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Article ; Online: The impact of COVID19 on the presentation, diagnosis and management of cutaneous melanoma and squamous cell carcinoma in a single tertiary referral centre.

McClean, Adam / Matteucci, Paolo / Totty, Joshua

Journal of plastic, reconstructive & aesthetic surgery : JPRAS

2022 Volume 75, Issue 8, Page(s) 2831–2870

MeSH term(s)	COVID-19 ; COVID-19 Testing ; Carcinoma, Squamous Cell/diagnosis ; Carcinoma, Squamous Cell/pathology ; Carcinoma, Squamous Cell/therapy ; Humans ; Melanoma/diagnosis ; Melanoma/pathology ; Melanoma/therapy ; Neoplasm Staging ; Skin Neoplasms/diagnosis ; Skin Neoplasms/pathology ; Skin Neoplasms/therapy ; Tertiary Care Centers ; Melanoma, Cutaneous Malignant
Language	English
Publishing date	2022-06-22
Publishing country	Netherlands
Document type	Letter
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.2022.06.062
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Article ; Online: The diagnostic test accuracy of telemedicine for detection of surgical site infection: A systematic review protocol.

Lathan, Ross / Sidapra, Misha / Yiasemidou, Marina / Long, Judith / Totty, Joshua / Smith, George / Chetter, Ian

PloS one

2022 Volume 17, Issue 11, Page(s) e0263549

Abstract: Since the COVID-19 pandemic there has been a rapid uptake and utilisation of telemedicine in all aspects of healthcare. This presents a key opportunity in surgical site infection surveillance. Remote follow up methods have been used via telephone, with ... ...

Abstract	Since the COVID-19 pandemic there has been a rapid uptake and utilisation of telemedicine in all aspects of healthcare. This presents a key opportunity in surgical site infection surveillance. Remote follow up methods have been used via telephone, with photographs and questionnaires for post-operative reviews with varying results. This review therefore aims to comprehensively synthesise available evidence for the diagnostic accuracy of all forms of SSI telemedicine monitoring. The protocol has been established as per both PRISMA-P (S1 Table) and the Cochrane handbook for reviews of diagnostic test accuracy. Medline, Embase, CENTRAL and CINAHL will be searched using a complete search strategy developed with librarian input, in addition to google scholar and hand searching. All study designs with patients over 18 and undergone a primarily closed surgical procedure will be eligible. Index tests will include all forms of telemedicine and a subgroup analysis performed for each of these. Comparative tests must include face to face review, and all reference standards will be included again for sub-group analyses. Search results will be screened by two investigators independently with a third providing consensus review on disagreements. Methodological quality will be assessed using the QUADAS-2 tool, first validated by two investigators as per the Cochrane handbook. Exploratory analysis will formulate summary receiver operating characteristic curves and forest plots with estimates of sensitivity and specificity of the included studies. Sources of heterogeneity will be identifying and investigated through further analysis. Potential benefits of telemedicine integration in surgical practice will reduce cost and travel time to patients in addition to avoiding wasted clinic appointments, important considerations in a peri-pandemic era. To avoid missed or further complications, there must be confidence in the ability to diagnose infection. This review will systematically determine whether telemedicine is accurate for surgical site infection diagnosis, which methods are well established and if further research is indicated.
MeSH term(s)	Humans ; Surgical Wound Infection/diagnosis ; Diagnostic Tests, Routine ; Pandemics ; COVID-19/diagnosis ; Systematic Reviews as Topic ; Meta-Analysis as Topic ; Telemedicine/methods ; Review Literature as Topic
Language	English
Publishing date	2022-11-17
Publishing country	United States
Document type	Journal Article
ZDB-ID	2267670-3
ISSN	1932-6203 ; 1932-6203
ISSN (online)	1932-6203
ISSN	1932-6203
DOI	10.1371/journal.pone.0263549
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Article ; Online: Diagnostic accuracy of telemedicine for detection of surgical site infection: a systematic review and meta-analysis.

Lathan, Ross / Sidapra, Misha / Yiasemidou, Marina / Long, Judith / Totty, Joshua / Smith, George / Chetter, Ian

NPJ digital medicine

2022 Volume 5, Issue 1, Page(s) 108

Abstract: The Sars-CoV-2 pandemic catalysed integration of telemedicine worldwide. This systematic review assesses it's accuracy for diagnosis of Surgical Site Infection (SSI). Databases were searched for telemedicine and wound infection studies. All types of ... ...

Abstract	The Sars-CoV-2 pandemic catalysed integration of telemedicine worldwide. This systematic review assesses it's accuracy for diagnosis of Surgical Site Infection (SSI). Databases were searched for telemedicine and wound infection studies. All types of studies were included, only paired designs were taken to meta-analysis. QUADAS-2 assessed methodological quality. 1400 titles and abstracts were screened, 61 full text reports were assessed for eligibility and 17 studies were included in meta-analysis, mean age was 47.1 ± 13.3 years. Summary sensitivity and specificity was 87.8% (95% CI, 68.4-96.1) and 96.8% (95% CI 93.5-98.4) respectively. The overall SSI rate was 5.6%. Photograph methods had lower sensitivity and specificity at 63.9% (95% CI 30.4-87.8) and 92.6% (95% CI, 89.9-94.5). Telemedicine is highly specific for SSI diagnosis is highly specific, giving rise to great potential for utilisation excluding SSI. Further work is needed to investigate feasibility telemedicine in the elderly population group.
Language	English
Publishing date	2022-08-03
Publishing country	England
Document type	Journal Article
ISSN	2398-6352
ISSN (online)	2398-6352
DOI	10.1038/s41746-022-00655-0
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Article ; Online: Extracorporeal shockwave therapy compared with standard care for diabetic foot ulcer healing: An updated systematic review.

Hitchman, Louise / Totty, Joshua / Smith, George E / Carradice, Daniel / Twiddy, Maureen / Iglesias, Cynthia / Russell, David / Chetter, Ian C

International wound journal

2022 Volume 20, Issue 6, Page(s) 2303–2320

Abstract: Emerging evidence suggests that extracorporeal shockwave therapy (ESWT) may improve time to DFU healing. The aim of this review was to appraise the evidence on role of ESWT in DFU healing and impact of different ESWT doses. Databases were searched for ... ...

Abstract	Emerging evidence suggests that extracorporeal shockwave therapy (ESWT) may improve time to DFU healing. The aim of this review was to appraise the evidence on role of ESWT in DFU healing and impact of different ESWT doses. Databases were searched for trials comparing ESWT plus standard care to standard care alone in participants with DFUs. Search results were reviewed by two independent reviewers. The Cochrane Risk of Bias 2 tool and GRADE approach was used to assess bias and certainty. The primary outcome was time to healing. The search identified 345 papers after duplicates removed. Six trials consisting of 471 participants were included. There was unclear or high risk of bias across all domains. Time to ulcer healing was probably shorter in patients treated with ESWT compared with standard ulcer care alone (GRADE: low certainty). Patients treated with ESWT were more likely to heal at 20 weeks post-ESWT compared with those treated with standard ulcer care alone (GRADE: low certainty). There was significant heterogeneity. ESWT remains a promising new treatment but the translation into routine clinical practice is still limited by the low certainty of evidence surrounding its effectiveness, case selection and optimum dose.
MeSH term(s)	Humans ; Diabetic Foot/therapy ; Extracorporeal Shockwave Therapy/methods ; Treatment Outcome ; Wound Healing ; Diabetes Mellitus
Language	English
Publishing date	2022-12-03
Publishing country	England
Document type	Systematic Review ; Journal Article ; Review
ZDB-ID	2170920-8
ISSN	1742-481X ; 1742-4801
ISSN (online)	1742-481X
ISSN	1742-4801
DOI	10.1111/iwj.14035
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Article: PRESS survey: PREvention of surgical site infection-a global pan-specialty survey of practice protocol.

Heinz, J / Walshaw, J / Kwan, J Y / Long, J / Carradice, D / Totty, J / Kontouli, K M / Lainas, P / Hitchman, L / Smith, G / Huo, B / Guadalajara, H / Garcia-Olmo, D / Sharma, D / Biyani, C S / Tomlinson, J / Loubani, M / Galli, R / Lathan, R /

Chetter, I / Yiasemidou, M

Frontiers in surgery

2023 Volume 10, Page(s) 1251444

Abstract: Background: Surgical site infections (SSI) complicate up to 40% of surgical procedures, leading to increased patient morbidity and mortality. Previous research identified disparities in SSI prevention guidelines and clinical practices across different ... ...

Abstract	Background: Surgical site infections (SSI) complicate up to 40% of surgical procedures, leading to increased patient morbidity and mortality. Previous research identified disparities in SSI prevention guidelines and clinical practices across different institutions. The study aims to identify variations in SSI prevention practices within and between specialties and financial systems and provide a representation of existing SSI preventative measures to help improve the standardization of SSI prevention practices. Methods: This collaborative cross-sectional survey will be aimed at pan-surgical specialties internationally. The study has been designed and will be reported in line with the CROSS and CHERRIES standards. An international study steering committee will design and internally validate the survey in multiple consensus-based rounds. This will be based on SSI prevention measures outlined in the CDC (2017), WHO (2018), NICE (2019), Wounds UK (2020) and the International Surgical Wound Complications Advisory Panel (ISWCAP) guidelines. The questionnaire will include demographics, SSI surveillance, preoperative, peri-operative and postoperative SSI prevention. Data will be collected on participants' surgical specialty, operative grade, of practice and financial healthcare system of practice. The online survey will be designed and disseminated using Qualtrics Discussion: Current SSI prevention practice in UK Vascular surgery varies considerably, with little consensus on many measures. Given the inconsistency in guidelines on how to prevent SSIs, there is a need for standardization. This survey will investigate the disparity in SSI preventative measures between different surgical fields and countries.
Language	English
Publishing date	2023-09-25
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2773823-1
ISSN	2296-875X
ISSN	2296-875X
DOI	10.3389/fsurg.2023.1251444
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Article ; Online: Life-threatening intraoperative anaphylaxis as a result of chlorhexidine present in Instillagel.

Totty, Joshua / Forsyth, James / Mekako, Anthony / Chetter, Ian

BMJ case reports

2017 Volume 2017

Abstract: A 70-year-old man with left lower limb critical ischaemia was admitted to our vascular unit for a femoral-popliteal bypass. He had experienced a skin reaction to chlorhexidine 6 months previously during an angioplasty procedure. After intubation, once in ...

Abstract	A 70-year-old man with left lower limb critical ischaemia was admitted to our vascular unit for a femoral-popliteal bypass. He had experienced a skin reaction to chlorhexidine 6 months previously during an angioplasty procedure. After intubation, once in the operating theatre, the patient had a urinary catheter inserted using Instillagel. Around 30 min later the patient had a full-blown anaphylactic reaction that required aggressive medical management and the abandoning of surgery. Postoperative allergy testing confirmed that the suspected primary trigger for the anaphylaxis was indeed chlorhexidine, which was present in Instillagel. The patient was also found to have allergies to atracurium and teicoplanin, which had been given on induction. This case report highlights the importance of recognising that Instillagel contains chlorhexidine, and that indeed intraurethral use during routine urinary catheterisation can be a cause of life-threatening anaphylaxis.
MeSH term(s)	Aged ; Anaphylaxis/diagnosis ; Anaphylaxis/drug therapy ; Anaphylaxis/etiology ; Anti-Infective Agents, Local/adverse effects ; Chlorhexidine/adverse effects ; Diagnosis, Differential ; Drug Combinations ; Femoral Artery/physiopathology ; Humans ; Intraoperative Complications/chemically induced ; Intraoperative Complications/diagnosis ; Intraoperative Complications/drug therapy ; Ischemia/surgery ; Lidocaine/adverse effects ; Lower Extremity/blood supply ; Male ; Urinary Catheterization/adverse effects ; Vascular Surgical Procedures/adverse effects
Chemical Substances	Anti-Infective Agents, Local ; Drug Combinations ; chlorhexidine gluconate, lidocaine drug combination (8060-72-8) ; Lidocaine (98PI200987) ; Chlorhexidine (R4KO0DY52L)
Language	English
Publishing date	2017-08-21
Publishing country	England
Document type	Case Reports ; Journal Article
ISSN	1757-790X
ISSN (online)	1757-790X
DOI	10.1136/bcr-2017-221443
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Article ; Online: Characterising non-melanoma skin cancer undergoing surgical management during the COVID-19 pandemic.

Capitelli-McMahon, Helen / Hurley, Anna / Pinder, Richard / Matteucci, Paolo / Totty, Joshua

Journal of plastic, reconstructive & aesthetic surgery : JPRAS

2020 Volume 74, Issue 3, Page(s) 644–710

MeSH term(s)	Aged ; COVID-19/epidemiology ; COVID-19/prevention & control ; Carcinoma, Basal Cell/epidemiology ; Carcinoma, Basal Cell/pathology ; Carcinoma, Squamous Cell/epidemiology ; Carcinoma, Squamous Cell/pathology ; England/epidemiology ; Female ; Health Services Accessibility/statistics & numerical data ; Health Services Accessibility/trends ; Health Services Needs and Demand ; Humans ; Incidence ; Male ; Margins of Excision ; Neoplasm Staging ; Reconstructive Surgical Procedures/adverse effects ; Reconstructive Surgical Procedures/methods ; Retrospective Studies ; SARS-CoV-2 ; Skin Neoplasms/epidemiology ; Skin Neoplasms/pathology ; Time-to-Treatment/trends ; Tumor Burden
Keywords	covid19
Language	English
Publishing date	2020-11-02
Publishing country	Netherlands
Document type	Letter
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.2020.10.042
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Article ; Online: Extracorporeal Shockwave Therapy for Peripheral Arterial Disease: A Review of the Potential Mechanisms of Action.

Raza, Ali / Harwood, Amy / Totty, Joshua / Smith, George / Chetter, Ian

Annals of vascular surgery

2017 Volume 45, Page(s) 294–298

Abstract: Background: Lower limb peripheral arterial disease (PAD) affects 20% of population over 65 years. Extracorporeal shockwave therapy (ESWT) has recently emerged as a novel, safe, and effective treatment option. This review aims to assess the mechanism of ... ...

Abstract	Background: Lower limb peripheral arterial disease (PAD) affects 20% of population over 65 years. Extracorporeal shockwave therapy (ESWT) has recently emerged as a novel, safe, and effective treatment option. This review aims to assess the mechanism of action by which ESWT improves symptoms in patients with PAD. Methods: MEDLINE and EMBASE databases were searched in line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Any article investigating the mechanism of action of ESWT in PAD was considered for inclusion. Results: The systematic review of the current literature yielded 8 relevant articles reporting studies on animal models of hind limb ischemia or on patients with PAD. These articles described the effects of ESWT on angiogenesis, arteriogenesis, vasculogenesis, endothelial nitric oxide synthase, lower limb micro/macrocirculation, and atherosclerosis. Conclusion: ESWT increases the expression of angiogenic, arteriogenic, and vasculogenic factors, reduces vessel wall stenosis, and improves limb perfusion. However, most of the evidence is based on animal studies. Future research should focus on elucidating the mechanism of action of ESWT in PAD patients.
Language	English
Publishing date	2017-11
Publishing country	Netherlands
Document type	Journal Article ; Review
ZDB-ID	1027366-9
ISSN	1615-5947 ; 0890-5096
ISSN (online)	1615-5947
ISSN	0890-5096
DOI	10.1016/j.avsg.2017.06.133
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Article ; Online: Incomplete surgical excision of keratinocyte skin cancers: a systematic review and meta-analysis.

Nolan, G S / Kiely, A L / Totty, J P / Wormald, J C R / Wade, R G / Arbyn, M / Jain, A

The British journal of dermatology

2020 Volume 184, Issue 6, Page(s) 1033–1044

Abstract: Background: Keratinocyte or nonmelanoma skin cancer (NMSC) is the commonest malignancy worldwide. The usual treatment is surgical excision. Current guidelines underestimate incomplete excision rates.: Objectives: We aimed to determine the risk of ... ...

Abstract	Background: Keratinocyte or nonmelanoma skin cancer (NMSC) is the commonest malignancy worldwide. The usual treatment is surgical excision. Current guidelines underestimate incomplete excision rates. Objectives: We aimed to determine the risk of incomplete excision of NMSCs through a systematic review and meta-analysis of primary clinical studies. Methods: A PRISMA-compliant systematic review and meta-analysis was performed using methodology proposed by Cochrane (PROSPERO CRD42019157936). A comprehensive search strategy was applied to MEDLINE, Embase, Scopus, CINAHL, EMCare, Cochrane Library and the grey literature (January 2000-27 November 2019). All studies were included except those on Mohs micrographic surgery, frozen section or biopsies. Abstract screening and data extraction were performed in duplicate. Risk of bias was assessed using a tool for prevalence/incidence studies. The primary outcome was the proportion of incomplete surgical excisions. A random-effects model for pooling of binomial data was used. Differences between proportions were assessed by subgroup meta-analysis and meta-regression, which were presented as risk ratios (RRs). Results: Searching identified 3477 records, with 110 studies included, comprising 53 796 patients with 106 832 basal cell carcinomas (BCCs) and 21 569 squamous cell carcinomas (SCCs). The proportion of incomplete excisions for BCC was 11·0% [95% confidence interval (CI) 9·7-12·4] and for SCC 9·4% (95% CI 7·6-11·4). Proportions of incomplete excisions by specialty were: dermatology, BCCs 6·2% and SCCs 4·7%; plastic surgery, BCCs 9·4% and SCCs 8·2%; general practitioners, BCCs 20·4% and SCCs 18·9%. The risk of incomplete excision for general practitioners was four times that of dermatologists for both BCCs (RR 3·9, 95% CI 2·0-7·3) and SCCs (RR 4·8, 95% CI 1·0-22·8). Studies were heterogeneous (I Conclusions: The proportion of incomplete excisions is higher than previously reported. Excisions performed by specialists may lower the risk of incomplete excision.
MeSH term(s)	Carcinoma, Basal Cell/epidemiology ; Carcinoma, Basal Cell/surgery ; Carcinoma, Squamous Cell/surgery ; Humans ; Keratinocytes ; Mohs Surgery ; Skin Neoplasms/surgery
Language	English
Publishing date	2020-12-30
Publishing country	England
Document type	Journal Article ; Meta-Analysis ; Review ; Systematic Review
ZDB-ID	80076-4
ISSN	1365-2133 ; 0007-0963
ISSN (online)	1365-2133
ISSN	0007-0963
DOI	10.1111/bjd.19660
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Article: Characterising non-melanoma skin cancer undergoing surgical management during the COVID-19 pandemic

Capitelli-McMahon, Helen / Hurley, Anna / Pinder, Richard / Matteucci, Paolo / Totty, Joshua

J. plast. reconstr. aesthet. surg

Keywords	covid19
Publisher	WHO
Document type	Article
Note	WHO #Covidence: #898528
Database	COVID19

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