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  1. Article ; Online: Mobile devices and wearable technology for measuring patient outcomes after surgery

    Stephen R. Knight / Nathan Ng / Athanasios Tsanas / Kenneth Mclean / Claudia Pagliari / Ewen M. Harrison

    npj Digital Medicine, Vol 4, Iss 1, Pp 1-

    a systematic review

    2021  Volume 14

    Abstract: Abstract Complications following surgery are common and frequently occur the following discharge. Mobile and wearable digital health interventions (DHI) provide an opportunity to monitor and support patients during their postoperative recovery. Lack of ... ...

    Abstract Abstract Complications following surgery are common and frequently occur the following discharge. Mobile and wearable digital health interventions (DHI) provide an opportunity to monitor and support patients during their postoperative recovery. Lack of high-quality evidence is often cited as a barrier to DHI implementation. This review captures and appraises the current use, evidence base and reporting quality of mobile and wearable DHI following surgery. Keyword searches were performed within Embase, Cochrane Library, Web of Science and WHO Global Index Medicus databases, together with clinical trial registries and Google scholar. Studies involving patients undergoing any surgery requiring skin incision where postoperative outcomes were measured using a DHI following hospital discharge were included, with DHI defined as mobile and wireless technologies for health to improve health system efficiency and health outcomes. Methodological reporting quality was determined using the validated mobile health evidence reporting and assessment (mERA) guidelines. Bias was assessed using the Cochrane Collaboration tool for randomised studies or MINORS depending on study type. Overall, 6969 articles were screened, with 44 articles included. The majority (n = 34) described small prospective study designs, with a high risk of bias demonstrated. Reporting standards were suboptimal across all domains, particularly in relation to data security, prior patient engagement and cost analysis. Despite the potential of DHI to improve postoperative patient care, current progress is severely restricted by limitations in methodological reporting. There is an urgent need to improve reporting for DHI following surgery to identify patient benefit, promote reproducibility and encourage sustainability.
    Keywords Computer applications to medicine. Medical informatics ; R858-859.7
    Subject code 300
    Language English
    Publishing date 2021-11-01T00:00:00Z
    Publisher Nature Portfolio
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  2. Article ; Online: Use of Renal Replacement Therapy May Influence Graft Outcomes following Liver Transplantation for Acute Liver Failure

    Stephen R Knight / Gabriel C Oniscu / Luke Devey / Kenneth J Simpson / Stephen J Wigmore / Ewen M Harrison

    PLoS ONE, Vol 11, Iss 3, p e

    A Propensity-Score Matched Population-Based Retrospective Cohort Study.

    2016  Volume 0148782

    Abstract: Introduction Acute kidney injury is associated with a poor prognosis in acute liver failure but little is known of outcomes in patients undergoing transplantation for acute liver failure who require renal replacement therapy. Methods A retrospective ... ...

    Abstract Introduction Acute kidney injury is associated with a poor prognosis in acute liver failure but little is known of outcomes in patients undergoing transplantation for acute liver failure who require renal replacement therapy. Methods A retrospective analysis of the United Kingdom Transplant Registry was performed (1 January 2001-31 December 2011) with patient and graft survival determined using Kaplan-Meier methods. Cox proportional hazards models were used together with propensity-score based full matching on renal replacement therapy use. Results Three-year patient and graft survival for patients receiving renal replacement therapy were 77.7% and 72.6% compared with 85.1% and 79.4% for those not requiring renal replacement therapy (P<0.001 and P = 0.009 respectively, n = 725). In a Cox proportional hazards model, renal replacement therapy was a predictor of both patient death (hazard ratio (HR) 1.59, 95% CI 1.01-2.50, P = 0.044) but not graft loss (HR 1.39, 95% CI 0.92-2.10, P = 0.114). In groups fully matched on baseline covariates, those not receiving renal replacement therapy with a serum creatinine greater than 175 μmol/L had a significantly worse risk of graft failure than those receiving renal replacement therapy. Conclusion In patients being transplanted for acute liver failure, use of renal replacement therapy is a strong predictor of patient death and graft loss. Those not receiving renal replacement therapy with an elevated serum creatinine may be at greater risk of early graft failure than those receiving renal replacement therapy. A low threshold for instituting renal replacement therapy may therefore be beneficial.
    Keywords Medicine ; R ; Science ; Q
    Subject code 610 ; 616
    Language English
    Publishing date 2016-01-01T00:00:00Z
    Publisher Public Library of Science (PLoS)
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  3. Article ; Online: Remote diagnosis of surgical-site infection using a mobile digital intervention

    Kenneth A. McLean / Katie E. Mountain / Catherine A. Shaw / Thomas M. Drake / Riinu Pius / Stephen R. Knight / Cameron J. Fairfield / Alessandro Sgrò / Matt Bouamrane / William A. Cambridge / Mathew Lyons / Aya Riad / Richard J. E. Skipworth / Stephen J. Wigmore / Mark A. Potter / Ewen M. Harrison / TWIST Collaborators

    npj Digital Medicine, Vol 4, Iss 1, Pp 1-

    a randomised controlled trial in emergency surgery patients

    2021  Volume 9

    Abstract: Abstract Surgical site infections (SSI) cause substantial morbidity and pose a burden to acute healthcare services after surgery. We aimed to investigate whether a smartphone-delivered wound assessment tool can expedite diagnosis and treatment of SSI ... ...

    Abstract Abstract Surgical site infections (SSI) cause substantial morbidity and pose a burden to acute healthcare services after surgery. We aimed to investigate whether a smartphone-delivered wound assessment tool can expedite diagnosis and treatment of SSI after emergency abdominal surgery. This single-blinded randomised control trial (NCT02704897) enroled adult emergency abdominal surgery patients in two tertiary care hospitals. Patients were randomised (1:1) to routine postoperative care or additional access to a smartphone-delivered wound assessment tool for 30-days postoperatively. Patient-reported SSI symptoms and wound photographs were requested on postoperative days 3, 7, and 15. The primary outcome was time-to-diagnosis of SSI (Centers for Disease Control definition). 492 patients were randomised (smartphone intervention: 223; routine care: 269). There was no significant difference in the 30-day SSI rate between trial arms: 21 (9.4%) in smartphone vs 20 (7.4%, p = 0.513) in routine care. Among the smartphone group, 32.3% (n = 72) did not utilise the tool. There was no significant difference in time-to-diagnosis of SSI for patients receiving the intervention (−2.5 days, 95% CI: −6.6−1.6, p = 0.225). However, patients in the smartphone group had 3.7-times higher odds of diagnosis within 7 postoperative days (95% CI: 1.02−13.51, p = 0.043). The smartphone group had significantly reduced community care attendance (OR: 0.57, 95% CI: 0.34−0.94, p = 0.030), similar hospital attendance (OR: 0.76, 95% CI: 0.28−1.96, p = 0.577), and significantly better experiences in accessing care (OR: 2.02, 95% CI: 1.17−3.53, p = 0.013). Smartphone-delivered wound follow-up is feasible following emergency abdominal surgery. This can facilitate triage to the appropriate level of assessment required, allowing earlier postoperative diagnosis of SSI.
    Keywords Computer applications to medicine. Medical informatics ; R858-859.7
    Subject code 610
    Language English
    Publishing date 2021-11-01T00:00:00Z
    Publisher Nature Portfolio
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  4. Article ; Online: Malnutrition and nutritional screening in patients undergoing surgery in low and middle income countries

    Debra Jones / Stephen R. Knight / Jana Sremanakova / Marie Carmela M. Lapitan / Ahmad U. Qureshi / Thomas M. Drake / Stephen Tabiri / Dhruva Ghosh / Maria Thomas / Pamela A. Kingsley / Sudha Sundar / Mayaba Maimbo / Edwin Yenli / Catherine Shaw / Apple P. Valparaiso / Aneel Bhangu / Laura Magill / John Norrie / Tracey E. Roberts /
    Evropi Theodoratou / Thomas G. Weiser / Ewen M. Harrison / Sorrel T. Burden / NIHR Global Health Research Unit on Global Surgery

    JCSM Clinical Reports, Vol 7, Iss 4, Pp 79-

    A systematic review

    2022  Volume 92

    Abstract: Abstract Background There is a high incidence of preoperative undernutrition in hospitalised patients in low and middle‐income countries (LMICs), leading to increased postoperative complications, length of hospital stay and early mortality. Review aims ... ...

    Abstract Abstract Background There is a high incidence of preoperative undernutrition in hospitalised patients in low and middle‐income countries (LMICs), leading to increased postoperative complications, length of hospital stay and early mortality. Review aims are to establish the prevalence of undernutrition and assess the use of validated nutritional screening tools in surgical patients across LMICs. Methods Protocol was PRISMA compliant and Prospero registered (CRD42019126765). Twelve international databases were searched from January 1990 to April 2021. Included studies were on nutritional screening in adults (≥16 years) undergoing surgery in LMICs. Two researchers screened studies and assessed quality. Prevalence of undernutrition was presented as a weighted percentage with confidence intervals (CI). Results Of the 4649 records identified, 16 studies (n = 4032) were eligible. Subjective global assessment (SGA) or patient generated (PG)‐SGA were the tools used most widely. SGA and PG‐SGA showed a high prevalence of undernutrition overall (0.61, 95% CI 0.50, 0.73), with a proportion identified with moderate undernutrition (0.44, 95% CI 0.31, 0.57) or severe undernutrition (0.32, 95% CI 0.19, 0.45). Conclusions Data show the prevalence of undernutrition in surgical patients as high as three in five patients within LMICs. Results indicate that the SGA is suitable for assessing this group of patients and that it may be the most appropriate tool to use due to its subjectivity and reliability. PG‐SGA although similar includes more symptom assessment, which is important for nutritionally depleted cancer patients. The limited data on validity and reliability of nutritional screening tools in LMICs indicates further research is required.
    Keywords Low and middle income countries ; Malnutrition ; Nutritional screening ; Surgical patients ; Systematic review ; Internal medicine ; RC31-1245
    Subject code 610
    Language English
    Publishing date 2022-10-01T00:00:00Z
    Publisher Wiley
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  5. Article ; Online: Impact of malnutrition on early outcomes after cancer surgery

    Aya Riad / Stephen R Knight / Dhruv Ghosh / Pamela A Kingsley / Marie Carmela Lapitan / Marie Dione Parreno-Sacdalan / Sudha Sundar / Ahmad Uzair Qureshi / Apple P Valparaiso / Riinu Pius / Catherine A Shaw / Thomas M Drake / Lisa Norman / Adesoji O Ademuyiwa / Adewale O Adisa / Maria Lorena Aguilera / Sara W Al-Saqqa / Ibrahim Al-Slaibi / Aneel Bhangu /
    Bruce M Biccard / Peter Brocklehurst / Sorrel Burden / Kathryn Chu / Ainhoa Costas-Chavarri / Anna J Dare / Muhammed Elhadi / Cameron J Fairfield / J Edward Fitzgerald / James Glasbey / Mark I. van Berge Henegouwen / J.C. Allen Ingabire / T Peter Kingham / Ismaïl Lawani / Bettina Lieske / Richard Lilford / Laura Magill / Mayaba Maimbo / Janet Martin / Sonia Mathai / Kenneth A McLean / Rachel Moore / Dion Morton / Dmitri Nepogodiev / John Norrie / Faustin Ntirenganya / Francesco Pata / Thomas Pinkney / Rajkumar Kottayasamy Seenivasagam / Antonio Ramos-De la Medina / Tracey E Roberts

    The Lancet Global Health, Vol 11, Iss 3, Pp e341-e

    an international, multicentre, prospective cohort study

    2023  Volume 349

    Abstract: Summary: Background: Malnutrition represents a key priority for global health policy, yet the impact of nutritional state on cancer surgery worldwide remains poorly described. We aimed to analyse the effect of malnutrition on early postoperative outcomes ...

    Abstract Summary: Background: Malnutrition represents a key priority for global health policy, yet the impact of nutritional state on cancer surgery worldwide remains poorly described. We aimed to analyse the effect of malnutrition on early postoperative outcomes following elective surgery for colorectal or gastric cancer. Methods: We did an international, multicentre, prospective cohort study of patients undergoing elective surgery for colorectal or gastric cancer between April 1, 2018, and Jan 31, 2019. Patients were excluded if the primary pathology was benign, they presented with cancer recurrence, or if they underwent emergency surgery (within 72 h of hospital admission). Malnutrition was defined with the Global Leadership Initiative on Malnutrition criteria. The primary outcome was death or a major complication within 30 days of surgery. Multilevel logistic regression and a three-way mediation analysis were done to establish the relationship between country income group, nutritional status, and 30-day postoperative outcomes. Findings: This study included 5709 patients (4593 with colorectal cancer and 1116 with gastric cancer) from 381 hospitals in 75 countries. The mean age was 64·8 years (SD 13·5) and 2432 (42·6%) patients were female . Severe malnutrition was present in 1899 (33·3%) of 5709 patients, with a disproportionate burden in upper-middle-income countries (504 [44·4%] of 1135) and low-income and lower-middle-income countries (601 [62·5%] of 962). After adjustment for patient and hospital risk factors, severe malnutrition was associated with an increased risk of 30-day mortality across all country income groups (high income: adjusted odds ratio [aOR] 1·96 [95% CI 1·14–3·37], p=0·015; upper-middle income: 3·05 [1·45–6·42], p=0·003; low income and lower-middle income: 11·57 [5·87–22·80], p<0·0001). Severe malnutrition mediated an estimated 32% of early deaths in low-income and lower-middle-income countries (aOR 1·41 [95% CI 1·22–1·64]) and an estimated 40% of early deaths in upper-middle-income countries ...
    Keywords Public aspects of medicine ; RA1-1270
    Subject code 610
    Language English
    Publishing date 2023-03-01T00:00:00Z
    Publisher Elsevier
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  6. Article ; Online: Effects of hospital facilities on patient outcomes after cancer surgery

    Stephen R Knight / Catherine A Shaw / Riinu Pius / Thomas M Drake / Lisa Norman / Adesoji O Ademuyiwa / Adewale O Adisa / Maria Lorena Aguilera / Sara W Al-Saqqa / Ibrahim Al-Slaibi / Aneel Bhangu / Bruce M Biccard / Peter Brocklehurst / Ainhoa Costas-Chavarri / Kathryn Chu / Anna Dare / Muhammed Elhadi / Cameron J Fairfield / J Edward Fitzgerald /
    Dhruv Ghosh / James Glasbey / Mark I. van Berge Henegouwen / J.C. Allen Ingabire / T Peter Kingham / Marie Carmela Lapitan / Ismaïl Lawani / Bettina Lieske / Richard Lilford / Janet Martin / Kenneth A McLean / Rachel Moore / Dion Morton / Dmitri Nepogodiev / Faustin Ntirenganya / Francesco Pata / Thomas Pinkney / Ahmad Uzair Qureshi / Antonio Ramos-De la Medina / Aya Riad / Hosni Khairy Salem / Joana Simões / Richard Spence / Neil Smart / Stephen Tabiri / Hannah Thomas / Thomas G Weiser / Malcolm West / John Whitaker / Ewen M Harrison / Arben Gjata

    The Lancet Global Health, Vol 10, Iss 7, Pp e1003-e

    an international, prospective, observational study

    2022  Volume 1011

    Abstract: Summary: Background: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of ... ...

    Abstract Summary: Background: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23–0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery ...
    Keywords Public aspects of medicine ; RA1-1270
    Subject code 616
    Language English
    Publishing date 2022-07-01T00:00:00Z
    Publisher Elsevier
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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