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The National Lung Cancer Audit: The Impact of COVID-19. Clin Oncol (R Coll Radiol) 2022; 34:701-707. [PMID: 36180356 PMCID: PMC9474418 DOI: 10.1016/j.clon.2022.09.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 08/21/2022] [Accepted: 09/02/2022] [Indexed: 01/31/2023]
Abstract
Since 2014, the National Lung Cancer Audit (NLCA) has been evaluating the performance of the UK NHS lung cancer services against established standards of care. Prior to the onset of the COVID-19 pandemic, the NLCA's annual reports revealed a steady stream of improvements in early diagnosis, access to surgery, treatment with anti-cancer therapies, input from specialist nursing and survival for patients with lung cancer in the NHS. In January 2022, the NLCA reported on the negative impact COVID-19 has had on all aspects of the lung cancer diagnosis and treatment pathway within the NHS. This article details the fundamental changes made to the NLCA data collection and analysis process during the COVID-19 pandemic and details the negative impact COVID-19 had on NHS lung cancer patient outcomes during 2020.
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Effectiveness of emergency surgery for five common acute conditions: an instrumental variable analysis of a national routine database. Anaesthesia 2022; 77:865-881. [PMID: 35588540 PMCID: PMC9540551 DOI: 10.1111/anae.15730] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 03/14/2022] [Accepted: 03/20/2022] [Indexed: 12/29/2022]
Abstract
The effectiveness of emergency surgery vs. non-emergency surgery strategies for emergency admissions with acute appendicitis, gallstone disease, diverticular disease, abdominal wall hernia or intestinal obstruction is unknown. Data on emergency admissions for adult patients from 2010 to 2019 at 175 acute National Health Service hospitals in England were extracted from the Hospital Episode Statistics database. Cohort sizes were: 268,144 (appendicitis); 240,977 (gallstone disease); 138,869 (diverticular disease); 106,432 (hernia); and 133,073 (intestinal obstruction). The primary outcome was number of days alive and out of hospital at 90 days. The effectiveness of emergency surgery vs. non-emergency surgery strategies was estimated using an instrumental variable design and is reported for the cohort and pre-specified sub-groups (age, sex, number of comorbidities and frailty level). Average days alive and out of hospital at 90 days for all five cohorts were similar, with the following mean differences (95%CI) for emergency surgery minus non-emergency surgery after adjusting for confounding: -0.73 days (-2.10-0.64) for appendicitis; 0.60 (-0.10-1.30) for gallstone disease; -2.66 (-15.7-10.4) for diverticular disease; -0.07 (-2.40-2.25) for hernia; and 3.32 (-3.13-9.76) for intestinal obstruction. For patients with 'severe frailty', mean differences (95%CI) in days alive and out of hospital for emergency surgery were lower than for non-emergency surgery strategies: -21.0 (-27.4 to -14.6) for appendicitis; -5.72 (-11.3 to -0.2) for gallstone disease, -38.9 (-63.3 to -14.6) for diverticular disease; -19.5 (-26.6 to -12.3) for hernia; and - 34.5 (-46.7 to -22.4) for intestinal obstruction. For patients without frailty, the mean differences (95%CI) in days alive and out of hospital were: -0.18 (-1.56-1.20) for appendicitis; 0.93 (0.48-1.39) for gallstone disease; 5.35 (-2.56-13.28) for diverticular disease; 2.26 (0.37-4.15) for hernia; and 18.2 (14.8-22.47) for intestinal obstruction. Emergency surgery and non-emergency surgery strategies led to similar average days alive and out of hospital at 90 days for five acute conditions. The comparative effectiveness of emergency surgery and non-emergency surgery strategies for these conditions may be modified by patient factors.
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Factors associated with delays in revascularization in patients with chronic limb-threatening ischaemia: population-based cohort study. Br J Surg 2021; 108:951-959. [PMID: 33842943 DOI: 10.1093/bjs/znab039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 12/24/2020] [Accepted: 01/17/2021] [Indexed: 11/14/2022]
Abstract
BACKGROUND Prompt revascularization in patients with chronic limb-threatening ischaemia (CLTI) is important, and recent guidance has suggested that patients should undergo revascularization within 5 days of an emergency admission to hospital. The aim of this cohort study was to identify factors associated with the ability of UK vascular services to meet this standard of care. METHODS Data on all patients admitted non-electively with CLTI who underwent open or endovascular revascularization between 2016 and 2019 were extracted from the National Vascular Registry. The primary outcome was interval between admission and procedure, analysed as a binary variable (5 days or less, over 5 days). Multivariable Poisson regression was used to examine the relationship between time to revascularization and patient and admission characteristics. RESULTS The study analysed information on 11 398 patients (5973 open, 5425 endovascular), 50.6 per of whom underwent revascularization within 5 days. The median interval between admission and intervention was 5 (i.q.r. 2-9) days. Patient factors associated with increased risk of delayed revascularization were older age, greater burden of co-morbidity, non-smoking status, presentation with infection and tissue loss, and a Fontaine score of IV. Patients admitted later in the week were less likely undergo revascularization within 5 days than those admitted on Sundays and Mondays (P < 0.001). Delays were slightly worse among patients having open compared with endovascular procedures (P = 0.005) and in hospitals with lower procedure volumes (P < 0.001). CONCLUSION Several factors were associated with delays in time to revascularization for patients with CLTI in the UK, most notably the weekday of admission, which reflects how services are organized. The results support arguments for vascular units providing revascularization to have the resources for a 7-day service.
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Failure to rescue patients after emergency laparotomy for large bowel perforation: analysis of the National Emergency Laparotomy Audit (NELA). BJS Open 2021; 5:6145788. [PMID: 33609399 PMCID: PMC7896807 DOI: 10.1093/bjsopen/zraa060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 12/01/2020] [Indexed: 12/03/2022] Open
Abstract
Background Past studies have highlighted variation in in-hospital mortality rates among hospitals performing emergency laparotomy for large bowel perforation. The aim of this study was to investigate whether failure to rescue (FTR) contributes to this variability. Methods Patients aged 18 years or over requiring surgery for large bowel perforation between 2013 and 2016 were extracted from the National Emergency Laparotomy Audit (NELA) database. Information on complications were identified using linked Hospital Episode Statistics data and in-hospital deaths from the Office for National Statistics. The FTR rate was defined as the proportion of patients dying in hospital with a recorded complication, and was examined in hospitals grouped as having low, medium or high overall postoperative mortality. Results Overall, 6413 patients were included with 1029 (16.0 per cent) in-hospital deaths. Some 3533 patients (55.1 per cent) had at least one complication: 1023 surgical (16.0 per cent) and 3332 medical (52.0 per cent) complications. There were 22 in-hospital deaths following a surgical complication alone, 685 deaths following a medical complication alone, 150 deaths following both a surgical and medical complication, and 172 deaths with no recorded complication. The risk of in-hospital death was high among patients who suffered either type of complication (857 deaths in 3533 patients; FTR rate 24.3 per cent): 172 deaths followed a surgical complication (FTR-surgical rate 16.8 per cent) and 835 deaths followed a medical complication (FTR-medical rate of 25.1 per cent). After adjustment for patient characteristics and hospital factors, hospitals grouped as having low, medium or high overall postoperative mortality did not have different FTR rates (P = 0.770). Conclusion Among patients having emergency laparotomy for large bowel perforation, efforts to reduce the risk of in-hospital death should focus on reducing avoidable complications. There was no evidence of variation in FTR rates across National Health Service hospitals in England.
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Delay in Source Control in Perforated Peptic Ulcer Leads to 6% Increased Risk of Death Per Hour: A Nationwide Cohort Study. World J Surg 2020; 44:869-875. [PMID: 31664496 DOI: 10.1007/s00268-019-05254-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Delay to theatre for patients with intra-abdominal sepsis is cited as a particular risk factor for death. Our aim was to evaluate the potential relationship between hourly delay from admission to surgery and post-operative mortality in patients with perforated peptic ulcer (PPU). METHODS All patients entered in the National Emergency Laparotomy Audit who had an emergency laparotomy for PPU within 24 h of admission from December 2013 to November 2017 were included. Time to theatre from admission was modelled as a continuous variable in hours. Outcome was 90-day mortality. Logistic regression adjusting for confounding factors was performed. RESULTS 3809 patients were included, and 90-day mortality rate was 10.61%. Median time to theatre was 7.5 h (IQR 5-11.6 h). The odds of death increased with time to operation once adjustment for confounding variables was performed (per hour after admission adjusted OR 1.04 95% CI 1.02-1.07). In patients who were physiologically shocked (N = 334), there was an increase of 6% in risk-adjusted odds of mortality for every hour Em Lap was delayed after admission (OR 1.06 95% CI 1.01-1.11). CONCLUSION Hourly delay to theatre in patients with PPU is independently associated with risk of death by 90 days. Therefore, we suggest that surgical source control should occur as soon as possible after admission regardless of time of day.
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Surgery of the primary tumour in women with metastatic breast cancer at diagnosis in England and Wales – how do treatment rates vary at an individual and regional level? Eur J Cancer 2020. [DOI: 10.1016/s0959-8049(20)30850-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Association between surgeon special interest and mortality after emergency laparotomy. Br J Surg 2019; 106:940-948. [DOI: 10.1002/bjs.11146] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 01/07/2019] [Accepted: 01/31/2019] [Indexed: 11/07/2022]
Abstract
Abstract
Background
Approximately 30 000 emergency laparotomies are performed each year in England and Wales. Patients with pathology of the gastrointestinal tract requiring emergency laparotomy are managed by general surgeons with an elective special interest focused on either the upper or lower gastrointestinal tract. This study investigated the impact of special interest on mortality after emergency laparotomy.
Methods
Adult patients having emergency laparotomy with either colorectal or gastroduodenal pathology were identified from the National Emergency Laparotomy Audit database and grouped according to operative procedure. Outcomes included all-cause 30-day mortality, length of hospital stay and return to theatre. Logistic and Poisson regression were used to analyse the association between consultant special interest and the three outcomes.
Results
A total of 33 819 patients (28 546 colorectal, 5273 upper gastrointestinal (UGI)) were included. Patients who had colorectal procedures performed by a consultant without a special interest in colorectal surgery had an increased adjusted 30-day mortality risk (odds ratio (OR) 1·23, 95 per cent c.i. 1·13 to 1·33). Return to theatre also increased in this group (OR 1·13, 1·05 to 1·20). UGI procedures performed by non-UGI special interest surgeons carried an increased adjusted risk of 30-day mortality (OR 1·24, 1·02 to 1·53). The risk of return to theatre was not increased (OR 0·89, 0·70 to 1·12).
Conclusion
Emergency laparotomy performed by a surgeon whose special interest is not in the area of the pathology carries an increased risk of death at 30 days. This finding potentially has significant implications for emergency service configuration, training and workforce provision, and should stimulate discussion among all stakeholders.
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Abstract P1-08-16: The influence of patient fitness on the likelihood of receiving primary surgery in older women with breast cancer: A population based cohort study. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p1-08-16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: There is evidence of variation in the patterns of treatment of older women with breast cancer (BC). As women age, there are less similarities in terms of their functional ability, physiology and social wellbeing. This multifaceted relationship between disease and ageing makes the interpretation of age-related differences in BC management and outcomes at a population level complex. Measuring frailty is as an emerging concept and offers a way to standardise how characteristics of ageing are used in BC.
Objective: We compared the primary treatment patterns of women aged ≥70yrs compared to those aged 50–69yrs, with early invasive BC (EIBC; stage 1-3A); using a novel measure of frailty in addition to commonly used patient fitness measures.
Methods: Women aged ≥50yrs, diagnosed with unilateral EIBC in England and Wales between 01/01/2014 and 31/12/2016; were identified by linkage of several national datasets. Patient fitness was measured by the reported WHO performance status (WHO PS), a calculated Charlson comorbidity score (CCS) and a developed frailty measure based on the electronic Frailty Index (eFI). Multilevel logistic regression was used to account for clustering in the data.
Results: Among 126,111 women aged ≥50yrs with BC, 88,028 had EIBC: 88% in women aged 50-69yrs and 75% in women aged ≥70yrs. Table 1 describes the proportion of women who received surgery by age and measures of fitness. Overall, older women were less likely to undergo primary surgery, regardless of fitness. For each measure of fitness, fewer women in both age groups underwent surgery as their levels of fitness decreased; the magnitude of this change was greater for women aged ≥70yrs. Older women were also less likely to receive BCS for tumours <5cm, compared to women aged 50-69yrs.
Receipt of surgery in women aged ≥50years with EIBC according to CCS, eFi and WHO PS status, by age at diagnosisMeasure of fitness50-69 years70+years No. of patients% having surgeryNo. of patients% having surgeryNumber of women5481796%2343687%Charlson comorbidity score04861697%2343687%1345495%439067%1+106389%309645%Unknown168462%228914%eFIFit5250697%570789%Mild frailty56489%236947%Moderate to severe frailty6362%66921%Unknown168462%228914%WHO performance status01507397%570788%1137293%226474%219885%91146%3-411652%79517%Unknown3805896%2353476%
The association between independent factors of ageing and fitness, and 'no surgery' remained after accounting for case-mix differences and clustering within geographical region. Compared to women aged 50–69yrs, there was strong regional variation in the adjusted rate of surgical treatment for EIBC in women aged ≥70yrs.
Discussion: Older women are less likely to undergo surgery for EIBC. Even a minor decrease in fitness levels significantly impacts the likelihood of receiving surgery in women ≥70yrs; such a pattern is not observed in women aged 50–69yrs. Long-term follow up of these women will enable further understanding of the implications of this variability in practice on outcomes. We also acknowledge poor data completion for the WHO PS, and propose that eFI is suitable replacement measure of fitness in older patients with BC.
Citation Format: Jauhari Y, Gannon M, Medina J, Horgan K, Dodwell D, Cromwell D. The influence of patient fitness on the likelihood of receiving primary surgery in older women with breast cancer: A population based cohort study [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P1-08-16.
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P127 Neonatal and infant readmissions for late preterm and early term babies in Ontario and England: a cohort study using linked population-level healthcare data. Br J Soc Med 2016. [DOI: 10.1136/jech-2016-208064.224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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The impact of The Royal College of Surgeons of England research fellowship scheme. Ann R Coll Surg Engl 2016; 98:431-5. [PMID: 27138854 DOI: 10.1308/rcsann.2016.0163] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Introduction The research fellowship scheme for surgeons in training run by The Royal College of Surgeons of England (RCS) had its 20th anniversary in 2013. A survey was undertaken to assess outcomes of the scheme during those 20 years. Methods Fellowship recipients were invited to complete an online 20-item questionnaire about their fellowship research and research activities since its completion. The questionnaire covered type of research undertaken, higher research degree enrolment, publications resulting from the fellowship research and subsequent research career. Results Of the 502 RCS fellowship recipients, 361 responded (72%). Their research covered a broad array of topics, Almost two-thirds (62%) undertook laboratory-based research and most of the remainder conducted patient-based clinical research. The vast majority (96%) of respondents had enrolled for a higher degree, with a high completion rate: 91% of fellowship recipients in the first 15 years of the scheme obtained their degree. Of the fellowships from the first 15 years of the scheme, between a fifth and a third of recipients subsequently held an academic position. The median number of peer reviewed articles and presentations per recipient was 3 and 6 respectively. Almost two-thirds (60%) of respondents had obtained funding for further research, with over half of these receiving grants from national research funding bodies. Conclusions The RCS research fellowship scheme has helped trainee surgeons to undertake research towards the start of their career. Most trainees used RCS fellowships as part of their funding towards a higher degree and this was regularly achieved, along with a number of peer reviewed publications. A significant proportion of fellowship recipients progressed into academic positions in surgery.
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P-434: Predicting 30 day mortality after hip fracture: validating the use of National Hip Fracture Database (NHFD) data. Eur Geriatr Med 2015. [DOI: 10.1016/s1878-7649(15)30531-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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48 * USING THE NATIONAL HIP FRACTURE DATABASE (NHFD) TO PROFILE THE IMPACT OF HIP FRACTURE ON THE NHS. Age Ageing 2014. [DOI: 10.1093/ageing/afu126.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Publication of surgeon-specific outcomes. Br J Surg 2014; 101:1335-7. [DOI: 10.1002/bjs.9641] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Accepted: 08/01/2014] [Indexed: 11/06/2022]
Abstract
Need to move to compulsory institutional reporting
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Authors' reply: Rates of subsequent surgery following endometrial ablation among English women with menorrhagia: population-based cohort study. BJOG 2014; 121:1316-7. [PMID: 25155327 DOI: 10.1111/1471-0528.12864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2014] [Indexed: 11/30/2022]
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USE OF HOSPITAL SERVICES AMONG PALLIATIVE OESOPHAGO-GASTRIC CANCER PATIENTS. BMJ Support Palliat Care 2014. [DOI: 10.1136/bmjspcare-2014-000653.32] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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PS37 Does the Route to Diagnosis Affect Outcomes for Oesophago-Gastric Cancer Patients. Br J Soc Med 2012. [DOI: 10.1136/jech-2012-201753.136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Use of Hospital Episode Statistics to investigate abdominal aortic aneurysm surgery. Br J Surg 2011; 99:66-72. [PMID: 22105834 DOI: 10.1002/bjs.7772] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2011] [Indexed: 01/17/2023]
Abstract
BACKGROUND A coding framework was evaluated to study patients undergoing open surgical replacement of an abdominal aortic aneurysm (AAA) in the English Hospital Episode Statistics (HES) database. The objective was to create groups of patients who are homogeneous with respect to diagnosis, prognosis and treatment. METHODS The frequency and consistency of potentially relevant diagnosis (International Classification of Diseases, 10th revision) and procedure (Office of Population Censuses and Surveys Classification, 4th revision) codes were assessed in patients admitted to English National Health Service hospitals between April 2003 and March 2008. Administrative codes were compared with diagnosis and procedure codes to check that patients who had undergone emergency surgery for a ruptured AAA were admitted as an emergency. RESULTS Of 20 290 patients undergoing AAA replacement, 19 250 (94·9 per cent) had a consistent diagnosis (unruptured or ruptured AAA); 79·3 per cent of patients with an emergency replacement were coded as having a ruptured AAA and 95·7 per cent of those with a non-emergency replacement as having an unruptured AAA. Of patients who had undergone emergency replacement of a ruptured AAA, 93·3 per cent were coded as having been admitted as an emergency. CONCLUSION Coding consistency was high. The proposed framework could define homogeneous groups by combining diagnosis, procedure and administrative codes. It also allows an assessment of potential miscoding at national and hospital level.
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Minimally invasive approaches to oesophago-gastric cancer resection result in higher anastomotic leak rates than open surgery. Eur J Surg Oncol 2010. [DOI: 10.1016/j.ejso.2010.08.120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Breast conserving surgery: are reoperation rates too high? Analyses of a linked HES-Cancer Registry dataset. Eur J Surg Oncol 2009. [DOI: 10.1016/j.ejso.2009.07.178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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The Illawarra Coordinated Care Trial: better outcomes with existing resources? AUST HEALTH REV 2001; 24:161-71. [PMID: 11496459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
The Illawarra Coordinated Care Trial was one of nine Australian trials undertaken to see whether different models of coordinated care could improve the health of people with multiple service needs within existing resources. This paper summarises the findings of an extensive local evaluation and discusses the impact of the trial on clients and service providers. It examines the main findings related to the principal trial hypothesis and points to lessons that might inform the next round of trials.
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Waiting list statistics as performance indicators: observations on their use in hospital management. AUST HEALTH REV 1999; 21:15-27. [PMID: 10537553 DOI: 10.1071/ah980015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Improvements in data collection and the types of statistics collected have enhanced the usefulness of waiting list statistics as a measure of hospital performance. But these changes are not sufficient for waiting list statistics to be used effectively for management purposes. The statistics need to be viewed alongside activity data if clinicians and managers are to identify specific areas that need improvement. This means that how the data are analysed and presented is also important. During a study into the management of waiting lists, we observed that waiting list data were typically presented in a way that made interpretation difficult. A simple but effective solution was found by using available PC-based software, but obstacles remain. These stem from limitations of current information systems and the awareness among staff of the potential of common software packages.
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Classifying sub-acute and non-acute patients: results of the New South Wales Casemix Area Network study. AUST HEALTH REV 1996; 20:26-42. [PMID: 10169365 DOI: 10.1071/ah970026] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
In 1994 the New South Wales Casemix Area Network initiated a study to develop a classification and funding model for sub-acute and non-acute care. Thirty-five rehabilitation, geriatric, psychogeriatric and palliative care services were recruited into the study throughout eight area health services. The aim of the first phase, summarised here, was to capture and analyse a sufficiently large quantity of data to select those variables most likely to predict resource utilisation, for subsequent use in a detailed costing study. It is known that acute care diagnosis related groups are not predictive of costs in sub-acute care. This phase of the project confirmed that, in New South Wales, the most predictive variables were case type, functional status measures, impairment type for rehabilitation, phase for palliative care and severity of symptoms for palliative care. The resultant Phase 1 casemix classification, which has built on recent United States experience and studies in other Australian States, has been termed the New South Wales Sub-Acute and Non-Acute Patient (SNAP) Version 1 classification.
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Abstract
E-64, 1-(L-trans-epoxysuccinylleucylamino)-4-guanidinobutane, is a potent and highly selective irreversible inhibitor of cysteine proteases. The crystal structure of a complex of actinidin and E-64 has been determined at 1.86-A resolution by using the difference Fourier method and refined to an R-factor of 14.5%. The electron density map clearly shows that the C2 atom of the E-64 epoxide ring is covalently bonded to the S atom of the active-site cysteine 25. The charged carboxyl group of E-64 forms four H-bonds with the protein and thus may play an important role in favorably positioning the inhibitor molecule for nucleophilic attack by the active-site thiolate anion. The interaction features between E-64 and actinidin are very similar to those seen in the papain-E-64 complex; however, the amino-4-guanidinobutane group orients differently. The crystals of the actinidin-E-64 complex diffracted much better than the papain-E-64 complex, and consequently the present study provides more precise geometrical information on the binding of the inhibitor. Moreover, this study provides yet another confirmation that the binding of E-64 is at the S subsites and not at the S' subsites as has been previously proposed. The original actinidin structure has been revised using the new cDNA sequence information.
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