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Benedetto U, Sinha S, Mulla A, Glampson B, Davies J, Panoulas V, Gautama S, Papadimitriou D, Woods K, Elliott P, Hemingway H, Williams B, Asselbergs FW, Melikian N, Krasopoulos G, Sayeed R, Wendler O, Baig K, Chukwuemeka A, Angelini GD, Sterne JAC, Johnson T, Shah AM, Perera D, Patel RS, Kharbanda R, Channon KM, Mayet J, Kaura A. Implications of elevated troponin on time-to-surgery in non-ST elevation myocardial infarction (NIHR Health Informatics Collaborative: TROP-CABG study). Int J Cardiol 2022; 362:14-19. [PMID: 35487318 DOI: 10.1016/j.ijcard.2022.04.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 04/18/2022] [Accepted: 04/25/2022] [Indexed: 11/05/2022]
Abstract
Implications of elevated troponin on time-to-surgery in non-ST elevation myocardial infarction(NIHR Health Informatics Collaborative:TROP-CABG study). Benedetto et al. BACKGROUND: The optimal timing of coronary artery bypass grafting (CABG) in patients with non-ST elevation myocardial infarction (NSTEMI) and the utility of pre-operative troponin levels in decision-making remains unclear. We investigated (a) the association between peak pre-operative troponin and survival post-CABG in a large cohort of NSTEMI patients and (b) the interaction between troponin and time-to-surgery. METHODS AND RESULTS: Our cohort consisted of 1746 patients (1684 NSTEMI; 62 unstable angina) (mean age 69 ± 11 years,21% female) with recorded troponins that had CABG at five United Kingdom centers between 2010 and 2017. Time-segmented Cox regression was used to investigate the interaction of peak troponin and time-to-surgery on early (within 30 days) and late (beyond 30 days) survival. Average interval from peak troponin to surgery was 9 ± 15 days, with 1466 (84.0%) patients having CABG during the same admission. Sixty patients died within 30-days and another 211 died after a mean follow-up of 4 ± 2 years (30-day survival 0.97 ± 0.004 and 5-year survival 0.83 ± 0.01). Peak troponin was a strong predictor of early survival (adjusted P = 0.002) with a significant interaction with time-to-surgery (P interaction = 0.007). For peak troponin levels <100 times the upper limit of normal, there was no improvement in early survival with longer time-to-surgery. However, in patients with higher troponins, early survival increased progressively with a longer time-to-surgery, till day 10. Peak troponin did not influence survival beyond 30 days (adjusted P = 0.64). CONCLUSIONS: Peak troponin in NSTEMI patients undergoing CABG was a significant predictor of early mortality, strongly influenced the time-to-surgery and may prove to be a clinically useful biomarker in the management of these patients.
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Affiliation(s)
- Umberto Benedetto
- NIHR Bristol Biomedical Research Centre, University of Bristol and University Hospitals Bristol NHS Foundation Trust, Bristol, UK; University Gabriele D'Annunzio Chieti Pescara, Italy
| | - Shubhra Sinha
- NIHR Bristol Biomedical Research Centre, University of Bristol and University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Abdulrahim Mulla
- NIHR Imperial Biomedical Research Centre, Imperial College London and Imperial College Healthcare NHS Trust, Hammersmith Hospital, London W12 0HS, UK
| | - Benjamin Glampson
- NIHR Imperial Biomedical Research Centre, Imperial College London and Imperial College Healthcare NHS Trust, Hammersmith Hospital, London W12 0HS, UK
| | - Jim Davies
- NIHR Oxford Biomedical Research Centre, University of Oxford and Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Vasileios Panoulas
- NIHR Imperial Biomedical Research Centre, Imperial College London and Imperial College Healthcare NHS Trust, Hammersmith Hospital, London W12 0HS, UK
| | - Sanjay Gautama
- NIHR Imperial Biomedical Research Centre, Imperial College London and Imperial College Healthcare NHS Trust, Hammersmith Hospital, London W12 0HS, UK
| | - Dimitri Papadimitriou
- NIHR Imperial Biomedical Research Centre, Imperial College London and Imperial College Healthcare NHS Trust, Hammersmith Hospital, London W12 0HS, UK
| | - Kerrie Woods
- NIHR Oxford Biomedical Research Centre, University of Oxford and Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Paul Elliott
- NIHR Imperial Biomedical Research Centre, Imperial College London and Imperial College Healthcare NHS Trust, Hammersmith Hospital, London W12 0HS, UK; Health Data Research UK, London, UK
| | - Harry Hemingway
- Health Data Research UK, London, UK; NIHR University College London Biomedical Research Centre, University College London and University College London Hospitals NHS Foundation Trust, London, UK
| | - Bryan Williams
- NIHR University College London Biomedical Research Centre, University College London and University College London Hospitals NHS Foundation Trust, London, UK
| | - Folkert W Asselbergs
- NIHR University College London Biomedical Research Centre, University College London and University College London Hospitals NHS Foundation Trust, London, UK
| | - Narbeh Melikian
- NIHR Guy's and St Thomas' Biomedical Research Centre, King's College London and King's College Hospital NHS Foundation Trust, London, UK
| | - George Krasopoulos
- NIHR Oxford Biomedical Research Centre, University of Oxford and Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Rana Sayeed
- NIHR Oxford Biomedical Research Centre, University of Oxford and Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Olaf Wendler
- NIHR Guy's and St Thomas' Biomedical Research Centre, King's College London and King's College Hospital NHS Foundation Trust, London, UK
| | - Kamran Baig
- NIHR Guy's and St Thomas' Biomedical Research Centre, King's College London and Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK
| | - Andrew Chukwuemeka
- NIHR Imperial Biomedical Research Centre, Imperial College London and Imperial College Healthcare NHS Trust, Hammersmith Hospital, London W12 0HS, UK
| | - Gianni D Angelini
- NIHR Bristol Biomedical Research Centre, University of Bristol and University Hospitals Bristol NHS Foundation Trust, Bristol, UK.
| | - Jonathan A C Sterne
- NIHR Bristol Biomedical Research Centre, University of Bristol and University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Tom Johnson
- NIHR Bristol Biomedical Research Centre, University of Bristol and University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Ajay M Shah
- NIHR Guy's and St Thomas' Biomedical Research Centre, King's College London and King's College Hospital NHS Foundation Trust, London, UK
| | - Divaka Perera
- NIHR Guy's and St Thomas' Biomedical Research Centre, King's College London and Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK
| | - Riyaz S Patel
- NIHR University College London Biomedical Research Centre, University College London and University College London Hospitals NHS Foundation Trust, London, UK
| | - Rajesh Kharbanda
- NIHR Oxford Biomedical Research Centre, University of Oxford and Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Keith M Channon
- NIHR Oxford Biomedical Research Centre, University of Oxford and Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Jamil Mayet
- NIHR Imperial Biomedical Research Centre, Imperial College London and Imperial College Healthcare NHS Trust, Hammersmith Hospital, London W12 0HS, UK
| | - Amit Kaura
- NIHR Imperial Biomedical Research Centre, Imperial College London and Imperial College Healthcare NHS Trust, Hammersmith Hospital, London W12 0HS, UK
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Kaura A, Trickey A, Shah ASV, Benedetto U, Glampson B, Mulla A, Mercuri L, Gautama S, Costelloe CE, Goodman I, Redhead J, Saravanakumar K, Mayer E, Mayet J. Comparing the longer-term effectiveness of a single dose of the Pfizer-BioNTech and Oxford-AstraZeneca COVID-19 vaccines across the age spectrum. EClinicalMedicine 2022; 46:101344. [PMID: 35295900 PMCID: PMC8918854 DOI: 10.1016/j.eclinm.2022.101344] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 02/10/2022] [Accepted: 02/22/2022] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND A single dose strategy may be adequate to confer population level immunity and protection against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, especially in low- and middle-income countries where vaccine supply remains limited. We compared the effectiveness of a single dose strategy of the Oxford-AstraZeneca or Pfizer-BioNTech vaccines against SARS-CoV-2 infection across all age groups and over an extended follow-up period. METHODS Individuals vaccinated in North-West London, UK, with either the first dose of the Oxford-AstraZeneca or Pfizer-BioNTech vaccines between January 12, 2021 and March 09, 2021, were matched to each other by demographic and clinical characteristics. Each vaccinated individual was additionally matched to an unvaccinated control. Study outcomes included SARS-CoV-2 infection of any severity, COVID-19 hospitalisation, COVID-19 death, and all-cause mortality. FINDINGS Amongst matched individuals, 63,608 were in each of the vaccine groups and 127,216 were unvaccinated. Between 14 and 84 days of follow-up after matching, there were 534 SARS-CoV-2 infections, 65 COVID-19 hospitalisations, and 190 deaths, of which 29 were categorized as due to COVID-19. The incidence rate ratio (IRR) for SARS-CoV-2 infection was 0.85 (95% confidence interval [CI], 0.69 to 1.05) for Oxford-Astra-Zeneca, and 0.69 (0.55 to 0.86) for Pfizer-BioNTech. The IRR for both vaccines was the same at 0.25 (0.09 to 0.55) and 0.14 (0.02 to 0.58) for reducing COVID-19 hospitalization and COVID-19 mortality, respectively. The IRR for all-cause mortality was 0.25 (0.15 to 0.39) and 0.18 (0.10 to 0.30) for the Oxford-Astra-Zeneca and Pfizer-BioNTech vaccines, respectively. Age was an effect modifier of the association between vaccination and SARS-CoV-2 infection of any severity; lower hazard ratios for increasing age. INTERPRETATION A single dose strategy, for both vaccines, was effective at reducing COVID-19 mortality and hospitalization rates. The magnitude of vaccine effectiveness was comparatively lower for SARS-CoV-2 infection, although this was variable across the age range, with higher effectiveness seen with older adults. Our results have important implications for health system planning -especially in low resource settings where vaccine supply remains constrained.
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Affiliation(s)
- Amit Kaura
- Hammersmith Hospital, National Heart and Lung Institute, Imperial College London, Du Cane Road, London W12 0HS, UK
- NIHR Imperial Biomedical Research Centre, Imperial College Healthcare NHS Trust, London, UK
- Corresponding author at: Hammersmith Hospital, National Heart and Lung Institute, Imperial College London, Du Cane Road, London W12 0HS, UK.
| | - Adam Trickey
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Anoop S V Shah
- Hammersmith Hospital, National Heart and Lung Institute, Imperial College London, Du Cane Road, London W12 0HS, UK
- NIHR Imperial Biomedical Research Centre, Imperial College Healthcare NHS Trust, London, UK
| | - Umberto Benedetto
- Population Health Sciences, University of Bristol, Bristol, UK
- NIHR Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
- Neuroscience, Imaging and Clinical Science, University Chieti-Pescara, G. d'Annunzio, Italy
| | - Ben Glampson
- Hammersmith Hospital, National Heart and Lung Institute, Imperial College London, Du Cane Road, London W12 0HS, UK
- NIHR Imperial Biomedical Research Centre, Imperial College Healthcare NHS Trust, London, UK
| | - Abdulrahim Mulla
- Hammersmith Hospital, National Heart and Lung Institute, Imperial College London, Du Cane Road, London W12 0HS, UK
- NIHR Imperial Biomedical Research Centre, Imperial College Healthcare NHS Trust, London, UK
| | - Luca Mercuri
- Hammersmith Hospital, National Heart and Lung Institute, Imperial College London, Du Cane Road, London W12 0HS, UK
- NIHR Imperial Biomedical Research Centre, Imperial College Healthcare NHS Trust, London, UK
| | - Sanjay Gautama
- NIHR Imperial Biomedical Research Centre, Imperial College Healthcare NHS Trust, London, UK
| | - Ceire E Costelloe
- Hammersmith Hospital, National Heart and Lung Institute, Imperial College London, Du Cane Road, London W12 0HS, UK
| | - Ian Goodman
- North West London Collaboration of Clinical Commissioning Groups and Whole Systems Integrated Care, London, UK
| | - Julian Redhead
- NIHR Imperial Biomedical Research Centre, Imperial College Healthcare NHS Trust, London, UK
| | - Kavitha Saravanakumar
- North West London Collaboration of Clinical Commissioning Groups and Whole Systems Integrated Care, London, UK
| | - Erik Mayer
- Hammersmith Hospital, National Heart and Lung Institute, Imperial College London, Du Cane Road, London W12 0HS, UK
- NIHR Imperial Biomedical Research Centre, Imperial College Healthcare NHS Trust, London, UK
| | - Jamil Mayet
- Hammersmith Hospital, National Heart and Lung Institute, Imperial College London, Du Cane Road, London W12 0HS, UK
- NIHR Imperial Biomedical Research Centre, Imperial College Healthcare NHS Trust, London, UK
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Sau A, Kaura A, Ahmed A, Patel KHK, Li X, Mulla A, Glampson B, Panoulas V, Davies J, Woods K, Gautama S, Shah AD, Elliott P, Hemingway H, Williams B, Asselbergs FW, Melikian N, Peters NS, Shah AM, Perera D, Kharbanda R, Patel RS, Channon KM, Mayet J, Ng FS. Prognostic Significance of Ventricular Arrhythmias in 13 444 Patients With Acute Coronary Syndrome: A Retrospective Cohort Study Based on Routine Clinical Data (NIHR Health Informatics Collaborative VA-ACS Study). J Am Heart Assoc 2022; 11:e024260. [PMID: 35258317 PMCID: PMC9075290 DOI: 10.1161/jaha.121.024260] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 12/07/2021] [Accepted: 01/06/2022] [Indexed: 12/19/2022]
Abstract
Background A minority of acute coronary syndrome (ACS) cases are associated with ventricular arrhythmias (VA) and/or cardiac arrest (CA). We investigated the effect of VA/CA at the time of ACS on long-term outcomes. Methods and Results We analyzed routine clinical data from 5 National Health Service trusts in the United Kingdom, collected between 2010 and 2017 by the National Institute for Health Research Health Informatics Collaborative. A total of 13 444 patients with ACS, 376 (2.8%) of whom had concurrent VA, survived to hospital discharge and were followed up for a median of 3.42 years. Patients with VA or CA at index presentation had significantly increased risks of subsequent VA during follow-up (VA group: adjusted hazard ratio [HR], 4.15 [95% CI, 2.42-7.09]; CA group: adjusted HR, 2.60 [95% CI, 1.23-5.48]). Patients who suffered a CA in the context of ACS and survived to discharge also had a 36% increase in long-term mortality (adjusted HR, 1.36 [95% CI, 1.04-1.78]), although the concurrent diagnosis of VA alone during ACS did not affect all-cause mortality (adjusted HR, 1.03 [95% CI, 0.80-1.33]). Conclusions Patients who develop VA or CA during ACS who survive to discharge have increased risks of subsequent VA, whereas those who have CA during ACS also have an increase in long-term mortality. These individuals may represent a subgroup at greater risk of subsequent arrhythmic events as a result of intrinsically lower thresholds for developing VA.
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Affiliation(s)
- Arunashis Sau
- National Heart and Lung InstituteImperial College LondonLondonUK
- National Institute for Health Research Imperial Biomedical Research CentreImperial College London and Imperial College Healthcare NHS TrustLondonUK
| | - Amit Kaura
- National Heart and Lung InstituteImperial College LondonLondonUK
- National Institute for Health Research Imperial Biomedical Research CentreImperial College London and Imperial College Healthcare NHS TrustLondonUK
| | - Amar Ahmed
- National Heart and Lung InstituteImperial College LondonLondonUK
| | | | - Xinyang Li
- National Heart and Lung InstituteImperial College LondonLondonUK
| | - Abdulrahim Mulla
- National Institute for Health Research Imperial Biomedical Research CentreImperial College London and Imperial College Healthcare NHS TrustLondonUK
| | - Benjamin Glampson
- National Institute for Health Research Imperial Biomedical Research CentreImperial College London and Imperial College Healthcare NHS TrustLondonUK
| | | | - Jim Davies
- National Institute for Health Research Oxford Biomedical Research CentreUniversity of Oxford and Oxford University Hospitals NHS Foundation TrustOxfordUK
| | - Kerrie Woods
- National Institute for Health Research Oxford Biomedical Research CentreUniversity of Oxford and Oxford University Hospitals NHS Foundation TrustOxfordUK
| | - Sanjay Gautama
- National Institute for Health Research Imperial Biomedical Research CentreImperial College London and Imperial College Healthcare NHS TrustLondonUK
| | - Anoop D. Shah
- National Institute for Health Research University College London Biomedical Research CentreUniversity College London and University College London Hospitals NHS Foundation TrustLondonUK
| | - Paul Elliott
- National Institute for Health Research Imperial Biomedical Research CentreImperial College London and Imperial College Healthcare NHS TrustLondonUK
- Health Data Research UKLondon Substantive SiteLondonUK
| | - Harry Hemingway
- National Institute for Health Research University College London Biomedical Research CentreUniversity College London and University College London Hospitals NHS Foundation TrustLondonUK
- Health Data Research UKLondon Substantive SiteLondonUK
| | - Bryan Williams
- National Institute for Health Research University College London Biomedical Research CentreUniversity College London and University College London Hospitals NHS Foundation TrustLondonUK
| | - Folkert W. Asselbergs
- National Institute for Health Research University College London Biomedical Research CentreUniversity College London and University College London Hospitals NHS Foundation TrustLondonUK
| | - Narbeh Melikian
- National Institute for Health Research King’s Biomedical Research CentreKing’s College London and King’s College Hospital NHS Foundation TrustLondonUK
| | | | - Ajay M. Shah
- National Institute for Health Research King’s Biomedical Research CentreKing’s College London and King’s College Hospital NHS Foundation TrustLondonUK
| | - Divaka Perera
- National Institute for Health Research King’s Biomedical Research CentreKing’s College London and Guy’s and St Thomas' NHS Foundation TrustLondonUK
| | - Rajesh Kharbanda
- National Institute for Health Research Oxford Biomedical Research CentreUniversity of Oxford and Oxford University Hospitals NHS Foundation TrustOxfordUK
| | - Riyaz S. Patel
- National Institute for Health Research University College London Biomedical Research CentreUniversity College London and University College London Hospitals NHS Foundation TrustLondonUK
| | - Keith M. Channon
- National Institute for Health Research Oxford Biomedical Research CentreUniversity of Oxford and Oxford University Hospitals NHS Foundation TrustOxfordUK
| | - Jamil Mayet
- National Heart and Lung InstituteImperial College LondonLondonUK
- National Institute for Health Research Imperial Biomedical Research CentreImperial College London and Imperial College Healthcare NHS TrustLondonUK
| | - Fu Siong Ng
- National Heart and Lung InstituteImperial College LondonLondonUK
- National Institute for Health Research Imperial Biomedical Research CentreImperial College London and Imperial College Healthcare NHS TrustLondonUK
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Aggarwal R, Visram S, Martin G, Sounderajah V, Gautama S, Jarrold K, Klaber R, Maxwell S, Neal J, Pegg J, Redhead J, King D, Ashrafian H, Darzi A. Defining the Enablers and Barriers to the Implementation of Large-scale, Health Care–Related Mobile Technology: Qualitative Case Study in a Tertiary Hospital Setting. JMIR Mhealth Uhealth 2022; 10:e31497. [PMID: 35133287 PMCID: PMC8864527 DOI: 10.2196/31497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 10/11/2021] [Accepted: 12/14/2021] [Indexed: 11/29/2022] Open
Abstract
Background The successful implementation of clinical smartphone apps in hospital settings requires close collaboration with industry partners. A large-scale, hospital-wide implementation of a clinical mobile app for health care professionals developed in partnership with Google Health and academic partners was deployed on a bring-your-own-device basis using mobile device management at our UK academic hospital. As this was the first large-scale implementation of this type of innovation in the UK health system, important insights and lessons learned from the deployment may be useful to other organizations considering implementing similar technology in partnership with commercial companies. Objective The aims of this study are to define the key enablers and barriers and to propose a road map for the implementation of a hospital-wide clinical mobile app developed in collaboration with an industry partner as a data processor and an academic partner for independent evaluation. Methods Semistructured interviews were conducted with high-level stakeholders from industry, academia, and health care providers who had instrumental roles in the implementation of the app at our hospital. The interviews explored the participants’ views on the enablers and barriers to the implementation process. The interviews were analyzed using a broadly deductive approach to thematic analysis. Results In total, 14 participants were interviewed. Key enablers identified were the establishment of a steering committee with high-level clinical involvement, well-defined roles and responsibilities between partners, effective communication strategies with end users, safe information governance precautions, and increased patient engagement and transparency. Barriers identified were the lack of dedicated resources for mobile change at our hospital, risk aversion, unclear strategy and regulation, and the implications of bring-your-own-device and mobile device management policies. The key lessons learned from the deployment process were highlighted, and a road map for the implementation of large-scale clinical mobile apps in hospital settings was proposed. Conclusions Despite partnering with one of the world’s biggest technology companies, the cultural and technological change required for mobile working and implementation in health care was found to be a significant challenge. With an increasing requirement for health care organizations to partner with industry for advanced mobile technologies, the lessons learned from our implementation can influence how other health care organizations undertake a similar mobile change and improve the chances of successful widespread mobile transformation.
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Affiliation(s)
- Ravi Aggarwal
- Institute of Global Health Innovation, Imperial College London, London, United Kingdom
- Department of Surgery & Cancer, Imperial College London, London, United Kingdom
| | - Sheena Visram
- Department of Computer Science, University College London, London, United Kingdom
| | - Guy Martin
- Institute of Global Health Innovation, Imperial College London, London, United Kingdom
- Department of Surgery & Cancer, Imperial College London, London, United Kingdom
| | - Viknesh Sounderajah
- Institute of Global Health Innovation, Imperial College London, London, United Kingdom
- Department of Surgery & Cancer, Imperial College London, London, United Kingdom
| | - Sanjay Gautama
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Kevin Jarrold
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Robert Klaber
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Shona Maxwell
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - John Neal
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Jack Pegg
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Julian Redhead
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Dominic King
- Institute of Global Health Innovation, Imperial College London, London, United Kingdom
| | - Hutan Ashrafian
- Institute of Global Health Innovation, Imperial College London, London, United Kingdom
- Department of Surgery & Cancer, Imperial College London, London, United Kingdom
| | - Ara Darzi
- Institute of Global Health Innovation, Imperial College London, London, United Kingdom
- Department of Surgery & Cancer, Imperial College London, London, United Kingdom
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Mobasheri MH, King D, Johnston M, Gautama S, Purkayastha S, Darzi A. The ownership and clinical use of smartphones by doctors and nurses in the UK: a multicentre survey study. ACTA ACUST UNITED AC 2015. [DOI: 10.1136/bmjinnov-2015-000062] [Citation(s) in RCA: 108] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Walker ST, Sevdalis N, McKay A, Lambden S, Gautama S, Aggarwal R, Vincent C. Unannounced in situ simulations: integrating training and clinical practice. BMJ Qual Saf 2012; 22:453-8. [PMID: 23211281 DOI: 10.1136/bmjqs-2012-000986] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [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: 11/04/2022]
Abstract
Simulation-based training for healthcare providers is well established as a viable, efficacious training tool, particularly for the training of non-technical team-working skills. These skills are known to be critical to effective teamwork, and important in the prevention of error and adverse events in hospitals. However, simulation suites are costly to develop and releasing staff to attend training is often difficult. These factors may restrict access to simulation training. We discuss our experiences of 'in situ' simulation for unannounced cardiac arrest training when the training is taken to the clinical environment. This has the benefit of decreasing required resources, increasing realism and affordability, and widening multidisciplinary team participation, thus enabling assessment and training of non-technical team-working skills in real clinical teams. While there are practical considerations of delivering training in the clinical environment, we feel there are many potential benefits compared with other forms of simulation training. We are able to tailor the training to the needs of the location, enabling staff to see a scenario that is relevant to their practice. This is particularly useful for staff who have less exposure to cardiac arrest events, such as radiology staff. We also describe the important benefit of risk assessment for a clinical environment. During our simulations we have identified a number of issues that, had they occurred during a real resuscitation attempt, may have led to patient harm or patient death. For these reasons we feel in situ simulation should be considered by every hospital as part of a patient safety initiative.
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Affiliation(s)
- Susanna T Walker
- Centre for Patient Safety and Service Quality, Department of Surgery and Cancer, Imperial College London, St Mary's Hospital, London, UK.
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Arora S, Miskovic D, Hull L, Moorthy K, Aggarwal R, Johannsson H, Gautama S, Kneebone R, Sevdalis N. Self vs expert assessment of technical and non-technical skills in high fidelity simulation. Am J Surg 2011; 202:500-6. [DOI: 10.1016/j.amjsurg.2011.01.024] [Citation(s) in RCA: 96] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2010] [Revised: 01/20/2011] [Accepted: 01/20/2011] [Indexed: 01/23/2023]
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Walker S, Lambden S, McKay A, Gautama S, Aggarwal R, Vincent V. Unannounced in situ simulation represents a realistic method for teaching the technical and non-technical skills required for resuscitation. Resuscitation 2010. [DOI: 10.1016/j.resuscitation.2010.09.131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Undre S, Koutantji M, Sevdalis N, Gautama S, Selvapatt N, Williams S, Sains P, McCulloch P, Darzi A, Vincent C. Multidisciplinary crisis simulations: the way forward for training surgical teams. World J Surg 2007; 31:1843-1853. [PMID: 17610109 DOI: 10.1007/s00268-007-9128-x] [Citation(s) in RCA: 172] [Impact Index Per Article: 10.1] [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: 08/05/2006] [Revised: 02/03/2007] [Accepted: 03/31/2007] [Indexed: 01/23/2023]
Abstract
BACKGROUND High-reliability organizations have stressed the importance of non-technical skills for safety and of regularly providing such training to their teams. Recently safety skills training has been applied in the practice of medicine. In this study, we developed and piloted a module using multidisciplinary crisis scenarios in a simulated operating theatre to train entire surgical teams. METHODS Twenty teams participated (n = 80); each consisted of a trainee surgeon, anesthetist, operating department practitioner (ODP), and scrub nurse. Crisis scenarios such as difficult intubation, hemorrhage, or cardiac arrest were simulated. Technical and non-technical skills (leadership, communication, team skills, decision making, and vigilance), were assessed by clinical experts and by two psychologists using relevant technical and human factors rating scales. Participants received technical and non-technical feedback, and the whole team received feedback on teamwork. RESULTS Trainees assessed the training favorably. For technical skills there were no differences between surgical trainees' assessment scores and the assessment scores of the trainers. However, nurses overrated their technical skill. Regarding non-technical skills, leadership and decision making were scored lower than the other three non-technical skills (communication, team skills, and vigilance). Surgeons scored lower than nurses on communication and teamwork skills. Surgeons and anesthetists scored lower than nurses on leadership. CONCLUSIONS Multidisciplinary simulation-based team training is feasible and well received by surgical teams. Non-technical skills can be assessed alongside technical skills, and differences in performance indicate where there is a need for further training. Future work should focus on developing team performance measures for training and on the development and evaluation of systematic training for technical and non-technical skills to enhance team performance and safety in surgery.
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Affiliation(s)
- Shabnam Undre
- Department of Bio-Surgery and Surgical Technology, Imperial College and St, Mary's Hospital, 10th floor QEQM building, Praed Street, London, W2 1NY, United Kingdom.
- Department of Anaesthesia, St. Mary's Hospital, London, W2 1NY, United Kingdom.
| | - Maria Koutantji
- Department of Bio-Surgery and Surgical Technology, Imperial College and St, Mary's Hospital, 10th floor QEQM building, Praed Street, London, W2 1NY, United Kingdom
| | - Nick Sevdalis
- Department of Bio-Surgery and Surgical Technology, Imperial College and St, Mary's Hospital, 10th floor QEQM building, Praed Street, London, W2 1NY, United Kingdom
| | - Sanjay Gautama
- Department of Bio-Surgery and Surgical Technology, Imperial College and St, Mary's Hospital, 10th floor QEQM building, Praed Street, London, W2 1NY, United Kingdom
| | - Nowlan Selvapatt
- Department of Bio-Surgery and Surgical Technology, Imperial College and St, Mary's Hospital, 10th floor QEQM building, Praed Street, London, W2 1NY, United Kingdom
| | - Samantha Williams
- Department of Bio-Surgery and Surgical Technology, Imperial College and St, Mary's Hospital, 10th floor QEQM building, Praed Street, London, W2 1NY, United Kingdom
| | - Parvinderpal Sains
- Department of Bio-Surgery and Surgical Technology, Imperial College and St, Mary's Hospital, 10th floor QEQM building, Praed Street, London, W2 1NY, United Kingdom
| | - Peter McCulloch
- Department of Bio-Surgery and Surgical Technology, Imperial College and St, Mary's Hospital, 10th floor QEQM building, Praed Street, London, W2 1NY, United Kingdom
| | - Ara Darzi
- Department of Bio-Surgery and Surgical Technology, Imperial College and St, Mary's Hospital, 10th floor QEQM building, Praed Street, London, W2 1NY, United Kingdom
| | - Charles Vincent
- Department of Bio-Surgery and Surgical Technology, Imperial College and St, Mary's Hospital, 10th floor QEQM building, Praed Street, London, W2 1NY, United Kingdom
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