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Article ; Online: Improving colonoscopy prioritisation and promoting the National Bowel Cancer Screening Program: keys to reducing bowel cancer burden.

Grogan, Paul / He, Emily / Pockney, Peter

Public health research & practice

2023 Volume 33, Issue 1

Abstract: Australia's National Bowel Cancer Screening Program (NBCSP) has the potential to prevent almost 84 000 bowel cancer deaths if 60% program participation rates could be reached and maintained over the next two decades. Immunochemical faecal occult blood ... ...

Abstract	Australia's National Bowel Cancer Screening Program (NBCSP) has the potential to prevent almost 84 000 bowel cancer deaths if 60% program participation rates could be reached and maintained over the next two decades. Immunochemical faecal occult blood test (iFOBT) is used as an initial screening tool. Participants who test positive are referred for colonoscopy for diagnostic assessment. Concerns about colonoscopy capacity and lengthy wait times between positive iFOBT and colonoscopy have hampered efforts to promote the program. However, a separate research paper published in this issue of PHRP shows that only an estimated 10-14% of Medicare-funded colonoscopies (almost 75% of all colonoscopies) in Australia are generated by the NBCSP. Inappropriate use of colonoscopy as a primary screening tool and failure to prioritise NBCSP participants may be the main reasons for long colonoscopy wait times associated with the program. Promoting clinical practice guidelines, and the Direct Access Colonoscopy initiative for priority patients, are key to reducing colonoscopy wait times and proactive promotion of the NBCSP.
MeSH term(s)	Aged ; Humans ; Colorectal Neoplasms/diagnosis ; Colorectal Neoplasms/prevention & control ; Early Detection of Cancer ; National Health Programs ; Australia ; Colonoscopy ; Mass Screening
Language	English
Publishing date	2023-03-15
Publishing country	Australia
Document type	Journal Article
ISSN	2204-2091
ISSN (online)	2204-2091
DOI	10.17061/phrp3312305
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Article ; Online: Combining sarcopenia and ASA status to inform emergency laparotomy outcomes: could it be that simple?

Ming, Yan Joyce / Howley, Peter / Holmes, Merran / Gani, Jon / Pockney, Peter

ANZ journal of surgery

2023 Volume 93, Issue 7-8, Page(s) 1811–1816

Abstract: Background: Risk assessment for emergency laparotomy (EL) is important for guiding decision-making and anticipating the level of perioperative care in acute clinical settings. While established tools such as the American College of Surgeons National ... ...

Abstract	Background: Risk assessment for emergency laparotomy (EL) is important for guiding decision-making and anticipating the level of perioperative care in acute clinical settings. While established tools such as the American College of Surgeons National Surgical Quality Improvement Program calculator (ACS-NSQIP), the National Emergency Laparotomy Audit Risk Prediction Calculator (NELA) and the Portsmouth Physiological and Operative Severity Score for the enumeration of Mortality and Morbidity calculation (P-POSSUM) are accurate predictors for mortality, there has been increasing recognition of the benefits from including measurements for frailty in a simple and quantifiable manner. Psoas muscle to 3rd lumbar vertebra area ratio (PM:L3) measured on CT scans was proven to have a significant inverse association with 30-, 90- and 365-day mortality in EL patients. Methods: A retrospective analysis was conducted of 500 patients admitted to four Australian hospitals who underwent EL during 2016-2017, and had contemporaneous abdomino-pelvic CT scans. Radiological sarcopenia was measured as PM:L3 ratios. ASC-NSQIP, NELA and P-POSSUM were retrospectively calculated. Univariate and multivariate logistic regression modelling was used to assess these ratios and scores, as well as American Society of Anaesthesiologists (ASA) classification separated into ASA I-III and IV/V (simplified ASA), as potential predictors of 30-, 90- and 365-day mortality. Results: PM:L3, simplified ASA, ACS-NSQIP, NELA and P-POSSUM were each statistically significant predictors of 30-day, 90-day and 365-day mortality (P < 0.001). Logistic regression models of 30-, 90- and 365-day mortality combining PM:L3 (P = 0.001) and simplified ASA (P < 0.001) exhibited AUCs of 0.838 (0.780, 0.896), 0.805 (0.751, 0.860) and 0.775 (0.729, 0.822), respectively, which were comparable to that of ACS-NSQIP and NELA. Conclusion: Combining the semi-physiological parameter ASA classification with PM:L3 provides a quick and simple alternative to the more complex established risk assessment scores and is superior to PM:L3 alone.
MeSH term(s)	Humans ; Retrospective Studies ; Laparotomy ; Sarcopenia/complications ; Sarcopenia/diagnostic imaging ; Australia/epidemiology ; Risk Assessment ; Postoperative Complications/epidemiology
Language	English
Publishing date	2023-05-30
Publishing country	Australia
Document type	Journal Article
ZDB-ID	2050749-5
ISSN	1445-2197 ; 1445-1433 ; 0004-8682
ISSN (online)	1445-2197
ISSN	1445-1433 ; 0004-8682
DOI	10.1111/ans.18551
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Article ; Online: Evaluation of a Multi-Gene Methylation Blood-Test for the Detection of Colorectal Cancer.

Petit, Joel / Carroll, Georgia / Williams, Henry / Pockney, Peter / Scott, Rodney J

Medical sciences (Basel, Switzerland)

2023 Volume 11, Issue 3

Abstract: Circulating tumour DNA biomarkers are an expanding field in oncology research that offer great potential but are currently often limited in value by overall cost. The aim of this study was to evaluate the efficacy of a novel multi-gene methylation blood ... ...

Abstract	Circulating tumour DNA biomarkers are an expanding field in oncology research that offer great potential but are currently often limited in value by overall cost. The aim of this study was to evaluate the efficacy of a novel multi-gene methylation blood test for the identification of colorectal cancer and throughout the spectrum of colorectal disease. Participants were recruited either prior to resection for known CRC or prior to screening colonoscopy after a positive faecal immunochemical test. Blood was collected from participants prior to their procedure being performed. The plasma was separated, and multiplex MethylLight droplet digital PCR was used to analyse for the presence of four methylated genes:
MeSH term(s)	Humans ; Methylation ; Hematologic Tests ; Circulating Tumor DNA/genetics ; Colonic Diseases ; Cytoskeletal Proteins ; Colorectal Neoplasms/diagnosis ; Colorectal Neoplasms/genetics
Chemical Substances	Circulating Tumor DNA ; Cytoskeletal Proteins
Language	English
Publishing date	2023-09-15
Publishing country	Switzerland
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2754473-4
ISSN	2076-3271 ; 2076-3271
ISSN (online)	2076-3271
ISSN	2076-3271
DOI	10.3390/medsci11030060
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Article ; Online: A Systematic Review and Meta-Analysis of Intra-Operative Surgical Site Sampling: Culture versus Culture-Independent Techniques in Predicting Downstream Surgical Site Infection.

Vishnoi, Veral / Morey, Tristan / Hoedt, Emily C / Keely, Simon / Pockney, Peter / Smith, Stephen R

Surgical infections

2023 Volume 24, Issue 4, Page(s) 293–302

Abstract: Background: ...

Abstract	Background:
MeSH term(s)	Humans ; Surgical Wound Infection/prevention & control
Language	English
Publishing date	2023-03-24
Publishing country	United States
Document type	Systematic Review ; Meta-Analysis ; Journal Article ; Review
ZDB-ID	1440120-4
ISSN	1557-8674 ; 1096-2964
ISSN (online)	1557-8674
ISSN	1096-2964
DOI	10.1089/sur.2023.012
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Zs.A 5617: Show issues

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Article ; Online: Getting back 'home' after emergency laparotomy: how many never make it?

Holmes, Merran / Rugendyke, Anya / Ming, Yan Joyce / Howley, Peter / Gani, Jon / Pockney, Peter

ANZ journal of surgery

2023 Volume 93, Issue 10, Page(s) 2433–2438

Abstract: Background: Emergency laparotomy (EL) is performed on about 15 500 patients in Australia each year. Aside from mortality there is significant concern about the possibility that previously independent patients discharged after EL will become reliant on ... ...

Abstract	Background: Emergency laparotomy (EL) is performed on about 15 500 patients in Australia each year. Aside from mortality there is significant concern about the possibility that previously independent patients discharged after EL will become reliant on long-term dependent care. This study aimed to establish the proportion of patients not returning to their pre-admission residence, a proxy for dependent care, following EL. Methods: Data were collected on all adult patients who underwent EL across four Australian hospitals over 2 years. A total of 113 data points were collected including pre-hospital residence, discharge destination, mortality and place of residence at 90 and 365 days. Results: A total of 782 patients underwent EL, the mean age was 64 years. Pre-admission, 95.5% of patients were living in their own home. Inpatient mortality was 7.0% and at discharge 72.4% of patients returned directly back to their pre-hospital residence. At 90 days, mortality was 10.5%, and 87% of patients had returned to their pre-hospital residence, including all patients under 70 years of age. By 365 days, overall mortality was 16.8%, and only 1.5% of patients (all aged >70 years) had not returned to their pre-hospital residence. Conclusion: Patients who survive 90 and 365 days following EL nearly all return to their pre-hospital residence, with only a very small proportion of previously independent patients entering dependent care. This should help inform shared decision-making regarding emergency laparotomy in the acute setting.
MeSH term(s)	Adult ; Humans ; Middle Aged ; Aged ; Laparotomy ; Australia/epidemiology ; Hospitals ; Length of Stay ; Patient Discharge
Language	English
Publishing date	2023-09-07
Publishing country	Australia
Document type	Journal Article
ZDB-ID	2050749-5
ISSN	1445-2197 ; 1445-1433 ; 0004-8682
ISSN (online)	1445-2197
ISSN	1445-1433 ; 0004-8682
DOI	10.1111/ans.18685
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Article ; Online: Somatic symptom severity, depression and anxiety associations with pancreatitis and undifferentiated abdominal pain in surgical inpatients.

Stieler, Melissa / Carter, Gregory / Spittal, Matthew J / Campbell, Cassidy / Pockney, Peter

ANZ journal of surgery

2023 Volume 94, Issue 4, Page(s) 634–639

Abstract: Background: Somatic Symptom Disorder is a psychiatric diagnosis that describes the experience of physical symptoms and associated distress, that is disproportionate to recognized organic pathology. Somatic symptom severity (SSS) may be associated with ... ...

Abstract	Background: Somatic Symptom Disorder is a psychiatric diagnosis that describes the experience of physical symptoms and associated distress, that is disproportionate to recognized organic pathology. Somatic symptom severity (SSS) may be associated with some surgical diagnoses; particularly the complex pain associated with pancreatitis, or the diagnostic ambiguity of undifferentiated abdominal pain (UAP). We aimed to estimate the prevalence of SSS in different diagnostic groups in surgical inpatients with abdominal pain; and to estimate the magnitude and direction of any association of SSS, anxiety and depression. Methods: Cross sectional analysis (n = 465) of adult admissions with non-traumatic abdominal pain, at a tertiary hospital in Australia. We estimated SSS with the Patient Health Questionnaire-15 (PHQ-15), depression with the Patient Health Questionnaire (PHQ-9) and anxiety with the General Anxiety Disorder (GAD-7), at standard cut-points ≥ 10; comparing acute pancreatitis (n = 20), chronic pancreatitis (n = 18) and UAP (n = 64) versus other causes of abdominal pain. Results: Somatic symptoms were common, 52% having moderate and 19.6% severe SSS. There was an association between moderate SSS and pancreatitis (OR 2.11, 95% CI 1.05-4.25) and depressive symptoms and chronic pancreatitis (OR = 3.47, 95% CI 1.31-9.24). There was no significant association between the four mental health categories and UAP. Conclusions: SSS and psychological comorbidity were common in a surgical inpatients admitted for abdominal pain and equally represented across most diagnostic sub-groups. However, the pancreatitis sub-group had greater proportions with clinically significant SSS and depression, suggesting that they have a higher requirement for psychological assessment and intervention.
MeSH term(s)	Adult ; Humans ; Medically Unexplained Symptoms ; Depression/epidemiology ; Surveys and Questionnaires ; Cross-Sectional Studies ; Acute Disease ; Inpatients ; Anxiety/epidemiology ; Anxiety/etiology ; Anxiety/psychology ; Abdominal Pain/diagnosis ; Abdominal Pain/epidemiology ; Abdominal Pain/etiology ; Pancreatitis, Chronic ; Anxiety Disorders
Language	English
Publishing date	2023-12-29
Publishing country	Australia
Document type	Journal Article
ZDB-ID	2050749-5
ISSN	1445-2197 ; 1445-1433 ; 0004-8682
ISSN (online)	1445-2197
ISSN	1445-1433 ; 0004-8682
DOI	10.1111/ans.18801
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Article ; Online: Delayed Splenic Artery Pseudoaneurysm After Laparoscopic Sleeve Gastrectomy.

Peters, Luke / Zhao, Jie / Makanyengo, Samwel / Pockney, Peter

Obesity surgery

2020 Volume 31, Issue 2, Page(s) 872–874

MeSH term(s)	Aneurysm, False/diagnostic imaging ; Aneurysm, False/etiology ; Aneurysm, False/surgery ; Gastrectomy/adverse effects ; Humans ; Laparoscopy ; Obesity, Morbid/surgery ; Splenic Artery/diagnostic imaging ; Splenic Artery/surgery ; Treatment Outcome
Language	English
Publishing date	2020-08-18
Publishing country	United States
Document type	Letter
ZDB-ID	1070827-3
ISSN	1708-0428 ; 0960-8923
ISSN (online)	1708-0428
ISSN	0960-8923
DOI	10.1007/s11695-020-04914-5
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Article ; Online: Adverse Events After Inpatient Colonoscopy in Octogenarians: Patient Selection Key for Colonoscopies.

Fenton, Mark / Gani, Jon / Pockney, Peter

Journal of clinical gastroenterology

2020 Volume 54, Issue 5, Page(s) 484

MeSH term(s)	Aged, 80 and over ; Colonoscopy ; Humans ; Inpatients ; Intestinal Perforation ; Patient Selection
Language	English
Publishing date	2020-04-02
Publishing country	United States
Document type	Letter ; Comment
ZDB-ID	448460-5
ISSN	1539-2031 ; 0192-0790
ISSN (online)	1539-2031
ISSN	0192-0790
DOI	10.1097/MCG.0000000000001345
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Article ; Online: Sarcopenia 'made simple' and outcomes from emergency laparotomy.

Ming, Yan Joyce / Howley, Peter / Holmes, Merran / Gani, Jon / Pockney, Peter

ANZ journal of surgery

2022 Volume 92, Issue 12, Page(s) 3198–3203

Abstract: Background: Emergency Laparotomy (EL) is recognized as high-risk surgery with high mortality. Established surgical risk assessment tools (NELA Risk Prediction Calculator, P-POSSUM, ACS-NSQIP) are accurate predictors of morbidity and mortality. However, ... ...

Abstract	Background: Emergency Laparotomy (EL) is recognized as high-risk surgery with high mortality. Established surgical risk assessment tools (NELA Risk Prediction Calculator, P-POSSUM, ACS-NSQIP) are accurate predictors of morbidity and mortality. However, their multicomponent complexity limits their use in practice. Sarcopenia is associated with poorer surgical outcomes. This study tests for an association between a simple measure of radiological sarcopenia and mortality in EL patients in an Australian cohort. Methods: A retrospective analysis was conducted of 500 patients admitted to four Australian hospitals who underwent EL during 2016-2017. All patients had a contemporaneous abdomino-pelvic CT scan. Radiological sarcopenia was measured as the ratio of total psoas muscle area (PM) to L3 vertebral body cross sectional area (PM:L3). Patients were followed up to 12 months. Primary outcomes were 30-, 90- and 365-day mortality. Results: The mean 30-day mortality predictions for NELA, P-POSSUM and ACS-NSQIP were 11.36%, 17.28% and 11.30% respectively. PM:L3 ratio was associated with 30-, 90- and 365-day mortality (P < 0.001) and sex (P < 0.001) and negatively correlated with age (r = -0.4612; P < 0.001). Radiological sarcopenia had a weak negative correlation with NELA (r = -0.2737; P < 0.001), P-POSSUM (r = -0.1880; P < 0.001) and ACS-NSQIP (r = -0.2351; P < 0.001). The latter three metrics were significantly correlated (r > 0.5696; P < 0.001). Conclusion: Radiological sarcopenia (CT-assessed PM:L3) is a significant predictor of mortality in EL patients in Australia. The results of this study suggest that radiological sarcopenia is equivalent to established risk assessment tools. The more timely and easily accessible CT-assessed PM:L3 metric is potentially automatable and may have significant utility in clinical practice.
MeSH term(s)	Humans ; Laparotomy ; Sarcopenia/complications ; Sarcopenia/diagnostic imaging ; Retrospective Studies ; Australia/epidemiology ; Postoperative Complications
Language	English
Publishing date	2022-05-16
Publishing country	Australia
Document type	Journal Article
ZDB-ID	2050749-5
ISSN	1445-2197 ; 1445-1433 ; 0004-8682
ISSN (online)	1445-2197
ISSN	1445-1433 ; 0004-8682
DOI	10.1111/ans.17759
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Zs.A 180: Show issues

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Article ; Online: Parental decision regret among Australian parents after consenting to or refusing hypospadias repair for their son: Results of a survey with controls.

Vavilov, Sergey / Roberts, Elysa / Smith, Grahame H H / Starkey, Malcolm / Pockney, Peter / Deshpande, Aniruddh V

Journal of pediatric urology

2022 Volume 18, Issue 4, Page(s) 482–488

Abstract: Introduction: Parental decision regret in hypospadias surgery is a recognised source of long-lasting psycho-social morbidity. High parental decision regret after their child's hypospadias repair is reported. The aim of this study is to report on ... ...

Abstract	Introduction: Parental decision regret in hypospadias surgery is a recognised source of long-lasting psycho-social morbidity. High parental decision regret after their child's hypospadias repair is reported. The aim of this study is to report on decision regret in Australian parents, who accepted and declined surgery for their son and explore underlying factors for decision-making, satisfaction, and regret. Materials and methods: An online anonymous survey was administered to three groups of parents: 1) parents who consented for hypospadias repair, 2) parents who declined repair and 3) a control group who requested circumcision for their child. Operations occurred between 2010 and 2020 in two paediatric hospitals in New South Wales, Australia. The survey included a validated decision regret assessment tool and additional questions to explore the possible basis of the opinions. Results: One hundred and eighteen parents (invited - 381, completed - 116, response rate - 31%) participated in the survey. Decision regret was present in group 1 (n = 89) - 55% (moderate-to-severe 15%), in group 2 (n = 14) - 71% (moderate-to-severe 57%), and in the control group (n = 15) - 15% (moderate-to-severe 8%) of parents. There was a significant difference in the median decision regret score between all three groups. Parents who chose hypospadias repair were mostly concerned about function. Conclusions: The prevalence of decision regret among Australian parents who consented for their son's hypospadias repair was lower compared with the mean decision regret reported in the literature to date (55% vs 65%). Decision regret and its severity were highest among parents who declined hypospadias repair. New strategies are needed to reduce decision regret in parents whether they elect for surgery or not.
MeSH term(s)	Child ; Male ; Female ; Humans ; Hypospadias/surgery ; Decision Making ; Australia ; Parents ; Surveys and Questionnaires ; Emotions
Language	English
Publishing date	2022-05-13
Publishing country	England
Document type	Journal Article
ZDB-ID	2237683-5
ISSN	1873-4898 ; 1477-5131
ISSN (online)	1873-4898
ISSN	1477-5131
DOI	10.1016/j.jpurol.2022.04.023
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