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  1. Article ; Online: Perioperative optimisation in low- and middle-income countries (LMICs): A systematic review and meta-analysis of enhanced recovery after surgery (ERAS).

    Riad, Aya M / Barry, Aisling / Knight, Stephen R / Arbaugh, Carlie J / Haque, Parvez D / Weiser, Thomas G / Harrison, Ewen M

    Journal of global health

    2023  Volume 13, Page(s) 4114

    Abstract: Background: Enhanced recovery after surgery (ERAS) protocols have largely been incorporated into practice in high-income settings due to proven improvement in perioperative outcomes. We aimed to review the implementation of ERAS protocols and other ... ...

    Abstract Background: Enhanced recovery after surgery (ERAS) protocols have largely been incorporated into practice in high-income settings due to proven improvement in perioperative outcomes. We aimed to review the implementation of ERAS protocols and other perioperative optimisation strategies in low- and middle-income countries (LMICs) and their impact on length of hospital stay (LOS).
    Methods: We searched MEDLINE, PubMed, Global Health (CABI), WHO Global Index Medicus, Index Medicus, and Latin American and Caribbean Health Sciences Literature (LILACS) for studies incorporating ERAS or other prehabilitation approaches in LMICs. We conducted a pooled analysis of LOS using a random-effects model to evaluate the impact of such programs. This systematic review was pre-registered on PROSPERO.
    Results: We screened 1205 studies and included 70 for a full-text review; six were eligible for inclusion and five for quantitative analysis, two of which were randomised controlled trials. ERAS was compared to routine practice in all included studies, while none implemented prehabilitation or other preoperative optimisation strategies. Pooled analysis of 290 patients showed reduced LOS in the ERAS group with a standardised mean difference of -2.18 (95% confidence interval (CI) = -4.13, -.0.05, P < 0.01). The prediction interval was wide (95% CI = -7.85, 3.48) with substantial heterogeneity (I
    Conclusions: Perioperative optimisation is feasible in LMICs and appears to reduce LOS, despite high levels of between-study heterogeneity. There is a need for high-quality data on perioperative practice in LMICs and supplementary qualitative analysis to further understand barriers to perioperative optimisation implementation.
    Registration: PROSPERO: CRD42021279053.
    MeSH term(s) Humans ; Enhanced Recovery After Surgery ; Developing Countries ; Postoperative Complications/epidemiology ; Postoperative Complications/prevention & control ; Length of Stay ; Caribbean Region
    Language English
    Publishing date 2023-10-03
    Publishing country Scotland
    Document type Meta-Analysis ; Systematic Review ; Journal Article
    ZDB-ID 2741629-X
    ISSN 2047-2986 ; 2047-2986
    ISSN (online) 2047-2986
    ISSN 2047-2986
    DOI 10.7189/jogh.13.04114
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Response to the Comment on "Perioperative Nonsteroidal Anti-Inflammatory Drugs (NSAID) Administration and Acute Kidney Injury (AKI) in Major Gastrointestinal Surgery".

    Ahmed, Waheed-Ul-Rahman / Shafi, Shiraz Q / Riad, Aya M / Glasbey, James C / Nepogodiev, Dmitri / Drake, Thomas M

    Annals of surgery

    2021  Volume 274, Issue 6, Page(s) e876

    MeSH term(s) Acute Kidney Injury/chemically induced ; Anti-Inflammatory Agents, Non-Steroidal/adverse effects ; Digestive System Surgical Procedures ; Humans ; Pharmaceutical Preparations
    Chemical Substances Anti-Inflammatory Agents, Non-Steroidal ; Pharmaceutical Preparations
    Language English
    Publishing date 2021-02-24
    Publishing country United States
    Document type Letter ; Comment
    ZDB-ID 340-2
    ISSN 1528-1140 ; 0003-4932
    ISSN (online) 1528-1140
    ISSN 0003-4932
    DOI 10.1097/SLA.0000000000004819
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: Educational impact and recommendations from implementation of student-led clinical trial recruitment: a mixed-methods study.

    Riad, Aya M / Cambridge, William A / Henshall, David / McAdam, Heather / Drake, Thomas M / Fairfield, Cameron J / Knight, Stephen R / Sgrò, Alessandro / Shaw, Catherine / Glasbey, James C / Potter, Mark A / Harrison, Ewen M / McLean, Kenneth A

    Postgraduate medical journal

    2023  Volume 99, Issue 1171, Page(s) 484–491

    Abstract: Medical students have an essential role in medical research, yet often lack opportunities for involvement within randomised trials. This study aimed to understand the educational impact of clinical trial recruitment for medical students. Tracking wound ... ...

    Abstract Medical students have an essential role in medical research, yet often lack opportunities for involvement within randomised trials. This study aimed to understand the educational impact of clinical trial recruitment for medical students. Tracking wound infection with smartphone technology (TWIST) was a randomised controlled trial that included adult patients undergoing emergency abdominal surgery across two university teaching hospitals. All recruiters underwent prerecruitment training based on 'Generating Student Recruiters for Randomised Trials' principles, and completed prerecruitment and postrecruitment surveys. Respondent agreement with statements were assessed using 5-point Likert scales (from 1 ('strongly disagree') to 5 ('strongly agree')). Quantitative data were analysed using paired t-tests to compare differences pre-involvement and post-involvement. Thematic content analysis was performed on free-text data to generate recommendations for future student research involvement. Of 492 patients recruited to TWIST between 26 July 2016 and 4 March 2020, 86.0% (n=423) were recruited by medical students. Following introduction of student co-investigators (n=31), the overall monthly recruitment rate tripled (4.8-15.7 patients). 96.8% of recruiters (n=30/31) completed both surveys, and all respondents reported significant improvement in clinical and academic competencies. Three higher-level thematic domains emerged from the qualitative analysis: (1) engagement, (2) preparation and (3) ongoing support. Student recruitment in clinical trials is feasible and accelerates recruitment to clinical trials. Students demonstrated novel clinical research competencies and increased their likelihood of future involvement. Adequate training, support and selection of suitable trials are essential for future student involvement in randomised trials.
    MeSH term(s) Adult ; Humans ; Students, Medical ; Surveys and Questionnaires ; Clinical Competence ; Biomedical Research ; Hospitals, University
    Language English
    Publishing date 2023-06-09
    Publishing country England
    Document type Randomized Controlled Trial ; Journal Article
    ZDB-ID 80325-x
    ISSN 1469-0756 ; 0032-5473
    ISSN (online) 1469-0756
    ISSN 0032-5473
    DOI 10.1136/pmj-2022-142122
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: Characterisation of in-hospital complications associated with COVID-19 using the ISARIC WHO Clinical Characterisation Protocol UK: a prospective, multicentre cohort study.

    Drake, Thomas M / Riad, Aya M / Fairfield, Cameron J / Egan, Conor / Knight, Stephen R / Pius, Riinu / Hardwick, Hayley E / Norman, Lisa / Shaw, Catherine A / McLean, Kenneth A / Thompson, A A Roger / Ho, Antonia / Swann, Olivia V / Sullivan, Michael / Soares, Felipe / Holden, Karl A / Merson, Laura / Plotkin, Daniel / Sigfrid, Louise /
    de Silva, Thushan I / Girvan, Michelle / Jackson, Clare / Russell, Clark D / Dunning, Jake / Solomon, Tom / Carson, Gail / Olliaro, Piero / Nguyen-Van-Tam, Jonathan S / Turtle, Lance / Docherty, Annemarie B / Openshaw, Peter Jm / Baillie, J Kenneth / Harrison, Ewen M / Semple, Malcolm G

    Lancet (London, England)

    2021  Volume 398, Issue 10296, Page(s) 223–237

    Abstract: Background: COVID-19 is a multisystem disease and patients who survive might have in-hospital complications. These complications are likely to have important short-term and long-term consequences for patients, health-care utilisation, health-care system ...

    Abstract Background: COVID-19 is a multisystem disease and patients who survive might have in-hospital complications. These complications are likely to have important short-term and long-term consequences for patients, health-care utilisation, health-care system preparedness, and society amidst the ongoing COVID-19 pandemic. Our aim was to characterise the extent and effect of COVID-19 complications, particularly in those who survive, using the International Severe Acute Respiratory and Emerging Infections Consortium WHO Clinical Characterisation Protocol UK.
    Methods: We did a prospective, multicentre cohort study in 302 UK health-care facilities. Adult patients aged 19 years or older, with confirmed or highly suspected SARS-CoV-2 infection leading to COVID-19 were included in the study. The primary outcome of this study was the incidence of in-hospital complications, defined as organ-specific diagnoses occurring alone or in addition to any hallmarks of COVID-19 illness. We used multilevel logistic regression and survival models to explore associations between these outcomes and in-hospital complications, age, and pre-existing comorbidities.
    Findings: Between Jan 17 and Aug 4, 2020, 80 388 patients were included in the study. Of the patients admitted to hospital for management of COVID-19, 49·7% (36 367 of 73 197) had at least one complication. The mean age of our cohort was 71·1 years (SD 18·7), with 56·0% (41 025 of 73 197) being male and 81·0% (59 289 of 73 197) having at least one comorbidity. Males and those aged older than 60 years were most likely to have a complication (aged ≥60 years: 54·5% [16 579 of 30 416] in males and 48·2% [11 707 of 24 288] in females; aged <60 years: 48·8% [5179 of 10 609] in males and 36·6% [2814 of 7689] in females). Renal (24·3%, 17 752 of 73 197), complex respiratory (18·4%, 13 486 of 73 197), and systemic (16·3%, 11 895 of 73 197) complications were the most frequent. Cardiovascular (12·3%, 8973 of 73 197), neurological (4·3%, 3115 of 73 197), and gastrointestinal or liver (0·8%, 7901 of 73 197) complications were also reported.
    Interpretation: Complications and worse functional outcomes in patients admitted to hospital with COVID-19 are high, even in young, previously healthy individuals. Acute complications are associated with reduced ability to self-care at discharge, with neurological complications being associated with the worst functional outcomes. COVID-19 complications are likely to cause a substantial strain on health and social care in the coming years. These data will help in the design and provision of services aimed at the post-hospitalisation care of patients with COVID-19.
    Funding: National Institute for Health Research and the UK Medical Research Council.
    MeSH term(s) Age Factors ; Aged ; COVID-19/complications ; COVID-19/epidemiology ; Cardiovascular Diseases ; Clinical Protocols/standards ; Comorbidity ; Female ; Hospital Mortality ; Hospitalization ; Hospitals ; Humans ; Male ; Nervous System Diseases ; Prospective Studies ; Respiratory Tract Diseases ; SARS-CoV-2 ; United Kingdom/epidemiology ; World Health Organization
    Language English
    Publishing date 2021-09-03
    Publishing country England
    Document type Journal Article ; Multicenter Study ; Research Support, Non-U.S. Gov't
    ZDB-ID 3306-6
    ISSN 1474-547X ; 0023-7507 ; 0140-6736
    ISSN (online) 1474-547X
    ISSN 0023-7507 ; 0140-6736
    DOI 10.1016/S0140-6736(21)00799-6
    Database MEDical Literature Analysis and Retrieval System OnLINE

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