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Article ; Online: A study of variation in therapeutic approach to low-risk differentiated thyroid cancer in the UK.

Maniam, Pavithran / Ishii, Hiro / Stechman, Michael J / Watkinson, John / Farnell, Kate / Kim, Dae / Nixon, Ian J

2023 Volume 138, Issue 1, Page(s) 83–88

Abstract: Background: The British Thyroid Association and American Thyroid Association guideline definitions for low-risk differentiated thyroid cancers are susceptible to differing interpretations, resulting in different clinical management in the UK.: ... ...

Abstract	Background: The British Thyroid Association and American Thyroid Association guideline definitions for low-risk differentiated thyroid cancers are susceptible to differing interpretations, resulting in different clinical management in the UK. Objective: To explore the national effect of these guidelines on the management of low-risk differentiated thyroid cancers. Methods: Anonymised questionnaires were sent to multidisciplinary teams performing thyroidectomies in the UK. Risk factors that multidisciplinary teams considered important when managing low-risk differentiated thyroid cancers were established. Results: Most surgeons (71 out of 75; 94.7 per cent) confirmed they were core multidisciplinary team members. More than 80 per cent of respondents performed at least 30 hemi- and/or total thyroidectomies per annum. A majority of multidisciplinary teams (50 out of 75; 66.7 per cent) followed British Thyroid Association guidelines. Risk factors considered important when managing low-risk differentiated thyroid cancers included: type of tumour histology findings (87.8 per cent), tumour size of greater than 4 cm (86.5 per cent), tumour stage T Conclusion: Management of low-risk differentiated thyroid cancers is highly variable, leading to a heterogeneous patient experience.
MeSH term(s)	Humans ; Thyroid Neoplasms/epidemiology ; Thyroid Neoplasms/surgery ; Thyroidectomy/methods ; Adenocarcinoma ; United Kingdom/epidemiology
Language	English
Publishing date	2023-05-17
Publishing country	England
Document type	Journal Article
ZDB-ID	218299-3
ISSN	1748-5460 ; 0022-2151
ISSN (online)	1748-5460
ISSN	0022-2151
DOI	10.1017/S0022215123000841
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Article ; Online: How to pass the emergency OSCE station.

Edwards, Peter J / Stechman, Michael J / Green, John T

BMJ (Clinical research ed.)

2019 Volume 367, Page(s) l2414

MeSH term(s)	Clinical Competence ; Clinical Decision-Making ; Critical Care ; Education, Medical, Undergraduate/methods ; Educational Measurement/methods ; Emergency Medical Services ; Humans ; Patient Simulation ; Schools, Medical ; Students, Medical/psychology
Language	English
Publishing date	2019-10-01
Publishing country	England
Document type	Journal Article
ZDB-ID	1362901-3
ISSN	1756-1833 ; 0959-8154 ; 0959-8146 ; 0959-8138 ; 0959-535X ; 1759-2151
ISSN (online)	1756-1833
ISSN	0959-8154 ; 0959-8146 ; 0959-8138 ; 0959-535X ; 1759-2151
DOI	10.1136/sbmj.l2414
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Article ; Online: Authors' Reply: A Review of Parathyroid Surgery for Primary Hyperparathyroidism from the United Kingdom Registry of Endocrine and Thyroid Surgery.

Ishii, Hiro / Stechman, Michael / Watkinson, John / Aspinall, Sebastian / Kim, Dae

World journal of surgery

2021 Volume 45, Issue 9, Page(s) 2947–2948

MeSH term(s)	Humans ; Hyperparathyroidism, Primary/surgery ; Parathyroid Glands ; Parathyroidectomy ; Registries ; Thyroid Gland
Language	English
Publishing date	2021-06-24
Publishing country	United States
Document type	Letter ; Comment
ZDB-ID	224043-9
ISSN	1432-2323 ; 0364-2313
ISSN (online)	1432-2323
ISSN	0364-2313
DOI	10.1007/s00268-021-06180-7
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Article ; Online: SHARP risk score: A predictor of poor outcomes in adults admitted for emergency general surgery: A prospective cohort study.

Tanos, Panayiotis / Ablett, Andrew D / Carter, Ben / Ceelen, Wim / Pearce, Lyndsay / Stechman, Michael / McCarthy, Kathryn / Hewitt, Jonathan / Myint, Phyo Kyaw

Asian journal of surgery

2022 Volume 46, Issue 7, Page(s) 2668–2674

Abstract: Purpose: Post-operative complications following emergency abdominal surgery are associated with significant morbidity and mortality. Despite the knowledge of prognostic factors associated with poor surgical outcomes; few have described risks of poor ... ...

Abstract	Purpose: Post-operative complications following emergency abdominal surgery are associated with significant morbidity and mortality. Despite the knowledge of prognostic factors associated with poor surgical outcomes; few have described risks of poor outcomes based on admission information in acute surgical setting. We aimed to derive a simple, point-of-care risk scale that predicts adults with increased risk of poor outcomes. Methods: We used data from an international multi-centre prospective cohort study. The effect of characteristics; age, hypoalbuminaemia, anaemia, renal insufficiency and polypharmacy on 90-day mortality was examined using fully adjusted multivariable models. For our secondary outcome we aimed to test whether these characteristics could be combined to predict poor outcomes in adults undergoing emergency general surgery. Subsequently, the impact of incremental increase in derived SHARP score on outcomes was assessed. Results: The cohort consisted of 419 adult patients between the ages of 16-94 years (median 52; IQR(39) consecutively admitted to five emergency general surgical units across the United Kingdom and one in Ghent, Belgium. In fully adjusted models the aforementioned characteristics; were associated with 90-day mortality. SHARP score was associated with higher odds of mortality in adults who underwent emergency general surgery, with a SHARP score of five also being associated with an increased length of hospital stay. Conclusions: SHARP risk score is a simple prognostic tool, using point-of-care information to predict poor outcomes in patients undergoing emergency general surgery. This information may be used to improve management plans and aid clinicians in delivering more person-centred care. Further validation studies are required to prove its utility.
MeSH term(s)	Humans ; Adult ; Adolescent ; Young Adult ; Middle Aged ; Aged ; Aged, 80 and over ; Prospective Studies ; Hospitalization ; Risk Factors ; Length of Stay ; Postoperative Complications/epidemiology ; Postoperative Complications/etiology
Language	English
Publishing date	2022-11-05
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	1068461-x
ISSN	0219-3108 ; 1015-9584
ISSN (online)	0219-3108
ISSN	1015-9584
DOI	10.1016/j.asjsur.2022.10.049
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Article: Impact of Surgery on Older Patients Hospitalized With an Acute Abdomen: Findings From the Older Persons Surgical Outcome Collaborative.

Tay, Hui Sian / Wood, Adrian D / Carter, Ben / Pearce, Lyndsay / McCarthy, Kathryn / Stechman, Michael J / Myint, Phyo K / Hewitt, Jonathan

Frontiers in surgery

2020 Volume 7, Page(s) 583653

Abstract: Background: ...

Abstract	Background:
Language	English
Publishing date	2020-11-16
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2773823-1
ISSN	2296-875X
ISSN	2296-875X
DOI	10.3389/fsurg.2020.583653
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Article ; Online: Accreditation of endocrine surgery units.

Musholt, Thomas J / Bränström, Robert / Kaderli, Reto Martin / Pérez, Nuria Muñoz / Raffaelli, Marco / Stechman, Michael J

Langenbeck's archives of surgery

2019 Volume 404, Issue 7, Page(s) 779–793

Abstract: Background/purpose: A key measure to maintain and improve the quality of healthcare is the formal accreditation of provider units. The European Society of Endocrine Surgeons (ESES) therefore proposes a system of accreditation for endocrine surgical ... ...

Abstract	Background/purpose: A key measure to maintain and improve the quality of healthcare is the formal accreditation of provider units. The European Society of Endocrine Surgeons (ESES) therefore proposes a system of accreditation for endocrine surgical centers in Europe to supplement existing measures that promote high standards in the practice in endocrine surgery. Methods: A working group analyzed the current healthcare situation in the field of endocrine surgery in Europe. Two surveys were distributed to ESES members to acquire information about the structure, staffing, caseload, specifications, and technology available to endocrine surgery units. Further data were sought on tracer diagnoses for quality standards, training provision, and research activity. Existing accreditation models related to endocrine surgery were included in the analysis. Results: The analysis of existing accreditation models, available evidence, and survey results suggests that a majority of ESES members aspire to a two-level model (termed competence and reference centers), sub-divided into those providing neck endocrine surgery and those providing endocrine surgery. Criteria for minimum caseload, number and certification of staff, unit structure, on-site collaborating disciplines, research activities, and training capacity for competence center accreditation are proposed. Lastly, quality indicators for distinct tracer diagnoses are defined. Conclusions: Differing healthcare structures, existing accreditation models, training models, and varied case volumes across Europe are barriers to the conception and implementation of a pan-European accreditation model. However, there is consensus on accepted standards required for accrediting an ESES competence center. These will serve as a basis for first-stage accreditation of endocrine surgery units.
MeSH term(s)	Accreditation/legislation & jurisprudence ; Child ; Endocrine Surgical Procedures/legislation & jurisprudence ; Germany ; Hospital Units/legislation & jurisprudence ; Humans ; Quality Assurance, Health Care/legislation & jurisprudence
Language	English
Publishing date	2019-09-07
Publishing country	Germany
Document type	Journal Article ; Review
ZDB-ID	1423681-3
ISSN	1435-2451 ; 1435-2443
ISSN (online)	1435-2451
ISSN	1435-2443
DOI	10.1007/s00423-019-01820-y
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Article ; Online: FMALE score: Combining practical risk scales to improve preoperative predictive accuracy in emergency general surgery: A multi-centre prospective cohort study.

Wong, Phui Yuen / Ablett, Andrew D / Myint, Phyo Kyaw / Carter, Ben / McCarthy, Kathryn / Stechman, Michael / Pearce, Lyndsay / Hewitt, Jonathan

American journal of surgery

2021 Volume 222, Issue 5, Page(s) 911–912

MeSH term(s)	Age Factors ; Aged ; Aged, 80 and over ; Emergencies ; Female ; Frail Elderly/statistics & numerical data ; Humans ; Male ; Prospective Studies ; Reproducibility of Results ; Risk Assessment ; Risk Factors ; Surgical Procedures, Operative/adverse effects
Language	English
Publishing date	2021-04-27
Publishing country	United States
Document type	Editorial ; Multicenter Study
ZDB-ID	2953-1
ISSN	1879-1883 ; 0002-9610
ISSN (online)	1879-1883
ISSN	0002-9610
DOI	10.1016/j.amjsurg.2021.04.009
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Article ; Online: Risk factors for postoperative complications after adrenalectomy for phaeochromocytoma: multicentre cohort study.

Parente, Alessandro / Kamarajah, Sivesh K / Thompson, Joseph P / Crook, Charlotte / Aspinall, Sebastian / Melvin, Ross / Stechman, Michael J / Perry, Helen / Balasubramanian, Sabapathy P / Pannu, Arslan / Palazzo, Fausto F / Van Den Heede, Klaas / Eatock, Fiona / Anderson, Hannah / Doran, Helen / Wang, Kelvin / Hubbard, Johnathan / Aldrees, Abdulaziz / Shore, Susannah L /

Fung, Clare / Waghorn, Alison / Ayuk, John / Bennett, Davinia / Sutcliffe, Robert P

BJS open

2023 Volume 7, Issue 5

Abstract: Background: To determine the incidence and risk factors for postoperative complications and prolonged hospital stay after adrenalectomy for phaeochromocytoma.: Methods: Demographics, perioperative outcomes and complications were evaluated for ... ...

Abstract	Background: To determine the incidence and risk factors for postoperative complications and prolonged hospital stay after adrenalectomy for phaeochromocytoma. Methods: Demographics, perioperative outcomes and complications were evaluated for consecutive patients who underwent adrenalectomy for phaeochromocytoma from 2012 to 2020 in nine high-volume UK centres. Odds ratios were calculated using multivariable models. The primary outcome was postoperative complications according to the Clavien---Dindo classification and secondary outcome was duration of hospital stay. Results: Data were available for 406 patients (female n = 221, 54.4 per cent). Two patients (0.5 per cent) had perioperative death, whilst 148 complications were recorded in 109 (26.8 per cent) patients. On adjusted analysis, the age-adjusted Charlson Co-morbidity Index ≥3 (OR 8.09, 95 per cent c.i. 2.31 to 29.63, P = 0.001), laparoscopic converted to open (OR 10.34, 95 per cent c.i. 3.24 to 36.23, P <0.001), and open surgery (OR 11.69, 95 per cent c.i. 4.52 to 32.55, P <0.001) were independently associated with postoperative complications. Overall, 97 of 430 (22.5 per cent) had a duration of stay ≥5 days and this was associated with an age-adjusted Charlson Co-morbidity Index ≥3 (OR 4.31, 95 per cent c.i. 1.08 to 18.26, P = 0.042), tumour size (OR 1.15, 95 per cent c.i. 1.05 to 1.28, P = 0.006), laparoscopic converted to open (OR 32.11, 95 per cent c.i. 9.2 to 137.77, P <0.001), and open surgery (OR 28.01, 95 per cent c.i. 10.52 to 83.97, P <0.001). Conclusion: Adrenalectomy for phaeochromocytoma is associated with a very low mortality rate, whilst postoperative complications are common. Several risk factors, including co-morbidities and operative approach, are independently associated with postoperative complications and/or prolonged hospitalization, and should be considered when counselling patients.
MeSH term(s)	Humans ; Female ; Male ; Pheochromocytoma/surgery ; Adrenalectomy/adverse effects ; Adrenal Gland Neoplasms/surgery ; Postoperative Complications/epidemiology ; Postoperative Complications/etiology ; Risk Factors ; Cohort Studies
Language	English
Publishing date	2023-09-25
Publishing country	England
Document type	Multicenter Study ; Journal Article
ISSN	2474-9842
ISSN (online)	2474-9842
DOI	10.1093/bjsopen/zrad090
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Article ; Online: The role of C-reactive protein as a prognostic marker in COVID-19.

Stringer, Dominic / Braude, Philip / Myint, Phyo K / Evans, Louis / Collins, Jemima T / Verduri, Alessia / Quinn, Terry J / Vilches-Moraga, Arturo / Stechman, Michael J / Pearce, Lyndsay / Moug, Susan / McCarthy, Kathryn / Hewitt, Jonathan / Carter, Ben

International journal of epidemiology

2021 Volume 50, Issue 2, Page(s) 420–429

Abstract: Background: C-reactive protein (CRP) is a non-specific acute phase reactant elevated in infection or inflammation. Higher levels indicate more severe infection and have been used as an indicator of COVID-19 disease severity. However, the evidence for ... ...

Abstract	Background: C-reactive protein (CRP) is a non-specific acute phase reactant elevated in infection or inflammation. Higher levels indicate more severe infection and have been used as an indicator of COVID-19 disease severity. However, the evidence for CRP as a prognostic marker is yet to be determined. The aim of this study is to examine the CRP response in patients hospitalized with COVID-19 and to determine the utility of CRP on admission for predicting inpatient mortality. Methods: Data were collected between 27 February and 10 June 2020, incorporating two cohorts: the COPE (COVID-19 in Older People) study of 1564 adult patients with a diagnosis of COVID-19 admitted to 11 hospital sites (test cohort) and a later validation cohort of 271 patients. Admission CRP was investigated, and finite mixture models were fit to assess the likely underlying distribution. Further, different prognostic thresholds of CRP were analysed in a time-to-mortality Cox regression to determine a cut-off. Bootstrapping was used to compare model performance [Harrell's C statistic and Akaike information criterion (AIC)]. Results: The test and validation cohort distribution of CRP was not affected by age, and mixture models indicated a bimodal distribution. A threshold cut-off of CRP ≥40 mg/L performed well to predict mortality (and performed similarly to treating CRP as a linear variable). Conclusions: The distributional characteristics of CRP indicated an optimal cut-off of ≥40 mg/L was associated with mortality. This threshold may assist clinicians in using CRP as an early trigger for enhanced observation, treatment decisions and advanced care planning.
MeSH term(s)	Adult ; Aged ; Biomarkers ; C-Reactive Protein/analysis ; COVID-19 ; Hospitalization ; Humans ; Prognosis ; Retrospective Studies ; SARS-CoV-2
Chemical Substances	Biomarkers ; C-Reactive Protein (9007-41-4)
Language	English
Publishing date	2021-03-06
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	187909-1
ISSN	1464-3685 ; 0300-5771
ISSN (online)	1464-3685
ISSN	0300-5771
DOI	10.1093/ije/dyab012
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Article: A Retroperitoneal Leiomyosarcoma Presenting as an Adrenal Incidentaloma in a Subject on Warfarin.

Khan, Ishrat N / Adlan, Mohamed A / Stechman, Michael J / Premawardhana, Lakdasa D

Case reports in endocrinology

2015 Volume 2015, Page(s) 830814

Abstract: Adrenal incidentalomas (AIs) are mostly benign and nonsecretory. Management algorithms lack sensitivity when assessing malignant potential, although functional status is easier to assess. We present a subject whose AI was a retroperitoneal leiomyosarcoma ...

Abstract	Adrenal incidentalomas (AIs) are mostly benign and nonsecretory. Management algorithms lack sensitivity when assessing malignant potential, although functional status is easier to assess. We present a subject whose AI was a retroperitoneal leiomyosarcoma (RL). Case Presentation. A woman on warfarin with SLE and the antiphospholipid syndrome, presented with left loin pain. She was normotensive and clinically normal. Ultrasound scans demonstrated left kidney scarring, but CT scans revealed an AI. MRI scans later confirmed the AI without significant fat and no interval growth. Cortisol after 1 mg dexamethasone, urinary free cortisol and catecholamines, plasma aldosterone renin ratio, and 17-hydroxyprogesterone were within the reference range. Initially, adrenal haemorrhage was diagnosed because of warfarin therapy and the acute presentation. However, she underwent adrenalectomy because of interval growth of the AI. Histology confirmed an RL. The patient received adjuvant radiotherapy. Discussion. Our subject presented with an NSAI. However, we highlight the following: (a) the diagnosis of adrenal haemorrhage in this anticoagulated woman was revised because of interval growth; (b) the tumour, an RL, was relatively small at diagnosis;
Language	English
Publishing date	2015-04-29
Publishing country	United States
Document type	Journal Article
ZDB-ID	2627633-1
ISSN	2090-651X ; 2090-6501
ISSN (online)	2090-651X
ISSN	2090-6501
DOI	10.1155/2015/830814
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