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Article ; Online: Can virtual reality enhance the patient experience during awake invasive procedures? A systematic review of randomized controlled trials.

Boyce, Louis / Jordan, Chloe / Egan, Timothy / Sivaprakasam, Rajesh

2023 Volume 165, Issue 4, Page(s) 741–752

Abstract: Abstract: Procedural anxiety and pain negatively affect surgical outcomes and the patient experience during awake, invasive procedures (AIPs). This systematic review aims to evaluate the effect of using virtual reality (VR) to enhance the ... ...

Abstract	Abstract: Procedural anxiety and pain negatively affect surgical outcomes and the patient experience during awake, invasive procedures (AIPs). This systematic review aims to evaluate the effect of using virtual reality (VR) to enhance the intraprocedural patient experience during AIPs. PRISMA, Cochrane, and SWiM Reporting Items guidelines were followed. PubMed, EMBASE, CENTRAL, and medRxiv databases were systematically searched for randomised controlled trials (RCTs) investigating the use of immersive VR headsets to enhance the patient experience in adults undergoing AIPs. Sixteen studies were included. The VR and control groups comprised 685 and 677 patients, respectively. Patients underwent endoscopic procedures in 9 studies ("endoscopic") and interventions that involved a skin incision in 7 studies ("incision"). Eleven (of 13) studies demonstrated a favourable effect on procedural anxiety with VR use compared with standard intraprocedural care (85% [95% CI: 46%-100%], P = 0.011). Ten (of 13) studies demonstrated a favourable effect on pain with VR use (77% [95% CI: 38%-100%], P = 0.046). Seven (of 9) studies demonstrated a favourable VR effect on patient satisfaction (78% (95% CI: 44%-100%), P = 0.070). The effect of VR on physiological markers of anxiety and pain and requirements for additional pro re nata (PRN) analgesia and sedation were not clear. No significant differences in patient experience were identified between the "incision" and "endoscopic" subgroups. This review demonstrates that VR can feasibly be used to enhance the patient experience during AIPs by attenuating subjective perceptions of procedural anxiety and pain. However, further RCTs are required to elucidate the effect of VR on more objective measures of the patient experience.
MeSH term(s)	Adult ; Humans ; Wakefulness ; Randomized Controlled Trials as Topic ; Virtual Reality ; Pain ; Patient Outcome Assessment
Language	English
Publishing date	2023-10-23
Publishing country	United States
Document type	Systematic Review ; Journal Article
ZDB-ID	193153-2
ISSN	1872-6623 ; 0304-3959
ISSN (online)	1872-6623
ISSN	0304-3959
DOI	10.1097/j.pain.0000000000003086
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Zs.A 1158: Show issues

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Article: The Global Use of Artificial Intelligence in the Undergraduate Medical Curriculum: A Systematic Review.

Varma, Jonny R / Fernando, Sherwin / Ting, Brian Y / Aamir, Shahrukh / Sivaprakasam, Rajesh

Cureus

2023 Volume 15, Issue 5, Page(s) e39701

Abstract: Artificial intelligence (AI) is a rapidly advancing technology that has the potential to revolutionize medical education. AI can provide personalized learning experiences, assist with student assessment, and aid in the integration of pre-clinical and ... ...

Abstract	Artificial intelligence (AI) is a rapidly advancing technology that has the potential to revolutionize medical education. AI can provide personalized learning experiences, assist with student assessment, and aid in the integration of pre-clinical and clinical curricula. Despite the potential benefits, there is a paucity of literature investigating the use of AI in undergraduate medical education. This study aims to evaluate the role of AI in undergraduate medical curricula worldwide and compare AI to current teaching and assessment methods. This systematic review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guidelines. Texts unavailable in English were excluded alongside those not focused on medical students alone or with little mention of AI. The key search terms were "undergraduate medical education," "medical students," "medical education," and "artificial intelligence." The methodological rigor of each study was assessed using the Medical Education Research Study Quality Instrument (MERSQI). A total of 36 articles were screened from 700 initial articles, of which 11 were deemed eligible. These were categorized into the following three domains: teaching (n = 6), assessing (n = 3), and trend spotting (n = 2). AI was shown to be highly accurate in studies that directly tested its ability. The mean overall MERSQI score for all selected papers was 10.5 (standard deviation = 2.3; range = 6 to 15.5) falling below the expected score of 10.7 due to notable weaknesses in study design, sampling methods, and study outcomes. AI performance was synergized with human involvement suggesting that AI would be best employed as a supplement to undergraduate medical curricula. Studies directly comparing AI to current teaching methods demonstrated favorable performance. While shown to have a promising role, there remains a limited number of studies in the field, and further research is needed to refine and establish clear foundations to assist in its development.
Language	English
Publishing date	2023-05-30
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	2747273-5
ISSN	2168-8184
ISSN	2168-8184
DOI	10.7759/cureus.39701
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Article: Robot-assisted kidney transplantation: an update.

Spiers, Harry V M / Sharma, Videha / Woywodt, Alexander / Sivaprakasam, Rajesh / Augustine, Titus

Clinical kidney journal

2021 Volume 15, Issue 4, Page(s) 635–643

Abstract: Renal transplantation has become the gold-standard treatment for the majority of patients with established renal failure. Recent decades have seen significant progress in immunosuppressive therapies and advances in post-transplant management of ... ...

Abstract	Renal transplantation has become the gold-standard treatment for the majority of patients with established renal failure. Recent decades have seen significant progress in immunosuppressive therapies and advances in post-transplant management of recipients, resulting in improved graft and patient outcomes. However, the open technique of allograft implantation has stood the test of time, remaining largely unchanged. In a world where major advances in surgery have been facilitated by innovations in the fields of biotechnology and medical instrumentation, minimally invasive options have been introduced for the recipient undergoing kidney transplantation. In this review we present the evolution of minimally invasive kidney transplantation, with a specific focus on robot-assisted kidney transplant and the benefits it offers to specific patient groups. We also discuss the ethical concerns that must be addressed by transplant teams considering developing or referring to robotic programs.
Language	English
Publishing date	2021-11-15
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	2655800-2
ISSN	2048-8513 ; 2048-8505
ISSN (online)	2048-8513
ISSN	2048-8505
DOI	10.1093/ckj/sfab214
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Zs.A 6587: Show issues

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Article ; Online: Outcomes of Renal Transplant Recipients With SARS-CoV-2 Infection in the Eye of the Storm: A Comparative Study With Waitlisted Patients.

Mohamed, Ismail H / Chowdary, Prashanth B / Shetty, Shraddha / Sammartino, Cinzia / Sivaprakasam, Rajesh / Lindsey, Ben / Thuraisingham, Raj / Yaqoob, Muhammad M / Khurram, Muhammad A

Transplantation

2021 Volume 105, Issue 1, Page(s) 115–120

Abstract: Background: Patients with chronic kidney disease stage 5 and those on immunosuppression are particularly vulnerable and are shielded as per public health strategy. We present our experience of coronavirus disease 2019 (COVID-19) transplant patients in ... ...

Abstract	Background: Patients with chronic kidney disease stage 5 and those on immunosuppression are particularly vulnerable and are shielded as per public health strategy. We present our experience of coronavirus disease 2019 (COVID-19) transplant patients in one of the most affected parts of the UK with direct comparison to waitlisted patients. Methods: A single-center prospective study of symptomatic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) positive waitlisted and transplant patients was undertaken to compare these groups and assess clinical outcomes. Results: A total of 60 consecutive symptomatic SARS-CoV-2 positive patients were identified with 32 active waitlisted patients and 28 functioning renal transplants. Demographics were similar. The incidence of symptomatic COVID-19 in the waitlisted group was 9.9% compared to 1.9% in renal transplant patients (P < 0.001). Immunosuppression did not influence initial symptomology. Fifteen percent of patients in the waitlisted and 32% in the transplant groups died (P = 0.726). Mortality as proportion of total waitlisted (321 patients) and transplant population (1434 patients) of our centre was 1.5% and 0.6% (P < 0.001), respectively. C-reactive protein (CRP) at 48 h and peak CRP were associated with mortality in both groups while quick sequential organ failure assessment score at 48 h (P = 0.036) was associated with mortality for transplant patients. Conclusions: Incidence of COVID-19 is higher in the waitlisted population but transplant patients have more severe disease, reflected by higher mortality. CRP at 48 h can be used as a predictive tool. In the absence of effective treatments, the current strategy of shielding is arguably the most important factor in protecting patients while resuming transplantation.
MeSH term(s)	Adult ; Aged ; COVID-19/epidemiology ; Comorbidity ; Female ; Follow-Up Studies ; Humans ; Immunocompromised Host ; Immunosuppression Therapy/methods ; Immunosuppressive Agents/therapeutic use ; Kidney Failure, Chronic/epidemiology ; Kidney Failure, Chronic/surgery ; Kidney Transplantation/methods ; Male ; Middle Aged ; Pandemics ; Prospective Studies ; RNA, Viral/analysis ; SARS-CoV-2/genetics ; Transplant Recipients ; Waiting Lists
Chemical Substances	Immunosuppressive Agents ; RNA, Viral
Language	English
Publishing date	2021-01-14
Publishing country	United States
Document type	Comparative Study ; Journal Article
ZDB-ID	208424-7
ISSN	1534-6080 ; 0041-1337
ISSN (online)	1534-6080
ISSN	0041-1337
DOI	10.1097/TP.0000000000003406
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Zs.A 488: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (1.OG) ab Jg. 2022: Lesesaal (EG)
Zs.MO 509: Show issues

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Article ; Online: The management of dialysis access thrombosis during the COVID-19 pandemic.

Seet, Christopher / Lindsey, Ben / Sivaprakasam, Rajesh / McCafferty, Kieran / Forbes, Suzanne / Akhtar, Mohammed Rashid / Khurram, Muhammad / Mohamed, Ismail H

The journal of vascular access

2021 Volume 24, Issue 4, Page(s) 660–665

Abstract: Background: Maintaining patent access is essential for haemodialysis dependent end stage renal failure patients. The COVID-19 pandemic has significantly affected surgical and interventional radiology services worldwide. We aimed to review the impact ... ...

Abstract	Background: Maintaining patent access is essential for haemodialysis dependent end stage renal failure patients. The COVID-19 pandemic has significantly affected surgical and interventional radiology services worldwide. We aimed to review the impact COVID-19 has caused to the management of acute dialysis access thrombosis. Methods: We conducted a single centre retrospective review of outcomes of patients with arteriovenous fistula and arteriovenous graft thrombosis between March and May 2020, which coincided with the first peak of the COVID-19 pandemic in London, and a similar period in the previous year, March-May 2019. Outcomes in both cohorts of patients were compared, including attempts at salvage, salvage success, 1-month patency rates after salvage and subsequent surgery on the same access. We also analysed the use of tunnelled haemodialysis lines (THL), either due to failed salvage attempts or when salvage was not attempted. Results: There was a similar incidence of access thrombosis in both periods (26 cases in 2019, 38 in 2020). There were 601 patients dialysing via an arteriovenous fistula or graft in 2019, and 568 patients in 2020. Access salvage, when attempted, had similar success rates and 1-month patency (salvage success 74% vs 80%, Conclusions: During the peak of the COVID-19 pandemic, there were fewer attempts at access salvage. This was a conscious decision due to increased pressure on the healthcare system, access to emergency interventional radiology or operative theatres and the perceived risk/benefit ratio of access salvage. The long-term effects of this change in practice remain unknown.
MeSH term(s)	Humans ; Arteriovenous Fistula/etiology ; Arteriovenous Shunt, Surgical/adverse effects ; COVID-19/epidemiology ; Graft Occlusion, Vascular/diagnostic imaging ; Graft Occlusion, Vascular/etiology ; Graft Occlusion, Vascular/therapy ; Pandemics ; Renal Dialysis ; Retrospective Studies ; Thrombosis/diagnostic imaging ; Thrombosis/etiology ; Thrombosis/therapy ; Treatment Outcome ; Vascular Patency
Language	English
Publishing date	2021-09-18
Publishing country	United States
Document type	Journal Article
ZDB-ID	2252820-9
ISSN	1724-6032 ; 1129-7298
ISSN (online)	1724-6032
ISSN	1129-7298
DOI	10.1177/11297298211045578
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Zs.A 6414: Show issues

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Article ; Online: Quality assurance in surgical trials of arteriovenous grafts for haemodialysis: A systematic review, a narrative exploration and expert recommendations.

The journal of vascular access

2024 , Page(s) 11297298241236521

Abstract: Background: Introducing new procedures and challenging established paradigms requires well-designed randomised controlled trials (RCT). However, RCT in surgery present unique challenges with much of treatment tailored to the individual patient ... ...

Abstract	Background: Introducing new procedures and challenging established paradigms requires well-designed randomised controlled trials (RCT). However, RCT in surgery present unique challenges with much of treatment tailored to the individual patient circumstances, refined by experience and limited by organisational factors. There has been considerable debate over the outcomes of arteriovenous grafts (AVG) compared to AVF, but any differences may reflect differing practice and potential variability. It is essential, therefore, when considering an RCT of a novel surgical procedure or device that Method: The methods of this have been previously registered (PROSPERO: CRD420234284280) and published. In summary, a four-stage review was performed: identification of RCT of AVG, initial review, multidisciplinary appraisal of QA methods and reconciliation. QA measures were sought in four areas - generic, credentialing, standardisation and monitoring, with data abstracted by a multi-national, multi-speciality review body. Results: QA in RCT involving AVG in all four domains is highly variable, often sub-optimally described and has not improved over the past three decades. Few RCT established or defined a pre-RCT level of experience, none documented a pre-trial education programme, or had minimal standards of peri-operative management, no study had a defined pre-trial monitoring programme, and none assessed technical performance. Conclusion: QA in RCT is a relatively new area that is expanding to ensure evidence is reliable and reproducible. This review demonstrates that QA has not previously been detailed, but can be measured in surgical RCT of vascular access, and that a four-domain approach can easily be implemented into future RCT.
Language	English
Publishing date	2024-03-19
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	2252820-9
ISSN	1724-6032 ; 1129-7298
ISSN (online)	1724-6032
ISSN	1129-7298
DOI	10.1177/11297298241236521
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Zs.A 6414: Show issues

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Article ; Online: Adapting a Dialysis Service for Delivery of Percutaneous Arteriovenous Fistulas.

Lie, Geoffrey / Ahmed, Niaz / Shah, Nimesh / Eleti, Saigeet / Lam, Stefan / Elsaadany, Amr / Akhtar, Mohammed Rashid / Egan, Timothy / White, William / Sivaprakasam, Rajesh / Jaffer, Ounali

Radiographics : a review publication of the Radiological Society of North America, Inc

2022 Volume 42, Issue 6, Page(s) 1795–1811

Abstract: The percutaneous arteriovenous fistula (pAVF) is an exciting and novel addition to the vascular access options available to patients with end-stage kidney disease who require dialysis. Early clinical results have been promising, with high rates of ... ...

Abstract	The percutaneous arteriovenous fistula (pAVF) is an exciting and novel addition to the vascular access options available to patients with end-stage kidney disease who require dialysis. Early clinical results have been promising, with high rates of maturation and low rates of reintervention. To successfully adapt an existing hemodialysis service to include the provision of pAVF formation, it is essential to identify and align the interests of key clinical and nonclinical stakeholders. Only through strong collaboration can the service be supported. The authors provide a comprehensive overview of the planning fundamentals required, including the referral pathway, screening and clinical assessment, and practical procedural elements and considerations, as well as follow-up requirements such as cannulation, fistula surveillance, and maintenance. Key staffing requirements are highlighted, including those pertaining to vascular US screening and dialysis nurse training. A broad and structured planning approach ensures that the entire network of key stakeholder interests is included and provides a strong foundation for a compelling business plan to attract the necessary funding and managerial support for the service. The authors present a systematic framework of the essential considerations necessary to facilitate the planning, funding, and ultimately delivery of a successful pAVF service.
MeSH term(s)	Arteriovenous Fistula ; Arteriovenous Shunt, Surgical/methods ; Humans ; Kidney Failure, Chronic/therapy ; Renal Dialysis/methods ; Retrospective Studies ; Treatment Outcome
Language	English
Publishing date	2022-10-03
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	603172-9
ISSN	1527-1323 ; 0271-5333
ISSN (online)	1527-1323
ISSN	0271-5333
DOI	10.1148/rg.220010
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Zs.A 1751: Show issues

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Article ; Online: Outcomes and surgical complications following living-donor renal transplantation using kidneys retrieved with trans-peritoneal or retro-peritoneal hand-assisted laparoscopic nephrectomy.

Favi, Evaldo / Iesari, Samuele / Catarsini, Nivia / Sivaprakasam, Rajesh / Cucinotta, Eugenio / Manzia, Tommaso / Puliatti, Carmelo / Cacciola, Roberto

Clinical transplantation

2020 Volume 34, Issue 12, Page(s) e14113

Abstract: The best minimally invasive procedure for living-donor kidney retrieval remains debated. Our objective was to assess trans-peritoneal (TP) and retro-peritoneal (RP) hand-assisted laparoscopic donor nephrectomy (HALDN). In this single-center retrospective ...

Abstract	The best minimally invasive procedure for living-donor kidney retrieval remains debated. Our objective was to assess trans-peritoneal (TP) and retro-peritoneal (RP) hand-assisted laparoscopic donor nephrectomy (HALDN). In this single-center retrospective study, we analyzed results from 317 living-donor renal transplants (RT) performed between 2008 and 2016. Donor and recipient outcomes were compared between TP-HALDN (n = 235) and RP-HALDN (n = 82). Conversion to open nephrectomy (0.4% vs 0%; P = 1.000), intra-operative complications (1.7% vs 1.2%; P = 1.000), and 1-year overall post-operative complications (11.9% vs 17.1%; P = .258) rates were similar in TP-HALDN and RP-HALDN. Overall surgical site infections were higher in RP-HALDN (6.1% vs 1.7%; P = .053), whereas incisional hernias were only recorded following TP-HALDN (3.4% vs 0%; P = .118). The duration of the procedure was 11-minute shorter for TP-HALDN than RP-HALDN (P < .001) but extraction time was equivalent (2, IQR 1.5-2.5 minutes; P = 1.000). RT following TP-HALDN and RP-HALDN showed comparable one-year death-censored allograft survival (97% vs 98.8%; P = .685), primary non-function (0.4% vs 0%; P = .290), delayed graft function (1.3% vs 4.9%; P = .077), and urological complications (2.6% vs 4.9%; P = .290) rates. In our series, donor and recipient outcomes were not substantially affected by the approach used for donor nephrectomy. TP-HALDN and RP-HALDN were both safe and effective.
MeSH term(s)	Hand-Assisted Laparoscopy/adverse effects ; Humans ; Kidney ; Kidney Transplantation/adverse effects ; Laparoscopy ; Living Donors ; Nephrectomy/adverse effects ; Retrospective Studies ; Tissue and Organ Harvesting
Language	English
Publishing date	2020-10-27
Publishing country	Denmark
Document type	Journal Article
ZDB-ID	639001-8
ISSN	1399-0012 ; 0902-0063
ISSN (online)	1399-0012
ISSN	0902-0063
DOI	10.1111/ctr.14113
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Zs.A 2204: Show issues

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Article ; Online: 'Abdominal reanimation' and massive flank hernias: Moving towards a more functional reconstruction.

Sadigh, Parviz / Burke, Josh / Nikkhah, Dariush / Sammartino, Cinzia / Puliatti, Carmelo / Sivaprakasam, Rajesh / Knowles, Charles

Journal of plastic, reconstructive & aesthetic surgery : JPRAS

2018 Volume 71, Issue 6, Page(s) 941–943

MeSH term(s)	Abdominal Wall/surgery ; Hernia, Abdominal/surgery ; Herniorrhaphy ; Quadriceps Muscle/transplantation ; Reconstructive Surgical Procedures/methods ; Surgical Flaps
Language	English
Publishing date	2018-02-06
Publishing country	Netherlands
Document type	Case Reports ; Letter ; Video-Audio Media
ZDB-ID	2217750-4
ISSN	1878-0539 ; 1748-6815 ; 0007-1226
ISSN (online)	1878-0539
ISSN	1748-6815 ; 0007-1226
DOI	10.1016/j.bjps.2018.01.024
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Article: Incidence, risk factors, and outcome of BK polyomavirus infection after kidney transplantation.

Favi, Evaldo / Puliatti, Carmelo / Sivaprakasam, Rajesh / Ferraresso, Mariano / Ambrogi, Federico / Delbue, Serena / Gervasi, Federico / Salzillo, Ilaria / Raison, Nicholas / Cacciola, Roberto

World journal of clinical cases

2019 Volume 7, Issue 3, Page(s) 270–290

Abstract: Background: Polyomavirus-associated nephropathy is a leading cause of kidney allograft failure. Therapeutic options are limited and prompt reduction of the net state of immunosuppression represents the mainstay of treatment. More recent application of ... ...

Abstract	Background: Polyomavirus-associated nephropathy is a leading cause of kidney allograft failure. Therapeutic options are limited and prompt reduction of the net state of immunosuppression represents the mainstay of treatment. More recent application of aggressive screening and management protocols for BK-virus infection after renal transplantation has shown encouraging results. Nevertheless, long-term outcome for patients with BK-viremia and nephropathy remains obscure. Risk factors for BK-virus infection are also unclear. Aim: To investigate incidence, risk factors, and outcome of BK-virus infection after kidney transplantation. Methods: This single-centre observational study with a median follow up of 57 (31-80) mo comprises 629 consecutive adult patients who underwent kidney transplantation between 2007 and 2013. Data were prospectively recorded and annually reviewed until 2016. Recipients were periodically screened for BK-virus by plasma quantitative polymerized chain reaction. Patients with BK viral load ≥ 1000 copies/mL were diagnosed BK-viremia and underwent histological assessment to rule out nephropathy. In case of BK-viremia, immunosuppression was minimized according to a prespecified protocol. The following outcomes were evaluated: patient survival, overall graft survival, graft failure considering death as a competing risk, 30-d-event-censored graft failure, response to treatment, rejection, renal function, urologic complications, opportunistic infections, new-onset diabetes after transplantation, and malignancies. We used a multivariable model to analyse risk factors for BK-viremia and nephropathy. Results: BK-viremia was detected in 9.5% recipients. Initial viral load was high (≥ 10000 copies/mL) in 66.7% and low (< 10000 copies/mL) in 33.3% of these patients. Polyomavirus-associated nephropathy was diagnosed in 6.5% of the study population. Patients with high initial viral load were more likely to experience sustained viremia (95% Conclusion: Current treatment of BK-virus infection offers sub-optimal results. Initial viremia is a valuable parameter to detect patients at increased risk of nephropathy. Panel-reactive antibody > 50% and Afro-Caribbean ethnicity are independent predictors of BK-virus infection whereas cytomegalovirus prophylaxis has a protective effect.
Language	English
Publishing date	2019-01-28
Publishing country	United States
Document type	Journal Article
ISSN	2307-8960
ISSN	2307-8960
DOI	10.12998/wjcc.v7.i3.270
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