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Article ; Online: The trauma laparotomy-A key procedure that lacks global data.

Bath, Michael F / Bashford, Tom

2024

Language	English
Publishing date	2024-04-17
Publishing country	United States
Document type	Editorial
ZDB-ID	224043-9
ISSN	1432-2323 ; 0364-2313
ISSN (online)	1432-2323
ISSN	0364-2313
DOI	10.1002/wjs.12168
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Article: Transient portal venous gas secondary to acute gastric dilatation.

Koh, Shern Wai / Bath, Michael F / Nair, Manoj

Journal of surgical case reports

2023 Volume 2023, Issue 12, Page(s) rjad705

Abstract: A female patient in her 60s with a history of Parkinson's disease developed epigastric and retrosternal chest pain, with associated vomiting. On examination, she had a distended abdomen with no focal peritonism. A computed tomography (CT) pulmonary ... ...

Abstract	A female patient in her 60s with a history of Parkinson's disease developed epigastric and retrosternal chest pain, with associated vomiting. On examination, she had a distended abdomen with no focal peritonism. A computed tomography (CT) pulmonary angiogram was organized, which demonstrated no evidence of pulmonary emboli, but an incidental finding of gas within the liver peripheries and gastric fundal wall. A plain film abdominal radiograph demonstrated a significantly distended stomach. Thus, acute gastric dilatation was diagnosed. A nasogastric tube was introduced and intravenous fluids were given promptly. An urgent CT scan of abdomen and pelvis with intravenous contrast demonstrated interval reduction with only minor residual gas evident within the left lobe of the liver and gastric fundal wall. We report the case of transient portal venous gas, secondary to acute gastric dilatation, most likely caused by a combination of opioid analgesia and gastric dysmotility from Parkinson's disease.
Language	English
Publishing date	2023-12-30
Publishing country	England
Document type	Case Reports
ZDB-ID	2580919-2
ISSN	2042-8812
ISSN	2042-8812
DOI	10.1093/jscr/rjad705
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Article ; Online: Re: colonoscopy in the nonagenarian population - the importance of patient selection.

Bath, Michael F / Kersey, James G / Nair, Manojkumar

ANZ journal of surgery

2023 Volume 93, Issue 9, Page(s) 2269

MeSH term(s)	Aged, 80 and over ; Humans ; Nonagenarians ; Patient Selection ; Colonoscopy
Language	English
Publishing date	2023-07-18
Publishing country	Australia
Document type	Letter ; Comment
ZDB-ID	2050749-5
ISSN	1445-2197 ; 1445-1433 ; 0004-8682
ISSN (online)	1445-2197
ISSN	1445-1433 ; 0004-8682
DOI	10.1111/ans.18432
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Zs.A 180: Show issues

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Article ; Online: Use of Pulsed Lavage Reduces the Rate of Surgical Site Infection After Laparotomy.

Bath, Michael F / Powell, Jordan / Ismail, Ismail / Machesney, Michael R

The Journal of surgical research

2021 Volume 266, Page(s) 300–305

Abstract: Introduction: Surgical site infections (SSI) are a preventable and common post-operative complication within general surgery. Intra-operative irrigation of surgical incisions is an inexpensive method to reduce post-operative SSI rates, however its use ... ...

Abstract	Introduction: Surgical site infections (SSI) are a preventable and common post-operative complication within general surgery. Intra-operative irrigation of surgical incisions is an inexpensive method to reduce post-operative SSI rates, however its use is predominantly limited to orthopaedic surgery. We aimed to assess the effects of pulsed lavage (PL) irrigation on SSI rates following elective and emergency laparotomies. Methods: Elective and emergency patients who underwent a laparotomy between 2018 and 2019 were included. Relevant demographic and peri-operative risk factors collected retrospectively, following strengthening the reporting of observational studies in epidemiology (STROBE) criteria. The primary outcome was rate of superficial SSI within 30 days of the operation. Independent risk factors were assessed via multivariate logistic regression analysis. Results: 176 patients were identified, with an average age of 60.7 ± 19.1 y. 82.4% (145/176) were emergencies and the mean ASA grade was 2.8. Fifty-two patients (29.5%) had PL used during their operation. Thirty-seven patients (29.8%, 37/124) in the control group developed a SSI, compared to seven patients (13.5%, 7/52) in the PL group (P = 0.022). At multi-variate analysis, the use PL conferring an Odds Ratio 0.36 (CI 0.12-0.94, P= 0.047) for developing a SSI. Conclusion: PL appears to significantly reduced the rate of SSI following laparotomy. There remains scope to reduce the incidence of this common and expensive post-operative complication, and PL could provide a potential cost-effective means to deliver improved outcomes. Future prospective randomised trials are essential to fully assess its benefits and wider use within general surgery.
MeSH term(s)	Adult ; Aged ; Aged, 80 and over ; Female ; Humans ; Laparotomy/adverse effects ; London/epidemiology ; Male ; Middle Aged ; Retrospective Studies ; Surgical Wound Infection/epidemiology ; Surgical Wound Infection/etiology ; Surgical Wound Infection/prevention & control ; Therapeutic Irrigation/methods ; Therapeutic Irrigation/statistics & numerical data
Language	English
Publishing date	2021-05-24
Publishing country	United States
Document type	Journal Article ; Observational Study
ZDB-ID	80170-7
ISSN	1095-8673 ; 0022-4804
ISSN (online)	1095-8673
ISSN	0022-4804
DOI	10.1016/j.jss.2021.04.019
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Zs.A 178: Show issues

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Article ; Online: Faecal immunochemical testing for haemoglobin in detecting bowel polyps in symptomatic patients: multicentre prospective cohort study.

Bath, Michael F / Malhi, Aman / Ayling, Ruth M / Seward, Edward / Pritchard-Jones, Kathy / Laszlo, Helga E / Hackshaw, Allan / Machesney, Michael R

BJS open

2023 Volume 7, Issue 2

Abstract: Background: Measurement of faecal haemoglobin using faecal immunochemistry testing is recommended in patients presenting with symptoms suspicious for colorectal cancer, to aid in triage and prioritization of definitive investigations. While its role in ... ...

Abstract	Background: Measurement of faecal haemoglobin using faecal immunochemistry testing is recommended in patients presenting with symptoms suspicious for colorectal cancer, to aid in triage and prioritization of definitive investigations. While its role in colorectal cancer has been extensively investigated, the ability of faecal immunochemistry testing to detect adenomas in symptomatic patients is unclear. Methods: A multicentre prospective observational study was conducted between April 2017 and March 2019, recruiting adults from 24 hospitals across England and 59 general practices in London who had been urgently referred with suspected colorectal cancer symptoms. Each patient provided a stool sample for faecal immunochemistry testing, in parallel with definitive investigation. A final diagnosis for each patient was recorded, including the presence, size, histology, and risk type of colonic polyps. The outcome of interest was the sensitivity of faecal immunochemistry testing in detecting the presence of adenomas. Results: Of 3496 patients included in the analysis, 553 (15.8 per cent) had polyps diagnosed. Sensitivity of faecal immunochemistry testing for polyp detection was low across all ranges; with a cut-off for faecal haemoglobin of 4 µg/g or lower, sensitivity was 34.9 per cent and 46.8 per cent for all polyp types and high-risk polyps respectively. The area under the receiver operating characteristic curve in detection probability was relatively low for both intermediate-risk (0.63) and high-risk polyps (0.63). Conclusion: While faecal immunochemistry testing may be useful in prioritizing investigations to diagnose colorectal cancer, if used as a sole test, the majority of polyps would be missed and the opportunity to prevent progression to colorectal cancer may be lost.
MeSH term(s)	Adult ; Humans ; Sensitivity and Specificity ; Prospective Studies ; Colorectal Neoplasms/diagnosis ; Colorectal Neoplasms/pathology ; Hemoglobins/analysis ; Adenoma
Chemical Substances	Hemoglobins
Language	English
Publishing date	2023-03-08
Publishing country	England
Document type	Observational Study ; Multicenter Study ; Journal Article ; Research Support, Non-U.S. Gov't
ISSN	2474-9842
ISSN (online)	2474-9842
DOI	10.1093/bjsopen/zrac161
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Article ; Online: International medical student electives: opportunity to support health worker education.

Bath, Michael F / Norris, Eleanor J / Fitzgerald, J E F

Postgraduate medical journal

2019 Volume 96, Issue 1134, Page(s) 181–182

MeSH term(s)	Developing Countries ; Education, Medical, Undergraduate/methods ; Global Health ; Health Personnel/education ; Humans ; International Cooperation ; Students, Medical ; Teaching ; Travel
Language	English
Publishing date	2019-12-04
Publishing country	England
Document type	Editorial
ZDB-ID	80325-x
ISSN	1469-0756 ; 0032-5473
ISSN (online)	1469-0756
ISSN	0032-5473
DOI	10.1136/postgradmedj-2019-136916
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Ua VI Zs.340: Show issues

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Article ; Online: Vasoreactivity to Acetylcholine During Porcine Kidney Perfusion for the Assessment of Ischemic Injury.

Bath, Michael F / Hosgood, Sarah A / Nicholson, Michael L

The Journal of surgical research

2019 Volume 238, Page(s) 96–101

Abstract: Background: The effects of renal allograft ischemic injury on vascular endothelial function have not been clearly established. The aim of this study was to examine vascular reactivity to acetylcholine (ACh) in kidneys subjected to ischemic injury and ... ...

Abstract	Background: The effects of renal allograft ischemic injury on vascular endothelial function have not been clearly established. The aim of this study was to examine vascular reactivity to acetylcholine (ACh) in kidneys subjected to ischemic injury and reperfusion. Methods: Porcine kidneys were exposed to different combinations of warm ischemic time (WIT) and cold ischemic time (CIT) as follows: 15 min (n = 7), 60 min (n = 6), 90 min (n = 6), or 120 min (n = 4) WIT + 2 h CIT or 15 min WIT + 16 h CIT (n = 8). Kidneys were reperfused at 38°C for 3 h. After reperfusion, ACh was infused into the circuit to assess endothelium-dependent vascular reactivity. Results: The dose-response relationships between renal blood flow and ACh demonstrated that ACh doses of 10 Conclusions: The loss of renal vascular reactivity after 120 min WIT suggests endothelial dysfunction leading to loss of nitric oxide synthesis/release. Measurement of vasoreactivity to ACh in an isolated organ perfusion system has the potential to be developed as a marker of ischemic renal injury before transplantation.
MeSH term(s)	Acetylcholine/administration & dosage ; Allografts/blood supply ; Allografts/drug effects ; Animals ; Cold Ischemia/adverse effects ; Disease Models, Animal ; Endothelium, Vascular/drug effects ; Endothelium, Vascular/physiopathology ; Feasibility Studies ; Female ; Humans ; Ischemia/complications ; Ischemia/physiopathology ; Kidney/blood supply ; Kidney/drug effects ; Kidney Transplantation/adverse effects ; Perfusion ; Renal Circulation/drug effects ; Reperfusion Injury/diagnosis ; Reperfusion Injury/etiology ; Reperfusion Injury/physiopathology ; Sus scrofa ; Vasodilation/drug effects ; Warm Ischemia/adverse effects
Chemical Substances	Acetylcholine (N9YNS0M02X)
Language	English
Publishing date	2019-02-12
Publishing country	United States
Document type	Journal Article
ZDB-ID	80170-7
ISSN	1095-8673 ; 0022-4804
ISSN (online)	1095-8673
ISSN	0022-4804
DOI	10.1016/j.jss.2019.01.019
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Article: Acute pancreatitis in the older patient: Is a new risk score required?

Bath, Michael F / Som, Robin / Curley, Daniel / Kerwat, Rajab

Journal of the Intensive Care Society

2020 Volume 22, Issue 3, Page(s) 187–191

Abstract: Introduction: The average age of the surgical patient in the UK is increasing. Frailty and cognitive impairment have been shown to be important risk factors in elderly patients with surgical pathology. Limited work has previously assessed the outcomes ... ...

Abstract	Introduction: The average age of the surgical patient in the UK is increasing. Frailty and cognitive impairment have been shown to be important risk factors in elderly patients with surgical pathology. Limited work has previously assessed the outcomes of acute pancreatitis in the elderly population and the usefulness of current severity scoring methods. We aimed to assess the mortality rates in this cohort and identify any factors that may influence patient outcome. Methods: All patients ≥ 80 years admitted with acute pancreatitis between 1 January 2014 and 31 May 2018 were retrospectively identified. Disease severity scores were measured by a modified Ranson score, and patients' co-morbidities were quantified with the Charlson Comorbidity Index. Primary endpoint was whether the patient was alive at discharge; multilevel logistic regression was used to identify any independent risk factors for patient outcomes. Results: Eighty-seven patients were included, with an average age of 86 years. The most common aetiology was gallstones. Nine patients died during admission, and ITU admission was the only predictor of mortality (p = 0.027). Twenty-three patients had died by one year. Endoscopic retrograde cholangiopancreatography was more common in patients with gallstone disease who were alive at one year (p = 0.029). Discussion: Risk severity and co-morbidity scores are not predictive of outcomes in elderly patients with acute pancreatitis. The use of endoscopic retrograde cholangiopancreatography should be considered in elderly patients with acute gallstone pancreatitis where suitable. Further work is needed to identify improved mortality prediction tools in the elderly with acute pancreatitis and optimal management strategies.
Language	English
Publishing date	2020-06-30
Publishing country	England
Document type	Journal Article
ZDB-ID	2701626-2
ISSN	1751-1437 ; 1751-1437
ISSN (online)	1751-1437
ISSN	1751-1437
DOI	10.1177/1751143720937877
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Article ; Online: Examination under anaesthesia of the rectum for removal of gallstones.

Bath, Michael F / George, Rhys / Hussain, Zakir J / Aston, Niall O

BMJ case reports

2019 Volume 12, Issue 1

MeSH term(s)	Aged, 80 and over ; Cholecystitis/complications ; Cholecystitis/diagnostic imaging ; Female ; Gallstones/complications ; Gallstones/diagnostic imaging ; Gallstones/surgery ; Humans ; Ileal Diseases/diagnostic imaging ; Ileal Diseases/etiology ; Ileal Diseases/surgery ; Intestinal Fistula/complications ; Intestinal Fistula/diagnostic imaging ; Intestinal Obstruction/diagnostic imaging ; Intestinal Obstruction/etiology ; Intestinal Obstruction/surgery ; Rectal Diseases/diagnostic imaging ; Rectal Diseases/etiology ; Rectal Diseases/surgery ; Sigmoidoscopy ; Tomography, X-Ray Computed
Language	English
Publishing date	2019-01-28
Publishing country	England
Document type	Case Reports ; Journal Article
ISSN	1757-790X
ISSN (online)	1757-790X
DOI	10.1136/bcr-2018-228632
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Article ; Online: Does the implementation of a trauma system affect injury-related morbidity and economic outcomes? A systematic review.

Bath, Michael F / Hobbs, Laura / Kohler, Katharina / Kuhn, Isla / Nabulyato, William / Kwizera, Arthur / Walker, Laura E / Wilkins, Tom / Stubbs, Daniel / Burnstein, R M / Kolias, Angelos / Hutchinson, Peter John / Clarkson, P John / Halimah, Sara / Bashford, Tom

Emergency medicine journal : EMJ

2024

Abstract: Background: Trauma accounts for a huge burden of disease worldwide. Trauma systems have been implemented in multiple countries across the globe, aiming to link and optimise multiple aspects of the trauma care pathway, and while they have been shown to ... ...

Abstract	Background: Trauma accounts for a huge burden of disease worldwide. Trauma systems have been implemented in multiple countries across the globe, aiming to link and optimise multiple aspects of the trauma care pathway, and while they have been shown to reduce overall mortality, much less is known about their cost-effectiveness and impact on morbidity. Methods: We performed a systematic review to explore the impact the implementation of a trauma system has on morbidity, quality of life and economic outcomes, in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. All comparator study types published since 2000 were included, both retrospective and prospective in nature, and no limits were placed on language. Data were reported as a narrative review. Results: Seven articles were identified that met the inclusion criteria, all of which reported a pre-trauma and post-trauma system implementation comparison in high-income settings. The overall study quality was poor, with all studies demonstrating a severe risk of bias. Five studies reported across multiple types of trauma patients, the majority describing a positive impact across a variety of morbidity and health economic outcomes following trauma system implementation. Two studies focused specifically on traumatic brain injury and did not demonstrate any impact on morbidity outcomes. Discussion: There is currently limited and poor quality evidence that assesses the impact that trauma systems have on morbidity, quality of life and economic outcomes. While trauma systems have a fundamental role to play in high-quality trauma care, morbidity and disability data can have large economic and cultural consequences, even if mortality rates have improved. The sociocultural and political context of the surrounding healthcare infrastructure must be better understood before implementing any trauma system, particularly in resource-poor and fragile settings. Prospero registration number: CRD42022348529 LEVEL OF EVIDENCE: Level III.
Language	English
Publishing date	2024-02-22
Publishing country	England
Document type	Journal Article
ZDB-ID	2040124-3
ISSN	1472-0213 ; 1472-0205
ISSN (online)	1472-0213
ISSN	1472-0205
DOI	10.1136/emermed-2023-213782
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