beckett University, Leeds, UK
| | - D M Baker
- Academic Directorate of General Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | | | - R Wootton
- Academic Directorate of General Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - K Robinson
- Department of Gastroenterology, Hull and East Yorkshire Hospitals, Hull, UK
| | - S Sebastian
- Sheffield Inflammatory Bowel Disease Centre, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - S R Brown
- Academic Directorate of General Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - G L Jones
- Department of Psychology, School of Social Sciences, Leeds Beckett University, Leeds, UK
| | - A J Lobo
- Department of Gastroenterology, Hull and East Yorkshire Hospitals, Hull, UK
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O’Connor T, MacKenzie L, Clarke RW, Bradburn M, Wilson TR, Lee MJ. Screening for malnutrition in emergency laparotomy patients: a comparison of three tools. Ann R Coll Surg Engl 2023; 105:413-421. [PMID: 36541125 PMCID: PMC10149256 DOI: 10.1308/rcsann.2022.0077] [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: 05/23/2022] [Indexed: 05/02/2023] Open
Abstract
INTRODUCTION Malnourished patients undergoing emergency laparotomy are at risk of significant morbidity. The optimum screening tool to identify such patients in practice and research is yet to be determined. This study aims to compare the performance of three nutrition risk tools in predicting time without enteral nutrition in this population. METHODS A prospective cohort study (NCT04696367) was conducted across two sites, recruiting patients undergoing National Emergency Laparotomy Audit eligible procedures. Data collected included demographics, diagnosis, procedure and outcomes. Nutrition risk was assessed using three tools: Malnutrition Universal Screening Tool (MUST) score, Nutritional Risk Index (NRI) and Nutritional Risk Score 2002 (NRS-2002). Complications were assessed with the Comprehensive Complication Index. Quality of life was measured at baseline and 5 days postsurgery using EQ-5D-5L. RESULTS A total of 59 patients were recruited. Median age was 69 years. Of the 59 participants, 23 were judged high risk using MUST score, 13 using NRS and 8 using NRI. Median time to restart enteral intake was 7 days (interquartile range 7-14). Time without intake was correlated with increasing score using MUST (r=0.463, p<0.001) and NRS-2002 (r=0.296, p=0.03) but not NRI (r=-0.121, p=0.38). High-risk nutritional groups also had increased length of hospital stay, but not complication scores. CONCLUSIONS Patients undergoing emergency laparotomy spend a prolonged time without enteral nutrition. Although all nutritional tools demonstrated some propensity to identify patients at higher risk of needing nutritional support, their performance was variable. Nevertheless, some may be useful in future clinical studies.
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Affiliation(s)
- T O’Connor
- Sheffield Teaching Hospitals NHS Foundation Trust, UK
| | - L MacKenzie
- Sheffield Teaching Hospitals NHS Foundation Trust, UK
| | - RW Clarke
- Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust, UK
| | - M Bradburn
- Clinical Trials Research Unit, University of Sheffield, UK
| | - TR Wilson
- Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust, UK
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O’Connor OM, Burns FA, Proctor VK, Green SK, Sayers AE, Smart NJ, Lee MJ. Clinician preferences in the treatment of acutely symptomatic hernia: the 'MASH' survey. Ann R Coll Surg Engl 2023; 105:225-230. [PMID: 35196151 PMCID: PMC9974343 DOI: 10.1308/rcsann.2021.0304] [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: 10/19/2021] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION There is limited high-quality evidence to guide the management of acute hernia presentation. The aim of this study was to survey surgeons to assess current trends in assessment, treatment strategy and operative decisions in the management of acutely symptomatic hernia. METHODS A survey was developed with reference to current guidelines, and reported according to Checklist for Reporting Results of Internet E-Surveys guidelines. Ethical approval was obtained from the University of Sheffield (UREC:034047). The survey explored practice in groin, umbilical/paraumbilical and incisional hernia presenting acutely. It captured respondent demographics, and preferences for investigations, treatment strategies and repair techniques for each hernia type, using a five-point Likert scale. RESULTS Some 145 responses were received, of which 39 declared a specialist hernia practice. Essential investigations included urea and electrolytes (58.6%) and inflammatory markers (55.6%). Computed tomography scan of the abdomen was essential for assessment of incisional hernia (90.9%), but not for other hernia types. Bowel compromise drives early surgery, and increasing American Society of Anesthesiology score pushes towards non-operative management. Type of repair was driven by hernia contents, with increasing contamination associated with increased rates of suture repair. Where mesh was proposed in contaminated settings, biological types were preferred. There was variation in the potential use of laparoscopy for groin hernia. CONCLUSIONS This survey provides a snapshot of current trends in the management of acutely symptomatic hernia. It demonstrates variation across aspects of assessment and repair technique. Additional data are required to inform practice in these areas.
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Affiliation(s)
- OM O’Connor
- Chesterfield Royal Hospital NHS Foundation Trust, UK
| | - FA Burns
- North Cumbria Integrated Care NHS Foundation Trust, UK
| | - VK Proctor
- Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust, UK
| | - SK Green
- York and Scarborough Teaching Hospitals NHS Foundation Trust, UK
| | - AE Sayers
- Sheffield Teaching Hospitals NHS Foundation Trust, UK
| | - NJ Smart
- Royal Devon and Exeter NHS Foundation Trust, UK
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Lee MJ, Lee SH, Jung Y. Development of concrete reference material for quality assurance/quality control of gamma radioactivity measurement for nuclear power plant decommissioning waste. J Environ Radioact 2022; 255:107031. [PMID: 36191508 DOI: 10.1016/j.jenvrad.2022.107031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 08/11/2022] [Accepted: 08/15/2022] [Indexed: 06/16/2023]
Abstract
The Korea Research Institute of Standards and Science has developed a new concrete reference material (RM) for measuring gamma-emitting radionuclides, such as 134Cs, 137Cs, 65Zn, 241Am, and 60Co, to improve and maintain the quality assurance and quality control of the radioactivity measurement in radioactive waste generated during the decommissioning of nuclear power plants. In this study, cement, SiO2, and bentonite, which are the main components of concrete, were mixed in an appropriate ratio with radionuclides. For certification and homogeneity assessment, 10 bottles were randomly selected, two sub-samples were collected from each bottle, and radionuclides were measured via HPGe gamma spectrometry. The results of the homogeneity tests using a one-way analysis of variance on 241Am, 134Cs, 137Cs, 65Zn, and 60Co in the concrete RM fulfilled the requirements of ISO Guide 35. Coincidence summing and self-absorption correction were performed on measurement results by introducing the Monte Carlo efficiency transfer code and Monte Carlo N-Particle transport code. The reference values for five radionuclides (60Co, 65Zn, 241Am, 134Cs, and 137Cs) in the RM were in the range of 15-40 Bq/kg, and the expanded uncertainty was within 10% (k = 2). To the best of our knowledge, this was the first study to develop concrete RM for measuring gamma-emitting radionuclides.
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Affiliation(s)
- M J Lee
- Korea Research Institute of Standards and Science, Daejeon, 34113, Republic of Korea
| | - S H Lee
- Korea Research Institute of Standards and Science, Daejeon, 34113, Republic of Korea.
| | - Y Jung
- Korea Research Institute of Standards and Science, Daejeon, 34113, Republic of Korea
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12
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Choi SH, Park SD, Lee MJ, Lee KJ. Comparison of trans-radial access and femoral access in cardiogenic shock patient who had undergone primary percutaneous coronary intervention from SMART RESCUE trial. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1246] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Introduction
Throughout the years of percutaneous coronary intervention (PCI), the debate regarding access route, whether it being trasns-radial or femoral, is an ongoing agenda yet to be solved. Recent guidelines suggest trans-radial approach as an option to be considered in acute coronary syndrome (ACS). However, data on cardiogenic shock patients undergoing PCI is relatively sparse.
Purpose
Compare the clinical implication of trans-radial and femoral approach in cardiogenic shock patients who had undergone PCI.
Method
Cardiogenic shock patients who had undergone PCI from January 2014 to December of 2018 were enrolled. Patients were divided according to their access route respectfully. Primary outcome was composite endpoints including all-cause death, re-admission due to heart failure, myocardial infarction (MI) and cerebrovascular accident.
Result
A total of 694 (572 via femoral approach, 122 via radial approach) cardiogenic shock patients who received PCI were enrolled. Mean age femoral and radial groups was 66.59±12.51 and 66.66±12.8 respectfully. Disease severity was higher for femoral patients compared to radial patients as represented by their LM involvement, mechanical organ support (extracorporeal membrane oxygenation, continuous renal replacement therapy, mechanical ventilation), left ventricular ejection fraction (LVEF) and vasoactive inotropic score. Cox regression analysis after adjusting for conventional risk factors showed that femoral route was a poor prognosticator with respect to composite endpoints (HR=2.059, 95% CI 1.249–3.397, p value = 0.005). Radial approach patients had higher survival probability compared to femoral approach patients (Figure 1).
Conclusion
Radial approach in cardiogenic shock patients who are in need for PCI with relatively less severe clinical condition could be a reasonable option for access route.
Funding Acknowledgement
Type of funding sources: Private hospital(s). Main funding source(s): Inha University Hospital
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Affiliation(s)
- S H Choi
- Inha University Hospital, Cardiology , Incheon , Korea (Republic of)
| | - S D Park
- Inha University Hospital, Cardiology , Incheon , Korea (Republic of)
| | - M J Lee
- Inha University Hospital, Critical Care Medicine , Incheon , Korea (Republic of)
| | - K J Lee
- Inha University Hospital, Cardiology , Incheon , Korea (Republic of)
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13
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Choi SH, Park SD, Lee MJ, Ko YG, Yu CW, Chun WJ, Jang WJ, Kim HJ, Bae JW, Kwon SU, Kim JS, Lee WS, Jeong JO, Lim SH, Yang JH. Prognostic impact of plasma glucose on cardiogenic shock patients with or without diabetes ellitus: smart rescue trial. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1442] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Even though the presence of hyperglycemia has shown to affect the clinical outcome of cardiogenic shock patients, the extent of hyperglycemia and its association with prognosis have not been fully addressed in large population
Purpose
Investigate the clinical relationship between hyperglycemic status and in-hospital mortality in cardiogenic shock patients
Method
A total of 1,177 consecutive cardiogenic shock patients were enrolled from January 2014 to December of 2018 at 12 hospitals in South Korea. The primary outcome was in-hospital mortality. Patients were divided into four groups according to their initial plasma glucose level in each of diabetes patients (n=752) and non-diabetes patients (n=425); group 1 (≤8 mmol/L), group 2 (8–12 mmol/L), group 3 (12–16 mmol/L) and group 4 (≥16 mmol/L).
Results
The groups with higher admission plasma glucose were associated with lower systolic blood pressure and higher lactic acid level in both diabetic and non-diabetic patients. In-hospital mortality increased in groups with higher admission plasma glucose level in non-diabetic patients (group-1:24.2%, group-2: 28.6%, group-3: 38.1%, group-4: 49.0%, p<0.01) whereas in diabetic patients, mortality and admission plasma glucose level showed no significant association (group-1: 45%, group-2: 35.4%, group-3: 33.3%, group-4: 43.1%, p=0.26). Even after Multivariate analysis, high plasma glucose was an independent predictor of in-hospital mortality in non-diabetic patients
Conclusion
In cardiogenic shock patients, plasma glucose obtained at admission was associated with in-hospital mortality in non-diabetic patients
Funding Acknowledgement
Type of funding sources: Private hospital(s). Main funding source(s): Inha University hospital
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Affiliation(s)
- S H Choi
- Inha University Hospital, Cardiology , Incheon , Korea (Republic of)
| | - S D Park
- Inha University Hospital, Cardiology , Incheon , Korea (Republic of)
| | - M J Lee
- Inha University Hospital, Cardiology , Incheon , Korea (Republic of)
| | - Y G Ko
- Severance Cardiovascular Hospital, Yonsei University College of Medicine, Cardiology , Seoul , Korea (Republic of)
| | - C W Yu
- Korea University Anam Hospital, Cardiology , Seoul , Korea (Republic of)
| | - W J Chun
- Samsung Changwon Hospital, Cardiology , Changwon , Korea (Republic of)
| | - W J Jang
- Ewha Womans University Seoul Hospital, Cardiology , Seoul , Korea (Republic of)
| | - H J Kim
- Konkuk University Hospital, Cardiology , Seoul , Korea (Republic of)
| | - J W Bae
- Chungbuk National University College of Medicine, Cardiology , Cheongju , Korea (Republic of)
| | - S U Kwon
- Inje University Ilsan Paik hospital, Cardiology , Goyang , Korea (Republic of)
| | - J S Kim
- Sejong General Hospital, Cardiology , Bucheon , Korea (Republic of)
| | - W S Lee
- Chung-Ang University Hospital, Cardiology , Seoul , Korea (Republic of)
| | - J O Jeong
- Chungnam National University hospital , Daejeon , Korea (Republic of)
| | - S H Lim
- Dankook University, Cardiology , Cheonan-si , Korea (Republic of)
| | - J H Yang
- Samsung Medical Center, Cardiology , Seoul , Korea (Republic of)
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14
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Lamidi S, Williams KM, Hind D, Peckham-Cooper A, Miller AS, Smith AM, Saha A, Macutkiewicz C, Griffiths EA, Catena F, Coccolini F, Toogood G, Tierney GM, Boyd-Carson H, Sartelli M, Blencowe NS, Lockwood S, Coe PO, Lee MJ, Barreto SG, Drake T, Gachabayov M, Hill J, Ioannidis O, Lostoridis E, Mehraj A, Negoi I, Pata F, Steenkamp C, Ahmed S, Alin V, Al-Rashedy M, Atici SD, Bains L, Bandyopadhyay SK, Baraket O, Bates T, Beral D, Brown L, Buonomo L, Burke D, Caravaglios G, Ceresoli M, Chapman SJ, Cillara N, Clarke R, Colak E, Daniels S, Demetrashvili Z, Di Carlo I, Duff S, Dziakova J, Elliott JA, El Zalabany T, Engledow A, Ewnte B, Fraga GP, George R, Giuffrida M, Glasbey J, Isik A, Kechagias A, Kenington C, Kessel B, Khokha V, Kong V, Laloë P, Litvin A, Lostoridis E, Marinis A, Martínez-Pérez A, Menzies D, Mills R, Monzon BI, Morgan R, Neri V, Nita GE, Perra T, Perrone G, Porcu A, Poskus T, Premnath S, Sall I, Sarma DR, Slavchev M, Spence G, Tarasconi A, Tolonen M, Toro A, Venn ML, Vimalachandran D, Wheldon L, Zakaria AD. Defining core patient descriptors for perforated peptic ulcer research: international Delphi. Br J Surg 2022; 109:603-609. [PMID: 35467718 DOI: 10.1093/bjs/znac096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 02/09/2022] [Accepted: 03/08/2022] [Indexed: 10/13/2023]
Abstract
BACKGROUND Perforated peptic ulcer (PPU) remains a common condition globally with significant morbidity and mortality. Previous work has demonstrated variation in reporting of patient characteristics in PPU studies, making comparison of studies and outcomes difficult. The aim of this study was to standardize the reporting of patient characteristics, by creating a core descriptor set (CDS) of important descriptors that should be consistently reported in PPU research. METHODS Candidate descriptors were identified through systematic review and stakeholder proposals. An international Delphi exercise involving three survey rounds was undertaken to obtain consensus on key patient characteristics for future research. Participants rated items on a scale of 1-9 with respect to their importance. Items meeting a predetermined threshold (rated 7-9 by over 70 per cent of stakeholders) were included in the final set and ratified at a consensus meeting. Feedback was provided between rounds to allow refinement of ratings. RESULTS Some 116 clinicians were recruited from 29 countries. A total of 63 descriptors were longlisted from the literature, and 27 were proposed by stakeholders. After three survey rounds and a consensus meeting, 27 descriptors were included in the CDS. These covered demographic variables and co-morbidities, risk factors for PPU, presentation and pathway factors, need for organ support, biochemical parameters, prognostic tools, perforation details, and surgical history. CONCLUSION This study defines the core descriptive items for PPU research, which will allow more robust synthesis of studies.
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Wheldon L, Morgan J, Lee MJ, Riley S, Brown SR, Wyld L. EP.TH.602Exploring decision-making of healthcare professionals in patients with benign large non-pedunculated colonic polyps (BLNPCP) virtually using combined focus group and nominal group technique. Br J Surg 2021. [DOI: 10.1093/bjs/znab309.063] [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
Aim
We aimed to elicit key factors that influence healthcare professional decision-making when deciding treatment for BLNPCP.
Background
Benign large non-pedunculated colonic polyps (BLNPCP) may harbour covert malignancy and opinions differ about the optimal treatment modality. There are several options available, including endoscopic mucosal resection, endoscopic submucosal resection, combined endoscopic laparoscopic surgery and surgical resection. Despite widespread availability of endoscopic resection techniques, there are high rates of surgery in the UK.
Methods
Three focus groups of healthcare professionals, comprised of either consultant colorectal surgeons, nurse endoscopists and consultant gastroenterologists, were conducted virtually utilising the Nominal Group Technique. Meetings were recorded and transcribed verbatim. Themes were devolved using the framework approach for qualitative analysis. A priority-ranked list of factors influencing healthcare professional decision-making in this setting was generated.
Results
Five main themes were identified as influencing decision-making: Shared decision making (patient preference, informed consent); Patient factors (co-morbidity, age, life-expectancy); Polyp factors (Location, size, morphology, risk of cancer); Healthcare professionals (skill-set, personal preference); System factors (techniques availability locally, regional referral networks). Nominal Group Technique generated 55 items across the three focus groups. Nurses and gastroentologists ranked patient factors (particularly drug history and tolerance of procedure) and shared decision making (patient preference) more highly then surgeons. Surgeons placed greater emphasis on polyp factors particularly location and the risk of submucosal invasive carcinoma.
Conclusion
Decision making is complex and multifactorial. These results support the benefits of complex polyp MDTs and patient involvement in the decision-making. The complexity of decision-making may underpin wide variation in practice.
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Affiliation(s)
- L Wheldon
- Sheffield Teaching Hospitals NHS Foundation Trust
- Department of Oncology and Metabolism, The University of Sheffield
| | - J Morgan
- Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust
- Department of Oncology and Metabolism, The University of Sheffield
| | - MJ Lee
- Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust
- Department of Oncology and Metabolism, The University of Sheffield
| | - S Riley
- Sheffield Teaching Hospitals NHS Foundation Trust
| | - SR Brown
- Sheffield Teaching Hospitals NHS Foundation Trust
| | - L Wyld
- Department of Oncology and Metabolism, The University of Sheffield
- Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust
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16
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Wheldon L, Spence O, Lee MJ, Riley S, Brown SR, Wyld L. TP7.2.20 Systematic Review and meta-analysis of Interventions for Benign Large Non-Pedunculated Colonic Polyps (BLNPCP). Br J Surg 2021. [DOI: 10.1093/bjs/znab362.065] [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
Aim
To examine the efficacy of treatment options for benign large non-pedunculated colonic polyps (BLNPCP).
Background
BLNPCP may harbour covert malignancy and opinions differ about the optimal treatment modality, be it endoscopic mucosal resection (EMR), endoscopic submucosal resection (ESD), combined endoscopic laparoscopic surgery (CELS) or surgical resection (SR). Despite the widespread availability of endoscopic resection (ER) techniques, rates of surgery in the UK remain high.
Methods
This review is reported in line with PRISMA guidelines (PROSPERO registration: CRD42021148944). EMBASE, CENTRAL, and MEDLINE databases were searched from January 2000 to January 2020 to evaluate interventions for treating BLNPCP in adults. The primary outcome was recurrence, adverse events were secondary outcomes. Meta-analysis was performed using a random effects model expressed as a percentage with 95% confidence interval. Quality assessment was performed using ROBINS-I.
Results
Ten studies (2499 polyps in 2327patients) were included (five assessed EMR, four SR, two CELS, two ESD). All studies were at moderate risk of bias. SR, ESD and CELS had the lowest recurrence rates 0% CI:0-1, 1% CI:0-2 and 2% CI:0-12 respectively. EMR had the highest (15% CI:9-22). SR complication rate was 12% CI:7-19, ESD 12% CI:9-15, CELS and EMR 11% CI:0-45 and 7% CI:5-9 respectively. Rescue surgery for complication or finding of invasive cancer was 17% CI:5-35 for ESD, CELS 14% CI:3-30, EMR 11% CI:7-15, SR 4% CI:2-6.
Conclusion
These data provide information that should be taken into account when considering the choice of intervention. It will allow a more robust shared decision-making process to occur.
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Affiliation(s)
- L Wheldon
- Sheffield Teaching Hospitals NHS Foundation Trust
- Department of Oncology and Metabolism, The University of Sheffield
| | - O Spence
- Sheffield Teaching Hospitals NHS Foundation Trust
| | - MJ Lee
- Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust
- Department of Oncology and Metabolism, The University of Sheffield
| | - S Riley
- Sheffield Teaching Hospitals NHS Foundation Trust
| | - SR Brown
- Sheffield Teaching Hospitals NHS Foundation Trust
| | - L Wyld
- Department of Oncology and Metabolism, The University of Sheffield
- Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust
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17
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Abi B, Albahri T, Al-Kilani S, Allspach D, Alonzi LP, Anastasi A, Anisenkov A, Azfar F, Badgley K, Baeßler S, Bailey I, Baranov VA, Barlas-Yucel E, Barrett T, Barzi E, Basti A, Bedeschi F, Behnke A, Berz M, Bhattacharya M, Binney HP, Bjorkquist R, Bloom P, Bono J, Bottalico E, Bowcock T, Boyden D, Cantatore G, Carey RM, Carroll J, Casey BCK, Cauz D, Ceravolo S, Chakraborty R, Chang SP, Chapelain A, Chappa S, Charity S, Chislett R, Choi J, Chu Z, Chupp TE, Convery ME, Conway A, Corradi G, Corrodi S, Cotrozzi L, Crnkovic JD, Dabagov S, De Lurgio PM, Debevec PT, Di Falco S, Di Meo P, Di Sciascio G, Di Stefano R, Drendel B, Driutti A, Duginov VN, Eads M, Eggert N, Epps A, Esquivel J, Farooq M, Fatemi R, Ferrari C, Fertl M, Fiedler A, Fienberg AT, Fioretti A, Flay D, Foster SB, Friedsam H, Frlež E, Froemming NS, Fry J, Fu C, Gabbanini C, Galati MD, Ganguly S, Garcia A, Gastler DE, George J, Gibbons LK, Gioiosa A, Giovanetti KL, Girotti P, Gohn W, Gorringe T, Grange J, Grant S, Gray F, Haciomeroglu S, Hahn D, Halewood-Leagas T, Hampai D, Han F, Hazen E, Hempstead J, Henry S, Herrod AT, Hertzog DW, Hesketh G, Hibbert A, Hodge Z, Holzbauer JL, Hong KW, Hong R, Iacovacci M, Incagli M, Johnstone C, Johnstone JA, Kammel P, Kargiantoulakis M, Karuza M, Kaspar J, Kawall D, Kelton L, Keshavarzi A, Kessler D, Khaw KS, Khechadoorian Z, Khomutov NV, Kiburg B, Kiburg M, Kim O, Kim SC, Kim YI, King B, Kinnaird N, Korostelev M, Kourbanis I, Kraegeloh E, Krylov VA, Kuchibhotla A, Kuchinskiy NA, Labe KR, LaBounty J, Lancaster M, Lee MJ, Lee S, Leo S, Li B, Li D, Li L, Logashenko I, Lorente Campos A, Lucà A, Lukicov G, Luo G, Lusiani A, Lyon AL, MacCoy B, Madrak R, Makino K, Marignetti F, Mastroianni S, Maxfield S, McEvoy M, Merritt W, Mikhailichenko AA, Miller JP, Miozzi S, Morgan JP, Morse WM, Mott J, Motuk E, Nath A, Newton D, Nguyen H, Oberling M, Osofsky R, Ostiguy JF, Park S, Pauletta G, Piacentino GM, Pilato RN, Pitts KT, Plaster B, Počanić D, Pohlman N, Polly CC, Popovic M, Price J, Quinn B, Raha N, Ramachandran S, Ramberg E, Rider NT, Ritchie JL, Roberts BL, Rubin DL, Santi L, Sathyan D, Schellman H, Schlesier C, Schreckenberger A, Semertzidis YK, Shatunov YM, Shemyakin D, Shenk M, Sim D, Smith MW, Smith A, Soha AK, Sorbara M, Stöckinger D, Stapleton J, Still D, Stoughton C, Stratakis D, Strohman C, Stuttard T, Swanson HE, Sweetmore G, Sweigart DA, Syphers MJ, Tarazona DA, Teubner T, Tewsley-Booth AE, Thomson K, Tishchenko V, Tran NH, Turner W, Valetov E, Vasilkova D, Venanzoni G, Volnykh VP, Walton T, Warren M, Weisskopf A, Welty-Rieger L, Whitley M, Winter P, Wolski A, Wormald M, Wu W, Yoshikawa C. Measurement of the Positive Muon Anomalous Magnetic Moment to 0.46 ppm. Phys Rev Lett 2021; 126:141801. [PMID: 33891447 DOI: 10.1103/physrevlett.126.141801] [Citation(s) in RCA: 111] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 03/25/2021] [Indexed: 06/12/2023]
Abstract
We present the first results of the Fermilab National Accelerator Laboratory (FNAL) Muon g-2 Experiment for the positive muon magnetic anomaly a_{μ}≡(g_{μ}-2)/2. The anomaly is determined from the precision measurements of two angular frequencies. Intensity variation of high-energy positrons from muon decays directly encodes the difference frequency ω_{a} between the spin-precession and cyclotron frequencies for polarized muons in a magnetic storage ring. The storage ring magnetic field is measured using nuclear magnetic resonance probes calibrated in terms of the equivalent proton spin precession frequency ω[over ˜]_{p}^{'} in a spherical water sample at 34.7 °C. The ratio ω_{a}/ω[over ˜]_{p}^{'}, together with known fundamental constants, determines a_{μ}(FNAL)=116 592 040(54)×10^{-11} (0.46 ppm). The result is 3.3 standard deviations greater than the standard model prediction and is in excellent agreement with the previous Brookhaven National Laboratory (BNL) E821 measurement. After combination with previous measurements of both μ^{+} and μ^{-}, the new experimental average of a_{μ}(Exp)=116 592 061(41)×10^{-11} (0.35 ppm) increases the tension between experiment and theory to 4.2 standard deviations.
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Affiliation(s)
- B Abi
- University of Oxford, Oxford, United Kingdom
| | - T Albahri
- University of Liverpool, Liverpool, United Kingdom
| | - S Al-Kilani
- Department of Physics and Astronomy, University College London, London, United Kingdom
| | - D Allspach
- Fermi National Accelerator Laboratory, Batavia, Illinois, USA
| | - L P Alonzi
- University of Washington, Seattle, Washington, USA
| | | | - A Anisenkov
- Budker Institute of Nuclear Physics, Novosibirsk, Russia
| | - F Azfar
- University of Oxford, Oxford, United Kingdom
| | - K Badgley
- Fermi National Accelerator Laboratory, Batavia, Illinois, USA
| | - S Baeßler
- University of Virginia, Charlottesville, Virginia, USA
| | - I Bailey
- Lancaster University, Lancaster, United Kingdom
| | - V A Baranov
- Joint Institute for Nuclear Research, Dubna, Russia
| | - E Barlas-Yucel
- University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | - T Barrett
- Cornell University, Ithaca, New York, USA
| | - E Barzi
- Fermi National Accelerator Laboratory, Batavia, Illinois, USA
| | - A Basti
- INFN, Sezione di Pisa, Pisa, Italy
- Università di Pisa, Pisa, Italy
| | | | - A Behnke
- Northern Illinois University, DeKalb, Illinois, USA
| | - M Berz
- Michigan State University, East Lansing, Michigan, USA
| | | | - H P Binney
- University of Washington, Seattle, Washington, USA
| | | | - P Bloom
- North Central College, Naperville, Illinois, USA
| | - J Bono
- Fermi National Accelerator Laboratory, Batavia, Illinois, USA
| | - E Bottalico
- INFN, Sezione di Pisa, Pisa, Italy
- Università di Pisa, Pisa, Italy
| | - T Bowcock
- University of Liverpool, Liverpool, United Kingdom
| | - D Boyden
- Northern Illinois University, DeKalb, Illinois, USA
| | - G Cantatore
- INFN, Sezione di Trieste, Trieste, Italy
- Università di Trieste, Trieste, Italy
| | - R M Carey
- Boston University, Boston, Massachusetts, USA
| | - J Carroll
- University of Liverpool, Liverpool, United Kingdom
| | - B C K Casey
- Fermi National Accelerator Laboratory, Batavia, Illinois, USA
| | - D Cauz
- INFN Gruppo Collegato di Udine, Sezione di Trieste, Udine, Italy
- Università di Udine, Udine, Italy
| | - S Ceravolo
- INFN, Laboratori Nazionali di Frascati, Frascati, Italy
| | | | - S P Chang
- Center for Axion and Precision Physics (CAPP)/Institute for Basic Science (IBS), Daejeon, Republic of Korea
- Department of Physics, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, Republic of Korea
| | | | - S Chappa
- Fermi National Accelerator Laboratory, Batavia, Illinois, USA
| | - S Charity
- Fermi National Accelerator Laboratory, Batavia, Illinois, USA
| | - R Chislett
- Department of Physics and Astronomy, University College London, London, United Kingdom
| | - J Choi
- Center for Axion and Precision Physics (CAPP)/Institute for Basic Science (IBS), Daejeon, Republic of Korea
| | - Z Chu
- School of Physics and Astronomy, Shanghai Jiao Tong University, Shanghai, China
| | - T E Chupp
- University of Michigan, Ann Arbor, Michigan, USA
| | - M E Convery
- Fermi National Accelerator Laboratory, Batavia, Illinois, USA
| | - A Conway
- Department of Physics, University of Massachusetts, Amherst, Massachusetts, USA
| | - G Corradi
- INFN, Laboratori Nazionali di Frascati, Frascati, Italy
| | - S Corrodi
- Argonne National Laboratory, Lemont, Illinois, USA
| | - L Cotrozzi
- INFN, Sezione di Pisa, Pisa, Italy
- Università di Pisa, Pisa, Italy
| | - J D Crnkovic
- Brookhaven National Laboratory, Upton, New York, USA
- University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
- University of Mississippi, University, Mississippi, USA
| | - S Dabagov
- INFN, Laboratori Nazionali di Frascati, Frascati, Italy
| | | | - P T Debevec
- University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | | | - P Di Meo
- INFN, Sezione di Napoli, Napoli, Italy
| | | | - R Di Stefano
- INFN, Sezione di Napoli, Napoli, Italy
- Università di Cassino e del Lazio Meridionale, Cassino, Italy
| | - B Drendel
- Fermi National Accelerator Laboratory, Batavia, Illinois, USA
| | - A Driutti
- INFN, Sezione di Trieste, Trieste, Italy
- Università di Udine, Udine, Italy
- University of Kentucky, Lexington, Kentucky, USA
| | - V N Duginov
- Joint Institute for Nuclear Research, Dubna, Russia
| | - M Eads
- Northern Illinois University, DeKalb, Illinois, USA
| | - N Eggert
- Cornell University, Ithaca, New York, USA
| | - A Epps
- Northern Illinois University, DeKalb, Illinois, USA
| | - J Esquivel
- Fermi National Accelerator Laboratory, Batavia, Illinois, USA
| | - M Farooq
- University of Michigan, Ann Arbor, Michigan, USA
| | - R Fatemi
- University of Kentucky, Lexington, Kentucky, USA
| | - C Ferrari
- INFN, Sezione di Pisa, Pisa, Italy
- Istituto Nazionale di Ottica-Consiglio Nazionale delle Ricerche, Pisa, Italy
| | - M Fertl
- Institute of Physics and Cluster of Excellence PRISMA+, Johannes Gutenberg University Mainz, Mainz, Germany
- University of Washington, Seattle, Washington, USA
| | - A Fiedler
- Northern Illinois University, DeKalb, Illinois, USA
| | - A T Fienberg
- University of Washington, Seattle, Washington, USA
| | - A Fioretti
- INFN, Sezione di Pisa, Pisa, Italy
- Istituto Nazionale di Ottica-Consiglio Nazionale delle Ricerche, Pisa, Italy
| | - D Flay
- Department of Physics, University of Massachusetts, Amherst, Massachusetts, USA
| | - S B Foster
- Boston University, Boston, Massachusetts, USA
| | - H Friedsam
- Fermi National Accelerator Laboratory, Batavia, Illinois, USA
| | - E Frlež
- University of Virginia, Charlottesville, Virginia, USA
| | - N S Froemming
- Northern Illinois University, DeKalb, Illinois, USA
- University of Washington, Seattle, Washington, USA
| | - J Fry
- University of Virginia, Charlottesville, Virginia, USA
| | - C Fu
- School of Physics and Astronomy, Shanghai Jiao Tong University, Shanghai, China
| | - C Gabbanini
- INFN, Sezione di Pisa, Pisa, Italy
- Istituto Nazionale di Ottica-Consiglio Nazionale delle Ricerche, Pisa, Italy
| | - M D Galati
- INFN, Sezione di Pisa, Pisa, Italy
- Università di Pisa, Pisa, Italy
| | - S Ganguly
- Fermi National Accelerator Laboratory, Batavia, Illinois, USA
- University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | - A Garcia
- University of Washington, Seattle, Washington, USA
| | - D E Gastler
- Boston University, Boston, Massachusetts, USA
| | - J George
- Department of Physics, University of Massachusetts, Amherst, Massachusetts, USA
| | | | - A Gioiosa
- INFN, Sezione di Pisa, Pisa, Italy
- Università del Molise, Campobasso, Italy
| | - K L Giovanetti
- Department of Physics and Astronomy, James Madison University, Harrisonburg, Virginia, USA
| | - P Girotti
- INFN, Sezione di Pisa, Pisa, Italy
- Università di Pisa, Pisa, Italy
| | - W Gohn
- University of Kentucky, Lexington, Kentucky, USA
| | - T Gorringe
- University of Kentucky, Lexington, Kentucky, USA
| | - J Grange
- Argonne National Laboratory, Lemont, Illinois, USA
- University of Michigan, Ann Arbor, Michigan, USA
| | - S Grant
- Department of Physics and Astronomy, University College London, London, United Kingdom
| | - F Gray
- Regis University, Denver, Colorado, USA
| | - S Haciomeroglu
- Center for Axion and Precision Physics (CAPP)/Institute for Basic Science (IBS), Daejeon, Republic of Korea
| | - D Hahn
- Fermi National Accelerator Laboratory, Batavia, Illinois, USA
| | | | - D Hampai
- INFN, Laboratori Nazionali di Frascati, Frascati, Italy
| | - F Han
- University of Kentucky, Lexington, Kentucky, USA
| | - E Hazen
- Boston University, Boston, Massachusetts, USA
| | - J Hempstead
- University of Washington, Seattle, Washington, USA
| | - S Henry
- University of Oxford, Oxford, United Kingdom
| | - A T Herrod
- University of Liverpool, Liverpool, United Kingdom
| | - D W Hertzog
- University of Washington, Seattle, Washington, USA
| | - G Hesketh
- Department of Physics and Astronomy, University College London, London, United Kingdom
| | - A Hibbert
- University of Liverpool, Liverpool, United Kingdom
| | - Z Hodge
- University of Washington, Seattle, Washington, USA
| | - J L Holzbauer
- University of Mississippi, University, Mississippi, USA
| | - K W Hong
- University of Virginia, Charlottesville, Virginia, USA
| | - R Hong
- Argonne National Laboratory, Lemont, Illinois, USA
- University of Kentucky, Lexington, Kentucky, USA
| | - M Iacovacci
- INFN, Sezione di Napoli, Napoli, Italy
- Università di Napoli, Napoli, Italy
| | | | - C Johnstone
- Fermi National Accelerator Laboratory, Batavia, Illinois, USA
| | - J A Johnstone
- Fermi National Accelerator Laboratory, Batavia, Illinois, USA
| | - P Kammel
- University of Washington, Seattle, Washington, USA
| | | | - M Karuza
- INFN, Sezione di Trieste, Trieste, Italy
- University of Rijeka, Rijeka, Croatia
| | - J Kaspar
- University of Washington, Seattle, Washington, USA
| | - D Kawall
- Department of Physics, University of Massachusetts, Amherst, Massachusetts, USA
| | - L Kelton
- University of Kentucky, Lexington, Kentucky, USA
| | - A Keshavarzi
- Department of Physics and Astronomy, University of Manchester, Manchester, United Kingdom
| | - D Kessler
- Department of Physics, University of Massachusetts, Amherst, Massachusetts, USA
| | - K S Khaw
- School of Physics and Astronomy, Shanghai Jiao Tong University, Shanghai, China
- Tsung-Dao Lee Institute, Shanghai Jiao Tong University, Shanghai, China
- University of Washington, Seattle, Washington, USA
| | | | - N V Khomutov
- Joint Institute for Nuclear Research, Dubna, Russia
| | - B Kiburg
- Fermi National Accelerator Laboratory, Batavia, Illinois, USA
| | - M Kiburg
- Fermi National Accelerator Laboratory, Batavia, Illinois, USA
- North Central College, Naperville, Illinois, USA
| | - O Kim
- Center for Axion and Precision Physics (CAPP)/Institute for Basic Science (IBS), Daejeon, Republic of Korea
- Department of Physics, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, Republic of Korea
| | - S C Kim
- Cornell University, Ithaca, New York, USA
| | - Y I Kim
- Center for Axion and Precision Physics (CAPP)/Institute for Basic Science (IBS), Daejeon, Republic of Korea
| | - B King
- University of Liverpool, Liverpool, United Kingdom
| | - N Kinnaird
- Boston University, Boston, Massachusetts, USA
| | | | - I Kourbanis
- Fermi National Accelerator Laboratory, Batavia, Illinois, USA
| | - E Kraegeloh
- University of Michigan, Ann Arbor, Michigan, USA
| | - V A Krylov
- Joint Institute for Nuclear Research, Dubna, Russia
| | - A Kuchibhotla
- University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | | | - K R Labe
- Cornell University, Ithaca, New York, USA
| | - J LaBounty
- University of Washington, Seattle, Washington, USA
| | - M Lancaster
- Department of Physics and Astronomy, University of Manchester, Manchester, United Kingdom
| | - M J Lee
- Center for Axion and Precision Physics (CAPP)/Institute for Basic Science (IBS), Daejeon, Republic of Korea
| | - S Lee
- Center for Axion and Precision Physics (CAPP)/Institute for Basic Science (IBS), Daejeon, Republic of Korea
| | - S Leo
- University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | - B Li
- Argonne National Laboratory, Lemont, Illinois, USA
- School of Physics and Astronomy, Shanghai Jiao Tong University, Shanghai, China
| | - D Li
- School of Physics and Astronomy, Shanghai Jiao Tong University, Shanghai, China
| | - L Li
- School of Physics and Astronomy, Shanghai Jiao Tong University, Shanghai, China
| | - I Logashenko
- Budker Institute of Nuclear Physics, Novosibirsk, Russia
| | | | - A Lucà
- Fermi National Accelerator Laboratory, Batavia, Illinois, USA
| | - G Lukicov
- Department of Physics and Astronomy, University College London, London, United Kingdom
| | - G Luo
- Northern Illinois University, DeKalb, Illinois, USA
| | - A Lusiani
- INFN, Sezione di Pisa, Pisa, Italy
- Scuola Normale Superiore, Pisa, Italy
| | - A L Lyon
- Fermi National Accelerator Laboratory, Batavia, Illinois, USA
| | - B MacCoy
- University of Washington, Seattle, Washington, USA
| | - R Madrak
- Fermi National Accelerator Laboratory, Batavia, Illinois, USA
| | - K Makino
- Michigan State University, East Lansing, Michigan, USA
| | - F Marignetti
- INFN, Sezione di Napoli, Napoli, Italy
- Università di Cassino e del Lazio Meridionale, Cassino, Italy
| | | | - S Maxfield
- University of Liverpool, Liverpool, United Kingdom
| | - M McEvoy
- Northern Illinois University, DeKalb, Illinois, USA
| | - W Merritt
- Fermi National Accelerator Laboratory, Batavia, Illinois, USA
| | | | - J P Miller
- Boston University, Boston, Massachusetts, USA
| | - S Miozzi
- INFN, Sezione di Roma Tor Vergata, Roma, Italy
| | - J P Morgan
- Fermi National Accelerator Laboratory, Batavia, Illinois, USA
| | - W M Morse
- Brookhaven National Laboratory, Upton, New York, USA
| | - J Mott
- Boston University, Boston, Massachusetts, USA
- Fermi National Accelerator Laboratory, Batavia, Illinois, USA
| | - E Motuk
- Department of Physics and Astronomy, University College London, London, United Kingdom
| | - A Nath
- INFN, Sezione di Napoli, Napoli, Italy
- Università di Napoli, Napoli, Italy
| | - D Newton
- University of Liverpool, Liverpool, United Kingdom
| | - H Nguyen
- Fermi National Accelerator Laboratory, Batavia, Illinois, USA
| | - M Oberling
- Argonne National Laboratory, Lemont, Illinois, USA
| | - R Osofsky
- University of Washington, Seattle, Washington, USA
| | - J-F Ostiguy
- Fermi National Accelerator Laboratory, Batavia, Illinois, USA
| | - S Park
- Center for Axion and Precision Physics (CAPP)/Institute for Basic Science (IBS), Daejeon, Republic of Korea
| | - G Pauletta
- INFN Gruppo Collegato di Udine, Sezione di Trieste, Udine, Italy
- Università di Udine, Udine, Italy
| | - G M Piacentino
- INFN, Sezione di Roma Tor Vergata, Roma, Italy
- Università del Molise, Campobasso, Italy
| | - R N Pilato
- INFN, Sezione di Pisa, Pisa, Italy
- Università di Pisa, Pisa, Italy
| | - K T Pitts
- University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | - B Plaster
- University of Kentucky, Lexington, Kentucky, USA
| | - D Počanić
- University of Virginia, Charlottesville, Virginia, USA
| | - N Pohlman
- Northern Illinois University, DeKalb, Illinois, USA
| | - C C Polly
- Fermi National Accelerator Laboratory, Batavia, Illinois, USA
| | - M Popovic
- Fermi National Accelerator Laboratory, Batavia, Illinois, USA
| | - J Price
- University of Liverpool, Liverpool, United Kingdom
| | - B Quinn
- University of Mississippi, University, Mississippi, USA
| | - N Raha
- INFN, Sezione di Pisa, Pisa, Italy
| | | | - E Ramberg
- Fermi National Accelerator Laboratory, Batavia, Illinois, USA
| | - N T Rider
- Cornell University, Ithaca, New York, USA
| | - J L Ritchie
- Department of Physics, University of Texas at Austin, Austin, Texas, USA
| | - B L Roberts
- Boston University, Boston, Massachusetts, USA
| | - D L Rubin
- Cornell University, Ithaca, New York, USA
| | - L Santi
- INFN Gruppo Collegato di Udine, Sezione di Trieste, Udine, Italy
- Università di Udine, Udine, Italy
| | - D Sathyan
- Boston University, Boston, Massachusetts, USA
| | - H Schellman
- Northwestern University, Evanston, Illinois, USA
| | - C Schlesier
- University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | - A Schreckenberger
- Boston University, Boston, Massachusetts, USA
- University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
- Department of Physics, University of Texas at Austin, Austin, Texas, USA
| | - Y K Semertzidis
- Center for Axion and Precision Physics (CAPP)/Institute for Basic Science (IBS), Daejeon, Republic of Korea
- Department of Physics, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, Republic of Korea
| | - Y M Shatunov
- Budker Institute of Nuclear Physics, Novosibirsk, Russia
| | - D Shemyakin
- Budker Institute of Nuclear Physics, Novosibirsk, Russia
| | - M Shenk
- Northern Illinois University, DeKalb, Illinois, USA
| | - D Sim
- University of Liverpool, Liverpool, United Kingdom
| | - M W Smith
- INFN, Sezione di Pisa, Pisa, Italy
- University of Washington, Seattle, Washington, USA
| | - A Smith
- University of Liverpool, Liverpool, United Kingdom
| | - A K Soha
- Fermi National Accelerator Laboratory, Batavia, Illinois, USA
| | - M Sorbara
- INFN, Sezione di Roma Tor Vergata, Roma, Italy
- Università di Roma Tor Vergata, Rome, Italy
| | - D Stöckinger
- Institut für Kern-und Teilchenphysik, Technische Universität Dresden, Dresden, Germany
| | - J Stapleton
- Fermi National Accelerator Laboratory, Batavia, Illinois, USA
| | - D Still
- Fermi National Accelerator Laboratory, Batavia, Illinois, USA
| | - C Stoughton
- Fermi National Accelerator Laboratory, Batavia, Illinois, USA
| | - D Stratakis
- Fermi National Accelerator Laboratory, Batavia, Illinois, USA
| | - C Strohman
- Cornell University, Ithaca, New York, USA
| | - T Stuttard
- Department of Physics and Astronomy, University College London, London, United Kingdom
| | - H E Swanson
- University of Washington, Seattle, Washington, USA
| | - G Sweetmore
- Department of Physics and Astronomy, University of Manchester, Manchester, United Kingdom
| | | | - M J Syphers
- Fermi National Accelerator Laboratory, Batavia, Illinois, USA
- Northern Illinois University, DeKalb, Illinois, USA
| | - D A Tarazona
- Michigan State University, East Lansing, Michigan, USA
| | - T Teubner
- University of Liverpool, Liverpool, United Kingdom
| | | | - K Thomson
- University of Liverpool, Liverpool, United Kingdom
| | - V Tishchenko
- Brookhaven National Laboratory, Upton, New York, USA
| | - N H Tran
- Boston University, Boston, Massachusetts, USA
| | - W Turner
- University of Liverpool, Liverpool, United Kingdom
| | - E Valetov
- Lancaster University, Lancaster, United Kingdom
- Michigan State University, East Lansing, Michigan, USA
- Tsung-Dao Lee Institute, Shanghai Jiao Tong University, Shanghai, China
| | - D Vasilkova
- Department of Physics and Astronomy, University College London, London, United Kingdom
| | | | - V P Volnykh
- Joint Institute for Nuclear Research, Dubna, Russia
| | - T Walton
- Fermi National Accelerator Laboratory, Batavia, Illinois, USA
| | - M Warren
- Department of Physics and Astronomy, University College London, London, United Kingdom
| | - A Weisskopf
- Michigan State University, East Lansing, Michigan, USA
| | - L Welty-Rieger
- Fermi National Accelerator Laboratory, Batavia, Illinois, USA
| | - M Whitley
- University of Liverpool, Liverpool, United Kingdom
| | - P Winter
- Argonne National Laboratory, Lemont, Illinois, USA
| | - A Wolski
- University of Liverpool, Liverpool, United Kingdom
| | - M Wormald
- University of Liverpool, Liverpool, United Kingdom
| | - W Wu
- University of Mississippi, University, Mississippi, USA
| | - C Yoshikawa
- Fermi National Accelerator Laboratory, Batavia, Illinois, USA
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18
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Tyrell S, Coates E, Brown SR, Lee MJ. A systematic review of the quality of reporting of interventions in the surgical treatment of Crohn's anal fistula: an assessment using the TIDiER and Blencowe frameworks. Tech Coloproctol 2021; 25:359-369. [PMID: 33599902 PMCID: PMC8016786 DOI: 10.1007/s10151-020-02359-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 10/10/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Crohn's anal fistula is a challenging condition, and may require multiple surgical procedures. To replicate successful procedures, these must be adequately reported in the literature. The aim of this study was to review the quality of reporting of components of surgical interventions for Crohn's anal fistula. METHODS A systematic review was conducted. It was registered with PROSPERO (CRD:42019135157). The Medline and EMBASE databases were searched for studies reporting interventions intended to close fistula in patients with Crohn's disease, published between 1999 and August 2019. Abstracts and full texts were screened for inclusion by two reviewers. Dual extraction of data was performed to compare reporting to the TIDiER and Blencowe frameworks for reporting of interventions. RESULTS Initial searches identified 207 unique studies; 38 full texts were screened for inclusion and 33 were included. The most common study design was retrospective cohort (17/33), and the most frequently reported interventions were anal fistula plug (n = 8) and fibrin glue (n = 6). No studies showed coverage of all domains of TIDieR. Reporting was poor among domains related to who provided an intervention, where it was provided, and how it was tailored. Reporting of domains in the Blencowe framework was poor; the majority of studies did not report the component steps of procedures or efforts to standardise them. CONCLUSIONS This study demonstrates that reporting on technical aspects of interventions for Crohn's anal fistula is poor. Surgeons should aim to improve reporting to allow accurate reproduction of techniques both in clinical practice and in clinical trials.
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Affiliation(s)
- S Tyrell
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - E Coates
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Steven R Brown
- Academic Directorate of General Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - M J Lee
- Academic Directorate of General Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.
- Department of Oncology and Metabolism, The Medical School, University of Sheffield, Sheffield, S10 2RX, UK.
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19
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Lee MK, Moon C, Lee MJ, Kwak YG, Lee E, Jeon JH, Park WB, Jung Y, Kim ES, Lee JH, Chun JY, Park SW. Risk factors for the delayed diagnosis of extrapulmonary TB. Int J Tuberc Lung Dis 2021; 25:191-198. [PMID: 33688807 DOI: 10.5588/ijtld.20.0788] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND: Extrapulmonary TB (EPTB) is more difficult to diagnose than pulmonary TB. The delayed management of EPTB can lead to complications and increase the socio-economic burden.METHODS: Patients newly diagnosed with EPTB were retrospectively enrolled from 11 general hospitals in South Korea from January 2017 to December 2018. The basic characteristics of patients were described. Univariable and multivariable analyses were performed between early and delayed diagnosis groups to identify risk factors for delayed diagnosis and treatment in EPTB.RESULTS: In total, 594 patients were enrolled. Lymph node TB (28.3%) was the predominant form, followed by abdominal (18.4%) and disseminated TB (14.5%). Concurrent lung involvement was 17.8%. The positivity of diagnostic tests showed no significant difference between the two groups. Acute clinical manifestations in disseminated, pericardial and meningeal TB, and immunosuppression were associated with early diagnosis. Delayed diagnosis was associated with outpatient clinic visits, delayed sample acquisition and diagnostic departments other than infection or pulmonology.CONCLUSION: The delay in diagnosis and treatment of EPTB was not related to differences in microbiological characteristics of Mycobacterium tuberculosis itself; rather, it was due to the indolent clinical manifestations that cause referral to non-TB-specialised departments in the outpatient clinic and delay the suspicion of TB and diagnostic testing.
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Affiliation(s)
- M K Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul
| | - C Moon
- Department of Internal Medicine, Inje University Busan Paik Hospital, Busan
| | - M J Lee
- Department of Internal Medicine, Inje University Sanggye Paik Hospital, Seoul
| | - Y G Kwak
- Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang
| | - E Lee
- Department of Internal Medicine, SoonChunHyang University Seoul Hospital, Seoul, Department of Internal Medicine, Boramae Medical Center, Seoul
| | - J H Jeon
- Department of Internal Medicine, Veterans Health Service Medical Center, Seoul, Department of Internal Medicine, National Medical Center, Seoul
| | - W B Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul
| | - Y Jung
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang
| | - E S Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam
| | - J H Lee
- Department of Internal Medicine, Wonkwang University College of Medicine, Iksan
| | - J Y Chun
- Department of Internal Medicine, National Cancer Center Hospital, Goyang, South Korea
| | - S W Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Department of Internal Medicine, Boramae Medical Center, Seoul
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20
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Baker DM, Folan AM, Lee MJ, Jones GL, Brown SR, Lobo AJ. A systematic review and meta-analysis of outcomes after elective surgery for ulcerative colitis. Colorectal Dis 2021; 23:18-33. [PMID: 32777171 DOI: 10.1111/codi.15301] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 07/18/2020] [Accepted: 07/30/2020] [Indexed: 12/11/2022]
Abstract
AIM Approximately 20%-30% of patients with ulcerative colitis (UC) will undergo surgery during their disease course, the vast majority being elective due to chronic refractory disease. The risks of elective surgery are reported variably. The aim of this systematic review and meta-analysis is to summarize the outcomes after elective surgery for UC. METHODS A systematic review was conducted that analysed studies reporting outcomes for elective surgery in the modern era (>2002). It was prospectively registered on the PROSPERO database (ref: CRD42018115513). Searches were performed of Embase and MEDLINE on 15 January 2019. Outcomes were split by operation performed. Primary outcome was quality of life; secondary outcomes were early, late and functional outcomes after surgery. Outcomes reported in five or more studies underwent a meta-analysis of incidence using random effects. Heterogeneity is reported with I2 , and publication bias was assessed using Doi plots and the Luis Furuya-Kanamori index. RESULTS A total of 34 studies were included (11 774 patients). Quality of life was reported in 12 studies, with variable and contrasting results. Thirteen outcomes (eight early surgical complications, five functional outcomes) were included in the formal meta-analysis, all of which were outcomes for ileal pouch-anal anastomosis (IPAA). A further 71 outcomes were reported (50 IPAA, 21 end ileostomy). Only 14 of 84 outcomes received formal definitions, with high inter-study variation of definitions. CONCLUSION Outcomes after elective surgery for UC are variably defined. This systematic review and meta-analysis highlights the range of reported incidences and provides practical information that facilitates shared decision making in clinical practice.
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Affiliation(s)
- D M Baker
- Academic Foundation Doctor, Sheffield Teaching Hospitals, Sheffield, UK
| | - A-M Folan
- Department of Psychology, School of Social Sciences, Leeds Beckett University, Leeds, UK
| | - M J Lee
- Academic Directorate Sheffield Teaching Hospitals, Sheffield, UK.,Department of Oncology and Metabolism, Sheffield Medical School, Sheffield, UK
| | - G L Jones
- Department of Psychology, School of Social Sciences, Leeds Beckett University, Leeds, UK
| | - S R Brown
- Department of General Surgery, Sheffield Teaching Hospitals, Sheffield, UK
| | - A J Lobo
- Gastroenterology Unit, P Floor, Royal Hallamshire Hospital, Sheffield, UK
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21
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Abstract
AIM Approximately 20%-30% of patients with ulcerative colitis (UC) will undergo surgery during their disease course, the vast majority being elective due to chronic refractory disease. The risks of elective surgery are reported variably. The aim of this systematic review and meta-analysis is to summarize the outcomes after elective surgery for UC. METHODS A systematic review was conducted that analysed studies reporting outcomes for elective surgery in the modern era (>2002). It was prospectively registered on the PROSPERO database (ref: CRD42018115513). Searches were performed of Embase and MEDLINE on 15 January 2019. Outcomes were split by operation performed. Primary outcome was quality of life; secondary outcomes were early, late and functional outcomes after surgery. Outcomes reported in five or more studies underwent a meta-analysis of incidence using random effects. Heterogeneity is reported with I2 , and publication bias was assessed using Doi plots and the Luis Furuya-Kanamori index. RESULTS A total of 34 studies were included (11 774 patients). Quality of life was reported in 12 studies, with variable and contrasting results. Thirteen outcomes (eight early surgical complications, five functional outcomes) were included in the formal meta-analysis, all of which were outcomes for ileal pouch-anal anastomosis (IPAA). A further 71 outcomes were reported (50 IPAA, 21 end ileostomy). Only 14 of 84 outcomes received formal definitions, with high inter-study variation of definitions. CONCLUSION Outcomes after elective surgery for UC are variably defined. This systematic review and meta-analysis highlights the range of reported incidences and provides practical information that facilitates shared decision making in clinical practice.
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Affiliation(s)
- D M Baker
- Academic Foundation Doctor, Sheffield Teaching Hospitals, Sheffield, UK
| | - A-M Folan
- Department of Psychology, School of Social Sciences, Leeds Beckett University, Leeds, UK
| | - M J Lee
- Academic Directorate Sheffield Teaching Hospitals, Sheffield, UK.,Department of Oncology and Metabolism, Sheffield Medical School, Sheffield, UK
| | - G L Jones
- Department of Psychology, School of Social Sciences, Leeds Beckett University, Leeds, UK
| | - S R Brown
- Department of General Surgery, Sheffield Teaching Hospitals, Sheffield, UK
| | - A J Lobo
- Gastroenterology Unit, P Floor, Royal Hallamshire Hospital, Sheffield, UK
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22
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Lee MJ, Hawkins DJ, Bradburn MJ, Lee J, Brown SR, Wilson MJ. Atrial fibrillation after resection: a PROGRESS III study. Colorectal Dis 2021; 23:307-315. [PMID: 32797702 DOI: 10.1111/codi.15314] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 08/05/2020] [Indexed: 12/13/2022]
Abstract
AIM Atrial fibrillation (AF) is a common cardiac arrhythmia, and is associated with worsening quality of life and complications such as stroke. Previous work showed that 8% of patients develop new-onset AF following colonic resection and highlighted factors that might predict the development of postoperative AF. The development of a new arrhythmia may have a negative effect on longer-term quality of life as well as cancer survivorship. The aim of this study is to accurately quantify the incidence of AF following colorectal cancer surgery and to validate a model to predict its development. METHOD The Atrial Fibrillation After Resection (AFAR) study will recruit 720 patients aged 65 or over undergoing resection of colorectal cancer with curative intent. The primary outcome is development of AF within 90 days of surgery. Assessment of cardiac rhythm will be performed using 24-h Holter monitors at baseline, 30 and 90 days after surgery. An electrocardiogram (ECG) will be performed on the day of discharge. Baseline descriptors including model variables and quality of life will be recorded using EQ-5D-5L. The occurrence of complications and other key surgical outcomes will be recorded. An additional blood test for N-terminal pro B-type natriuretic peptide (NT-proBNP) will be performed prior to surgery. Statistical analysis will validate a previously derived model and will test the incremental value of added variables such as NT-proBNP. Finally, an exploratory analysis will assess whether changes in ECG measures between baseline and postoperative ECG can predict subsequent new-onset AF. CONCLUSION This study will provide data that may allow us to stratify the risk of developing AF following colorectal cancer surgery. This may inform screening or prophylactic approaches.
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Affiliation(s)
- M J Lee
- General Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.,Department of Oncology and Metabolism, The Medical School, University of Sheffield, Sheffield, UK
| | - D J Hawkins
- General Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - M J Bradburn
- Clinical Trials Research Unit, University of Sheffield, Sheffield, UK
| | - J Lee
- Department of Cardiology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - S R Brown
- General Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - M J Wilson
- School of Health and Related Research, Sheffield, UK
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23
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Choi HG, Lee JK, Lee MJ, Park B, Sim S, Lee SM. Blindness increases the risk for hip fracture and vertebral fracture but not the risk for distal radius fracture: a longitudinal follow-up study using a national sample cohort. Osteoporos Int 2020; 31:2345-2354. [PMID: 32632509 DOI: 10.1007/s00198-020-05475-0] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 05/21/2020] [Indexed: 12/14/2022]
Abstract
UNLABELLED The risks for hip fracture and vertebral fracture, but not the risk for distal radius fracture, were significantly higher in the blindness group than in the control group with a maximum 12-year follow-up. PURPOSE To evaluate the influence of visual impairment on the risk for osteoporotic fractures at common sites: hip, thoracic/lumbar vertebra, and distal radius. METHODS This longitudinal follow-up study used a database of a national sample cohort from 2002 to 2013 provided by the Korean National Health Insurance Service. Of a total of 1,125,691 subjects, 3918 patients with visual impairment and age ≥ 50 years were enrolled in a 1:4 ratio; 15,672 control participants were matched for age, sex, income, and region of residence. Stratified Cox proportional-hazards models were used to evaluate the crude and adjusted (for steroid medication, rheumatoid arthritis, depression, osteoporosis, diabetes mellitus, and stroke history) hazard ratios (HRs) for each fracture site. Fracture diagnoses were based on the ICD-10 codes: hip fracture (S720, S721, S722), vertebral fracture (S220, S320), and distal radius fracture (S525). RESULTS The HRs for hip and vertebral fracture were significantly higher in the blindness group (adjusted HR = 2.46, p < 0.001 for hip fracture; adjusted HR = 1.42, p = 0.020 for thoracic/lumbar vertebral fracture) than in the matched control group. However, the HR for distal radius fracture was not higher in the blindness group. The HRs for all three fracture sites were not significantly higher in the non-blindness visual impairment group after adjustment. CONCLUSION The risks for hip fracture and vertebral fracture were significantly higher in the blindness group. However, the risk for distal radius fracture was not related to visual impairment including blindness.
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Affiliation(s)
- H G Choi
- Department of Otorhinolaryngology-Head & Neck Surgery, Hallym University College of Medicine, Anyang, Republic of Korea
- Hallym Data Science Laboratory, Hallym University College of Medicine, Anyang, Republic of Korea
| | - J K Lee
- Department of Orthopaedic Surgery, Konkuk University Medical Center, Research Institute of Medical Science, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - M J Lee
- Department of Ophthalmology, Hallym University College of Medicine, Anyang, Republic of Korea
| | - B Park
- Department of Otorhinolaryngology-Head & Neck Surgery, Hallym University College of Medicine, Anyang, Republic of Korea
| | - S Sim
- Department of Statistics and Institute of Statistics, Hallym University, 1 Hallymdaehak-gil, Chuncheon-si, Gangwon-do, 24252, Republic of Korea.
| | - S-M Lee
- Department of Cornea, External Disease & Refractive Surgery, HanGil Eye Hospital, Catholic Kwandong University College of Medicine, 35 Bupyeong-daero, Bupyeong-gu, Incheon, 21388, Republic of Korea.
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Lee MJ, Dimairo M, Edwards J, Hawkins DJ, Hind D, Knowles CH, Hooper R, Brown SR. Non-randomized studies should be considered for assessing surgical techniques in rectal prolapse: prospective cohort study. Colorectal Dis 2020; 22:2170-2180. [PMID: 32757339 DOI: 10.1111/codi.15293] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 07/24/2020] [Accepted: 07/28/2020] [Indexed: 12/13/2022]
Abstract
AIM Randomized trials comparing surgical techniques for rectal prolapse are not always feasible. We assessed whether non-randomized comparisons of those who have had surgery with those still waiting would be confounding baseline health status. METHOD This was a prospective cohort study in seven UK hospitals. Participants were ≥ 18 years and listed for surgical interventions of equivalent intensity for rectal prolapse. They were defined as short or long waiters (≤ 18 or > 18 weeks, respectively). Time on the waiting list was compared with baseline comorbidity (Charlson comorbidity index) and change from baseline in health status (EQ-5D-5L) at the time of surgery. RESULTS In all, 203 patients were analysed. Median (interquartile range) waiting time was 13.7 weeks (8.1, 20.4) varying across sites. Baseline comorbidity was not an important predictor of waiting time. Median Charlson comorbidity index was 2 (0, 3) for short and 1 (0, 3) for long waiters. A change in waiting time by a week was associated with negligible improvement in the EQ-5D-5L index of 0.001 (95% CI -0.000 to 0.003, P = 0.106). CONCLUSION Negligible change in patient reported health status while on the waiting list and lack of effect of comorbidities in influencing waiting time support the use of non-randomized pre-/post-studies to compare the effects of surgical interventions for rectal prolapse.
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Affiliation(s)
- M J Lee
- Academic Directorate of General Surgery, Sheffield Teaching Hospitals NHS FT, Northern General Hospital, Sheffield, UK
| | - M Dimairo
- Clinical Trials Research Unit, ScHARR, University of Sheffield, Sheffield, UK
| | - J Edwards
- ScHARR, University of Sheffield, Sheffield, UK
| | - D J Hawkins
- Academic Directorate of General Surgery, Sheffield Teaching Hospitals NHS FT, Northern General Hospital, Sheffield, UK
| | - D Hind
- Clinical Trials Research Unit, ScHARR, University of Sheffield, Sheffield, UK
| | - C H Knowles
- Pragmatic Clinical Trials Unit, Queen Mary University of London, London, UK
| | - R Hooper
- Pragmatic Clinical Trials Unit, Queen Mary University of London, London, UK
| | - S R Brown
- Academic Directorate of General Surgery, Sheffield Teaching Hospitals NHS FT, Northern General Hospital, Sheffield, UK
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25
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Lee MJ, Sugiyama G, Alfonso A, Coppa GF, Chung PJ. It's not just an ileus: disparities associated with ileus following ventral hernia repair. Hernia 2020; 25:1021-1026. [PMID: 33211208 DOI: 10.1007/s10029-020-02339-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 11/04/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE We sought to identify risk factors associated with postoperative ileus following ventral hernia repair. METHODS Utilizing the Nationwide Inpatient Sample (NIS) from 2008 to 2012, we identified adult patients that underwent either open or laparoscopic hernia repair for umbilical and ventral hernias with a diagnosis of umbilical/ventral hernia. We excluded cases with diagnosis of obstruction and bowel gangrene that underwent bowel resection, or with missing data. Risk variables of interest were age, sex, race, income status, insurance status, elective admission, comorbidity status (using the validated van Walraven Score), complications (mechanical, respiratory, postoperative infection, cardiovascular, intraoperative), morbid obesity, procedure type, conversion to open, mesh use, hospital type (rural, urban non-teaching, urban teaching), bed size, and region (northeast, midwest, south, west). Univariate analysis comparing patients with ileus vs control was performed. We then performed multivariable analysis using logistic regression, adjusting for all the risk variables, with ileus as the dependent variable. RESULTS 30,912 patients were identified that met criteria. Of these, 2660 (8.61%) had postoperative ileus during their stay at the hospital. Univariate analysis showed all risk variables were associated with development of ileus with the exception of income status (p = 0.2903), elective admission (p = 0.7989), mesh use (p = 0.3620), and hospital bed size (p = 0.08351). Median length of stay was 7 days in the ileus cohort vs 3 days in control (p < 0.0001). Median total charges (adjusted to 2012 dollars) was $54,819 vs $35,058 (p < 0.0001). We then performed logistic regression adjusting for all risk variables and found that age (OR 1.66, p < 0.0001), male sex (OR 1.51, p < 0.0001), Black race (OR 1.49, p < 0.0001), comorbidity status (OR 1.12, p < 0.0001), laparoscopic cases converted to open (OR 1.55, p < 0.0001), postoperative complications (mechanical: OR 2.32, p < 0.0001, respiratory: OR 1.54, p < 0.0001, postoperative infection: OR 2.12, p < 0.0001, cardiovascular: OR 1.57, p = 0.0006, intraoperative: OR 1.29, p = 0.0200) were independently associated with increased risk of ileus. However, laparoscopic vs open (OR 0.76, p < 0.0001), elective admission (OR 0.91, p = 0.0378), and northeast vs south hospital region (OR 0.74, p < 0.0001) were independently associated with decreased risk of ileus. CONCLUSION We performed a large observational study looking for risk factors associated with ileus following ventral hernia repair. Race and region of treatment are independent risk factors associated with ileus following ventral hernia repair, and a potential source of disparities in care and increased admission length and higher cost of care. Further prospective studies are warranted.
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Affiliation(s)
- M J Lee
- Department of Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY, USA.
| | - G Sugiyama
- Department of Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY, USA
| | - A Alfonso
- Department of Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY, USA
| | - G F Coppa
- Department of Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY, USA
| | - P J Chung
- Department of Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY, USA
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26
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Lee HJ, Lee JY, Lee MJ, Kim HK, Kim N, Kim GU, Lee JS, Park HW, Chang HS, Yang DH, Choe J, Byeon JS. Association of low skeletal muscle mass with the presence of advanced colorectal neoplasm: integrative analysis using three skeletal muscle mass indices. Colorectal Dis 2020; 22:1293-1303. [PMID: 32363686 DOI: 10.1111/codi.15103] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 04/14/2020] [Indexed: 02/08/2023]
Abstract
AIM This study aimed to evaluate an association between colorectal neoplasm (CRN) and skeletal muscle mass using three widely accepted skeletal muscle mass indices (SMIs) in a large population at average risk. METHOD We performed a cross-sectional study using a screening colonoscopy database of 33 958 asymptomatic subjects aged 40-75 years. Appendicular skeletal muscle mass (ASM) was measured using a bioelectrical impedance analyser. ASM adjusted for height squared (ASM/ht2 ), weight (ASM/wt) and body mass index (ASM/BMI) were used as indices for muscle mass. Logistic regression models were used to evaluate the association between SMIs and CRN. RESULTS In a multivariable-adjusted model, the risk of an advanced CRN increased linearly with decreasing quartiles for all three SMIs. The adjusted odds ratios (ORs) for advanced CRN in quartiles 1, 2 and 3 of ASM/wt compared with that in quartile 4 were 1.279, 1.196 and 1.179, respectively (Ptrend = 0.017); for ASM/BMI, ORs were 1.307, 1.144 and 1.091, respectively (Ptrend = 0.002); and for ASM/ht2 , ORs were 1.342, 1.169 and 1.062, respectively (Ptrend = 0.002). The risk of distally located advanced CRN was higher in quartile 1 than in quartile 4 for all three SMIs (ASM/wt, OR = 1.356; ASM/BMI, OR = 1.383; ASM/ht2 , OR = 1.430). CONCLUSION Our study demonstrated that low skeletal muscle mass was consistently associated with the presence of advanced CRN in a population at average risk regardless of the operational definition of the SMI, and it was particularly associated with distal advanced CRN.
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Affiliation(s)
- H J Lee
- Division of Gastroenterology, Health Screening and Promotion Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - J Y Lee
- Division of Gastroenterology, Health Screening and Promotion Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - M J Lee
- Division of Endocrinology, Health Screening and Promotion Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - H-K Kim
- Division of Endocrinology, Health Screening and Promotion Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - N Kim
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - G-U Kim
- Division of Gastroenterology, Health Screening and Promotion Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - J-S Lee
- Division of Gastroenterology, Health Screening and Promotion Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - H W Park
- Division of Gastroenterology, Health Screening and Promotion Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - H-S Chang
- Division of Gastroenterology, Health Screening and Promotion Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - D-H Yang
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - J Choe
- Division of Gastroenterology, Health Screening and Promotion Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.,Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - J-S Byeon
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Wu WC, Tsai WL, Lee MJ. Virtual and reality: risk and protective factors of cyber and offline relational victimization. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa166.878] [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: 11/13/2022] Open
Abstract
Abstract
Background
Cyber victimization (CV) and offline relational victimization (ORV) both impede adolescent development and might pose self-harm or suicide. The aim of this work is to examine the risk and protective factors of the two experiences across gender.
Methods
A total of 1,712 junior and senior high school students who came from 34 schools randomly sampled from northern Taiwan. The study included multi-facet supports (i.e. maternal, paternal, grandparent, peer, and teacher supports), positive and negative peer connections, smartphone addiction and family characteristics (i.e. parental marital status and self-perceived financial status) as predictors.
Results
10.3% of the participants reported CV more than once (56.8% girls) and 35.2% of them reported ORV more than once (52.4% girls) in the last three months. Results of logistic regression models showed that smartphone addiction positively related to CV (boys: OR = 1.3, 95% CI = 1.1-1.6; girls: OR = 1.6, 95% CI = 1.3-2.0) and ORV (boys: OR = 1.2, 95% CI = 1.1-1.4; girls: OR = 1.2, 95% CI = 1.1-1.3) regardless gender. Negative peer connection related to ORV only among boys (OR = 1.4, 95% CI = 1.7-1.7). Low-level self-perceived financial status related to having CV (OR = 2.8, 95% CI = 1.4-5.5) and ORV (OR = 2.0, 95% CI = 1.2-3.4) only among girls. Interestingly, paternal support is the only significant protective factor among three family supports. Paternal support negatively associated with CV (OR = 0.8, 95% CI = 0.6-0.9) and ORV of boys (OR = 0.8, 95% CI = 0.7-0.9) as well as ORV of girls (OR = 0.8, 95% CI = 0.6-0.9). Furthermore, teacher support negatively associated with girls' CV (OR = 0.8, 95% CI = 0.6-0.9) and boys' ORV (OR = 0.8, 95% CI = 0.7-0.9).
Conclusions
The study identified a few gender-specific risk factors. For both gender, to prevent CV and ORV, supporting adolescents to avoid smartphone addiction is critical. Enhancing paternal support and teacher support can be effective in preventing adolescents' cyber and offline relational victimization.
Key messages
Paternal and teacher supports, rather than other sources of supports, are protective factors of cyber victimization and offline relational victimization among adolescents. Smartphone addiction, regardless of gender, not only positively associated with cyber victimization but also positively related to offline relational victimization.
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Affiliation(s)
- W C Wu
- Department of Health Promotion and Health Education, National Taiwan Normal University, Taipei, Taiwan
| | - W L Tsai
- Department of Health Promotion and Health Education, National Taiwan Normal University, Taipei, Taiwan
| | - M J Lee
- Graduate Institute of Social Work, National Taiwan Normal University, Taipei, Taiwan
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28
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Leung E, Maingard J, Yeh J, Lee MJ, Brooks DM, Asadi H, Burrows DA, Kok HK. Contemporary endovascular management of splenic vascular pathologies. Clin Radiol 2020; 75:960.e23-960.e34. [PMID: 32819705 DOI: 10.1016/j.crad.2020.07.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 07/06/2020] [Indexed: 11/28/2022]
Abstract
The spleen is a commonly injured organ and the splenic vasculature is also susceptible to inflammation and trauma, often resulting in aneurysm formation. Splenic artery aneurysms carry a high risk of rupture and are associated with high mortality and morbidity. Due to the advances in endovascular techniques and devices, endovascular management of splenic vascular pathologies is now considered a first-line strategy. Endovascular embolisation and advance techniques including balloon- or stent-assisted coil embolisation enables minimally invasive management option while preserving splenic function.
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Affiliation(s)
- E Leung
- Interventional Radiology Service - Department of Radiology, Northern Health, Melbourne, Australia.
| | - J Maingard
- Interventional Neuroradiology Service - Monash Imaging, Monash Health, Melbourne, Australia; School of Medicine, Faculty of Health, Deakin University, Waurn Ponds, Australia
| | - J Yeh
- Interventional Radiology Service - Department of Radiology, Northern Health, Melbourne, Australia
| | - M J Lee
- Department of Radiology, Beaumont Hospital and Royal College of Surgeons in Ireland, Dublin, Ireland
| | - D M Brooks
- School of Medicine, Faculty of Health, Deakin University, Waurn Ponds, Australia; Interventional Neuroradiology Service - Radiology Department, Austin Hospital, Melbourne, Australia
| | - H Asadi
- Interventional Neuroradiology Service - Monash Imaging, Monash Health, Melbourne, Australia; School of Medicine, Faculty of Health, Deakin University, Waurn Ponds, Australia; Interventional Neuroradiology Service - Radiology Department, Austin Hospital, Melbourne, Australia
| | - D A Burrows
- Interventional Radiology Service - Department of Radiology, Northern Health, Melbourne, Australia
| | - H K Kok
- Interventional Radiology Service - Department of Radiology, Northern Health, Melbourne, Australia; School of Medicine, Faculty of Health, Deakin University, Waurn Ponds, Australia
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29
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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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30
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Lee MJ, Coe PO, O'Donoghue R, Peirson M, Saha A. Variation in descriptors of patient characteristics in randomized clinical trials of peptic ulcer repair: a systematic review. Br J Surg 2020; 107:1570-1579. [PMID: 32671830 DOI: 10.1002/bjs.11771] [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] [Received: 03/11/2020] [Revised: 05/02/2020] [Accepted: 05/14/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND The ability to compare findings across surgical research is important. Inadequate description of participants, interventions or outcomes could lead to bias and inaccurate assessment of findings. The aim of this study was to assess consistency of description of participants using studies comparing laparoscopic and open repair of peptic ulcer as an example. METHODS This systematic review is reported in line with the PRISMA checklist. Searches of MEDLINE and Embase databases were performed to identify studies comparing laparoscopic and open repair of perforated peptic ulcer in adults, published in the English language. Manuscripts were dual-screened for eligibility. Full texts were retrieved and dual-screened for inclusion. Data extracted from studies included descriptors of participants in studies from tables and text. Descriptors were categorized into conceptual domains by the research team, and coverage of each domain by study was tabulated. RESULTS Searches identified 2018 studies. After screening, 37 full texts were retrieved and 23 studies were included in the final synthesis. A total of 76 unique descriptors were identified. These were classified into demographics (11 descriptors), vital signs (9 descriptors), disease-specific characteristics (10 descriptors), presentation and pathway factors (4 descriptors), risk factors (8 descriptors), laboratory tests (14 descriptors) and baseline health (28 descriptors). The number of descriptors in a single study ranged from three to 31. All studies reported at least one demographic descriptor. Laboratory tests was the least frequently described domain. CONCLUSION Study participants are described inconsistently in studies of a single example surgical condition.
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Affiliation(s)
- M J Lee
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK.,Academic Directorate of General Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - P O Coe
- Academic Directorate of General Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | | | - M Peirson
- Department of General Surgery, Ysbyty Gwynedd Hospital, Bangor, UK
| | - A Saha
- Department of General Surgery, Calderdale and Huddersfield NHS Foundation Trust, Huddersfield, UK
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31
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Lee MJ, Marshall JH, Jones GL, Lobo AJ, Brown SR. The informational and decisional preferences of patients undergoing surgery for Crohn's anal fistula: a qualitative study. Colorectal Dis 2020; 22:703-712. [PMID: 31868981 DOI: 10.1111/codi.14936] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Accepted: 10/08/2019] [Indexed: 12/17/2022]
Abstract
AIM One in three patients with Crohn's disease will develop a perianal fistula, but only a few achieve long-term healing. Treatment is both medical and surgical. Since there is no 'best' surgical procedure, patient preference is important in selecting the appropriate treatment for this condition. The aim of this study was to investigate the informational and decisional preferences of patients when surgical treatment is being considered. METHOD Patients who had undergone surgery for Crohn's anal fistula underwent face-to-face semi-structured interviews. These explored the experience of treatments for fistula, of receiving information and of participation in decision-making. Transcripts were analysed by two investigators through inductive thematic analysis. Saturation was assessed for at 12 interviews and then after each subsequent interview. RESULTS Seventeen patients completed interviews, and saturation was achieved. Five themes were identified, of which two (desired information and decision-making) were relevant to this study. Other themes included experience of Crohn's disease, experience of receiving information and procedure-specific comments. Participants wanted to have information on any risks, high-level outcomes (e.g. success), impact on day-to-day life and aftercare. Participants felt they did not always receive the information they needed to select the best treatment option. Participants felt uninvolved in treatment decisions and would have liked to trade off operations to reach their treatment goal. CONCLUSION Information provided to patients about surgical treatment of Crohn's perianal fistula does not meet their needs. Clinicians should address aftercare, impact on quality of life and the risks and benefits of the any proposed procedure.
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Affiliation(s)
- M J Lee
- Academic Department of General Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.,Department of Oncology and Metabolism, The Medical School, University of Sheffield, Sheffield, UK
| | - J H Marshall
- The Medical School, University of Sheffield, Sheffield, UK
| | - G L Jones
- Department of Psychology, Leeds Beckett University, Leeds, UK
| | - A J Lobo
- Academic Unit of Gastroenterology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - S R Brown
- Academic Department of General Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
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32
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Affiliation(s)
- M J Lee
- Department of General Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.,Department of Oncology and Metabolism, The Medical School, University of Sheffield, Sheffield, UK
| | - S R Brown
- Department of General Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
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33
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Redmond CE, Crawford R, O'Neill DC, Lee MJ. Social Media as a Learning Resource for Medical Students. Ir Med J 2020; 113:64. [PMID: 32268057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- C E Redmond
- Department of Radiology, University of British Columbia, Vancouver, Canada
| | - R Crawford
- Department of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - D C O'Neill
- Department of Radiology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - M J Lee
- Department of Radiology, Royal College of Surgeons in Ireland, Dublin, Ireland
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34
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Chapman SJ, Lee MJ, Blackwell S, Arnott R, Ten Broek RPG, Delaney CP, Dudi-Venkata NN, Hind D, Jayne DG, Mellor K, Mishra A, O'Grady G, Sammour T, Thorpe G, Wells CI, Wolthuis AM, Fearnhead NS. Establishing core outcome sets for gastrointestinal recovery in studies of postoperative ileus and small bowel obstruction: protocol for a nested methodological study. Colorectal Dis 2020; 22:459-464. [PMID: 31701620 DOI: 10.1111/codi.14899] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 10/08/2019] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Gastrointestinal recovery describes the restoration of normal bowel function in patients with bowel disease. This may be prolonged in two common clinical settings: postoperative ileus and small bowel obstruction. Improving gastrointestinal recovery is a research priority but researchers are limited by variation in outcome reporting across clinical studies. This protocol describes the development of core outcome sets for gastrointestinal recovery in the contexts of postoperative ileus and small bowel obstruction. METHOD An international Steering Group consisting of patient and clinician representatives has been established. As overlap between clinical contexts is anticipated, both outcome sets will be co-developed and may be combined to form a common output with disease-specific domains. The development process will comprise three phases, including definition of outcomes relevant to postoperative ileus and small bowel obstruction from systematic literature reviews and nominal-group stakeholder discussions; online-facilitated Delphi surveys via international networks; and a consensus meeting to ratify the final output. A nested study will explore if the development of overlapping outcome sets can be rationalized. DISSEMINATION AND IMPLEMENTATION The final output will be registered with the Core Outcome Measures in Effectiveness Trials initiative. A multi-faceted, quality improvement campaign for the reporting of gastrointestinal recovery in clinical studies will be launched, targeting international professional and patient groups, charitable organizations and editorial committees. Success will be explored via an updated systematic review of outcomes 5 years after registration of the core outcome set.
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Affiliation(s)
- S J Chapman
- Leeds Institute of Medical Research at St. James's, University of Leeds, Leeds, UK
| | - M J Lee
- Academic Directorate of General Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.,Department of Oncology and Metabolism, Medical School, University of Sheffield, Sheffield, UK
| | | | - R Arnott
- Patient Representative, Green Templeton College, Oxford, UK
| | - R P G Ten Broek
- Department of Surgery, Radboud University Medical Center, Nijmegen, Netherlands
| | - C P Delaney
- Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - N N Dudi-Venkata
- Discipline of Surgery, Faculty of Health and Medical Science, School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - D Hind
- Clinical Trials Research Unit, University of Sheffield, Sheffield, UK
| | - D G Jayne
- Leeds Institute of Medical Research at St. James's, University of Leeds, Leeds, UK
| | - K Mellor
- Clinical Trials Research Unit, University of Sheffield, Sheffield, UK
| | - A Mishra
- Department of Surgery, Maulana Azad Medical College, New Delhi, India
| | - G O'Grady
- Department of Surgery, Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand
| | - T Sammour
- Colorectal Unit, Department of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - G Thorpe
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - C I Wells
- Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - A M Wolthuis
- Department of Abdominal Surgery, University Hospital Leuven, Leuven, Belgium
| | - N S Fearnhead
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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Lee MJ, Vaughan-Shaw P, Vimalachandran D. A systematic review and meta-analysis of baseline risk factors for the development of postoperative ileus in patients undergoing gastrointestinal surgery. Ann R Coll Surg Engl 2019; 102:194-203. [PMID: 31858809 DOI: 10.1308/rcsann.2019.0158] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Postoperative ileus occurs frequently following abdominal surgery. Identification of groups at high risk of developing ileus before surgery may allow targeted interventions. This review aimed to identify baseline risk factors for ileus. METHODS A systematic review was conducted with reference to PRISMA and MOOSE guidelines. It was registered on PROSPERO (CRD42017068697). Searches of MEDLINE, EMBASE and CENTRAL were undertaken. Studies reporting baseline risk factors for the development of postoperative ileus based on cohort or trial data and published in English were eligible for inclusion. Dual screening of abstracts and full texts was undertaken. Independent dual extraction was performed. Bias assessment was undertaken using the quality in prognostic studies tool. Meta-analysis using a random effects model was undertaken where two or more studies assessed the same variable. FINDINGS Searches identified 2,430 papers, of which 28 were included in qualitative analysis and 12 in quantitative analysis. Definitions and incidence of ileus varied between studies. No consistent significant effect was found for association between prior abdominal surgery, age, body mass index, medical comorbidities or smoking status. Male sex was associated with ileus on meta-analysis (odds ratio 1.12, 95% confidence interval 1.02-1.23), although this may reflect unmeasured factors. The literature shows inconsistent effects of baseline factors on the development of postoperative ileus. A large cohort study using consistent definitions of ileus and factors should be undertaken.
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Affiliation(s)
- M J Lee
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.,The Medical School, University of Sheffield, Sheffield, UK
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Park SJ, Park J, Lee MJ, Seo JS, Ahn JY, Cho JW. Time series analysis of delta neutrophil index as the predictor of sepsis in patients with acute poisoning. Hum Exp Toxicol 2019; 39:86-94. [PMID: 31558056 DOI: 10.1177/0960327119878244] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Delta neutrophil index (DNI), which reflects the fraction of immature granulocytes, is used to detect infection and sepsis from noninfectious conditions, but few studies have evaluated in the early stage of acute poisoning. This retrospective observational study was performed on acute poisoning patients who visited to the emergency department (ED) and were consecutively admitted in intensive care units over 18-month period. The serial DNI, conventional inflammatory biomarkers, and culture results were obtained in the ED and after admission. The outcomes were the identification of sepsis, bacteremia, and 30-day mortality. Of 166 patients (mean age, 56.0 years) in this cohort, 59 (35.5%) had sepsis and 29 (17.5%) had bacteremia. Initial and peak DNI fractions 24 h after ED admission were strong independent predictors of sepsis development. Analysis of the area under the curve according to multiple receiver operating characteristics showed that DNI had a higher capability to predict sepsis than other parameters (0.815 for DNI, 0.700 for procalcitonin, 0.681 for C-reactive protein, and 0.741 for white blood cell). Using multivariable logistic regression analysis, it was found that DNI was an independent predictor of sepsis (95% confidence interval (CI) of odds: 1.03-1.18) and bacteremia (95% CI: 1.01-1.14). Therefore, initial and serial measurement of DNI may serve as useful risk predictor for development of sepsis or bacteremia in acute poisoning.
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Affiliation(s)
- S J Park
- Department of Emergency Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - J Park
- Department of Emergency Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - M J Lee
- Department of Emergency Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - J S Seo
- Department of Emergency Medicine, Dongguk University Ilsan Hospital, College of Medicine, Dongguk University, Seoul, Republic of Korea
| | - J Y Ahn
- Department of Emergency Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - J W Cho
- Department of Emergency Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
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Lee MJ, Sayers AE, Drake TM, Marriott PJ, Anderson ID, Bach SP, Bradburn M, Hind D, Verjee A, Fearnhead NS. National prospective cohort study of the burden of acute small bowel obstruction. BJS Open 2019; 3:354-366. [PMID: 31183452 PMCID: PMC6551410 DOI: 10.1002/bjs5.50136] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [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: 10/02/2018] [Accepted: 11/27/2018] [Indexed: 12/21/2022] Open
Abstract
Background Small bowel obstruction is a common surgical emergency, and is associated with high levels of morbidity and mortality across the world. The literature provides little information on the conservatively managed group. The aim of this study was to describe the burden of small bowel obstruction in the UK. Methods This prospective cohort study was conducted in 131 acute hospitals in the UK between January and April 2017, delivered by trainee research collaboratives. Adult patients with a diagnosis of mechanical small bowel obstruction were included. The primary outcome was in‐hospital mortality. Secondary outcomes included complications, unplanned intensive care admission and readmission within 30 days of discharge. Practice measures, including use of radiological investigations, water soluble contrast, operative and nutritional interventions, were collected. Results Of 2341 patients identified, 693 (29·6 per cent) underwent immediate surgery (within 24 h of admission), 500 (21·4 per cent) had delayed surgery after initial conservative management, and 1148 (49·0 per cent) were managed non‐operatively. The mortality rate was 6·6 per cent (6·4 per cent for non‐operative management, 6·8 per cent for immediate surgery, 6·8 per cent for delayed surgery; P = 0·911). The major complication rate was 14·4 per cent overall, affecting 19·0 per cent in the immediate surgery, 23·6 per cent in the delayed surgery and 7·7 per cent in the non‐operative management groups (P < 0·001). Cox regression found hernia or malignant aetiology and malnutrition to be associated with higher rates of death. Malignant aetiology, operative intervention, acute kidney injury and malnutrition were associated with increased risk of major complication. Conclusion Small bowel obstruction represents a significant healthcare burden. Patient‐level factors such as timing of surgery, acute kidney injury and nutritional status are factors that might be modified to improve outcomes.
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Affiliation(s)
- M J Lee
- Department of General Surgery Northern General Hospital Sheffield UK.,South Yorkshire Surgical Research Group Sheffield UK
| | - A E Sayers
- South Yorkshire Surgical Research Group Sheffield UK.,Department of General Surgery Doncaster Royal Infirmary Doncaster UK
| | - T M Drake
- South Yorkshire Surgical Research Group Sheffield UK.,Department of Clinical Surgery University of Edinburgh Edinburgh UK
| | - P J Marriott
- Department of General Surgery Warwick Hospital Warwick UK.,Department of General Surgery Salford Royal Infirmary Salford UK
| | - I D Anderson
- West Midlands Research Collaborative, Academic Department of Surgery Queen Elizabeth Hospital Birmingham UK
| | - S P Bach
- Academic Department of Surgery Queen Elizabeth Hospital Birmingham UK
| | - M Bradburn
- Clinical Trials and Research Unit University of Sheffield Sheffield UK
| | - D Hind
- Clinical Trials and Research Unit University of Sheffield Sheffield UK
| | - A Verjee
- Patient Representative, Association of Coloproctology of Great Britain and Ireland Patient Liaison Group London UK
| | - N S Fearnhead
- Department of Surgery Addenbrooke's Hospital Cambridge UK
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Lee MJ, Morgan J, Watson AJM, Jones GL, Brown SR. A validated severity score for haemorrhoids as an essential prerequisite for future haemorrhoid trials. Tech Coloproctol 2019; 23:33-41. [PMID: 30725242 PMCID: PMC6394714 DOI: 10.1007/s10151-019-01936-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 12/29/2018] [Indexed: 12/27/2022]
Abstract
BACKGROUND There is a lack of standardised outcomes for haemorrhoidal disease making comparison between trials difficult. A need for a very well validated severity score is essential to facilitate meta-analysis of comparative studies, enabling evidence-based clinical practice. METHODS The Hubble trial provides a large cohort of patients with haemorrhoidal disease randomised to rubber band ligation (RBL) or haemorrhoidal artery ligation. The haemorrhoid severity score (HSS) was collected on each patient at baseline, 6 weeks and 1 year after intervention. This allows for the responsiveness of the HSS instrument to be examined and compared with a more specific instrument, the Vaizey incontinence score (also collected). Responsiveness was tested using four methods (effect size, standardised response means (SRM), significance of change, and responsiveness statistic). RESULTS The four tests of responsiveness demonstrated that the HSS was more responsive to changes in the patient's health status following both of the interventions compared to the Vaizey questionnaire. For example, between baseline and 6 weeks, the RBL intervention effect size scores and SRM calculations indicated a non-significant small amount of change (0.20 and 0.16 respectively). However, using the HSS, the effect size and SRM demonstrated a large magnitude of change (1.12 and 1.01, respectively) which was significant. Similar results were observed at 1 year. Significance of change scores and the index of responsiveness were also higher for the HSS questionnaire than the Vaizey across both treatment modalities. CONCLUSIONS The HSS is a highly responsive tool for the detection of changes in haemorrhoid symptoms. It should form an essential patient-reported outcome tool for future studies on haemorrhoidal disease.
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Affiliation(s)
- M J Lee
- Department of Surgery, Sheffield Teaching Hospitals, Northern General Hospital, Sheffield, UK
| | - J Morgan
- Department of Psychology, School of Social Sciences, Leeds Beckett University, Leeds, UK
| | - A J M Watson
- Department of Colorectal Surgery, Raigmore Hospital, Inverness, UK
| | - G L Jones
- Department of Psychology, School of Social Sciences, Leeds Beckett University, Leeds, UK
| | - S R Brown
- Department of Surgery, Sheffield Teaching Hospitals, Northern General Hospital, Sheffield, UK.
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Abstract
Machine learning (ML) is a burgeoning field of medicine with huge resources being applied to fuse computer science and statistics to medical problems. Proponents of ML extol its ability to deal with large, complex and disparate data, often found within medicine and feel that ML is the future for biomedical research, personalized medicine, computer-aided diagnosis to significantly advance global health care. However, the concepts of ML are unfamiliar to many medical professionals and there is untapped potential in the use of ML as a research tool. In this article, we provide an overview of the theory behind ML, explore the common ML algorithms used in medicine including their pitfalls and discuss the potential future of ML in medicine.
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Affiliation(s)
| | - H K Kok
- Interventional Radiology Service, Northern Hospital Radiology, Epping, Vic, Australia
| | - R V Chandra
- Interventional Neuroradiology Service, Monash Imaging, Monash Health, Clayton, Vic, Australia.,Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Vic, Australia
| | - A H Razavi
- School of Information Technology and Engineering, University of Ottawa, Ottawa, ON, Canada.,BCE Corporate Security, Ottawa, ON, Canada
| | - M J Lee
- Department of Radiology, Beaumont Hospital and Royal College of Surgeons in Ireland, Dublin, Ireland
| | - H Asadi
- Interventional Neuroradiology Service, Monash Imaging, Monash Health, Clayton, Vic, Australia.,Department of Radiology, Interventional Neuroradiology Service, Austin Health, Heidelberg, Vic, Australia.,School of Medicine, Faculty of Health, Deakin University, Waurn Ponds, Vic, Australia
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Sayers AE, Lee MJ, Smart N, Fearnhead NS. Optimizing collaborator recruitment and maintaining engagement via social media during large multicentre studies: lessons learned from the National Audit of Small Bowel Obstruction (NASBO). Colorectal Dis 2018; 20:1142-1150. [PMID: 30171749 DOI: 10.1111/codi.14394] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 07/02/2018] [Indexed: 02/01/2023]
Abstract
AIM The National Audit of Small Bowel Obstruction was a UK-wide study active in early 2017. A Twitter© account was used to interact with collaborators and the public throughout the study to assess whether the use of social media improved study engagement and to establish which Tweet signature styles achieved the highest levels of reach and engagement. METHOD Twitter© analytics for @NASBO2017 covering June 2016-May 2017 were reviewed. The number of impressions, Tweet engagements and the engagement rate were analysed according to study stage. RESULTS A total of 176 Tweets were made over the study period. The median number of impressions achieved by a Tweet was 533 (75-2709). 3863 engagements were made with National Audit of Small Bowel Obstruction Tweets with a median number of 10 (0-159) per Tweet. The average overall Tweet engagement rate was 3.3% (0%-14.2%). Tweets with most impressions either used images or tagged institutions (e.g. Royal Colleges, professional bodies). The number of impressions and engagement with the Tweets increased over the study period, due to the incremental growth of the National Audit of Small Bowel Obstruction Twitter© account and the identification of successful Tweet styles. CONCLUSIONS Social media provided a major contribution to a successful concerted policy of maintaining collaborator engagement during the National Audit of Small Bowel Obstruction. The use of images and videos and tagging of relevant professional bodies aided the reach and engagement of each Tweet. These data can be used to inform engagement strategies for future collaborative projects.
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Affiliation(s)
- A E Sayers
- Doncaster and Bassetlaw, Teaching Hospitals NHS Foundation Trust, Doncaster, UK
| | - M J Lee
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.,University of Sheffield, Sheffield, UK
| | - N Smart
- Royal Devon and Exeter NHS Foundation Trust, Doncaster, UK
| | - N S Fearnhead
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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Chapman SJ, Thorpe G, Vallance AE, Harji DP, Lee MJ, Fearnhead NS. Systematic review of definitions and outcome measures for return of bowel function after gastrointestinal surgery. BJS Open 2018; 3:1-10. [PMID: 30734010 PMCID: PMC6354191 DOI: 10.1002/bjs5.102] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [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: 06/27/2018] [Accepted: 08/06/2018] [Indexed: 12/11/2022] Open
Abstract
Background Ileus is common after gastrointestinal surgery and has been identified as a research priority. Several issues have limited previous research, including a widely accepted definition and agreed outcome measure. This review is the first stage in the development of a core outcome set for the return of bowel function after gastrointestinal surgery. It aims to characterize the extent of variation in current outcome reporting. Methods A systematic search of MEDLINE, Embase, CINAHL (Cumulative Index to Nursing and Allied Health Literature) and the Cochrane Library was performed for 1990–2017. RCTs of adults undergoing gastrointestinal surgery, including at least one reported measure relating to return of bowel function, were eligible. Trial registries were searched across the same period for ongoing and completed (but not published) RCTs. Definitions of ileus and outcome measures describing the return of bowel function were extracted. Results Of 5670 manuscripts screened, 215 (reporting 217 RCTs) were eligible. Most RCTs involved patients undergoing colorectal surgery (161 of 217, 74·2 per cent). A total of 784 outcomes were identified across all published RCTs, comprising 73 measures (clinical: 63, 86 per cent; radiological: 6, 8 per cent; physiological: 4, 5 per cent). The most commonly reported outcome measure was ‘time to first passage of flatus’ (140 of 217, 64·5 per cent). The outcomes ‘ileus’ and ‘prolonged ileus’ were defined infrequently and variably. Conclusion Outcome reporting for the return of bowel function after gastrointestinal surgery is variable and not fit for purpose. An agreed core outcome set will improve the consistency, reliability and clinical value of future studies.
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Affiliation(s)
- S J Chapman
- Leeds Institute of Biomedical and Clinical Sciences University of Leeds Leeds UK
| | - G Thorpe
- Faculty of Medicine and Health Sciences University of East Anglia Norwich UK
| | | | - D P Harji
- Newcastle Centre for Bowel Disease, Royal Victoria Infirmary Newcastle upon Tyne UK
| | - M J Lee
- Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust Sheffield UK
| | - N S Fearnhead
- Department of Colorectal Surgery Cambridge University Hospitals NHS Foundation Trust Cambridge UK
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Román LS, Menon BK, Blasco J, Hernández-Pérez M, Dávalos A, Majoie CBLM, Campbell BCV, Guillemin F, Lingsma H, Anxionnat R, Epstein J, Saver JL, Marquering H, Wong JH, Lopes D, Reimann G, Desal H, Dippel DWJ, Coutts S, du Mesnil de Rochemont R, Yavagal D, Ferre JC, Roos YBWEM, Liebeskind DS, Lenthall R, Molina C, Al Ajlan FS, Reddy V, Dowlatshahi D, Sourour NA, Oppenheim C, Mitha AP, Davis SM, Weimar C, van Oostenbrugge RJ, Cobo E, Kleinig TJ, Donnan GA, van der Lugt A, Demchuk AM, Berkhemer OA, Boers AMM, Ford GA, Muir KW, Brown BS, Jovin T, van Zwam WH, Mitchell PJ, Hill MD, White P, Bracard S, Goyal M, Berkhemer OA, Fransen PSS, Beumer D, van den Berg LA, Lingsma HF, Yoo AJ, Schonewille WJ, Vos JA, Nederkoorn PJ, Wermer MJH, van Walderveen MAA, Staals J, Hofmeijer J, van Oostayen JA, Lycklama à Nijeholt GJ, Boiten J, Brouwer PA, Emmer BJ, de Bruijn SF, van Dijk LC, Kappelle J, Lo RH, van Dijk EJ, de Vries J, de Kort PL, van Rooij WJJ, van den Berg JS, van Hasselt BA, Aerden LA, Dallinga RJ, Visser MC, Bot JC, Vroomen PC, Eshghi O, Schreuder TH, Heijboer RJ, Keizer K, Tielbeek AV, den Hertog HM, Gerrits DG, van den Berg-Vos RM, Karas GB, Steyerberg EW, Flach Z, Marquering HA, Sprengers ME, Jenniskens SF, Beenen LF, Zech M, Kowarik M, Seifert C, Schwaiger B, Puri A, Hou S, Wakhloo A, Moonis M, Henniger N, Goddeau R, van den Berg R, Massari F, Minaeian A, Lozano JD, Ramzan M, Stout C, Patel A, Tunguturi A, Onteddu S, Carandang R, Howk M, Koudstaal PJ, Ribó M, Sanjuan E, Rubiera M, Pagola J, Flores A, Muchada M, Meler P, Huerga E, Gelabert S, Coscojuela P, van Zwam WH, Tomasello A, Rodriguez D, Santamarina E, Maisterra O, Boned S, Seró L, Rovira A, Molina CA, Millán M, Muñoz L, Roos YB, Pérez de la Ossa N, Gomis M, Dorado L, López-Cancio E, Palomeras E, Munuera J, García Bermejo P, Remollo S, Castaño C, García-Sort R, van der Lugt A, Cuadras P, Puyalto P, Hernández-Pérez M, Jiménez M, Martínez-Piñeiro A, Lucente G, Dávalos A, Chamorro A, Urra X, Obach V, van Oostenbrugge RJ, Cervera A, Amaro S, Llull L, Codas J, Balasa M, Navarro J, Ariño H, Aceituno A, Rudilosso S, Renu A, Majoie CB, Macho JM, San Roman L, Blasco J, López A, Macías N, Cardona P, Quesada H, Rubio F, Cano L, Lara B, Dippel DW, de Miquel MA, Aja L, Serena J, Cobo E, Albers GW, Lees KR, Arenillas J, Roberts R, Minhas P, Al-Ajlan F, Brown MM, Salluzzi M, Zimmel L, Patel S, Eesa M, Martí-Fàbregas J, Jankowitz B, Serena J, Salvat-Plana M, López-Cancio E, Bracard S, Liebig T, Ducrocq X, Anxionnat R, Baillot PA, Barbier C, Derelle AL, Lacour JC, Richard S, Samson Y, Sourour N, Baronnet-Chauvet F, Stijnen T, Clarencon F, Crozier S, Deltour S, Di Maria F, Le Bouc R, Leger A, Mutlu G, Rosso C, Szatmary Z, Yger M, Andersson T, Zavanone C, Bakchine S, Pierot L, Caucheteux N, Estrade L, Kadziolka K, Leautaud A, Renkes C, Serre I, Desal H, Mattle H, Guillon B, Boutoleau-Bretonniere C, Daumas-Duport B, De Gaalon S, Derkinderen P, Evain S, Herisson F, Laplaud DA, Lebouvier T, Lintia-Gaultier A, Wahlgren N, Pouclet-Courtemanche H, Rouaud T, Rouaud Jaffrenou V, Schunck A, Sevin-Allouet M, Toulgoat F, Wiertlewski S, Gauvrit JY, Ronziere T, Cahagne V, van der Heijden E, Ferre JC, Pinel JF, Raoult H, Mas JL, Meder JF, Al Najjar-Carpentier AA, Birchenall J, Bodiguel E, Calvet D, Domigo V, Ghannouti N, Godon-Hardy S, Guiraud V, Lamy C, Majhadi L, Morin L, Naggara O, Trystram D, Turc G, Berge J, Sibon I, Fleitour N, Menegon P, Barreau X, Rouanet F, Debruxelles S, Kazadi A, Renou P, Fleury O, Pasco-Papon A, Dubas F, Caroff J, Hooijenga I, Godard Ducceschi S, Hamon MA, Lecluse A, Marc G, Giroud M, Ricolfi F, Bejot Y, Chavent A, Gentil A, Kazemi A, Puppels C, Osseby GV, Voguet C, Mahagne MH, Sedat J, Chau Y, Suissa L, Lachaud S, Houdart E, Stapf C, Buffon Porcher F, Pellikaan W, Chabriat H, Guedin P, Herve D, Jouvent E, Mawet J, Saint-Maurice JP, Schneble HM, Turjman F, Nighoghossian N, Berhoune NN, Geerling A, Bouhour F, Cho TH, Derex L, Felix S, Gervais-Bernard H, Gory B, Manera L, Mechtouff L, Ritzenthaler T, Riva R, Lindl-Velema A, Salaris Silvio F, Tilikete C, Blanc R, Obadia M, Bartolini MB, Gueguen A, Piotin M, Pistocchi S, Redjem H, Drouineau J, van Vemde G, Neau JP, Godeneche G, Lamy M, Marsac E, Velasco S, Clavelou P, Chabert E, Bourgois N, Cornut-Chauvinc C, Ferrier A, de Ridder A, Gabrillargues J, Jean B, Marques AR, Vitello N, Detante O, Barbieux M, Boubagra K, Favre Wiki I, Garambois K, Tahon F, Greebe P, Ashok V, Voguet C, Coskun O, Guedin P, Rodesch G, Lapergue B, Bourdain F, Evrard S, Graveleau P, Decroix JP, de Bont-Stikkelbroeck J, Wang A, Sellal F, Ahle G, Carelli G, Dugay MH, Gaultier C, Lebedinsky AP, Lita L, Musacchio RM, Renglewicz-Destuynder C, de Meris J, Tournade A, Vuillemet F, Montoro FM, Mounayer C, Faugeras F, Gimenez L, Labach C, Lautrette G, Denier C, Saliou G, Janssen K, Chassin O, Dussaule C, Melki E, Ozanne A, Puccinelli F, Sachet M, Sarov M, Bonneville JF, Moulin T, Biondi A, Struijk W, De Bustos Medeiros E, Vuillier F, Courtheoux P, Viader F, Apoil-Brissard M, Bataille M, Bonnet AL, Cogez J, Kazemi A, Touze E, Licher S, Leclerc X, Leys D, Aggour M, Aguettaz P, Bodenant M, Cordonnier C, Deplanque D, Girot M, Henon H, Kalsoum E, Boodt N, Lucas C, Pruvo JP, Zuniga P, Bonafé A, Arquizan C, Costalat V, Machi P, Mourand I, Riquelme C, Bounolleau P, Ros A, Arteaga C, Faivre A, Bintner M, Tournebize P, Charlin C, Darcel F, Gauthier-Lasalarie P, Jeremenko M, Mouton S, Zerlauth JB, Venema E, Lamy C, Hervé D, Hassan H, Gaston A, Barral FG, Garnier P, Beaujeux R, Wolff V, Herbreteau D, Debiais S, Slokkers I, Murray A, Ford G, Muir KW, White P, Brown MM, Clifton A, Freeman J, Ford I, Markus H, Wardlaw J, Ganpat RJ, Lees KR, Molyneux A, Robinson T, Lewis S, Norrie J, Robertson F, Perry R, Dixit A, Cloud G, Clifton A, Mulder M, Madigan J, Roffe C, Nayak S, Lobotesis K, Smith C, Herwadkar A, Kandasamy N, Goddard T, Bamford J, Subramanian G, Saiedie N, Lenthall R, Littleton E, Lamin S, Storey K, Ghatala R, Banaras A, Aeron-Thomas J, Hazel B, Maguire H, Veraque E, Heshmatollah A, Harrison L, Keshvara R, Cunningham J, Schipperen S, Vinken S, van Boxtel T, Koets J, Boers M, Santos E, Borst J, Jansen I, Kappelhof M, Lucas M, Geuskens R, Barros RS, Dobbe R, Csizmadia M, Hill MD, Goyal M, Demchuk AM, Menon BK, Eesa M, Ryckborst KJ, Wright MR, Kamal NR, Andersen L, Randhawa PA, Stewart T, Patil S, Minhas P, Almekhlafi M, Mishra S, Clement F, Sajobi T, Shuaib A, Montanera WJ, Roy D, Silver FL, Jovin TG, Frei DF, Sapkota B, Rempel JL, Thornton J, Williams D, Tampieri D, Poppe AY, Dowlatshahi D, Wong JH, Mitha AP, Subramaniam S, Hull G, Lowerison MW, Sajobi T, Salluzzi M, Wright MR, Maxwell M, Lacusta S, Drupals E, Armitage K, Barber PA, Smith EE, Morrish WF, Coutts SB, Derdeyn C, Demaerschalk B, Yavagal D, Martin R, Brant R, Yu Y, Willinsky RA, Montanera WJ, Weill A, Kenney C, Aram H, Stewart T, Stys PK, Watson TW, Klein G, Pearson D, Couillard P, Trivedi A, Singh D, Klourfeld E, Imoukhuede O, Nikneshan D, Blayney S, Reddy R, Choi P, Horton M, Musuka T, Dubuc V, Field TS, Desai J, Adatia S, Alseraya A, Nambiar V, van Dijk R, Wong JH, Mitha AP, Morrish WF, Eesa M, Newcommon NJ, Shuaib A, Schwindt B, Butcher KS, Jeerakathil T, Buck B, Khan K, Naik SS, Emery DJ, Owen RJ, Kotylak TB, Ashforth RA, Yeo TA, McNally D, Siddiqui M, Saqqur M, Hussain D, Kalashyan H, Manosalva A, Kate M, Gioia L, Hasan S, Mohammad A, Muratoglu M, Williams D, Thornton J, Cullen A, Brennan P, O'Hare A, Looby S, Hyland D, Duff S, McCusker M, Hallinan B, Lee S, McCormack J, Moore A, O'Connor M, Donegan C, Brewer L, Martin A, Murphy S, O'Rourke K, Smyth S, Kelly P, Lynch T, Daly T, O'Brien P, O'Driscoll A, Martin M, Daly T, Collins R, Coughlan T, McCabe D, Murphy S, O'Neill D, Mulroy M, Lynch O, Walsh T, O'Donnell M, Galvin T, Harbison J, McElwaine P, Mulpeter K, McLoughlin C, Reardon M, Harkin E, Dolan E, Watts M, Cunningham N, Fallon C, Gallagher S, Cotter P, Crowe M, Doyle R, Noone I, Lapierre M, Coté VA, Lanthier S, Odier C, Durocher A, Raymond J, Weill A, Daneault N, Deschaintre Y, Jankowitz B, Baxendell L, Massaro L, Jackson-Graves C, Decesare S, Porter P, Armbruster K, Adams A, Billigan J, Oakley J, Ducruet A, Jadhav A, Giurgiutiu DV, Aghaebrahim A, Reddy V, Hammer M, Starr M, Totoraitis V, Wechsler L, Streib S, Rangaraju S, Campbell D, Rocha M, Gulati D, Silver FL, Krings T, Kalman L, Cayley A, Williams J, Stewart T, Wiegner R, Casaubon LK, Jaigobin C, del Campo JM, Elamin E, Schaafsma JD, Willinsky RA, Agid R, Farb R, ter Brugge K, Sapkoda BL, Baxter BW, Barton K, Knox A, Porter A, Sirelkhatim A, Devlin T, Dellinger C, Pitiyanuvath N, Patterson J, Nichols J, Quarfordt S, Calvert J, Hawk H, Fanale C, Frei DF, Bitner A, Novak A, Huddle D, Bellon R, Loy D, Wagner J, Chang I, Lampe E, Spencer B, Pratt R, Bartt R, Shine S, Dooley G, Nguyen T, Whaley M, McCarthy K, Teitelbaum J, Tampieri D, Poon W, Campbell N, Cortes M, Dowlatshahi D, Lum C, Shamloul R, Robert S, Stotts G, Shamy M, Steffenhagen N, Blacquiere D, Hogan M, AlHazzaa M, Basir G, Lesiuk H, Iancu D, Santos M, Choe H, Weisman DC, Jonczak K, Blue-Schaller A, Shah Q, MacKenzie L, Klein B, Kulandaivel K, Kozak O, Gzesh DJ, Harris LJ, Khoury JS, Mandzia J, Pelz D, Crann S, Fleming L, Hesser K, Beauchamp B, Amato-Marzialli B, Boulton M, Lopez-Ojeda P, Sharma M, Lownie S, Chan R, Swartz R, Howard P, Golob D, Gladstone D, Boyle K, Boulos M, Hopyan J, Yang V, Da Costa L, Holmstedt CA, Turk AS, Navarro R, Jauch E, Ozark S, Turner R, Phillips S, Shankar J, Jarrett J, Gubitz G, Maloney W, Vandorpe R, Schmidt M, Heidenreich J, Hunter G, Kelly M, Whelan R, Peeling L, Burns PA, Hunter A, Wiggam I, Kerr E, Watt M, Fulton A, Gordon P, Rennie I, Flynn P, Smyth G, O'Leary S, Gentile N, Linares G, McNelis P, Erkmen K, Katz P, Azizi A, Weaver M, Jungreis C, Faro S, Shah P, Reimer H, Kalugdan V, Saposnik G, Bharatha A, Li Y, Kostyrko P, Santos M, Marotta T, Montanera W, Sarma D, Selchen D, Spears J, Heo JH, Jeong K, Kim DJ, Kim BM, Kim YD, Song D, Lee KJ, Yoo J, Bang OY, Rho S, Lee J, Jeon P, Kim KH, Cha J, Kim SJ, Ryoo S, Lee MJ, Sohn SI, Kim CH, Ryu HG, Hong JH, Chang HW, Lee CY, Rha J, Davis SM, Donnan GA, Campbell BCV, Mitchell PJ, Churilov L, Yan B, Dowling R, Yassi N, Oxley TJ, Wu TY, Silver G, McDonald A, McCoy R, Kleinig TJ, Scroop R, Dewey HM, Simpson M, Brooks M, Coulton B, Krause M, Harrington TJ, Steinfort B, Faulder K, Priglinger M, Day S, Phan T, Chong W, Holt M, Chandra RV, Ma H, Young D, Wong K, Wijeratne T, Tu H, Mackay E, Celestino S, Bladin CF, Loh PS, Gilligan A, Ross Z, Coote S, Frost T, Parsons MW, Miteff F, Levi CR, Ang T, Spratt N, Kaauwai L, Badve M, Rice H, de Villiers L, Barber PA, McGuinness B, Hope A, Moriarty M, Bennett P, Wong A, Coulthard A, Lee A, Jannes J, Field D, Sharma G, Salinas S, Cowley E, Snow B, Kolbe J, Stark R, King J, Macdonnell R, Attia J, D'Este C, Saver JL, Goyal M, Diener HC, Levy EI, Bonafé A, Mendes Pereira V, Jahan R, Albers GW, Cognard C, Cohen DJ, Hacke W, Jansen O, Jovin TG, Mattle HP, Nogueira RG, Siddiqui AH, Yavagal DR, von Kummer R, Smith W, Turjman F, Hamilton S, Chiacchierini R, Amar A, Sanossian N, Loh Y, Devlin T, Baxter B, Hawk H, Sapkota B, Quarfordt S, Sirelkhatim A, Dellinger C, Barton K, Reddy VK, Ducruet A, Jadhav A, Horev A, Giurgiutiu DV, Totoraitis V, Hammer M, Jankowitz B, Wechsler L, Rocha M, Gulati D, Campbell D, Star M, Baxendell L, Oakley J, Siddiqui A, Hopkins LN, Snyder K, Sawyer R, Hall S, Costalat V, Riquelme C, Machi P, Omer E, Arquizan C, Mourand I, Charif M, Ayrignac X, Menjot de Champfleur N, Leboucq N, Gascou G, Moynier M, du Mesnil de Rochemont R, Singer O, Berkefeld J, Foerch C, Lorenz M, Pfeilschifer W, Hattingen E, Wagner M, You SJ, Lescher S, Braun H, Dehkharghani S, Belagaje SR, Anderson A, Lima A, Obideen M, Haussen D, Dharia R, Frankel M, Patel V, Owada K, Saad A, Amerson L, Horn C, Doppelheuer S, Schindler K, Lopes DK, Chen M, Moftakhar R, Anton C, Smreczak M, Carpenter JS, Boo S, Rai A, Roberts T, Tarabishy A, Gutmann L, Brooks C, Brick J, Domico J, Reimann G, Hinrichs K, Becker M, Heiss E, Selle C, Witteler A, Al-Boutros S, Danch MJ, Ranft A, Rohde S, Burg K, Weimar C, Zegarac V, Hartmann C, Schlamann M, Göricke S, Ringlestein A, Wanke I, Mönninghoff C, Dietzold M, Budzik R, Davis T, Eubank G, Hicks WJ, Pema P, Vora N, Mejilla J, Taylor M, Clark W, Rontal A, Fields J, Peterson B, Nesbit G, Lutsep H, Bozorgchami H, Priest R, Ologuntoye O, Barnwell S, Dogan A, Herrick K, Takahasi C, Beadell N, Brown B, Jamieson S, Hussain MS, Russman A, Hui F, Wisco D, Uchino K, Khawaja Z, Katzan I, Toth G, Cheng-Ching E, Bain M, Man S, Farrag A, George P, John S, Shankar L, Drofa A, Dahlgren R, Bauer A, Itreat A, Taqui A, Cerejo R, Richmond A, Ringleb P, Bendszus M, Möhlenbruch M, Reiff T, Amiri H, Purrucker J, Herweh C, Pham M, Menn O, Ludwig I, Acosta I, Villar C, Morgan W, Sombutmai C, Hellinger F, Allen E, Bellew M, Gandhi R, Bonwit E, Aly J, Ecker RD, Seder D, Morris J, Skaletsky M, Belden J, Baker C, Connolly LS, Papanagiotou P, Roth C, Kastrup A, Politi M, Brunner F, Alexandrou M, Merdivan H, Ramsey C, Given II C, Renfrow S, Deshmukh V, Sasadeusz K, Vincent F, Thiesing JT, Putnam J, Bhatt A, Kansara A, Caceves D, Lowenkopf T, Yanase L, Zurasky J, Dancer S, Freeman B, Scheibe-Mirek T, Robison J, Rontal A, Roll J, Clark D, Rodriguez M, Fitzsimmons BFM, Zaidat O, Lynch JR, Lazzaro M, Larson T, Padmore L, Das E, Farrow-Schmidt A, Hassan A, Tekle W, Cate C, Jansen O, Cnyrim C, Wodarg F, Wiese C, Binder A, Riedel C, Rohr A, Lang N, Laufs H, Krieter S, Remonda L, Diepers M, Añon J, Nedeltchev K, Kahles T, Biethahn S, Lindner M, Chang V, Gächter C, Esperon C, Guglielmetti M, Arenillas Lara JF, Martínez Galdámez M, Calleja Sanz AI, Cortijo Garcia E, Garcia Bermejo P, Perez S, Mulero Carrillo P, Crespo Vallejo E, Ruiz Piñero M, Lopez Mesonero L, Reyes Muñoz FJ, Brekenfeld C, Buhk JH, Krützelmann A, Thomalla G, Cheng B, Beck C, Hoppe J, Goebell E, Holst B, Grzyska U, Wortmann G, Starkman S, Duckwiler G, Jahan R, Rao N, Sheth S, Ng K, Noorian A, Szeder V, Nour M, McManus M, Huang J, Tarpley J, Tateshima S, Gonzalez N, Ali L, Liebeskind D, Hinman J, Calderon-Arnulphi M, Liang C, Guzy J, Koch S, DeSousa K, Gordon-Perue G, Haussen D, Elhammady M, Peterson E, Pandey V, Dharmadhikari S, Khandelwal P, Malik A, Pafford R, Gonzalez P, Ramdas K, Andersen G, Damgaard D, Von Weitzel-Mudersbach P, Simonsen C, Ruiz de Morales Ayudarte N, Poulsen M, Sørensen L, Karabegovich S, Hjørringgaard M, Hjort N, Harbo T, Sørensen K, Deshaies E, Padalino D, Swarnkar A, Latorre JG, Elnour E, El-Zammar Z, Villwock M, Farid H, Balgude A, Cross L, Hansen K, Holtmannspötter M, Kondziella D, Hoejgaard J, Taudorf S, Soendergaard H, Wagner A, Cronquist M, Stavngaard T, Cortsen M, Krarup LH, Hyldal T, Haring HP, Guggenberger S, Hamberger M, Trenkler J, Sonnberger M, Nussbaumer K, Dominger C, Bach E, Jagadeesan BD, Taylor R, Kim J, Shea K, Tummala R, Zacharatos H, Sandhu D, Ezzeddine M, Grande A, Hildebrandt D, Miller K, Scherber J, Hendrickson A, Jumaa M, Zaidi S, Hendrickson T, Snyder V, Killer-Oberpfalzer M, Mutzenbach J, Weymayr F, Broussalis E, Stadler K, Jedlitschka A, Malek A, Mueller-Kronast N, Beck P, Martin C, Summers D, Day J, Bettinger I, Holloway W, Olds K, Arkin S, Akhtar N, Boutwell C, Crandall S, Schwartzman M, Weinstein C, Brion B, Prothmann S, Kleine J, Kreiser K, Boeckh-Behrens T, Poppert H, Wunderlich S, Koch ML, Biberacher V, Huberle A, Gora-Stahlberg G, Knier B, Meindl T, Utpadel-Fischler D. Imaging features and safety and efficacy of endovascular stroke treatment: a meta-analysis of individual patient-level data. Lancet Neurol 2018; 17:895-904. [DOI: 10.1016/s1474-4422(18)30242-4] [Citation(s) in RCA: 213] [Impact Index Per Article: 35.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 06/11/2018] [Accepted: 06/12/2018] [Indexed: 11/29/2022]
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Worley GHT, Fearnhead NS, Brown SR, Acheson AG, Lee MJ, Faiz OD. Review of current practice and outcomes following ileoanal pouch surgery: lessons learned from the Ileoanal Pouch Registry and the 2017 Ileoanal Pouch Report. Colorectal Dis 2018; 20:913-922. [PMID: 29927537 DOI: 10.1111/codi.14316] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 04/16/2018] [Indexed: 12/13/2022]
Abstract
AIM The second Association of Coloproctology of Great Britain and Ireland (ACPGBI) Ileoanal Pouch Registry (IPR) report was released in July 2017 following a first report in 2012. This article provides a summary of data derived from the most recent IPR report (2017 Ileoanal Pouch Report. https://www.acpgbi.org.uk/content/uploads/2016/07/Ileoanal-Pouch-Report-2017-FINAL.compressed.pdf). METHOD The IPR is an electronic database of voluntarily submitted data including patient demographics, disease, intra-operative and postoperative factors submitted by consultant surgeons or delegates. Data up to 31 March 2017 have been analysed for this report. RESULTS A total of 5352 pouch operations were carried out at 76 UK and four European centres by 154 surgeons over four decades. Recorded procedures have increased over time but data submission is voluntary and underestimates actual volume. Significant variation exists in institutional volume; 73 centres entered data on patients undergoing pouch surgery during the past 5 years. Of these, 44 centres have submitted ≤ 10 cases, with 10 centres submitting one patient and nine centres two cases. Since 2013, minimal access surgery has been employed in 54% of cases. Rectal dissection was undertaken in the total mesorectal excision plane in 69%. J-pouch configuration was used in 99% of cases and 90% of pouch-anal anastomoses were performed using a stapled technique. Including all years, the IPR rate of pelvic sepsis was 9.4% and the rate of pouch failure was 4.7%. CONCLUSION The IPR holds the largest voluntary repository of data on ileoanal pouch surgery. The second report from the IPR records marked refinements in surgical technique over time but also highlights wide variation in institutional caseload and outcome across the UK.
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Affiliation(s)
- G H T Worley
- St Mark's Hospital and Academic Institute, London North West University Healthcare NHS Trust, London, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - N S Fearnhead
- Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- ACPGBI Inflammatory Bowel Disease Clinical Advisory Group, UK
| | - S R Brown
- ACPGBI Inflammatory Bowel Disease Clinical Advisory Group, UK
- Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - A G Acheson
- National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK
| | - M J Lee
- Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - O D Faiz
- St Mark's Hospital and Academic Institute, London North West University Healthcare NHS Trust, London, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
- ACPGBI Inflammatory Bowel Disease Clinical Advisory Group, UK
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Malik TAM, Lee MJ, Harikrishnan AB. The incidence of stoma related morbidity - a systematic review of randomised controlled trials. Ann R Coll Surg Engl 2018; 100:501-508. [PMID: 30112948 PMCID: PMC6214073 DOI: 10.1308/rcsann.2018.0126] [Citation(s) in RCA: 104] [Impact Index Per Article: 17.3] [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: 04/30/2018] [Indexed: 12/11/2022] Open
Abstract
Introduction Several stoma related complications can occur following ileostomy or colostomy formation. The reported incidence of these conditions varies widely in the literature. A systematic review of randomised controlled trials reporting the incidence of stoma related complications in adults was performed to provide the most comprehensive summary of existing data. Methods PubMed, CINAHL® (Cumulative Index to Nursing and Allied Health Literature) and the Cochrane Library were searched for trials assessing the incidence of complications in adults undergoing conventional stoma formation. Data were extracted by two independent reviewers and entered into SPSS® for statistical analysis. The Cochrane Collaboration tool for assessing risk of bias was used to critically appraise each study. Cochran's Q statistic and the I2 statistic were used to measure the level of heterogeneity between studies. Results Overall, 18 trials were included, involving 1,009 patients. The incidence of stoma related complications ranged from 2.9% to 81.1%. Peristomal skin complications and parastomal hernia were the most common complications. End colostomy had the highest incidence of morbidity, followed by loop colostomy and loop ileostomy. There were no trials involving patients with end ileostomy. There was a high level of detection bias and heterogeneity between studies. Conclusions This systematic review has summarised the best available evidence concerning the incidence of stoma related morbidity. The high level of heterogeneity between studies has limited the accuracy with which the true incidence of each stoma related complication can be reported. Large, multicentre trials investigating homogenous participant populations are therefore required.
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Affiliation(s)
| | - MJ Lee
- University of Sheffield, UK
- Sheffield Teaching Hospitals NHS Foundation Trust, UK
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Lee MJ, Freer C, Adegbola S, Elkady S, Parkes M, Hart A, Fearnhead NS, Lobo AJ, Brown SR. Patients with perianal Crohn's fistulas experience delays in accessing anti-TNF therapy due to slow recognition, diagnosis and integration of specialist services: lessons learned from three referral centres. Colorectal Dis 2018; 20:797-803. [PMID: 29569419 DOI: 10.1111/codi.14102] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 03/01/2018] [Indexed: 12/30/2022]
Abstract
AIM Crohn's anal fistula should be managed by a multidisciplinary team. There is no clearly defined 'patient pathway' from presentation to treatment. The aim of this study was to describe the patient route from presentation with symptomatic Crohn's anal fistula to starting anti-tumour necrosis factor (anti-TNF) therapy. METHOD Case note review was undertaken at three hospitals with established inflammatory bowel disease services. Patients with Crohn's anal fistula presenting between 2010 and 2015 were identified through clinical coding and local databases. Baseline demographics were captured. Patient records were interrogated to identify route of access, and clinical contacts during the patient pathway. RESULTS Seventy-nine patients were included in the study, of whom 54 (68%) had an established diagnosis of Crohn's disease (CD). Median time from presentation to anti-TNF therapy was 204 days (174 vs 365 days for existing and new diagnosis of CD, respectively; P = 0.019). The mean number of surgical outpatient attendances, operations and MRI scans per patient was 1.03, 1.71 and 1.03, respectively. Patients attended a mean of 1.49 medical clinics. Seton insertion was the most common procedure, accounting for 48.6% of all operations. Where care episodes ('clinical events per 30 days') were infrequent this correlated with prolongation of the pathway (r = -0.87; P < 0.01). CONCLUSION This study highlights two key challenges in the treatment pathway: (i) delays in diagnosis of underlying CD in patients with anal fistula and (ii) the pathway to anti-TNF therapy is long, suggesting issues with service design and delivery. These should be addressed to improve patient experience and outcome.
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Affiliation(s)
- M J Lee
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - C Freer
- Addenbrookes Hospital, Cambridge, UK
| | | | - S Elkady
- St Mark's Hospital, Harrow, UK.,University of Alexandria, Alexandria, Egypt
| | - M Parkes
- Addenbrookes Hospital, Cambridge, UK
| | - A Hart
- St Mark's Hospital, Harrow, UK
| | | | - A J Lobo
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - S R Brown
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
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Lee SH, Lee MJ, Lyoo CH, Cho H, Lee MS. Impaired finger dexterity and nigrostriatal dopamine loss in Parkinson's disease. J Neural Transm (Vienna) 2018; 125:1333-1339. [PMID: 29971496 DOI: 10.1007/s00702-018-1901-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 06/29/2018] [Indexed: 11/28/2022]
Abstract
Impaired finger dexterity occurs in Parkinson's disease (PD) and has been considered a limb-kinetic apraxia associated with primary sensory cortical dysfunction. To study the role of nigrostriatal dopamine loss and elementary parkinsonian motor deficits in impaired finger dexterity of PD. Thirty-two right-handed untreated PD patients and 30 right-handed healthy controls were included. All patients underwent [18F] FP-CIT positron emission tomography studies. We examined the associations among unilateral coin rotation (CR) score, Unified Parkinson's Disease Rating Scale (UPDRS) subscores for bradykinesia and rigidity of the corresponding arm, and contralateral regional striatal dopamine transporter (DAT) uptake. We also measured the effect of oral levodopa dose on CR scores and UPDRS subscores. PD patients performed worse than controls on the CR task. Unilateral arm UPDRS bradykinesia scores were associated with DAT uptake in the contralateral putamen. The left CR score was associated with left arm bradykinesia and rigidity scores and DAT uptake in the right posterior putamen, whereas no such associations were found for the right CR score. There was a significant effect of handedness on the association of putamen DAT uptake with CR scores, but not with UPDRS subscores. An oral levodopa challenge improved CR scores and UPDRS subscores on both sides. Impaired finger dexterity in PD is related to elementary parkinsonian motor deficits and nigrostriatal dopamine loss. Impaired dominant hand dexterity associated with nigrostriatal dopamine loss seems to be compensated to some extent by the dominant cerebral cortex specialized for controlling precise finger movements.
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Affiliation(s)
- S H Lee
- Department of Neurology, Gangnam Severance Hospital, Yonsei University College of Medicine, Eonjuro 211, Gangnam-gu, Seoul, South Korea
| | - M J Lee
- Department of Neurology, Pusan National University Hospital, Pusan National University School of Medicine and Biomedical Research Institute, Busan, South Korea
| | - C H Lyoo
- Department of Neurology, Gangnam Severance Hospital, Yonsei University College of Medicine, Eonjuro 211, Gangnam-gu, Seoul, South Korea
| | - H Cho
- Department of Neurology, Gangnam Severance Hospital, Yonsei University College of Medicine, Eonjuro 211, Gangnam-gu, Seoul, South Korea
| | - M S Lee
- Department of Neurology, Gangnam Severance Hospital, Yonsei University College of Medicine, Eonjuro 211, Gangnam-gu, Seoul, South Korea.
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Fearnhead NS, Lee MJ, Acheson AG, Worley G, Faiz OD, Brown SR. Variation in practice of pouch surgery in England - using SWORD data to cut to the chase and justify centralization. Colorectal Dis 2018; 20:597-605. [PMID: 29383826 DOI: 10.1111/codi.14036] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 01/20/2018] [Indexed: 12/14/2022]
Abstract
AIM Increasing scrutiny on both individual and unit outcomes after surgical procedures is now expected. In the field of inflammatory bowel disease, this is particularly pertinent for outcomes after ileoanal pouch surgery. METHOD The Surgical Workload and Outcomes Research Database (SWORD) relies on administrative data derived from Hospital Episode Statistics collected in England. The platform was interrogated for pouch procedures undertaken in England between April 2009 and December 2016 to assess national caseload and, between April 2012 and December 2016, to assess variation in caseload and outcomes after pouch surgery. RESULTS In England there is a suggestion that numbers of pouch procedures may be decreasing. Over 80% of Trusts offering pouch surgery do so at very low volume with less than five procedures per year. There is also a clear phenomenon of the occasional pouch surgeon with 126 surgeons undertaking just one pouch operation during the study period of almost 5 years. Laparoscopic practice varies but 60% of pouches overall were done via an open approach. Mean length of stay was 10.1 days and average 30-day readmission rates were 27.4%. Outside London there appears to be an increasing trend for higher volume units to do more adult pouch procedures and lower volume units to do fewer. CONCLUSION Low volume units and occasional pouch surgeons present a strong argument for centralization of pouch surgery. Data from England outside London suggest that this may already be happening.
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Affiliation(s)
- N S Fearnhead
- Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - M J Lee
- Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - A G Acheson
- Nottingham Biomedical Research Centre, National Institute for Health Research (NIHR), Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK
| | - G Worley
- London North West Healthcare NHS Trust, St Mark's Hospital, Middlesex, UK
| | - O D Faiz
- London North West Healthcare NHS Trust, St Mark's Hospital, Middlesex, UK
| | - S R Brown
- Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
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Lee MJ, Sayers AE, Wilson TR, Acheson AG, Anderson ID, Fearnhead NS. Current management of small bowel obstruction in the UK: results from the National Audit of Small Bowel Obstruction clinical practice survey. Colorectal Dis 2018; 20:623-630. [PMID: 29331086 DOI: 10.1111/codi.14016] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2017] [Accepted: 12/30/2017] [Indexed: 02/08/2023]
Abstract
AIM Small bowel obstruction (SBO) is associated with high rates of morbidity and mortality. The National Audit of Small Bowel Obstruction (NASBO) is a collaboration between trainees and specialty associations to improve the care of patients with SBO through national clinical audit. The aim of this study was to define current consultant practice preferences in the management of SBO in the UK. METHOD A survey was designed to assess practice preferences of consultant surgeons. The anonymous survey captured demographics, indications for surgery or conservative management, use of investigations including water-soluble contrast agents (WSCA), use of laparoscopy and nutritional support strategies. The questionnaire underwent two pilot rounds prior to dissemination via the NASBO network. RESULTS A total of 384 responses were received from 131 NASBO participating units (overall response rate 29.2%). Abdominal CT and serum urea and electrolytes were considered essential initial investigations by more than 80% of consultants. Consensus was demonstrated on indications for early surgery and conservative management. Three hundred and thirty-eight (88%) respondents would consider use of WSCA; of these, 328 (97.1%) would use it in adhesive SBO. Two hundred (52.1%) consultants considered a laparoscopic approach when operating for SBO. Oral nutritional supplements were favoured in operatively managed patients by 259 (67.4%) respondents compared with conservatively managed patients (186 respondents, 48.4%). CONCLUSION This survey demonstrates consensus on imaging requirements and indications for early surgery in the management of SBO. Significant variation exists around awareness of the need for nutritional support in patients with SBO, and on strategies to achieve this support.
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Affiliation(s)
- M J Lee
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.,South Yorkshire Surgical Research Group, Sheffield, UK
| | - A E Sayers
- South Yorkshire Surgical Research Group, Sheffield, UK.,Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust, Doncaster, UK
| | - T R Wilson
- Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust, Doncaster, UK
| | - A G Acheson
- Nottingham University Hospitals NHS Foundation Trust, Nottingham, UK
| | | | - N S Fearnhead
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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Marshall JH, Baker DM, Lee MJ, Jones GL, Lobo AJ, Brown SR. The assessment of online health videos for surgery in Crohn's disease. Colorectal Dis 2018; 20:606-613. [PMID: 29427466 DOI: 10.1111/codi.14045] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2017] [Accepted: 01/29/2018] [Indexed: 02/08/2023]
Abstract
AIM YouTube™ is an open-access, nonpeer-reviewed video-hosting site and is used as a source of publicly available healthcare information. This study aimed to assess the thematic content of the most viewed videos relating to surgery and Crohn's disease and to explore the viewer interactions with these videos. METHOD A search of YouTube™ was carried out using one search string. The 50 most viewed videos were identified and categorized by source and content themes and assessed for viewer interactions. Video comments were used to describe the usefulness of the video content to viewers. RESULTS The majority of videos were uploaded by patients (n = 21).The remainder were uploaded by individual healthcare professionals (n = 9), hospital/speciality associations (n = 18) and industry (n = 2). The median number of likes for patient videos was significantly higher than for hospital/speciality association videos (P < 0.001). Patient videos received more comments praising the video content (n = 27) and more comments asking for further information (n = 14). The median number of likes for 'experience of surgery' (P < 0.001) and 'experience of disease' (P = 0.0015) themed videos were significantly higher than for 'disease management' themed videos. CONCLUSION Crohn's disease patients use YouTube™ as a surgical information source. The content of patient-sourced videos focused on surgical and disease experience, suggesting that these themes are important to patients. Current patient developed videos provide limited information, as reflected by viewers requesting further information. Storytelling patient-centred videos combined with clinical evidence may be a good model for future videos.
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Affiliation(s)
- J H Marshall
- University of Sheffield Medical School, Sheffield, UK
| | - D M Baker
- University of Sheffield Medical School, Sheffield, UK
| | - M J Lee
- University of Sheffield Medical School, Sheffield, UK.,Department of General Surgery, Sheffield Teaching Hospitals, Sheffield, UK
| | - G L Jones
- Department of Psychology, Leeds Beckett University, Leeds, UK
| | - A J Lobo
- Department of Gastroenterology, Sheffield Teaching Hospitals, Sheffield, UK
| | - S R Brown
- Department of General Surgery, Sheffield Teaching Hospitals, Sheffield, UK
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Pakianathan M, Whittaker W, Lee MJ, Avery J, Green S, Nathan B, Hegazi A. Chemsex and new HIV diagnosis in gay, bisexual and other men who have sex with men attending sexual health clinics. HIV Med 2018; 19:485-490. [PMID: 29790254 DOI: 10.1111/hiv.12629] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The aim of the study was to analyse associations between chemsex and new HIV and sexually transmitted infection (STI) diagnoses among gay, bisexual and other men who have sex with men (GBMSM) accessing sexual health clinics. METHODS A retrospective case note review was carried out for all GBMSM attending two London sexual health clinics between 1 June 2014 and 31 July 2015. RESULTS Chemsex status was documented for 1734 of 1840 patients. Overall, 27.1% (n = 463) disclosed current recreational drug use, of whom 286 (16.5%) disclosed chemsex participation and 74 of 409 (18.1%) injected drugs. GBMSM who were already HIV positive were more likely to disclose chemsex participation [adjusted odds ratio (AOR) 2.55; 95% confidence interval (CI) 1.89-3.44; P < 0.001]. Those disclosing chemsex participation had higher odds of being newly diagnosed with HIV infection (AOR 5.06; 95% CI 2.56-10.02; P < 0.001), acute bacterial STIs (AOR 3.94; 95% CI 3.00-5.17; P < 0.001), rectal STIs (AOR 4.45; 95% CI 3.37-6.06; P < 0.001) and hepatitis C (AOR 9.16; 95% CI 2.31-36.27; P = 0.002). HIV-negative chemsex participants were also more likely to have accessed post-exposure prophylaxis for HIV in the study period and to report sex with a discordant HIV- or hepatitis C virus-infected partner (P < 0.001). CONCLUSIONS Chemsex disclosure in sexual health settings is associated with higher rates of STI diagnoses, including HIV infection and hepatitis C. GBMSM attending sexual health services should therefore be assessed for chemsex participation and disclosure should prompt health promotion, harm minimization and wellbeing interventions.
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Affiliation(s)
- M Pakianathan
- Wandsworth Integrated Sexual Health, The Courtyard Clinic, St George's University Hospital Foundation Trust, London, UK
| | - W Whittaker
- Centre for Health Economics, University of Manchester, Manchester, UK
| | - M J Lee
- Wandsworth Integrated Sexual Health, The Courtyard Clinic, St George's University Hospital Foundation Trust, London, UK
| | - J Avery
- Wandsworth Integrated Sexual Health, The Courtyard Clinic, St George's University Hospital Foundation Trust, London, UK
| | - S Green
- Department of Sexual Health, The Wolverton Centre, Kingston Hospital NHS Foundation Trust, London, UK
| | - B Nathan
- Department of Sexual Health, The Wolverton Centre, Kingston Hospital NHS Foundation Trust, London, UK
| | - A Hegazi
- Wandsworth Integrated Sexual Health, The Courtyard Clinic, St George's University Hospital Foundation Trust, London, UK
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