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Hart MG, Polyhronopoulos N, Sandhu MK, Honey CR. Deep Brain Stimulation Improves Symptoms of Spasmodic Dysphonia Through Targeting of Thalamic Sensorimotor Connectivity. Neurosurgery 2024:00006123-990000000-01027. [PMID: 38251897 DOI: 10.1227/neu.0000000000002836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 11/27/2023] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Spasmodic dysphonia is a dystonia of the vocal chords producing difficulty with speech. Current hypotheses are that this is a condition of dysregulated thalamic sensory motor integration. A recent randomized controlled trial of thalamic deep brain stimulation (DBS) demonstrated its safety and efficacy. Our objective was to determine whether the outcome could be predicted by stimulation of thalamic sensorimotor areas and adjacent white matter connectivity as assessed by diffusion tractography. METHODS A cohort of 6 participants undergoing thalamic DBS for adductor spasmodic dysphonia was studied. Electrodes were localized with the Lead-DBS toolbox. Group-based analyses were performed with atlases, coordinates, and using voxel-based symptom mapping. Diffusion tensor imaging (3 T, 64 directions, 2-mm isotropic) was used to perform individual probabilistic tractography (cerebellothalamic tract and pallidothalamic tract) and segmentation of the thalamus. Monopolar review was performed at 0.5 V and binarised as effective or ineffective. RESULTS Effective contacts stimulated more of thalamic sensorimotor areas than ineffective contacts (P < .05, false discovery rate corrected). This effect was consistent across analytical and statistical techniques. Group-level and tractography analyses did not identify a specific "sweet spot" suggesting the benefit of DBS is derived from modulating individual thalamic sensorimotor areas. Stimulations at 1 year involved predicted thalamic sensorimotor regions with additional cerebellothalamic tract involvement. CONCLUSION Stimulation of thalamic sensorimotor areas was associated with improvement in symptoms of spasmodic dysphonia. These data are consistent with DBS acting on pathophysiologically dysregulated thalamic sensorimotor integration in spasmodic dysphonia.
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Affiliation(s)
- Michael G Hart
- St George's, University of London & St George's Hospitals NHS Foundation Trust, Institute of Molecular and Clinical Sciences, Neurosciences Research Centre, London, UK
| | - Nancy Polyhronopoulos
- Division of Neurosurgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mandeep K Sandhu
- Division of Neurosurgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Christopher R Honey
- Division of Neurosurgery, University of British Columbia, Vancouver, British Columbia, Canada
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Tochel C, Pead E, McTrusty A, Buckmaster F, MacGillivray T, Tatham AJ, Strang NC, Dhillon B, Bernabeu MO. Novel linkage approach to join community-acquired and national data. BMC Med Res Methodol 2024; 24:13. [PMID: 38233744 PMCID: PMC10792819 DOI: 10.1186/s12874-024-02143-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 01/05/2024] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND Community optometrists in Scotland have performed regular free-at-point-of-care eye examinations for all, for over 15 years. Eye examinations include retinal imaging but image storage is fragmented and they are not used for research. The Scottish Collaborative Optometry-Ophthalmology Network e-research project aimed to collect these images and create a repository linked to routinely collected healthcare data, supporting the development of pre-symptomatic diagnostic tools. METHODS As the image record was usually separate from the patient record and contained minimal patient information, we developed an efficient matching algorithm using a combination of deterministic and probabilistic steps which minimised the risk of false positives, to facilitate national health record linkage. We visited two practices and assessed the data contained in their image device and Practice Management Systems. Practice activities were explored to understand the context of data collection processes. Iteratively, we tested a series of matching rules which captured a high proportion of true positive records compared to manual matches. The approach was validated by testing manual matching against automated steps in three further practices. RESULTS A sequence of deterministic rules successfully matched 95% of records in the three test practices compared to manual matching. Adding two probabilistic rules to the algorithm successfully matched 99% of records. CONCLUSIONS The potential value of community-acquired retinal images can be harnessed only if they are linked to centrally-held healthcare care data. Despite the lack of interoperability between systems within optometry practices and inconsistent use of unique identifiers, data linkage is possible using robust, almost entirely automated processes.
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Affiliation(s)
- Claire Tochel
- Centre for Medical Informatics, University of Edinburgh, Edinburgh, UK.
| | - Emma Pead
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Alice McTrusty
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Fiona Buckmaster
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Tom MacGillivray
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Andrew J Tatham
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
- Princess Alexandra Eye Pavilion, NHS Lothian, Edinburgh, UK
| | - Niall C Strang
- Department of Vision Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Baljean Dhillon
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
- Princess Alexandra Eye Pavilion, NHS Lothian, Edinburgh, UK
| | - Miguel O Bernabeu
- Centre for Medical Informatics, University of Edinburgh, Edinburgh, UK
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Ishihara BK, Hart MG, Barrick TR, Howe FA, Morgante F, Pereira EA. Radiofrequency thalamotomy for tremor produces focused and predictable lesions shown on magnetic resonance images. Brain Commun 2023; 5:fcad329. [PMID: 38075945 PMCID: PMC10710300 DOI: 10.1093/braincomms/fcad329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 10/06/2023] [Accepted: 11/28/2023] [Indexed: 02/23/2024] Open
Abstract
Radiofrequency thalamotomy is a neurosurgical management option for medically-refractory tremor. In this observational study, we evaluate the MRI features of the resultant lesion, their temporal dynamics, and how they vary depending on surgical factors. We report on lesion characteristics including size and location, as well as how these vary over time and across different MRI sequences. Data from 12 patients (2 essential tremor, 10 Parkinson's disease) who underwent unilateral radiofrequency thalamotomy for tremor were analysed. Lesion characteristics were compared across five structural sequences. Volumetric analysis of lesion features was performed at early (<5 weeks) and late (>5 months) timepoints by manual segmentation. Lesion location was determined after registration of lesions to standard space. All patients showed tremor improvement (clinical global impressions scale) postoperatively. Chronic side-effects included balance disturbances (n = 4) and worsening mobility due to parkinsonism progression (n = 1). Early lesion features including a necrotic core, cytotoxic oedema and perilesional oedema were best demarcated on T2-weighted sequences. Multiple lesions were associated with greater cytotoxic oedema compared with single lesions (T2-weighted mean volume: 537 ± 112 mm³ versus 302 ± 146 mm³, P = 0.028). Total lesion volume reduced on average by 90% between the early and late scans (T2-weighted mean volume: 918 ± 517 versus 75 ± 50 mm³, t = 3.592, P = 0.023, n = 5), with comparable volumes demonstrated at ∼6 months after surgery. Lesion volumes on susceptibility-weighted images were larger than those of T2-weighted images at later timepoints. Radiofrequency thalamotomy produces focused and predictable lesion imaging characteristics over time. T2-weighted scans distinguish between the early lesion core and oedema characteristics, while lesions may remain more visible on susceptibility-weighted images in the months following surgery. Scanning patients in the immediate postoperative period and then at 6 months is clinically meaningful for understanding the anatomical basis of the transient and permanent effects of thalamotomy.
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Affiliation(s)
- Bryony K Ishihara
- Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George’s, University of London, London SW17 0RE, UK
| | - Michael G Hart
- Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George’s, University of London, London SW17 0RE, UK
| | - Thomas R Barrick
- Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George’s, University of London, London SW17 0RE, UK
| | - Franklyn A Howe
- Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George’s, University of London, London SW17 0RE, UK
| | - Francesca Morgante
- Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George’s, University of London, London SW17 0RE, UK
- Department of Experimental and Clinical Medicine, University of Messina, 98122 Messina, Italy
| | - Erlick A Pereira
- Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George’s, University of London, London SW17 0RE, UK
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McLean KA, Goel T, Lawday S, Riad A, Simoes J, Knight SR, Ghosh D, Glasbey JC, Bhangu A, Harrison EM. Prognostic models for surgical-site infection in gastrointestinal surgery: systematic review. Br J Surg 2023; 110:1441-1450. [PMID: 37433918 PMCID: PMC10564404 DOI: 10.1093/bjs/znad187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 04/11/2023] [Accepted: 05/20/2023] [Indexed: 07/13/2023]
Abstract
BACKGROUND Identification of patients at high risk of surgical-site infection may allow clinicians to target interventions and monitoring to minimize associated morbidity. The aim of this systematic review was to identify and evaluate prognostic tools for the prediction of surgical-site infection in gastrointestinal surgery. METHODS This systematic review sought to identify original studies describing the development and validation of prognostic models for 30-day SSI after gastrointestinal surgery (PROSPERO: CRD42022311019). MEDLINE, Embase, Global Health, and IEEE Xplore were searched from 1 January 2000 to 24 February 2022. Studies were excluded if prognostic models included postoperative parameters or were procedure specific. A narrative synthesis was performed, with sample-size sufficiency, discriminative ability (area under the receiver operating characteristic curve), and prognostic accuracy compared. RESULTS Of 2249 records reviewed, 23 eligible prognostic models were identified. A total of 13 (57 per cent) reported no internal validation and only 4 (17 per cent) had undergone external validation. Most identified operative contamination (57 per cent, 13 of 23) and duration (52 per cent, 12 of 23) as important predictors; however, there remained substantial heterogeneity in other predictors identified (range 2-28). All models demonstrated a high risk of bias due to the analytic approach, with overall low applicability to an undifferentiated gastrointestinal surgical population. Model discrimination was reported in most studies (83 per cent, 19 of 23); however, calibration (22 per cent, 5 of 23) and prognostic accuracy (17 per cent, 4 of 23) were infrequently assessed. Of externally validated models (of which there were four), none displayed 'good' discrimination (area under the receiver operating characteristic curve greater than or equal to 0.7). CONCLUSION The risk of surgical-site infection after gastrointestinal surgery is insufficiently described by existing risk-prediction tools, which are not suitable for routine use. Novel risk-stratification tools are required to target perioperative interventions and mitigate modifiable risk factors.
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Affiliation(s)
- Kenneth A McLean
- Department of Clinical Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Tanvi Goel
- India Hub, NIHR Global Health Research Unit on Global Surgery, Ludhiana, India
| | - Samuel Lawday
- Bristol Centre for Surgical Research, University of Bristol, Bristol, UK
| | - Aya Riad
- Department of Clinical Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Joana Simoes
- Institute of Translational Medicine, University of Birmingham, Birmingham, UK
| | - Stephen R Knight
- Department of Clinical Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Dhruva Ghosh
- India Hub, NIHR Global Health Research Unit on Global Surgery, Ludhiana, India
| | - James C Glasbey
- Institute of Translational Medicine, University of Birmingham, Birmingham, UK
| | - Aneel Bhangu
- Institute of Translational Medicine, University of Birmingham, Birmingham, UK
| | - Ewen M Harrison
- Department of Clinical Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK
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Tandle S, Wohlgemut JM, Marsden MER, Pisirir E, Kyrimi E, Stoner RS, Marsh W, Perkins ZB, Tai NRM. Enhancing the clinical relevance of haemorrhage prediction models in trauma. Mil Med Res 2023; 10:43. [PMID: 37726859 PMCID: PMC10510175 DOI: 10.1186/s40779-023-00476-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 08/22/2023] [Indexed: 09/21/2023] Open
Affiliation(s)
- Sankalp Tandle
- Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London, London, E1 2AT UK
- The Royal London Hospital, Barts Health NHS Trust, London, E1 1FR UK
| | - Jared M. Wohlgemut
- Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London, London, E1 2AT UK
- The Royal London Hospital, Barts Health NHS Trust, London, E1 1FR UK
| | - Max E. R. Marsden
- Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London, London, E1 2AT UK
- Academic Department of Military Surgery and Trauma, Research and Clinical Innovation, The Royal Centre for Defence Medicine, Birmingham, B15 2WB UK
| | - Erhan Pisirir
- Department of Electronic Engineering and Computer Science, Queen Mary University of London, London, E1 4NS UK
| | - Evangelia Kyrimi
- Department of Electronic Engineering and Computer Science, Queen Mary University of London, London, E1 4NS UK
| | - Rebecca S. Stoner
- Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London, London, E1 2AT UK
- The Royal London Hospital, Barts Health NHS Trust, London, E1 1FR UK
| | - William Marsh
- Department of Electronic Engineering and Computer Science, Queen Mary University of London, London, E1 4NS UK
| | - Zane B. Perkins
- Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London, London, E1 2AT UK
- The Royal London Hospital, Barts Health NHS Trust, London, E1 1FR UK
| | - Nigel R. M. Tai
- Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London, London, E1 2AT UK
- The Royal London Hospital, Barts Health NHS Trust, London, E1 1FR UK
- Academic Department of Military Surgery and Trauma, Research and Clinical Innovation, The Royal Centre for Defence Medicine, Birmingham, B15 2WB UK
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Shah AP, Cleland J, Hawick L, Walker KA, Walker KG. Integrating simulation into surgical training: a qualitative case study of a national programme. Adv Simul (Lond) 2023; 8:20. [PMID: 37596692 PMCID: PMC10436455 DOI: 10.1186/s41077-023-00259-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 07/31/2023] [Indexed: 08/20/2023] Open
Abstract
BACKGROUND Applying simulation-based education (SBE) into surgical curricula is challenging and exacerbated by the absence of guidance on implementation processes. Empirical studies evaluating implementation of SBE interventions focus primarily on outcomes. However, understanding the processes involved in organising, planning, and delivering SBE adds knowledge on how best to develop, implement, and sustain surgical SBE. This study used a reform of early years surgical training to explore the implementation of a new SBE programme in Scotland. It aimed to understand the processes that are involved in the relative success (or failure) when implementing surgical SBE interventions. METHODS This qualitative case study, underpinned by social constructionism, used publicly available documents and the relevant surgical SBE literature to inform the research focus and contextualise data obtained from semi-structured interviews with core surgical trainees (n = 46), consultant surgeons (n = 25), and key leaders with roles in surgical training governance in Scotland (n = 7). Initial data coding and analysis were inductive. Secondary data analysis was then undertaken using Normalisation Process Theory (NPT). NPTs' four constructs (coherence, cognitive participation, collective action, reflexive monitoring) provided an explanatory framework for scrutinising how interventions are implemented, embedded, and integrated into practice, i.e. the "normalisation" process. RESULTS Distributed leadership (individual SBE initiatives assigned to faculty but overall programme overseen by a single leader) and the quality improvement practise of iterative refinement were identified as key novel processes promoting successful normalisation of the new SBE programme. Other processes widely described in the literature were also identified: stakeholder collaboration, personal contacts/relational processes, effective communication, faculty development, effective leadership, and tight programme management. The study also identified that learners valued SBE activities in group- or team-based social environments over isolated deliberate practice. CONCLUSIONS SBE is most effective when designed as a comprehensive programme aligned to the curriculum. Programmes incorporating both group-based and isolated SBE activities promote deliberate practice. Distributed leadership amongst faculty attracts wide engagement integral to SBE programme implementation, while iterative programme refinement through regular evaluation and action on feedback encourages integration into practice. The knowledge contributed by critically analysing SBE programme implementation processes can support development of much needed guidance in this area.
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Affiliation(s)
- Adarsh P Shah
- Centre for Healthcare Education Research and Innovation (CHERI), University of Aberdeen, Aberdeen, UK
| | - Jennifer Cleland
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Lorraine Hawick
- Centre for Healthcare Education Research and Innovation (CHERI), University of Aberdeen, Aberdeen, UK
| | - Kim A Walker
- Centre for Healthcare Education Research and Innovation (CHERI), University of Aberdeen, Aberdeen, UK
| | - Kenneth G Walker
- NHS Education for Scotland, Centre for Health Science, Old Perth Road, Inverness, IV2 3JH, UK.
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Shah AP, Walker KA, Walker KG, Cleland J. Context matters in curriculum reform: An analysis of change in surgical training. Med Educ 2023; 57:741-752. [PMID: 36869257 DOI: 10.1111/medu.15071] [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] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 02/16/2023] [Accepted: 02/24/2023] [Indexed: 06/18/2023]
Abstract
INTRODUCTION Education and training reforms are typically devised by accreditation bodies and rolled out nationally. This top-down approach is positioned as contextually independent, yet context is highly influential in shaping the impact of change. Given this, it is critical to consider how curriculum reform plays out as it meets local settings. We have therefore used a national-level curriculum reform process of surgical training, Improving Surgical Training (IST), to examine the influence of context in IST implementation across two UK countries. METHODS Adopting a case study approach, we used document data for contextualisation purposes and semi-structured interviews with key stakeholders across multiple organisations (n = 17, plus four follow-up interviews) as our main source of data. Initial data coding and analysis were inductive. We followed this with a secondary analysis using Engeström's second-generation activity theory nested within an overarching framework of complexity theory to help tease out some key elements of IST development and implementation. RESULTS The introduction of IST into the surgical training system was historically situated within a landscape of previous reforms. IST's aims collided with existing practices and rules, thus creating tensions. In one country, the systems of IST and surgical training came together to some extent, mostly due to processes of social networks, negotiation and leverage nested in a relatively cohesive setting. These processes were not apparent in the other country, and instead of transformative change, the system contracted. Change was not integrated, and the reform was halted. CONCLUSIONS Our use of a case study approach and complexity theory deepens understanding of how history, systems and contexts interact to facilitate or inhibit change within one area of medical education. Our study paves the way for further empirical work examining the influence of context in curriculum reform, and thus determining how best to bring about change in practice.
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Affiliation(s)
- Adarsh P Shah
- Centre for Healthcare Education Research and Innovation (CHERI), University of Aberdeen, Aberdeen, UK
| | - Kim A Walker
- Centre for Healthcare Education Research and Innovation (CHERI), University of Aberdeen, Aberdeen, UK
| | - Kenneth G Walker
- NHS Education for Scotland, Centre for Health Science, Inverness, UK
| | - Jennifer Cleland
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore
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Ng HJ, Quasim T, Rattray NJW, Moug S. Investigation of frailty markers including a novel biomarker panel in emergency laparotomy: protocol of a prospective cohort study. BMC Surg 2023; 23:190. [PMID: 37408022 DOI: 10.1186/s12893-023-02093-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 06/25/2023] [Indexed: 07/07/2023] Open
Abstract
BACKGROUND Emergency laparotomy (EmLAP) is one of the commonest emergency operations performed in the United Kingdom (approximately 30, 000 laparotomies annually). These potentially high-risk procedures can be life changing with frail patients and/ or older adults (≥ 65 years) having the poorest outcomes, including mortality. There is no gold standard of frailty assessment and no clinical chemical biomarkers existing in practice. Early detection of subclinical changes or deficits at the molecular level are essential in improving our understanding of the biology of frailty and ultimately improving patient outcomes. This study aims primarily to compare preoperative frailty markers, including a blood-based biomarker panel, in their ability to predict 30 and 90-day mortality post-EmLAP. The secondary aim is to analyse the influence of perioperative frailty on morbidity and quality of life post-EmLAP. METHODS A prospective single centred observational study will be conducted on 150 patients ≥ 40 years of age that undergo EmLAP. Patients will be included according to the established NELA (National Emergency Laparotomy Audit) criteria. The variables collected include demographics, co-morbidities, polypharmacy, place of residence, indication and type of surgery (as per NELA criteria) and prognostic NELA score. Frailty will be assessed using: a blood sample for ultra-high performance liquid chromatography mass spectrometry analysis; preoperative CT abdomen pelvis (sarcopenia) and Rockwood Clinical Frailty Scale (CFS). Patients will be followed up for 90 days. Variables collected include blood samples (at post operative day 1, 7, 30 and 90), place of residence on discharge, morbidity, mortality and quality of life (EQ-5D-5 L). The frailty markers will be compared between groups of frail (CFS ≥ 4) and non-frail using statistical methods such as regression model and adjusted for appropriate confounding factors. DISCUSSION This study hypothesises that frailty level changes following EmLAP in frail and non- frail patients, irrespective of age. We propose that non- frail patients will have better survival rates and report better quality of life compared to the frail. By studying the changes in metabolites/ biomarkers in these patients and correlate them to frailty status pre-surgery, this highly novel approach will develop new knowledge of frailty and define a new area of clinical biomolecular research. TRIAL REGISTRATION ClinicalTrials.gov: NCT05416047. Registered on 13/06/2022 (retrospectively registered).
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Affiliation(s)
- Hwei Jene Ng
- School of Medical, Veterinary & Life Sciences (MVLS), University of Glasgow, Glasgow, UK.
- Department of General Surgery, Royal Alexandra Hospital, NHS Greater Glasgow and Clyde, Corsebar Road, Paisley, PA2 9PN, UK.
| | - Tara Quasim
- Department of Intensive Care Medicine, Glasgow Royal Infirmary, NHS Greater Glasgow and Clyde, Glasgow, UK
- Academic Unit of Anaesthesia, Critical Care and Peri- operative Medicine, University of Glasgow, Glasgow, UK
| | - Nicholas J W Rattray
- Strathclyde Institute of Pharmacy & Biomedical Sciences, University of Strathclyde, Glasgow, G4 0RE, UK
- Strathclyde Centre for Molecular Bioscience, University of Strathclyde, Glasgow, G4 0RE, UK
| | - Susan Moug
- Department of General Surgery, Royal Alexandra Hospital, NHS Greater Glasgow and Clyde, Corsebar Road, Paisley, PA2 9PN, UK
- School of Medicine, Dentistry & Nursing, University of Glasgow, Glasgow, United Kingdom
- Department of Colorectal Surgery, Golden Jubilee University National Hospital, Glasgow, United Kingdom
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Shah AP, Walker KA, Walker KG, Hawick L, Cleland J. "It's making me think outside the box at times": a qualitative study of dynamic capabilities in surgical training. Adv Health Sci Educ Theory Pract 2023; 28:499-518. [PMID: 36287293 PMCID: PMC9607851 DOI: 10.1007/s10459-022-10170-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 09/27/2022] [Indexed: 05/11/2023]
Abstract
Craft specialties such as surgery endured widespread disruption to postgraduate education and training during the pandemic. Despite the expansive literature on rapid adaptations and innovations, generalisability of these descriptions is limited by scarce use of theory-driven methods. In this research, we explored UK surgical trainees' (n = 46) and consultant surgeons' (trainers, n = 25) perceptions of how learning in clinical environments changed during a time of extreme uncertainty (2020/2021). Our ultimate goal was to identify new ideas that could shape post-pandemic surgical training. We conducted semi-structured virtual interviews with participants from a range of working/training environments across thirteen Health Boards in Scotland. Initial analysis of interview transcripts was inductive. Dynamic capabilities theory (how effectively an organisation uses its resources to respond to environmental changes) and its micro-foundations (sensing, seizing, reconfiguring) were used for subsequent theory-driven analysis. Findings demonstrate that surgical training responded dynamically and adapted to external and internal environmental uncertainty. Sensing threats and opportunities in the clinical environment prompted trainers' institutions to seize new ways of working. Learners gained from reconfigured training opportunities (e.g., splitting operative cases between trainees), pan-surgical working (e.g., broader surgical exposure), redeployment (e.g., to medical specialties), collaborative working (working with new colleagues and in new ways) and supervision (shifting to online supervision). Our data foreground the human resource and structural reconfigurations, and technological innovations that effectively maintained surgical training during the pandemic, albeit in different ways. These adaptations and innovations could provide the foundations for enhancing surgical education and training in the post-pandemic era.
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Affiliation(s)
- Adarsh P Shah
- Centre for Healthcare Education Research and Innovation (CHERI), School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, AB25 2ZD, UK.
| | - Kim A Walker
- Centre for Healthcare Education Research and Innovation (CHERI), School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, AB25 2ZD, UK
| | - Kenneth G Walker
- NHS Education for Scotland, Centre for Health Science, Inverness, UK
| | - Lorraine Hawick
- Centre for Healthcare Education Research and Innovation (CHERI), School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, AB25 2ZD, UK
| | - Jennifer Cleland
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
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Ellis R, Brennan PA, Scrimgeour DSG, Lee AJ, Cleland J. Does performance at the intercollegiate Membership of the Royal Colleges of Surgeons (MRCS) examination vary according to UK medical school and course type? A retrospective cohort study. BMJ Open 2022; 12:e054616. [PMID: 34987044 PMCID: PMC8734024 DOI: 10.1136/bmjopen-2021-054616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 12/02/2021] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES The knowledge, skills and behaviours required of new UK medical graduates are the same but how these are achieved differs given medical schools vary in their mission, curricula and pedagogy. Medical school differences seem to influence performance on postgraduate assessments. To date, the relationship between medical schools, course types and performance at the Membership of the Royal Colleges of Surgeons examination (MRCS) has not been investigated. Understanding this relationship is vital to achieving alignment across undergraduate and postgraduate training, learning and assessment values. DESIGN AND PARTICIPANTS A retrospective longitudinal cohort study of UK medical graduates who attempted MRCS Part A (n=9730) and MRCS Part B (n=4645) between 2007 and 2017, using individual-level linked sociodemographic and prior academic attainment data from the UK Medical Education Database. METHODS We studied MRCS performance across all UK medical schools and examined relationships between potential predictors and MRCS performance using χ2 analysis. Multivariate logistic regression models identified independent predictors of MRCS success at first attempt. RESULTS MRCS pass rates differed significantly between individual medical schools (p<0.001) but not after adjusting for prior A-Level performance. Candidates from courses other than those described as problem-based learning (PBL) were 53% more likely to pass MRCS Part A (OR 1.53 (95% CI 1.25 to 1.87) and 54% more likely to pass Part B (OR 1.54 (1.05 to 2.25)) at first attempt after adjusting for prior academic performance. Attending a Standard-Entry 5-year medicine programme, having no prior degree and attending a Russell Group university were independent predictors of MRCS success in regression models (p<0.05). CONCLUSIONS There are significant differences in MRCS performance between medical schools. However, this variation is largely due to individual factors such as academic ability, rather than medical school factors. This study also highlights group level attainment differences that warrant further investigation to ensure equity within medical training.
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Affiliation(s)
- Ricky Ellis
- University of Aberdeen Institute of Applied Health Sciences, Aberdeen, UK
- Urology Department, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Peter A Brennan
- Department of Maxillo-Facial Surgery, Queen Alexandra Hospital, Portsmouth, UK
| | - Duncan S G Scrimgeour
- University of Aberdeen Institute of Applied Health Sciences, Aberdeen, UK
- Department of Colorectal Surgery, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Amanda J Lee
- Medical Statistics Team, University of Aberdeen Institute of Applied Health Sciences, Aberdeen, UK
| | - Jennifer Cleland
- Medical Education Research and Scholarship Unit (MERSU), Lee Kong Chian School of Medicine, Singapore
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Ellis R, Scrimgeour DSG, Brennan PA, Lee AJ, Cleland J. Does performance at medical school predict success at the Intercollegiate Membership of the Royal College of Surgeons (MRCS) examination? A retrospective cohort study. BMJ Open 2021; 11:e046615. [PMID: 34400449 PMCID: PMC8370550 DOI: 10.1136/bmjopen-2020-046615] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Identifying predictors of success in postgraduate examinations can help guide the career choices of medical students and may aid early identification of trainees requiring extra support to progress in specialty training. We assessed whether performance on the educational performance measurement (EPM) and situational judgement test (SJT) used for selection into foundation training predicted success at the Membership of the Royal College of Surgeons (MRCS) examination. METHODS This was a longitudinal, cohort study using data from the UK Medical Education Database (https://www.ukmed.ac.uk). UK medical graduates who had attempted Part A (n=2585) and Part B (n=755) of the MRCS between 2014 and 2017 were included. χ2 and independent t-tests were used to examine the relationship between medical school performance and sociodemographic factors with first-attempt success at MRCS Part A and B. Multivariate logistic regression was employed to identify independent predictors of MRCS performance. RESULTS The odds of passing MRCS increased by 55% for Part A (OR 1.55 (95% CI 1.48 to 1.61)) and 23% for Part B (1.23 (1.14 to 1.32)) for every additional EPM decile point gained. For every point awarded for additional degrees in the EPM, candidates were 20% more likely to pass MRCS Part A (1.20 (1.13 to 1.29)) and 17% more likely to pass Part B (1.17 (1.04 to 1.33)). For every point awarded for publications in the EPM, candidates were 14% more likely to pass MRCS Part A (1.14 (1.01 to 1.28)). SJT score was not a statistically significant independent predictor of MRCS success. CONCLUSION This study has demonstrated the EPM's independent predictive power and found that medical school performance deciles are the most significant measure of predicting later success in the MRCS. These findings can be used by medical schools, training boards and workforce planners to inform evidence-based and contemporary selection and assessment strategies.
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Affiliation(s)
- Ricky Ellis
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
- Department of Urology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Duncan S G Scrimgeour
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
- Department of Colorectal Surgery, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Peter A Brennan
- Department of Maxillo-Facial Surgery, Queen Alexandra Hospital, Portsmouth, UK
| | - Amanda J Lee
- Department of Medical Statistics, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Jennifer Cleland
- Medical Education Research and Scholarship Unit (MERSU), Lee Kong Chian School of Medicine, Singapore
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12
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Shapey IM, Summers A, Khambalia H, Yiannoullou P, Fullwood C, Hanley NA, Augustine T, Rutter MK, van Dellen D. Donor insulin therapy in intensive care predicts early outcomes after pancreas transplantation. Diabetologia 2021; 64:1375-1384. [PMID: 33665687 PMCID: PMC8099796 DOI: 10.1007/s00125-021-05411-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 12/22/2020] [Indexed: 12/11/2022]
Abstract
AIMS/HYPOTHESIS Approximately 50% of organ donors develop hyperglycaemia in intensive care, which is managed with insulin therapy. We aimed to determine the relationships between donor insulin use (DIU) and graft failure in pancreas transplantation. METHODS UK Transplant Registry organ donor data were linked with national data from the UK solid pancreas transplant programme. All pancreas transplants performed between 2004 and 2016 with complete follow-up data were included. Logistic regression models determined associations between DIU and causes of graft failure within 3 months. Area under the receiver operating characteristic curve (aROC) and net reclassification improvement (NRI) assessed the added value of DIU as a predictor of graft failure. RESULTS In 2168 pancreas transplant recipients, 1112 (51%) donors were insulin-treated. DIU was associated with a higher risk of graft loss from isolated islet failure: OR (95% CI), 1.79 (1.05, 3.07), p = 0.03, and this relationship was duration/dose dependent. DIU was also associated with a higher risk of graft loss from anastomotic leak (2.72 [1.07, 6.92], p = 0.04) and a lower risk of graft loss from thrombosis (0.62 [0.39, 0.96], p = 0.03), although duration/dose-dependent relationships were only identified in pancreas transplant alone/pancreas after kidney transplant recipients with grafts failing due to thrombosis (0.86 [0.74, 0.99], p = 0.03). The relationships between donor insulin characteristics and isolated islet failure remained significant after adjusting for potential confounders: DIU 1.75 (1.02, 2.99), p = 0.04; duration 1.08 (1.01, 1.16), p = 0.03. In multivariable analyses, donor insulin characteristics remained significant predictors of lower risk of graft thrombosis in pancreas transplant alone/pancreas after kidney transplant recipients: DIU, 0.34 (0.13, 0.90), p = 0.03; insulin duration/dose, 0.02 (0.001, 0.85), p = 0.04. When data on insulin were added to models predicting isolated islet failure, a significant improvement in discrimination and risk reclassification was observed in all models: no DIU aROC 0.56; DIU aROC 0.57, p = 0.86; NRI 0.28, p < 0.00001; insulin duration aROC 0.60, p = 0.47; NRI 0.35, p < 0.00001. CONCLUSIONS/INTERPRETATION DIU predicts graft survival in pancreas transplant recipients. This assessment could help improve donor selection and thereby improve patient and graft outcomes.
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Affiliation(s)
- Iestyn M Shapey
- Faculty of Medicine, Biology and Health, University of Manchester, Manchester, UK.
- Department of Renal and Pancreatic Transplantation, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.
| | - Angela Summers
- Faculty of Medicine, Biology and Health, University of Manchester, Manchester, UK
- Department of Renal and Pancreatic Transplantation, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Hussein Khambalia
- Faculty of Medicine, Biology and Health, University of Manchester, Manchester, UK
- Department of Renal and Pancreatic Transplantation, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Petros Yiannoullou
- Faculty of Medicine, Biology and Health, University of Manchester, Manchester, UK
- Department of Renal and Pancreatic Transplantation, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Catherine Fullwood
- Department of Research and Innovation (Medical Statistics), Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Neil A Hanley
- Faculty of Medicine, Biology and Health, University of Manchester, Manchester, UK
| | - Titus Augustine
- Faculty of Medicine, Biology and Health, University of Manchester, Manchester, UK
- Department of Renal and Pancreatic Transplantation, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Martin K Rutter
- Faculty of Medicine, Biology and Health, University of Manchester, Manchester, UK
- Manchester Diabetes Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - David van Dellen
- Faculty of Medicine, Biology and Health, University of Manchester, Manchester, UK
- Department of Renal and Pancreatic Transplantation, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
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National Audit of Small Bowel Obstruction Steering Group and National Audit of Small Bowel Obstruction Collaborators., NASBO Steering Group., NASBO Collaborators., West Midlands Research Collaborative. Outcomes of obstructed abdominal wall hernia: results from the UK national small bowel obstruction audit. BJS Open 2020; 4:924-34. [PMID: 32648645 DOI: 10.1002/bjs5.50315] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 05/26/2020] [Indexed: 12/21/2022] Open
Abstract
Background Abdominal wall hernia is a common surgical condition. Patients may present in an emergency with bowel obstruction, incarceration or strangulation. Small bowel obstruction (SBO) is a serious surgical condition associated with significant morbidity. The aim of this study was to describe current management and outcomes of patients with obstructed hernia in the UK as identified in the National Audit of Small Bowel Obstruction (NASBO). Methods NASBO collated data on adults treated for SBO at 131 UK hospitals between January and March 2017. Those with obstruction due to abdominal wall hernia were included in this study. Demographics, co‐morbidity, imaging, operative treatment, and in‐hospital outcomes were recorded. Modelling for factors associated with mortality and complications was undertaken using Cox proportional hazards and multivariable regression modelling. Results NASBO included 2341 patients, of whom 415 (17·7 per cent) had SBO due to hernia. Surgery was performed in 312 (75·2 per cent) of the 415 patients; small bowel resection was required in 198 (63·5 per cent) of these operations. Non‐operative management was reported in 35 (54 per cent) of 65 patients with a parastomal hernia and in 34 (32·1 per cent) of 106 patients with an incisional hernia. The in‐hospital mortality rate was 9·4 per cent (39 of 415), and was highest in patients with a groin hernia (11·1 per cent, 17 of 153). Complications were common, including lower respiratory tract infection in 16·3 per cent of patients with a groin hernia. Increased age was associated with an increased risk of death (hazard ratio 1·05, 95 per cent c.i. 1·01 to 1·10; P = 0·009) and complications (odds ratio 1·05, 95 per cent c.i. 1·02 to 1·09; P = 0·001). Conclusion NASBO has highlighted poor outcomes for patients with SBO due to hernia, highlighting the need for quality improvement initiatives in this group.
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Minty G, Hoppen A, Boehm I, Alhindi A, Gibb L, Potter E, Wagner BC, Miller J, Skipworth RJE, Gillingwater TH, Jones RA. aNMJ-morph: a simple macro for rapid analysis of neuromuscular junction morphology. R Soc Open Sci 2020; 7:200128. [PMID: 32431902 PMCID: PMC7211862 DOI: 10.1098/rsos.200128] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 03/23/2020] [Indexed: 06/11/2023]
Abstract
Large-scale data analysis of synaptic morphology is becoming increasingly important to the field of neurobiological research (e.g. 'connectomics'). In particular, a detailed knowledge of neuromuscular junction (NMJ) morphology has proven to be important for understanding the form and function of synapses in both health and disease. The recent introduction of a standardized approach to the morphometric analysis of the NMJ-'NMJ-morph'-has provided the first common software platform with which to analyse and integrate NMJ data from different research laboratories. Here, we describe the design and development of a novel macro-'automated NMJ-morph' or 'aNMJ-morph'-to update and streamline the original NMJ-morph methodology. ImageJ macro language was used to encode the complete NMJ-morph workflow into seven navigation windows that generate robust data for 19 individual pre-/post-synaptic variables. The aNMJ-morph scripting was first validated against reference data generated by the parent workflow to confirm data reproducibility. aNMJ-morph was then compared with the parent workflow in large-scale data analysis of original NMJ images (240 NMJs) by multiple independent investigators. aNMJ-morph conferred a fourfold increase in data acquisition rate compared with the parent workflow, with average analysis times reduced to approximately 1 min per NMJ. Strong concordance was demonstrated between the two approaches for all 19 morphological variables, confirming the robust nature of aNMJ-morph. aNMJ-morph is a freely available and easy-to-use macro for the rapid and robust analysis of NMJ morphology and offers significant improvements in data acquisition and learning curve compared to the original NMJ-morph workflow.
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Affiliation(s)
- Gavin Minty
- Edinburgh Medical School: Biomedical Sciences (Anatomy), University of Edinburgh, Edinburgh EH8 9AG, UK
- Euan MacDonald Centre for Motor Neurone Disease Research, University of Edinburgh, Edinburgh EH8 9AG, UK
| | - Alex Hoppen
- RWTH Aachen University, 52062 Aachen, Germany
| | - Ines Boehm
- Edinburgh Medical School: Biomedical Sciences (Anatomy), University of Edinburgh, Edinburgh EH8 9AG, UK
- Euan MacDonald Centre for Motor Neurone Disease Research, University of Edinburgh, Edinburgh EH8 9AG, UK
| | - Abrar Alhindi
- Edinburgh Medical School: Biomedical Sciences (Anatomy), University of Edinburgh, Edinburgh EH8 9AG, UK
- Euan MacDonald Centre for Motor Neurone Disease Research, University of Edinburgh, Edinburgh EH8 9AG, UK
| | - Larissa Gibb
- Edinburgh Medical School: Biomedical Sciences (Anatomy), University of Edinburgh, Edinburgh EH8 9AG, UK
- Euan MacDonald Centre for Motor Neurone Disease Research, University of Edinburgh, Edinburgh EH8 9AG, UK
| | - Ellie Potter
- Edinburgh Medical School: Biomedical Sciences (Anatomy), University of Edinburgh, Edinburgh EH8 9AG, UK
- Euan MacDonald Centre for Motor Neurone Disease Research, University of Edinburgh, Edinburgh EH8 9AG, UK
| | - Boris C. Wagner
- Edinburgh Medical School: Biomedical Sciences (Anatomy), University of Edinburgh, Edinburgh EH8 9AG, UK
- Euan MacDonald Centre for Motor Neurone Disease Research, University of Edinburgh, Edinburgh EH8 9AG, UK
| | - Janice Miller
- Clinical Surgery, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, EH16 4SA, UK
| | - Richard J. E. Skipworth
- Clinical Surgery, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, EH16 4SA, UK
| | - Thomas H. Gillingwater
- Edinburgh Medical School: Biomedical Sciences (Anatomy), University of Edinburgh, Edinburgh EH8 9AG, UK
- Euan MacDonald Centre for Motor Neurone Disease Research, University of Edinburgh, Edinburgh EH8 9AG, UK
| | - Ross A. Jones
- Edinburgh Medical School: Biomedical Sciences (Anatomy), University of Edinburgh, Edinburgh EH8 9AG, UK
- Euan MacDonald Centre for Motor Neurone Disease Research, University of Edinburgh, Edinburgh EH8 9AG, UK
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Hoeritzauer I, Pronin S, Carson A, Statham P, Demetriades AK, Stone J. The clinical features and outcome of scan-negative and scan-positive cases in suspected cauda equina syndrome: a retrospective study of 276 patients. J Neurol 2018; 265:2916-2926. [PMID: 30298195 PMCID: PMC6244667 DOI: 10.1007/s00415-018-9078-2] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 09/17/2018] [Accepted: 09/30/2018] [Indexed: 12/24/2022]
Abstract
BACKGROUND The majority of patients presenting with suspected clinical cauda equina syndrome (CES) have no identifiable structural cause for their symptoms ('scan-negative' CES). Understanding these patients aids clinical differentiation and management in CES. METHODS A retrospective electronic note review was undertaken of patients presenting with suspected CES, defined as ≥ 1 of acute bladder, bowel, sexual dysfunction or saddle numbness, to a regional neurosciences centre. We investigated radiology, clinical features, psychiatric and functional disorder comorbidities and outcome of patients with 'scan-negative' CES and patients with MRI confirmed compression of the cauda equina ('scan-positive' CES). RESULTS 276 patients were seen over 16 months. There were three main radiologically defined patient groups: (1) 'scan-positive' CES (n = 78, mean age 48 years, 56% female), (2) 'scan-negative' CES without central canal stenosis but with lumbosacral nerve root compression not explaining the clinical presentation (n = 87, mean age 43 years, 68% female) and (3) 'scan-negative' CES without neural compromise (n = 104, mean age 42 years, 70% female). In the two 'scan-negative' groups (no neural compromise and nerve root compression), there were higher rates of functional disorders (37% and 29% vs. 9%), functional neurological disorders (12% and 11% vs 0%) and psychiatric comorbidity (53% and 40% vs 20%). On follow-up (mean 13-16 months), only 1 of the 191 patients with 'scan-negative' CES was diagnosed with an explanatory neurological disorder (transverse myelitis). CONCLUSIONS The data support a model in which scan-negative cauda equina syndrome arises as an end pathway of acute pain, sometimes with partly structural findings and vulnerability to functional disorders.
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Affiliation(s)
- Ingrid Hoeritzauer
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
- Department of Clinical Neurosciences, Western General Hospital, Edinburgh, EH4 2XU UK
- Edinburgh Spinal Surgery Outcome Studies Group, Edinburgh, UK
| | - Savva Pronin
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
- Edinburgh Spinal Surgery Outcome Studies Group, Edinburgh, UK
| | - Alan Carson
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
- Department of Clinical Neurosciences, Western General Hospital, Edinburgh, EH4 2XU UK
- Department of Rehabilitation Medicine, NHS Lothian, Edinburgh, UK
| | - Patrick Statham
- Department of Clinical Neurosciences, Western General Hospital, Edinburgh, EH4 2XU UK
- Department of Neurosurgery, Western General Hospital, Edinburgh, EH4 2XU UK
- Edinburgh Spinal Surgery Outcome Studies Group, Edinburgh, UK
| | - Andreas K. Demetriades
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
- Department of Clinical Neurosciences, Western General Hospital, Edinburgh, EH4 2XU UK
- Department of Neurosurgery, Western General Hospital, Edinburgh, EH4 2XU UK
- Edinburgh Spinal Surgery Outcome Studies Group, Edinburgh, UK
| | - Jon Stone
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
- Department of Clinical Neurosciences, Western General Hospital, Edinburgh, EH4 2XU UK
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Abstract
BACKGROUND The Basic Surgical Skills (BSS) course is a common component of postgraduate surgical training programmes in sub-Saharan Africa, but was originally designed in a UK context, and its efficacy and relevance have not been formally assessed in Africa. METHODS An observational study was carried out during a BSS course delivered to early-stage surgical trainees from Rwanda and the Democratic Republic of the Congo. Technical skill in a basic wound closure task was assessed in a formal Objective Structured Assessment of Technical Skills (OSAT) before and after course completion. Participants completed a pre-course questionnaire documenting existing surgical experience and self-perceived confidence levels in surgical skills which were to be taught during the course. Participants repeated confidence ratings and completed course evaluation following course delivery. RESULTS A cohort of 17 participants had completed a pre-course median of 150 Caesarean sections as primary operator. Performance on the OSAT improved from a mean of 10.5/17 pre-course to 14.2/17 post-course (mean of paired differences 3.7, p < 0.001). Improvements were seen in 15/17 components of wound closure. Pre-course, only 47% of candidates were forming hand-tied knots correctly and 38% were appropriately crossing hands with each throw, improving to 88 and 76%, respectively, following the course (p = 0.01 for both components). Confidence levels improved significantly in all technical skills taught, and the course was assessed as highly relevant by trainees. CONCLUSION The Basic Surgical Skills course is effective in improving the basic surgical technique of surgical trainees from sub-Saharan Africa and their confidence in key technical skills.
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Affiliation(s)
| | | | - Georges Ntakiyiruta
- Ejo Heza Surgical Centre, KN 25, St 9, Kiyovu Sector, Nyarugenge District, Ishema Village, Kigali, Rwanda
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Lee MJ, Sayers AE, Drake TM, Hollyman M, Bradburn M, Hind D, Wilson TR, Fearnhead NS. UK-based, multisite, prospective cohort study of small bowel obstruction in acute surgical services: National Audit of Small Bowel Obstruction (NASBO) protocol. BMJ Open 2017; 7:e016796. [PMID: 28982819 PMCID: PMC5640021 DOI: 10.1136/bmjopen-2017-016796] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION Small bowel obstruction (SBO) is a common indication for emergency laparotomy in the UK, which is associated with a 90-day mortality rate of 13%. There are currently no UK clinical guidelines for the management of this condition. The aim of this multicentre prospective cohort study is to describe the burden, variation in management and associated outcomes of SBO in the UK adult population. METHODS AND ANALYSIS UK hospitals providing emergency general surgery are eligible to participate. This study has three components: (1) a clinical preference questionnaire to be completed by consultants providing emergency general surgical care to assesses preferences in diagnostics and therapeutic approaches, including laparoscopy and nutritional interventions; (2) site resource profile questionnaire to indicate ease of access to diagnostic services, operating theatres, nutritional support teams and postoperative support including intensive care; (3) prospective cohort study of all cases of SBO admitted during an 8-week period at participating trusts. Data on diagnostics, operative and nutritional interventions, and in-hospital mortality and morbidity will be captured, followed by data validation. ETHICS AND DISSEMINATION This will be conducted as a national audit of practice in conjunction with trainee research collaboratives, with support from patient representatives, surgeons, anaesthetists, gastroenterologists and a clinical trials unit. Site-specific reports will be provided to each participant site as well as an overall report to be disseminated through specialist societies. Results will be published in a formal project report endorsed by stakeholders, and in peer-reviewed scientific reports. Key findings will be debated at a focused national meeting with a view to quality improvement initiatives.
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Affiliation(s)
- Matthew J Lee
- Department of General Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, South Yorkshire, UK
- South Yorkshire Surgical Research Group, Sheffield, UK
| | - Adele E Sayers
- South Yorkshire Surgical Research Group, Sheffield, UK
- Department of General Surgery, Mid-Yorkshire NHS Trust, Wakefield, UK
| | - Thomas M Drake
- South Yorkshire Surgical Research Group, Sheffield, UK
- Department of Clinical Surgery, University of Edinburgh, Edinburgh, UK
| | - Marianne Hollyman
- Department of General Surgery, North Bristol NHS Trust, Bristol, UK
- Severn and Peninsula Audit and Research Collaborative, Bristol, UK
| | - Mike Bradburn
- Clinical Trials Research Unit, School of Health and Related Research, Sheffield, UK
| | - Daniel Hind
- Clinical Trials Research Unit, School of Health and Related Research, Sheffield, UK
| | - Timothy R Wilson
- Department of General Surgery, Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust, Doncaster, UK
- Association of Coloproctology of Great Britain and Ireland, London, UK
| | - Nicola S Fearnhead
- Association of Coloproctology of Great Britain and Ireland, London, UK
- Department of Colorectal Surgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, Cambridgeshire, UK
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