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Kovoor JG, Bacchi S, Nann SD, Luo Y, Stretton B, Gupta AK, Zaka A, Warren LR, Clarke JM, Gluck S, Vanlint AS, Chan W, Marshall-Webb M. All Aboard: Towards Standardisation of Surgical Resident Onboarding. J Surg Educ 2024; 81:769-771. [PMID: 38658311 DOI: 10.1016/j.jsurg.2024.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 03/02/2024] [Indexed: 04/26/2024]
Affiliation(s)
- Joshua G Kovoor
- Ballarat Base Hospital, Ballarat, Australia; The University of Adelaide, Adelaide, Australia; Health and Information, Australia.
| | - Stephen Bacchi
- Health and Information, Australia; Lyell McEwin Hospital, Adelaide, Australia; Flinders University, Adelaide, Australia
| | - Silas D Nann
- Health and Information, Australia; Gold Coast University Hospital, Gold Coast, Australia
| | - Yuchen Luo
- Health and Information, Australia; Austin Health, Melbourne, Australia
| | - Brandon Stretton
- The University of Adelaide, Adelaide, Australia; Health and Information, Australia; Royal Adelaide Hospital, Adelaide, Australia
| | - Aashray K Gupta
- The University of Adelaide, Adelaide, Australia; Health and Information, Australia; Royal North Shore Hospital, Sydney, Australia
| | - Ammar Zaka
- Health and Information, Australia; Gold Coast University Hospital, Gold Coast, Australia
| | - Leigh R Warren
- The University of Adelaide, Adelaide, Australia; Royal Adelaide Hospital, Adelaide, Australia
| | | | - Samuel Gluck
- The University of Adelaide, Adelaide, Australia; Health and Information, Australia; Lyell McEwin Hospital, Adelaide, Australia
| | - Andrew S Vanlint
- The University of Adelaide, Adelaide, Australia; Health and Information, Australia; Lyell McEwin Hospital, Adelaide, Australia
| | - WengOnn Chan
- The University of Adelaide, Adelaide, Australia; The Queen Elizabeth Hospital, Adelaide, Australia
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Goh R, Bacchi S, Kovoor JG, Gupta AK, Tan S, Stretton B, Ovenden CD, To MS, Moey A, Schultz D, Li JY, Juneja R, Kleinig T, Jannes J. Renal disease is not associated with delays in hyperacute stroke management in South Australia. Emerg Med Australas 2024; 36:479-481. [PMID: 38374542 DOI: 10.1111/1742-6723.14378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 01/18/2024] [Accepted: 02/01/2024] [Indexed: 02/21/2024]
Abstract
OBJECTIVE The aims of the present study were to determine how renal disease is associated with the time to receive hyperacute stroke care. METHODS The present study involved a 5-year cohort of all patients admitted to stroke units in South Australia. RESULTS In those with pre-existing renal disease there were no significant differences in the time taken to receive a scan, thrombolysis or endovascular thrombectomy. CONCLUSIONS The present study shows that in protocolised settings there were no significant delays in hyperacute stroke management for patients with renal disease.
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Affiliation(s)
- Rudy Goh
- Lyell McEwin Hospital, Adelaide, South Australia, Australia
- University of Adelaide, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Stephen Bacchi
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Flinders University College of Medicine and Public Health, Adelaide, South Australia, Australia
| | - Joshua G Kovoor
- University of Adelaide, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Aashray K Gupta
- University of Adelaide, Adelaide, South Australia, Australia
- Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Sheryn Tan
- University of Adelaide, Adelaide, South Australia, Australia
| | - Brandon Stretton
- University of Adelaide, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Christopher D Ovenden
- University of Adelaide, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Minh-Son To
- Flinders University College of Medicine and Public Health, Adelaide, South Australia, Australia
| | - Andrew Moey
- Lyell McEwin Hospital, Adelaide, South Australia, Australia
| | - David Schultz
- Flinders University College of Medicine and Public Health, Adelaide, South Australia, Australia
| | - Jordan Y Li
- Flinders University College of Medicine and Public Health, Adelaide, South Australia, Australia
- Department of Renal Medicine, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Rajiv Juneja
- Flinders University College of Medicine and Public Health, Adelaide, South Australia, Australia
- Department of Renal Medicine, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Timothy Kleinig
- University of Adelaide, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Jim Jannes
- University of Adelaide, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
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Gupta AK, Bacchi S, Kovoor JG, Jiang M, Stretton B, Zaka A, He C, Vallely MP, Kovoor P, Bennetts JS, Maddern GJ. Re: "Rates and risk factors for persistent opioid use after cardiothoracic surgery: A cohort study". Surgery 2024:S0039-6060(24)00273-3. [PMID: 38760233 DOI: 10.1016/j.surg.2024.04.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 04/13/2024] [Accepted: 04/16/2024] [Indexed: 05/19/2024]
Affiliation(s)
- Aashray K Gupta
- University of Adelaide, Adelaide, Australia; Gold Coast University Hospital, Southport, Australia.
| | - Stephen Bacchi
- University of Adelaide, Adelaide, Australia; Flinders University, Adelaide, Australia; Royal Adelaide Hospital, Adelaide, Australia
| | - Joshua G Kovoor
- University of Adelaide, Adelaide, Australia; Royal Adelaide Hospital, Adelaide, Australia
| | | | | | - Ammar Zaka
- Gold Coast University Hospital, Southport, Australia
| | - Cheng He
- Gold Coast University Hospital, Southport, Australia
| | | | - Pramesh Kovoor
- Department of Cardiology, Westmead Hospital, Westmead, Australia
| | - Jayme S Bennetts
- Flinders University, Adelaide, Australia; Flinders Medical Centre, Adelaide, Australia
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Zaka A, Mutahar D, Ponen K, Abtahi J, Mridha N, Williams AB, Kamali M, Kovoor JG, Bacchi S, Gupta AK, Psaltis PJ, Bhamidipaty V. Prognostic value of left ventricular systolic function before vascular surgery: a systematic review. ANZ J Surg 2024; 94:826-832. [PMID: 38305060 DOI: 10.1111/ans.18866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 12/21/2023] [Accepted: 01/08/2024] [Indexed: 02/03/2024]
Abstract
BACKGROUND Vascular surgery carries a high risk of post-operative cardiac complications. Recent studies have shown an association between asymptomatic left ventricular systolic dysfunction and increased risk of major adverse cardiovascular events (MACE). This systematic review aims to evaluate the prognostic value of left ventricular function as determined by left ventricular ejection fraction (LVEF) measured by resting echocardiography before vascular surgery. METHODS This review conformed to PRISMA and MOOSE guidelines. PubMed, OVID Medline and Cochrane databases were searched from inception to 27 October 2022. Eligible studies assessed vascular surgery patients, with multivariable-adjusted or propensity-matched observational studies measuring LVEF via resting echocardiography and providing risk estimates for outcomes. The primary outcomes measures were all-cause mortality and congestive heart failure at 30 days. Secondary outcome included the composite outcome MACE. RESULTS Ten observational studies were included (4872 vascular surgery patients). Studies varied widely in degree of left ventricular systolic dysfunction, symptom status, and outcome reporting, precluding reliable meta-analysis. Available data demonstrated a trend towards increased incidence of all-cause mortality, congestive heart failure and MACE in patients with pre-operative LVEF <50%. Methodological quality of the included studies was found to be of moderate quality according to the Newcastle Ottawa Checklist. CONCLUSION The evidence surrounding the prognostic value of LVEF measurement before vascular surgery is currently weak and inconclusive. Larger scale, prospective studies are required to further refine cardiac risk prediction before vascular surgery.
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Affiliation(s)
- Ammar Zaka
- Department of Cardiology, Department of Vascular Surgery, Gold Coast University Hospital, Gold Coast, Queensland, Australia
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Daud Mutahar
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Kreyen Ponen
- Department of Cardiology, Department of Vascular Surgery, Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Johayer Abtahi
- Department of Cardiology, Department of Vascular Surgery, Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Naim Mridha
- Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Aman B Williams
- Department of Cardiology, Department of Vascular Surgery, Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Mohammed Kamali
- Department of Cardiology, Department of Vascular Surgery, Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Joshua G Kovoor
- Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
| | - Stephen Bacchi
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Aashray K Gupta
- Department of Cardiology, Department of Vascular Surgery, Gold Coast University Hospital, Gold Coast, Queensland, Australia
- Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
| | - Peter J Psaltis
- Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
- Lifelong Health Theme, South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Venu Bhamidipaty
- Department of Cardiology, Department of Vascular Surgery, Gold Coast University Hospital, Gold Coast, Queensland, Australia
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Daniel J, Glynatsis JM, Kovoor JG, Stretton B, Bacchi S, Ovenden CD, To MS, Goh R, Hewitt JN, Sahota RS, Chan JCY, Ramponi F, Krishnan G, Gupta AK. Sensorineural hearing loss after cardiac surgery: a systematic review. ANZ J Surg 2024; 94:536-544. [PMID: 37872745 DOI: 10.1111/ans.18742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 06/19/2023] [Accepted: 10/02/2023] [Indexed: 10/25/2023]
Abstract
BACKGROUND Sensorineural hearing loss (SNHL) may occur following cardiac surgery. Although preventing post-operative complications is vitally important in cardiac surgery, there are few guidelines regarding this issue. This review aimed to characterize SNHL after cardiac surgery. METHOD This systematic review was registered on PROSPERO and conducted in accordance with PRISMA guidelines. A systematic search of the PubMed, Embase and Cochrane Library were conducted from inception. Eligibility determination, data extraction and methodological quality analysis were conducted in duplicate. RESULTS There were 23 studies included in the review. In the adult population, there were six cohort studies, which included 36 cases of hearing loss in a total of 7135 patients (5.05 cases per 1000 operations). In seven cohort studies including paediatric patients, there were 88 cases of hearing loss in a total of 1342 operations. The majority of cases of hearing loss were mild in the adult population (56.6%). In the paediatric population 59.2% of hearing loss cases had moderate or worse hearing loss. The hearing loss most often affected the higher frequencies, over 6000 Hz. There have been studies indicating an association between hearing loss and extracorporeal circulation, but cases have also occurred without this intervention. CONCLUSION SNHL is a rare but potentially serious complication after cardiac surgery. This hearing loss affects both paediatric and adult populations and may have significant long-term impacts. Further research is required, particularly with respect to the consideration of screening for SNHL in children after cardiac surgery.
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Affiliation(s)
- Jonathan Daniel
- Discipline of Surgery, University of Adelaide, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - John M Glynatsis
- Discipline of Surgery, University of Adelaide, Adelaide, South Australia, Australia
- Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Joshua G Kovoor
- Discipline of Surgery, University of Adelaide, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
- The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
| | - Brandon Stretton
- Discipline of Surgery, University of Adelaide, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Stephen Bacchi
- Discipline of Surgery, University of Adelaide, Adelaide, South Australia, Australia
- Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Christopher D Ovenden
- Discipline of Surgery, University of Adelaide, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Minh-Son To
- Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Rudy Goh
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Joseph N Hewitt
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | | | - Justin C Y Chan
- Discipline of Surgery, University of Adelaide, Adelaide, South Australia, Australia
- NYU Langone, New York City, New York, USA
| | - Fabio Ramponi
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Giri Krishnan
- Discipline of Surgery, University of Adelaide, Adelaide, South Australia, Australia
| | - Aashray K Gupta
- Discipline of Surgery, University of Adelaide, Adelaide, South Australia, Australia
- Gold Coast University Hospital, Southport, Queensland, Australia
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Sutaoney P, Rai SN, Sinha S, Choudhary R, Gupta AK, Singh SK, Banerjee P. Current perspective in research and industrial applications of microbial cellulases. Int J Biol Macromol 2024; 264:130639. [PMID: 38453122 DOI: 10.1016/j.ijbiomac.2024.130639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 01/12/2024] [Accepted: 03/03/2024] [Indexed: 03/09/2024]
Abstract
The natural interactions between various bacteria, fungi, and other cellulolytic microorganisms destroy lignocellulosic polymers. The efficacy of this process is determined by the combined action of three main enzymes: endoglucanases, exo-glucanases, and β-glucosidase. The enzyme attacks the polymeric structure's β-1,4-linkages during the cellulose breakdown reaction. This mechanism is crucial for the environment as it recycles cellulose in the biosphere. However, there are problems with enzymatic cellulose breakdown, including complex cellulase structure, insufficient degradation efficacy, high production costs, and post-translational alterations, many of which are closely related to certain unidentified cellulase properties. These issues impede the practical use of cellulases. A developing area of research is the application of this similar paradigm for industrial objectives. Cellulase enzyme exhibits greater promise in many critical industries, including biofuel manufacture, textile smoothing and finishing, paper and pulp manufacturing, and farming. However, the study on cellulolytic enzymes must move forward in various directions, including increasing the activity of cellulase as well as designing peptides to give biocatalysts their desired attributes. This manuscript includes an overview of current research on different sources of cellulases, their production, and biochemical characterization.
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Affiliation(s)
- Priya Sutaoney
- Present address-Department of Microbiology, Kalinga University, Raipur 492101, Chhattisgarh, India; Microbiology Laboratory, School of Studies in Life Science, Pt. Ravishankar Shukla University, Raipur 492010, Chhattisgarh, India
| | - Sachchida Nand Rai
- Centre of Experimental Medicine and Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi 221005, India
| | - Sakshi Sinha
- Present address-Department of Microbiology, Kalinga University, Raipur 492101, Chhattisgarh, India
| | - Rachana Choudhary
- Department of Microbiology, Shri Shankaracharya Mahavidyalaya, Junwani, Durg 490005, Chhattisgarh, India
| | - A K Gupta
- Microbiology Laboratory, School of Studies in Life Science, Pt. Ravishankar Shukla University, Raipur 492010, Chhattisgarh, India
| | - Santosh Kumar Singh
- Centre of Experimental Medicine and Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi 221005, India.
| | - Paromita Banerjee
- Department of Cardiology, All India Institute of Medical Sciences, Rishikesh, 249203, Uttarakhand, India.
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Kovoor JG, Ittimani C, Godber H, Herath A, Ovenden M, Ovenden CD, Hewitt JN, Zaka A, Ittimani M, Marshall-Webb M, Gupta AK, Stretton B, Bacchi S. No shortcuts: False economy prevention during artificial intelligence implementation in rural Australian health care. Aust J Rural Health 2024; 32:408-410. [PMID: 38506496 DOI: 10.1111/ajr.13104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 02/27/2024] [Accepted: 03/04/2024] [Indexed: 03/21/2024] Open
Affiliation(s)
- Joshua G Kovoor
- Ballarat Base Hospital, Ballarat, Victoria, Australia
- University of Adelaide, Adelaide, South Australia, Australia
- Health and Information, Australia
| | | | - Harry Godber
- Spark Festival, Sydney, New South Wales, Australia
| | - Asith Herath
- Fox Sports Australia, Sydney, New South Wales, Australia
| | - Morgan Ovenden
- University of Adelaide, Adelaide, South Australia, Australia
| | | | - Joseph N Hewitt
- Wagga Wagga Base Hospital, Wagga Wagga, New South Wales, Australia
| | - Ammar Zaka
- Health and Information, Australia
- Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Mana Ittimani
- Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- University of Sydney, Sydney, New South Wales, Australia
| | | | - Aashray K Gupta
- University of Adelaide, Adelaide, South Australia, Australia
- Health and Information, Australia
- Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Brandon Stretton
- University of Adelaide, Adelaide, South Australia, Australia
- Health and Information, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Stephen Bacchi
- Health and Information, Australia
- Lyell McEwin Hospital, Adelaide, South Australia, Australia
- Flinders University, Adelaide, South Australia, Australia
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Bacchi S, Kovoor JG, Goh R, Gupta AK, Tan S, Ovenden CD, To MS, Moey A, Sanders P, Chew DP, Schultz D, Kovoor P, Kleinig T, Jannes J. Pre-stroke anticoagulation for atrial fibrillation in primary English speakers and non-primary English speakers: a multicentre retrospective cohort study. Intern Med J 2024; 54:620-625. [PMID: 37860995 DOI: 10.1111/imj.16253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 09/16/2023] [Indexed: 10/21/2023]
Abstract
BACKGROUND Anticoagulation can prevent most strokes in individuals with atrial fibrillation (AF); however, many people presenting with stroke and known AF are not anticoagulated. Language barriers and poor health literacy have previously been associated with decreased patient medication adherence. The association between language barriers and initiation of anticoagulation therapy for AF is uncertain. AIMS The aims of this study were to determine whether demographic factors, including non-English primary language, were (1) associated with not being initiated on anticoagulation for known AF prior to admission with stroke, and (2) associated with non-adherence to anticoagulation in the setting of known AF prior to admission with stroke. METHODS A multicentre retrospective cohort study was conducted for consecutive individuals admitted to the three South Australian tertiary hospitals with stroke units over a 5-year period. RESULTS There were 6829 individuals admitted with stroke. These cases included 5835 ischaemic stroke patients, 1333 of whom had pre-existing AF. Only 40.0% presenting with ischaemic stroke in the setting of known pre-existing AF were anticoagulated. When controlling for demographics, socioeconomic status and past medical history (including the components of the CHADS2VASC score and anticoagulation contraindications), having a primary language other than English was associated with a lower likelihood of having been commenced on anticoagulant for known pre-stroke AF (odds ratio: 0.52, 95% confidence interval: 0.36-0.77, P = 0.001), but was not associated with a differing likelihood of anticoagulation adherence. CONCLUSIONS A significant proportion of patients with stroke have pre-existing unanticoagulated AF; these rates are substantially higher if the primary language is other than English. Targeted research and interventions to minimise evidence-treatment gaps in this cohort may significantly reduce stroke burden.
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Affiliation(s)
- Stephen Bacchi
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
- University of Adelaide, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Joshua G Kovoor
- University of Adelaide, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Rudy Goh
- University of Adelaide, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Lyell McEwin Hospital, Adelaide, South Australia, Australia
| | - Aashray K Gupta
- University of Adelaide, Adelaide, South Australia, Australia
- Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Sheryn Tan
- University of Adelaide, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Christopher D Ovenden
- University of Adelaide, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Minh-Son To
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Andrew Moey
- Lyell McEwin Hospital, Adelaide, South Australia, Australia
| | - Prashanthan Sanders
- University of Adelaide, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Derek P Chew
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - David Schultz
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Pramesh Kovoor
- Westmead Private Hospital, Sydney, New South Wales, Australia
| | - Timothy Kleinig
- University of Adelaide, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Jim Jannes
- University of Adelaide, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
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Wilson-Smith AR, Wilson-Smith CJ, Smith JS, Ng D, Muston BT, Eranki A, Williams ML, Ussher N, Gupta AK. The outcomes of concomitant catheter ablation in non-mitral valve cardiac surgery-a systematic review and meta-analysis of the literature. Ann Cardiothorac Surg 2024; 13:108-116. [PMID: 38590993 PMCID: PMC10998963 DOI: 10.21037/acs-2023-afm-17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 01/17/2024] [Indexed: 04/10/2024]
Abstract
Background Atrial fibrillation (AF) is the most common form of cardiac arrythmia, with a key importance in the perioperative setting of cardiac surgery. In recent years, the question as to whether pre-existent AF should be treated concomitantly when undergoing cardiac surgery has been heatedly debated. This systematic review and meta-analysis sought to delineate the outcomes of patients undergoing concomitant AF ablation procedures alongside cardiac surgery. Methods The methods for this systematic review and meta-analysis adhered to the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement. Four databases were searched, ultimately yielding 22 papers for inclusion, using appropriate search terminology. Meta-analysis using proportions or means, as appropriate, were applied. Kaplan-Meier curves were digitized and aggregated using previously reported and validated techniques. Results A total of 9,428 patients (67% male) were identified across the study period as having received non-mitral cardiac surgery and concomitant AF ablation procedures. On actuarial assessment, freedom from AF was found to be 93%, 88%, 85%, 82%, and 79% at 1 through to 5 years, respectively. Freedom from mortality was found to be 94%, 93%, 91%, 90%, and 87% at 1 through to 5 years, respectively. Conclusions This review demonstrated excellent freedom from AF out to a long-term follow-up of 5 years. Freedom from mortality was also encouraging. Emerging data are increasingly illustrating that in this patient cohort, concurrent treatment of pre-existent AF with cardiac and/or valvular disease at the point of operation should be the standard of care. Robust data in the form of randomized control trials will hopefully solidify this assertion.
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Affiliation(s)
- Ashley R. Wilson-Smith
- Chris O’Brien Lifehouse Center, Sydney, Australia
- Collaborative Research Group (CORE), Sydney, Australia
- Hunter Medical Research Institute (HMRI), Newcastle, Australia
- University of New South Wales Medical School, Sydney, Australia
- Royal Prince Alfred Hospital, Camperdown, Sydney, Australia
- University of Sydney, Camperdown, Australia
- Macquarie University, Sydney, Australia
| | | | | | - Dominic Ng
- Royal Prince Alfred Hospital, Camperdown, Sydney, Australia
| | - Benjamin T. Muston
- Collaborative Research Group (CORE), Sydney, Australia
- University of New South Wales Medical School, Sydney, Australia
| | - Aditya Eranki
- Collaborative Research Group (CORE), Sydney, Australia
- Royal Prince Alfred Hospital, Camperdown, Sydney, Australia
| | | | - Nathan Ussher
- Royal Prince Alfred Hospital, Camperdown, Sydney, Australia
| | - Aashray K. Gupta
- University of Adelaide, Adelaide, Australia
- Prince of Wales Hospital, Sydney, Australia
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Eranki A, Muston B, Ng D, Wilson-Smith AR, Gupta AK. Atrial fibrillation ablation during robotic mitral valve surgery: a systematic review and meta-analysis. Ann Cardiothorac Surg 2024; 13:117-125. [PMID: 38590987 PMCID: PMC10998967 DOI: 10.21037/acs-2023-afm-20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 02/13/2024] [Indexed: 04/10/2024]
Abstract
Background Atrial fibrillation (AF) is the most common arrhythmia, and is also associated with mitral valve disease. Although the benefits of robotic mitral valve surgery are well documented, literature combining robotic mitral valve surgery with AF surgery remains sparse. The aim of this systematic review and meta-analysis is to evaluate the evidence assessing the efficacy and safety of AF ablation during robotic mitral valve surgery. Methods Five electronic databases were searched from inception to April 2023. All studies reporting the primary outcome, freedom from AF, for patients with a history of AF undergoing robotic mitral valve surgery and AF ablation were identified. Studies which included mixed cohorts, or patients who did not undergo robotic mitral valve surgery were excluded. Relevant data were extracted and a meta-analysis of proportions was conducted using a random-effects model. Results Five studies were included with a total of 241 patients. Cohort sizes ranged from 11 to 94 patients. The aggregate mean age was 58.5 years and patients had persistent AF (71.1%). All five studies utilised the da Vinci® Surgical System, and performed variable lesion sets. The freedom from AF was 88.1% at a weighted mean follow-up of 6.9 months. There were two mortalities (0.8%), two patients required conversion to sternotomy (1.4%) and eight required a permanent pacemaker (3.7%). Conclusions AF ablation with robotic mitral valve surgery can be performed with adequate short-term efficacy and safety profile. Current evidence on AF ablation and robotic mitral valve surgery is limited to low-quality retrospective data with inherent selection bias. Further large-scale prospective data is required to verify these results.
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Affiliation(s)
- Aditya Eranki
- Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, Australia
| | - Benjamin Muston
- School of Medicine and Surgery, University of New South Wales, Sydney, Australia
| | - Dominic Ng
- Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, Australia
| | - Ashley R. Wilson-Smith
- Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, Australia
- School of Medicine and Surgery, University of Sydney, Sydney, Australia
| | - Aashray K. Gupta
- Department of Cardiothoracic Surgery, Prince of Wales Hospital, Randwick, Sydney, Australia
- Adelaide Medical School, University of Adelaide, Adelaide, Australia
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Kovoor JG, Nematzadeh N, Ataie S, Thomas B, Short R, Davey A, Goodrich A, Shrestha T, Gupta AK, Stretton B, Bacchi S, Marshall-Webb M, Kaeppeli R, Navidi M, Liyanage C, Maddern GJ, Barreto SG, Kow L, Padbury RT. Understanding the length of hospital stay after general surgery using a prospectively maintained local database. Surgery 2024:S0039-6060(24)00070-9. [PMID: 38508918 DOI: 10.1016/j.surg.2024.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 01/31/2024] [Accepted: 02/02/2024] [Indexed: 03/22/2024]
Affiliation(s)
- Joshua G Kovoor
- University of Adelaide, South Australia, Australia; The Queen Elizabeth Hospital, Adelaide, South Australia, Australia; Flinders Medical Centre, Adelaide, South Australia, Australia; Ballarat Base Hospital, Victoria, Australia.
| | | | - Sara Ataie
- Flinders University, Adelaide, South Australia, Australia
| | - Bev Thomas
- Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Rachel Short
- Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Amy Davey
- Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Angie Goodrich
- Flinders Medical Centre, Adelaide, South Australia, Australia
| | | | | | - Brandon Stretton
- University of Adelaide, South Australia, Australia; The Queen Elizabeth Hospital, Adelaide, South Australia, Australia; Royal Adelaide Hospital, South Australia, Australia
| | - Stephen Bacchi
- Flinders University, Adelaide, South Australia, Australia; Royal Adelaide Hospital, South Australia, Australia; Lyell McEwin Hospital, Adelaide, South Australia, Australia
| | - Matthew Marshall-Webb
- The Queen Elizabeth Hospital, Adelaide, South Australia, Australia; Flinders University, Adelaide, South Australia, Australia; Box Hill Hospital, Melbourne, Victoria, Australia
| | - Reto Kaeppeli
- Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Maziar Navidi
- Flinders Medical Centre, Adelaide, South Australia, Australia
| | | | - Guy J Maddern
- University of Adelaide, South Australia, Australia; The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
| | - S George Barreto
- Flinders Medical Centre, Adelaide, South Australia, Australia; Flinders University, Adelaide, South Australia, Australia
| | - Lilian Kow
- Flinders Medical Centre, Adelaide, South Australia, Australia; Flinders University, Adelaide, South Australia, Australia
| | - Robert T Padbury
- Flinders Medical Centre, Adelaide, South Australia, Australia; Flinders University, Adelaide, South Australia, Australia
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Kovoor JG, Bacchi S, Sharma P, Sharma S, Kumawat M, Stretton B, Gupta AK, Chan W, Abou-Hamden A, Maddern GJ. Artificial intelligence for surgical services in Australia and New Zealand: opportunities, challenges and recommendations. Med J Aust 2024; 220:234-237. [PMID: 38321813 DOI: 10.5694/mja2.52225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 01/22/2024] [Indexed: 02/08/2024]
Affiliation(s)
- Joshua G Kovoor
- University of Adelaide, Adelaide, SA
- Ballarat Base Hospital, Ballarat, VIC
| | | | | | | | | | | | | | - WengOnn Chan
- University of Adelaide, Adelaide, SA
- Queen Elizabeth Hospital, Adelaide, SA
| | - Amal Abou-Hamden
- University of Adelaide, Adelaide, SA
- Royal Adelaide Hospital, Adelaide, SA
| | - Guy J Maddern
- University of Adelaide, Adelaide, SA
- Queen Elizabeth Hospital, Adelaide, SA
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13
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Kleinig O, Gao C, Kovoor JG, Gupta AK, Bacchi S, Chan WO. How to use large language models in ophthalmology: from prompt engineering to protecting confidentiality. Eye (Lond) 2024; 38:649-653. [PMID: 37798360 PMCID: PMC10920651 DOI: 10.1038/s41433-023-02772-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 09/19/2023] [Accepted: 09/21/2023] [Indexed: 10/07/2023] Open
Affiliation(s)
- Oliver Kleinig
- Royal Adelaide Hospital, Adelaide, SA, Australia.
- University of Adelaide, Adelaide, SA, Australia.
| | - Christina Gao
- Royal Adelaide Hospital, Adelaide, SA, Australia
- University of Adelaide, Adelaide, SA, Australia
| | - Joshua G Kovoor
- Royal Adelaide Hospital, Adelaide, SA, Australia
- University of Adelaide, Adelaide, SA, Australia
| | - Aashray K Gupta
- University of Adelaide, Adelaide, SA, Australia
- Gold Coast University Hospital, Gold Coast, QLD, Australia
| | - Stephen Bacchi
- Royal Adelaide Hospital, Adelaide, SA, Australia
- University of Adelaide, Adelaide, SA, Australia
- Flinders University, Adelaide, SA, Australia
| | - Weng Onn Chan
- Royal Adelaide Hospital, Adelaide, SA, Australia
- University of Adelaide, Adelaide, SA, Australia
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14
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Kleinig O, To MS, Ovenden CD, Kovoor JG, Goh R, Lam L, Wenzel T, Tan Y, Harish H, Gupta AK, Gluck S, Gilbert T, Bacchi S. Vital sign measurements demonstrate terminal digit bias and boundary effects. Emerg Med Australas 2024. [PMID: 38413380 DOI: 10.1111/1742-6723.14395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 01/18/2024] [Accepted: 02/14/2024] [Indexed: 02/29/2024]
Abstract
OBJECTIVE The measurement and recording of vital signs may be impacted by biases, including preferences for even and round numbers. However, other biases, such as variation due to defined numerical boundaries (also known as boundary effects), may be present in vital signs data and have not yet been investigated in a medical setting. We aimed to assess vital signs data for such biases. These parameters are clinically significant as they influence care escalation. METHODS Vital signs data (heart rate, respiratory rate, oxygen saturation and systolic blood pressure) were collected from a tertiary hospital electronic medical record over a 2-year period. These data were analysed using polynomial regression with additional terms to assess for underreporting of out-of-range observations and overreporting numbers with terminal digits of 0 (round numbers), 2 (even numbers) and 5. RESULTS It was found that heart rate, oxygen saturation and systolic blood pressure demonstrated 'boundary effects', with values inside the 'normal' range disproportionately more likely to be recorded. Even number bias was observed in systolic heart rate, respiratory rate and blood pressure. Preference for multiples of 5 was observed for heart rate and blood pressure. Independent overrepresentation of multiples of 10 was demonstrated in heart rate data. CONCLUSION Although often considered objective, vital signs data are affected by bias. These biases may impact the care patients receive. Additionally, it may have implications for creating and training machine learning models that utilise vital signs data.
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Affiliation(s)
- Oliver Kleinig
- Department of Neurology, Department of Neurosurgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
- School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - Minh-Son To
- Department of Radiology, Department of Neurology, Flinders University, Adelaide, South Australia, Australia
| | - Christopher D Ovenden
- Department of Neurology, Department of Neurosurgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
- School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - Joshua G Kovoor
- Department of Neurology, Department of Neurosurgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
- School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
- Department of Cardiothoracic Surgery, Gold Coast University Hospital, Gold Coast, South Australia, Australia
- Department of Surgery, Ballarat Base Hospital, Ballarat, Victoria, Australia
| | - Rudy Goh
- School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
- Department of Neurology, Lyell McEwin Hospital, Adelaide, South Australia, Australia
| | - Lydia Lam
- Department of Neurology, Department of Neurosurgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
- School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - Tara Wenzel
- Department of Radiology, Department of Neurology, Flinders University, Adelaide, South Australia, Australia
| | - Yiran Tan
- Department of Neurology, Department of Neurosurgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
- School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - Hrishikesh Harish
- Department of Neurology, Department of Neurosurgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
- School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - Aashray K Gupta
- School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
- Department of Cardiothoracic Surgery, Gold Coast University Hospital, Gold Coast, South Australia, Australia
| | - Sam Gluck
- Department of Neurology, Department of Neurosurgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Department of Neurology, Lyell McEwin Hospital, Adelaide, South Australia, Australia
| | - Toby Gilbert
- Department of Neurology, Department of Neurosurgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
- School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - Stephen Bacchi
- Department of Neurology, Department of Neurosurgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
- School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
- Department of Radiology, Department of Neurology, Flinders University, Adelaide, South Australia, Australia
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Maniero C, Ng SM, Collett G, Godec T, Siddiqui I, Antoniou S, Kumar A, Janmohamed A, Nair S, Kotecha A, Khan R, Khanji MY, Kapil V, Gupta J, Gupta AK. Differential impact of COVID-19 on mental health and burnout. Occup Med (Lond) 2024; 74:45-52. [PMID: 37040624 PMCID: PMC10875923 DOI: 10.1093/occmed/kqad011] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2023] Open
Abstract
BACKGROUND There may be differential impact of the COVID-19 pandemic on mental health and burnout rates of healthcare professionals (HCPs) performing different roles. AIMS To examine mental health and burnout rates, and possible drivers for any disparities between professional roles. METHODS In this cohort study, online surveys were distributed to HCPs in July-September 2020 (baseline) and re-sent 4 months later (follow-up; December 2020) assessing for probable major depressive disorder (MDD), generalized anxiety disorder (GAD), insomnia, mental well-being and burnout (emotional exhaustion and depersonalization). Separate logistic regression models (at both phases) compared the risk of outcomes between roles: healthcare assistants (HCAs), nurses and midwives (nurses), allied health professionals (AHPs) and doctors (reference group). Separate linear regression models were also developed relating the change in scores to professional role. RESULTS At baseline (n = 1537), nurses had a 1.9-fold and 2.5-fold increased risk of MDD and insomnia, respectively. AHPs had a 1.7-fold and 1.4-fold increased risk of MDD and emotional exhaustion, respectively. At follow-up (n = 736), the disproportionate risk between doctors and others worsened: nurses and HCAs were at 3.7-fold and 3.6-fold increased risk of insomnia, respectively. Nurses also had a significantly increased risk of MDD, GAD, poor mental well-being and burnout. Nurses also had significantly worsened anxiety, mental well-being and burnout scores over time, relative to doctors. CONCLUSIONS Nurses and AHPs had excess risk of adverse mental health and burnout during the pandemic, and this difference worsened over time (in nurses especially). Our findings support adoption of targeted strategies accounting for different HCP roles.
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Affiliation(s)
- C Maniero
- Barts Heart Centre, St. Bartholomew’s Hospital, Barts Health NHS Trust, London EC1A 7BE, UK
- William Harvey Research Institute, Queen Mary University of London, London EC1M 6BQ, UK
| | - S M Ng
- Barts Heart Centre, St. Bartholomew’s Hospital, Barts Health NHS Trust, London EC1A 7BE, UK
| | - G Collett
- William Harvey Research Institute, Queen Mary University of London, London EC1M 6BQ, UK
| | - T Godec
- William Harvey Research Institute, Queen Mary University of London, London EC1M 6BQ, UK
| | - I Siddiqui
- Wellbeing Hub, Newham Training Hub, London E15 1HP, UK
- Northeast London CCG, London E15 1DA, UK
- Woodgrange Medical Practice, London E7 0QH, UK
| | - S Antoniou
- Barts Heart Centre, St. Bartholomew’s Hospital, Barts Health NHS Trust, London EC1A 7BE, UK
| | - A Kumar
- Wrightington, Wigan and Leigh NHS Foundation Trust, Wigan WN1 1XX, UK
| | - A Janmohamed
- St George’s University Hospitals NHS Foundation Trust, London SW17 0QT, UK
| | - S Nair
- Glan Clwyd Hospital, Betsi Cadwaladr University Health Board, Wales LL18 5UJ, UK
| | - A Kotecha
- Royal Devon and Exeter Hospital, Exeter, Devon EX2 5DW, UK
| | - R Khan
- The Royal London Hospital, Barts Health NHS Trust, London E1 1BB, UK
| | - M Y Khanji
- Barts Heart Centre, St. Bartholomew’s Hospital, Barts Health NHS Trust, London EC1A 7BE, UK
- William Harvey Research Institute, Queen Mary University of London, London EC1M 6BQ, UK
- UCLPartners, London W1T 7HA, UK
- Newham University Hospital, Barts Health NHS Trust, London E13 8SL, UK
| | - V Kapil
- Barts Heart Centre, St. Bartholomew’s Hospital, Barts Health NHS Trust, London EC1A 7BE, UK
- William Harvey Research Institute, Queen Mary University of London, London EC1M 6BQ, UK
- The Royal London Hospital, Barts Health NHS Trust, London E1 1BB, UK
| | - J Gupta
- South West London and St George’s Mental Health NHS Trust, London SW17 0YF, UK
| | - A K Gupta
- Barts Heart Centre, St. Bartholomew’s Hospital, Barts Health NHS Trust, London EC1A 7BE, UK
- William Harvey Research Institute, Queen Mary University of London, London EC1M 6BQ, UK
- The Royal London Hospital, Barts Health NHS Trust, London E1 1BB, UK
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Kovoor JG, Gupta AK, Bacchi S, Stretton B, O'Callaghan PG, Murphy E, Hugh TJ, Padbury RT, Trochsler MI, Maddern GJ. Achieving equity: patient demographics and outcomes after surgical and non-surgical procedures in South Australia, 2022. ANZ J Surg 2024; 94:96-102. [PMID: 38291008 DOI: 10.1111/ans.18871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 01/10/2024] [Indexed: 02/01/2024]
Abstract
BACKGROUND Although modern Australian healthcare systems provide patient-centred care, the ability to predict and prevent suboptimal post-procedural outcomes based on patient demographics at admission may improve health equity. This study aimed to identify patient demographic characteristics that might predict disparities in mortality, readmission, and discharge outcomes after either an operative or non-operative procedural hospital admission. METHODS This retrospective cohort study included all surgical and non-surgical procedural admissions at three of the four major metropolitan public hospitals in South Australia in 2022. Multivariable logistic regression, with backwards selection, evaluated association between patient demographic characteristics and outcomes up to 90 days post-procedurally. RESULTS 40 882 admissions were included. Increased likelihood of all-cause, post-procedure mortality in-hospital, at 30 days, and 90 days, were significantly associated with increased age (P < 0.001), increased comorbidity burden (P < 0.001), an emergency admission (P < 0.001), and male sex (P = 0.046, P = 0.03, P < 0.001, respectively). Identification as ATSI (P < 0.001) and being born in Australia (P = 0.03, P = 0.001, respectively) were associated with an increased likelihood of 30-day hospital readmission and decreased likelihood of discharge directly home, as was increased comorbidity burden (P < 0.001) and emergency admission (P < 0.001). Being married (P < 0.001) and male sex (P = 0.003) were predictive of an increased likelihood of discharging directly home; in contrast to increased age (P < 0.001) which was predictive of decreased likelihood of this occurring. CONCLUSIONS This study characterized several associations between patient demographic factors present on admission and outcomes after surgical and non-surgical procedures, that can be integrated within patient flow pathways through the Australian healthcare system to improve healthcare equity.
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Affiliation(s)
- Joshua G Kovoor
- The University of Adelaide, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
- Royal Australasian College of Surgeons, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Health and Information, Adelaide, South Australia, Australia
- Ballarat Base Hospital, Ballarat, Victoria, Australia
| | - Aashray K Gupta
- Health and Information, Adelaide, South Australia, Australia
- University of Adelaide, Adelaide, South Australia, Australia
- Gold Coast University Hospital, Gold Coast, Queensland, Australia
- Prince of Wales Hospital, Sydney, New South Wales, Australia
- Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Stephen Bacchi
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Health and Information, Adelaide, South Australia, Australia
- Flinders University, Adelaide, South Australia, Australia
- Lyell McEwin Hospital, Adelaide, South Australia, Australia
| | - Brandon Stretton
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Health and Information, Adelaide, South Australia, Australia
- University of Adelaide, Adelaide, South Australia, Australia
| | - Patrick G O'Callaghan
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
- University of Adelaide, Adelaide, South Australia, Australia
| | - Elizabeth Murphy
- University of Adelaide, Adelaide, South Australia, Australia
- Lyell McEwin Hospital, Adelaide, South Australia, Australia
| | - Thomas J Hugh
- Royal North Shore Hospital, Sydney, New South Wales, Australia
- The University of Sydney, Sydney, New South Wales, Australia
| | - Robert T Padbury
- Flinders University, Adelaide, South Australia, Australia
- Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Markus I Trochsler
- The University of Adelaide, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Guy J Maddern
- The University of Adelaide, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
- Royal Australasian College of Surgeons, Adelaide, South Australia, Australia
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Kovoor JG, Gupta AK, Bacchi S, Stretton B, Padbury RT. Power Distance Impacts Surgical Staff and Patients. J Surg Educ 2024; 81:178-179. [PMID: 38160115 DOI: 10.1016/j.jsurg.2023.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 10/13/2023] [Indexed: 01/03/2024]
Affiliation(s)
- Joshua G Kovoor
- Flinders Medical Centre, Adelaide, South Australia, Australia; The Queen Elizabeth Hospital, Adelaide, South Australia, Australia; The University of Adelaide, Adelaide, South Australia, Australia; Royal Adelaide Hospital, Adelaide, South Australia, Australia; Health and Information, Adelaide, South Australia, Australia.
| | - Aashray K Gupta
- The University of Adelaide, Adelaide, South Australia, Australia; Health and Information, Adelaide, South Australia, Australia; Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Stephen Bacchi
- The Queen Elizabeth Hospital, Adelaide, South Australia, Australia; The University of Adelaide, Adelaide, South Australia, Australia; Royal Adelaide Hospital, Adelaide, South Australia, Australia; Health and Information, Adelaide, South Australia, Australia
| | - Brandon Stretton
- The Queen Elizabeth Hospital, Adelaide, South Australia, Australia; The University of Adelaide, Adelaide, South Australia, Australia; Royal Adelaide Hospital, Adelaide, South Australia, Australia; Health and Information, Adelaide, South Australia, Australia
| | - Robert T Padbury
- Flinders Medical Centre, Adelaide, South Australia, Australia; Flinders University, Adelaide, South Australia, Australia
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18
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Kovoor JG, Bacchi S, Stretton B, Gupta AK, Maddern GJ, Nelson R. Response to Letter: Update of risk factors for surgical site infection in clean-contaminated wounds after gastroenterological surgery: An analysis of 1,878 participants enrolled in 2 recent randomized control trials for the prevention of surgical site infection. Surgery 2024; 175:570-571. [PMID: 37758635 DOI: 10.1016/j.surg.2023.08.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 08/16/2023] [Indexed: 09/29/2023]
Affiliation(s)
- Joshua G Kovoor
- University of Adelaide, South Australia, Australia; Queen Elizabeth Hospital, Adelaide, South Australia, Australia; Royal Adelaide Hospital, South Australia, Australia.
| | - Stephen Bacchi
- University of Adelaide, South Australia, Australia; Queen Elizabeth Hospital, Adelaide, South Australia, Australia; Royal Adelaide Hospital, South Australia, Australia
| | - Brandon Stretton
- University of Adelaide, South Australia, Australia; Queen Elizabeth Hospital, Adelaide, South Australia, Australia; Royal Adelaide Hospital, South Australia, Australia
| | | | - Guy J Maddern
- University of Adelaide, South Australia, Australia; Queen Elizabeth Hospital, Adelaide, South Australia, Australia
| | - Renjy Nelson
- University of Adelaide, South Australia, Australia; Queen Elizabeth Hospital, Adelaide, South Australia, Australia; Royal Adelaide Hospital, South Australia, Australia
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Pietris J, Lam A, Bacchi S, Gupta AK, Kovoor JG, Simon S, Slee M, Chan W. The Efficacy, Adverse Effects and Economic Implications of Oral Versus Intravenous Methylprednisolone for the Treatment of Optic Neuritis: A Systematic Review. Semin Ophthalmol 2024; 39:6-16. [PMID: 38013424 DOI: 10.1080/08820538.2023.2287100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 04/27/2023] [Indexed: 11/29/2023]
Abstract
INTRODUCTION Optic neuritis may occur in a variety of conditions, including as a manifestation of multiple sclerosis. Despite significant research into the efficacy of corticosteroids as a first-line treatment, the optimal route of administration has not been well defined. This review aims to explore the efficacy, adverse effects and economic implications of using oral versus intravenous methylprednisolone to treat acute optic neuritis. METHODS A systematic search of the databases PubMed/MEDLINE, Embase and CENTRAL was performed to July 2022, prior to data collection and risk of bias analysis in accordance with the PRISMA guidelines. RESULTS Six articles fulfilled the inclusion criteria. The results showed that in the treatment of acute optic neuritis, oral methylprednisolone has a non-inferior efficacy and adverse effect profile in comparison to intravenous methylprednisolone. In a cost analysis, oral methylprednisolone to be more cost-effective than intravenous methylprednisolone. CONCLUSIONS Oral methylprednisolone has comparable efficacy and adverse effect profiles to intravenous methylprednisolone for the treatment of optic neuritis. The analysis suggests oral administration is more cost-effective than intravenous administration; however, further analyses of the formal cost-benefit ratio are required.
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Affiliation(s)
- James Pietris
- Faculty of Medicine, University of Queensland, Herston, Australia
- Princess Alexandra Hospital, Woolloongabba, Australia
| | - Antoinette Lam
- University of Adelaide, Adelaide, Australia
- Royal Adelaide Hospital, Adelaide, Australia
| | - Stephen Bacchi
- University of Adelaide, Adelaide, Australia
- Royal Adelaide Hospital, Adelaide, Australia
- College of Medicine and Public Health Flinders University, Bedford Park, Australia
| | - Aashray K Gupta
- University of Adelaide, Adelaide, Australia
- Gold Coast University Hospital, Southport, Australia
| | - Joshua G Kovoor
- University of Adelaide, Adelaide, Australia
- Royal Adelaide Hospital, Adelaide, Australia
| | - Sumu Simon
- Royal Adelaide Hospital, Adelaide, Australia
| | - Mark Slee
- College of Medicine and Public Health Flinders University, Bedford Park, Australia
| | - WengOnn Chan
- University of Adelaide, Adelaide, Australia
- Royal Adelaide Hospital, Adelaide, Australia
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20
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Wiseman TJ, Kovoor JG, Jiang M, Stretton B, Gupta AK, Bacchi S, Kette FE. Adrenaline autoinjectors for Australian out-of-hospital anaphylaxis: where to from here? Intern Med J 2024; 54:187-189. [PMID: 37926733 DOI: 10.1111/imj.16282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 10/01/2023] [Indexed: 11/07/2023]
Abstract
Intramuscular adrenaline autoinjectors are accepted as first-line treatment for out-of-hospital anaphylaxis but face ongoing issues of patient nonadherence related to drug expiry, availability, correct administration, and public recognition of the disease. Adrenaline is associated with possible harms in patients with defined comorbidities but is still considered preferable. Further research and policy is required to facilitate the effective treatment of anaphylaxis.
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Affiliation(s)
- Thomas J Wiseman
- School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - Joshua G Kovoor
- School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - Melinda Jiang
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Brandon Stretton
- School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - Aashray K Gupta
- School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - Stephen Bacchi
- School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Frank E Kette
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
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21
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Stretton B, Koovor JG, Hains L, Kleinig O, Tan S, Gupta AK, Ittimani M, Dwyer A, McNeil K, Chan W, Cusack M, O'Callaghan PG, Maddison J, Bacchi S. How will the artificial intelligence algorithm work within the constraints of this healthcare system? Intern Med J 2024; 54:190-191. [PMID: 38267379 DOI: 10.1111/imj.16308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Accepted: 11/30/2023] [Indexed: 01/26/2024]
Affiliation(s)
- Brandon Stretton
- SA Health, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
- University of Adelaide, Adelaide, South Australia, Australia
| | - Joshua G Koovor
- SA Health, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
- University of Adelaide, Adelaide, South Australia, Australia
| | - Lewis Hains
- University of Adelaide, Adelaide, South Australia, Australia
| | - Oliver Kleinig
- University of Adelaide, Adelaide, South Australia, Australia
| | - Sheryn Tan
- University of Adelaide, Adelaide, South Australia, Australia
| | - Aashray K Gupta
- University of Adelaide, Adelaide, South Australia, Australia
| | - Mana Ittimani
- Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Andrew Dwyer
- SA Health, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
- South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Keith McNeil
- Commission on Excellence and Innovation in Health, Adelaide, South Australia, Australia
| | - WengOnn Chan
- SA Health, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
- University of Adelaide, Adelaide, South Australia, Australia
| | | | - Patrick G O'Callaghan
- SA Health, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
- University of Adelaide, Adelaide, South Australia, Australia
| | - John Maddison
- SA Health, Adelaide, South Australia, Australia
- University of Adelaide, Adelaide, South Australia, Australia
- Lyell McEwin Hospital, Adelaide, South Australia, Australia
| | - Stephen Bacchi
- SA Health, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Flinders University, Adelaide, South Australia, Australia
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Kovoor JG, Nann SD, Chambers C, Mishra K, Goel S, Thompson I, Koh D, Litwin P, Bacchi S, Harford PJ, Stretton B, Gupta AK. Prehabilitation before general surgery: Worth the effort? J Perioper Pract 2023:17504589231214395. [PMID: 38149496 DOI: 10.1177/17504589231214395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2023]
Abstract
Prehabilitation, or interventions before surgery aimed at improving preoperative health and postoperative outcomes, has various forms. Although it may confer benefit to patients undergoing general surgery, this is not certain. Furthermore, although it may yield a net monetary gain, it is also likely to require substantial monetary and non-monetary investment. The impact of prehabilitation is highly variable and dependent on multiple factors. Physical function and pulmonary outcomes are likely to be improved by most forms of prehabilitation involving physical and multimodal exercise programmes. However, other surgical outcomes have demonstrated mixed results from prehabilitation. Within this issue, the measures used for evaluating baseline patient biopsychosocial health are important, and collecting sufficient data to accurately inform patient-centred prehabilitation programmes is only possible through thorough clinical and laboratory investigation and synthesised metrics such as cardiopulmonary exercise testing. Although a multimodal approach to prehabilitation is the current gold standard, societal factors may affect engagement with programmes that require a significant in-person activity. However, this is weighed against the substantial financial and non-financial investment that accompanies many programmes. The overall effectiveness and optimal mode of intervention across the discipline of general surgery remains unclear, and further research is needed to prove prehabilitation's full worth.
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Affiliation(s)
- Joshua G Kovoor
- Discipline of Surgery, The University of Adelaide, Adelaide, SA, Australia
- The Queen Elizabeth Hospital, Adelaide, SA, Australia
- Royal Adelaide Hospital, Adelaide, SA, Australia
- Health and Information, Adelaide, SA, Australia
| | - Silas D Nann
- Health and Information, Adelaide, SA, Australia
- Gold Coast University Hospital, Gold Coast, QLD, Australia
| | - Courtney Chambers
- The Queen Elizabeth Hospital, Adelaide, SA, Australia
- Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Kritika Mishra
- The Queen Elizabeth Hospital, Adelaide, SA, Australia
- Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Sahil Goel
- The Queen Elizabeth Hospital, Adelaide, SA, Australia
- Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Isabella Thompson
- Gold Coast University Hospital, Gold Coast, QLD, Australia
- Bond University, Gold Coast, QLD, Australia
| | - Dong Koh
- The Queen Elizabeth Hospital, Adelaide, SA, Australia
- Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Peter Litwin
- The Queen Elizabeth Hospital, Adelaide, SA, Australia
- Royal Adelaide Hospital, Adelaide, SA, Australia
- Health and Information, Adelaide, SA, Australia
| | - Stephen Bacchi
- Discipline of Surgery, The University of Adelaide, Adelaide, SA, Australia
- The Queen Elizabeth Hospital, Adelaide, SA, Australia
- Royal Adelaide Hospital, Adelaide, SA, Australia
- Health and Information, Adelaide, SA, Australia
| | - Philip J Harford
- The Queen Elizabeth Hospital, Adelaide, SA, Australia
- Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Brandon Stretton
- Discipline of Surgery, The University of Adelaide, Adelaide, SA, Australia
- The Queen Elizabeth Hospital, Adelaide, SA, Australia
- Royal Adelaide Hospital, Adelaide, SA, Australia
- Health and Information, Adelaide, SA, Australia
| | - Aashray K Gupta
- Discipline of Surgery, The University of Adelaide, Adelaide, SA, Australia
- Health and Information, Adelaide, SA, Australia
- Gold Coast University Hospital, Gold Coast, QLD, Australia
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Campbell JO, Gupta AK, Lu A, Lim YF, Mishra N, Hewitt JN, Ovenden CD, Kovoor JG, Bacchi S, Trochsler M, Wells A. The geographic diversity of authorship in leading general surgery journals; A study of 24,332 authors. Surgeon 2023; 21:390-396. [PMID: 37659863 DOI: 10.1016/j.surge.2023.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 08/04/2023] [Accepted: 08/14/2023] [Indexed: 09/04/2023]
Abstract
BACKGROUND Research guides evidence-based general surgery practice, advocacy, policy and resource allocation, but is seemingly lacking representation from those countries with greatest disease burden and mortality. Accordingly, we conducted a geographic study of publications in the most impactful general surgery journals worldwide. METHODS The six general surgery journals with the highest 2020 impact factors were selected. Only journals specific to general surgery were included. For all original articles over the past five years, the affiliated country and city were extracted for the first, second and last author. Number of publications were adjusted per capita, and compared to Human Development Index (HDI) using logistic regression. RESULTS 8274 original articles were published in the top six ranked general surgery journals over 2016-2020, with 24,332 affiliated authors. Authors were most commonly associated with the US (27.88%), Japan (9.09%) and China (8.46%), or per capita, The Netherlands, Sweden and Singapore. There is a linear association between publishing in a top six journal and HDI of country of affiliation. Just four publications were from medium or low HDI countries over the period. CONCLUSION Authorship in leading general surgery journals is predominantly from wealthy, Western countries. Authorship is associated with affiliation with a high HDI country, with few authors from medium or low HDI countries. There is a lack of representation in literature from Africa, Russia, and parts of Southeast Asia, and thus a lack of locally relevant evidence to guide surgical practice in these areas of high disease burden and low life expectancy.
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Affiliation(s)
- Jed O Campbell
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia.
| | - Aashray K Gupta
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia; Department of Cardiothoracic Surgery, Gold Coast University Hospital, Southport, Australia
| | - Amy Lu
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
| | - Ye Fang Lim
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
| | - Neel Mishra
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
| | - Joseph N Hewitt
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
| | - Christopher D Ovenden
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
| | - Joshua G Kovoor
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
| | - Stephen Bacchi
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
| | - Markus Trochsler
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
| | - Adam Wells
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
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Jiang M, Lam L, Kovoor JG, Kimber J, Gupta AK, Stretton B, Goh R, Bacchi S. Intravenous immunoglobulin alteration in response to adverse reactions in neurological conditions: A retrospective cohort study. Transfus Med 2023; 33:478-482. [PMID: 37964154 DOI: 10.1111/tme.13013] [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: 04/13/2023] [Revised: 09/22/2023] [Accepted: 09/26/2023] [Indexed: 11/16/2023]
Abstract
INTRODUCTION Intravenous immunoglobulin (IVIg) is an important treatment in a range of neurological conditions. There is currently limited evidence regarding the frequency and management of IVIg-associated adverse reactions (AR) in neurological disorders. METHODS A single-centre 18-month retrospective cohort study was conducted for all patients at a single tertiary hospital receiving IVIg as an inpatient or the medical day unit. Electronic medical record AR and alerts were reviewed for entries relating to IVIg, and prescribing records associated with recent IVIg administration were reviewed for the use of premedications. Case note review was undertaken to identify AR associated with alterations in IVIg treatment (such as reduction in rate, use of premedications or cessation of IVIg). Demographic, patient, and treatment factors were analysed for associations with AR necessitating alteration in IVIg treatment. RESULTS This study included 98 individuals who received IVIg during the study period. Of these, 12 (12.1%) patients required an alteration in their IVIg treatment. In total, 3 (3.1%) of the 98 included patients required a reduced rate of IVIg, and 10 (10.2%) patients received premedication. The most common premedications were normal saline at the time of the infusion, cetirizine, and hydrocortisone. No demographic factors, indications or comorbidities were found to be associated with an increased likelihood of AR. However, an IVIg daily dose of >35 g and >45 g were associated with an increased likelihood of requiring IVIg treatment alteration due to AR. CONCLUSIONS Alterations to IVIg treatment due to AR are commonly required in neurology patients, and may be associated with higher daily doses of IVIg.
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Affiliation(s)
- Melinda Jiang
- Neurology Department, Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Lydia Lam
- Neurology Department, Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Joshua G Kovoor
- Neurology Department, Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - James Kimber
- Neurology Department, Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Aashray K Gupta
- Neurology Department, Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Brandon Stretton
- Neurology Department, Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Rudy Goh
- Neurology Department, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Stephen Bacchi
- Neurology Department, Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
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Kovoor JG, Bacchi S, Stretton B, Gupta AK, Chan W. Eye of providence: Disclosing conflicts of interest in surgical research. Surgery 2023; 174:1485. [PMID: 37743103 DOI: 10.1016/j.surg.2023.08.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 08/08/2023] [Indexed: 09/26/2023]
Affiliation(s)
- Joshua G Kovoor
- Queen Elizabeth Hospital, Adelaide, South Australia, Australia; University of Adelaide, South Australia, Australia; Royal Adelaide Hospital, South Australia, Australia; Health and Information, Adelaide, South Australia, Australia.
| | - Stephen Bacchi
- Queen Elizabeth Hospital, Adelaide, South Australia, Australia; University of Adelaide, South Australia, Australia; Royal Adelaide Hospital, South Australia, Australia; Health and Information, Adelaide, South Australia, Australia
| | - Brandon Stretton
- Queen Elizabeth Hospital, Adelaide, South Australia, Australia; University of Adelaide, South Australia, Australia; Royal Adelaide Hospital, South Australia, Australia; Health and Information, Adelaide, South Australia, Australia
| | - Aashray K Gupta
- Queen Elizabeth Hospital, Adelaide, South Australia, Australia; University of Adelaide, South Australia, Australia; Royal Adelaide Hospital, South Australia, Australia; Health and Information, Adelaide, South Australia, Australia; Gold Coast University Hospital, Queensland, Australia
| | - WengOnn Chan
- Queen Elizabeth Hospital, Adelaide, South Australia, Australia; University of Adelaide, South Australia, Australia
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Kovoor JG, Bacchi S, Gupta AK, Nann SD, Stretton B, Chong EHL, Hewitt JN, Bhanushali A, Nathin K, Aujayeb N, Lu A, Ovenden CD, John A, Reid JL, Gluck S, Liew D, Reddi BA, Hugh TJ, Dobbins C, Padbury RT, Hewett PJ, Trochsler MI, Maddern GJ. Sociocultural and Demographic Factors Predict Readmissions for General Surgery Patients. World J Surg 2023; 47:3124-3130. [PMID: 37775572 PMCID: PMC10694098 DOI: 10.1007/s00268-023-07177-0] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2023] [Indexed: 10/01/2023]
Abstract
INTRODUCTION Readmission is a poor outcome for both patients and healthcare systems. The association of certain sociocultural and demographic characteristics with likelihood of readmission is uncertain in general surgical patients. METHOD A multi-centre retrospective cohort study of consecutive unique individuals who survived to discharge during general surgical admissions was conducted. Sociocultural and demographic variables were evaluated alongside clinical parameters (considered both as raw values and their proportion of change in the 1-2 days prior to admission) for their association with 7 and 30 days readmission using logistic regression. RESULTS There were 12,701 individuals included, with 304 (2.4%) individuals readmitted within 7 days, and 921 (7.3%) readmitted within 30 days. When incorporating absolute values of clinical parameters in the model, age was the only variable significantly associated with 7-day readmission, and primary language and presence of religion were the only variables significantly associated with 30-day readmission. When incorporating change in clinical parameters between the 1-2 days prior to discharge, primary language and religion were predictive of 30-day readmission. When controlling for changes in clinical parameters, only higher comorbidity burden (represented by higher Charlson comorbidity index score) was associated with increased likelihood of 30-day readmission. CONCLUSIONS Sociocultural and demographic patient factors such as primary language, presence of religion, age, and comorbidity burden predict the likelihood of 7 and 30-day hospital readmission after general surgery. These findings support early implementation a postoperative care model that integrates all biopsychosocial domains across multiple disciplines of healthcare.
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Affiliation(s)
- Joshua G Kovoor
- Department of Surgery, The University of Adelaide, The Queen Elizabeth Hospital, 28 Woodville Road, Woodville South, SA, Australia
- Royal Australasian College of Surgeons, Adelaide, SA, Australia
- Port Augusta Hospital, Port Augusta, SA, Australia
| | - Stephen Bacchi
- Flinders Medical Centre, Flinders University, Adelaide, SA, Australia
- Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Aashray K Gupta
- University of Adelaide, Adelaide, SA, Australia
- Gold Coast University Hospital, Gold Coast, QLD, Australia
| | - Silas D Nann
- Port Augusta Hospital, Port Augusta, SA, Australia
- Royal Adelaide Hospital, Adelaide, SA, Australia
- University of Adelaide, Adelaide, SA, Australia
| | - Brandon Stretton
- Department of Surgery, The University of Adelaide, The Queen Elizabeth Hospital, 28 Woodville Road, Woodville South, SA, Australia
- Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Esther H L Chong
- Department of Surgery, The University of Adelaide, The Queen Elizabeth Hospital, 28 Woodville Road, Woodville South, SA, Australia
- Port Augusta Hospital, Port Augusta, SA, Australia
- Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Joseph N Hewitt
- Royal Adelaide Hospital, Adelaide, SA, Australia
- University of Adelaide, Adelaide, SA, Australia
| | - Ameya Bhanushali
- Flinders Medical Centre, Flinders University, Adelaide, SA, Australia
- Royal Adelaide Hospital, Adelaide, SA, Australia
- University of Adelaide, Adelaide, SA, Australia
| | | | | | - Amy Lu
- University of Adelaide, Adelaide, SA, Australia
| | - Christopher D Ovenden
- Royal Adelaide Hospital, Adelaide, SA, Australia
- University of Adelaide, Adelaide, SA, Australia
| | - Athul John
- Department of Surgery, The University of Adelaide, The Queen Elizabeth Hospital, 28 Woodville Road, Woodville South, SA, Australia
| | - Jessica L Reid
- Department of Surgery, The University of Adelaide, The Queen Elizabeth Hospital, 28 Woodville Road, Woodville South, SA, Australia
| | - Samuel Gluck
- Royal Adelaide Hospital, Adelaide, SA, Australia
- University of Adelaide, Adelaide, SA, Australia
| | - Danny Liew
- Royal Adelaide Hospital, Adelaide, SA, Australia
- University of Adelaide, Adelaide, SA, Australia
| | - Benjamin A Reddi
- Royal Adelaide Hospital, Adelaide, SA, Australia
- University of Adelaide, Adelaide, SA, Australia
| | - Thomas J Hugh
- University of Sydney, Sydney, NSW, Australia
- Royal North Shore Hospital, Sydney, NSW, Australia
| | - Christopher Dobbins
- Port Augusta Hospital, Port Augusta, SA, Australia
- Royal Adelaide Hospital, Adelaide, SA, Australia
- University of Adelaide, Adelaide, SA, Australia
| | - Robert T Padbury
- Flinders Medical Centre, Flinders University, Adelaide, SA, Australia
- Flinders Medical Centre, Adelaide, SA, Australia
| | - Peter J Hewett
- Department of Surgery, The University of Adelaide, The Queen Elizabeth Hospital, 28 Woodville Road, Woodville South, SA, Australia
| | - Markus I Trochsler
- Department of Surgery, The University of Adelaide, The Queen Elizabeth Hospital, 28 Woodville Road, Woodville South, SA, Australia
- Port Augusta Hospital, Port Augusta, SA, Australia
| | - Guy J Maddern
- Department of Surgery, The University of Adelaide, The Queen Elizabeth Hospital, 28 Woodville Road, Woodville South, SA, Australia.
- Royal Australasian College of Surgeons, Adelaide, SA, Australia.
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Kleinig O, Kovoor JG, Gupta AK, Bacchi S. Universal precautions required: Artificial intelligence takes on the Australian Medical Council's trial examination. Aust J Gen Pract 2023; 52:863-865. [PMID: 38049136 DOI: 10.31128/ajgp-02-23-6708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/06/2023]
Abstract
BACKGROUND AND OBJECTIVES The potential of artificial intelligence in medical practice is increasingly being investigated. This study aimed to examine OpenAI's ChatGPT in answering medical multiple choice questions (MCQ) in an Australian context. METHOD We provided MCQs from the Australian Medical Council's (AMC) medical licencing practice examination to ChatGPT. The chatbot's responses were graded using AMC's online portal. This experiment was repeated twice. RESULTS ChatGPT was moderately accurate in answering the questions, achieving a score of 29/50. It was able to generate answer explanations to most questions (45/50). The chatbot was moderately consistent, providing the same overall answer to 40 of the 50 questions between trial runs. DISCUSSION The moderate accuracy of ChatGPT demonstrates potential risks for both patients and physicians using this tool. Further research is required to create more accurate models and to critically appraise such models.
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Affiliation(s)
- Oliver Kleinig
- MBBS III, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA; Royal Adelaide Hospital, Adelaide, SA
| | - Joshua G Kovoor
- MS, Surgical Resident Medical Officer, Department of General Surgery, Queen Elizabeth Hospital, Woodville South, SA
| | - Aashray K Gupta
- MBBS, MS, Cardiothoracic Registrar, Department of Cardiothoracic Surgery, Gold Coast University Hospital, Gold Coast, QLD
| | - Stephen Bacchi
- MBBS, PhD, Neurology Registrar, Department of Neurology, Royal Adelaide Hospital, Adelaide, SA; Neurology Registrar, Department of Neurology, Flinders University, Bedford Park, SA
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Kovoor JG, Bacchi S, Gupta AK, Stretton B, Nann SD, Aujayeb N, Lu A, Nathin K, Lam L, Jiang M, Lee S, To MS, Ovenden CD, Hewitt JN, Goh R, Gluck S, Reid JL, Khurana S, Dobbins C, Hewett PJ, Padbury RT, Malycha J, Trochsler MI, Hugh TJ, Maddern GJ. Surgery's Rosetta Stone: Natural language processing to predict discharge and readmission after general surgery. Surgery 2023; 174:1309-1314. [PMID: 37778968 DOI: 10.1016/j.surg.2023.08.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 08/04/2023] [Accepted: 08/16/2023] [Indexed: 10/03/2023]
Abstract
BACKGROUND This study aimed to examine the accuracy with which multiple natural language processing artificial intelligence models could predict discharge and readmissions after general surgery. METHODS Natural language processing models were derived and validated to predict discharge within the next 48 hours and 7 days and readmission within 30 days (based on daily ward round notes and discharge summaries, respectively) for general surgery inpatients at 2 South Australian hospitals. Natural language processing models included logistic regression, artificial neural networks, and Bidirectional Encoder Representations from Transformers. RESULTS For discharge prediction analyses, 14,690 admissions were included. For readmission prediction analyses, 12,457 patients were included. For prediction of discharge within 48 hours, derivation and validation data set area under the receiver operator characteristic curves were, respectively: 0.86 and 0.86 for Bidirectional Encoder Representations from Transformers, 0.82 and 0.81 for logistic regression, and 0.82 and 0.81 for artificial neural networks. For prediction of discharge within 7 days, derivation and validation data set area under the receiver operator characteristic curves were, respectively: 0.82 and 0.81 for Bidirectional Encoder Representations from Transformers, 0.75 and 0.72 for logistic regression, and 0.68 and 0.67 for artificial neural networks. For readmission prediction within 30 days, derivation and validation data set area under the receiver operator characteristic curves were, respectively: 0.55 and 0.59 for Bidirectional Encoder Representations from Transformers and 0.77 and 0.62 for logistic regression. CONCLUSION Modern natural language processing models, particularly Bidirectional Encoder Representations from Transformers, can effectively and accurately identify general surgery patients who will be discharged in the next 48 hours. However, these approaches are less capable of identifying general surgery patients who will be discharged within the next 7 days or who will experience readmission within 30 days of discharge.
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Affiliation(s)
- Joshua G Kovoor
- Department of Surgery, The Queen Elizabeth Hospital, The University of Adelaide, Adelaide, South Australia, Australia; Royal Australasian College of Surgeons, Adelaide, South Australia, Australia; Health and Information, Adelaide, South Australia, Australia. https://twitter.com/josh.kovoor
| | - Stephen Bacchi
- Health and Information, Adelaide, South Australia, Australia; Royal Adelaide Hospital, Adelaide, South Australia, Australia; University of Adelaide, Adelaide, South Australia, Australia
| | - Aashray K Gupta
- Department of Surgery, The Queen Elizabeth Hospital, The University of Adelaide, Adelaide, South Australia, Australia; Health and Information, Adelaide, South Australia, Australia; University of Adelaide, Adelaide, South Australia, Australia; Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Brandon Stretton
- Department of Surgery, The Queen Elizabeth Hospital, The University of Adelaide, Adelaide, South Australia, Australia; Health and Information, Adelaide, South Australia, Australia; Royal Adelaide Hospital, Adelaide, South Australia, Australia; University of Adelaide, Adelaide, South Australia, Australia
| | - Silas D Nann
- Health and Information, Adelaide, South Australia, Australia; University of Adelaide, Adelaide, South Australia, Australia; Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Nidhi Aujayeb
- Health and Information, Adelaide, South Australia, Australia; University of Adelaide, Adelaide, South Australia, Australia
| | - Amy Lu
- Health and Information, Adelaide, South Australia, Australia; University of Adelaide, Adelaide, South Australia, Australia
| | - Kayla Nathin
- Health and Information, Adelaide, South Australia, Australia; University of Adelaide, Adelaide, South Australia, Australia
| | - Lydia Lam
- Health and Information, Adelaide, South Australia, Australia; University of Adelaide, Adelaide, South Australia, Australia
| | - Melinda Jiang
- Health and Information, Adelaide, South Australia, Australia; Royal Adelaide Hospital, Adelaide, South Australia, Australia; University of Adelaide, Adelaide, South Australia, Australia
| | - Shane Lee
- Health and Information, Adelaide, South Australia, Australia; Royal Adelaide Hospital, Adelaide, South Australia, Australia; University of Adelaide, Adelaide, South Australia, Australia
| | - Minh-Son To
- Health and Information, Adelaide, South Australia, Australia; Royal Adelaide Hospital, Adelaide, South Australia, Australia; Flinders Medical Centre, Flinders University, Adelaide, South Australia, Australia
| | - Christopher D Ovenden
- Health and Information, Adelaide, South Australia, Australia; Royal Adelaide Hospital, Adelaide, South Australia, Australia; University of Adelaide, Adelaide, South Australia, Australia
| | - Joseph N Hewitt
- Department of Surgery, The Queen Elizabeth Hospital, The University of Adelaide, Adelaide, South Australia, Australia; Health and Information, Adelaide, South Australia, Australia; Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Rudy Goh
- Health and Information, Adelaide, South Australia, Australia; Royal Adelaide Hospital, Adelaide, South Australia, Australia; University of Adelaide, Adelaide, South Australia, Australia
| | - Samuel Gluck
- University of Adelaide, Adelaide, South Australia, Australia
| | - Jessica L Reid
- Department of Surgery, The Queen Elizabeth Hospital, The University of Adelaide, Adelaide, South Australia, Australia
| | - Sanjeev Khurana
- Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - Christopher Dobbins
- Royal Adelaide Hospital, Adelaide, South Australia, Australia; University of Adelaide, Adelaide, South Australia, Australia
| | - Peter J Hewett
- Department of Surgery, The Queen Elizabeth Hospital, The University of Adelaide, Adelaide, South Australia, Australia
| | - Robert T Padbury
- Flinders Medical Centre, Flinders University, Adelaide, South Australia, Australia
| | - James Malycha
- Royal Adelaide Hospital, Adelaide, South Australia, Australia; University of Adelaide, Adelaide, South Australia, Australia
| | - Markus I Trochsler
- Department of Surgery, The Queen Elizabeth Hospital, The University of Adelaide, Adelaide, South Australia, Australia
| | - Thomas J Hugh
- University of Sydney, Sydney, New South Wales, Australia; Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Guy J Maddern
- Department of Surgery, The Queen Elizabeth Hospital, The University of Adelaide, Adelaide, South Australia, Australia; Royal Australasian College of Surgeons, Adelaide, South Australia, Australia.
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Mishra K, Kovoor JG, Gupta AK, Bacchi S, Lai CS, Stain SC, Maddern GJ. Evolving challenges of leadership in surgery to improve inclusivity, representation, and well-being. Br J Surg 2023; 110:1723-1729. [PMID: 37758505 DOI: 10.1093/bjs/znad274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 06/18/2023] [Accepted: 08/08/2023] [Indexed: 10/03/2023]
Abstract
BACKGROUND Leadership is a complex and demanding process crucial to maintaining quality in surgical systems of care. Once an autocratic practice, modern-day surgical leaders must demonstrate inclusivity, flexibility, emotional competence, team-building, and a multidisciplinary approach. The complex healthcare environment challenges those in leadership positions. The aim of this narrative review was to consolidate the major challenges facing surgeons today and to suggest evidence-based strategies to support surgical leaders. METHODS Google Scholar, PubMed, MEDLINE, and Ovid databases were searched to review literature on the challenges faced by surgical leaders. The commonly identified areas that compromise inclusivity and productive leadership practices were consolidated into 10 main subheadings. Further research was conducted using the aforementioned databases to outline the importance of addressing such challenges, and to consolidate evidence-based strategies to resolve them. RESULTS The importance of increasing representation of marginalized groups in leadership positions, including women, ethnic groups, the queer community, and ageing professionals, has been identified by surgical colleges in many countries. Leaders must create a collegial environment with proactive, honest communication and robust reporting pathways for victims of workplace harassment. The retention of diverse, empowering, and educating leaders relies on equitable opportunities, salaries, recognition, and support. Thus, it is important to implement formal training and mentorship, burnout prevention, conflict management, and well-being advocacy. CONCLUSION There are two aspects to addressing challenges facing surgical leadership; improving advocacy by and for leaders. Systems must be designed to support surgical leaders through formal education and training, meaningful mentorship programmes, and well-being advocacy, thus enabling them to proactively and productively advocate and care for their patients, colleagues, and professional communities.
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Affiliation(s)
- Kritika Mishra
- Flinders University, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Joshua G Kovoor
- Discipline of Surgery, University of Adelaide, Queen Elizabeth Hospital, Adelaide, South Australia, Australia
- Royal Australasian College of Surgeons, Adelaide, South Australia, Australia
| | - Aashray K Gupta
- Discipline of Surgery, University of Adelaide, Queen Elizabeth Hospital, Adelaide, South Australia, Australia
- Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Stephen Bacchi
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
- University of Adelaide, Adelaide, South Australia, Australia
- Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Christine S Lai
- Discipline of Surgery, University of Adelaide, Queen Elizabeth Hospital, Adelaide, South Australia, Australia
- Royal Australasian College of Surgeons, Adelaide, South Australia, Australia
| | - Steven C Stain
- Department of Surgery, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
| | - Guy J Maddern
- Discipline of Surgery, University of Adelaide, Queen Elizabeth Hospital, Adelaide, South Australia, Australia
- Royal Australasian College of Surgeons, Adelaide, South Australia, Australia
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Kimber JS, Kovoor JG, Glynatsis JM, West SJ, Mai TTN, Jacobsen JHW, Ovenden CD, Bacchi S, Hewitt JN, Gupta AK, Edwards S, Taverner FJ, Watson DI. Isopropyl alcohol inhalation versus 5-HT 3 antagonists for treatment of nausea: a meta-analysis of randomised controlled trials. Eur J Clin Pharmacol 2023; 79:1525-1535. [PMID: 37704796 PMCID: PMC10618376 DOI: 10.1007/s00228-023-03560-x] [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: 04/19/2023] [Accepted: 08/25/2023] [Indexed: 09/15/2023]
Abstract
PURPOSE Nausea is a common and unpleasant sensation for which current therapies such as serotonin (5-HT3) antagonists are often ineffective, while also conferring a risk of potential adverse events. Isopropyl alcohol (IPA) has been proposed as a treatment for nausea. We aimed to compare IPA with 5-HT3 antagonists for the treatment of nausea across all clinical settings. METHODS MEDLINE, EMBASE, PubMed, CENTRAL and CINAHL were searched from inception to 17 July 2023 for randomised controlled trials (RCTs) comparing inhaled IPA and a 5-HT3 antagonist for treatment of nausea. Severity and duration of nausea, rescue antiemetic use, adverse events and patient satisfaction were the outcomes sought. Risk of bias (RoB) was assessed using Cochrane RoB 2. Random-effects model was used for meta-analysis. Combination of meta-analyses and narrative review was used to synthesise findings. The evidence was appraised using GRADE. RESULTS From 1242 records, 4 RCTs were included with 382 participants. Participants receiving IPA had a significantly lower mean time to 50% reduction in nausea (MD - 20.06; 95% CI - 26.26, - 13.85). Nausea score reduction at 30 min was significantly greater in the IPA group (MD 21.47; 95% CI 15.47, 27.47). IPA led to significantly reduced requirement for rescue antiemetics (OR 0.60; 95% CI 0.37, 0.95; p = 0.03). IPA led to no significant difference in patient satisfaction when compared with a 5-HT3 antagonist. The overall GRADE assessment of evidence quality ranged from very low to low. CONCLUSION IPA may provide rapid, effective relief of nausea when compared with 5-HT3 antagonists.
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Affiliation(s)
- James S Kimber
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, 5000, Australia.
| | - Joshua G Kovoor
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, 5000, Australia
- Research, Audit and Academic Surgery, Royal Australasian College of Surgeons, Adelaide, SA, Australia
| | - John M Glynatsis
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, 5000, Australia
| | - Samuel J West
- Central Adelaide Local Health Network, Adelaide, SA, Australia
| | | | - Jonathan Henry W Jacobsen
- Research, Audit and Academic Surgery, Royal Australasian College of Surgeons, Adelaide, SA, Australia
| | - Christopher D Ovenden
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, 5000, Australia
| | - Stephen Bacchi
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, 5000, Australia
- Central Adelaide Local Health Network, Adelaide, SA, Australia
| | - Joseph N Hewitt
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, 5000, Australia
| | - Aashray K Gupta
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, 5000, Australia
| | - Suzanne Edwards
- Adelaide Health Technology Assessment, School of Public Health, University of Adelaide, Adelaide, SA, Australia
| | - Fiona J Taverner
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, 5000, Australia
- Department of Anaesthesia, Flinders Medical Centre, Adelaide, SA, Australia
| | - David I Watson
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
- Department of Surgery, Flinders Medical Centre, Adelaide, SA, Australia
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Tsang JNJ, Bacchi S, Kovoor JG, Gupta AK, Stretton B, Gluck S, Gilbert T, Sharma Y, Woodman R, Mangoni AA. Systolic blood pressure levels and mortality in Australian medical inpatients. J Clin Hypertens (Greenwich) 2023; 25:1036-1039. [PMID: 37787074 PMCID: PMC10631088 DOI: 10.1111/jch.14735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 09/15/2023] [Accepted: 09/17/2023] [Indexed: 10/04/2023]
Abstract
The epidemiology of elevations in blood pressure is incompletely characterized, particularly in Australia. Given the lack of evidence regarding the frequency and the optimal management of in-hospital hypertension, the authors performed a multicenter retrospective cohort study of consecutive medical admissions in South Australia over a 2-year period to investigate systolic blood pressure levels and their association with in-hospital mortality. Among 16 896 inpatients, 76% had at least one systolic blood pressure reading of ≥140 mmHg and 11.7% of ≥180 mmHg during hospitalization. A statistically significant negative relationship was observed between having at least one reading ≥140 mmHg and a likelihood of in-hospital mortality (odds ratio 0.41, 95% CI: 0.35 to 0.49, P < .001). Our results suggest that elevations in systolic blood pressure are common in Australian medical inpatients. However, the inverse association observed between systolic blood pressure values ≥140 mmHg and in-hospital mortality warrants further research to determine the clinical significance and optimal management of blood pressure elevations in this group.
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Affiliation(s)
- Jin Nuo Joan Tsang
- College of Medicine and Public HealthFlinders UniversityAdelaideSouth AustraliaAustralia
| | - Stephen Bacchi
- College of Medicine and Public HealthFlinders UniversityAdelaideSouth AustraliaAustralia
- University of AdelaideAdelaideSouth AustraliaAustralia
- Royal Adelaide HospitalCentral Adelaide Local Health NetworkAdelaideSouth AustraliaAustralia
| | - Joshua G. Kovoor
- University of AdelaideAdelaideSouth AustraliaAustralia
- Royal Adelaide HospitalCentral Adelaide Local Health NetworkAdelaideSouth AustraliaAustralia
- Queen Elizabeth HospitalCentral Adelaide Local Health NetworkWoodvilleSouth AustraliaAustralia
| | - Aashray K. Gupta
- University of AdelaideAdelaideSouth AustraliaAustralia
- Gold Coast University HospitalSouthportQueenslandAustralia
| | - Brandon Stretton
- Royal Adelaide HospitalCentral Adelaide Local Health NetworkAdelaideSouth AustraliaAustralia
| | - Samuel Gluck
- Lyell McEwin HospitalNorthern Adelaide Local Health NetworkElizabeth ValeSouth AustraliaAustralia
| | - Toby Gilbert
- Royal Adelaide HospitalCentral Adelaide Local Health NetworkAdelaideSouth AustraliaAustralia
| | - Yogesh Sharma
- Flinders Medical CentreSouthern Adelaide Local Health NetworkBedford ParkSouth AustraliaAustralia
| | - Richard Woodman
- College of Medicine and Public HealthFlinders UniversityAdelaideSouth AustraliaAustralia
| | - Arduino A. Mangoni
- College of Medicine and Public HealthFlinders UniversityAdelaideSouth AustraliaAustralia
- Flinders Medical CentreSouthern Adelaide Local Health NetworkBedford ParkSouth AustraliaAustralia
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Kovoor JG, Bacchi S, Gupta AK, Vo T, Lam C, Lam L, Jiang M, Stretton B, To MS, Nann S, Ovenden CD, Hewitt JN, Goh R, Reid JL, Hugh TJ, Dobbins C, Hewett PJ, Trochsler MI, Kette FE, Maddern GJ. Opioid prescribing, pain, and hospital stay of general surgery patients with oxycodone allergies in South Australia. ANZ J Surg 2023; 93:2631-2637. [PMID: 37837230 DOI: 10.1111/ans.18722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 09/16/2023] [Accepted: 09/21/2023] [Indexed: 10/15/2023]
Abstract
BACKGROUND The frequency of oxycodone adverse reactions, subsequent opioid prescription, effect on pain and patient care in general surgery patients are not well known. This study aimed to determine prevalence of documented oxycodone allergy and intolerances (independent variables) in a general surgical cohort, and association with prescribing other analgesics (particularly opioids), subjective pain scores, and length of hospital stay (dependent variables). METHODS This retrospective cohort study included general surgery patients from two South Australian hospitals between April 2020 and March 2022. Multivariable logistic regression evaluated associations between previous oxycodone allergies and intolerances, prescription records, subjective pain scores, and length of hospital stay. RESULTS Of 12 846 patients, 216 (1.7%) had oxycodone allergies, and 84 (0.7%) oxycodone intolerances. The 216 oxycodone allergy patients had lower odds of receiving oxycodone (OR 0.17, P < 0.001), higher odds of tramadol (OR 3.01, P < 0.001) and tapentadol (OR 2.87, P = 0.001), but 91 (42.3%) still received oxycodone and 19 (8.8%) morphine. The 84 with oxycodone intolerance patients had lower odds of receiving oxycodone (OR 0.23, P < 0.001), higher odds of fentanyl (OR 3.6, P < 0.001) and tramadol (OR 3.35, P < 0.001), but 42 (50%) still received oxycodone. Patients with oxycodone allergies and intolerances had higher odds of elevated subjective pain (OR 1.60, P = 0.013; OR 2.36, P = 0.002, respectively) and longer length of stay (OR 1.36, P = 0.038; OR 2.24, P = 0.002, respectively) than patients without these. CONCLUSIONS General surgery patients with oxycodone allergies and intolerances are at greater risk of worse postoperative pain and longer length of stay, compared to patients without. Many still receive oxycodone, and other opioids that could cause cross-reactivity.
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Affiliation(s)
- Joshua G Kovoor
- Discipline of Surgery, The Queen Elizabeth Hospital, University of Adelaide, Adelaide, South Australia, Australia
- Royal Australasian College of Surgeons, Adelaide, South Australia, Australia
| | - Stephen Bacchi
- University of Adelaide, Adelaide, South Australia, Australia
- Flinders Medical Centre, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Aashray K Gupta
- University of Adelaide, Adelaide, South Australia, Australia
- Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Tammy Vo
- Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Cindy Lam
- Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Lydia Lam
- University of Adelaide, Adelaide, South Australia, Australia
| | - Melinda Jiang
- University of Adelaide, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Brandon Stretton
- University of Adelaide, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Minh-Son To
- Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Silas Nann
- University of Adelaide, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Christopher D Ovenden
- University of Adelaide, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Joseph N Hewitt
- Discipline of Surgery, The Queen Elizabeth Hospital, University of Adelaide, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Rudy Goh
- University of Adelaide, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Jessica L Reid
- Discipline of Surgery, The Queen Elizabeth Hospital, University of Adelaide, Adelaide, South Australia, Australia
| | - Thomas J Hugh
- University of Sydney, Sydney, New South Wales, Australia
- Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Christopher Dobbins
- University of Adelaide, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Peter J Hewett
- Discipline of Surgery, The Queen Elizabeth Hospital, University of Adelaide, Adelaide, South Australia, Australia
| | - Markus I Trochsler
- Discipline of Surgery, The Queen Elizabeth Hospital, University of Adelaide, Adelaide, South Australia, Australia
| | - Frank E Kette
- University of Adelaide, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Guy J Maddern
- Discipline of Surgery, The Queen Elizabeth Hospital, University of Adelaide, Adelaide, South Australia, Australia
- Royal Australasian College of Surgeons, Adelaide, South Australia, Australia
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Pietris J, Madike R, Lam A, Al Sharifi A, Bacchi S, Gupta AK, Kovoor JG, Chan W. Cogan's Lid Twitch for Myasthenia Gravis: A Systematic Review. Semin Ophthalmol 2023; 38:727-736. [PMID: 37166275 DOI: 10.1080/08820538.2023.2211134] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 04/17/2023] [Accepted: 04/18/2023] [Indexed: 05/12/2023]
Abstract
INTRODUCTION Myasthenia gravis is an autoimmune condition affecting the neuromuscular junction of skeletal muscles and may be difficult to diagnose. Several clinical signs may have diagnostic utility, including Cogan's lid twitch. This systematic review aims to synthesise the literature on the accuracy of Cogan's lid twitch for diagnosing myasthenia gravis. METHODS A systematic search of the databases PubMed/MEDLINE, Embase and CENTRAL was performed from inception to August 2022. Risk of bias analysis and data extraction were performed in accordance with the PRISMA 2020 guidelines. RESULTS Seven articles satisfied the inclusion criteria. The results showed that for the diagnosis of myasthenia gravis, Cogan's lid twitch has a sensitivity between 50% and 99% and specificity between 75% and 100%. CONCLUSIONS Cogan's lid twitch is a physical examination finding with moderate diagnostic performance in the diagnosis of myasthenia gravis with ocular involvement. Future studies may seek to evaluate the performance of Cogan's lid twitch in conjunction with other signs of myasthenia gravis with ocular involvements, such as fatigable ptosis or a positive icepack test.
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Affiliation(s)
- James Pietris
- Faculty of Medicine, University of Queensland, Herston, Australia
- Princess Alexandra Hospital, Woolloongabba, Australia
| | - Reema Madike
- Faculty of Medicine, University of Adelaide, Adelaide, SA, Australia
- Department of Ophthalmology, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Antoinette Lam
- Faculty of Medicine, University of Adelaide, Adelaide, SA, Australia
- Department of Ophthalmology, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Ali Al Sharifi
- Faculty of Medicine, University of Adelaide, Adelaide, SA, Australia
- Department of Ophthalmology, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Stephen Bacchi
- Faculty of Medicine, University of Adelaide, Adelaide, SA, Australia
- Department of Ophthalmology, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Aashray K Gupta
- Faculty of Medicine, University of Adelaide, Adelaide, SA, Australia
- Gold Coast University Hospital, Southport, Australia
| | - Joshua G Kovoor
- Faculty of Medicine, University of Adelaide, Adelaide, SA, Australia
- Department of Ophthalmology, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - WengOnn Chan
- Faculty of Medicine, University of Adelaide, Adelaide, SA, Australia
- Department of Ophthalmology, Royal Adelaide Hospital, Adelaide, SA, Australia
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Kovoor JG, Hewitt JN, Barbaro A, Gupta AK, Ovenden CD, Stretton B, Bacchi S, Dobbins C. Proposal of the Whyalla Direct Access Tool and pathway for rural Australian colonoscopy services. Aust J Rural Health 2023; 31:1032-1035. [PMID: 37635312 DOI: 10.1111/ajr.13031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 08/06/2023] [Indexed: 08/29/2023] Open
Affiliation(s)
- Joshua G Kovoor
- University of Adelaide, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Queen Elizabeth Hospital, Adelaide, South Australia, Australia
- Port Augusta Hospital, Port Augusta, South Australia, Australia
| | - Joseph N Hewitt
- University of Adelaide, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Queen Elizabeth Hospital, Adelaide, South Australia, Australia
- Port Augusta Hospital, Port Augusta, South Australia, Australia
- Whyalla Hospital, Whyalla, South Australia, Australia
| | - Antonio Barbaro
- University of Adelaide, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Queen Elizabeth Hospital, Adelaide, South Australia, Australia
- Whyalla Hospital, Whyalla, South Australia, Australia
| | - Aashray K Gupta
- University of Adelaide, Adelaide, South Australia, Australia
| | - Christopher D Ovenden
- University of Adelaide, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Brandon Stretton
- University of Adelaide, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Queen Elizabeth Hospital, Adelaide, South Australia, Australia
| | - Stephen Bacchi
- University of Adelaide, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Queen Elizabeth Hospital, Adelaide, South Australia, Australia
| | - Christopher Dobbins
- University of Adelaide, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Queen Elizabeth Hospital, Adelaide, South Australia, Australia
- Port Augusta Hospital, Port Augusta, South Australia, Australia
- Whyalla Hospital, Whyalla, South Australia, Australia
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Kovoor JG, Nann SD, Barot DD, Garg D, Hains L, Stretton B, Ovenden CD, Bacchi S, Chan E, Gupta AK, Hugh TJ. Prehabilitation for general surgery: a systematic review of randomized controlled trials. ANZ J Surg 2023; 93:2411-2425. [PMID: 37675939 DOI: 10.1111/ans.18684] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 07/23/2023] [Accepted: 08/27/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND Prehabilitation seeks to optimize patient health before surgery to improve outcomes. Randomized controlled trials (RCTs) have been conducted on prehabilitation, however an updated synthesis of this evidence is required across General Surgery to inform potential Supplementary discipline-level protocols. Accordingly, this systematic review of RCTs aimed to evaluate the use of prehabilitation interventions across the discipline of General Surgery. METHODS This study was registered with PROSPERO (CRD42023403289), and adhered to PRISMA 2020 and SWiM guidelines. PubMed/MEDLINE and Ovid Embase were searched to 4 March 2023 for RCTs evaluating prehabilitation interventions within the discipline of General Surgery. After data extraction, risk of bias was assessed using the Cochrane RoB 2 tool. Quantitative and qualitative data were synthesized and analysed. However, meta-analysis was precluded due to heterogeneity across included studies. RESULTS From 929 records, 36 RCTs of mostly low risk of bias were included. 17 (47.2%) were from Europe, and 14 (38.9%) North America. 30 (83.3%) investigated cancer populations. 31 (86.1%) investigated physical interventions, finding no significant difference in 16 (51.6%) and significant improvement in 14 (45.2%). Nine (25%) investigated psychological interventions: six (66.7%) found significant improvement, three (33.3%) found no significant difference. Five (13.9%) investigated nutritional interventions, finding no significant difference in three (60%), and significant improvement in two (40%). CONCLUSIONS Prehabilitation interventions showed mixed levels of effectiveness, and there is insufficient RCT evidence to suggest system-level delivery across General Surgery within standardized protocols. However, given potential benefits and non-inferiority to standard care, they should be considered on a case-by-case basis.
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Affiliation(s)
- Joshua G Kovoor
- University of Sydney, Sydney, New South Wales, Australia
- Queen Elizabeth Hospital, Adelaide, South Australia, Australia
- Health and Information, Adelaide, South Australia, Australia
| | - Silas D Nann
- Health and Information, Adelaide, South Australia, Australia
- Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Dwarkesh D Barot
- Health and Information, Adelaide, South Australia, Australia
- Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Devanshu Garg
- Health and Information, Adelaide, South Australia, Australia
- University of Adelaide, Adelaide, South Australia, Australia
| | - Lewis Hains
- Health and Information, Adelaide, South Australia, Australia
- University of Adelaide, Adelaide, South Australia, Australia
| | - Brandon Stretton
- Queen Elizabeth Hospital, Adelaide, South Australia, Australia
- Health and Information, Adelaide, South Australia, Australia
- University of Adelaide, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Christopher D Ovenden
- Health and Information, Adelaide, South Australia, Australia
- University of Adelaide, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Stephen Bacchi
- Queen Elizabeth Hospital, Adelaide, South Australia, Australia
- Health and Information, Adelaide, South Australia, Australia
- University of Adelaide, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Erick Chan
- Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Aashray K Gupta
- University of Sydney, Sydney, New South Wales, Australia
- Health and Information, Adelaide, South Australia, Australia
- Gold Coast University Hospital, Gold Coast, Queensland, Australia
- University of Adelaide, Adelaide, South Australia, Australia
| | - Thomas J Hugh
- University of Sydney, Sydney, New South Wales, Australia
- Royal North Shore Hospital, Sydney, New South Wales, Australia
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Kovoor JG, Bacchi S, Stretton B, Gupta AK, Lam L, Jiang M, Lee S, To MS, Ovenden CD, Hewitt JN, Goh R, Gluck S, Reid JL, Hugh TJ, Dobbins C, Padbury RT, Hewett PJ, Trochsler MI, Flabouris A, Maddern GJ. Vital signs and medical emergency response (MER) activation predict in-hospital mortality in general surgery patients: a study of 15 969 admissions. ANZ J Surg 2023; 93:2426-2432. [PMID: 37574649 DOI: 10.1111/ans.18648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 06/28/2023] [Accepted: 07/21/2023] [Indexed: 08/15/2023]
Abstract
BACKGROUND The applicability of the vital signs prompting medical emergency response (MER) activation has not previously been examined specifically in a large general surgical cohort. This study aimed to characterize the distribution, and predictive performance, of four vital signs selected based on Australian guidelines (oxygen saturation, respiratory rate, systolic blood pressure and heart rate); with those of the MER activation criteria. METHODS A retrospective cohort study was conducted including patients admitted under general surgical services of two hospitals in South Australia over 2 years. Likelihood ratios for patients meeting MER activation criteria, or a vital sign in the most extreme 1% for general surgery inpatients (<0.5th percentile or > 99.5th percentile), were calculated to predict in-hospital mortality. RESULTS 15 969 inpatient admissions were included comprising 2 254 617 total vital sign observations. The 0.5th and 99.5th centile for heart rate was 48 and 133, systolic blood pressure 85 and 184, respiratory rate 10 and 31, and oxygen saturations 89% and 100%, respectively. MER activation criteria with the highest positive likelihood ratio for in-hospital mortality were heart rate ≤ 39 (37.65, 95% CI 27.71-49.51), respiratory rate ≥ 31 (15.79, 95% CI 12.82-19.07), and respiratory rate ≤ 7 (10.53, 95% CI 6.79-14.84). These MER activation criteria likelihood ratios were similar to those derived when applying a threshold of the most extreme 1% of vital signs. CONCLUSIONS This study demonstrated that vital signs within Australian guidelines, and escalation to MER activation, appropriately predict in-hospital mortality in a large cohort of patients admitted to general surgical services in South Australia.
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Affiliation(s)
- Joshua G Kovoor
- University of Adelaide, Discipline of Surgery, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
- Royal Australasian College of Surgeons, Adelaide, South Australia, Australia
- Health and Information, Adelaide, South Australia, Australia
| | - Stephen Bacchi
- Health and Information, Adelaide, South Australia, Australia
- University of Adelaide, Adelaide, South Australia, Australia
- Flinders Medical Centre, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Brandon Stretton
- Health and Information, Adelaide, South Australia, Australia
- University of Adelaide, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Aashray K Gupta
- Health and Information, Adelaide, South Australia, Australia
- University of Adelaide, Adelaide, South Australia, Australia
- Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Lydia Lam
- Health and Information, Adelaide, South Australia, Australia
- University of Adelaide, Adelaide, South Australia, Australia
| | - Melinda Jiang
- Health and Information, Adelaide, South Australia, Australia
- University of Adelaide, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Shane Lee
- Health and Information, Adelaide, South Australia, Australia
- University of Adelaide, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Minh-Son To
- Health and Information, Adelaide, South Australia, Australia
- Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Christopher D Ovenden
- Health and Information, Adelaide, South Australia, Australia
- University of Adelaide, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Joseph N Hewitt
- University of Adelaide, Discipline of Surgery, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
- Health and Information, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Rudy Goh
- Health and Information, Adelaide, South Australia, Australia
- University of Adelaide, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Samuel Gluck
- University of Adelaide, Adelaide, South Australia, Australia
| | - Jessica L Reid
- University of Adelaide, Discipline of Surgery, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
| | - Thomas J Hugh
- University of Sydney, Sydney, New South Wales, Australia
- Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Christopher Dobbins
- University of Adelaide, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | | | - Peter J Hewett
- University of Adelaide, Discipline of Surgery, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
| | - Markus I Trochsler
- University of Adelaide, Discipline of Surgery, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
| | - Arthas Flabouris
- University of Adelaide, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Guy J Maddern
- University of Adelaide, Discipline of Surgery, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
- Royal Australasian College of Surgeons, Adelaide, South Australia, Australia
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Kovoor JG, Bacchi S, Gupta AK, Stretton B, Malycha J, Reddi BA, Liew D, O'Callaghan PG, Beltrame JF, Zannettino AC, Jones KL, Horowitz M, Dobbins C, Hewett PJ, Trochsler MI, Maddern GJ. The Adelaide Score: An artificial intelligence measure of readiness for discharge after general surgery. ANZ J Surg 2023; 93:2119-2124. [PMID: 37264548 DOI: 10.1111/ans.18546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 05/17/2023] [Accepted: 05/21/2023] [Indexed: 06/03/2023]
Abstract
BACKGROUND This study aimed to examine the performance of machine learning algorithms for the prediction of discharge within 12 and 24 h to produce a measure of readiness for discharge after general surgery. METHODS Consecutive general surgery patients at two tertiary hospitals, over a 2-year period, were included. Observation and laboratory parameter data were stratified into training, testing and validation datasets. Random forest, XGBoost and logistic regression models were evaluated. Each ward round note time was taken as a different event. Primary outcome was classification accuracy of the algorithmic model able to predict discharge within the next 12 h on the validation data set. RESULTS 42 572 ward round note timings were included from 8826 general surgery patients. Discharge occurred within 12 h for 8800 times (20.7%), and within 24 h for 9885 (23.2%). For predicting discharge within 12 h, model classification accuracies for derivation and validation data sets were: 0.84 and 0.85 random forest, 0.84 and 0.83 XGBoost, 0.80 and 0.81 logistic regression. For predicting discharge within 24 h, model classification accuracies for derivation and validation data sets were: 0.83 and 0.84 random forest, 0.82 and 0.81 XGBoost, 0.78 and 0.79 logistic regression. Algorithms generated a continuous number between 0 and 1 (or 0 and 100), representing readiness for discharge after general surgery. CONCLUSIONS A derived artificial intelligence measure (the Adelaide Score) successfully predicts discharge within the next 12 and 24 h in general surgery patients. This may be useful for both treating teams and allied health staff within surgical systems.
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Affiliation(s)
- Joshua G Kovoor
- Queen Elizabeth Hospital, University of Adelaide, Adelaide, South Australia, Australia
- Royal Australasian College of Surgeons, Adelaide, South Australia, Australia
- Health and Information, Adelaide, South Australia, Australia
| | - Stephen Bacchi
- Health and Information, Adelaide, South Australia, Australia
- University of Adelaide, Adelaide, South Australia, Australia
- Flinders University, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Aashray K Gupta
- Health and Information, Adelaide, South Australia, Australia
- University of Adelaide, Adelaide, South Australia, Australia
- Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Brandon Stretton
- Queen Elizabeth Hospital, University of Adelaide, Adelaide, South Australia, Australia
- Health and Information, Adelaide, South Australia, Australia
- Flinders University, Adelaide, South Australia, Australia
| | - James Malycha
- University of Adelaide, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Benjamin A Reddi
- University of Adelaide, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Danny Liew
- University of Adelaide, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Patrick G O'Callaghan
- University of Adelaide, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - John F Beltrame
- Queen Elizabeth Hospital, University of Adelaide, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | | | - Karen L Jones
- University of Adelaide, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Michael Horowitz
- University of Adelaide, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Christopher Dobbins
- University of Adelaide, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Peter J Hewett
- Queen Elizabeth Hospital, University of Adelaide, Adelaide, South Australia, Australia
| | - Markus I Trochsler
- Queen Elizabeth Hospital, University of Adelaide, Adelaide, South Australia, Australia
| | - Guy J Maddern
- Queen Elizabeth Hospital, University of Adelaide, Adelaide, South Australia, Australia
- Royal Australasian College of Surgeons, Adelaide, South Australia, Australia
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Kovoor JG, Bacchi S, Gupta AK, Stretton B, Page GJ, Kovoor P. Refining Automated External Defibrillator Signage to Improve Out-of-Hospital Cardiac Arrest Survival. Heart Lung Circ 2023; 32:e51-e52. [PMID: 37673552 DOI: 10.1016/j.hlc.2023.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 03/06/2023] [Accepted: 03/21/2023] [Indexed: 09/08/2023]
Affiliation(s)
- Joshua G Kovoor
- University of Adelaide, Adelaide, SA, Australia; Queen Elizabeth Hospital, Adelaide, SA, Australia; Heart of the Nation, Sydney, NSW, Australia; Health and Information, Adelaide, SA, Australia; Royal Adelaide Hospital, Adelaide, SA, Australia. http://www.twitter.com/josh.kovoor
| | - Stephen Bacchi
- Health and Information, Adelaide, SA, Australia; Royal Adelaide Hospital, Adelaide, SA, Australia; Flinders University, Flinders Medical Centre, Adelaide, SA, Australia
| | - Aashray K Gupta
- University of Adelaide, Adelaide, SA, Australia; Health and Information, Adelaide, SA, Australia; Gold Coast University Hospital, Gold Coast, Qld, Australia
| | - Brandon Stretton
- University of Adelaide, Adelaide, SA, Australia; Queen Elizabeth Hospital, Adelaide, SA, Australia; Health and Information, Adelaide, SA, Australia; Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Gregory J Page
- Heart of the Nation, Sydney, NSW, Australia. http://www.twitter.com/GregPage_Yellow
| | - Pramesh Kovoor
- Heart of the Nation, Sydney, NSW, Australia; Health and Information, Adelaide, SA, Australia; University of Sydney, Westmead Hospital, Sydney, NSW, Australia.
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Gowda A, Bacchi S, Kovoor JG, Gupta AK, Maddern GJ, Chan WO. Should research success be predicted amongst medical students and junior doctors? ANZ J Surg 2023; 93:1742-1743. [PMID: 37565636 DOI: 10.1111/ans.18460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 03/18/2023] [Accepted: 04/06/2023] [Indexed: 08/12/2023]
Affiliation(s)
- Akash Gowda
- Discipline of Surgery, The University of Adelaide, South Australia, Adelaide, Australia
- Department of Ophthalmology, The Royal Adelaide Hospital, South Australia, Adelaide, Australia
| | - Stephen Bacchi
- Discipline of Surgery, The University of Adelaide, South Australia, Adelaide, Australia
- Department of Ophthalmology, The Royal Adelaide Hospital, South Australia, Adelaide, Australia
| | - Joshua G Kovoor
- Discipline of Surgery, The University of Adelaide, South Australia, Adelaide, Australia
- Department of Ophthalmology, The Royal Adelaide Hospital, South Australia, Adelaide, Australia
| | - Aashray K Gupta
- Discipline of Surgery, The University of Adelaide, South Australia, Adelaide, Australia
- Department of Surgery, University Hospital, Queensland, Gold Coast, Australia
| | - Guy J Maddern
- Discipline of Surgery, The University of Adelaide, South Australia, Adelaide, Australia
- Discipline of Surgery, The Queen Elizabeth Hospital, South Australia, Adelaide, Australia
| | - Weng Onn Chan
- Department of Ophthalmology, The Royal Adelaide Hospital, South Australia, Adelaide, Australia
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Jolly S, Chu MKW, Gupta AK, Mitchell J, Kovoor JG, Stewart SK, Babidge WJ, Chan JCY, Trochsler MI, Maddern GJ. Potentially avoidable mortality after endoscopic retrograde cholangiopancreatography in Australia: an 8-year qualitative analysis. ANZ J Surg 2023; 93:1825-1832. [PMID: 37209092 DOI: 10.1111/ans.18511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 04/14/2023] [Accepted: 04/29/2023] [Indexed: 05/22/2023]
Abstract
BACKGROUND Endoscopic retrograde cholangiopancreatography (ERCP) is a commonly performed procedure worldwide. The aim of this study was to examine cases of mortality after ERCP to identify clinical incidents that are potentially preventable, to improve patient safety. METHODS The Australian and New Zealand Audit of Surgical Mortality provides an independent and externally peer-reviewed audit of surgical mortality pertaining to potentially avoidable issues. A retrospective review of prospectively collected data within this database was performed for the 8-year audit period from 1 January 2009 to 31 December 2016. Clinical incidents were identified by assessors through first- or second-line review, and thematically coded into periprocedural stages. These themes were then qualitatively analysed. RESULTS There were 58 potentially avoidable deaths following ERCP, with 85 clinical incidents. Preprocedural incidents were most common (n = 37), followed by postprocedural (n = 32) and then intraprocedural (n = 8). Communication issues occurred across the periprocedural period (n = 8). Preprocedural incidents included delay to procedure, inadequate resuscitative management, decision to perform procedure and inadequate assessment. Intraprocedural incidents comprised technical factors and inadequate support. Postprocedural incidents involved inappropriate treatment, delay in definitive surgical treatment or in recognizing complications, inappropriate second-line intervention and inadequate assessment. Communication incidents comprised inadequate documentation, failure to escalate care and poor inter-clinician communication. CONCLUSION Causes of mortality following ERCP are wide-ranging, and reviewing clinical incidents associated with potentially avoidable mortality can serve to inform and educate practitioners. In collating a subset of cases in which procedure-related mortality was deemed avoidable, a series of cautionary tales about ERCP is presented that may provide cues to practitioners on improving patient safety and inform future surgical practice.
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Affiliation(s)
- Samantha Jolly
- Research, Audit and Academic Surgery, Royal Australasian College of Surgeons, Adelaide, South Australia, Australia
| | - Matthew K W Chu
- Research, Audit and Academic Surgery, Royal Australasian College of Surgeons, Adelaide, South Australia, Australia
- The Department of Gastroenterology and Hepatology, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
- School of Medicine, Faculty of Health Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Aashray K Gupta
- Discipline of Surgery, The Queen Elizabeth Hospital, University of Adelaide, Adelaide, South Australia, Australia
| | - Jessica Mitchell
- Research, Audit and Academic Surgery, Royal Australasian College of Surgeons, Adelaide, South Australia, Australia
| | - Joshua G Kovoor
- Research, Audit and Academic Surgery, Royal Australasian College of Surgeons, Adelaide, South Australia, Australia
- Discipline of Surgery, The Queen Elizabeth Hospital, University of Adelaide, Adelaide, South Australia, Australia
| | - Sasha K Stewart
- Research, Audit and Academic Surgery, Royal Australasian College of Surgeons, Adelaide, South Australia, Australia
| | - Wendy J Babidge
- Research, Audit and Academic Surgery, Royal Australasian College of Surgeons, Adelaide, South Australia, Australia
- Discipline of Surgery, The Queen Elizabeth Hospital, University of Adelaide, Adelaide, South Australia, Australia
| | - Justin C Y Chan
- Research, Audit and Academic Surgery, Royal Australasian College of Surgeons, Adelaide, South Australia, Australia
| | - Markus I Trochsler
- Discipline of Surgery, The Queen Elizabeth Hospital, University of Adelaide, Adelaide, South Australia, Australia
| | - Guy J Maddern
- Research, Audit and Academic Surgery, Royal Australasian College of Surgeons, Adelaide, South Australia, Australia
- Discipline of Surgery, The Queen Elizabeth Hospital, University of Adelaide, Adelaide, South Australia, Australia
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Kovoor JG, Gupta AK, Bacchi S, Stretton B, Padbury RT. 'Hurry up' syndrome harms surgical patients and staff. ANZ J Surg 2023; 93:1756-1757. [PMID: 37458228 DOI: 10.1111/ans.18593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 06/19/2023] [Accepted: 06/27/2023] [Indexed: 08/12/2023]
Affiliation(s)
- Joshua G Kovoor
- Flinders Medical Centre, Adelaide, South Australia, Australia
- Queen Elizabeth Hospital, Adelaide, South Australia, Australia
- University of Adelaide, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Health and Information, Adelaide, South Australia, Australia
| | - Aashray K Gupta
- University of Adelaide, Adelaide, South Australia, Australia
- Health and Information, Adelaide, South Australia, Australia
- Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Stephen Bacchi
- Queen Elizabeth Hospital, Adelaide, South Australia, Australia
- University of Adelaide, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Health and Information, Adelaide, South Australia, Australia
| | - Brandon Stretton
- Queen Elizabeth Hospital, Adelaide, South Australia, Australia
- University of Adelaide, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Health and Information, Adelaide, South Australia, Australia
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Gupta AK, Kleinig O, Tan S, Nagarathinam B, Kovoor JG, Bacchi S, Zaka A, He C, Stroebel A, Beltrame JF, Vallely MP, Bennetts JS, Maddern GJ. Lost in Translation: The Impact of Language Barriers on the Outcomes of Patients Receiving Coronary Artery Revascularization. Cardiovasc Revasc Med 2023; 52:94-98. [PMID: 36990850 DOI: 10.1016/j.carrev.2023.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 03/23/2023] [Indexed: 03/28/2023]
Abstract
INTRODUCTION Clear and effective communication is vital in discussions regarding coronary revascularization. Language barriers may limit communication in healthcare settings. Previous studies on the influence of language barriers on the outcomes of patients receiving coronary revascularization have produced conflicting results. The aim of this systematic review was to evaluate and synthesise the existing evidence regarding the effects of language barrier on the outcomes of patients receiving coronary revascularization. METHODS A systematic review was conducted, including a search of the PubMed, EMBASE, Cochrane, and Google Scholar databases on 01/10/2022. The review was conducted in accordance with PRISMA guidelines. This review was also prospectively registered on PROSPERO. RESULTS Searches identified 3983 articles of which a total 12 studies were included in the review. Most studies describe that language barriers result in delayed presentation, but not delays in treatment following hospital arrival with respect to coronary revascularization. The findings with respect to the likelihood of receiving revascularization have varied significantly; however, some studies have indicated that those with language barriers may be less likely to receive revascularization. There have been some conflicting results with respect to the association between language barrier and mortality. However, most studies suggest that there is no association with increased mortality. In studies that evaluated length of stay variable results have been reported based on geographical location. Namely Australian studies have suggested no association between language barrier and length of stay, but Canadian studies support an association. Language barriers may also be associated with readmissions following discharge, and major adverse cardiovascular and cerebrovascular events (MACCE). CONCLUSION This study demonstrates that patients with language barriers may have poorer outcomes from coronary revascularization. Future interventional studies will be required to consider the sociocultural context of patients with language barriers, and may be targeted at timepoints including prior to, during, or after hospitalisation for coronary revascularization. Further examination of the adverse health outcomes of those with language barriers in fields outside of coronary revascularization are required in view of the stark inequities identified in this field.
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Affiliation(s)
- Aashray K Gupta
- University of Adelaide, Adelaide, Australia; Gold Coast University Hospital, Southport, Australia.
| | | | - Sheryn Tan
- University of Adelaide, Adelaide, Australia
| | | | - Joshua G Kovoor
- University of Adelaide, Adelaide, Australia; Royal Adelaide Hospital, Adelaide, Australia
| | - Stephen Bacchi
- University of Adelaide, Adelaide, Australia; Flinders University, Adelaide, Australia; Royal Adelaide Hospital, Adelaide, Australia
| | - Ammar Zaka
- Gold Coast University Hospital, Southport, Australia
| | - Cheng He
- Gold Coast University Hospital, Southport, Australia
| | | | - John F Beltrame
- University of Adelaide, Adelaide, Australia; Royal Adelaide Hospital, Adelaide, Australia
| | | | - Jayme S Bennetts
- Flinders University, Adelaide, Australia; Flinders Medical Centre, Adelaide, Australia
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Tan S, Tang C, Ng JS, Ng C, Kovoor JG, Gupta AK, Ovenden C, Goh R, Courtney MR, Neal A, Whitham E, Frasca J, Abou-Hamden A, Bacchi S. Identifying epilepsy surgery candidates with natural language processing: A systematic review. J Clin Neurosci 2023; 114:104-109. [PMID: 37354663 DOI: 10.1016/j.jocn.2023.06.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 06/12/2023] [Accepted: 06/13/2023] [Indexed: 06/26/2023]
Abstract
INTRODUCTION Epilepsy surgery is an underutilised, efficacious management strategy for selected individuals with drug-resistant epilepsy. Natural language processing (NLP) may aid in the identification of patients who are suitable to undergo evaluation for epilepsy surgery. The feasibility of this approach is yet to be determined. METHOD In accordance with the PRISMA guidelines, a systematic review of the databases PubMed, EMBASE and Cochrane library was performed. This systematic review was prospectively registered on PROSPERO. RESULTS 6 studies fulfilled inclusion criteria. The majority of included studies reported on datasets from only a single centre, with one study utilising data from two centres and one study six centres. The most commonly employed algorithms were support vector machines (5/6), with only one study utilising NLP strategies such as random forest models and gradient boosted machines. However, the results are promising, with all studies demonstrating moderate to high levels of performance in the identification of patients who may be suitable to undergo epilepsy surgery evaluation. Furthermore, multiple studies demonstrated that NLP could identify such patients 1-2 years prior to the treating clinicians instigating referral. However, no studies were identified that have evaluated the influence of implementing such algorithms on healthcare systems or patient outcomes. CONCLUSIONS NLP is a promising approach to aid in the identification of patients that may be suitable to undergo epilepsy surgery evaluation. Further studies are required examining diverse datasets with additional analytical methodologies. Studies evaluating the impact of implementation of such algorithms would be beneficial.
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Affiliation(s)
- Sheryn Tan
- University of Adelaide, Adelaide, SA 5005, Australia.
| | - Charis Tang
- University of Adelaide, Adelaide, SA 5005, Australia
| | - Jeng Swen Ng
- University of Adelaide, Adelaide, SA 5005, Australia
| | - Cleo Ng
- University of Adelaide, Adelaide, SA 5005, Australia
| | - Joshua G Kovoor
- University of Adelaide, Adelaide, SA 5005, Australia; Royal Adelaide Hospital, Adelaide, SA 5000, Australia
| | - Aashray K Gupta
- University of Adelaide, Adelaide, SA 5005, Australia; Gold Coast University Hospital, Southport, QLD 4215, Australia
| | - Christopher Ovenden
- University of Adelaide, Adelaide, SA 5005, Australia; Royal Adelaide Hospital, Adelaide, SA 5000, Australia
| | - Rudy Goh
- University of Adelaide, Adelaide, SA 5005, Australia; Royal Adelaide Hospital, Adelaide, SA 5000, Australia
| | - Merran R Courtney
- Central Clinical School, Monash University, Melbourne, VIC 3004, Australia; Alfred Health, Melbourne, VIC 3004, Australia; Royal Melbourne Hospital, Parkville, VIC 3050, Australia
| | - Andrew Neal
- Central Clinical School, Monash University, Melbourne, VIC 3004, Australia; Alfred Health, Melbourne, VIC 3004, Australia; Royal Melbourne Hospital, Parkville, VIC 3050, Australia
| | - Emma Whitham
- Flinders University and Medical Centre, Bedford Park, SA 5042, Australia
| | - Joseph Frasca
- Flinders University and Medical Centre, Bedford Park, SA 5042, Australia
| | - Amal Abou-Hamden
- University of Adelaide, Adelaide, SA 5005, Australia; Royal Adelaide Hospital, Adelaide, SA 5000, Australia
| | - Stephen Bacchi
- University of Adelaide, Adelaide, SA 5005, Australia; Royal Adelaide Hospital, Adelaide, SA 5000, Australia; Flinders University and Medical Centre, Bedford Park, SA 5042, Australia
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James J, Tan S, Stretton B, Kovoor JG, Gupta AK, Gluck S, Gilbert T, Sharma Y, Bacchi S. Why do we evaluate 30-day readmissions in general medicine? A historical perspective and contemporary data. Intern Med J 2023; 53:1070-1075. [PMID: 37278138 DOI: 10.1111/imj.16115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 04/11/2023] [Indexed: 06/07/2023]
Abstract
Reducing preventable readmissions is important to help manage current strains on healthcare systems. The metric of 30-day readmissions is commonly cited in discussions regarding this topic. While such thresholds have contemporary funding implications, the rationale for individual cut-off points is partially historical in nature. Through the examination of the basis for the analysis of 30-day readmissions, greater insight into the possible benefits and limitations of such a metric may be obtained.
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Affiliation(s)
- Jonathan James
- Flinders University, Adelaide, South Australia, Australia
| | - Sheryn Tan
- University of Adelaide, Adelaide, South Australia, Australia
| | - Brandon Stretton
- University of Adelaide, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Joshua G Kovoor
- University of Adelaide, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Queen Elizabeth Hospital, Adelaide, South Australia, Australia
| | - Aashray K Gupta
- University of Adelaide, Adelaide, South Australia, Australia
- Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Samuel Gluck
- University of Adelaide, Adelaide, South Australia, Australia
- Lyell McEwin Hospital, Adelaide, South Australia, Australia
| | - Toby Gilbert
- University of Adelaide, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Yogesh Sharma
- Flinders University, Adelaide, South Australia, Australia
| | - Stephen Bacchi
- Flinders University, Adelaide, South Australia, Australia
- University of Adelaide, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
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Kovoor JG, Bacchi S, Gupta AK, Elliott R, Page GJ, Kovoor P. Staying Alive: Promoting Bystander CPR and Defibrillation With Public Messaging. Heart Lung Circ 2023; 32:e42-e43. [PMID: 37344053 DOI: 10.1016/j.hlc.2023.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 03/25/2023] [Indexed: 06/23/2023]
Affiliation(s)
- Joshua G Kovoor
- University of Adelaide, Adelaide, SA, Australia; Health and Information, Adelaide, SA, Australia; Heart of the Nation, Sydney, NSW, Australia. http://www.twitter.com/josh.kovoor
| | - Stephen Bacchi
- University of Adelaide, Adelaide, SA, Australia; Health and Information, Adelaide, SA, Australia
| | | | | | - Gregory J Page
- Heart of the Nation, Sydney, NSW, Australia. http://www.twitter.com/GregPage_Yellow
| | - Pramesh Kovoor
- Heart of the Nation, Sydney, NSW, Australia; University of Sydney, Westmead Hospital, Sydney, NSW, Australia.
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Leslie A, Kovoor JG, Gupta AK, Bacchi S. Modern internet connectivity for modern rural Australian telehealth. Aust J Rural Health 2023; 31:596-597. [PMID: 36920479 DOI: 10.1111/ajr.12976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 02/14/2023] [Accepted: 02/27/2023] [Indexed: 03/16/2023] Open
Affiliation(s)
- Alasdair Leslie
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
- University of Adelaide, Adelaide, South Australia, Australia
| | - Joshua G Kovoor
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
- University of Adelaide, Adelaide, South Australia, Australia
- Port Augusta Hospital, Port Augusta, South Australia, Australia
- Queen Elizabeth Hospital, Adelaide, South Australia, Australia
| | - Aashray K Gupta
- University of Adelaide, Adelaide, South Australia, Australia
- Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Stephen Bacchi
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Flinders Medical Centre, Flinders University, Adelaide, South Australia, Australia
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Kovoor JG, Gupta AK, Bacchi S. ChatGPT: effective writing is succinct. BMJ 2023; 381:1125. [PMID: 37220943 DOI: 10.1136/bmj.p1125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Affiliation(s)
- Joshua G Kovoor
- University of Adelaide, Adelaide, South Australia, Australia
| | - Aashray K Gupta
- University of Adelaide, Adelaide, South Australia, Australia
| | - Stephen Bacchi
- University of Adelaide, Adelaide, South Australia, Australia
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Kovoor JG, Jacobsen JHW, Stretton B, Bacchi S, Gupta AK, Claridge B, Steen MV, Bhanushali A, Bartholomeusz L, Edwards S, Asokan GP, Asokan G, McGee A, Ovenden CD, Hewitt JN, Trochsler MI, Padbury RT, Perry SW, Wong ML, Licinio J, Maddern GJ, Hewett PJ. Depression after stoma surgery: a systematic review and meta-analysis. BMC Psychiatry 2023; 23:352. [PMID: 37217917 DOI: 10.1186/s12888-023-04871-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 05/15/2023] [Indexed: 05/24/2023] Open
Abstract
BACKGROUND Depression is the leading cause of global disability and can develop following the change in body image and functional capacity associated with stoma surgery. However, reported prevalence across the literature is unknown. Accordingly, we performed a systematic review and meta-analysis aiming to characterise depressive symptoms after stoma surgery and potential predictive factors. METHODS PubMed/MEDLINE, Embase, CINAHL and Cochrane Library were searched from respective database inception to 6 March 2023 for studies reporting rates of depressive symptoms after stoma surgery. Risk of bias was assessed using the Downs and Black checklist for non-randomised studies of interventions (NRSIs), and Cochrane RoB2 tool for randomised controlled trials (RCTs). Meta-analysis incorporated meta-regressions and a random-effects model. REGISTRATION PROSPERO, CRD42021262345. RESULTS From 5,742 records, 68 studies were included. According to Downs and Black checklist, the 65 NRSIs were of low to moderate methodological quality. According to Cochrane RoB2, the three RCTs ranged from low risk of bias to some concerns of bias. Thirty-eight studies reported rates of depressive symptoms after stoma surgery as a proportion of the respective study populations, and from these, the median rate across all timepoints was 42.9% 42.9% (IQR: 24.2-58.9%). Pooled scores for respective validated depression measures (Hospital Anxiety and Depression Score (HADS), Beck Depression Inventory (BDI), and Patient Health Questionnaire-9 (PHQ-9)) across studies reporting those scores were below clinical thresholds for major depressive disorder according to severity criteria of the respective scores. In the three studies that used the HADS to compare non-stoma versus stoma surgical populations, depressive symptoms were 58% less frequent in non-stoma populations. Region (Asia-Pacific; Europe; Middle East/Africa; North America) was significantly associated with postoperative depressive symptoms (p = 0.002), whereas age (p = 0.592) and sex (p = 0.069) were not. CONCLUSIONS Depressive symptoms occur in almost half of stoma surgery patients, which is higher than the general population, and many inflammatory bowel disease and colorectal cancer populations outlined in the literature. However, validated measures suggest this is mostly at a level of clinical severity below major depressive disorder. Stoma patient outcomes and postoperative psychosocial adjustment may be enhanced by increased psychological evaluation and care in the perioperative period.
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Affiliation(s)
- Joshua G Kovoor
- University of Adelaide, Adelaide, South Australia, Australia.
- The Queen Elizabeth Hospital, Adelaide, South Australia, Australia.
- Royal Australasian College of Surgeons, Adelaide, South Australia, Australia.
- Royal Adelaide Hospital, Adelaide, South Australia, Australia.
- Flinders Medical Centre, Flinders University, Adelaide, South Australia, Australia.
- Health and Information, Adelaide, South Australia, Australia.
| | | | - Brandon Stretton
- University of Adelaide, Adelaide, South Australia, Australia
- The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Health and Information, Adelaide, South Australia, Australia
| | - Stephen Bacchi
- University of Adelaide, Adelaide, South Australia, Australia
- The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Flinders Medical Centre, Flinders University, Adelaide, South Australia, Australia
- Health and Information, Adelaide, South Australia, Australia
| | - Aashray K Gupta
- University of Adelaide, Adelaide, South Australia, Australia
- Health and Information, Adelaide, South Australia, Australia
- Gold Coast University Hospital, Gold Coast, QLD, Australia
| | - Brayden Claridge
- The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Matthew V Steen
- Glenside Health Services, Adelaide, South Australia, Australia
| | - Ameya Bhanushali
- University of Adelaide, Adelaide, South Australia, Australia
- The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Lorenz Bartholomeusz
- The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Suzanne Edwards
- University of Adelaide, Adelaide, South Australia, Australia
| | - Gayatri P Asokan
- Flinders Medical Centre, Flinders University, Adelaide, South Australia, Australia
| | - Gopika Asokan
- University of Adelaide, Adelaide, South Australia, Australia
- The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Amanda McGee
- Stoma Care Services, Adelaide, South Australia, Australia
| | - Christopher D Ovenden
- University of Adelaide, Adelaide, South Australia, Australia
- The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Health and Information, Adelaide, South Australia, Australia
| | - Joseph N Hewitt
- University of Adelaide, Adelaide, South Australia, Australia
- The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Health and Information, Adelaide, South Australia, Australia
| | - Markus I Trochsler
- University of Adelaide, Adelaide, South Australia, Australia
- The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Robert T Padbury
- Flinders Medical Centre, Flinders University, Adelaide, South Australia, Australia
| | - Seth W Perry
- State University of New York Upstate Medical University, Syracuse, NY, USA
| | - Ma-Li Wong
- State University of New York Upstate Medical University, Syracuse, NY, USA
| | - Julio Licinio
- Flinders Medical Centre, Flinders University, Adelaide, South Australia, Australia
- State University of New York Upstate Medical University, Syracuse, NY, USA
| | - Guy J Maddern
- University of Adelaide, Adelaide, South Australia, Australia
- The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
- Royal Australasian College of Surgeons, Adelaide, South Australia, Australia
| | - Peter J Hewett
- University of Adelaide, Adelaide, South Australia, Australia
- The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
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49
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Connell NT, Caicedo J, Nieto N, Chatterjee S, Hait A, Gupta AK, Bullano M, Schultz BG. Real-world healthcare costs and resource utilization in patients with von Willebrand disease and angiodysplasia. Expert Rev Pharmacoecon Outcomes Res 2023:1-9. [PMID: 37183836 DOI: 10.1080/14737167.2023.2211270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
OBJECTIVE To describe the economic burden among VWD patients with angiodysplasia compared to VWD patients without angiodysplasia and the general population. METHODS This was a retrospective analysis using the Merative MarketScan Commercial and Medicare Databases® (January 2011-September 2020). Selected patients had ≥1 medical claim for VWD or low VWF, ≥1 medical claim for AGD, and ≥3 GI-related bleeding episodes within a year. HCRU and all-cause costs were compared with the VWD (only) and the general cohorts. RESULTS The mean total all-cause costs were $150,101 among patients with VWD and angiodysplasia (n = 34), higher compared to $48,249 among matched VWD patients without angiodysplasia (n = 136) and $31,029 among matched individuals of the general population [n = 136; p-value < 0.0001]. The differences in costs between groups were primarily due to inpatient care. During the 12-month follow-up, VWD patients with symptomatic (n = 35), asymptomatic (n = 81), and suspected (n = 378) angiodysplasia had an average of 4.1, 0.6, and 3.8 gastrointestinal (GI) bleeds, respectively. Desmopressin, VWF concentrates, and aminocaproic acid were the most frequent treatments used. The most frequent procedures to treat GI-related bleeding and underlying lesions were blood transfusion and laser therapy. CONCLUSIONS Despite recent therapeutic advances, there is room for considerable reduction of the disease burden in patients with VWD and angiodysplasia.
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Affiliation(s)
- N T Connell
- Hematology Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - J Caicedo
- US Medical Affairs, Takeda Pharmaceuticals USA Inc, Lexington, MA, USA
| | - N Nieto
- US Medical Affairs, Takeda Pharmaceuticals USA Inc, Lexington, MA, USA
| | | | - A Hait
- Complete HEOR Solutions, North Wales, PA, USA
| | - A K Gupta
- Complete HEOR Solutions, North Wales, PA, USA
| | - M Bullano
- US Medical Affairs, Takeda Pharmaceuticals USA Inc, Lexington, MA, USA
| | - B G Schultz
- US Medical Affairs, Takeda Pharmaceuticals USA Inc, Lexington, MA, USA
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50
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Stretton B, Tran V, Kovoor JG, Gupta AK, Bacchi S, Maddern GJ, Boyd M. Phone home: The translational benefits of space medicine for rural and remote perioperative medicine on Earth. Aust J Rural Health 2023. [PMID: 37166117 DOI: 10.1111/ajr.12995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 12/21/2022] [Accepted: 05/01/2023] [Indexed: 05/12/2023] Open
Affiliation(s)
- Brandon Stretton
- Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
| | - Vienna Tran
- Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
| | - Joshua G Kovoor
- Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
- Discipline of Surgery, The Queen Elizabeth Hospital, University of Adelaide, Adelaide, South Australia, Australia
| | - Aashray K Gupta
- Department of Cardiothoracic Surgery, Gold Coast University Hospital, Southport, Queensland, Australia
| | - Stephen Bacchi
- Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
| | - Guy J Maddern
- Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
- Discipline of Surgery, The Queen Elizabeth Hospital, University of Adelaide, Adelaide, South Australia, Australia
| | - Mark Boyd
- Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
- Northern Adelaide Local Health Network, Adelaide, South Australia, Australia
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