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Article ; Online: Postoperative surveillance after surgery for colorectal liver metastasis: a cross-sectional study.

Nzenwa, I C / Pathak, S / Knight, S R / Mowbray, N G / O'Reilly, D / Jones, R P

Annals of the Royal College of Surgeons of England

2023 Volume 106, Issue 3, Page(s) 213–218

Abstract: Introduction: Colorectal liver metastases (CRLM) are associated with a high recurrence rate after surgery. There is paucity of high-quality evidence regarding the nature and overall benefit of surveillance after hepatectomy for CRLM. As part of a ... ...

Abstract	Introduction: Colorectal liver metastases (CRLM) are associated with a high recurrence rate after surgery. There is paucity of high-quality evidence regarding the nature and overall benefit of surveillance after hepatectomy for CRLM. As part of a broader programme of research, this study aimed to assess current strategies for surveillance after liver resection for CRLM and outline surgeons' opinions regarding the benefit of postoperative surveillance. Methods: An online survey was sent to clinicians performing surgery for CRLM at tertiary hepatobiliary centres in the UK. Results: There were responses from a total of 23 centres (88% response rate); 15/23 centres used standardised surveillance protocols for all patients. Most centres followed patients up at six months, but there is variation in postoperative surveillance at 3, 9, 18 and beyond 60 months. Patient comorbidities, indeterminate findings on imaging, margin status and assessment of recurrence risk were identified as the major factors influencing personalised surveillance strategies. There was clear clinician equipoise regarding the costs and benefits of surveillance. Conclusion: There is heterogeneity in postoperative follow-up for CRLM in the UK. High-quality prospective studies and randomised trials are necessary to elucidate the value of postoperative surveillance and identify optimal follow-up strategies.
MeSH term(s)	Humans ; Cross-Sectional Studies ; Prospective Studies ; Hepatectomy ; Liver Neoplasms/surgery ; Colorectal Neoplasms/surgery
Language	English
Publishing date	2023-05-23
Publishing country	England
Document type	Journal Article
ZDB-ID	80044-2
ISSN	1478-7083 ; 0035-8843
ISSN (online)	1478-7083
ISSN	0035-8843
DOI	10.1308/rcsann.2023.0027
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Article ; Online: GRADE concept paper 8: judging the certainty of discrimination performance estimates of prognostic models in a body of validation studies.

Foroutan, Farid / Mayer, Martin / Guyatt, Gordon / Riley, Richard D / Mustafa, Reem / Kreuzberger, Nina / Skoetz, Nicole / Darzi, Andrea / Alba, Ana Carolina / Mowbray, Fabrice / Rayner, Daniel G / Schunemann, Holger / Iorio, Alfonso

Journal of clinical epidemiology

2024 Volume 170, Page(s) 111344

Abstract: Background: Prognostic models incorporate multiple prognostic factors to estimate the likelihood of future events for individual patients based on their prognostic factor values. Evaluating these models crucially involves conducting studies to assess ... ...

Abstract	Background: Prognostic models incorporate multiple prognostic factors to estimate the likelihood of future events for individual patients based on their prognostic factor values. Evaluating these models crucially involves conducting studies to assess their predictive performance, like discrimination. Systematic reviews and meta-analyses of these validation studies play an essential role in selecting models for clinical practice. Methods: In this paper, we outline 3 thresholds to determine the target for certainty rating in the discrimination of prognostic models, as observed across a body of validation studies. Results and conclusion: We propose 3 thresholds when rating the certainty of evidence about a prognostic model's discrimination. The first threshold amounts to rating certainty in the model's ability to classify better than random chance. The other 2 approaches involve setting thresholds informed by other mechanisms for classification: clinician intuition or an alternative prognostic model developed for the same disease area and outcome. The choice of threshold will vary based on the context. Instead of relying on arbitrary discrimination cut-offs, our approach positions the observed discrimination within an informed spectrum, potentially aiding decisions about a prognostic model's practical utility.
Language	English
Publishing date	2024-04-03
Publishing country	United States
Document type	Journal Article
ZDB-ID	639306-8
ISSN	1878-5921 ; 0895-4356
ISSN (online)	1878-5921
ISSN	0895-4356
DOI	10.1016/j.jclinepi.2024.111344
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Article ; Online: What influences whether parents recognise COVID-19 symptoms, request a test and self-isolate: A qualitative study.

Woodland, Lisa / Mowbray, Fiona / Smith, Louise E / Webster, Rebecca K / Amlôt, Richard / Rubin, G James

PloS one

2022 Volume 17, Issue 2, Page(s) e0263537

Abstract: ... with parents (n = 18) of school-aged (4 to 18 years) children living in England between 30 November to 11 ... supported symptomatic testing and described trusting official sources of information (e.g., Government and ...

Abstract	Background: Using test, trace and isolate systems can help reduce the spread of COVID-19. Parents have the additional responsibility of using these systems for themselves and acting on behalf of their children to help control COVID-19. We explored factors associated with the use of England's NHS Test and Trace service among parents of school-aged children. Methods: One-to-one telephone interviews with parents (n = 18) of school-aged (4 to 18 years) children living in England between 30 November to 11 December 2020. Data were explored using thematic analysis. Results: Three themes and eight sub-themes emerged. In terms of recognising symptoms of COVID-19, parents needed prompting before recalling the main symptoms described by the NHS. Parents suggested several factors relating to the nature of the symptom(s) and contextual information that might lead to or prevent them from seeking a test. Although parents supported symptomatic testing and described trusting official sources of information (e.g., Government and NHS websites). However, some concerns were raised regarding the accuracy of test results, safety at testing centres and logistics of testing but none of the concerns appeared to prevent engagement with testing. Parents perceived adherence to testing and self-isolation as pro-social behaviour, although family resources and circumstances impacted their ability to adhere fully. Conclusions: Our study identified several barriers to parents using NHS Test and Trace as needed. Information about the eligibility of testing (main symptoms of COVID-19 and the age of eligibility) needs to be more precise and resources provided to enable families to adhere to self-isolation if the efficiency of test, trace and isolate systems is to be optimised.
MeSH term(s)	Adolescent ; Adult ; COVID-19/diagnosis ; COVID-19/pathology ; COVID-19/virology ; COVID-19 Testing ; Child ; Child, Preschool ; England ; Female ; Humans ; Interviews as Topic ; Male ; Middle Aged ; Parents/psychology ; Qualitative Research ; Quarantine ; SARS-CoV-2/isolation & purification ; Social Behavior ; Young Adult
Language	English
Publishing date	2022-02-23
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2267670-3
ISSN	1932-6203 ; 1932-6203
ISSN (online)	1932-6203
ISSN	1932-6203
DOI	10.1371/journal.pone.0263537
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Article: The impact of "freedom day" on COVID-19 health protective behaviour in England: An observational study of hand hygiene, face covering use and physical distancing in public spaces pre and post the relaxing of restrictions.

Davies, Rachel / Martin, Alex F / Smith, Louise E / Mowbray, Fiona / Woodland, Lisa / Amlôt, Richard / Rubin, G James

JRSM open

2023 Volume 14, Issue 3, Page(s) 20542704231153563

Abstract: ... occurred in supermarkets (n = 10), train stations (n = 10), bus stops (n = 10), a coach station (n = 1) and ... a London Underground station (n = 1). The survey recruited a nationally representative sample ... Participants: All adults entering the observed locations during a one-hour period (n = 3819 pre- and n = 2948 ...

Abstract	Objectives: To study the prevalence of COVID-19 health protective behaviours before and after rules eased in England on the 19 Design: Observational study pre (12 Setting: Observations occurred in supermarkets (n = 10), train stations (n = 10), bus stops (n = 10), a coach station (n = 1) and a London Underground station (n = 1). The survey recruited a nationally representative sample. Participants: All adults entering the observed locations during a one-hour period (n = 3819 pre- and n = 2948 post-19 Main outcome measures: We observed whether people wore a face covering, maintained distance from others and cleaned their hands. We investigated self-reports of wearing a face covering while in shops or using public transport. Results: In most locations observed, the proportion of people wearing face coverings, cleaning the hands and maintaining physical distance declined post 19th July. Pre 19 Conclusions: Adherence to protective behaviours was sub-optimal and declined during the relaxation of restrictions, despite appeals to exercise caution. Self-reports of "always" wearing a face covering in specific locations appear valid.
Language	English
Publishing date	2023-03-06
Publishing country	England
Document type	Journal Article
ZDB-ID	2762955-7
ISSN	2054-2704
ISSN	2054-2704
DOI	10.1177/20542704231153563
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Article ; Online: Where have all the appendicectomies gone?

Mowbray, N G / Hurt, L / Powell-Chandler, A / Reeves, N / Chandler, S / Walters, E / Cornish, J

Annals of the Royal College of Surgeons of England

2021 Volume 103, Issue 4, Page(s) 250–254

Abstract: Introduction: The COVID-19 pandemic stimulated a national lockdown in the UK. The public were advised to avoid unnecessary hospital attendances and health professionals were advised to avoid aerosol-generating procedures wherever possible. The authors ... ...

Abstract	Introduction: The COVID-19 pandemic stimulated a national lockdown in the UK. The public were advised to avoid unnecessary hospital attendances and health professionals were advised to avoid aerosol-generating procedures wherever possible. The authors hypothesised that these measures would result in a reduction in the number of patients presenting to hospital with acute appendicitis and alter treatment choices. Methods: A multicentred, prospective observational study was undertaken during April 2020 to identify adults treated for acute appendicitis. Searches of operative and radiological records were performed to identify patients treated during April 2018 and April 2019 for comparison. Results: A total of 190 patients were treated for acute appendicitis pre-lockdown compared with 64 patients treated during lockdown. Patients treated during the pandemic were more likely to have a higher American Society of Anesthesiology (ASA) score ( Conclusions: The COVID-19 lockdown was associated with a decreased incidence of acute appendicitis and a significant shift in the management approach. The increased use of CT allows the identification of simple appendicitis for conservative treatment and decreases the negative appendicectomy rate.
MeSH term(s)	Acute Disease ; Adult ; Aged ; Aged, 80 and over ; Anti-Bacterial Agents/therapeutic use ; Appendectomy/methods ; Appendectomy/trends ; Appendicitis/diagnosis ; Appendicitis/drug therapy ; Appendicitis/epidemiology ; Appendicitis/surgery ; COVID-19/prevention & control ; Conservative Treatment/methods ; Conservative Treatment/trends ; Delayed Diagnosis/trends ; Female ; Health Services Accessibility/trends ; Humans ; Incidence ; Male ; Middle Aged ; Pandemics ; Patient Acceptance of Health Care/statistics & numerical data ; Practice Patterns, Physicians'/trends ; Prospective Studies ; Severity of Illness Index ; United Kingdom/epidemiology
Chemical Substances	Anti-Bacterial Agents
Language	English
Publishing date	2021-03-08
Publishing country	England
Document type	Journal Article ; Multicenter Study ; Observational Study
ZDB-ID	80044-2
ISSN	1478-7083 ; 0035-8843
ISSN (online)	1478-7083
ISSN	0035-8843
DOI	10.1308/rcsann.2020.7128
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Article ; Online: Title: Obesogenic microbial signatures and the development of obesity in childhood acute lymphoblastic leukemia.

Park, Heekuk / Uhlemann, A C / Jacobs, S S / Mowbray, C / Jubelirer, T / Kelly, K M / Walters, M / Ladas, E J

Leukemia research

2023 Volume 126, Page(s) 107017

Abstract: ... with the development of OW/OB during the first six months of treatment at diagnosis, and two subsequent timepoints (N ... presence of several species (e.g., Klebsiella pneumoniae, Escherichia coli) was observed in children ...

Abstract	Childhood acute lymphoblastic leukemia (ALL) is the most common childhood cancer with survival exceeding 90% for standard-risk groups. A debilitating side-effect of treatment is the development of overweight/obesity (OW/OB), which develops in approximately 40% of children by the end of treatment. The microbiome has been associated with the development of OW/OB. We examined fluctuations in the microbiome with the development of OW/OB during the first six months of treatment at diagnosis, and two subsequent timepoints (N = 62). Shotgun metagenomic sequencing was performed on Illumina Nextseq system, and taxa and functional pathways were extracted from sequences using kraken2 and humann2, respectively. An association of increased presence of several species (e.g., Klebsiella pneumoniae, Escherichia coli) was observed in children with OW/OB, while lean-promoting species (Veillonella, Haemophilus, and Akkermansia) were increased in children who maintained a normal weight. Pathway analysis revealed purine nucleotide biosynthesis, sugar nucleotide biosynthesis, and enzyme cofactor biosynthesis were positively correlated with Bacteroides spp. among children with OW/OB. We identified several taxa and functional pathways that may confer increased risk for the development of OW/OB. The associations observed in this pilot are preliminary and warrant further research in the microbiome and the development of OW/OB in childhood ALL.
MeSH term(s)	Child ; Humans ; Pediatric Obesity ; Overweight ; Risk Factors ; Prevalence ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; Body Mass Index
Language	English
Publishing date	2023-01-05
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	752396-8
ISSN	1873-5835 ; 0145-2126
ISSN (online)	1873-5835
ISSN	0145-2126
DOI	10.1016/j.leukres.2023.107017
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Article ; Online: Cohort study of long-term survival and recurrence patterns following operative management of colorectal liver metastasis - is follow-up beyond 5 years warranted?

Hajibandeh, Shahab / Mowbray, Nicholas George / Chin, Carven / Alessandri, Giorgio / Duncan, Trish / O'Reilly, David / Kumar, Nagappan

Langenbeck's archives of surgery

2022 Volume 407, Issue 8, Page(s) 3543–3551

Abstract: Aims: To evaluate the patterns of overall survival (OS) and recurrence following surgical resection of colorectal liver metastases (CRLM).: Methods: In compliance with STROCSS guideline, a single-centre retrospective cohort study was conducted. All ... ...

Abstract	Aims: To evaluate the patterns of overall survival (OS) and recurrence following surgical resection of colorectal liver metastases (CRLM). Methods: In compliance with STROCSS guideline, a single-centre retrospective cohort study was conducted. All consecutive patients undergoing resection of CRLM between 2003 and 2019 were considered eligible for inclusion. The outcome measures included OS, recurrence-free survival (RFS), recurrence rate, time to recurrence (TTR) and longest TTR. Statistical analyses included simple descriptive statistics and Kaplan-Meier survival statistics. Results: We included 486 liver resections in 472 patients. The estimated median OS and RFS were 5.1 years and 3.1 years, respectively. The probability of 1-year, 3-year, 5-year and 10-year OS was 93%, 69%, 50% and 34%, respectively. The probability of 1-year, 3-year, 5-year and 10-year RFS was 81%, 50%, 34% and 33%, respectively. Recurrence occurred in 56% (271/486) of patients, and the median TTR was 1.6 years (IQR: 0.8-2.7) with longest TTR of 4.8 years. Although there were no recurrences in the 66 patients that entered the 6th year, the 95% CI for true rate of recurrence in the population given these data is 0-5.4%. Conclusions: Our results suggest that recurrences that occur after operative management of CRLM are almost certain to occur within the first 5 years even for patients surviving longer than 5 years. This does not disprove the requirement for follow up beyond 5 years. However, based on this data, we have altered our follow up from 10 to 6 years. The need for the 6th year of follow up will be reassessed in light of further observations.
Language	English
Publishing date	2022-10-19
Publishing country	Germany
Document type	Journal Article
ZDB-ID	1423681-3
ISSN	1435-2451 ; 1435-2443
ISSN (online)	1435-2451
ISSN	1435-2443
DOI	10.1007/s00423-022-02707-1
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Article ; Online: Safe management of surgical smoke in the age of COVID-19.

Mowbray, N G / Ansell, J / Horwood, J / Cornish, J / Rizkallah, P / Parker, A / Wall, P / Spinelli, A / Torkington, J

The British journal of surgery

2020 Volume 107, Issue 11, Page(s) 1406–1413

Abstract: Background: The COVID-19 global pandemic has resulted in a plethora of guidance and opinion from surgical societies. A controversial area concerns the safety of surgically created smoke and the perceived potential higher risk in laparoscopic surgery.: ...

Abstract	Background: The COVID-19 global pandemic has resulted in a plethora of guidance and opinion from surgical societies. A controversial area concerns the safety of surgically created smoke and the perceived potential higher risk in laparoscopic surgery. Methods: The limited published evidence was analysed in combination with expert opinion. A review was undertaken of the novel coronavirus with regards to its hazards within surgical smoke and the procedures that could mitigate the potential risks to healthcare staff. Results: Using existing knowledge of surgical smoke, a theoretical risk of virus transmission exists. Best practice should consider the operating room set-up, patient movement and operating theatre equipment when producing a COVID-19 operating protocol. The choice of energy device can affect the smoke produced, and surgeons should manage the pneumoperitoneum meticulously during laparoscopic surgery. Devices to remove surgical smoke, including extractors, filters and non-filter devices, are discussed in detail. Conclusion: There is not enough evidence to quantify the risks of COVID-19 transmission in surgical smoke. However, steps can be undertaken to manage the potential hazards. The advantages of minimally invasive surgery may not need to be sacrificed in the current crisis.
MeSH term(s)	COVID-19/prevention & control ; COVID-19/transmission ; Humans ; Infection Control/instrumentation ; Infection Control/methods ; Infectious Disease Transmission, Patient-to-Professional/prevention & control ; Laparoscopy/adverse effects ; Laparoscopy/instrumentation ; Laparoscopy/methods ; Smoke/adverse effects
Chemical Substances	Smoke
Keywords	covid19
Language	English
Publishing date	2020-05-03
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	2985-3
ISSN	1365-2168 ; 0263-1202 ; 0007-1323 ; 1355-7688
ISSN (online)	1365-2168
ISSN	0263-1202 ; 0007-1323 ; 1355-7688
DOI	10.1002/bjs.11679
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Article ; Online: A qualitative process analysis of daily contact testing as an alternative to self-isolation following close contact with a confirmed carrier of SARS-CoV-2.

Denford, Sarah / Martin, Alex F / Towler, Lauren / Mowbray, Fiona / Essery, Rosie / Bloomer, Rachael / Ready, Derren / Love, Nicola / Amlôt, Richard / Oliver, Isabel / Rubin, G James / Yardley, Lucy

BMC public health

2022 Volume 22, Issue 1, Page(s) 1373

Abstract: Background: In July 2021, a randomised controlled trial was conducted to compare the effect on SARS-CoV-2 transmission of seven days of Daily Contact Testing (DCT) using Lateral Flow Test (LFT) and two Polymerase Chain Reaction (PCR) tests as an ... ...

Abstract	Background: In July 2021, a randomised controlled trial was conducted to compare the effect on SARS-CoV-2 transmission of seven days of Daily Contact Testing (DCT) using Lateral Flow Test (LFT) and two Polymerase Chain Reaction (PCR) tests as an alternative to 10 days of standard self-isolation with one PCR, following close contact with a SARS-CoV-2 carrier. In this qualitative study, we used a nested process evaluation to aid interpretation of the trial and provide insight into factors influencing use of tests, understanding of test results, and how tests were used to inform behavioural decisions. Methods: Interviews were conducted with 60 participants (42 randomised to DCT and 18 randomised to self-isolation) who had been in close contact with a confirmed SARS-CoV-2 carrier and had consented to take part in the trial. Results: Data were organised into three overarching themes: (1) assessing the risks and benefits of DCT (2) use of testing during the study period and (3) future use of testing. Attitudes toward DCT as an alternative to self-isolation and behaviour during the testing period appeared to be informed by an assessment of the associated risks and benefits. Participants reported how important it was for them to avoid isolation, how necessary self-isolation was considered to be, and the ability of LFTs to detect infection. Behaviour during the testing period was modified to reduce risks and harms as much as possible. Testing was considered a potential compromise, reducing both risk of transmission and the negative impact of self-isolation, and was regarded as a way to return to normal. Conclusion: Participants in this study viewed DCT as a sensible, feasible, and welcome means of avoiding unnecessary self-isolation. Although negative LFTs provided reassurance, most people still restricted their activity as recommended. DCT was also highly valued by those in vulnerable households as a means of providing reassurance of the absence of infection and as an important means of detecting infection and prompting self-isolation when necessary.
MeSH term(s)	COVID-19/diagnosis ; COVID-19/prevention & control ; Humans ; SARS-CoV-2/genetics
Language	English
Publishing date	2022-07-18
Publishing country	England
Document type	Journal Article ; Randomized Controlled Trial ; Research Support, Non-U.S. Gov't
ZDB-ID	2041338-5
ISSN	1471-2458 ; 1471-2458
ISSN (online)	1471-2458
ISSN	1471-2458
DOI	10.1186/s12889-022-13800-x
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Article ; Online: Severe lactic acidosis and multiorgan failure due to thiamine deficiency during total parenteral nutrition.

Ramsi, Musaab / Mowbray, Claire / Hartman, Gary / Pageler, Natalie

BMJ case reports

2014 Volume 2014

Abstract: A 16-year-old perioperative paediatric patient presented with refractory lactic acidosis and multiorgan failure due to thiamine-deficient total parenteral nutrition during a recent national multivitamin shortage. Urgent empiric administration of ... ...

Abstract	A 16-year-old perioperative paediatric patient presented with refractory lactic acidosis and multiorgan failure due to thiamine-deficient total parenteral nutrition during a recent national multivitamin shortage. Urgent empiric administration of intravenous thiamine resulted in prompt recovery from this life-threatening condition. Despite readily available treatment, a high index of suspicion is required to prevent cardiovascular collapse and mortality.
MeSH term(s)	Acidosis, Lactic/blood ; Acidosis, Lactic/diagnosis ; Acidosis, Lactic/etiology ; Adolescent ; Diagnosis, Differential ; Humans ; Hydrogen-Ion Concentration ; Lactic Acid/blood ; Male ; Multiple Organ Failure/diagnosis ; Multiple Organ Failure/etiology ; Parenteral Nutrition, Total ; Thiamine Deficiency/complications ; Thiamine Deficiency/therapy
Chemical Substances	Lactic Acid (33X04XA5AT)
Language	English
Publishing date	2014-06-03
Publishing country	England
Document type	Case Reports ; Journal Article
ISSN	1757-790X
ISSN (online)	1757-790X
DOI	10.1136/bcr-2014-205264
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