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  1. Article ; Online: Acute infections in people who inject drugs.

    Stevenson, Neil / Suttie, Stuart / Fernandes, Eduardo / Rae, Nikolas

    BMJ (Clinical research ed.)

    2022  Volume 379, Page(s) e072635

    MeSH term(s) Drug Users ; HIV Infections ; Humans ; Substance Abuse, Intravenous/complications
    Language English
    Publishing date 2022-10-07
    Publishing country England
    Document type Journal Article
    ZDB-ID 1362901-3
    ISSN 1756-1833 ; 0959-8154 ; 0959-8146 ; 0959-8138 ; 0959-535X ; 1759-2151
    ISSN (online) 1756-1833
    ISSN 0959-8154 ; 0959-8146 ; 0959-8138 ; 0959-535X ; 1759-2151
    DOI 10.1136/bmj-2022-072635
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  2. Article: Enhancing junior doctors' working lives.

    Forsythe, Rachael O / Suttie, Stuart A

    Surgery (Oxford, Oxfordshire)

    2020  Volume 38, Issue 10, Page(s) 607–611

    Abstract: Junior doctor wellbeing has been a topic of increasing interest in recent years. There is increasing evidence of poor workplace satisfaction, rising levels of burnout and increasing diaspora of UK-trained junior doctors. There is therefore a pressing ... ...

    Abstract Junior doctor wellbeing has been a topic of increasing interest in recent years. There is increasing evidence of poor workplace satisfaction, rising levels of burnout and increasing diaspora of UK-trained junior doctors. There is therefore a pressing need to address the wellbeing of our trainees and recent concerted efforts at local, national and international levels are working towards this, with the ultimate goal of also improving patient care. The tension between the personal and the professional may never be so keenly felt as during the unique challenges we are facing this year, in 2020, as we tackle the biggest global health emergency of our lives brought about by COVID-19. There are many positive examples of new initiatives aimed at supporting the medical community at this time; however, we must all work together to sustain these endeavors in post-pandemic times. We here summarize a number of pertinent issues affecting trainee wellbeing, outline current attempts at addressing these and make further suggestions as how to enhance the working lives of our junior doctors. However there is much still to be done.
    Keywords covid19
    Language English
    Publishing date 2020-08-30
    Publishing country England
    Document type Journal Article ; Review
    ZDB-ID 2180570-2
    ISSN 1878-1764 ; 0263-9319
    ISSN (online) 1878-1764
    ISSN 0263-9319
    DOI 10.1016/j.mpsur.2020.07.002
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  3. Article ; Online: REPAIRS Delphi: A UK and Ireland Consensus Statement on the Management of Infected Arterial Pseudoaneurysms Secondary to Groin Injecting Drug Use.

    MacLeod, Caitlin S / Nagy, John / Radley, Andrew / Khan, Faisel / Rae, Nikolas / Wilson, Michael S J / Suttie, Stuart A

    European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery

    2024  

    Abstract: Objective: Consensus guidelines on the optimal management of infected arterial pseudoaneurysms secondary to groin injecting drug use are lacking. This pathology is a problem in the UK and globally, and operative management options remain contentious. ... ...

    Abstract Objective: Consensus guidelines on the optimal management of infected arterial pseudoaneurysms secondary to groin injecting drug use are lacking. This pathology is a problem in the UK and globally, and operative management options remain contentious. This study was designed to establish consensus to promote better management of these patients, drawing on the expert experience of those in a location with a high prevalence of illicit drug use.
    Methods: A three round modified Delphi was undertaken, systematically surveying consultant vascular surgeons in the UK and Ireland using an online platform. Seventy five vascular surgery units were invited to participate, with one consultant providing the unit consensus practice. Round one responses were thematically analysed to generate statements for round two. These statements were evaluated by participants using a five point Likert scale. Consensus was achieved at a threshold of 70% or more agreement or disagreement. Those statements not reaching consensus were assessed and modified for round three. The results of the Delphi process constituted the consensus statement.
    Results: Round one received 64 (86%) responses, round two 59 (79%) responses, and round three 62 (83%) responses; 73 out of 75 (97%) units contributed. Round two comprised 150 statements and round three 24 statements. Ninety one statements achieved consensus agreement and 15 consensus disagreement. The Delphi statements covered sequential management of these patients from diagnosis and imaging, antibiotics and microbiology, surgical approach, wound management, follow up, and additional considerations. Pre-operative imaging achieved consensus agreement (97%), with computerised tomography angiogram being the modality of choice (97%). Ligation and debridement without arterial reconstruction was the preferred approach at initial surgical intervention (89%). Multidisciplinary management, ensuring holistic care and access to substance use services, also gained consensus agreement.
    Conclusion: This comprehensive consensus statement provides a strong insight into the standard of care for these patients.
    Language English
    Publishing date 2024-04-23
    Publishing country England
    Document type Journal Article
    ZDB-ID 1225869-6
    ISSN 1532-2165 ; 1078-5884
    ISSN (online) 1532-2165
    ISSN 1078-5884
    DOI 10.1016/j.ejvs.2024.04.016
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  4. Article ; Online: Management of the infected arterial pseudoaneurysm secondary to groin injecting drug use and outcomes: a systematic review protocol.

    MacLeod, Caitlin Sara / Radley, Andrew / Strachan, David / Khan, Faisel / Nagy, John / Suttie, Stuart

    BMJ open

    2023  Volume 13, Issue 6, Page(s) e070615

    Abstract: Introduction: People who inject drugs are at risk of a range of injecting-related infections and injuries, which can threaten life and limb. In parallel to escalating rates of drug-related deaths seen in Scotland and the UK, there has also been an ... ...

    Abstract Introduction: People who inject drugs are at risk of a range of injecting-related infections and injuries, which can threaten life and limb. In parallel to escalating rates of drug-related deaths seen in Scotland and the UK, there has also been an increase in hospital admissions for skin and soft tissue infections related to injecting drug use. One such injecting complication is the infected arterial pseudoaneurysm, which risks rupture and life-threatening haemorrhage. Surgical management options for the infected arterial pseudoaneurysm secondary to groin injecting drug use remain contentious, with some advocates for ligation and debridement alone, whilst others promote acute arterial reconstruction (suture or patch repair, bypass or, more recently, endovascular stent-graft placement). Rates of major lower limb amputations related to surgical management for this pathology vary in the literature. This review aims to evaluate the outcomes of arterial ligation alone compared with arterial reconstruction, including open and endovascular options, for the infected arterial pseudoaneurysm secondary to groin injecting drug use.
    Methods and analysis: The methods will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. Three electronic databases will be searched and the resultant papers screened according to the study inclusion and exclusion criteria (detailed in the Population, Intervention, Comparison, Outcomes and Study design statement). Grey literature will be excluded. All papers at each stage will be screened by two independent authors, with disagreements arbitrated by a third. Papers will be subject to appropriate standardised quality assessments.
    Primary outcome: Major lower limb amputation.
    Secondary outcomes: Reintervention rate, rebleeding rate, development of chronic limb-threatening ischaemia 30-day mortality and claudication.
    Ethics and dissemination: This is a systematic review based on previously conducted studies, therefore, no ethical approval is required. The results of this work will be published in a peer-reviewed journal and presented at relevant conferences.
    Prospero registration number: CRD42022358209.
    MeSH term(s) Humans ; Aneurysm, False/etiology ; Aneurysm, False/surgery ; Arteries ; Groin ; Intermittent Claudication ; Substance-Related Disorders ; Systematic Reviews as Topic/methods ; Vascular Surgical Procedures
    Language English
    Publishing date 2023-06-15
    Publishing country England
    Document type Journal Article
    ZDB-ID 2599832-8
    ISSN 2044-6055 ; 2044-6055
    ISSN (online) 2044-6055
    ISSN 2044-6055
    DOI 10.1136/bmjopen-2022-070615
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  5. Article: The prognostic value of clinical frailty and American Society of Anesthesiology score in patients with chronic limb threatening ischaemia.

    Walter, Amy / Bradley, Nicholas / Flett, Murray / Nagy, John / Suttie, Stuart / Guthrie, Graeme

    VASA. Zeitschrift fur Gefasskrankheiten

    2023  Volume 52, Issue 5, Page(s) 302–309

    MeSH term(s) Humans ; Middle Aged ; Prognosis ; Frailty/diagnosis ; Frailty/complications ; Frailty/epidemiology ; Chronic Limb-Threatening Ischemia ; Anesthesiology ; Hospitalization
    Language English
    Publishing date 2023-08-02
    Publishing country Switzerland
    Document type Journal Article
    ZDB-ID 120977-2
    ISSN 1664-2872 ; 0301-1526
    ISSN (online) 1664-2872
    ISSN 0301-1526
    DOI 10.1024/0301-1526/a001085
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  6. Article: Enhancing junior doctors' working lives

    Forsythe, Rachael O / Suttie, Stuart A

    Surgery (Oxford)

    Abstract: Junior doctor wellbeing has been a topic of increasing interest in recent years. There is increasing evidence of poor workplace satisfaction, rising levels of burnout and increasing diaspora of UK-trained junior doctors. There is therefore a pressing ... ...

    Abstract Junior doctor wellbeing has been a topic of increasing interest in recent years. There is increasing evidence of poor workplace satisfaction, rising levels of burnout and increasing diaspora of UK-trained junior doctors. There is therefore a pressing need to address the wellbeing of our trainees and recent concerted efforts at local, national and international levels are working towards this, with the ultimate goal of also improving patient care. The tension between the personal and the professional may never be so keenly felt as during the unique challenges we are facing this year, in 2020, as we tackle the biggest global health emergency of our lives brought about by COVID-19. There are many positive examples of new initiatives aimed at supporting the medical community at this time; however, we must all work together to sustain these endeavors in post-pandemic times. We here summarize a number of pertinent issues affecting trainee wellbeing, outline current attempts at addressing these and make further suggestions as how to enhance the working lives of our junior doctors. However there is much still to be done.
    Keywords covid19
    Publisher WHO
    Document type Article
    Note WHO #Covidence: #733687
    Database COVID19

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  7. Article ; Online: Predicting necrotising soft tissue infections in people who inject drugs: poor performance of the Laboratory Risk Indicator for Necrotising Fasciitis score and development of a novel clinical predictive nomogram in a retrospective cohort with internal validation.

    MacLeod, Caitlin S / O'Neill, Hannah L / Shaalan, Ramy / Nagy, John / Flett, Murray M / Guthrie, Graeme J K / McLeod, Graeme / Suttie, Stuart A

    International journal of surgery (London, England)

    2023  Volume 109, Issue 6, Page(s) 1561–1572

    Abstract: Introduction: Necrotising soft tissue infections (NSTI) can threaten life and limb. Early identification and urgent surgical debridement are key for improved outcomes. NSTI can be insidious. Scoring systems, like the Laboratory Risk Indicator for ... ...

    Abstract Introduction: Necrotising soft tissue infections (NSTI) can threaten life and limb. Early identification and urgent surgical debridement are key for improved outcomes. NSTI can be insidious. Scoring systems, like the Laboratory Risk Indicator for Necrotising Fasciitis (LRINEC), exist to aid diagnosis. People who inject drugs (PWID) are high risk for NSTI. This study aimed to assess the utility of the LRINEC in PWID with lower limb infections and develop a predictive nomogram.
    Methods: A retrospective database of all hospital admissions due to limb-related complications secondary to injecting drug use between December 2011 and December 2020 was compiled through discharge codes and a prospectively maintained Vascular Surgery database. All lower limb infections were extracted from this database, dichotomised by NSTI and non-NSTI with the LRINEC applied. Specialty management times were evaluated. Statistical analyses involved: chi-square; Analysis of "variance"; Kaplan-Meier, and receiver operating characteristic curves. Nomograms were developed to facilitate diagnosis and predict survival.
    Results: There were 557 admissions for 378 patients, with 124 (22.3%; 111 patients) NSTI. Time from admission to: theatre and computed tomography imaging respectively varied significantly between specialties ( P =0.001). Surgical specialties were faster than medical ( P =0.001). Vascular surgery received the most admissions and had the quickest time to theatre. During follow-up there were 79 (20.9%) deaths: 27 (24.3%) NSTI and 52 (19.5%) non-NSTI. LRINEC ≥6 had a positive predictive value of 33.3% and sensitivity of 74% for NSTI. LRINEC <6 had a negative predictive value of 90.7% and specificity of 63.2% for non-NSTI. Area under the curve was 0.697 (95% CI: 0.615-0.778). Nomogram models found age, C-reactive protein, and non-linear albumin to be significant predictors of NSTI, with age, white cell count, sodium, creatinine, C-reactive protein, and albumin being significant in predicting survival on discharge.
    Conclusion: There was reduced performance of the LRINEC in this PWID cohort. Diagnosis may be enhanced through use of this predictive nomogram.
    MeSH term(s) Humans ; Fasciitis, Necrotizing/diagnosis ; Fasciitis, Necrotizing/etiology ; Soft Tissue Infections/diagnosis ; Soft Tissue Infections/etiology ; Soft Tissue Infections/therapy ; Retrospective Studies ; Nomograms ; C-Reactive Protein ; Drug Users ; Substance Abuse, Intravenous/complications ; Risk Factors ; Albumins
    Chemical Substances C-Reactive Protein (9007-41-4) ; Albumins
    Language English
    Publishing date 2023-06-01
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2212038-5
    ISSN 1743-9159 ; 1743-9191
    ISSN (online) 1743-9159
    ISSN 1743-9191
    DOI 10.1097/JS9.0000000000000367
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  8. Article ; Online: The Needle and the Damage Done: A Retrospective Review of the Health Impact of Recreational Intravenous Drug Use and the Collateral Consequences for Vascular Surgery.

    MacLeod, Caitlin S / Senior, Yashika / Lim, Jun / Mittapalli, Devender / Rae, Nikolas / Guthrie, Graeme Jk / Suttie, Stuart A

    Annals of vascular surgery

    2021  Volume 78, Page(s) 103–111

    Abstract: Background: The UK has one of the highest rates of recreational drug use and consequent deaths in Europe. Scotland is the "Drug deaths capital of Europe." Intravenous drug use can result in limb- and life-threatening pathology. This study aimed to ... ...

    Abstract Background: The UK has one of the highest rates of recreational drug use and consequent deaths in Europe. Scotland is the "Drug deaths capital of Europe." Intravenous drug use can result in limb- and life-threatening pathology. This study aimed to characterise limb-related admissions associated with intravenous drug use, outcomes and healthcare expenditure.
    Methods: Retrospective data collection between December 2011 and August 2018. Patients were identified through discharge codes. Admission details were extracted from electronic records and a database compiled. Statistical analyses were performed using Statistical Package for the Social Science, P < 0.05 denoted significance.
    Results: There were 558 admissions for 330 patients (1-9 admissions/patient), mean age 37 years (+/-7.6 SD) and 196 (59.2%; 319 admissions, 57.2%) were male. Three hundred forty-eight (62.4%) admissions were to surgical specialties, predominantly Vascular Surgery (247). Including onward referrals, Vascular ultimately managed 54.8% of admissions. Patients presented with multiple pathologies: 249 groin abscesses; 38 other abscesses; 74 pseudoaneurysms; 102 necrotising soft tissue infections (NSTI); 85 cellulitis; 138 deep venous thrombosis (DVTs); 28 infected DVTs and 70 other diagnoses. Two hundred and seventy-seven admissions (220 patients) required operations, with 361 procedures performed (1-7 operations/admission). There were 24 major limb amputations and 74 arterial ligations. Eleven amputations were due to NSTI and 13 followed ligation (17.6% of ligations). During follow-up 50 (15.2%) patients died, of which 6 (12%) had amputations (OR 3.2, 95% CI 1.04-9.61, P = 0.043). Cumulative cost of acute care was £4,783,241.
    Conclusions: Limb-related sequalae of intravenous drug use represents a substantial surgical workload, especially for Vascular. These are complex, high-risk patients with poor outcomes and high healthcare costs.
    MeSH term(s) Abscess/epidemiology ; Abscess/etiology ; Adult ; Amputation/statistics & numerical data ; Aneurysm, False/epidemiology ; Aneurysm, False/etiology ; Aneurysm, False/surgery ; Cellulitis/epidemiology ; Cellulitis/etiology ; Female ; Humans ; Length of Stay ; Male ; Retrospective Studies ; Scotland/epidemiology ; Soft Tissue Infections/epidemiology ; Soft Tissue Infections/etiology ; Soft Tissue Infections/surgery ; Specialties, Surgical ; Substance Abuse, Intravenous/complications ; Vascular Surgical Procedures ; Venous Thrombosis/epidemiology ; Venous Thrombosis/etiology ; Venous Thrombosis/surgery
    Language English
    Publishing date 2021-08-30
    Publishing country Netherlands
    Document type Journal Article
    ZDB-ID 1027366-9
    ISSN 1615-5947 ; 0890-5096
    ISSN (online) 1615-5947
    ISSN 0890-5096
    DOI 10.1016/j.avsg.2021.06.018
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  9. Article ; Online: Giant Carotid Artery Aneurysm.

    Walter, Amy M / Flett, Murray M / Nagy, John / Suttie, Stuart A / Dalton, Andrew / Casey, Matthew / Guthrie, Graeme J K

    Vascular and endovascular surgery

    2021  Volume 55, Issue 8, Page(s) 873–877

    Abstract: Carotid artery aneurysms account for 4% of peripheral aneurysms and may present as a neck mass, with hemispheric ischaemic symptoms, or with symptoms secondary to local compression. This case explores the presentation, investigations and management of a ... ...

    Abstract Carotid artery aneurysms account for 4% of peripheral aneurysms and may present as a neck mass, with hemispheric ischaemic symptoms, or with symptoms secondary to local compression. This case explores the presentation, investigations and management of a presumed mycotic common carotid artery aneurysm in a 77-year-old male, which was repaired using end-to-end interposition vein graft using long saphenous vein. This report discusses the aetiology, presentation and surgical management for carotid artery aneurysms, as well as focusing on that of the rare mycotic carotid artery aneurysm.
    MeSH term(s) Aged ; Aneurysm, Infected/diagnostic imaging ; Aneurysm, Infected/surgery ; Carotid Arteries ; Carotid Artery Diseases/diagnostic imaging ; Carotid Artery Diseases/surgery ; Carotid Artery, Internal ; Humans ; Male ; Saphenous Vein/diagnostic imaging ; Treatment Outcome
    Language English
    Publishing date 2021-05-19
    Publishing country United States
    Document type Case Reports ; Journal Article
    ZDB-ID 2076272-0
    ISSN 1938-9116 ; 1538-5744
    ISSN (online) 1938-9116
    ISSN 1538-5744
    DOI 10.1177/15385744211017114
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  10. Article ; Online: Improved arterial exposure and ergonomics with use of elasticated retractors in vascular surgery.

    Guthrie, Graeme / Mountain, Rodney / Suttie, Stuart

    The journal of vascular access

    2016  Volume 17, Issue 4, Page(s) 371–372

    Abstract: Traditional self-retaining retraction devices do not always provide adequate exposure and, on occasion, hamper economy of movement during vascular surgical procedures. We report the novel use of elasticated retractors to improve surgical exposure for ... ...

    Abstract Traditional self-retaining retraction devices do not always provide adequate exposure and, on occasion, hamper economy of movement during vascular surgical procedures. We report the novel use of elasticated retractors to improve surgical exposure for vascular access procedures that may be transferable to other vascular surgical procedures.
    MeSH term(s) Arteries/surgery ; Arteriovenous Shunt, Surgical/instrumentation ; Elasticity ; Equipment Design ; Ergonomics ; Humans ; Motor Activity ; Surgical Instruments
    Language English
    Publishing date 2016-07-12
    Publishing country Italy
    Document type Journal Article
    ZDB-ID 2252820-9
    ISSN 1724-6032 ; 1129-7298
    ISSN (online) 1724-6032
    ISSN 1129-7298
    DOI 10.5301/jva.5000523
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