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Article ; Online: Telemedicine in postoperative follow-up of STOMa PAtients: a randomized clinical trial (the STOMPA trial).

Augestad, K M / Sneve, A M / Lindsetmo, R-O

2020 Volume 107, Issue 5, Page(s) 509–518

Abstract: Background: A stoma has severe impact on the patient's quality of life (QoL). Postoperative home community follow-up by teleconsultation (TC) and stoma nurses may reduce the burden of travel and improve QoL.: Methods: A university hospital and five ... ...

Abstract	Background: A stoma has severe impact on the patient's quality of life (QoL). Postoperative home community follow-up by teleconsultation (TC) and stoma nurses may reduce the burden of travel and improve QoL. Methods: A university hospital and five district medical centres participated. Patients with a stoma were randomized to follow-up by either TC (intervention) or hospital (control). Stoma nurses performed the clinical examination at the TC studio, aided remotely by hospital nurses and surgeons. The primary endpoint was the EQ-5D™ index score; secondary endpoints were the Stoma Quality-of-Life Scale, the OutPatient Experiences Questionnaire, and use of hospital resources. Results: A total of 110 patients were randomized to hospital (58 patients) or TC (52) follow-up; 64 patients (hospital 38, TC 26) were followed for more than 12 months and 246 consultations (hospital 151, TC 95) were performed. There were no differences in QoL: EQ-5D™ index score (P = 0·301) and EQ-5D™ visual analogue scale (VAS) score (P = 0·775); Work/Social Function (P = 0·822); Sexuality/Body Image (P = 0·253) and Stoma Function (P = 0·074). Hospital follow-up performed better for organization of care (staff collaboration, P = 0·004; met same persons, P = 0·003) and communication (surgeon understandable, P < 0·001; surgeon caring P = 0·003). TC did not increase the number of hospital consultations (P = 0·684) and reduced the number of journeys of more than 8 h (P = 0·007). Conclusion: Telemedicine follow-up by stoma nurses did not improve the QoL of patients, but decreased the readmission rate and burden of travel. Registration number NCT01600508 ( https://www.clinicaltrials.gov).
MeSH term(s)	Aged ; Ambulatory Care/statistics & numerical data ; Colostomy/nursing ; Cost of Illness ; Facilities and Services Utilization ; Female ; Follow-Up Studies ; Home Nursing ; Humans ; Ileostomy/nursing ; Male ; Middle Aged ; Norway ; Patient Outcome Assessment ; Patient Readmission/statistics & numerical data ; Postoperative Care/methods ; Quality of Life ; Remote Consultation ; Surgical Stomas ; Time Factors ; Travel
Language	English
Publishing date	2020-02-26
Publishing country	England
Document type	Journal Article ; Randomized Controlled Trial ; Research Support, Non-U.S. Gov't
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.11491
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Article ; Online: Benchmarking of abdominal surgery: a study evaluating the HARM score in a European national cohort.

Helgeland, J / Skyrud, K / Lindahl, A K / Keller, D / Augestad, K M

BJS open

2020 Volume 4, Issue 4, Page(s) 637–644

Abstract: Background: Reliable, easily accessible metrics of surgical quality are currently lacking. The HARM (HospitAl length of stay, Readmission and Mortality) score is a composite measure that has been validated across diverse surgical cohorts. The aim of ... ...

Abstract	Background: Reliable, easily accessible metrics of surgical quality are currently lacking. The HARM (HospitAl length of stay, Readmission and Mortality) score is a composite measure that has been validated across diverse surgical cohorts. The aim of this study was to validate the HARM score in a national population of patients undergoing abdominal surgery. Methods: Data on all abdominal surgery in Norwegian hospitals from 2011 to 2017 were obtained from the Norwegian Patient Registry. Readmissions and 30-day postoperative complications as well as deaths in and out of hospital were evaluated. The HARM scoring algorithm was tested after adjustment by establishing a newly proposed length of stay score. The correlation between the HARM score and complications, as well as the ability of aggregated HARM scores to discriminate between hospitals, were analysed. Risk adjustment models were developed for nationwide hospital comparisons. Results: The data consisted of 407 113 primary operations on 295 999 patients in 85 hospitals. The HARM score was associated with complications and complication severity (Goodman-Kruskal γ value 0·59). Surgical specialty was the dominating variable for risk adjustment. Based on 1-year data, the risk-adjusted score classified 16 hospitals as low HARM score and 16 as high HARM score of the 53 hospitals that had at least 30 operations. Conclusion: The HARM score correlates with major outcomes and is associated with the presence and severity of complications. After risk adjustment, the HARM score discriminated strongly between hospitals in a European population of abdominal surgery.
MeSH term(s)	Abdomen/surgery ; Adult ; Aged ; Aged, 80 and over ; Benchmarking ; Cohort Studies ; Digestive System Surgical Procedures/mortality ; Female ; Hospital Mortality ; Humans ; Length of Stay ; Logistic Models ; Male ; Middle Aged ; Norway/epidemiology ; Patient Outcome Assessment ; Patient Readmission ; Postoperative Complications ; Reproducibility of Results ; Risk Adjustment
Language	English
Publishing date	2020-04-21
Publishing country	England
Document type	Journal Article ; Multicenter Study ; Research Support, Non-U.S. Gov't ; Validation Study
ISSN	2474-9842
ISSN (online)	2474-9842
DOI	10.1002/bjs5.50284
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Article: Leger på ferie.

Augestad, K M

Tidsskrift for den Norske laegeforening : tidsskrift for praktisk medicin, ny raekke

1998 Volume 118, Issue 27, Page(s) 4270

Title translation	Physician on vacation.
MeSH term(s)	Aerospace Medicine ; Decision Making ; Ethics, Medical ; Humans ; Physician's Role ; Travel
Language	Norwegian
Publishing date	1998-11-10
Publishing country	Norway
Document type	Comment ; Letter
ZDB-ID	603504-8
ISSN	0807-7096 ; 0029-2001
ISSN (online)	0807-7096
ISSN	0029-2001
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Zs.B 422: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 2021: Bestellungen von Artikeln über das Online-Bestellformular ab Jg. 2022: Lesesaal (EG)
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Article ; Online: Educational implications for surgical telementoring: a current review with recommendations for future practice, policy, and research.

Augestad, K M / Han, H / Paige, J / Ponsky, T / Schlachta, C M / Dunkin, B / Mellinger, J

Surgical endoscopy

2017 Volume 31, Issue 10, Page(s) 3836–3846

Abstract: Background: Surgical telementoring (ST) was introduced in the sixties, promoting videoconferencing to enhance surgical education across large distances. Widespread use of ST in the surgical community is lacking. Despite numerous surveys assessing ST, ... ...

Abstract	Background: Surgical telementoring (ST) was introduced in the sixties, promoting videoconferencing to enhance surgical education across large distances. Widespread use of ST in the surgical community is lacking. Despite numerous surveys assessing ST, there remains a lack of high-level scientific evidence demonstrating its impact on mentorship and surgical education. Despite this, there is an ongoing paradigm shift involving remote presence technologies and their application to skill development and technique dissemination in the international surgical community. Factors facilitating this include improved access to ST technology, including ease of use and data transmission, and affordability. Several international research initiatives have commenced to strengthen the scientific foundation documenting the impact of ST in surgical education and performance. Methods: International experts on ST were invited to the SAGES Project Six Summit in August 2015. Two experts in surgical education prepared relevant questions for discussion and organized the meeting (JP and HH). The questions were open-ended, and the discussion continued until no new item appeared. The transcripts of interviews were recorded by a secretary from SAGES. Results: In this paper, we present a summary of the work performed by the SAGES Project 6 Education Working Group. We summarize the existing evidence regarding education in ST, identify and detail conceptual educational frameworks that may be used during ST, and present a structured framework for an educational curriculum in ST. Conclusions: The educational impact and optimal curricular organization of ST programs are largely unexplored. We outline the critical components of a structured ST curriculum, including prerequisites, teaching modalities, and key curricular components. We also detail research strategies critical to its continued evolution as an educational tool, including randomized controlled trials, establishment of a quality registry, qualitative research, learning analytics, and development of a standardized taxonomy.
MeSH term(s)	Clinical Competence ; Curriculum ; Education, Medical/methods ; General Surgery/education ; Humans ; Mentors ; Telemedicine/methods
Language	English
Publishing date	2017
Publishing country	Germany
Document type	Journal Article ; Review
ZDB-ID	639039-0
ISSN	1432-2218 ; 0930-2794
ISSN (online)	1432-2218
ISSN	0930-2794
DOI	10.1007/s00464-017-5690-y
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Article ; Online: Metastatic spread pattern after curative colorectal cancer surgery. A retrospective, longitudinal analysis.

Augestad, K M / Bakaki, P M / Rose, J / Crawshaw, B P / Lindsetmo, R O / Dørum, L M / Koroukian, S M / Delaney, C P

Cancer epidemiology

2015 Volume 39, Issue 5, Page(s) 734–744

Abstract: Objective: The most common sites of colorectal cancer (CRC) recurrence are the local tissues, liver or lungs. The objective was to identify risk factors associated with the primary CRC tumor and cancer recurrence in these anatomical sites.: Methods: ... ...

Abstract	Objective: The most common sites of colorectal cancer (CRC) recurrence are the local tissues, liver or lungs. The objective was to identify risk factors associated with the primary CRC tumor and cancer recurrence in these anatomical sites. Methods: Retrospective, longitudinal analyses of data on CRC survivors. Multivariable Cox regression analysis was performed to examine the association between possible cofounders with recurrence to various anatomical sites. Results: Data for 10,398CRC survivors (tumor location right colon=3870, left colon=2898, high rectum=2569, low rectum=1061) were analyzed; follow up time was up to five years. Mean age at curative surgery was 71.5 (SD 11.8) years, 20.2% received radio-chemotherapy, stage T3 (64.4%) and N0 (65.1%) were most common. Overall 1632 (15.7%) had cancer recurrence (Isolated liver n=412, 3,8%; isolated lung n=252, 2,4%; isolated local n=223, 2.1%). Risk factors associated with recurrent CRC were identified, i.e. isolated liver metastases (male: Adjusted Hazard Ratio (AHR) 1,45; colon left: AHR 1,63; N2 disease: AHR 3,35; T2 disease: AHR 2,82), isolated lung metastases (colon left: AHR 1,53; rectum high: AHR 2,48; rectum low: AHR 2,65; N2 disease 3,76), and local recurrence (glands examined<12: AHR 1,51; CRM <3mm: AHR 1,60; rectum high: AHR 2,15; N2 disease: AHR 2,58) (all p values <0001). Conclusion: Our study finds that the site of the primary CRC tumor is associated with location of subsequent metastasis. Left sided colon cancers have increased risk of metastatic spread to the liver, whereas rectal cancers have increased risk of local recurrence and metastatic spread to the lungs. These results, in combination with other risk factors for CRC recurrence, should be taken into consideration when designing risk adapted post-treatment CRC surveillance programs.
MeSH term(s)	Aged ; Colorectal Neoplasms/pathology ; Humans ; Liver Neoplasms/secondary ; Longitudinal Studies ; Lung Neoplasms/secondary ; Male ; Middle Aged ; Neoplasm Recurrence, Local/pathology ; Proportional Hazards Models ; Retrospective Studies ; Risk Factors
Language	English
Publishing date	2015-10
Publishing country	Netherlands
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ZDB-ID	2508729-0
ISSN	1877-783X ; 1877-7821
ISSN (online)	1877-783X
ISSN	1877-7821
DOI	10.1016/j.canep.2015.07.009
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Zs.A 1427: Show issues

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Article ; Online: Standards for reporting randomized controlled trials in medical informatics: a systematic review of CONSORT adherence in RCTs on clinical decision support.

Augestad, K M / Berntsen, G / Lassen, K / Bellika, J G / Wootton, R / Lindsetmo, R O

Journal of the American Medical Informatics Association : JAMIA

2011 Volume 19, Issue 1, Page(s) 13–21

Abstract: Introduction: The Consolidated Standards for Reporting Trials (CONSORT) were published to standardize reporting and improve the quality of clinical trials. The objective of this study is to assess CONSORT adherence in randomized clinical trials (RCT) of ...

Abstract	Introduction: The Consolidated Standards for Reporting Trials (CONSORT) were published to standardize reporting and improve the quality of clinical trials. The objective of this study is to assess CONSORT adherence in randomized clinical trials (RCT) of disease specific clinical decision support (CDS). Methods: A systematic search was conducted of the Medline, EMBASE, and Cochrane databases. RCTs on CDS were assessed against CONSORT guidelines and the Jadad score. Result: 32 of 3784 papers identified in the primary search were included in the final review. 181 702 patients and 7315 physicians participated in the selected trials. Most trials were performed in primary care (22), including 897 general practitioner offices. RCTs assessing CDS for asthma (4), diabetes (4), and hyperlipidemia (3) were the most common. Thirteen CDS systems (40%) were implemented in electronic medical records, and 14 (43%) provided automatic alerts. CONSORT and Jadad scores were generally low; the mean CONSORT score was 30.75 (95% CI 27.0 to 34.5), median score 32, range 21-38. Fourteen trials (43%) did not clearly define the study objective, and 11 studies (34%) did not include a sample size calculation. Outcome measures were adequately identified and defined in 23 (71%) trials; adverse events or side effects were not reported in 20 trials (62%). Thirteen trials (40%) were of superior quality according to the Jadad score (≥3 points). Six trials (18%) reported on long-term implementation of CDS. Conclusion: The overall quality of reporting RCTs was low. There is a need to develop standards for reporting RCTs in medical informatics.
MeSH term(s)	Decision Support Systems, Clinical ; Evidence-Based Medicine ; Guideline Adherence ; Guidelines as Topic ; Humans ; Medical Informatics/standards ; Publishing/standards ; Quality Control ; Randomized Controlled Trials as Topic/standards ; Research Design/standards
Language	English
Publishing date	2011-07-29
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Review ; Systematic Review
ZDB-ID	1205156-1
ISSN	1527-974X ; 1067-5027
ISSN (online)	1527-974X
ISSN	1067-5027
DOI	10.1136/amiajnl-2011-000411
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Zs.A 4128: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (2.OG) ab Jg. 2022: Lesesaal (EG)
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Article ; Online: System-based factors influencing intraoperative decision-making in rectal cancer by surgeons: an international assessment.

Augestad, K M / Lindsetmo, R-O / Stulberg, J J / Reynolds, H / Champagne, B / Senagore, A J / Delaney, C P

Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland

2012 Volume 14, Issue 10, Page(s) e679–88

Abstract: Aim: Sound surgical judgement is the goal of training and experience; however, system-based factors may also colour selection of options by a surgeon. We analysed potential organizational characteristics that might influence rectal cancer decision- ... ...

Abstract	Aim: Sound surgical judgement is the goal of training and experience; however, system-based factors may also colour selection of options by a surgeon. We analysed potential organizational characteristics that might influence rectal cancer decision-making by an experienced surgeon. Method: One hundred and seventy-three international centres treating rectal cancer were invited to participate in a survey assessment of key treatment options for patients undergoing curative rectal-cancer surgery. The key organizational characteristics were analysed using multivariate methods for association with intra-operative surgical decision-making. Results: The response rate was 71% (123 centres). Sphincter-saving surgery was more likely to be performed at university hospitals (OR=3.63, P=0.01) and by high-caseload surgeons (OR=2.77 P=0.05). A diverting stoma was performed more frequently in departments with clinical audits (OR=3.06, P=0.02), and a diverting stoma with coloanal anastomosis was more likely in European centres (OR=4.14, P=0.004). One-stage surgery was less likely where there was assessment by a multidisciplinary team (OR=0.24, P=0.02). Multivariate analysis showed that university hospital, clinical audit, European centre, multidisciplinary team and high caseload significantly impacted on surgical decision-making. Conclusion: Treatment variance of rectal cancer surgeons appears to be significantly influenced by organizational characteristics and complex team-based decision-making. System-based factors may need to be considered as a source of outcome variation that may impact on quality metrics.
MeSH term(s)	Australia ; Clinical Audit ; Cross-Sectional Studies ; Decision Making ; Digestive System Surgical Procedures/methods ; Digestive System Surgical Procedures/psychology ; Europe ; Health Care Surveys ; Hospitals, University ; Humans ; Intraoperative Period ; Multivariate Analysis ; Organizational Culture ; Patient Care Team/organization & administration ; Physicians/psychology ; Professional Practice Location ; Rectal Neoplasms/surgery ; Rectum/surgery ; Surveys and Questionnaires ; Systems Theory ; United States ; Workload
Language	English
Publishing date	2012-10
Publishing country	England
Document type	Journal Article
ZDB-ID	1440017-0
ISSN	1463-1318 ; 1462-8910
ISSN (online)	1463-1318
ISSN	1462-8910
DOI	10.1111/j.1463-1318.2012.03093.x
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Article ; Online: Single incision laparoscopic colectomy: technical aspects, feasibility, and expected benefits.

Leblanc, F / Champagne, B J / Augestad, K M / Stein, S L / Marderstein, E / Reynolds, H L / Delaney, C P

Diagnostic and therapeutic endoscopy

2010 Volume 2010, Page(s) 913216

Abstract: Background. This paper studied technical aspects and feasibility of single incision laparoscopic colectomy (SILC). Methods. Bibliographic search was carried out up to October 2009 including original articles, case reports, and technical notes. Assessed ... ...

Abstract	Background. This paper studied technical aspects and feasibility of single incision laparoscopic colectomy (SILC). Methods. Bibliographic search was carried out up to October 2009 including original articles, case reports, and technical notes. Assessed criteria were techniques, operative time, scar length, conversion, complications, and hospitalization duration. Results. The review analyzed seventeen SILCs by seven surgical teams. A single port system was used by four teams. No team used the same laparoscope. Two teams used two laparoscopes. All teams used curved instruments. SILC time was 116 +/- 34 minutes. Final scar was longer than port incision (31 +/- 7 versus 24 +/- 8 mm; P = .036). No conversion was reported. The only complication was a bacteremia. Hospitalization was 5 +/- 2 days. Conclusion. SILC is feasible. A single incision around the umbilical scar represents cosmetic progress. Comparative studies are needed to assess potential abdominal wall and recovery benefits to justify the increased cost of SILC.
Language	English
Publishing date	2010-05-30
Publishing country	United States
Document type	Journal Article
ZDB-ID	1327325-5
ISSN	1029-0516 ; 1070-3608
ISSN (online)	1029-0516
ISSN	1070-3608
DOI	10.1155/2010/913216
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Article ; Online: Assessment of comparative skills between hand-assisted and straight laparoscopic colorectal training on an augmented reality simulator.

Leblanc, F / Delaney, C P / Neary, P C / Rose, J / Augestad, K M / Senagore, A J / Ellis, C N / Champagne, B J

Diseases of the colon and rectum

2010 Volume 53, Issue 9, Page(s) 1323–1327

Abstract: Purpose: The aim of this study was to compare skills sets during a hand-assisted and straight laparoscopic colectomy on an augmented reality simulator.: Methods: Twenty-nine surgeons, assigned randomly in 2 groups, performed laparoscopic sigmoid ... ...

Abstract	Purpose: The aim of this study was to compare skills sets during a hand-assisted and straight laparoscopic colectomy on an augmented reality simulator. Methods: Twenty-nine surgeons, assigned randomly in 2 groups, performed laparoscopic sigmoid colectomies on a simulator: group A (n = 15) performed hand-assisted then straight procedures; group B (n = 14) performed straight then hand-assisted procedures. Groups were compared according to prior laparoscopic colorectal experience, performance (time, instrument path length, and instrument velocity changes), technical skills, and operative error. Results: Prior laparoscopic colorectal experience was similar in both groups. Both groups had better performances with the hand-assisted approach, although technical skill scores were similar between approaches. The error rate was higher with the hand-assisted approach in group A, but similar between both approaches in group B. Conclusions: These data define the metrics of performance for hand-assisted and straight laparoscopic colectomy on an augmented reality simulator. The improved scores with the hand-assisted approach suggest that with this simulator a hand-assisted model may be technically easier to perform, although it is associated with increased intraoperative errors.
MeSH term(s)	Clinical Competence ; Colectomy/standards ; Colorectal Surgery/education ; Colorectal Surgery/standards ; Computer Simulation ; Computer-Assisted Instruction ; Humans ; Laparoscopy/standards ; Psychomotor Performance ; Statistics, Nonparametric ; Task Performance and Analysis ; User-Computer Interface
Language	English
Publishing date	2010-09
Publishing country	United States
Document type	Comparative Study ; Journal Article ; Randomized Controlled Trial ; Research Support, Non-U.S. Gov't
ZDB-ID	212581-x
ISSN	1530-0358 ; 0012-3706
ISSN (online)	1530-0358
ISSN	0012-3706
DOI	10.1007/DCR.0b013e3181e263f1
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Article: Closed mitral commissurotomy in Archangel, Northern Russia, 1965-1993. Operative assessment of 367 patients operated on for rheumatic mitral stenosis.

Augestad, K M / Martyushova, K / Fedorov, B / Martyushov, S / Lie, M

Scandinavian cardiovascular journal : SCJ

2001 Volume 34, Issue 5, Page(s) 533–535

Abstract: Objective: Preoperative and operative assessment of the 367 patients operated on for rheumatic mitral stenosis with closed mitral commissurotomy (CMC) at the regional hospital in Archangel, northwest Russia, between 1965 and 1993.: Design: ... ...

Abstract	Objective: Preoperative and operative assessment of the 367 patients operated on for rheumatic mitral stenosis with closed mitral commissurotomy (CMC) at the regional hospital in Archangel, northwest Russia, between 1965 and 1993. Design: Retrospective survey. Results: Mean age at first attack of rheumatic fever was 15 years +/- 1.09 years. Mean age at time of surgery was 33.4 years +/- 0.92. Preoperatively, most patients (67%, n = 245) were in New York Heart Association stage III; 29% (n = 107) in stage IV. Digital commissurotomy alone was performed in 16% (n = 57) and a transventricular dilator was used in 84% (n = 310). Operative blood loss was average (384.4 ml +/- 34 ml); 20% (n = 73) developed wound infection, 21% (n = 77) pericarditis. In-hospital stay was above 50 days for both sexes. In-hospital mortality was 1.6% (n = 6). Conclusion: Rheumatic heart disease developed rapidly in these patients. CMC has a place as a low cost treatment of mitral stenosis when a heart lung machine is not available.
MeSH term(s)	Adult ; Cardiac Surgical Procedures/methods ; Female ; Humans ; Male ; Mitral Valve Stenosis/etiology ; Mitral Valve Stenosis/surgery ; Retrospective Studies ; Rheumatic Heart Disease/surgery ; Russia ; Treatment Outcome
Language	English
Publishing date	2001-01-31
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	1379906-x
ISSN	1651-2006 ; 1401-7431
ISSN (online)	1651-2006
ISSN	1401-7431
DOI	10.1080/140174300750064738
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