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  1. Article ; Online: Mandatory vaccination of National Health Service staff against COVID-19: more harm than good?

    Savic, Louise C / Savic, Sinisa / Pearse, Rupert M

    British journal of anaesthesia

    2022  Volume 128, Issue 4, Page(s) 608–609

    Abstract: Despite the clear benefits of vaccination against COVID-19, there was significant unease relating to the government policy of mandatory vaccination of health and care staff in England and the potential inequities this may lead to. Healthcare staff, and ... ...

    Abstract Despite the clear benefits of vaccination against COVID-19, there was significant unease relating to the government policy of mandatory vaccination of health and care staff in England and the potential inequities this may lead to. Healthcare staff, and in particular doctors, speaking out on this issue may have inadvertently provided a narrative, which undermined the objective of achieving widespread vaccination of populations against this serious disease. The recent reversal of this policy may not mark the end of this debate amongst health and social care staff.
    MeSH term(s) COVID-19/prevention & control ; England/epidemiology ; Humans ; Physicians ; State Medicine ; Vaccination
    Language English
    Publishing date 2022-02-03
    Publishing country England
    Document type Editorial
    ZDB-ID 80074-0
    ISSN 1471-6771 ; 0007-0912
    ISSN (online) 1471-6771
    ISSN 0007-0912
    DOI 10.1016/j.bja.2022.01.030
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  2. Article ; Online: Perioperative anaphylaxis: diagnostic challenges and management.

    Savic, Louise C / Garvey, Lene Heise

    Current opinion in anaesthesiology

    2020  Volume 33, Issue 3, Page(s) 448–453

    Abstract: Purpose of review: Perioperative hypersensitivity reactions can pose diagnostic and management challenges for the anaesthetist. Difficulties in diagnosing hypersensitivity reactions in the perioperative setting are highlighted and recommendations from ... ...

    Abstract Purpose of review: Perioperative hypersensitivity reactions can pose diagnostic and management challenges for the anaesthetist. Difficulties in diagnosing hypersensitivity reactions in the perioperative setting are highlighted and recommendations from recent guidelines on the acute management of life-threatening anaphylaxis are presented.
    Recent findings: Anaesthetists play a key role in investigating perioperative hypersensitivity reactions. During a suspected perioperative hypersensitivity event, a serum tryptase level should be measured to help with subsequent allergy investigation. Moreover, anaesthetists can ensure that a high-quality referral is made to allergy clinics by providing thorough documentation of the events, detailing symptoms, treatments, and the chronology of drug administrations.
    Summary: Perioperative hypersensitivity reactions are rare but can be life-threatening. A high index of suspicion should be maintained for their successful management. Whenever a perioperative hypersensitivity reaction is suspected, close collaboration between anaesthetist and the allergy team investigating the patient is paramount, in order for the patient to be appropriately investigated and have an uneventful anaesthetic in the future.
    MeSH term(s) Anaphylaxis/chemically induced ; Anesthetics/adverse effects ; Anesthetists/psychology ; Drug Hypersensitivity ; Humans ; Hypnotics and Sedatives/adverse effects ; Perioperative Period ; Preoperative Care ; Risk Factors
    Chemical Substances Anesthetics ; Hypnotics and Sedatives
    Language English
    Publishing date 2020-05-05
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 645203-6
    ISSN 1473-6500 ; 0952-7907
    ISSN (online) 1473-6500
    ISSN 0952-7907
    DOI 10.1097/ACO.0000000000000857
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  3. Article ; Online: Drug provocation testing: risk stratification is key.

    Garvey, Lene H / Savic, Louise C

    Current opinion in allergy and clinical immunology

    2019  Volume 19, Issue 4, Page(s) 266–271

    Abstract: Purpose of review: This review aims to describe current best practice and recent advances in the use of risk stratification as a tool for drug provocation testing (DPT). In particular, we focus on the testing of unsubstantiated penicillin allergy labels. ...

    Abstract Purpose of review: This review aims to describe current best practice and recent advances in the use of risk stratification as a tool for drug provocation testing (DPT). In particular, we focus on the testing of unsubstantiated penicillin allergy labels.
    Recent findings: The inherent risks of DPT are mitigated through careful selection of patients. A detailed history will elicit features of a potentially severe index reaction, as well as significant patient comorbidities which may increase the risks associated with DPT. Such patients require skin testing and/or in vitro testing prior to consideration for a DPT. However, there is increasing evidence that patients without these features may be able to proceed directly to DPT. This has been demonstrated extensively with unsubstantiated penicillin allergy labels, and a variety of risk stratification models have been employed to identify the 'low-risk' patient. Improved outcomes and reduced cost have been demonstrated with such models without compromising patient safety.
    Summary: Risk stratification tools may enable well-tolerated and effective 'delabelling' of low-risk patients, with less demand on already scarce resources.
    MeSH term(s) Administration, Oral ; Allergens/immunology ; Animals ; Drug Hypersensitivity/diagnosis ; Humans ; Immunization/methods ; Medical History Taking ; Patient Selection ; Penicillins/immunology ; Risk
    Chemical Substances Allergens ; Penicillins
    Language English
    Publishing date 2019-05-23
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 2088710-3
    ISSN 1473-6322 ; 1528-4050
    ISSN (online) 1473-6322
    ISSN 1528-4050
    DOI 10.1097/ACI.0000000000000543
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  4. Article ; Online: Management of penicillin allergy in primary care: a qualitative study with patients and primary care physicians.

    Wanat, Marta / Anthierens, Sibyl / Butler, Christopher C / Savic, Louise / Savic, Sinisa / Pavitt, Sue H / Sandoe, Jonathan A T / Tonkin-Crine, Sarah

    BMC family practice

    2021  Volume 22, Issue 1, Page(s) 112

    Abstract: Background: Six percent of patients are allergic to penicillin according to their medical records. While this designation protects a small number of truly allergic patients from serious reactions, those who are incorrectly labelled may be denied access ... ...

    Abstract Background: Six percent of patients are allergic to penicillin according to their medical records. While this designation protects a small number of truly allergic patients from serious reactions, those who are incorrectly labelled may be denied access to recommended first line treatment for many infections. Removal of incorrect penicillin allergy may have positive health consequences for the individual and the general population. We aimed to explore primary care physicians' (PCPs) and patients' views and understanding of penicillin allergy with a focus on clinical management of infections in the face of a penicillin allergy record.
    Methods: We conducted an interview study with 31 patients with a penicillin allergy record, and 19 PCPs in the North of England. Data were analysed thematically.
    Results: Patients made sense of their allergy status by considering the timing and severity of symptoms. Diagnosis of penicillin allergy was reported to be 'imperfect' with PCPs relying on patient reports and incomplete medical records. PCPs and patients often suspected that an allergy record was incorrect, but PCPs were reluctant to change records. PCPs had limited knowledge of allergy services. PCPs often prescribed alternative antibiotics which were easy to identify. Both patients and PCPs differed in the extent to which they were aware of the negative consequences of incorrect penicillin allergy records, their relevance and importance to their lives, and management of penicillin allergy.
    Conclusions: PCPs and patients appear insufficiently aware of potential harms associated with incorrect penicillin allergy records. Some of the problems experienced by PCPs could be reduced by ensuring the details of newly diagnosed reactions to antibiotics are clearly documented. In order for PCPs to overturn more incorrect penicillin records through appropriate use of allergy services, more information and training about these services will be needed.
    MeSH term(s) Drug Hypersensitivity/diagnosis ; Drug Hypersensitivity/therapy ; Humans ; Penicillins/adverse effects ; Physicians, Primary Care ; Primary Health Care ; Qualitative Research
    Chemical Substances Penicillins
    Language English
    Publishing date 2021-06-11
    Publishing country England
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ISSN 1471-2296
    ISSN (online) 1471-2296
    DOI 10.1186/s12875-021-01465-1
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  5. Article ; Online: Mixed-methods evaluation of a behavioural intervention package to identify and amend incorrect penicillin allergy records in UK general practice.

    Wanat, Marta / Santillo, Marta / Galal, Ushma / Davoudianfar, Mina / Bongard, Emily / Savic, Sinisa / Savic, Louise / Porter, Catherine / Fielding, Joanne / Butler, Christopher C / Pavitt, Sue / Sandoe, Jonathan / Tonkin-Crine, Sarah

    BMJ open

    2022  Volume 12, Issue 6, Page(s) e057471

    Abstract: Objectives: About 6% of the UK general practice population has a record of a penicillin allergy but fewer than 10% of these are likely to be truly allergic. In the ALABAMA (Allergy Antibiotics and Microbial resistance) feasibility trial, primary care ... ...

    Abstract Objectives: About 6% of the UK general practice population has a record of a penicillin allergy but fewer than 10% of these are likely to be truly allergic. In the ALABAMA (Allergy Antibiotics and Microbial resistance) feasibility trial, primary care patients with penicillin allergy were randomised to penicillin allergy assessment pathway or usual care to assess the effect on health outcomes. A behavioural intervention package was developed to aid delabelling. This study aimed to investigate patients' and clinicians' views of penicillin allergy testing (PAT).
    Design: We conducted a mixed-methods process evaluation embedded within the ALABAMA trial, which included a clinician survey, a patient survey (at baseline and follow-up) and semistructured interviews with patients and clinicians.
    Settings: The study was conducted in primary care, as part of the feasibility stage of the ALABAMA trial.
    Participants: Patients and primary care clinicians.
    Results: Clinicians (N=53; 52.2%) were positive about PAT and its potential value but did not have previous experience of referring patients for a PAT and were unsure whether patients would take penicillin after a negative allergy test. Patients (N=36; 46%) were unsure whether they were severely allergic to penicillin and did not fear a severe allergic reaction to penicillin. Clinician interviews showed that they were already aware of the benefit of PAT. Interviews with patients suggested the importance of safety as patients valued having numerous opportunities to address their concerns about safety of the test.
    Conclusions: This study highlights the positive effects of the ALABAMA behavioural intervention for both patients and clinicians.
    Trial registration number: NCT04108637; ISRCTN20579216; Pre-results.
    MeSH term(s) Humans ; Penicillins ; Behavior Therapy ; Drug Hypersensitivity ; General Practice ; Hypersensitivity ; United Kingdom ; Anti-Bacterial Agents
    Chemical Substances Penicillins ; Anti-Bacterial Agents
    Language English
    Publishing date 2022-06-03
    Publishing country England
    Document type Randomized Controlled Trial ; Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 2599832-8
    ISSN 2044-6055 ; 2044-6055
    ISSN (online) 2044-6055
    ISSN 2044-6055
    DOI 10.1136/bmjopen-2021-057471
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  6. Article ; Online: Patient and Primary Care Physician Perceptions of Penicillin Allergy Testing and Subsequent Use of Penicillin-Containing Antibiotics: A Qualitative Study.

    Wanat, Marta / Anthierens, Sibyl / Butler, Christopher C / Savic, Louise / Savic, Sinisa / Pavitt, Sue H / Sandoe, Jonathan A T / Tonkin-Crine, Sarah

    The journal of allergy and clinical immunology. In practice

    2019  Volume 7, Issue 6, Page(s) 1888–1893.e1

    Abstract: Background: Removal of an inaccurate penicillin allergy record following testing allows patients to access first-line treatment for infections, and reduce the use of broad-spectrum antibiotics, which contribute to antibiotic resistance. However, it is ... ...

    Abstract Background: Removal of an inaccurate penicillin allergy record following testing allows patients to access first-line treatment for infections, and reduce the use of broad-spectrum antibiotics, which contribute to antibiotic resistance. However, it is seldom undertaken.
    Objectives: To identify clinicians' working in primary care and patients' views on barriers and enablers for penicillin allergy testing and subsequent antibiotic use.
    Methods: Fifty interviews with patients and clinicians, including 31 patients with a record of penicillin allergy, 16 with experience of testing, and 19 clinicians. Interviews were analyzed thematically.
    Results: Patients were often unaware of the benefits of penicillin allergy testing and only those patients who had experienced negative consequences of having a penicillin allergy label were motivated to get tested. Clinicians were reluctant to change patient records on the basis of their clinical judgment alone but had limited experience of referring patients with suspected penicillin allergy and were often uncertain about referral criteria and what the testing involved. Clinicians felt that allergy testing could be beneficial and patients who had attended testing reported benefits of the test. Clinicians expressed uncertainty related to whose responsibility it was to make sure that the patient understood allergy test results.
    Conclusions: Clinicians would benefit from information about penicillin allergy testing to be able to use these services appropriately, and to discuss referral with patients. Patients might be more motivated to seek testing if they were more informed regarding its benefits. Good communication between primary and secondary care would facilitate the updating of medical records, and promote better patient education.
    MeSH term(s) Adult ; Aged ; Anti-Bacterial Agents/adverse effects ; Attitude of Health Personnel ; Attitude to Health ; Drug Hypersensitivity/diagnosis ; Female ; Humans ; Male ; Middle Aged ; Penicillins/adverse effects ; Perception ; Physicians, Primary Care/psychology ; Qualitative Research ; Skin Tests ; Young Adult
    Chemical Substances Anti-Bacterial Agents ; Penicillins
    Language English
    Publishing date 2019-03-12
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 2843237-X
    ISSN 2213-2201 ; 2213-2198
    ISSN (online) 2213-2201
    ISSN 2213-2198
    DOI 10.1016/j.jaip.2019.02.036
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  7. Article ; Online: DALES, Drug Allergy Labels in Elective Surgical patients: a prospective, multicentre cross-sectional study of prevalence, nature and anaesthetists' approach to management.

    Thomas, Caroline / Clark, Sam / Fallaha, David / Wilson, Michelle / Hopkins, Philip M / Savic, Sinisa / Savic, Louise

    British journal of anaesthesia

    2021  Volume 127, Issue 6, Page(s) 897–904

    Abstract: Background: We sought to define the prevalence and nature of patient-reported drug allergies, determine their impact on prescribing, and explore drug allergy knowledge and attitudes amongst anaesthetists.: Methods: We performed a prospective cross- ... ...

    Abstract Background: We sought to define the prevalence and nature of patient-reported drug allergies, determine their impact on prescribing, and explore drug allergy knowledge and attitudes amongst anaesthetists.
    Methods: We performed a prospective cross-sectional study in 213 UK hospitals in 2018. Elective surgical patients were interviewed, with a detailed allergy history taken in those self-reporting drug allergy. Anaesthetists completed a questionnaire concerning perioperative drug allergy.
    Results: Of 21 219 patients included, 6214 (29.3 %) (95% confidence interval [CI]: 28.7-29.9) reported drug allergy. Antibiotics, NSAIDs, and opioids were the most frequently implicated agents. Of a total of 8755 reactions, 2462 (28.1%) (95% CI: 29.2-31.1) were categorised as high risk for representing genuine allergy after risk stratification. A history suggestive of chronic spontaneous urticaria significantly increased the risk of reporting drug allergy (odds ratio 2.68; 95% CI: 2.4-3; P<0.01). Of 4756 anaesthetists completing the questionnaire, 1473 (31%) (95% CI: 29.7-32.3) routinely discuss perioperative allergy risk with patients. Prescribing habits in the presence of drug allergy labels differ depending on the implicated agent. Most anaesthetists (4678/4697; 99.6%) (95% CI: 99.4-99.8) prescribe opioids when reactions are consistent with side-effects, although 2269/4697 (48%) (95% CI: 46.9-49.7) would avoid the specific opioid reported.
    Conclusions: Almost 30% of UK elective surgical patients report a history of drug allergies, but the majority of reported reactions are likely to be non-allergic reactions. Allergy labels can impact on perioperative prescribing through avoidance of important drugs and use of less effective alternatives. We highlight important knowledge gaps about drug allergy amongst anaesthetists, and the need for improved education around allergy.
    MeSH term(s) Adolescent ; Adult ; Aged ; Anesthetists/statistics & numerical data ; Attitude of Health Personnel ; Clinical Competence/statistics & numerical data ; Cross-Sectional Studies ; Drug Hypersensitivity/epidemiology ; Drug Hypersensitivity/prevention & control ; Drug Labeling/statistics & numerical data ; Elective Surgical Procedures ; Female ; Humans ; Male ; Middle Aged ; Practice Patterns, Physicians'/statistics & numerical data ; Prevalence ; Prospective Studies ; Surveys and Questionnaires ; United Kingdom/epidemiology ; Young Adult
    Language English
    Publishing date 2021-07-07
    Publishing country England
    Document type Journal Article ; Multicenter Study ; Observational Study
    ZDB-ID 80074-0
    ISSN 1471-6771 ; 0007-0912
    ISSN (online) 1471-6771
    ISSN 0007-0912
    DOI 10.1016/j.bja.2021.05.026
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  8. Article ; Online: Management of penicillin allergy in primary care

    Marta Wanat / Sibyl Anthierens / Christopher C. Butler / Louise Savic / Sinisa Savic / Sue H. Pavitt / Jonathan A. T. Sandoe / Sarah Tonkin-Crine

    BMC Family Practice, Vol 22, Iss 1, Pp 1-

    a qualitative study with patients and primary care physicians

    2021  Volume 9

    Abstract: Abstract Background Six percent of patients are allergic to penicillin according to their medical records. While this designation protects a small number of truly allergic patients from serious reactions, those who are incorrectly labelled may be denied ... ...

    Abstract Abstract Background Six percent of patients are allergic to penicillin according to their medical records. While this designation protects a small number of truly allergic patients from serious reactions, those who are incorrectly labelled may be denied access to recommended first line treatment for many infections. Removal of incorrect penicillin allergy may have positive health consequences for the individual and the general population. We aimed to explore primary care physicians’ (PCPs) and patients’ views and understanding of penicillin allergy with a focus on clinical management of infections in the face of a penicillin allergy record. Methods We conducted an interview study with 31 patients with a penicillin allergy record, and 19 PCPs in the North of England. Data were analysed thematically. Results Patients made sense of their allergy status by considering the timing and severity of symptoms. Diagnosis of penicillin allergy was reported to be ‘imperfect’ with PCPs relying on patient reports and incomplete medical records. PCPs and patients often suspected that an allergy record was incorrect, but PCPs were reluctant to change records. PCPs had limited knowledge of allergy services. PCPs often prescribed alternative antibiotics which were easy to identify. Both patients and PCPs differed in the extent to which they were aware of the negative consequences of incorrect penicillin allergy records, their relevance and importance to their lives, and management of penicillin allergy. Conclusions PCPs and patients appear insufficiently aware of potential harms associated with incorrect penicillin allergy records. Some of the problems experienced by PCPs could be reduced by ensuring the details of newly diagnosed reactions to antibiotics are clearly documented. In order for PCPs to overturn more incorrect penicillin records through appropriate use of allergy services, more information and training about these services will be needed.
    Keywords Penicillin allergy ; Qualitative ; Primary care ; Antibiotics ; Medicine (General) ; R5-920
    Subject code 616
    Language English
    Publishing date 2021-06-01T00:00:00Z
    Publisher BMC
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  9. Article ; Online: Developing a behavioural intervention package to identify and amend incorrect penicillin allergy records in UK general practice and subsequently change antibiotic use.

    Santillo, Marta / Wanat, Marta / Davoudianfar, Mina / Bongard, Emily / Savic, Sinisa / Savic, Louise / Porter, Catherine / Fielding, Joanne / Butler, Christopher C / Pavitt, Sue / Sandoe, Jonathan / Tonkin-Crine, Sarah

    BMJ open

    2020  Volume 10, Issue 10, Page(s) e035793

    Abstract: Objectives: To develop a behavioural intervention package to support clinicians and patients to amend incorrect penicillin allergy records in general practice. The intervention aimed to: (1) support clinicians to refer patients for penicillin allergy ... ...

    Abstract Objectives: To develop a behavioural intervention package to support clinicians and patients to amend incorrect penicillin allergy records in general practice. The intervention aimed to: (1) support clinicians to refer patients for penicillin allergy testing (PAT), (2) support patients to attend for PAT and (3) support clinicians and patients to prescribe or consume penicillin, when indicated, following a negative PAT result.
    Methods: Theory-based, evidence-based and person-based approaches were used in the intervention development. We used evidence from a rapid review, two qualitative studies, and expert consultations with the clinical research team to identify the intervention 'guiding principles' and develop an intervention plan. Barriers and facilitators to the target behaviours were mapped to behaviour change theory in order to describe the proposed mechanisms of change. In the final stage, think-aloud interviews were conducted to optimise intervention materials.
    Results: The collated evidence showed that the key barriers to referral of patients by clinicians were limited experience of referral and limited knowledge of referral criteria and PAT. Barriers for patients attending PAT were lack of knowledge of the benefits of testing and lack of motivation to get tested. The key barriers to the prescription and consumption of first-line penicillin following a negative test result were patient and clinician beliefs about the accuracy of PAT and whether taking penicillin was safe. Intervention materials were designed and developed to address these barriers.
    Conclusions: We present a novel behavioural intervention package designed to address the multiple barriers to uptake of PAT in general practice by clinicians and patients. The intervention development details how behaviour change techniques have been incorporated to hypothesise how the intervention is likely to work to help amend incorrect penicillin allergy records. The intervention will go on to be tested in a feasibility trial and randomised controlled trial in England.
    MeSH term(s) Anti-Bacterial Agents/adverse effects ; England ; General Practice ; Humans ; Penicillins/adverse effects ; United Kingdom
    Chemical Substances Anti-Bacterial Agents ; Penicillins
    Language English
    Publishing date 2020-10-01
    Publishing country England
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 2599832-8
    ISSN 2044-6055 ; 2044-6055
    ISSN (online) 2044-6055
    ISSN 2044-6055
    DOI 10.1136/bmjopen-2019-035793
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  10. Article ; Online: DALES, Drug Allergy Labels in Elective Surgical patients: a prospective multicentre cross-sectional study of incidence, risks, and attitudes in penicillin de-labelling strategies.

    Savic, Louise / Thomas, Caroline / Fallaha, David / Wilson, Michelle / Hopkins, Philip M / Savic, Sinisa / Clark, Samuel H

    British journal of anaesthesia

    2020  Volume 125, Issue 6, Page(s) 962–969

    Abstract: Background: Penicillin allergy is associated with a range of poor health outcomes. Allergy testing can be made simpler by using a direct drug provocation test in patients at low risk of genuine allergy. This approach could allow population-level 'de- ... ...

    Abstract Background: Penicillin allergy is associated with a range of poor health outcomes. Allergy testing can be made simpler by using a direct drug provocation test in patients at low risk of genuine allergy. This approach could allow population-level 'de-labelling'. We sought to determine the incidence and nature of penicillin allergy labels in UK surgical patients and define patient and anaesthetist attitudes towards penicillin allergy testing.
    Methods: A prospective cross-sectional questionnaire study was performed in 213 UK hospitals. 'Penicillin allergic' patients were interviewed and risk-stratified. Knowledge and attitudes around penicillin allergy were defined in patients and anaesthetists.
    Results: Of 21 219 patients, 12% (n=2626) self-reported penicillin allergy; 27% reported low-risk histories potentially suitable for a direct drug provocation test; an additional 40% reported symptoms potentially suitable for a direct drug provocation test after more detailed assessment. Of 4798 anaesthetists, 40% claimed to administer penicillin routinely when they judged the label low risk. Only 47% of anaesthetists would be happy to administer penicillin to a patient previously de-labelled by an allergy specialist using a direct drug provocation test; perceived lack of support was the most common reason for not doing so.
    Conclusions: At least 27% of patients with a penicillin allergy label may be suitable for a direct drug provocation test. Anaesthetists demonstrated potentially unsafe prescribing in patients with penicillin allergy labels. More than half of anaesthetists lack confidence in the results of a direct drug provocation tests undertaken by a specialist. Our findings highlight significant barriers to the effective implementation of widespread de-labelling in surgical patients.
    MeSH term(s) Adolescent ; Adult ; Aged ; Anti-Bacterial Agents/adverse effects ; Cross-Sectional Studies ; Drug Hypersensitivity/epidemiology ; Drug Hypersensitivity/prevention & control ; Drug Labeling/methods ; Drug Labeling/statistics & numerical data ; Elective Surgical Procedures ; Female ; Humans ; Incidence ; Male ; Middle Aged ; Penicillins/adverse effects ; Prospective Studies ; Surveys and Questionnaires ; United Kingdom/epidemiology ; Young Adult
    Chemical Substances Anti-Bacterial Agents ; Penicillins
    Language English
    Publishing date 2020-08-25
    Publishing country England
    Document type Journal Article ; Multicenter Study ; Research Support, Non-U.S. Gov't
    ZDB-ID 80074-0
    ISSN 1471-6771 ; 0007-0912
    ISSN (online) 1471-6771
    ISSN 0007-0912
    DOI 10.1016/j.bja.2020.07.048
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