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Glasbey J, Ademuyiwa A, Bhatt A, Biccard B, Blazeby J, Brocklehurst P, Chakrabortee S, Allen Ingabire JC, Dossou FM, Durán I, Dutta R, Ghosh D, Gyamfi F, Haque P, Hardy P, Horton M, Hyman G, Jain R, Ladipo-Ajayi O, Lawani I, Lawani S, Kachapila M, Lillywhite R, Macefield R, Magill L, Martin J, Mathers J, McLean K, Mistry P, Mittal R, Monahan M, Moore R, Morton D, Ojo M, Ntirenganya F, Ofori E, Pearse R, Peón A, Pinkney T, de la Medina AR, Ronald T, Roman D, Runingamugabo E, Sitch A, Slade A, Tabiri S, Smith D, Bhangu A, Glasbey J, Sitch A, Slade A, To DK, Bhangu A, Hardy P, Ademuyiwa AO, Ismail L, Ghosh D, de la Medina AR, Moore R, Ntirenganya F, Tabiri S, Runingamugabo E, Patrawala S, Prah A, Oko C, Kroese K, Lawani I, Dossou FM, Dzemta C, Kandokponou CMB, Lawani S, Behanzin H, Kpangon C, Ofori BA, Tabiri S, Saba AH, Limann G, Acquah DK, Alhassan SM, Mohammed S, Emmanuel OA, Musah Y, Edwin Y, Kunfah S, Mustapha Y, Francis AA, Ayingayure E, Limann G, Amponsah-Manu F, Agyemang E, Agyekum V, Adjei-Acquah E, Twerefour EY, Koomson B, Boateng RA, Acquah AO, Ofosu-Akromah R, Adam-Zakariah LI, Adu-Aryee NA, Wordui T, Larbi CC, Enoch AA, Elijah M, Christian K, Kwame AG, Percy B, Bismark KE, Brian G, Ruth M, Hussey R, Dadzie S, Appiah AD, Yeboah G, Yeboah C, Amoako J, Acquah R, Sowah NA, Kusiwaa A, Asabre E, Ballu C, Barimah CG, Owusu F, Sie-Broni C, Adobea V, Owusu PY, Zume M, Labaran AH, Adu-Brobbey R, Morna MT, Debrah SA, Maison POM, Nortey M, Enti D, Amoako-Boateng MP, Appiah AB, Ofori EO, Kpankpari R, Boakye B, Quartson EM, Koggoh P, Agbeko AE, Gyamfi FE, Arthur J, Yorke J, Gyasi-Sarpong CK, Dally C, Lovi AK, Amoah M, Nimako B, Sagoe R, Davor A, Galley F, Adinku M, Boakye-Yiadom J, Acquaye J, Appiah J, Acheampong DO, Haruna I, Boateng EA, Ayodeji EK, Tuffuor S, Kwarley N, Tufuor Y, Abdulai RD, Dankwah F, Armah R, Ofosuhene D, Osei-Poku D, Temitope AE, Gakpetor DA, Gawu VS, Asare C, Tackie E, Ankomah J, Nyarko IO, Robertson Z, Godwin S, Boakye AA, Fosu G, Assah-Adjei F, Haque P, Jain R, Bhatt A, Dhiman J, Dutta R, Ghosh D, Daniel E, K P, Madankumar L, Mittal R, Nagomy I, Prasad S, Mathew AJ, Prakash D, Jacob P, Anachy JP, Mathew A, Thomas J, Alexander PV, Zechariah P, Aruldas ND, Mehraj A, Ahmed HI, Wani RA, Parray FQ, Chowdri NA, De la Medina AR, Maldonado LMP, Vazquez DSG, Sánchez IID, Lara MJM, de la Fuente ANS, Flores AOC, Gallo MEB, Ojeda AG, Velasco MEJ, Miguelena LH, Ortiz RJC, Gonzalez GIH, Romero MH, Krauss RIH, Sansores LAD, Avendaño AC, Aguirre CC, Gomez IB, Mejia HO, Ojeda AG, Flores OEO, González García de Rojas EA, Belmontes KJP, Camacho FJB, Hernández AB, Aguirre LR, Galaviz REM, Orozco CF, Bueno WGÁ, Marbello FSR, Acevedo DEL, Valadez MH, Arellano ALB, Ramírez-González LR, Ramírez BGG, Robles EV, García RIR, Navarro JVP, Torres EJC, Solano DRD, Peón AN, Menindez RDL, Gamez RR, Muñoz MCP, Belie O, Adeleye V, Ademuyiwa A, Adeniyi O, Akinajo O, Akinboyewa D, Alakaloko F, Atoyebi O, Balogun O, Bode C, Elebute O, Ezenwankwo F, Adedotun A, Ihediwa G, Kuku J, Ladipo-Ajayi O, Makanjuola A, Nwokocha S, Ogein O, Ojewola R, Oladimeji A, Olajide T, Alasi I, Oluseye O, Seyi-Olajide J, Soibi-Harry A, Williams E, Vincent AM, Duru NJ, Onyekachi KU, Ashley C, Mgbemena CV, Ojo M, Oluyemisi O, Ikuewunmi I, Adebunmi A, Bassey EG, Ohazurike EO, Amao OM, Oluwaseun OB, Doris E, Stephen O, Gbenga-Oke C, Olayioye O, Oluyemisi O, Oluremi K, Abunimye E, Oyegbola C, Kayode O, Orowale AA, Williams OM, Omisanjo OA, Faboya OM, Imam ZO, Oshodi OA, Oshodi YA, Ogunyemi AA, Ajai OT, Nwaenyi FC, Adisa AO, Aderounmu AA, Wuraola FO, Sowande O, Abdur-Rahman LO, Bello JO, Raji HO, Adeleke NA, Lawal SA, Afolabi RT, Lawal A, Ekwunife OH, Egwuonwu OA, Uche CF, Muhammad ABAB, Muhammad SS, Takai IUIU, Aliyu Salele MAS, Ukata OG, Magashi MKMK, Abdullahi LBLB, Muideen BABA, Ado KA, Anyawu LJCLJC, Olori S, Sani SA, Osagie OO, Mbajiekwe N, Aisuodionoe-Shadrach O, Akaba GO, Ameh L, Ameh L, Adebayo FO, Uanikhoba M, Ogbo FO, Tabuanu NO, Lawal TA, Abdus-Salam RA, Ajao AE, Takure AO, Ayandipo OO, Ekwuazi HO, Abayomi O, Lawal OO, Olagunju S, Egbuchulem KI, Adebayo SA, Elemile P, Usang UE, Udosen JE, Edet EE, Inyang AW, Olory EM, Udie GU, Chiejina GO, Marwa AD, Iseh FJ, Ogbeche SA, Isa MO, Ezomike UO, Ekenze SO, Eze MI, Izuka EO, Ede JK, Enemuo VC, Mbadiwe OM, Mbah NG, Imanishimwe A, Habumuremyi S, Ntirenganya F, Allen Ingabire JC, Ncogoza I, Munyaneza E, Haragirimana JDD, Urimubabo CJ, Mukanyange V, Nyirahabimana J, Mutabazi E, Mpirimbanyi C, Mwenedata O, Maniraguha HL, Izabiriza E, Dusabe M, Zirikana J, Uwizeyimana F, Mutuyimana J, Rwagahirima E, Imanishimwe A, Tubasiime R, Munyaneza A, Habumuremyi S, Kanyarukiko S, Ndegamiye G, Mukaneza F, Uwimana JC, Nyirangeri P, Mukantibaziyaremye D, Hirwa AD, Mbonimpaye S, Muroruhirwe P, Mukakomite C, Kabanda E, Moore R, Nhlabathi NA, Fourtounas M, Adams MA, Hyman G, Nxumalo HS, Sentholang N, Sethoana ME, Mathe MN, Ally Z, Flint M, Biccard B, Ademuyiwa AO, Adisa AO, Bhangu A, Brocklehurst P, Chakrabortee S, Hardy P, Harrison E, Allen Ingabire JC, Haque PD, Ismail L, Glasbey J, Ghosh D, Gyamfi FE, Li E, Lillywhite R, de la Medina AR, Moore R, Magill L, Morton D, Nepogodiev D, Ntirenganya F, Pinkney T, Omar O, Simoes J, Smith D, Tabiri S, Ademuyiwa AO, Ismail L, Ghosh D, de la Medina AR, Moore R, Ntirenganya F, Tabiri S, Ademuyiwa A, Bhangu A, Brant F, Brocklehurst P, Chakrabortee S, Ghosh D, Glasbey J, Hardy P, Harrison E, Heritage E, Ismail L, Kroese K, Lapitan C, Lillywhite R, Lissauer D, Magill L, de la Medina AR, Mistry P, Monahan M, Moore R, Morton D, Nepogodiev D, Ntirenganya F, Omar O, Pinkney T, Roberts T, Smith D, Tabiri S, Winkles N, Hardy P, Omar O, Runigamugabo E, Verjee A, Sodonougbo P, Assouto P, Fiogbe M, Koco H, Metchinhoungbe S, Sogbo H, Behanzin H, Seto DM, Tandje Y, Kangni S, Kpangon C, Akpla M, Chobli HH, Kovohouande B, Agboton G, Ahossi R, Ngabo RB, Bisimwa N, Kandokponou CMB, Dokponou M, Dossou FM, Dzemta C, Gaou A, Goudou R, Hedefoun E, Houtoukpe S, Kamga F, Kiki-Migan E, Lawani S, Lawani I, Loko R, Moutaïrou A, Ogouyemi P, Soumanou F, Tamadaho P, Zounon MA, Adagrah LA, Alhassan BBA, Amoako-Boateng MP, Appiah AB, Asante-Asamani A, Boakye B, Debrah SA, Enti D, Ganiyu RA, Koggoh P, Kpankpari R, Opandoh INM, Manu MA, Manu MPO, Mensah S, Morna MT, Nkrumah J, Nortey M, Ofori EO, Quartson EM, Adjei-Acquah E, Agyekum V, Agyemang E, Akesseh RA, Amponsah-Manu F, Ofosu-Akromah R, Acquah AO, Adam-Zakariah LI, Asabre E, Boateng RA, Koomson B, Kusiwaa A, Twerefour EY, Ankomah J, Assah-Adjei F, Boakye AA, Fosu G, Serbeh G, Gyan KY, Nyarko IO, Robertson Z, Armah R, Asare C, Gakpetor DA, Gawu VS, Obbeng A, Ofosuhene D, Osei-Poku D, Puozaa D, Tackie E, Temitope AE, Acquah R, Amoako J, Appiah AD, Aseti M, Banka C, Dadzie S, Essien D, Gyamfi FE, Hussey R, Kwarteng J, Sowah NA, Yeboah G, Yeboah C, Addo KG, Akosa EA, Boakye P, Coompson CL, Gyamfi B, Kontor BE, Kyeremeh C, Manu R, Mensah E, Solae FI, Toffah GK, Acheampong DO, Acquaye J, Adinku M, Agbedinu K, Agbeko AE, Amankwa EG, Amoah M, Amoah G, Appiah J, Arthur J, Ayim A, Ayodeji EK, Boakye-Yiadom J, Boateng EA, Dally C, Davor A, Gyasi-Sarpong CK, Hamidu NNN, Haruna I, Kwarley N, Lovi AK, Nimako B, Nyadu BB, Opoku D, Osabutey A, Sagoe R, Tuffour S, Tufour Y, Yamoah FA, Yefieye AC, Yorke J, Adu-Aryee NA, Adjei F, Akoto E, Ametefe E, Amoako JK, Attepor GS, Brown GD, Fenu B, Kumassah PK, Olayiwola DO, Wordui T, Agboadoh N, Abubakari F, Ballu C, Barimah CG, Boateng GC, Luri PT, Titigah A, Owusu F, Adu-Brobbey R, Coompson CL, Labaran AH, Owusu JA, Adobea V, Bennin A, Dankwah F, Doe S, Kantanka RS, Kobby E, Larnyor KKKH, Osei E, Owusu PY, Sie-Broni CA, Zume M, Abantanga FA, Abdulai DR, Acquah DK, Ayingayure E, Osman I, Kunfah S, Limann G, Mohammed SA, Mohammed S, Musah Y, Ofori B, Owusu EA, Saba AH, Seidu AS, Tabiri S, Yakubu M, Yenli EMT, Gautham A, Hepzibah A, Mary G, Singh D, Bhatti D, Bhatti W, Bir K, Daniel S, Dhar T, Dhiman J, Ghosh D, Goyal S, Ankush, Goyal, Hans M, Haque P, Konda S, Luther A, Mahajan A, Makkar S, Mandrelle K, Michael V, Mukherjee P, Rajappa R, Singh P, Suroy A, Thind R, Thomas A, Tuli A, Veetil S, Jesudason EDM, K P, Madankumar L, Mittal R, Nagomy I, Selvakumar R, Shankar B, Sivakumar M, Sridhar R, Thomas C, Titus D, Aggarwal M, Dhamija P, Gupta H, Kanna V, Kumar A, Singh G, Alexander P, Thomas J, Zechariah P, Dasari A, Jacob P, Kurien E, Mathew A, Prakash D, Susan A, Varghese R, Alpheus R, Choudhrie A, Kumar H, Peters N, Raul S, Sharma R, Vakil R, Bueno WÁ, Camacho FB, Hernández AB, Arellano AB, Torres EC, Orozco CF, de Rojas EGG, Ojeda AG, Ramírez BG, Valadez MH, Acevedo DL, Galaviz RM, Flores OO, Navarro JP, Belmontes KP, Marbello FR, Ramírez-González L, Aguirre LR, García RR, Robles EV, Ortiz RC, Gonzalez GH, Krauss RH, Miguelena LH, Romero MH, Gomez IB, Aguirre CC, Avendaño AC, Sansores LD, Mejia HO, del Campo LUG, Cerdan CC, Solano DD, Garcia RT, Gallo MB, Flores AC, Ojeda AG, Velasco MJ, Gamez RR, Menindez RL, Peón AN, Muñoz MP, Sánchez IID, Vázquez DSG, Lara MJM, Maldonado LMP, de la Fuente ANS, De la Medina AR, Abdullahi L, Ado K, Aliyu M, Anyanwu LJ, Magashi M, Muhammad A, Muhammad S, Muideen B, Takai I, Ukata O, Adesanya O, Awonuga D, Fasiku O, Ogo C, Abdulsalam M, Adeniran A, Ajai O, Akande O, Atobatele K, Eke G, Faboya O, Imam Z, Momson E, Nwaenyi F, Ogunyemi A, Oludara M, Omisanjo O, Oshodi O, Oshodi Y, Oyewole Y, Salami O, Williams O, Adeleye V, Ademuyiwa A, Adeniyi O, Akinajo O, Akinboyewa D, Alasi I, Alakaloko F, Atoyebi O, Balogun O, Belie O, Bode C, Ekwesianya A, Elebute O, Ezenwankwo F, Fatuga A, Ihediwa G, Jimoh A, Kuku J, LadipoAjayi O, Makanjuola A, Mokwenyei O, Nwokocha S, Ogein O, Ojewola R, Oladimeji A, Olajide T, Oluseye O, Seyi-Olajide J, Soibi-Harry A, Ugwu A, Williams E, Egwuonwu O, Ekwunife O, Modekwe V, Okoro C, Uche C, Ugwuanyi K, Ugwunne C, Adeleke A, Adenikinju W, Adeniyi O, Adepiti A, Aderounmu A, Adesunkanmi A, Adisa A, Ajekwu S, Ajenjfuja O, Akindojutimi J, Akinkuolie A, Alatise O, Allen O, Amosu L, Archibong M, Arowolo O, Ayantona D, Ayinde A, Badejoko O, Badmus T, Etonyeaku A, Igbodike E, Ijarotimi O, Lawal A, Nana F, Oduanafolabi T, Olasehinde O, Olayemi O, Omitinde S, Oni O, Onyeze C, Orji E, Rotimi A, Salako A, Solaja O, Sowemimo O, Talabi A, Tajudeen M, Wuraola F, Adebayo F, Aisuodionoe-Shadrach O, Akaba G, Ameh L, Mbajiekwe N, Ogbo F, Olori S, Osagie O, Sadiq A, Sani S, Tabuanu N, Uanikhoba M, Chiejina G, Edet E, Inyang A, Isa M, Iseh F, Marwa A, Ogbeche S, Olory E, Udie G, Udosen J, Usang U, Abayomi O, Abdus-Salam R, Adebayo S, Ajao A, Amusat O, Ayandipo O, Egbuchulem K, Ekwuazi H, Elemile P, Lawal T, Lawal O, Olagunju S, Osuala P, Suleman B, Takure A, Abdur-Rahman L, Adeleke N, Adesola M, Afolabi R, Agodirin S, Aremu I, Bello J, Lawal S, Lawal A, Raji H, Sayomi O, Shittu A, Ede J, Ekenze S, Enemuo V, Eze M, Ezomike U, Izuka E, Mbadiwe O, Mbah N, Ezinne U, Francis M, Ikechukwu I, Nnyonno O, Okoro P, Patrick I, Raphael J, Vaduneme O, Victor A, Kanyarukiko S, Mukaneza F, Mukantibaziyaremye D, Munyaneza A, Ndegamiye G, Tubasiime R, Dusabe M, Izabiriza E, Maniraguha HL, Mpirimbanyi C, Mutuyimana J, Mwenedata O, Rwagahirima E, Uwizeyimana F, Zirikana J, Hirwa AD, Kabanda E, Mbonimpaye S, Mukakomite C, Muroruhirwe P, Bucyibaruta G, Bunogerane GJ, Habumuremyi S, Haragirimana JDD, Imanishimwe A, Allen Ingabire JC, Mukanyange V, Munyaneza E, Mutabazi E, Ncogoza I, Ntirenganya F, Nyirahabimana J, Urimubabo C, Adams MA, Crawford R, Ede CJ, Fourtounas M, Hyman G, Khan Z, Kwati M, Mathe MN, Moore R, Nhlabathi NA, Nxumalo HS, Pattinson P, Sentholang N, Sethoana ME, Stassen ME, Thornley L, Wondoh P, Birtles C, Ivy M, Mbavhalelo C, Ally Z, Adewunmi AS, Cook J, Jayne D, Laurberg S, Brown J, Cousens S, Smart N. Accuracy of the Wound Healing Questionnaire in the diagnosis of surgical-site infection after abdominal surgery in low- and middle-income countries. Br J Surg 2024; 111:znad446. [PMID: 38747515 PMCID: PMC10895408 DOI: 10.1093/bjs/znad446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 09/07/2023] [Accepted: 10/12/2023] [Indexed: 05/19/2024]
Abstract
INTRODUCTION Telemedicine is being adopted for postoperative surveillance but requires evaluation for efficacy. This study tested a telephone Wound Healing Questionnaire (WHQ) to diagnose surgical site infection (SSI) after abdominal surgery in low- and middle-income countries. METHOD A multi-centre, international, prospective study was embedded in the FALCON trial; a factorial RCT testing measures to reduce SSI in seven low- and middle-income countries (NCT03700749). It was conducted according to a pre-registered protocol (SWAT126) and reported according to STARD guidelines. The reference test was in-person review by a trained clinician at 30 postoperative days according to US Centres for Disease Control criteria. The index test was telephone administration of an adapted WHQ at 27 to 30 postoperative days by a researcher blinded to the outcome of in-person review. The sum of item response scores generated an overall score between 0 and 29. The primary outcome was the diagnostic accuracy of the WHQ, defined as the proportion of SSI correctly identified by the telephone WHQ, and summarized using the area under the receiving operator characteristic curve (AUROC) and diagnostic test accuracy statistics. RESULTS Patients were included from three upper-middle income (396 patients, 13 hospitals), three lower-middle income (746 patients, 19 hospitals), and one low-income country (54 patients, 4 hospitals). 90.3% (1088 of 1196) patients were successfully contacted. Those with non-midline incisions (adjusted odds ratio: 0.36, 95% c.i. 0.17 to 0.73, P=0.005) or a confirmed diagnosis of SSI on in-person assessment (odds ratio: 0.42, 95% c.i. 0.20 to 0.92, P=0.006) were harder to reach. The questionnaire correctly discriminated between most patients with and without SSI (AUROC 0.869, 95% c.i. 0.824 to 0.914), which was consistent across subgroups. A representative cut-off score of ≥4 displayed a sensitivity of 0.701 (0.610-0.792), specificity of 0.911 (0.878-0.943), positive predictive value of 0.723 (0.633-0.814) and negative predictive value of 0.901 (0.867-0.935). CONCLUSION SSI can be diagnosed using a telephone questionnaire (obviating in-person assessment) in low resource settings.
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Glasbey JC, Kadir B, Ademuyiwa AO, Adisa AO, Bhangu A, Brocklehurst P, Chakrabortee S, Hardy P, Harrison E, Ingabire JCA, Haque PD, Ismail L, Ghosh D, Gyamfi FE, Li E, Lillywhite R, de la Medina AR, Moore R, Magill L, Morton D, Nepogodiev D, Ntirenganya F, Pinkney T, Omar O, Simoes JFF, Smith D, Tabiri S, Runigamugabo E, Sodonougbo P, Behanzin H, Kangni S, Agboton G, Adagrah LA, Adjei-Acquah E, Acquah AO, Ankomah J, Armah R, Acquah R, Addo KG, Acheampong DO, Adu-Aryee NA, Abubakari F, Titigah A, Owusu F, Adu-Brobbey R, Adobea V, Abantanga FA, Gautham A, Bhatti D, Jesudason EDM, Aggarwal M, Alexander P, Dasari A, Alpheus R, Kumar H, Raul S, Bueno WÁ, Ortiz RC, Gomez IB, Cerdan CC, Gallo MB, Gamez RR, Sánchez ID, Abdullahi L, Adesanya O, Abdulsalam M, Adeleye V, Egwuonwu O, Adeleke A, Adebayo F, Chiejina G, Abayomi O, Abdur-Rahman L, Ede J, Ezinne U, Kanyarukiko S, Dusabe M, Hirwa AD, Bucyibaruta G, Adams MA, Birtles C, Ally Z, Adewunmi AS, Cook J, Brown J, Verjee A, Assouto P, Seto DM, Kpangon C, Ahossi R, Alhassan BBA, Agyekum V, Adam-Zakariah LI, Assah-Adjei F, Asare C, Amoako J, Akosa EA, Acquaye J, Adjei F, Ballu C, Coompson CL, Bennin A, Abdulai DR, Hepzibah A, Bhatti W, Paul PK, Dhamija P, Thomas J, Jacob P, Choudhrie A, Peters N, Sharma R, Camacho FB, Gonzalez GH, Aguirre CC, Solano DD, Flores AC, Menindez RL, Vazquez DG, Ado K, Awonuga D, Adeniran A, Ademuyiwa A, Ekwunife O, Adenikinju W, Aisuodionoe-Shadrach O, Edet E, Abdus-Salam R, Adeleke N, Ekenze S, Francis M, Mukaneza F, Izabiriza E, Kabanda E, Bunogerane GJ, Crawford R, Ivy M, Jayne D, Cousens S, Brant F, Fiogbe M, Tandje Y, Akpla M, Ngabo RB, Amoako-Boateng MP, Agyemang E, Asabre E, Boakye AA, Gakpetor DA, Appiah AD, Boakye P, Adinku M, Akoto E, Barimah CG, Labaran AH, Dankwah F, Acquah DK, Mary G, Bir K, Madankumar L, Gupta H, Zechariah P, Kurien E, Vakil R, Hernández AB, Krauss RH, Avendaño AC, Garcia RT, Ojeda AG, Peón AN, Lara MM, Aliyu M, Fasiku O, Ajai O, Adeniyi O, Modekwe V, Adeniyi O, Akaba G, Inyang A, Adebayo S, Adesola M, Enemuo V, Ikechukwu I, Mukantibaziyaremye D, Maniraguha HL, Mbonimpaye S, Habumuremyi S, Ede CJ, Mbavhalelo C, Laurberg S, Smart N, Koco H, Chobli HH, Bisimwa N, Appiah AB, Akesseh RA, Boateng RA, Fosu G, Gawu VS, Aseti M, Coompson CL, Agbedinu K, Ametefe E, Boateng GC, Owusu JA, Doe S, Ayingayure E, Singh D, Daniel S, Mittal R, Kanna V, Mathew A, Arellano AB, Miguelena LH, Sansores LD, Velasco MJ, Muñoz MP, Perez-Maldonado LM, Anyanwu LJ, Ogo C, Akande O, Akinajo O, Okoro C, Adepiti A, Ameh L, Isa M, Ajao A, Afolabi R, Eze M, Nnyonno O, Munyaneza A, Mpirimbanyi C, Mukakomite C, Haragirimana JDD, Fourtounas M, Chakrabortee S, Metchinhoungbe S, Kovohouande B, Kandokponou CMB, Asante-Asamani A, Amponsah-Manu F, Koomson B, Serbeh G, Obbeng A, Banka C, Gyamfi B, Agbeko AE, Amoako JK, Luri PT, Kantanka RS, Osman I, Dhar T, Nagomy I, Kumar A, Prakash D, Torres EC, Romero MH, Mejia HO, de la Fuente ANS, Magashi M, Atobatele K, Akinboyewa D, Uche C, Aderounmu A, Mbajiekwe N, Iseh F, Amusat O, Agodirin S, Ezomike U, Okoro P, Ndegamiye G, Mutuyimana J, Muroruhirwe P, Imanishimwe A, Hyman G, Sogbo H, Dokponou M, Boakye B, Ofosu-Akromah R, Kusiwaa A, Gyan KY, Ofosuhene D, Dadzie S, Kontor BE, Amankwa EG, Attepor GS, Kobby E, Kunfah S, Dhiman J, Selvakumar R, Singh G, Susan A, Orozco CF, del Campo LUG, de la Medina ARD, Muhammad A, Eke G, Alasi I, Ugwuanyi K, Adesunkanmi A, Ogbo F, Marwa A, Ayandipo O, Aremu I, Izuka E, Patrick I, Tubasiime R, Mwenedata O, Ingabire JCA, Khan Z, Dossou FM, Debrah SA, Enti D, Twerefour EY, Nyarko IO, Osei-Poku D, Essien D, Kyeremeh C, Amoah M, Brown GD, Larnyor KKKH, Limann G, Ghosh D, Shankar B, Varghese R, de Rojas EGG, Muhammad S, Faboya O, Alakaloko F, Ugwunne C, Adisa A, Olori S, Ogbeche S, Egbuchulem K, Bello J, Mbadiwe O, Raphael J, Rwagahirima E, Mukanyange V, Kwati M, Dzemta C, Ganiyu RA, Robertson Z, Puozaa D, Gyamfi FE, Manu R, Amoah G, Fenu B, Osei E, Mohammed SA, Goyal S, Sivakumar M, Ojeda AG, Muideen B, Imam Z, Atoyebi O, Ajekwu S, Osagie O, Olory E, Ekwuazi H, Lawal S, Mbah N, Vaduneme O, Uwizeyimana F, Munyaneza E, Mathe MN, Gaou A, Koggoh P, Tackie E, Hussey R, Mensah E, Appiah J, Kumassah PK, Owusu PY, Mohammed S, Goyal A, Sridhar R, Ramírez BG, Takai I, Momson E, Balogun O, Ajenjfuja O, Sadiq A, Udie G, Elemile P, Lawal A, Victor A, Zirikana J, Mutabazi E, Moore R, Heritage E, Goudou R, Kpankpari R, Temitope AE, Kwarteng J, Solae FI, Arthur J, Olayiwola DO, Sie-Broni CA, Musah Y, Goyal S, Thomas C, Valadez MHV, Ukata O, Nwaenyi F, Belie O, Akindojutimi J, Sani S, Udosen J, Lawal T, Raji H, Ncogoza I, Nhlabathi NA, Hedefoun E, Opandoh INM, Sowah NA, Toffah GK, Ayim A, Wordui T, Zume M, Ofori B, Hans M, Titus D, Acevedo DL, Ogunyemi A, Bode C, Akinkuolie A, Tabuanu N, Usang U, Lawal O, Sayomi O, Ntirenganya F, Nxumalo HS, Kroese K, Houtoukpe S, Manu MA, Yeboah G, Ayodeji EK, Agboadoh N, Owusu EA, Haque P, Galaviz RM, Oludara M, Ekwesianya A, Alatise O, Uanikhoba M, Olagunju S, Shittu A, Nyirahabimana J, Pattinson P, Lapitan C, Kamga F, Manu MPO, Yeboah C, Boakye-Yiadom J, Saba AH, Konda S, Flores OO, Omisanjo O, Elebute O, Allen O, Osuala P, Urimubabo C, Sentholang N, Kiki-Migan E, Mensah S, Boateng EA, Seidu AS, Luther A, Navarro JP, Oshodi O, Ezenwankwo F, Amosu L, Suleman B, Sethoana ME, Lissauer D, Lawani S, Morna MT, Dally C, Tabiri S, Mahajan A, Belmontes KP, Oshodi Y, Fatuga A, Archibong M, Takure A, Stassen ME, Lawani I, Nkrumah J, Davor A, Yakubu M, Makkar S, Marbello FR, Oyewole Y, Ihediwa G, Arowolo O, Thornley L, Loko R, Nortey M, Gyasi-Sarpong CK, Yenli EMTA, Mandrelle K, Ramírez-González L, Salami O, Jimoh A, Ayantona D, Wondoh P, Mistry P, Moutaïrou A, Ofori EO, Hamidu NNN, Michael V, Aguirre LR, Williams O, Kuku J, Ayinde A, Monahan M, Ogouyemi P, Quartson EMQ, Haruna I, Mukherjee P, García RR, Ladipo-Ajayi O, Badejoko O, Soumanou F, Kwarley N, Rajappa R, Robles EV, Makanjuola A, Badmus T, Tamadaho P, Lovi AK, Singh P, Mokwenyei O, Etonyeaku A, Zounon MA, Nimako B, Suroy A, Nwokocha S, Igbodike E, Nyadu BB, Thind R, Ogein O, Ijarotimi O, Opoku D, Thomas A, Ojewola R, Lawal A, Osabutey A, Tuli A, Oladimeji A, Nana F, Roberts T, Sagoe R, Veetil S, Olajide T, Oduanafolabi T, Tuffour S, Oluseye O, Olasehinde O, Tufour Y, Seyi-Olajide J, Olayemi O, Winkles N, Yamoah FA, Soibi-Harry A, Omitinde S, Yefieye AC, Ugwu A, Oni O, Yorke J, Williams E, Onyeze C, Orji E, Rotimi A, Salako A, Solaja O, Sowemimo O, Talabi A, Tajudeen M, Wuraola F. The importance of post-discharge surgical site infection surveillance: an exploration of surrogate outcome validity in a global randomised controlled trial (FALCON). Lancet Glob Health 2023; 11:e1178-e1179. [PMID: 37474222 DOI: 10.1016/s2214-109x(23)00256-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 04/05/2023] [Accepted: 05/26/2023] [Indexed: 07/22/2023]
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Dibley L, Hart A, Duncan J, Knowles CH, Kerry S, Lanz D, Berdunov V, Madurasinghe VW, Wade T, Terry H, Verjee A, Fader M, Norton C. Supported Intervention Versus Intervention Alone for Management of Fecal Incontinence in Patients With Inflammatory Bowel Disease: A Multicenter Mixed-Methods Randomized Controlled Trial. J Wound Ostomy Continence Nurs 2023; 50:235-244. [PMID: 37146115 DOI: 10.1097/won.0000000000000979] [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] [Indexed: 05/07/2023]
Abstract
PURPOSE The aims of this study were to test a noninvasive self-management intervention supported by specialist nurses versus intervention alone in patients with inflammatory bowel disease (IBD) experiencing fecal incontinence and to conduct a qualitative evaluation of the trial. DESIGN Multicenter, parallel-group, open-label, mixed-methods randomized controlled trial (RCT). SUBJECTS AND SETTING The sample comprised patients from a preceding case-finding study who reported fecal incontinence and met study requirements; the RCT was delivered via IBD outpatient clinics in 6 hospitals (5 in major UK cities, 1 rural) between September 2015 and August 2017. Sixteen participants and 11 staff members were interviewed for qualitative evaluation. METHODS Adults with IBD completed the study activities over a 3-month period following randomization. Each participant received either four 30-minute structured sessions with an IBD clinical nurse specialist and a self-management booklet or the booklet alone. Low retention numbers precluded statistical analysis; individual face-to-face or telephone interviews, recorded digitally and transcribed professionally, were conducted to evaluate the RCT. Transcripts were analyzed thematically using an inductive method. RESULTS Sixty-seven participants (36%) of the targeted 186 participants were recruited. The groups comprised 32 participants (17% of targeted participants) allocated to the nurse + booklet intervention and 35 (18.8% of targeted participants) allocated to the booklet alone. Less than one-third (n = 21, 31.3%) completed the study. Given the low recruitment and high attrition, statistical analysis of quantitative data was considered futile. Participant interviews were conducted concerning study participation and 4 themes emerged that described experiences of patients and staff. These data provided insights into reasons for low recruitment and high attrition, as well as challenges of delivering resource-heavy studies in busy health service environments. CONCLUSIONS Alternative approaches to trials of nurse-led interventions in hospital settings are needed as many interfering factors may prevent successful completion.
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Affiliation(s)
- Lesley Dibley
- Lesley Dibley, PhD, Florence Nightingale Faculty of Nursing, Midwifery and Palliative, King's College London, London, United Kingdom; University of Greenwich, London, United Kingdom
- Ailsa Hart, PhD, St Mark's Hospital (IBD Unit), Northwick Park Hospital, Harrow, Middlesex, United Kingdom
- Julie Duncan, MSc, Department of Gastroenterology, St Thomas' NHS Foundation Trust, London, London, United Kingdom; Takeda UK, London, United Kingdom
- Charles H. Knowles, PhD, Blizard Institute, Barts and The London School of Medicine and Dentistry, London, United Kingdom
- Sally Kerry, MSc, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom
- Doris Lanz, MA, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom
- Vladislav Berdunov, PhD, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom
- Vichithranie W. Madurasinghe, MSc, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom; University of Oxford, Oxford, United Kingdom
- Tiffany Wade, MSc, Florence Nightingale Faculty of Nursing, Midwifery and Palliative, King's College London, London, United Kingdom
- Helen Terry, BA(Hons), Crohn's and Colitis UK, Hatfield Business Park, Hatfield, United Kingdom
- Azmina Verjee, PGDip, Patient and Public Involvement Team Lead. Crohn's and Colitis UK, Hatfield Business Park, Hatfield, United Kingdom
- Mandy Fader, PhD, School of Health Sciences, University of Southampton, Southampton, United Kingdom
- Christine Norton, PhD, Florence Nightingale Faculty of Nursing, Midwifery and Palliative, King's College London, London, United Kingdom
| | - Ailsa Hart
- Lesley Dibley, PhD, Florence Nightingale Faculty of Nursing, Midwifery and Palliative, King's College London, London, United Kingdom; University of Greenwich, London, United Kingdom
- Ailsa Hart, PhD, St Mark's Hospital (IBD Unit), Northwick Park Hospital, Harrow, Middlesex, United Kingdom
- Julie Duncan, MSc, Department of Gastroenterology, St Thomas' NHS Foundation Trust, London, London, United Kingdom; Takeda UK, London, United Kingdom
- Charles H. Knowles, PhD, Blizard Institute, Barts and The London School of Medicine and Dentistry, London, United Kingdom
- Sally Kerry, MSc, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom
- Doris Lanz, MA, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom
- Vladislav Berdunov, PhD, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom
- Vichithranie W. Madurasinghe, MSc, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom; University of Oxford, Oxford, United Kingdom
- Tiffany Wade, MSc, Florence Nightingale Faculty of Nursing, Midwifery and Palliative, King's College London, London, United Kingdom
- Helen Terry, BA(Hons), Crohn's and Colitis UK, Hatfield Business Park, Hatfield, United Kingdom
- Azmina Verjee, PGDip, Patient and Public Involvement Team Lead. Crohn's and Colitis UK, Hatfield Business Park, Hatfield, United Kingdom
- Mandy Fader, PhD, School of Health Sciences, University of Southampton, Southampton, United Kingdom
- Christine Norton, PhD, Florence Nightingale Faculty of Nursing, Midwifery and Palliative, King's College London, London, United Kingdom
| | - Julie Duncan
- Lesley Dibley, PhD, Florence Nightingale Faculty of Nursing, Midwifery and Palliative, King's College London, London, United Kingdom; University of Greenwich, London, United Kingdom
- Ailsa Hart, PhD, St Mark's Hospital (IBD Unit), Northwick Park Hospital, Harrow, Middlesex, United Kingdom
- Julie Duncan, MSc, Department of Gastroenterology, St Thomas' NHS Foundation Trust, London, London, United Kingdom; Takeda UK, London, United Kingdom
- Charles H. Knowles, PhD, Blizard Institute, Barts and The London School of Medicine and Dentistry, London, United Kingdom
- Sally Kerry, MSc, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom
- Doris Lanz, MA, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom
- Vladislav Berdunov, PhD, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom
- Vichithranie W. Madurasinghe, MSc, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom; University of Oxford, Oxford, United Kingdom
- Tiffany Wade, MSc, Florence Nightingale Faculty of Nursing, Midwifery and Palliative, King's College London, London, United Kingdom
- Helen Terry, BA(Hons), Crohn's and Colitis UK, Hatfield Business Park, Hatfield, United Kingdom
- Azmina Verjee, PGDip, Patient and Public Involvement Team Lead. Crohn's and Colitis UK, Hatfield Business Park, Hatfield, United Kingdom
- Mandy Fader, PhD, School of Health Sciences, University of Southampton, Southampton, United Kingdom
- Christine Norton, PhD, Florence Nightingale Faculty of Nursing, Midwifery and Palliative, King's College London, London, United Kingdom
| | - Charles H Knowles
- Lesley Dibley, PhD, Florence Nightingale Faculty of Nursing, Midwifery and Palliative, King's College London, London, United Kingdom; University of Greenwich, London, United Kingdom
- Ailsa Hart, PhD, St Mark's Hospital (IBD Unit), Northwick Park Hospital, Harrow, Middlesex, United Kingdom
- Julie Duncan, MSc, Department of Gastroenterology, St Thomas' NHS Foundation Trust, London, London, United Kingdom; Takeda UK, London, United Kingdom
- Charles H. Knowles, PhD, Blizard Institute, Barts and The London School of Medicine and Dentistry, London, United Kingdom
- Sally Kerry, MSc, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom
- Doris Lanz, MA, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom
- Vladislav Berdunov, PhD, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom
- Vichithranie W. Madurasinghe, MSc, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom; University of Oxford, Oxford, United Kingdom
- Tiffany Wade, MSc, Florence Nightingale Faculty of Nursing, Midwifery and Palliative, King's College London, London, United Kingdom
- Helen Terry, BA(Hons), Crohn's and Colitis UK, Hatfield Business Park, Hatfield, United Kingdom
- Azmina Verjee, PGDip, Patient and Public Involvement Team Lead. Crohn's and Colitis UK, Hatfield Business Park, Hatfield, United Kingdom
- Mandy Fader, PhD, School of Health Sciences, University of Southampton, Southampton, United Kingdom
- Christine Norton, PhD, Florence Nightingale Faculty of Nursing, Midwifery and Palliative, King's College London, London, United Kingdom
| | - Sally Kerry
- Lesley Dibley, PhD, Florence Nightingale Faculty of Nursing, Midwifery and Palliative, King's College London, London, United Kingdom; University of Greenwich, London, United Kingdom
- Ailsa Hart, PhD, St Mark's Hospital (IBD Unit), Northwick Park Hospital, Harrow, Middlesex, United Kingdom
- Julie Duncan, MSc, Department of Gastroenterology, St Thomas' NHS Foundation Trust, London, London, United Kingdom; Takeda UK, London, United Kingdom
- Charles H. Knowles, PhD, Blizard Institute, Barts and The London School of Medicine and Dentistry, London, United Kingdom
- Sally Kerry, MSc, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom
- Doris Lanz, MA, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom
- Vladislav Berdunov, PhD, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom
- Vichithranie W. Madurasinghe, MSc, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom; University of Oxford, Oxford, United Kingdom
- Tiffany Wade, MSc, Florence Nightingale Faculty of Nursing, Midwifery and Palliative, King's College London, London, United Kingdom
- Helen Terry, BA(Hons), Crohn's and Colitis UK, Hatfield Business Park, Hatfield, United Kingdom
- Azmina Verjee, PGDip, Patient and Public Involvement Team Lead. Crohn's and Colitis UK, Hatfield Business Park, Hatfield, United Kingdom
- Mandy Fader, PhD, School of Health Sciences, University of Southampton, Southampton, United Kingdom
- Christine Norton, PhD, Florence Nightingale Faculty of Nursing, Midwifery and Palliative, King's College London, London, United Kingdom
| | - Doris Lanz
- Lesley Dibley, PhD, Florence Nightingale Faculty of Nursing, Midwifery and Palliative, King's College London, London, United Kingdom; University of Greenwich, London, United Kingdom
- Ailsa Hart, PhD, St Mark's Hospital (IBD Unit), Northwick Park Hospital, Harrow, Middlesex, United Kingdom
- Julie Duncan, MSc, Department of Gastroenterology, St Thomas' NHS Foundation Trust, London, London, United Kingdom; Takeda UK, London, United Kingdom
- Charles H. Knowles, PhD, Blizard Institute, Barts and The London School of Medicine and Dentistry, London, United Kingdom
- Sally Kerry, MSc, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom
- Doris Lanz, MA, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom
- Vladislav Berdunov, PhD, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom
- Vichithranie W. Madurasinghe, MSc, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom; University of Oxford, Oxford, United Kingdom
- Tiffany Wade, MSc, Florence Nightingale Faculty of Nursing, Midwifery and Palliative, King's College London, London, United Kingdom
- Helen Terry, BA(Hons), Crohn's and Colitis UK, Hatfield Business Park, Hatfield, United Kingdom
- Azmina Verjee, PGDip, Patient and Public Involvement Team Lead. Crohn's and Colitis UK, Hatfield Business Park, Hatfield, United Kingdom
- Mandy Fader, PhD, School of Health Sciences, University of Southampton, Southampton, United Kingdom
- Christine Norton, PhD, Florence Nightingale Faculty of Nursing, Midwifery and Palliative, King's College London, London, United Kingdom
| | - Vladislav Berdunov
- Lesley Dibley, PhD, Florence Nightingale Faculty of Nursing, Midwifery and Palliative, King's College London, London, United Kingdom; University of Greenwich, London, United Kingdom
- Ailsa Hart, PhD, St Mark's Hospital (IBD Unit), Northwick Park Hospital, Harrow, Middlesex, United Kingdom
- Julie Duncan, MSc, Department of Gastroenterology, St Thomas' NHS Foundation Trust, London, London, United Kingdom; Takeda UK, London, United Kingdom
- Charles H. Knowles, PhD, Blizard Institute, Barts and The London School of Medicine and Dentistry, London, United Kingdom
- Sally Kerry, MSc, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom
- Doris Lanz, MA, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom
- Vladislav Berdunov, PhD, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom
- Vichithranie W. Madurasinghe, MSc, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom; University of Oxford, Oxford, United Kingdom
- Tiffany Wade, MSc, Florence Nightingale Faculty of Nursing, Midwifery and Palliative, King's College London, London, United Kingdom
- Helen Terry, BA(Hons), Crohn's and Colitis UK, Hatfield Business Park, Hatfield, United Kingdom
- Azmina Verjee, PGDip, Patient and Public Involvement Team Lead. Crohn's and Colitis UK, Hatfield Business Park, Hatfield, United Kingdom
- Mandy Fader, PhD, School of Health Sciences, University of Southampton, Southampton, United Kingdom
- Christine Norton, PhD, Florence Nightingale Faculty of Nursing, Midwifery and Palliative, King's College London, London, United Kingdom
| | - Vichithranie W Madurasinghe
- Lesley Dibley, PhD, Florence Nightingale Faculty of Nursing, Midwifery and Palliative, King's College London, London, United Kingdom; University of Greenwich, London, United Kingdom
- Ailsa Hart, PhD, St Mark's Hospital (IBD Unit), Northwick Park Hospital, Harrow, Middlesex, United Kingdom
- Julie Duncan, MSc, Department of Gastroenterology, St Thomas' NHS Foundation Trust, London, London, United Kingdom; Takeda UK, London, United Kingdom
- Charles H. Knowles, PhD, Blizard Institute, Barts and The London School of Medicine and Dentistry, London, United Kingdom
- Sally Kerry, MSc, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom
- Doris Lanz, MA, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom
- Vladislav Berdunov, PhD, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom
- Vichithranie W. Madurasinghe, MSc, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom; University of Oxford, Oxford, United Kingdom
- Tiffany Wade, MSc, Florence Nightingale Faculty of Nursing, Midwifery and Palliative, King's College London, London, United Kingdom
- Helen Terry, BA(Hons), Crohn's and Colitis UK, Hatfield Business Park, Hatfield, United Kingdom
- Azmina Verjee, PGDip, Patient and Public Involvement Team Lead. Crohn's and Colitis UK, Hatfield Business Park, Hatfield, United Kingdom
- Mandy Fader, PhD, School of Health Sciences, University of Southampton, Southampton, United Kingdom
- Christine Norton, PhD, Florence Nightingale Faculty of Nursing, Midwifery and Palliative, King's College London, London, United Kingdom
| | - Tiffany Wade
- Lesley Dibley, PhD, Florence Nightingale Faculty of Nursing, Midwifery and Palliative, King's College London, London, United Kingdom; University of Greenwich, London, United Kingdom
- Ailsa Hart, PhD, St Mark's Hospital (IBD Unit), Northwick Park Hospital, Harrow, Middlesex, United Kingdom
- Julie Duncan, MSc, Department of Gastroenterology, St Thomas' NHS Foundation Trust, London, London, United Kingdom; Takeda UK, London, United Kingdom
- Charles H. Knowles, PhD, Blizard Institute, Barts and The London School of Medicine and Dentistry, London, United Kingdom
- Sally Kerry, MSc, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom
- Doris Lanz, MA, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom
- Vladislav Berdunov, PhD, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom
- Vichithranie W. Madurasinghe, MSc, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom; University of Oxford, Oxford, United Kingdom
- Tiffany Wade, MSc, Florence Nightingale Faculty of Nursing, Midwifery and Palliative, King's College London, London, United Kingdom
- Helen Terry, BA(Hons), Crohn's and Colitis UK, Hatfield Business Park, Hatfield, United Kingdom
- Azmina Verjee, PGDip, Patient and Public Involvement Team Lead. Crohn's and Colitis UK, Hatfield Business Park, Hatfield, United Kingdom
- Mandy Fader, PhD, School of Health Sciences, University of Southampton, Southampton, United Kingdom
- Christine Norton, PhD, Florence Nightingale Faculty of Nursing, Midwifery and Palliative, King's College London, London, United Kingdom
| | - Helen Terry
- Lesley Dibley, PhD, Florence Nightingale Faculty of Nursing, Midwifery and Palliative, King's College London, London, United Kingdom; University of Greenwich, London, United Kingdom
- Ailsa Hart, PhD, St Mark's Hospital (IBD Unit), Northwick Park Hospital, Harrow, Middlesex, United Kingdom
- Julie Duncan, MSc, Department of Gastroenterology, St Thomas' NHS Foundation Trust, London, London, United Kingdom; Takeda UK, London, United Kingdom
- Charles H. Knowles, PhD, Blizard Institute, Barts and The London School of Medicine and Dentistry, London, United Kingdom
- Sally Kerry, MSc, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom
- Doris Lanz, MA, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom
- Vladislav Berdunov, PhD, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom
- Vichithranie W. Madurasinghe, MSc, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom; University of Oxford, Oxford, United Kingdom
- Tiffany Wade, MSc, Florence Nightingale Faculty of Nursing, Midwifery and Palliative, King's College London, London, United Kingdom
- Helen Terry, BA(Hons), Crohn's and Colitis UK, Hatfield Business Park, Hatfield, United Kingdom
- Azmina Verjee, PGDip, Patient and Public Involvement Team Lead. Crohn's and Colitis UK, Hatfield Business Park, Hatfield, United Kingdom
- Mandy Fader, PhD, School of Health Sciences, University of Southampton, Southampton, United Kingdom
- Christine Norton, PhD, Florence Nightingale Faculty of Nursing, Midwifery and Palliative, King's College London, London, United Kingdom
| | - Azmina Verjee
- Lesley Dibley, PhD, Florence Nightingale Faculty of Nursing, Midwifery and Palliative, King's College London, London, United Kingdom; University of Greenwich, London, United Kingdom
- Ailsa Hart, PhD, St Mark's Hospital (IBD Unit), Northwick Park Hospital, Harrow, Middlesex, United Kingdom
- Julie Duncan, MSc, Department of Gastroenterology, St Thomas' NHS Foundation Trust, London, London, United Kingdom; Takeda UK, London, United Kingdom
- Charles H. Knowles, PhD, Blizard Institute, Barts and The London School of Medicine and Dentistry, London, United Kingdom
- Sally Kerry, MSc, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom
- Doris Lanz, MA, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom
- Vladislav Berdunov, PhD, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom
- Vichithranie W. Madurasinghe, MSc, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom; University of Oxford, Oxford, United Kingdom
- Tiffany Wade, MSc, Florence Nightingale Faculty of Nursing, Midwifery and Palliative, King's College London, London, United Kingdom
- Helen Terry, BA(Hons), Crohn's and Colitis UK, Hatfield Business Park, Hatfield, United Kingdom
- Azmina Verjee, PGDip, Patient and Public Involvement Team Lead. Crohn's and Colitis UK, Hatfield Business Park, Hatfield, United Kingdom
- Mandy Fader, PhD, School of Health Sciences, University of Southampton, Southampton, United Kingdom
- Christine Norton, PhD, Florence Nightingale Faculty of Nursing, Midwifery and Palliative, King's College London, London, United Kingdom
| | - Mandy Fader
- Lesley Dibley, PhD, Florence Nightingale Faculty of Nursing, Midwifery and Palliative, King's College London, London, United Kingdom; University of Greenwich, London, United Kingdom
- Ailsa Hart, PhD, St Mark's Hospital (IBD Unit), Northwick Park Hospital, Harrow, Middlesex, United Kingdom
- Julie Duncan, MSc, Department of Gastroenterology, St Thomas' NHS Foundation Trust, London, London, United Kingdom; Takeda UK, London, United Kingdom
- Charles H. Knowles, PhD, Blizard Institute, Barts and The London School of Medicine and Dentistry, London, United Kingdom
- Sally Kerry, MSc, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom
- Doris Lanz, MA, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom
- Vladislav Berdunov, PhD, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom
- Vichithranie W. Madurasinghe, MSc, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom; University of Oxford, Oxford, United Kingdom
- Tiffany Wade, MSc, Florence Nightingale Faculty of Nursing, Midwifery and Palliative, King's College London, London, United Kingdom
- Helen Terry, BA(Hons), Crohn's and Colitis UK, Hatfield Business Park, Hatfield, United Kingdom
- Azmina Verjee, PGDip, Patient and Public Involvement Team Lead. Crohn's and Colitis UK, Hatfield Business Park, Hatfield, United Kingdom
- Mandy Fader, PhD, School of Health Sciences, University of Southampton, Southampton, United Kingdom
- Christine Norton, PhD, Florence Nightingale Faculty of Nursing, Midwifery and Palliative, King's College London, London, United Kingdom
| | - Christine Norton
- Lesley Dibley, PhD, Florence Nightingale Faculty of Nursing, Midwifery and Palliative, King's College London, London, United Kingdom; University of Greenwich, London, United Kingdom
- Ailsa Hart, PhD, St Mark's Hospital (IBD Unit), Northwick Park Hospital, Harrow, Middlesex, United Kingdom
- Julie Duncan, MSc, Department of Gastroenterology, St Thomas' NHS Foundation Trust, London, London, United Kingdom; Takeda UK, London, United Kingdom
- Charles H. Knowles, PhD, Blizard Institute, Barts and The London School of Medicine and Dentistry, London, United Kingdom
- Sally Kerry, MSc, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom
- Doris Lanz, MA, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom
- Vladislav Berdunov, PhD, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom
- Vichithranie W. Madurasinghe, MSc, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom; University of Oxford, Oxford, United Kingdom
- Tiffany Wade, MSc, Florence Nightingale Faculty of Nursing, Midwifery and Palliative, King's College London, London, United Kingdom
- Helen Terry, BA(Hons), Crohn's and Colitis UK, Hatfield Business Park, Hatfield, United Kingdom
- Azmina Verjee, PGDip, Patient and Public Involvement Team Lead. Crohn's and Colitis UK, Hatfield Business Park, Hatfield, United Kingdom
- Mandy Fader, PhD, School of Health Sciences, University of Southampton, Southampton, United Kingdom
- Christine Norton, PhD, Florence Nightingale Faculty of Nursing, Midwifery and Palliative, King's College London, London, United Kingdom
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Adegbola SO, Dibley L, Sahnan K, Wade T, Verjee A, Sawyer R, Mannick S, McCluskey D, Bassett P, Yassin N, Warusavitarne J, Faiz O, Phillips R, Tozer PJ, Norton C, Hart AL. Development and initial psychometric validation of a patient-reported outcome measure for Crohn's perianal fistula: the Crohn's Anal Fistula Quality of Life (CAF-QoL) scale. Gut 2021; 70:1649-1656. [PMID: 33272978 PMCID: PMC8355881 DOI: 10.1136/gutjnl-2019-320553] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 08/22/2020] [Accepted: 10/29/2020] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Crohn's perianal fistulas are challenging for patients and clinicians. Many do not respond to available treatments and despite recommendations by a global consensus, there are currently no specific patient-derived quality of life tools to measure response to treatment. We present a new validated patient-reported outcome measure (PROM) for this complicated disease phenotype. METHODS A draft questionnaire was generated using unstructured qualitative patient interviews on the experience of living with Crohn's perianal fistula, a nationwide multidisciplinary consensus exercise, a systematic review of outcomes assessing medical/surgical/combined treatment and a patient and public involvement day. Psychometric properties were assessed including construct validity (by comparison with the Hospital Anxiety and Depression Scale (HADS) and the UK Inflammatory Bowel Disease Questionnaire (UK-IBDQ)), and reliability and responsiveness was assessed by test-retest analysis. RESULTS Data from 211 patients contributed to development of a final 28-item questionnaire. The Crohn's Anal Fistula Quality of Life (CAF-QoL) demonstrated good internal consistency (Cronbach's alpha 0.88), excellent stability (intraclass correlation 0.98) and good responsiveness and construct validity, with positive correlation with the UK-IBDQ and HADS. CONCLUSION The CAF-QoL scale is ready for use as a PROM in research and clinical practice. It complements objective clinical evaluation of fistula by capturing impact on the patient.
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Affiliation(s)
- Samuel O Adegbola
- Surgery and Cancer, Imperial College London, London, UK .,Robin Phillips Fistula Research Unit, St Mark's Hospital and Academic Institute, London, UK
| | - Lesley Dibley
- Faculty of Education, Health and Human Sciences, University of Greenwich, London, UK
| | - Kapil Sahnan
- Surgery and Cancer, Imperial College London, London, UK,Robin Phillips Fistula Research Unit, St Mark's Hospital and Academic Institute, London, UK
| | - Tiffany Wade
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
| | - Azmina Verjee
- CAF-QoL Patient and Public Involvement Team, London, UK
| | - Rachel Sawyer
- CAF-QoL Patient and Public Involvement Team, London, UK
| | | | | | - Paul Bassett
- Robin Phillips Fistula Research Unit, St Mark's Hospital and Academic Institute, London, UK
| | - Nuha Yassin
- Robin Phillips Fistula Research Unit, St Mark's Hospital and Academic Institute, London, UK
| | - Janindra Warusavitarne
- Surgery and Cancer, Imperial College London, London, UK,Robin Phillips Fistula Research Unit, St Mark's Hospital and Academic Institute, London, UK
| | - Omar Faiz
- Surgery and Cancer, Imperial College London, London, UK,Robin Phillips Fistula Research Unit, St Mark's Hospital and Academic Institute, London, UK
| | - Robin Phillips
- Surgery and Cancer, Imperial College London, London, UK,Robin Phillips Fistula Research Unit, St Mark's Hospital and Academic Institute, London, UK
| | - Phil J Tozer
- Surgery and Cancer, Imperial College London, London, UK,Robin Phillips Fistula Research Unit, St Mark's Hospital and Academic Institute, London, UK
| | - Christine Norton
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
| | - Ailsa L Hart
- Surgery and Cancer, Imperial College London, London, UK,Robin Phillips Fistula Research Unit, St Mark's Hospital and Academic Institute, London, UK
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Knight SR, Shaw CA, Pius R, Drake TM, Norman L, Ademuyiwa AO, Adisa AO, Aguilera ML, Al-Saqqa SW, Al-Slaibi I, Bhangu A, Biccard BM, Brocklehurst P, Costas-Chavarri A, Chu K, Dare A, Elhadi M, Fairfield CJ, Fitzgerald JE, Ghosh D, Glasbey J, van Berge Henegouwen MI, Ingabire JA, Kingham TP, Lapitan MC, Lawani I, Lieske B, Lilford R, Martin J, McLean KA, Moore R, Morton D, Nepogodiev D, Ntirenganya F, Pata F, Pinkney T, Qureshi AU, Ramos-De la Medina A, Riad A, Salem HK, Simões J, Spence R, Smart N, Tabiri S, Thomas H, Weiser TG, West M, Whitaker J, Harrison EM, Gjata A, Modolo MM, King S, Chan E, Nahar SN, Waterman A, Vervoort D, Lawani I, Bedada AG, De Azevedo B, Figueiredo AG, Sokolov M, Barendegere V, Ekwen G, Agarwal A, Dare A, Liu Q, Camilo Correa J, Malemo KL, Bake J, Mihanovic J, Kuncarová K, Orhalmi J, Salem H, Teras J, Kechagias A, Arnaud AP, Lindert J, Tabiri S, Kalles V, Aguilera-Arevalo ML, Recinos G, Baranyai Z, Kumar B, Neelamraju Lakshmi H, Zachariah SK, Alexander P, Kumar Venkatappa S, Pramesh C, Amandito R, Fleming C, Ansaloni L, Pata F, Pellino G, Altibi AM, Nour I, Hamdun I, Elhadi M, Ghellai AM, Venskutonis D, Poskus T, Zilinskas J, Whitaker J, Malemia P, Tew YY, Borg E, Ellul S, Ramos-De la Medina A, Wafqui FZ, Borowski DW, van Dalen AS, Wells C, Adamou H, Ademuyiwa A, Adisa A, Søreide K, Qureshi AU, Al-Slaibi I, Al Saqqa S, Alser O, Tahboub H, Segovia Lohse HA, Shu Yip S, Lapitan MC, Major P, Simões J, Sampaio Soares A, Bratu MR, Litvin A, Vardanyan A, Allen Ingabire JC, Costas-Chavarri A, Gudal A, Albati N, Juloski J, Lieske B, Rems M, Rayne S, Van Straten S, Moodley Y, Chu K, Moore R, Ortega Vázquez I, Ruiz-Tovar J, Senanayake KJ, Thalgaspitiya SPB, Omer OA, Homeida A, Cengiz Y, Clerc D, Alshaar M, Bouaziz H, Altinel Y, Doe M, Freigofer M, Teasdale E, Kabariti R, Clements JM, Knight SR, Ashfaq A, Azodo I, Wagner G, Trostchansky I, Maimbo M, Linyama D, Nina H, Zeko A, Fermani CG, Modolo MM, Villalobos S, Carballo F, Farina P, Guckenheimer S, Dickfos M, Ajmera A, Chong C, Gourlay R, Hussaini S, Lee YJ, Majid A, Martin P, Miles R, Morris OJ, Phua J, Ridley W, Saluja T, Tan RR, Teh J, Wells A, Arora B, Dollie Q, Ho D, Ma Y, Perera OM, Truong A, Dawson AC, Lim B, Pahalawatta U, Phan J, Woon-Shoo-Tong XMS, Yeoh A, Charman L, Drane A, Laura S, Lo CCW, Mozes A, Poon R, Tan HH, Wall E, Chopra P, De Giovanni J, Dhital B, Draganic B, Duller A, Gani J, Goh YK, Jeong JY, McManus B, Nagappan P, Pockney P, Rugendyke A, Sarrami M, Smith S, Wills V, Wong HV, Ye G, Zhang G, Brooker E, Feng D, Lau B, Ngai C, Birks S, Gyorki D, Otero de Pablos J, Abbosh A, Gillespie C, Mahmoud A, Kwan B, Lawson J, Warwick A, Bingham J, Cockbain AJ, Dudi-Venkata NN, Ellaby-Hall J, Finlay B, Humphries E, Pisaniello J, Pisaniello M, Salih S, Sammour T, Abd Wahab HH, De Silva A, Hayward N, Iyer K, Maddern G, Prevost GA, Annapureddy N, Settipalli KP, Yeo J, Hempenstall L, Pham L, Purcell S, Talavera C, Vaska AI, Chaggar G, Chrapko P, Cocco A, Coulter-Nile SMCJ, Ctercteko G, French J, Gong H, Gosselink M, Jegathees T, Jin I, Kalachov M, Kiefhaber K, Lee K, Luong J, Phan S, Pleass H, Veale K, Zeng Z, Au A, DeBiasio A, Deng I, Myooran J, Nair A, Stewart P, Stift A, Unger LW, Wimmer K, Ahmed N, Hasan S, Rahman S, O'Shea M, Padmore G, Peters A, Perduca P, Pulcina G, Tinton N, Buxant F, Dabin E, Garofalo G, Dossou F, Lawani I, Gnangnon FHR, Imorou Souaibou Y, Bedada AG, Motlaleselelo P, Tlhomelang O, Lima Buarque I, Mendonça Ataíde Gomes G, Vieira Barros A, Batashki I, Damianov N, Stoyanov V, Dardanov D, Maslyankov S, Petkov P, Sokolov M, Todorov G, Zhivkov E, Akisheva A, Castilla Moreno MA, Genov G, Ilieva I, Ivanov T, Karamanliev M, Khan A, Mitkov E, Yotsov T, Atanasov B, Belev N, Slavchev M, Nsengiyumva C, Jones E, Stock S, Ekwen G, Kyota S, Brown J, Mabanza K. T, Nigo Samuel L, Otuneme C, Prosper N, Umenze F, Boutros M, Caminsky N, Dumitra S, Garfinkle R, Morency D, Salama E, Banks A, Ferri L, He H, Katz A, Liberman AS, Meterissian S, Pang A, Parvez E, Agarwal A, Dare A, Hameed U, Osman F, Sequeira S, Coburn N, Dare A, Jaffer A, Karanicolas P, Mosseler M, Musselman R, Liu X, Yip CW, Garces-Otero JS, Guzman C, Sierra S, Uribe Valencia A, Cabrera Rivera PA, Camelo S, Gonzalez A, González-Orozco A, Mosquera Paz MS, Perez Rivera CJ, Gonzalez F, Isaza-Restrepo A, Nino- Torres L, Arias Madrid N, Mendoza Arango MC, Sierra S, Bake J, Tsandiraki J, Jemendžic D, Kocman B, Šuman O, Canic R, Jurišic D, Karakas I, Krizanovic Rupcic A, Pitlovic V, Samardžic J, Kopljar M, Bacic I, Domini E, Karlo R, Mihanovic J, Miljanic D, Simic A, Ahmed M, Al Nassrallah M, Altaf R, Amjad T, Eltoum R, Haidar H, Hassan A, Khalil O, Qasem M, Ramesh R, Sajith G, Wisal M, Žatecký J, Bujda M, Jirankova K, Paclik A, Abdallah A, Abdulgawad Almogy M, Ayman El-sawy E, ElFayoumy AM, Elghareeb N, Esmat NA, Fadel A, Habater A, Hamdy H, Hefni A, Kamal M, Mohamed Abobakr N, Sayed A, Shaker N, Taha E, Tharwat H, Zakaria O, Abdelmotaleb I, Al-Dhufri A, Al-Himyari HS, El sheikh E, Eldmaty A, Elkhalawy A, M.Elkhashen A, Magdy K, Mostafa S, Sadia HD, Saleh MM, Samir D, Yahia Mohamed Ali M, A. Nassar M, Abdelhady S, Abdelrazek A, Abdelsalam I, El-Sawy A, Essam E, Gadelkarim M, Ghaly K, Hassabalnaby M, Masarani R, Mohamed Shaaban N, Sabry A, Salem M, Soliman NA, Zahran D, Abou El.soud MR, Badr ET, Borham H, Elmeslemany N, Elsayed M, Elsherif F, Eslam S, Gaber G, Ibrahim S, Kamh Y, Mahmoud A, Mohamed SG, Morshedy E, Omar C, Salem Soliman F, Abdelkawy S, Abdelmohsen N, Abdelshakour M, Dahy A, Gamal N, Gamal M, Hasan A, Hetta H, Mousa N, Omar M, Rabie S, Saad M, Saleh B, Sayed Mohamed M, Shawqi M, Abdelhady Mousa H, Alnoury M, Elbealawy M, Elshafey A, Essam Ibrahim El Desouki Muhammad Ahmed M, Ghonaim M, Hgag F, Ibrahim M, Morsy M, Reda Loaloa M, Refaat A, Samir H, Shahien F, Sobhy M, Sroor F, Abdellatif E, Adel M, Afifi AA, Afifi E, Antaky M, Dawoud A, El Zoghby N, El-remaily A, Elzanfaly AA, Gadallah A, Gamal FA, Hashem O, Medhat Youssef S, Muhammad Attyah A, Munir M, Shazly O, Taha E, Wilson K, Adel S, Ali A, Eid E, Elhelow E, Elmahdy M, Elshatby B, Hossam el-din Zakaria A, Hossny A, Ibrahim E, M.Yonis A, Metwalli M, Yousry B, Zid E, A Yacoub M, Abdelhakim A, Abouelsoad N, Alkhatib M, Ashraf A, Ashraf A, Elazab Y, Elfanty M, Elkabir O, Elsayed M, Elshimy A, Elsobky H, Eskander J, Gad A, Hamsho W, Khaled Abdelwahed N, Magdy M, Moharam D, Osama A, Ramadan S, Roum R, Sayed T, Shehada T, Zidan AM, Abbas K, Ali A, Attia M, Balata M, El Nakeeb A, Elewaily MIE, Elfallal A, Elfeki H, Elkhadragy A, Emile S, Ezzat H, Hosni H, Mansour I, Omar W, Othman G, Sadek K, Shalaby M, Shehab-Eldeen N, Anas khalifa R, Badr H, Eldeep M, Eldeep A, Eldoseuky mohammed A, Khallaf S, Magdy Hegazy E, Mahmoud R, Mikhail P, Morsi M, Mowafy S, Raafat D, Safy A, Sera M, Sera AS, AbdAllah MSM, Abdelkader M, Abdou AO, Ahmed A, Gaafar S, Ibrahim negm F, Lapic M, Maher A, Mahmoud H, Mostafa A, Samir M, Samy F, Semeda N, Shalaby HI, El-taweel A, Galal Elnagar A, Hemidan AG, Hussein M, Kandil A, Moawad M, Nasser Hamamah AA, Soliman M, Abdelkhalek M, Abdelmaksoud Tawakel N, Abdelwahed AM, Abdou A, Atallah K, Elsherbeny MY, Emara E, Hamdy M, Hamdy O, Haron A, Ismail S, Metwally IH, Mohamed Hamed Elgaml N, Nassar A, Refky B, Sadek M, Saleh M, Yunes A, Zakaria M, Zuhdy M, Fayed N, Mohammed MMH, Kütner S, Melnik P, Seire I, Teras J, Ümarik T, Ainoa E, Eerola V, Koppatz H, Koskenvuo L, Sallinen V, Takala S, Katunin J, Kechagias A, Turunen A, Christou N, Mathonnet M, Lavoue V, Nyangoh Timoh K, Soulabaille L, Lesourd R, Merdrignac A, Sulpice L, André B, Chantalat E, Vaysse C, Dousset B, Gaujoux S, Martin G, Clonda O, Juodis D, Kienle K, Mravik A, Palmer S, Szabadhegyi G, Agbeko AE, Gyabaah S, Gyamfi FE, Naabo N, Owusu senior A, Yorke J, Owusu F, Abantanga F, Anyomih TTK, Muntaka AJM, Owusu Abem E, Sheriff M, Tabiri S, Wondoh PM, Balalis D, Korkolis D, Gkiokas G, Pantiora E, Theodosopoulos T, Ioannidis A, Konstantinidis K, Konstantinidou S, Machairas N, Paspala A, Prodromidou A, Chouliaras C, Papadopoulos K, Baloyiannis I, Mamaloudis I, Tzovaras G, Akrida I, Argentou MI, Germanos S, Iliopoulos E, Maroulis I, Skroubis G, Theofanis G, Chatzakis C, Ioannidis O, Loutzidou L, Kalles V, Karathanasis P, Michalopoulos N, Theodoropoulos C, Theodorou D, Triantafyllou T, Garoufalia Z, Hasemaki N, Kontos M, Kouraklis G, Kykalos S, Liakakos T, Mpaili E, Papalampros A, Schizas D, Syllaios A, Tampaki EC, Tsimpoukelis A, Antonopoulou MI, Deskou E, Manatakis DK, Papageorgiou D, Zoulamoglou M, Anthoulakis C, Margaritis M, Nikoloudis N, Campo V, Ceballos A, Flores MA, Giron W, Ko D, Martinez G, Recinos G, Rivera Lara V, Rueda N, Sanchez A, Tejeda Garrido JCG, Aguilera-Arevalo ML, Alvarez Rivera AE, Bamaca Ixcajoc EB, Barreda Zelaya LE, Chacòn-Herrera P, Corea Ruiz LM, Echeverria-Davila G, Garcia M, García D, Gutiérrez Mayen EF, José N, Mazariegos N, Méndez D, Paniagua Espinoza M, Baranyai Z, Bardos D, Benke M, Illes K, Kokas BA, Szabó R, Appukuttan A, Asok A, D.k V, Malik K, Ravishankaran P, Tapkire R, Moorthy G, Abraham J, Muthuvel R, Alapatt J, Kattepur A, Pareekutty N, Garod M, Harris C, Wanniang C, Gupta A, Nehra D, Parshad S, Acharya R, Badwe R, Bhandare M, Jain U, Kirti K, Nair N, Shrikhande S, Thakkar P, Anandan P, C S A, Holenarasipur Narasannaiah A, Jagarlamudi T, Kumar Venkatappa S, M R R, Manangi M, Raghavendra A, Rao KS, S V, Sajjan V, Shenoy A, Shivashankar Chikkanayakanahalli S, Tharanath K, V S, Adidharma P, Agarwal R, Amandito R, Anggita Gultom P, Arifin GR, Billy M, Elfizri Z, Fahira A, Felicia D, Gunardi TH, Johanna N, Nugrahadi NR, Panigoro SS, Rahmayanti S, Sihotang RC, Brata SY, Winoto H, Barati N, Karami M, Khorshidi H, Naderifar H, Abdulla MA, Coleman M, Doherty RJ, Hannon R, Murphy B, Stakelum A, Winter D, Aljohmani L, Farnan R, Seldon Y, Tan T, Varghese S, Alherz M, Ather M, Bajilan M, Graziadei V, Pilkington I, Quidwai O, Ridgway P, Shiwani H, Tahir AAR, Blunnie E, Burke D, Kennedy N, Macdonagh K, O'Neill M, Rooney S, Falco G, Ferrari G, Mele S, Nita GE, Ugoletti L, Zizzo M, Confalonieri G, Pesenti G, Tagliabue F, Baronio G, Ongaro D, Pata G, Compagnoni B, Salvadori R, Taglietti L, D'Alessandro N, Di Lascio P, Pascale G, Bortolasi L, Campagnaro T, Carlini M, Lisi G, Lombardi D, Pedrazzani C, Spoletini D, Turri G, Violi P, Altomare DF, Aquilino F, Musa N, Papagni V, Picciariello A, Vincenti L, Andreotti D, Occhionorelli S, Tondo M, Basso SMM, Cirelli R, Maino MEM, Piozzi GN, Picone E, Scaramuzzo R, Sinibaldi G, Amendola A, Anastasio L, Bucci L, Caruso E, Castaldi A, Di Maso S, Dinuzzi VP, Esposito G, Gaudiello M, Giglio MC, Greco PA, Luglio G, Manfreda A, Marra E, Mastella F, Pagano G, Peltrini R, Pepe V, Sacco M, Sollazzo V, Spiezio G, Cianchetti E, Menduni N, Carvello MM, Di Candido F, Spinelli A, Corsi F, Sorrentino L, Marino F, Asti ELG, Bonavina L, Rausa E, Asta M, Belli A, Bianco F, Cervone C, Delrio P, Falato A, Fares Bucci A, Guarino R, Pace U, Rega D, De Luca E, Gallo G, Sammarco G, Sena G, Vescio G, Santandrea L, Ugolini G, Zattoni D, Chetta N, Logrieco G, Vanella S, Garulli G, Zanini N, Bondurri A, Cammarata F, Colombo F, Foschi D, Lamperti GMB, Maffioli A, Sampietro GM, Yakushkina A, Zaffaroni G, Ansaloni L, Cicuttin E, Sibilla MG, Impellizzeri H, Inama M, Moretto G, Mochet S, Ponte E, Usai A, Mancini S, Sagnotta A, Solinas L, Bolzonaro E, Tamini N, Curletti G, Galleano R, Malerba M, Campanella S, Cocorullo G, Colli F, De Marco P, Falco N, Fontana T, Kamdem Mambou LJ, La Brocca A, Licari L, Randisi B, Rizzo G, Rotolo G, Salamone G, Tutino R, Venturelli P, Malabarba S, Sgrò A, Vella I, Cirillo B, Crocetti D, De Toma G, Lapolla P, Mingoli A, Sapienza P, Belvedere A, Bianchini S, Binetti M, Birindelli A, Tonini V, Podda M, Pulighe F, De Rosa M, Bono L, Borghi F, Geretto P, Giuffrida MC, Lauro C, Marano A, Pellegrino L, Salusso P, Sasia D, Campanelli M, Realis Luc A, Trompetto M, Cardia R, Cillara N, Giordano AN, Costanzo A, Giovilli MA, Turati L, Canonico S, Pellino G, Sciaudone G, Selvaggi F, Selvaggi L, Albsoul N, AlBsoul A, Alkhatib AA, Alsallaq O, Amarin JZ, Ayoub R, Bsisu I, El Muhtaseb MS, Jabaiti M, Melhem J, Nour I, Qwaider YZ, Salameh MH, Suleihat A, Suradi HH, Alammarin M, Aljaafreh A, Bani hani M, Bani hani Z, Bani Hani F, Fahmawee T, Hamouri S, Katanani C, Tawalbeh R, Tawalbeh T, Zawahrah H, Abou Chaar MK, Abusalem L, Al-Masri M, Al-Najjar H, Barghuthi L, Ahmed Z, Maulana A, Ngotho O, Kamau C, Stanley Mwenda A, Bosire F, Mwachiro E, Parker R, Simel I, Sylvester K, Althini AAM, Elbarouni S, Elbeshina AE, Gwea A, Malek A, Masoud Farag WA, Abdalei A, Abdel Malik AB, Abo-khammash A, Abuhlaiga M, Adnan N, Albaggar M, Alfitory A, Aljanfi A, Almuzghi F, Altumei Z, Alzabti F, Ashoushan H, Assalhi M, Azzubia J, Bnhameida S, Delhen M, Elshafei H, Elteir H, Esbaga F, Gobbi AA, Hamouda F, Hilan H, Ismail R, Jebran F, Kasbour M, Maderi G, Mohammad S, Mohammed B, Murtadi H, Mustafa H, Rajab M, Trenba S, Wafaa M, Al Sagheir E, Almigheerbi A, Alzahaf A, Bahroun SG, Ben Dallah N, Elshaibani M, Eswaye H, Karar M, Omar S, Younes E, Younes M, Zreeg D, Abujamra S, Ashour F, Elgammudi M, Omar F. Aljadidi W, Saddouh E, Sharif R, Alabuzidi A, Alwerfally A, Aribi S, Bibas F, Elfaituri T, Elhajjaji Y, Khaled A, Khalil W, Layas T, Soula E, Tarek A, Abu hallalah MFK, Abujamra S, Ahmed HA, Alsharef T, Ben Saoud AA, El Gharmoul T, Elhadi A, Elrais S, Shebani A, Zarti H, Zeiton A, Ambrazevicius M, Kaselis N, Stakyte M, Aliosin O, Cizauskaite A, Dailidenas S, Eismontas V, Kybransiene M, Nutautiene V, Samalavicius N, Simcikas D, Slepavicius A, Tamosiunas A, Ubartas N, Zeromskas P, Bradulskis S, Dainius E, Juocas J, Kubiliute E, Kutkevicius J, Opolskis A, Parseliunas A, Subocius A, Venskutonis D, Virbickaite E, Zuikyte D, Bogusevicius A, Buzaite K, Cepuliene D, Cesleviciene I, Cesna V, Gribauskaite J, Ignatavicius P, Jokubauskas M, Liugailaite M, Margelis E, Mazelyte R, Pankratjevaite L, Pažusis M, Rackeviciute A, Saladyte J, Škimelyte M, Šlenfuktas V, Sudeikyte M, Tamelis A, Vanagas T, Žumbakys Ž, Atkociunas A, Dulskas A, Kuliavas J, Birutis J, Paškevicius S, Šatkauskas M, Danys D, Jakubauskas M, Jakubauskiene L, Kryzauskas M, Lipnickas V, Makunaite G, Rasoaherinomenjanahary F, Rasolofonarivo H, Samison LH, Banda B, Malemia P, Msosa V, Ahmad Izzuddin AI, Das A, Gan YY, Shong Sheng T, Siaw JY, Ab Rahim MF, Abang Jamari DZH, Che Husin N, Kamarulzaman MY, Lim YP, Mohamed Kamil NA, Mohd Hassan MR, Mohd Sahid S, Mustafa J, Ng EHB, Wan Khazim WK, Chang Ern N, Lingeshan P, Sulaiman SE, Ang SE, Bin Mohamad Sithik MN, Cheong YJ, Deva Tata M, Jia Xian L, Kadravello A, Koh IE, Ng LY, Ng We Yong YJ, Palayan K, Sam CX, Siow Jin P, Tan Ern Hwei J, Tang Y, Ter AZ, Wong MPK, Zakaria AD, Zakaria Z, Henry F, Kalaiselvan T, Abd Karim MFS, Abdul Aziz MR, Abdul Aziz N, Khong TL, Lau PC, Lim HC, Roslani AC, Seak JCK, Wong SW, Wong LF, Yeen Chin L, Anyanwu MC, Borg E, Busuttil Z, Calleja T, Chircop KL, Cutajar R, Dimech AM, Ellul S, Galea J, Gascon Perai K, Gatt R, Kelman L, Micallef E, Nwolu F, Sammut K, Thompson J, Warwicker S, Zammit M, Cordera F, Cruz González E, Sánchez-García J, Barbosa Camacho FJ, Barrera López FJ, Zuloaga Fernandez del Valle CJ, Acosta E, González Espinoza IR, Moreno P, Cortes-Flores AO, Fuentes Orozco C, Gonzalez Ojeda A, Corro Díaz González S, Martinez L, Ramos-De la Medina A, Mosqueda Amador B, Novoa A, Olazo Espejo DA, Jimenez A, Lopez Rosales F, Vanoye EG, Garcia Gonzalez LA, Miranda-Ackerman RC, Solano-Genesta M, Alvarez-Cano A, Romero-Garza HH, Medina-Franco H, Mejía-Fernández L, Salgado-Nesme N, Vergara-Fernandez O, Gutiérrez-Mota GM, Hernandez Vera FX, Llantada Lopez A, Morgan Villela G, Ramirez Padilla FDJ, Tapia Marin W, Martínez Maldonado M, Sánchez Suárez R, Troche JM, Benyaiche C, Outani O, Amine S, Benkabbou A, Majbar AM, Mohsine R, Rafik A, Oung T, Tin MM, Borowski DW, Plarre P, Borowski DW, Plarre P, Alberga A, Sluiter N, Tuynman J, Blok R, Cömert D, Hompes R, Kalff M, Stellingwerf ME, Tanis P, van Berge Henegouwen M, van Praag EM, Wisselink D, Gerhards M, Lopes Cardozo J, Westerduin E, de Jonge J, van Geloven A, van Schilt K, den Boer F, Stoots S, Vlek S, Adams J, Al-Busaidi IS, Budd G, Choi SI, Chu MJJ, Ganugapati A, McKinstry L, Pascoe R, Richards S, Rosser K, Stevenson A, White R, Farik S, Kwun J, Murad A, Cowan S, Hall T, Hayton M, Malam Sani L, Oumarou Garba S, Adamou H, Amadou Magagi I, Habou O, Aliyu H, Daniyan M, Sholadoye TT, Abdullahi L, Anyanwu LJ, Mohammad Mohammad A, Muhammad AB, Sheshe AA, Suleiman I, Adesina A, Awolowo A, Onuoha C, Salami O, Taiwo O, Taiwo A, Kache S, Makama JG, Sale D, Abiola O, Ajao A, Ajiboye A, Etonyeaku A, Olaogun J, Adebanjo A, Adesanya O, Afolayan MO, Balogun O, Makanjuola A, Nwokocha S, Ojewola RW, Olajide TO, Aderounmu A, Adesunkanmi AR, Adisa A, Agbakwuru A, Akeem Aderogba A, Alatise OI, Arowolo O, Lawal O, Mohammed T, Ndegbu C, Olasehinde O, Wuraola F, Akinkuolie A, Etonyeaku A, Mosanya A, Ayandipo O, Elemile P, Lawal TA, Ali SANI S, Garba S, Hauwa SANI R, Olori S, Onyebuashi H, Umoke I, Adenuga A, Adeyeye A, Habeeb O, Lawal B, Nasir A, Aahlin EK, Kjønås D, Myrseth E, Abbasy J, Alvi A, Saleem O, Afzal A, Nazir A, Farooq M, Liaqat A, Naqi SA, Raza A, Sarfraz M, Sarwar M, Banglani M, Munir A, Sehrish R, Ayub B, Sayyed R, Altaf A, Ayub S, Qureshi AU, Saeed K, Syed B, Akbar SA, Anwer AW, Khan RN, Khan AI, Khattak S, Mohtasham S, Parvaiz MA, Syed AA, Ansari AB, Shahzad N, Khaliq T, Rashid I, Waqar SH, Abu Al-saleem H, Abu Alqumboz A, Alqadi M, Amro A, Assa R, Awesat E, Ayyad R, Hammad M, Haymony A, Hijazi B, Hmeidat B, Lahaseh R, Qawasmi A, Rajabi A, Shehada M, Shkokani S, Yaghi Y, Yaghi N, AlZohour M, Farid M, Habes YM, Juba W, Nubani Y, Rabee A, Sa'deh M, Abed S, Al basos I, Alswerki M, Ashour D, Awad I, Diab S, El Jamassi A, El-Kahlout S, Elhout S, Hajjaj ANK, Hasanain D, Nabil hajjaj B, Obaid M, Saikaly E, Salhi A, Al-Tammam H, Almasri M, Baniowda M, Beshtawi D, Horoub A, Misk R, Mohammad B, Qasrawi R, Sholi T, Abu-Nimeh S, Abu-srour A, Abukhalaf SA, Adawi S, Alsalameh B, Ayesh K, Elqadi M, Hammouri A, Karim Mustafa F, Marzouqa N, Melhem S, Miqdad D, Mohamad B, Rawhi M, Abu Ahammala AB, Abu Ataya A, Abu Jayyab I, Al-Shwaikh S, Alagha O, Alasttal M, Awadallah H, Elblbessy M, Fares J, Jarbou A, Mahfouz I, Albahnasawi MA, Abo mahadi A, Abuelhatal H, Abuelqomboz A, Almoqayyad A, Alwali A, Balaawi R, Hamouda M, Humeid M, Jedyan A, Mahmoud Abu hamam T, Matar G, Salem A, Samra T, Shaheen N, Shihada K, A.Nemer A, Abu Al Amrain M, Abu Alamrain A, Abu Jamie N, Abu-Rous MR, Alfarra N, AlTaweel M, Alwhaidi N, Hamed R, Saqqa B, Shaheen A, Aljaber D, Aljaberi L, Alwaheidi M, Jawaada A, Khaldi H, Qahoush R, Qari J, Saadeh R, Salim A, Yacoub A, Abbas A, Abu shua`ib R, Abu Zainah B, AbuSirrees M, Babaa B, Barhoush O, Belal qadomi A, Daraghmeh L, Haji R, Khatatbeh A, Khatib L, Qarariah S, Quzmar Y, Safadi K, Salameh R, Hassan M, Herzallah S, Massad L, Nazzal A, Nazzal R, Escobar D, Machain V GM, Rodriguez Gonzalez A, Chachaima Mar JE, Chinchihualpa Paredes NO, Cuba V, Lopez W, Niquen Jimenez MM, Sanchez Bartra NA, Sapallanay Ojeda O, Sequeiros D, Toscano Pacheco A, Vergara M, Abarca S, Alcorta R, Borda-Luque G, Eusebio Zegarra IE, Luján López C, Marrufo M, Mogrovejo C, Nomura A, Rodríguez Angeles Y, Vidal Meza MR, Zavala G, Castillo Arrascue JN, Hidrogo Cabrera JC, Larrea vera JJM, Osorio M, Ylatoma Díaz EA, Fontanilla MA, Fuentes JR, Salazar AL, Dominguez G, Lopez MP, Macalindong S, Onglao MA, Ramirez A, Sacdalan MD, Tampo MM, Uy GL, Mangahas J, Yabut K, Cañete JP, Cansana BE, Castro EJ, Lipana MK, Roxas MF, Zara VJ, Chrol M, Franczak P, Orlowski M, Budzynski P, Budzynski A, Bury P, Czerwinska A, Dworak J, Dziedzic J, Kisielewski M, Kulawik J, Lasek A, Major P, Malczak P, Migaczewski M, Pedziwiatr M, Pisarska M, Radkowiak D, Rubinkiewicz M, Rzepa A, Skoczylas T, Stanek M, Truszkiewicz K, Wierdak M, Winiarski M, Zarzycki P, Zub-Pokrowiecka A, Kowalewski P, Roszkowski R, Waledziak M, Tomé M, Patrocinio S, Guerreiro I, Almeida F, de Sousa X, Monteiro N, Costa Santos MT, de Oliveira D, Lopes Serra M, Morgado D, Neves C, Oliveira AC, Pimentel A, Silva S, Carvalho M, Carvalho L, Magalhães J, Matos L, Monteiro T, Ramos C, Santos V, Barbosa J, Costa-Maia J, Devezas V, Fareleira A, Fernandes C, Gonçalves D, Mora H, Morais M, Silva de Sousa F, Catarino Santos S, Logrado A, Tojal A, Amorim E, Cunha MF, Fazenda A, Melo Neves JP, Sampaio da Nóvoa Gomes Miguel II, Veiga D, Azevedo J, Cardoso Louro H, Leite M, Azevedo J, Bairos Menezes M, Gama B, Brito D, Cruz Martins MC, Graça e Magalhães A, Longras AC, Lourenço R, Matos D, Castro L, Policarpo F, Romano J, Leite M, Monteiro C, Pinto D, Duarte M, Fortuna Martins S, Oliveira M, Galvão D, Martins L, Silva A, Taranu V, Vieira B, Neves J, Oliveira S, Ribeiro H, Cinza M, Felix R, Machado A, Oliveira J, Patrício J, Pedroso de Lima R, Pereira M, Rocha Melo M, Velez C, Abreu da Silva A, Claro M, Costa Santos D, Ferreira A, Capote H, Rosado D, Taré F, Nogueira O, Ângelo M, Baiao JM, Guimarães A, Marques J, Nico Albano M, Silva M, Valente da Costa A, Vieira Caroço T, Almeida Braga S, Capunge I, Fragoso M, Guimarães J, Pinto B, Ribeiro J, Angel M, Fialho G, Guerrero M, Campos Costa F, Cardoso D, Cardoso V, Alves M, Estalagem I, Louro T, Marques C, Martelo R, Morgado M, Canotilho R, Correia AM, Martins P, Peyroteo M, Gomes J, Monteiro R, Romano M, Alves DM, Peixoto R, Quintela C, Jervis MJ, Melo D, Pacheco A, Paixão V, Pedro V, Pimenta J, Pimenta de Castro J, Rocha A, Beuran M, Bratu MR, Ciubotaru C, Diaconescu B, Hostiuc S, Negoi I, Stoica B, NA NA, Anokhin E, Kuznetsov G, Oganezov G, Paramzin F, Romanova E, Rutkovskii V, Rutkovskii V, Shushval M, Zabiyaka M, Dzhumabaev K, Ivanov V, Mamedli Z, Achkasov S, Balkarov A, Nabiev E, Nagudov M, Rybakov E, Saifutdinova K, Sushkov O, Vardanyan A, Costas-Chavarri A, Joseph L, Ndayishimiye I, Allen Ingabire JC, Faustin N, Mutabazi AZ, Mvukiyehe JP, Nsengimana VJ, Uwakunda C, Abbas MM, Akeel N, Aljiffry M, Awaji K, Farsi A, Jamjoum G, Khoja A, Maghrabi A, Malibary N, Nassif M, Saleem A, Sultan A, Tashkandi W, Tashkandi H, Trabulsi N, Ba MB, Diallo AC, Ndong A, Cuk V, Jankovic U, Juloski J, Koh SZ, Koh F, Lee KC, Lee KY, Lee S, Leong WQ, Lieske B, Lui SA, Prakash P, Grosek J, Norcic G, Tomazic A, Fitchat N, Jaich R, Wineberg D, Koto MZ, Baiocchi D, Clarke D, Steenkamp CJ, Van Straten S, Bannister S, Boutall A, Chinnery G, Coccia A, Dell A, Karjiker P, Kloppers C, Loxton N, Mabogoane T, Malherbe F, Panieri E, Rayamajhi S, Spence R, van Wyngaard T, Warden C, Madiba TE, Moodley Y, Pillay N, Brooks S, Kruger C, Van Der Merwe LH, Gool F, Kariem M, Bougard H, Chu K, Kariem N, Noor F, Pillay R, Steynfaardt L, González González L, Marín Santos JM, Martín-Borregón P, Martínez Caballero J, Nevado García C, Rodriguez Fraga P, De Castro Parga G, Fernández Veiga MP, Garrido López L, Infante Pino H, Lages Cal I, López Otero M, Nogueira Sixto M, Paniagua García Señorans M, Rodríguez Fernández L, Ruano Poblador A, Rufo Crespo E, Sanchez-Santos R, Vigorita V, Alonso Batanero E, Asnel D, Cifrian Canales I, Contreras Saiz E, De Santiago Alvarez I, Díaz Vico T, Fernandez Arias S, Fernández Martínez D, García Bernardo C, García Flórez LJ, Garcia Gutierrez C, García Munar M, Márquez Zorrilla Molina CA, Merayo M, Michi Campos JL, Moreno Gijon M, Otero-Diez JL, Rodicio Miravalles JL, Solar-Garcia L, Suárez Sánchez A, Truan N, Alejandre Villalobos C, Caballero Díaz Y, Jimenez M, Montesdeoca D, Navarro-Sánchez A, Vega V, Beltrán de Heredia J, Gómez Z, Jezieniecki C, Legido Morán AP, Montes-Manrique M, Rodriguez-Lopez M, Ruiz Soriano M, Trujillo Díaz J, Vazquez Fernandez A, Argudo N, Pera M, Torrent Jansà L, García Domínguez M, Goded I, Roldón Golet M, Talal El-Abur I, Utrilla Fornals A, Zambrana Campos V, Aguilar Martinez MDM, Bosch M, García-Catalá L, Sánchez-Guillén L, Artigau E, Gomez Romeu N, Julià Bergkvist D, Espina Perez B, Morató O, Olona C, Diéguez B, Forero-Torres A, Losada M, Gomez-Abril S, Gonzálvez P, Martinez R, Navarro Martínez S, Payá-Llorente C, Pérez Rubio Á, Santarrufina Martinez S, Sebastián Tomás JC, Trullenque Juan R, Gegúndez Simón A, Maté P, Prieto-Nieto MI, Rubio-Perez I, Urbieta A, Vicario Bravo M, Abelló D, Frasson M, Garcia-Granero A, Abad Gurumeta A, Abad-Motos A, Lucena-de Pablo E, Nozal B, Ripollés-Melchor J, Salvachúa R, Ferrero E, Garcia-Sancho Tellez L, Ortega Vázquez I, Picardo AL, Rojo López JA, Zorrilla Matilla LP, Cagigas Fernandez C, Castanedo Bezanilla S, Estevez Tesouro J, Fernandez-Diaz MJ, García Cardo J, Gomez Ruiz M, Gonzalez-Tolaretxipi E, Jimeno Fraile J, Poch C, Rodriguez-Aguirre M, Troche Pesqueira N, Trugeda-Carrera MS, de la Torre J, Blanco-Colino R, Espin-Basany E, Espinosa-Bravo M, Morales Comas C, Reyes Afonso E, Rivero Déniz J, Siso Raber C, Verdaguer Tremolosa M, Chandrasinghe P, Kumarage S, Wijekoon Arachchilage N, Senanayake KJ, Abdalla Ahmed Elkamel A, A. Adam M, Saleh M, Blomme N, Thorell A, Wogensen F, Älgå A, Ansarei D, Celebioglu F, Heinius G, Nigard L, Pieniowski E, Ahlqvist S, Björklund I, Cengiz Y, Frånberg A, Håkansson M, Adamo K, Franklin O, Sund M, Wiberg R, Andersson Y, Chabok A, Nikberg M, Kugelberg A, Canonica C, Christoforidis D, Fasolini F, Gaffuri P, Giuliani M, Meani F, Popeskou SG, Pozza S, Wandschneider W, Peterer L, Widmer LW, Zimmermann B, Bakoleas P, Chanousi I, Charalampidou L, Grochola LF, Heid F, Ntaoulas S, Outos M, Peros G, Podolska-Skoczek H, Reinisch KB, Zielasek C, Clerc D, Demartines N, Gilgien J, Kefleyesus A, St-Amour P, Toussaint A, Alhimyar M, Alsaid B, Alyafi A, Alkhaledi A, Kouz B, Omarain A, Al-Sabbagh Y, Alkhatib H, Sara S, Alhaj A, Danial A, Kadoura L, Maa Albared S, Monawar Y, Nahas L, Abd B, Saad A, Wakkaf H, Bouaziz H, Bouzaiene H, Ghalleb M, Akaydin E, Akbaba AC, Atakul O, Baltaci E, Besli S, Burgu G, Cenal U, de Muijnck C, Demirkaya HC, Dogruoz A, Gezer ZI, Gündogdu Y, Kara M, Korkmaz HK, Kurtoglu GK, Ozben V, Ozmen BB, Pektas AM, Sel EK, Yenidünya N, Bengur FB, Oral BM, Yozgatli TK, Abdullayev S, Gunes ME, Sahbaz NA, Banaz T, Kargici K, Kuyumcu OF, Yanikoglu E, Yesilsancak M, Yilmaz D, Aktas MK, Rencuzogullari A, Isik A, Leventoglu S, Yalçinkaya A, Yüksel O, Kalayci MU, Kara Y, Sarici IS, Akin A, Alemdag GN, Arslan E, Baki BE, Bodur MS, Calik A, Candas Altinbas B, Cihanyurdu I, Erkul O, Gül B, Guner A, Köse B, Semiz A, Sevim S, Tayar S, Tomas K, Tüfek OY, Türkyilmaz S, Ulusahin M, Usta A, Yildirim R, Güler SA, Tatar OC, Varol E, Kirimtay B, Uysal M, Yildiz A, Kose E, Ciftci AB, Çolak E, Eraslan H, Kucuk GO, Yemez K, Lule H, Bienfait M, Lule H, Bua E, Doe M, Okalany N, Birindelli A, Basarab M, Bielosludtsev O, Freigofer M, Kolhanova K, Perepelytsia K, Romanukha K, Savenkov D, Siryi S, Tereshchenko M, Viacheslav N, Volovetskyi A, Kebkalo A, Tryliskyy Y, Tyselskiy V, Bruce E, Chow BL, Iddles E, McGuckin S, Newall N, Ramsay G, Sharma P, Stewart C, Wong J, Badran A, Bath M, Belais F, Butt E, Joshi K, Kapur M, Shaw M, Townson A, Williams CYK, Gray T, Greig R, Husain M, Murray E, Mustafa A, Asif A, Gokul A, Shah M, Akitikori MT, Charalabopoulos A, Davidson S, McNally S, Rupani S, Juma F, Mills SC, Muirhead L, Sellars K, Walsh U, Warren O, Chambers A, Hunt R, Teasdale E, Boyce S, Cornwall H, Tol I, Argyriou EO, Eardley N, Povey M, Aithie JMS, Irfan A, McGuigan MC, Starr R, Warren CR, Archibald J, Kirby G, Kisyov I, Khoo CK, Lee R, Photiou D, Davis R, Prasad U, Yang PZ, Bird J, Leung E, Summerour V, Currow C, Kiam J, Tan GJS, Muthusami A, Pegba-Otemolu I, Urbonas T, Nunoo-Mensah J, Smolskas E, Boddy A, Gravante G, Hunter D, Andrew D, Koh A, Thompson A, Adams L, Clements HA, De Silva K, Ekpete O, Haque S, Henderson S, Ibrahim B, Jayasinghe T, Livie J, Mailley K, Nair G, Tan D, Baggaley C, Dawidziuk A, Szyszka B, Barter C, Gandhi N, Hassell K, Hitchin S, Kelsall J, Nagy E, Nessa A, Whisker L, Yanni F, Ali M, Arora D, Hediwattege S, Kumarasinghe N, Rathore M, Tennakoon A, Ali Ahmad SM, Bajomo O, Nadira F, Celentano V, Bhangu A, Glasbey J, Griffiths E, Karri RS, Mak JKC, Nepogodiev D, Pipe M, Bhatti MI, Rabie M, Boyle C, Hamilton D, Mihuna A, Ng JCK, Nicholson G, Oliwa A, Pearson R, Rose A, Yong SQ, Boereboom C, Hanna M, Walter C, Greensmith TS, Mitchell R, Monaghan E, Crawford J, Moug S, Blackwell J, Boyd-Carson H, Herrod P, Al-Allaf O, Beattie M, Bullock C, Burman S, Clark G, Flamey N, Flannery O, Harding A, Kodiatt B, Lawday S, Mahapatra S, Mukundu Nagesh N, Ng M, Rye D, Yoong A, Clark L, Deans C, Edirisooriya M, Fairfield CJ, Harrison EM, Carrington EV, Wong TLE, Yusuf B, Chamberlain C, Duke K, Kmiotek E, Botes A, Condie N, Schrire T, Shah R, Thomas-Jones I, Yates C, Anthony N, Matthews E, Sahnan K, Tankel J, Tucker S, Winter Beatty J, Ziprin P, Duggan W, Kantartzi A, Sridhar S, Khaw RA, Srivastava P, Underwood C, Alves do Canto Brum H, Chopra S, Davis L, Hughes R, Tulley J, Alberts J, Athisayaraj T, Olugbemi M, Ahmad K, Chan C, Chapman G, Fleming H, Fox B, Grewar J, Hulse K, Rutherford D, Sinead M, Smith S, Speake D, Vaughan-Shaw PG, Christodoulides N, Kudhail S, Welch M, Husaini SM, Lambracos S, Anyanwu C, Suresh R, Thomas JS, Gleeson E, Platoff R, Saif A, Enumah Z, Etchill E, Gabre-Kidan A, Bernstein M, Carrano FM, Connors J, Lynn P, Melis M, Newman E, Foster DS, Perrone K, Titan A, Weiser TG, Ahmad S, Bafford ACM, Dal Molin M, Hanna N, Zafar SN, Hemmila M, Napolitano L, Wong JJ, Chandler J, Wood L, Wren S, Ottesen T, You L, Yu K, Arciénega Yañez MDP, Ferreira Fernandes M, González D, Cubas S, González MC, Zubiaurre V, Demolin R, Giroff N, Sciuto P, Campos M, Rodríguez Cantera G, Wagner G, Deepika G, Maimbo M, Simuchimba E, Bulaya A, Chibuye C, Chirengendure B, Kabale MR, Kabongo K, Linyama D, Munthali J, Mweso O, Pikiti F, Otieno J, Chan E, Lai LT, Blackman B, Richards S, Subramaniam S, Karim R, Kok N, Lee YD, Ali S, Sinha A, Corrigan R, Barnes N, Wong F, Dennis G, Jedamzik J, Phillips E, Piette W, Van hentenryck M, Koco H, Lawani S, Kassa MW, Santos Bezerra T, Gribnev P, Dimitrov D, Krastev P, Oum S, Bonghaseh DT, Al Farsi M, Alsharqawi N, Agarwal A, Acevedo V, Castillo Barbosa AC, Giron F, Leon Rodriguez JP, Kucan D, Rosko D, Barsic N, Župan D, Hegazi A, Truncíková V, Fryba V, Mohamed M, Sultan A, Nagi A, Rashad Temerik A, Elshawy ME, Mahmoud MI, Omar S, Anwar M, Rageh T, Elmokadem A, Gaballa K, Teppo S, Turunen A, Pengermä P, Ballouhey Q, Bergeat D, Weyl A, Hain E, Gyedu A, Yenli E, Osei-Poku D, Rompou VA, Zoikas A, Gaitanidis A, Koukis G, Perivoliotis K, Tavlas P, Galanos-Demiris K, Zografos G, Karavokyros I, Xanthopoulou G, Iordanidou E, Ayau F, Garcia A, Damján P, Wason D, B L A, Rangganata E, Kamath P, O'Connor DB, Pinto M, Perrone F, Tropeano FP, Troilo F, Bossi D, Scala D, Pulitanò L, Carella M, Pietrabissa A, Gori A, Giraudo G, De Simone V, Russo AA, Braccio B, Al-Taher R, Athamneh S, Parker A, Sawiee A, Kattia A, Salem M, Tababa O, Shaeeb Z, Syminas V, Jurgaitis J, Damuleviciene G, Svagzdys S, Poskus T, Razafimanjato NNM, Chieng Loo L, Tiong IC, Wan Muhmad WF, Vijeyan H, Li Ying T, Grech G, Arrangoiz R, Jimenez Ley VB, Arizpe D, Jimenez Ley VB, Lagunes Lara E, Castro López EV, Eaazim J, Gordinou de Gouberville M, Bastiaenen V, Rottier S, Nahab F, Ji MY, Seyoji M, Nwachukwu C, Emeghara O, Muhammed SE, Idowu A, Sowemimo O, Ogundoyin O, Akande O, Lott A, Nadeem M, Laghari AA, Loya A, Mushtaq H, Abdullah MT, Abuhilal B, Atawneh M, Hamdan H, Alhabil B, Srour A, Mousa I, Da Silva Medina L, Sacdalan MD, Lapitan MC, Sacdalan MD, Sacdalan MD, Bartosiak K, Ferreira P, Francisco V, Lemos R, Frutuoso L, Fernandes S, Fonseca T, Pereira J, Rachadell J, Torre A, Madeira Martins F, Carvalho AC, Rodrigues Ferreira J, Ribeiro da Silva B, Devesa H, Vieira A, Mónica I, Amaro M, Sousa D, Reia M, Louro J, Martins A, Dominguez J, Santos I, Freitas Oliveira NM, Pereira JC, Silva-Vaz P, Freire L, Escrevente R, Negoita VM, Shakhmatov D, Nezerwa Y, Radulovic R, Moore R, Obery G, Viljoen F, Mendes T, Suarez A, Moncada E, Fernandez-Hevia M, Curtis Martínez C, Gil Garcia JM, González Zunzarren M, Idris T, Eklöv K, Grahn O, Amin L, Blomqvist M, Ajani C, Kraus R, Seeger N, Willemin M, Rayya F, Ayash M, Msouti R, Kannas I, Abazid E, Esper A, Slim S, Kavcar AS, Aytac E, Dural AC, Ilker A, Eray IC, Kurnaz E, Altiner S, Tepe MD, Sahin C, Savli E, Innocent A, Babirye L, Diachenko A, Hordoskiy V, Curry H, Chau CYC, Robertson H, Mahmoud A, Lennon H, Loi L, Kirkham E, McCann C, Watts D, Gurung B, Wilson M, Tribedi T, Garofalo E, Zahra B, MacDonald S, Daniels I, Ng N, Khosla S, Olivier J, Yue SYP, Suresh G, Wellington J, Lorejo E, Mossaad M, Tryliskyy Y, Crutcher M, Alimi M, Baiu I, Abdou H, Conway A, Peck C, Wagner G, Perdomo Perez MA, Trostchansky I, Zulu S, Nakazwe M, Knight SR, Drake TM, Nepogodiev D, Fitzgerald JE, Ademuyiwa A, Alexander P, Ingabire JA, Al-Saqqa SW, Biccard BM, Borda-Luque G, Borowski DW, Burger S, Chu K, Clarke D, Costas-Chavarri A, Davies J, Donaldson R, Ede C, Garden OJ, Ghosh D, Glasbey J, Kingham TP, Salem HK, Anyomih TTK, Koto MZ, Lapitan MC, Lawani I, Lesetedi C, Aguilera-Arevalo ML, Mabedi C, Maimbo M, Magill L, Makinde Alakaloko F, Makupe A, Martin J, Ramos-De la Medina A, Monahan M, Moore R, Msosa V, Mulira S, Mutabazi AZ, Muller E, Musowoyo J, Adisa AO, Olory-Togbe JL, Pius R, Qureshi AU, Rayne S, Roberts T, Sacdalan MD, Shaw CA, Smart N, Smith M, Spence R, Van Straten S, Tabiri S, Tayler V, Weiser TG, Windsor J, Yorke J, Yepez R, Lilford R, Morton D, Bhangu A, Sundar S, Harrison EM, Runigamugabo E, Verjee A, Chen J, Daya L, El Aroussi N, Farina V, Gnintedeme Olivier T, Gonzales Nacarino M, Hammani A, Honjo S, Jacobs R, Kimura H, Litvin A, Nkoronko M, Nour I, Oscullo Yepez JJ, Pagano G, Pata F, Pin Hung W, Raj A, Romani Pozo A, Rommaneh M, Sassamela Fabiano SC, Shiroma Gago CM, Shu Yip S, Srinivas A, Sung CY, Tai A, Valle Aranda YC, Venturini S, Vervoort D, Wilguens Lartigue J. Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries. Lancet 2021; 397:387-397. [PMID: 33485461 PMCID: PMC7846817 DOI: 10.1016/s0140-6736(21)00001-5] [Citation(s) in RCA: 104] [Impact Index Per Article: 34.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 12/02/2020] [Accepted: 12/17/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. METHODS This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. FINDINGS Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70-8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39-8·80) and upper-middle-income countries (2·06, 1·11-3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26-11·59) and upper-middle-income countries (3·89, 2·08-7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. INTERPRETATION Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. FUNDING National Institute for Health Research Global Health Research Unit.
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Adegbola SO, Dibley L, Sahnan K, Wade T, Verjee A, Sawyer R, Mannick S, McCluskey D, Yassin N, Phillips RKS, Tozer PJ, Norton C, Hart AL. Burden of disease and adaptation to life in patients with Crohn's perianal fistula: a qualitative exploration. Health Qual Life Outcomes 2020; 18:370. [PMID: 33218361 PMCID: PMC7678264 DOI: 10.1186/s12955-020-01622-7] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 11/06/2020] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Perianal fistulas are a challenging manifestation of Crohn's disease. Best medical and surgical therapy results in only about a third of patients remaining in remission at one year on maintenance treatment and sustained healing is often elusive. There is little published data on patient perspective of living with the condition or coping strategies in the face of non-curative/non-definitive treatment. We aimed to understand the experience of living with perianal fistula(s) and their impact on quality of life and routine functioning. METHODS This exploratory qualitative study used purposive sampling to recruit participants with current / previous diagnosis of Crohn's anal fistulas, from national IBD / bowel disease charities. The "standards for reporting qualitative research" (SRQR) recommendations were followed. Unstructured individual face-to-face interviews were audio recorded, transcribed and analysed thematically. Early themes were reviewed by the study team including patient advocates, clinicians and qualitative researchers. RESULTS Twelve interviews were conducted, achieving apparent data saturation. Three broad themes were uncovered: Burden of symptoms; Burden of treatment; and Impact on emotional, physical and social well-being. Each included several sub-themes, with considerable interplay between these. The impact of perianal fistula(s) on patients with CD is intense and wide reaching, negatively affecting intimate, close and social relationships. Fistulas cause losses in life and work-related opportunities, and treatments can be difficult to tolerate. CONCLUSION Crohn's perianal fistulas exert a heavy negative physical and emotional impact on patients. These findings will inform development of a patient reported outcome measure to assess treatment effectiveness and quality of life for patients living with this challenging condition.
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Affiliation(s)
- Samuel O Adegbola
- Robin Phillips Fistula Research Unit, St Mark's Hospital and Academic Institute, Watford Road, Harrow, HA1 3UJ, Middlesex, UK.
- Department of Surgery and Cancer, Imperial College London, St Mary's Hospital, Praed Street, London, W2 1NY, UK.
| | - Lesley Dibley
- Faculty of Education, Health and Human Sciences, University of Greenwich, London, UK
| | - Kapil Sahnan
- Robin Phillips Fistula Research Unit, St Mark's Hospital and Academic Institute, Watford Road, Harrow, HA1 3UJ, Middlesex, UK
- Department of Surgery and Cancer, Imperial College London, St Mary's Hospital, Praed Street, London, W2 1NY, UK
| | - Tiffany Wade
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College, London, UK
| | | | | | | | | | - Nuha Yassin
- Robin Phillips Fistula Research Unit, St Mark's Hospital and Academic Institute, Watford Road, Harrow, HA1 3UJ, Middlesex, UK
| | - Robin K S Phillips
- Robin Phillips Fistula Research Unit, St Mark's Hospital and Academic Institute, Watford Road, Harrow, HA1 3UJ, Middlesex, UK
- Department of Surgery and Cancer, Imperial College London, St Mary's Hospital, Praed Street, London, W2 1NY, UK
| | - Philip J Tozer
- Robin Phillips Fistula Research Unit, St Mark's Hospital and Academic Institute, Watford Road, Harrow, HA1 3UJ, Middlesex, UK
- Department of Surgery and Cancer, Imperial College London, St Mary's Hospital, Praed Street, London, W2 1NY, UK
| | - Christine Norton
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College, London, UK
| | - Ailsa L Hart
- Robin Phillips Fistula Research Unit, St Mark's Hospital and Academic Institute, Watford Road, Harrow, HA1 3UJ, Middlesex, UK
- Department of Surgery and Cancer, Imperial College London, St Mary's Hospital, Praed Street, London, W2 1NY, UK
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Lopes G, Stern MC, Temin S, Sharara AI, Cervantes A, Costas-Chavarri A, Engineer R, Hamashima C, Ho GF, Huitzil FD, Moghani MM, Nandakumar G, Shah MA, Teh C, Manjarrez SEV, Verjee A, Yantiss R, Correa MC. Early Detection for Colorectal Cancer: ASCO Resource-Stratified Guideline. J Glob Oncol 2020; 5:1-22. [PMID: 30802159 PMCID: PMC6426543 DOI: 10.1200/jgo.18.00213] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
PURPOSE To provide resource-stratified, evidence-based recommendations on the early detection of colorectal cancer in four tiers to clinicians, patients, and caregivers. METHODS American Society of Clinical Oncology convened a multidisciplinary, multinational panel of medical oncology, surgical oncology, surgery, gastroenterology, health technology assessment, cancer epidemiology, pathology, radiology, radiation oncology, and patient advocacy experts. The Expert Panel reviewed existing guidelines and conducted a modified ADAPTE process and a formal consensus-based process with additional experts (Consensus Ratings Group) for two round(s) of formal ratings. RESULTS Existing sets of guidelines from eight guideline developers were identified and reviewed; adapted recommendations form the evidence base. These guidelines, along with cost-effectiveness analyses, provided evidence to inform the formal consensus process, which resulted in agreement of 75% or more. CONCLUSION In nonmaximal settings, for people who are asymptomatic, are ages 50 to 75 years, have no family history of colorectal cancer, are at average risk, and are in settings with high incidences of colorectal cancer, the following screening options are recommended: guaiac fecal occult blood test and fecal immunochemical testing (basic), flexible sigmoidoscopy (add option in limited), and colonoscopy (add option in enhanced). Optimal reflex testing strategy for persons with positive screens is as follows: endoscopy; if not available, barium enema (basic or limited). Management of polyps in enhanced is as follows: colonoscopy, polypectomy; if not suitable, then surgical resection. For workup and diagnosis of people with symptoms, physical exam with digital rectal examination, double contrast barium enema (only in basic and limited); colonoscopy; flexible sigmoidoscopy with biopsy (if contraindication to latter) or computed tomography colonography if contraindications to two endoscopies (enhanced only).
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Affiliation(s)
- Gilberto Lopes
- University of Miami, Sylvester Comprehensive Cancer Center, Miami, FL
| | - Mariana C Stern
- Keck School of Medicine of University of Southern California, Los Angeles, CA
| | - Sarah Temin
- American Society of Clinical Oncology, Alexandria, VA
| | | | | | | | | | | | | | - Fidel David Huitzil
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | | | - Govind Nandakumar
- Columbia Asia Hospitals, Bangalore, India, and Weill Cornell Medical College, New York, NY
| | - Manish A Shah
- New York-Presbyterian/Weill Cornell Medical Center, New York, NY
| | | | | | - Azmina Verjee
- Homerton University Hospital Foundation Trust, Bowel Disease Research Foundation, London, United Kingdom
| | - Rhonda Yantiss
- New York-Presbyterian/Weill Cornell Medical Center, New York, NY
| | - Marcia Cruz Correa
- The University of Puerto Rico, San Juan, Puerto Rico, and MD Anderson Cancer Center, Houston, TX
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Costas-Chavarri A, Nandakumar G, Temin S, Lopes G, Cervantes A, Cruz Correa M, Engineer R, Hamashima C, Ho GF, Huitzil FD, Malekzadeh Moghani M, Sharara AI, Stern MC, Teh C, Vázquez Manjarrez SE, Verjee A, Yantiss R, Shah MA. Treatment of Patients With Early-Stage Colorectal Cancer: ASCO Resource-Stratified Guideline. J Glob Oncol 2020; 5:1-19. [PMID: 30802158 PMCID: PMC6426503 DOI: 10.1200/jgo.18.00214] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
PURPOSE To provide resource-stratified, evidence-based recommendations on the treatment and follow-up of patients with early-stage colorectal cancer. METHODS ASCO convened a multidisciplinary, multinational Expert Panel that reviewed existing guidelines and conducted a modified ADAPTE process and a formal consensus process with additional experts for one round of formal ratings. RESULTS Existing sets of guidelines from 12 guideline developers were identified and reviewed; adapted recommendations from six guidelines form the evidence base and provide evidence to inform the formal consensus process, which resulted in agreement of 75% or more on all recommendations. RECOMMENDATIONS For nonmaximal settings, the recommended treatments for colon cancer stages nonobstructing, I-IIA: in basic and limited, open resection; in enhanced, adequately trained surgeons and laparoscopic or minimally invasive surgery, unless contraindicated. Treatments for IIB-IIC: in basic and limited, open en bloc resection following standard oncologic principles, if not possible, transfer to higher-level facility; in emergency, limit to life-saving procedures; in enhanced, laparoscopic en bloc resection, if not possible, then open. Treatments for obstructing, IIB-IIC: in basic, resection and/or diversion; in limited or enhanced, emergency surgical resection. Treatment for IIB-IIC with left-sided: in enhanced, may place colonic stent. Treatment for T4N0/T3N0 high-risk features or stage II high-risk obstructing: in enhanced, may offer adjuvant chemotherapy. Treatment for rectal cancer cT1N0 and cT2n0: in basic, limited, or enhanced, total mesorectal excision principles. Treatment for cT3n0: in basic and limited, total mesorectal excision, if not, diversion. Treatment for high-risk patients who did not receive neoadjuvant chemotherapy: in basic, limited, or enhanced, may offer adjuvant therapy. Treatment for resectable cT3N0 rectal cancer: in enhanced, base neoadjuvant chemotherapy on preoperative factors. For post-treatment surveillance, a combination of medical history, physical examination, carcinoembryonic antigen testing, imaging, and endoscopy is performed. Frequency depends on setting. Maximal setting recommendations are in the guideline. Additional information can be found at www.asco.org/resource-stratified-guidelines. NOTICE It is the view of the American Society of Clinical Oncology that health care providers and health care system decision makers should be guided by the recommendations for the highest stratum of resources available. The guidelines are intended to complement but not replace local guidelines.
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Affiliation(s)
| | - Govind Nandakumar
- Columbia Asia Hospitals, Bangalore, India.,Weill Cornell Medical College, New York, NY
| | - Sarah Temin
- American Society of Clinical Oncology, Alexandria, VA
| | | | | | - Marcia Cruz Correa
- The University of Puerto Rico, San Juan, PR.,The University of Texas M.D. Anderson Cancer Center, Houston, TX
| | | | | | | | - Fidel David Huitzil
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | | | | | - Mariana C Stern
- Keck School of Medicine of the University of Southern California, Los Angeles, CA
| | | | | | - Azmina Verjee
- Homerton University Hospital National Health Service Foundation Trust, London, United Kingdom.,Bowel Disease Research Foundation, London, United Kingdom
| | - Rhonda Yantiss
- New York-Presbyterian/Weill Cornell Medical Center, New York, NY
| | - Manish A Shah
- New York-Presbyterian/Weill Cornell Medical Center, New York, NY
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Harji DP, Marshall H, Gordon K, Twiddy M, Pullan A, Meads D, Croft J, Burke D, Griffiths B, Verjee A, Sagar P, Stocken D, Brown J. Laparoscopic versus open colorectal surgery in the acute setting (LaCeS trial): a multicentre randomized feasibility trial. Br J Surg 2020; 107:1595-1604. [PMID: 32573782 DOI: 10.1002/bjs.11703] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 03/11/2020] [Accepted: 04/22/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Approximately 30 000 people undergo major emergency abdominal gastrointestinal surgery annually, and 36 per cent of these procedures (around 10 800) are carried out for emergency colorectal pathology. Some 14 per cent of all patients requiring emergency surgery have a laparoscopic procedure. The aims of the LaCeS (laparoscopic versus open colorectal surgery in the acute setting) feasibility trial were to assess the feasibility, safety and acceptability of performing a large-scale definitive phase III RCT, with a comparison of emergency laparoscopic versus open surgery for acute colorectal pathology. METHODS LaCeS was designed as a prospective, multicentre, single-blind, parallel-group, pragmatic feasibility RCT with an integrated qualitative study. Randomization was undertaken centrally, with patients randomized on a 1 : 1 basis between laparoscopic or open surgery. RESULTS A total of 64 patients were recruited across five centres. The overall mean steady-state recruitment rate was 1·2 patients per month per site. Baseline compliance for clinical and health-related quality-of-life data was 99·8 and 93·8 per cent respectively. The conversion rate from laparoscopic to open surgery was 39 (95 per cent c.i. 23 to 58) per cent. The 30-day postoperative complication rate was 27 (13 to 46) per cent in the laparoscopic arm and 42 (25 to 61) per cent in the open arm. CONCLUSION Laparoscopic emergency colorectal surgery may have an acceptable safety profile. Registration number: ISRCTN15681041 ( http://www.controlled-trials.com).
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Affiliation(s)
- D P Harji
- Department of Colorectal Surgery, Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - H Marshall
- Clinical Trials Research Unit, Leeds, UK
| | - K Gordon
- Clinical Trials Research Unit, Leeds, UK
| | - M Twiddy
- Institute of Clinical and Applied Health Research, University of Hull, Hull, UK
| | - A Pullan
- Clinical Trials Research Unit, Leeds, UK
| | - D Meads
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - J Croft
- Clinical Trials Research Unit, Leeds, UK
| | - D Burke
- Department of Colorectal Surgery, St James's University Hospital, Leeds, UK
| | - B Griffiths
- Department of Colorectal Surgery, Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - A Verjee
- Patient and Public Involvement Representative for LaCeS Trial, UK
| | - P Sagar
- Department of Colorectal Surgery, St James's University Hospital, Leeds, UK
| | - D Stocken
- Clinical Trials Research Unit, Leeds, UK
| | - J Brown
- Clinical Trials Research Unit, Leeds, UK
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Evans R, Taylor S, Kalasthry J, Sakai N, Miles A, Aboagye A, Agoramoorthy L, Ahmed S, Amadi A, Anand G, Atkin G, Austria A, Ball S, Bazari F, Beable R, Beare S, Beedham H, Beeston T, Bharwani N, Bhatnagar G, Bhowmik A, Blakeway L, Blunt D, Boavida P, Boisfer D, Breen D, Bridgewater J, Burke S, Butawan R, Campbell Y, Chang E, Chao D, Chukundah S, Clarke C, Collins B, Collins C, Conteh V, Couture J, Crosbie J, Curtis H, Daniel A, Davis L, Desai K, Duggan M, Ellis S, Elton C, Engledow A, Everitt C, Ferdous S, Frow A, Furneaux M, Gibbons N, Glynne-Jones R, Gogbashian A, Goh V, Gourtsoyianni S, Green A, Green L, Green L, Groves A, Guthrie A, Hadley E, Halligan S, Hameeduddin A, Hanid G, Hans S, Hans B, Higginson A, Honeyfield L, Hughes H, Hughes J, Hurl L, Isaac E, Jackson M, Jalloh A, Janes S, Jannapureddy R, Jayme A, Johnson A, Johnson E, Julka P, Kalasthry J, Karapanagiotou E, Karp S, Kay C, Kellaway J, Khan S, Koh D, Light T, Limbu P, Lock S, Locke I, Loke T, Lowe A, Lucas N, Maheswaran S, Mallett S, Marwood E, McGowan J, Mckirdy F, Mills-Baldock T, Moon T, Morgan V, Morris S, Morton A, Nasseri S, Navani N, Nichols P, Norman C, Ntala E, Nunes A, Obichere A, O'Donohue J, Olaleye I, Oliver A, Onajobi A, O'Shaughnessy T, Padhani A, Pardoe H, Partridge W, Patel U, Perry K, Piga W, Prezzi D, Prior K, Punwani S, Pyers J, Rafiee H, Rahman F, Rajanpandian I, Ramesh S, Raouf S, Reczko K, Reinhardt A, Robinson D, Rockall A, Russell P, Sargus K, Scurr E, Shahabuddin K, Sharp A, Shepherd B, Shiu K, Sidhu H, Simcock I, Simeon C, Smith A, Smith D, Snell D, Spence J, Srirajaskanthan R, Stachini V, Stegner S, Stirling J, Strickland N, Tarver K, Teague J, Thaha M, Train M, Tulmuntaha S, Tunariu N, van Ree K, Verjee A, Wanstall C, Weir S, Wijeyekoon S, Wilson J, Wilson S, Win T, Woodrow L, Yu D. Patient deprivation and perceived scan burden negatively impact the quality of whole-body MRI. Clin Radiol 2020; 75:308-315. [PMID: 31836179 DOI: 10.1016/j.crad.2019.10.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 10/30/2019] [Indexed: 01/26/2023]
Abstract
AIM To evaluate the association between the image quality of cancer staging whole-body magnetic resonance imaging (WB-MRI) and patient demographics, distress, and perceived scan burden. MATERIALS AND METHODS A sample of patients recruited prospectively to multicentre trials comparing WB-MRI with standard scans for staging lung and colorectal cancer were invited to complete two questionnaires. The baseline questionnaire, administered at recruitment, collated data on demographics, distress and co-morbidity. The follow-up questionnaire, completed after staging investigations, measured perceived WB-MRI scan burden (scored 1 low to 7 high). WB-MRI anatomical coverage, and technical quality was graded by a radiographic technician and grading combined to categorise the scan as "optimal", "sub-optimal" or "degraded". A radiologist categorised 30 scans to test interobserver agreement. Data were analysed using the chi-square, Fisher's exact, t-tests, and multinomial regression. RESULTS One hundred and fourteen patients were included in the study (53 lung, 61 colorectal; average age 65.3 years, SD=11.8; 66 men [57.9%]). Overall, 45.6% (n=52), scans were classified as "optimal" quality, 39.5% (n=45) "sub-optimal", and 14.9% (n=17) as "degraded". In adjusted analyses, greater deprivation level and higher patient-reported scan burden were both associated with a higher likelihood of having a sub-optimal versus an optimal scan (odds ratio [OR]: 4.465, 95% confidence interval [CI]: 1.454 to 13.709, p=0.009; OR: 1.987, CI: 1.153 to 3.425, p=0.013, respectively). None of the variables predicted the likelihood of having a degraded scan. CONCLUSIONS Deprivation and patients' perceived experience of the WB-MRI are related to image quality. Tailored protocols and individualised patient management before and during WB-MRI may improve image quality.
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Keane C, Fearnhead NS, Bordeianou LG, Christensen P, Basany EE, Laurberg S, Mellgren A, Messick C, Orangio GR, Verjee A, Wing K, Bissett I. International Consensus Definition of Low Anterior Resection Syndrome. Dis Colon Rectum 2020; 63:274-284. [PMID: 32032141 PMCID: PMC7034376 DOI: 10.1097/dcr.0000000000001583] [Citation(s) in RCA: 84] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Low anterior resection syndrome is pragmatically defined as disordered bowel function after rectal resection leading to a detriment in quality of life. This broad characterization does not allow for precise estimates of prevalence. The low anterior resection syndrome score was designed as a simple tool for clinical evaluation of low anterior resection syndrome. Although the low anterior resection syndrome score has good clinical utility, it may not capture all important aspects that patients may experience. OBJECTIVE The aim of this collaboration was to develop an international consensus definition of low anterior resection syndrome that encompasses all aspects of the condition and is informed by all stakeholders. DESIGN This international patient-provider initiative used an online Delphi survey, regional patient consultation meetings, and an international consensus meeting. PARTICIPANTS Three expert groups participated: patients, surgeons, and other health professionals from 5 regions (Australasia, Denmark, Spain, Great Britain and Ireland, and North America) and in 3 languages (English, Spanish, and Danish). MAIN OUTCOME MEASURE The primary outcome measured was the priorities for the definition of low anterior resection syndrome. RESULTS Three hundred twenty-five participants (156 patients) registered. The response rates for successive rounds of the Delphi survey were 86%, 96%, and 99%. Eighteen priorities emerged from the Delphi survey. Patient consultation and consensus meetings refined these priorities to 8 symptoms and 8 consequences that capture essential aspects of the syndrome. LIMITATIONS Sampling bias may have been present, in particular, in the patient panel because social media was used extensively in recruitment. There was also dominance of the surgical panel at the final consensus meeting despite attempts to mitigate this. CONCLUSIONS This is the first definition of low anterior resection syndrome developed with direct input from a large international patient panel. The involvement of patients in all phases has ensured that the definition presented encompasses the vital aspects of the patient experience of low anterior resection syndrome. The novel separation of symptoms and consequences may enable greater sensitivity to detect changes in low anterior resection syndrome over time and with intervention.
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Affiliation(s)
- Celia Keane
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - Nicola S. Fearnhead
- Department of Colorectal Surgery, Cambridge University Hospital NHS Foundation Trust, Cambridge, United Kingdom
| | - Liliana G. Bordeianou
- Colorectal Surgery Centre/Department of Surgery at the Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Peter Christensen
- Danish Cancer Society National Research Centre for Survivorship and Late Side Effect to Cancer in the Pelvic Organs, Department of Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Eloy Espin Basany
- Colon and Recto Unit, Department of General Surgery, Vall de Hebron Hospital, Universitat Autonoma de Barcelona, Spain
| | - Søren Laurberg
- Danish Cancer Society National Research Centre for Survivorship and Late Side Effect to Cancer in the Pelvic Organs, Department of Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Anders Mellgren
- Division of Colon & Rectal Surgery, Department of Surgery, University of Illinois at Chicago, Illinois
| | - Craig Messick
- Department of Surgical Oncology, Section of Colon and Rectal Surgery, The University of Texas MD Anderson Cancer Center, Houston and Sugar Land, Texas
| | - Guy R. Orangio
- Department of Surgery/School of Medicine, Louisiana State University, New Orleans, Louisiana
| | - Azmina Verjee
- Bowel Disease Research Foundation, London, England, United Kingdom
| | - Kirsty Wing
- Otago Community Hospice, Dunedin, New Zealand
| | - Ian Bissett
- Department of Surgery, University of Auckland, Auckland, New Zealand
- Department of Surgery, Auckland City Hospital, Auckland, New Zealand
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12
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Keane C, Fearnhead NS, Bordeianou L, Christensen P, Espin Basany E, Laurberg S, Mellgren A, Messick C, Orangio GR, Verjee A, Wing K, Bissett I. International consensus definition of low anterior resection syndrome. Colorectal Dis 2020; 22:331-341. [PMID: 32037685 DOI: 10.1111/codi.14957] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [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: 07/09/2019] [Accepted: 08/23/2019] [Indexed: 12/13/2022]
Abstract
AIM Low anterior resection syndrome (LARS) is pragmatically defined as disordered bowel function after rectal resection leading to a detriment in quality of life. This broad characterization does not allow for precise estimates of prevalence. The LARS score was designed as a simple tool for clinical evaluation of LARS. Although the LARS score has good clinical utility, it may not capture all important aspects that patients may experience. The aim of this collaboration was to develop an international consensus definition of LARS that encompasses all aspects of the condition and is informed by all stakeholders. METHOD This international patient-provider initiative used an online Delphi survey, regional patient consultation meetings, and an international consensus meeting. Three expert groups participated: patients, surgeons and other health professionals from five regions (Australasia, Denmark, Spain, Great Britain and Ireland, and North America) and in three languages (English, Spanish, and Danish). The primary outcome measured was the priorities for the definition of LARS. RESULTS Three hundred twenty-five participants (156 patients) registered. The response rates for successive rounds of the Delphi survey were 86%, 96% and 99%. Eighteen priorities emerged from the Delphi survey. Patient consultation and consensus meetings refined these priorities to eight symptoms and eight consequences that capture essential aspects of the syndrome. Sampling bias may have been present, in particular, in the patient panel because social media was used extensively in recruitment. There was also dominance of the surgical panel at the final consensus meeting despite attempts to mitigate this. CONCLUSION This is the first definition of LARS developed with direct input from a large international patient panel. The involvement of patients in all phases has ensured that the definition presented encompasses the vital aspects of the patient experience of LARS. The novel separation of symptoms and consequences may enable greater sensitivity to detect changes in LARS over time and with intervention.
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Affiliation(s)
- C Keane
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - N S Fearnhead
- Department of Colorectal Surgery, Cambridge University Hospital NHS Foundation Trust, Cambridge, UK
| | - L Bordeianou
- Colorectal Surgery Centre/Department of Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - P Christensen
- Danish Cancer Society National Research Centre for Survivorship and Late Side Effect to Cancer in the Pelvic Organs, Department of Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - E Espin Basany
- Colon and Recto Unit, Department of General Surgery, Vall de Hebron Hospital, Universitat Autonoma de Barcelona, Spain
| | - S Laurberg
- Danish Cancer Society National Research Centre for Survivorship and Late Side Effect to Cancer in the Pelvic Organs, Department of Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - A Mellgren
- Division of Colon and Rectal Surgery, Department of Surgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - C Messick
- Department of Surgical Oncology, Section of Colon and Rectal Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - G R Orangio
- Department of Surgery/School of Medicine, Louisiana State University, New Orleans, Louisiana, USA
| | - A Verjee
- Bowel Disease Research Foundation, London, UK
| | - K Wing
- Otago Community Hospice, Dunedin, New Zealand
| | - I Bissett
- Department of Surgery, Auckland City Hospital, Auckland, New Zealand
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13
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Keane C, Fearnhead NS, Bordeianou LG, Christensen P, Espin Basany E, Laurberg S, Mellgren A, Messick C, Orangio GR, Verjee A, Wing K, Bissett IP. International consensus definition of low anterior resection syndrome. ANZ J Surg 2020; 90:300-307. [PMID: 32040983 DOI: 10.1111/ans.15421] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 07/28/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Low anterior resection syndrome (LARS) is pragmatically defined as disordered bowel function after rectal resection leading to a detriment in quality of life. This broad characterization does not allow for precise estimates of prevalence. The LARS score was designed as a simple tool for clinical evaluation of LARS. Although the LARS score has good clinical utility, it may not capture all important aspects that patients may experience. The aim of this collaboration was to develop an international consensus definition of LARS that encompasses all aspects of the condition and is informed by all stakeholders. METHODS This international patient-provider initiative used an online Delphi survey, regional patient consultation meetings and an international consensus meeting. Three expert groups participated: patients, surgeons and other health professionals from five regions (Australasia, Denmark, Spain, Great Britain and Ireland, and North America) and in three languages (English, Spanish and Danish). The primary outcome measured was the priorities for the definition of LARS. RESULTS Three hundred and twenty-five participants (156 patients) registered. The response rates for successive rounds of the Delphi survey were 86%, 96% and 99%. Eighteen priorities emerged from the Delphi survey. Patient consultation and consensus meetings refined these priorities to eight symptoms and eight consequences that capture essential aspects of the syndrome. Sampling bias may have been present, in particular, in the patient panel because social media was used extensively in recruitment. There was also dominance of the surgical panel at the final consensus meeting despite attempts to mitigate this. CONCLUSIONS This is the first definition of LARS developed with direct input from a large international patient panel. The involvement of patients in all phases has ensured that the definition presented encompasses the vital aspects of the patient experience of LARS. The novel separation of symptoms and consequences may enable greater sensitivity to detect changes in LARS over time and with intervention.
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Affiliation(s)
- Celia Keane
- Department of Surgery, The University of Auckland, Auckland, New Zealand
| | - Nicola S Fearnhead
- Department of Colorectal Surgery, Cambridge University Hospital NHS Foundation Trust, Cambridge, UK
| | - Liliana G Bordeianou
- Colorectal Surgery Centre/Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Peter Christensen
- Danish Cancer Society Centre for Research on Survivorship and Late Adverse Effects After Cancer in the Pelvic Organs, Department of Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Eloy Espin Basany
- Colon and Recto Unit, Department of General Surgery, Vall d'Hebron Hospital, The Autonomous University of Barcelona, Barcelona, Spain
| | - Søren Laurberg
- Danish Cancer Society Centre for Research on Survivorship and Late Adverse Effects After Cancer in the Pelvic Organs, Department of Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Anders Mellgren
- Division of Colon and Rectal Surgery, Department of Surgery, University of Illinois, Chicago, Illinois, USA
| | - Craig Messick
- Department of Surgical Oncology, Section of Colon and Rectal Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Guy R Orangio
- Department of Surgery/School of Medicine, Louisiana State University, New Orleans, Louisiana, USA
| | | | - Kirsty Wing
- Otago Community Hospice, Dunedin, New Zealand
| | - Ian P Bissett
- Department of Surgery, The University of Auckland, Auckland, New Zealand.,Department of Surgery, Auckland City Hospital, Auckland, New Zealand
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14
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Symons NRA, McArthur D, Miller A, Verjee A, Senapati A. Emergency general surgeons, subspeciality surgeons and the future management of emergency surgery: results of a national survey. Colorectal Dis 2019; 21:342-348. [PMID: 30444316 DOI: 10.1111/codi.14474] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Accepted: 10/30/2018] [Indexed: 02/08/2023]
Abstract
AIM This study aimed to survey consultants' experience of working as or with emergency general surgery (EGS) surgeons and to investigate the role they fulfil in the management of general and subspeciality emergencies. METHOD An electronic survey, designed to capture both quantitative and qualitative data, was piloted and then circulated to members of the Association of Coloproctology of Great Britain and Ireland. RESULTS Two hundred and forty-two responses were received from 848 recipients (a 29% response rate) covering 104 of 135 (77%) acute NHS Trusts in England. EGS surgeons were in post in 43/141 (30%) hospitals overall and 12/24 (50%) of hospitals in London. Most respondents working in units with EGS surgeons found them to be advantageous (46/63, 73%). Consultants working with EGS surgeons were significantly more likely to support their use (49/63, 78%) than those without them (83/178, 47%) (χ2 = 16.9, P < 0.001). EGS surgeons were considered to improve the delivery of EGS (78%), create time for subspecialists (70%) and provide service (73%). However, there were concerns about the quality of surgery (43%), an insufficient standard of specialist care (54%) and compromise in the training of juniors (25%). Respondents commented on a lack of job structure with a high attrition rate (21%), the insufficient quality of applicants (18%) and that subspecialization and split on-call was preferable (17%). CONCLUSION Respondents were supportive of the ability of EGS surgeons to relieve pressure on subspecialists; however, there were significant concerns about the sustainability and quality of the EGS surgeon role. Emergency colorectal resections should have the input of a surgeon who performs elective colorectal resections.
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Affiliation(s)
- N R A Symons
- Imperial College London and Speciality Registrar in General Surgery, North East Thames, London, UK
| | - D McArthur
- Heart of England Foundation Trust, Birmingham, UK
| | - A Miller
- University Hospitals of Leicester NHS Trust, Leicester, UK
| | - A Verjee
- ACPGBI Patient Liaison Group, London, UK
| | - A Senapati
- ACPGBI EGS Working Group and Portsmouth Hospitals NHS Trust, Portsmouth, UK
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15
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Lee MJ, Sayers AE, Drake TM, Marriott PJ, Anderson ID, Bach SP, Bradburn M, Hind D, Verjee A, Fearnhead NS. National prospective cohort study of the burden of acute small bowel obstruction. BJS Open 2019; 3:354-366. [PMID: 31183452 PMCID: PMC6551410 DOI: 10.1002/bjs5.50136] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 11/27/2018] [Indexed: 12/21/2022] Open
Abstract
Background Small bowel obstruction is a common surgical emergency, and is associated with high levels of morbidity and mortality across the world. The literature provides little information on the conservatively managed group. The aim of this study was to describe the burden of small bowel obstruction in the UK. Methods This prospective cohort study was conducted in 131 acute hospitals in the UK between January and April 2017, delivered by trainee research collaboratives. Adult patients with a diagnosis of mechanical small bowel obstruction were included. The primary outcome was in‐hospital mortality. Secondary outcomes included complications, unplanned intensive care admission and readmission within 30 days of discharge. Practice measures, including use of radiological investigations, water soluble contrast, operative and nutritional interventions, were collected. Results Of 2341 patients identified, 693 (29·6 per cent) underwent immediate surgery (within 24 h of admission), 500 (21·4 per cent) had delayed surgery after initial conservative management, and 1148 (49·0 per cent) were managed non‐operatively. The mortality rate was 6·6 per cent (6·4 per cent for non‐operative management, 6·8 per cent for immediate surgery, 6·8 per cent for delayed surgery; P = 0·911). The major complication rate was 14·4 per cent overall, affecting 19·0 per cent in the immediate surgery, 23·6 per cent in the delayed surgery and 7·7 per cent in the non‐operative management groups (P < 0·001). Cox regression found hernia or malignant aetiology and malnutrition to be associated with higher rates of death. Malignant aetiology, operative intervention, acute kidney injury and malnutrition were associated with increased risk of major complication. Conclusion Small bowel obstruction represents a significant healthcare burden. Patient‐level factors such as timing of surgery, acute kidney injury and nutritional status are factors that might be modified to improve outcomes.
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Affiliation(s)
- M J Lee
- Department of General Surgery Northern General Hospital Sheffield UK.,South Yorkshire Surgical Research Group Sheffield UK
| | - A E Sayers
- South Yorkshire Surgical Research Group Sheffield UK.,Department of General Surgery Doncaster Royal Infirmary Doncaster UK
| | - T M Drake
- South Yorkshire Surgical Research Group Sheffield UK.,Department of Clinical Surgery University of Edinburgh Edinburgh UK
| | - P J Marriott
- Department of General Surgery Warwick Hospital Warwick UK.,Department of General Surgery Salford Royal Infirmary Salford UK
| | - I D Anderson
- West Midlands Research Collaborative, Academic Department of Surgery Queen Elizabeth Hospital Birmingham UK
| | - S P Bach
- Academic Department of Surgery Queen Elizabeth Hospital Birmingham UK
| | - M Bradburn
- Clinical Trials and Research Unit University of Sheffield Sheffield UK
| | - D Hind
- Clinical Trials and Research Unit University of Sheffield Sheffield UK
| | - A Verjee
- Patient Representative, Association of Coloproctology of Great Britain and Ireland Patient Liaison Group London UK
| | - N S Fearnhead
- Department of Surgery Addenbrooke's Hospital Cambridge UK
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16
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Sahnan K, Tozer PJ, Adegbola SO, Lee MJ, Heywood N, McNair AGK, Hind D, Yassin N, Lobo AJ, Brown SR, Sebastian S, Phillips RKS, Lung PFC, Faiz OD, Crook K, Blackwell S, Verjee A, Hart AL, Fearnhead NS. Developing a core outcome set for fistulising perianal Crohn's disease. Gut 2019; 68:226-238. [PMID: 29437911 PMCID: PMC6352412 DOI: 10.1136/gutjnl-2017-315503] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Revised: 12/15/2017] [Accepted: 12/18/2017] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Lack of standardised outcomes hampers effective analysis and comparison of data when comparing treatments in fistulising perianal Crohn's disease (pCD). Development of a standardised set of outcomes would resolve these issues. This study provides the definitive core outcome set (COS) for fistulising pCD. DESIGN Candidate outcomes were generated through a systematic review and patient interviews. Consensus was established via a three-round Delphi process using a 9-point Likert scale based on how important they felt it was in determining treatment success culminating in a final consensus meeting. Stakeholders were recruited nationally and grouped into three panels (surgeons and radiologists, gastroenterologists and IBD specialist nurses, and patients). Participants received feedback from their panel (in the second round) and all participants (in the third round) to allow refinement of their scores. RESULTS A total of 295 outcomes were identified from systematic reviews and interviews that were categorised into 92 domains. 187 stakeholders (response rate 78.5%) prioritised 49 outcomes through a three-round Delphi study. The final consensus meeting of 41 experts and patients generated agreement on an eight domain COS. The COS comprised three patient-reported outcome domains (quality of life, incontinence and a combined score of patient priorities) and five clinician-reported outcome domains (perianal disease activity, development of new perianal abscess/sepsis, new/recurrent fistula, unplanned surgery and faecal diversion). CONCLUSION A fistulising pCD COS has been produced by all key stakeholders. Application of the COS will reduce heterogeneity in outcome reporting, thereby facilitating more meaningful comparisons between treatments, data synthesis and ultimately benefit patient care.
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Affiliation(s)
- Kapil Sahnan
- Fistula Research Unit, St Mark’s Hospital and Academic Institute, London, UK,Department of Surgery and Cancer, Imperial College, St Mary’s Hospital, London, UK
| | - Phil J Tozer
- Fistula Research Unit, St Mark’s Hospital and Academic Institute, London, UK,Department of Surgery and Cancer, Imperial College, St Mary’s Hospital, London, UK
| | - Samuel O Adegbola
- Fistula Research Unit, St Mark’s Hospital and Academic Institute, London, UK,Department of Surgery and Cancer, Imperial College, St Mary’s Hospital, London, UK
| | - Matthew J Lee
- Department of Colorectal Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Nick Heywood
- Department of Colorectal Surgery, University Hospitals of South Manchester, Manchester, UK
| | - Angus G K McNair
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Daniel Hind
- Clinical Trials Research Unit, School of Health and Related Research, Sheffield, UK
| | - Nuha Yassin
- Fistula Research Unit, St Mark’s Hospital and Academic Institute, London, UK
| | - Alan J Lobo
- Department of Colorectal Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Steven R Brown
- Department of Colorectal Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Shaji Sebastian
- Department of Gastroenterology, Hull and East Yorkshire NHS trust, Hull, UK
| | - Robin K S Phillips
- Fistula Research Unit, St Mark’s Hospital and Academic Institute, London, UK,Department of Surgery and Cancer, Imperial College, St Mary’s Hospital, London, UK
| | - Phillip F C Lung
- Fistula Research Unit, St Mark’s Hospital and Academic Institute, London, UK,Department of Surgery and Cancer, Imperial College, St Mary’s Hospital, London, UK
| | - Omar D Faiz
- Fistula Research Unit, St Mark’s Hospital and Academic Institute, London, UK,Department of Surgery and Cancer, Imperial College, St Mary’s Hospital, London, UK
| | - Kay Crook
- Fistula Research Unit, St Mark’s Hospital and Academic Institute, London, UK
| | | | | | - Ailsa L Hart
- Fistula Research Unit, St Mark’s Hospital and Academic Institute, London, UK,Department of Surgery and Cancer, Imperial College, St Mary’s Hospital, London, UK
| | - Nicola S Fearnhead
- Department of Colorectal Surgery, Cambridge University Hospitals, Cambridge, UK
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17
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Brown SR, Fearnhead NS, Faiz OD, Abercrombie JF, Acheson AG, Arnott RG, Clark SK, Clifford S, Davies RJ, Davies MM, Douie WJP, Dunlop MG, Epstein JC, Evans MD, George BD, Guy RJ, Hargest R, Hawthorne AB, Hill J, Hughes GW, Limdi JK, Maxwell-Armstrong CA, O'Connell PR, Pinkney TD, Pipe J, Sagar PM, Singh B, Soop M, Terry H, Torkington J, Verjee A, Walsh CJ, Warusavitarne JH, Williams AB, Williams GL, Wilson RG. The Association of Coloproctology of Great Britain and Ireland consensus guidelines in surgery for inflammatory bowel disease. Colorectal Dis 2018; 20 Suppl 8:3-117. [PMID: 30508274 DOI: 10.1111/codi.14448] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 09/17/2018] [Indexed: 12/14/2022]
Abstract
AIM There is a requirement of an expansive and up to date review of surgical management of inflammatory bowel disease (IBD) that can dovetail with the medical guidelines produced by the British Society of Gastroenterology. METHODS Surgeons who are members of the ACPGBI with a recognised interest in IBD were invited to contribute various sections of the guidelines. They were directed to produce a procedure based document using literature searches that were systematic, comprehensible, transparent and reproducible. Levels of evidence were graded. An editorial board was convened to ensure consistency of style, presentation and quality. Each author was asked to provide a set of recommendations which were evidence based and unambiguous. These recommendations were submitted to the whole guideline group and scored. They were then refined and submitted to a second vote. Only those that achieved >80% consensus at level 5 (strongly agree) or level 4 (agree) after 2 votes were included in the guidelines. RESULTS All aspects of surgical care for IBD have been included along with 157 recommendations for management. CONCLUSION These guidelines provide an up to date and evidence based summary of the current surgical knowledge in the management of IBD and will serve as a useful practical text for clinicians performing this type of surgery.
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Affiliation(s)
- S R Brown
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - N S Fearnhead
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - O D Faiz
- St Mark's Hospital, Middlesex, Harrow, UK
| | | | - A G Acheson
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - R G Arnott
- Patient Liaison Group, Association of Coloproctology of Great Britain and Ireland, Royal College of Surgeons of England, London, UK
| | - S K Clark
- St Mark's Hospital, Middlesex, Harrow, UK
| | | | - R J Davies
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - M M Davies
- University Hospital of Wales, Cardiff, UK
| | - W J P Douie
- University Hospitals Plymouth NHS Trust, Plymouth, UK
| | | | - J C Epstein
- Salford Royal NHS Foundation Trust, Salford, UK
| | - M D Evans
- Morriston Hospital, Morriston, Swansea, UK
| | - B D George
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - R J Guy
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - R Hargest
- University Hospital of Wales, Cardiff, UK
| | | | - J Hill
- Manchester Foundation Trust, Manchester, UK
| | - G W Hughes
- University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - J K Limdi
- The Pennine Acute Hospitals NHS Trust, Manchester, UK
| | | | | | - T D Pinkney
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - J Pipe
- Patient Liaison Group, Association of Coloproctology of Great Britain and Ireland, Royal College of Surgeons of England, London, UK
| | - P M Sagar
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - B Singh
- University Hospitals of Leicester NHS Trust, Leicester, UK
| | - M Soop
- Salford Royal NHS Foundation Trust, Salford, UK
| | - H Terry
- Crohn's and Colitis UK, St Albans, UK
| | | | - A Verjee
- Patient Liaison Group, Association of Coloproctology of Great Britain and Ireland, Royal College of Surgeons of England, London, UK
| | - C J Walsh
- Wirral University Teaching Hospital NHS Foundation Trust, Arrowe Park Hospital, Upton, UK
| | | | - A B Williams
- Guy's and St Thomas' NHS Foundation Trust, London, UK
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18
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Harji D, Marshall H, Gordon K, Crow H, Hiley V, Burke D, Griffiths B, Moriarty C, Twiddy M, O'Dwyer JL, Verjee A, Brown J, Sagar P. Feasibility of a multicentre, randomised controlled trial of laparoscopic versus open colorectal surgery in the acute setting: the LaCeS feasibility trial protocol. BMJ Open 2018; 8:e018618. [PMID: 29472259 PMCID: PMC5879497 DOI: 10.1136/bmjopen-2017-018618] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
INTRODUCTION Acute colorectal surgery forms a significant proportion of emergency admissions within the National Health Service. There is limited evidence to suggest minimally invasive surgery may be associated with improved clinical outcomes in this cohort of patients. Consequently, there is a need to assess the clinical effectiveness and cost-effectiveness of laparoscopic surgery in the acute colorectal setting. However,emergency colorectal surgical trials have previously been difficult to conduct due to issues surrounding recruitment and equipoise. The LaCeS (randomised controlled trial of Laparoscopic versus open Colorectal Surgery in the acute setting) feasibility trial will determine the feasibility of conducting a definitive, phase III trial of laparoscopic versus open acute colorectal resection. METHODS AND ANALYSIS The LaCeS feasibility trial is a prospective, multicentre, single-blinded, parallel group, pragmatic randomised controlled feasibility trial. Patients will be randomised on a 1:1 basis to receive eitherlaparoscopic or open surgery. The trial aims to recruit at least 66 patients from five acute general surgical units across the UK. Patients over the age of 18 with a diagnosis of acute colorectal pathology requiring resection on clinical and radiological/endoscopic investigations, with a National Confidential Enquiry into Patient Outcome and Death classification of urgent will be considered eligible for participation. The primary outcome is recruitment. Secondary outcomes include assessing the safety profile of laparoscopic surgery using intraoperative and postoperative complication rates, conversion rates and patient-safety indicators as surrogate markers. Clinical and patient-reported outcomes will also be reported. The trial will contain an embedded qualitative study to assess clinician and patient acceptability of trial processes. ETHICS AND DISSEMINATION The LaCeS feasibility trial is approved by the Yorkshire and The Humber, Bradford Leeds Research Ethics Committee (REC reference: 15/ YH/0542). The results from the trial will be presented at national and international colorectal conferences and will be submitted for publication to peer-reviewed journals. TRIAL REGISTRATION NUMBER ISRCTN15681041; Pre-results.
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Affiliation(s)
- Deena Harji
- Newcastle Centre for Bowel Disease, Royal Victoria Infirmary, Newcastle Upon Tyne, UK
- Clinical Trials Research Unit, University of Leeds, Leeds, UK
| | - Helen Marshall
- Clinical Trials Research Unit, University of Leeds, Leeds, UK
| | - Katie Gordon
- Clinical Trials Research Unit, University of Leeds, Leeds, UK
| | - Hannah Crow
- Clinical Trials Research Unit, University of Leeds, Leeds, UK
| | - Victoria Hiley
- Clinical Trials Research Unit, University of Leeds, Leeds, UK
| | - Dermot Burke
- John Goligher Colorectal Department, St James' University Hospital, Leeds, UK
| | - Ben Griffiths
- Newcastle Centre for Bowel Disease, Royal Victoria Infirmary, Newcastle Upon Tyne, UK
| | - Catherine Moriarty
- John Goligher Colorectal Department, St James' University Hospital, Leeds, UK
| | - Maureen Twiddy
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - John L O'Dwyer
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Azmina Verjee
- Patient and Public Representative, Association of Coloprocotology of Great Britain and Ireland, London, UK
| | - Julia Brown
- Clinical Trials Research Unit, University of Leeds, Leeds, UK
| | - Peter Sagar
- John Goligher Colorectal Department, St James' University Hospital, Leeds, UK
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19
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Dibley L, Czuber-Dochan W, Wade T, Duncan J, Burch J, Warusavitarne J, Norton C, Artom M, O'Sullivan L, Verjee A, Cann D. Patient Decision-Making About Emergency and Planned Stoma Surgery for IBD: A Qualitative Exploration of Patient and Clinician Perspectives. Inflamm Bowel Dis 2018; 24:235-246. [PMID: 29361098 DOI: 10.1093/ibd/izx043] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Many inflammatory bowel disease (IBD) patients worry about stoma-forming surgery (SFS), sometimes enduring poor bowel-related quality of life to avoid it. Anticipation of SFS and whether expectations match experience is underreported. This qualitative study explored influences on patients' SFS decision-making and compared preoperative concerns with postoperative outcomes. METHODS We purposively recruited participants with IBD from UK hospital outpatient and community sources, and IBD clinicians from public hospitals. Four focus groups, 29 semistructured patient participant interviews, and 18 clinician interviews were audio recorded, transcribed, and analysed thematically. Participants had a current temporary, recently-reversed, or permanent stoma, or were stoma naive. RESULTS Four themes emerged: Preoperative concerns and expectations, Patient decision-making, Surgery and recovery, and Long-term outcomes. Participants and clinicians agreed about most preoperative concerns, that outcomes were often better than expected, and support from others with a stoma is beneficial. Patient decision-making involves multiple factors, including disease status. Some clinicians avoid discussing SFS, and the phrase 'last resort' can bias patient perceptions; others recommend early discussion, increasing dialogue when medical management becomes ineffective. The postoperative period is particularly challenging for patients. Stoma acceptance is influenced by personal perceptions and pre- and postoperative clinical and social support. CONCLUSION Patients need balanced information on all treatment options, including surgery, from an early stage. Early multidisciplinary team dialogue about SFS, and contact with others living well with a stoma, could enable informed decision-making. Life with a stoma is often better than anticipated, improving quality of life and control. Ongoing specialist nursing support aids recovery and adjustment.
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Affiliation(s)
- Lesley Dibley
- Faculty of Education and Health, University of Greenwich, London, UK.,Bart's Health NHS Trust, London, UK
| | | | - Tiffany Wade
- Florence Nightingale Faculty of Nursing & Midwifery, King's College London, UK
| | | | | | | | - Christine Norton
- Florence Nightingale Faculty of Nursing & Midwifery, King's College London, UK
| | - Micol Artom
- Florence Nightingale Faculty of Nursing & Midwifery, King's College London, UK
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20
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Lomer MC, Hart AL, Verjee A, Daly A, Solomon J, Mclaughlin J. What are the dietary treatment research priorities for inflammatory bowel disease? A short report based on a priority setting partnership with the James Lind Alliance. J Hum Nutr Diet 2017; 30:709-713. [DOI: 10.1111/jhn.12494] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- M. C. Lomer
- Department of Nutrition and Dietetics; Guy's and St Thomas’ NHS Foundation Trust; London UK
- Diabetes & Nutritional Sciences Division; Kings College London; London UK
| | - A. L. Hart
- IBD Unit; St Mark's Hospital; Harrow Middlesex UK
| | - A. Verjee
- Bowel Disease Research Foundation; Royal College of Surgeons of England; London UK
| | - A. Daly
- Birmingham Women's Hospital; Birmingham Women's NHS Foundation Trust; Birmingham UK
| | - J. Solomon
- British Society of Gastroenterology; London UK
| | - J. Mclaughlin
- Division of Endocrinology, Diabetes & Gastroenterology; School of Medical Sciences; Faculty of Biology, Medicine and Health; University of Manchester and Manchester Academic Health Sciences Centre; Salford UK
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21
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Hart AL, Lomer M, Verjee A, Kemp K, Faiz O, Daly A, Solomon J, McLaughlin J. What Are the Top 10 Research Questions in the Treatment of Inflammatory Bowel Disease? A Priority Setting Partnership with the James Lind Alliance. J Crohns Colitis 2017; 11:204-211. [PMID: 27506537 PMCID: PMC5266081 DOI: 10.1093/ecco-jcc/jjw144] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Revised: 06/15/2016] [Accepted: 07/08/2016] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND AIMS Many uncertainties remain regarding optimal therapies and strategies for the treatment of inflammatory bowel disease. Setting research priorities addressing therapies requires a partnership between health care professionals, patients and organisations supporting patients. We aimed to use the structure of the James Lind Alliance Priority Setting Partnership, which has been used in other disease areas, to identify and prioritise unanswered questions about treatments for inflammatory bowel disease. METHODS The James Lind Priority Setting Partnership uses methods agreed and adopted in other disease areas to work with patients and clinicians: to identify uncertainties about treatments; to agree by consensus a prioritised list of uncertainties for research; then to translate these uncertainties into research questions which are amenable to hypothesis testing; and finally to take results to research commissioning bodies to be considered for funding. RESULTS A total of 1636 uncertainties were collected in the initial survey from 531 respondents, which included 22% health care professionals and 78% patients and carers. Using the rigorously applied processes of the priority setting partnership, this list was distilled down to the top 10 research priorities for inflammatory bowel disease. The top priorities were: identifying treatment strategies to optimise efficacy, safety and cost-effectiveness; and stratifying patients with regard to their disease course and treatment response. Diet and symptom control [pain, incontinence and fatigue] were also topics which were prioritised. CONCLUSIONS A partnership involving multidisciplinary clinicians, patients and organisations supporting patients has identified the top 10 research priorities in the treatment of patients with inflammatory bowel disease.
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Affiliation(s)
| | - Miranda Lomer
- Diabetes & Nutritional Sciences Division, Kings College London, London, UK
| | - Azmina Verjee
- Bowel Disease Research Foundation, Royal College of Surgeons of England, London, UK
| | - Karen Kemp
- Department of Gastroenterology, Manchester Royal Infirmary, Central Manchester University Hospitals NHS Trust, Manchester, UK
| | - Omar Faiz
- IBD Unit, St Mark’s Hospital, Harrow, Middlesex, UK
| | - Ann Daly
- Birmingham Women's Hospital, Birmingham Women’s NHS Foundation Trust, Birmingham, UK
| | | | - John McLaughlin
- University of Manchester Institute of Inflammation and Repair, Salford, UK
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22
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McNair AGK, Heywood N, Tiernan J, Verjee A, Bach SP, Fearnhead NS. A national patient and public colorectal research agenda: integration of consumer perspectives in bowel disease through early consultation. Colorectal Dis 2017; 19:O75-O85. [PMID: 27870254 DOI: 10.1111/codi.13564] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 09/15/2016] [Indexed: 02/08/2023]
Abstract
AIM There is a recognized need to include the views of patients and the public in prioritizing health research. This study aimed: (i) to explore patients' views on colorectal research; and (ii) to prioritize research topics with patients and the public. METHOD In phase 1, 12 charitable organizations and patient groups with an interest in bowel disease were invited to attend a consultation exercise. Participants were briefed on 25 colorectal research topics prioritized by members of the Association of Coloproctology of Great Britain and Ireland. Focus groups were conducted and discussions were recorded with field notes. Analysis was conducted using principles of thematic analysis. In phase 2, a free public consultation was undertaken. Participants were recruited from newspaper advertisements, were briefed on the same research topics and were asked to rate the importance of each on a five-point Likert scale. Descriptive statistics were used to rank the topics. Univariable linear regression compared recorded demographic details with mean topic scores. RESULTS Focus groups were attended by 12 patients who highlighted the importance of patient-centred information for trial recruitment and when selecting outcome measures. Some 360 people attended the public consultation, of whom 277 (77%) were recruited. Participants rated 'What is the best way to treat early cancer in the back passage?' highest, with 227 (85%) scoring it 4 or 5. There was no correlation between participant demographics and mean topic scores. CONCLUSION The present study prioritized a colorectal research agenda with the input of patients and the public. Further research is required to translate this agenda into real improvements in patient care.
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Affiliation(s)
- A G K McNair
- Centre for Surgical Research, School of Social and Community Medicine, University of Bristol, Bristol, UK
- National Cancer Research Institute, London, UK
| | - N Heywood
- University Hospital of South Manchester, Wythenshaw, UK
| | - J Tiernan
- John Goligher Colorectal Unit, St James's University Hospital, Leeds, UK
| | - A Verjee
- Bowel Disease Research Foundation, London, UK
- Crohn's and Colitis UK, St Albans, UK
| | - S P Bach
- Colorectal Surgery, University of Birmingham, Birmingham, UK
- Royal College of Surgeons of England, Lincoln's Inn Fields, London, UK
| | - N S Fearnhead
- Addenbrooke's Hospital, Cambridge, UK
- Research and Audit Committee, Association of Coloproctology of Great Britain and Ireland, London, UK
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23
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Norton C, Dibley LB, Hart A, Duncan J, Emmanuel A, Knowles CH, Stevens N, Terry H, Verjee A, Kerry S, Hounsome N. Faecal incontinence intervention study (FINS): self-management booklet information with or without nurse support to improve continence in people with inflammatory bowel disease: study protocol for a randomized controlled trial. Trials 2015; 16:444. [PMID: 26445224 PMCID: PMC4594995 DOI: 10.1186/s13063-015-0962-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 09/17/2015] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Inflammatory bowel disease, comprising Crohn's disease and ulcerative colitis, is a life-long currently incurable illness. It causes bouts of acute intestinal inflammation, in an unpredictable relapsing-remitting course, with bloody diarrhoea and extreme urgency to access a toilet. Faecal incontinence is a devastating social and hygiene problem, impacting heavily on quality of life and ability to work and socialise. Faecal incontinence affects 2-10 % of adults in the general population. People with inflammatory bowel disease have a high risk of incontinence with up to 74 % affected. No previous study has explored conservative interventions for these patients. METHODS This randomised controlled trial will recruit 186 participants to answer the research question: does implementation of the UK nationally recommended guidance approach to stepwise management of faecal incontinence improve bowel control and quality of life in people with inflammatory bowel disease? We have worked with people with inflammatory bowel disease to translate this guidance into a condition-specific information booklet on managing incontinence. We will randomise participants to receive the booklet, or the booklet plus up to four 30-minute sessions with an inflammatory bowel disease specialist nurse. To be eligible, patients must be in disease remission and report incontinence. The primary outcome measure at 6 months after randomisation is the St Mark's incontinence score. Other outcomes include quality of life, MY-MOP (generic tool: participants set two goals for intervention, grading goals at baseline and then re-scoring after intervention) and EQ-5D-5 L to enable calculation of quality-adjusted life years. Analysis will be on an intention-to-treat basis. Qualitative interviews will explore participant and health professionals' views on the interventions. DISCUSSION Few high-quality studies of conservative interventions in inflammatory bowel disease, and none for faecal incontinence, have been conducted. We have collaborated with patients to design this study. Blinding to this behavioural intervention is not possible, but our self-report outcome measures with a degree of objectivity. There is genuine equipoise between the booklet only and booklet plus nurse arms, and the study will determine if additional support from a nurse is a crucial element in implementing advice. TRIAL REGISTRATION clinitrials.gov.uk: NCT02355834 (Date of registration: 12 December 2014). Protocol version: 4.0. 08.04.15.
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Affiliation(s)
- Christine Norton
- Florence Nightingale Faculty of Nursing and Midwifery, King's College, 57 Waterloo Road, London, SE1 8WA, UK.
| | - Lesley B Dibley
- Florence Nightingale Faculty of Nursing and Midwifery, King's College, 57 Waterloo Road, London, SE1 8WA, UK.
| | - Ailsa Hart
- St Mark's Hospital, Watford Road, Harrow, HA1 3UJ, UK.
| | - Julie Duncan
- Guy's and St Thomas's NHS Trust, Westminster Bridge Road, London, SE1 7EH, UK.
| | - Anton Emmanuel
- University College Hospital, 235 Euston Road, London, NW1 2BU, UK.
| | - Charles H Knowles
- Blizard Institute, Queen Mary, University of London, 4 Newark Street, London, E1 2AT, UK.
- Barts Health NHS Trust, 80 Newark Street, London, E1 2ES, UK.
| | - Natasha Stevens
- Blizard Institute, Queen Mary, University of London, 4 Newark Street, London, E1 2AT, UK.
| | - Helen Terry
- Crohn's and Colitis UK, 4 Beaumont House, Sutton Road, St Albans, Hertfordshire, AL1 5HH, UK.
| | - Azmina Verjee
- Bowel Disease Research Foundation, The Royal College of Surgeons of England, 35-43 Lincoln's Inn Fields, London, WC2A 3PE, UK
| | - Sally Kerry
- Pragmatic Clinical Trials Unit, Blizard Institute, Queen Mary, University of London, 4 Newark Street, London, E1 2AT, UK.
| | - Natalia Hounsome
- Pragmatic Clinical Trials Unit, Blizard Institute, Queen Mary, University of London, 4 Newark Street, London, E1 2AT, UK.
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24
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Tiernan J, Cook A, Geh I, George B, Magill L, Northover J, Verjee A, Wheeler J, Fearnhead N. Use of a modified Delphi approach to develop research priorities for the association of coloproctology of Great Britain and Ireland. Colorectal Dis 2014; 16:965-70. [PMID: 25284641 PMCID: PMC4262073 DOI: 10.1111/codi.12790] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Accepted: 08/18/2014] [Indexed: 12/13/2022]
Abstract
AIM The modified Delphi approach is an established method for reaching a consensus opinion among a group of experts in a particular field. We have used this technique to survey the entire membership of the Association of Coloproctology of Great Britain and Ireland (ACPGBI) to reach a consensus on prioritizing clinical research questions in colorectal disease. METHOD Three rounds of surveys were conducted using a web-based tool. In the first, the ACPGBI membership was invited to submit research questions. In Rounds 2 and 3 they were asked to score questions on priority. A steering group analysed the results of each round to identify those questions ranked as being of highest priority. RESULTS Five hundred and two questions were submitted in Round 1. Following two rounds of voting and analysis, a list of 25 priority questions was produced, including 15 cancer-related and 10 noncancer-related questions. CONCLUSION It is anticipated that these results will: (i) set the research agenda over the next few years for the study of colorectal disease in the United Kingdom, (ii) promote development and (iii) define funding of new research and prioritize areas of unmet clinical need where the potential clinical impact is greatest.
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Affiliation(s)
- J Tiernan
- Huddersfield Royal InfirmaryHuddersfield, UK
| | - A Cook
- NIHR Evaluations Trials and Studies Coordinating Centre, Wessex Institute, University of Southampton, University Hospitals NHS TrustSouthampton, UK
| | - I Geh
- University Hospital Birmingham NHS Trust and University of BirminghamBirmingham, UK
| | - B George
- John Radcliffe HospitalOxford, UK
| | - L Magill
- Birmingham Clinical Trials Unit, University of BirminghamBirmingham, UK
| | - J Northover
- Imperial CollegeLondon, UK,St Mark's HospitalHarrow, UK
| | - A Verjee
- Bowel Disease Research FoundationLondon, UK,Crohn's and Colitis UKSt Alban's, UK
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