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Article ; Online: Quality and efficacy of Multidisciplinary Team (MDT) quality assessment tools and discussion checklists: a systematic review.

Brown, George T F / Bekker, Hilary L / Young, Alastair L

2022 Volume 22, Issue 1, Page(s) 286

Abstract: Background: MDT discussion is the gold standard for cancer care in the UK. With the incidence of cancer on the rise, demand for MDT discussion is increasing. The need for efficiency, whilst maintaining high standards, is therefore clear. Paper-based MDT ...

Abstract	Background: MDT discussion is the gold standard for cancer care in the UK. With the incidence of cancer on the rise, demand for MDT discussion is increasing. The need for efficiency, whilst maintaining high standards, is therefore clear. Paper-based MDT quality assessment tools and discussion checklists may represent a practical method of monitoring and improving MDT practice. This reviews aims to describe and appraise these tools, as well as consider their value to quality improvement. Methods: Medline, EMBASE and PsycInfo were searched using pre-defined terms. The PRISMA model was followed throughout. Studies were included if they described the development of a relevant tool, or if an element of the methodology further informed tool quality assessment. To investigate efficacy, studies using a tool as a method of quality improvement in MDT practice were also included. Study quality was appraised using the COSMIN risk of bias checklist or the Newcastle-Ottawa scale, depending on study type. Results: The search returned 7930 results. 18 studies were included. In total 7 tools were identified. Overall, methodological quality in tool development was adequate to very good for assessed aspects of validity and reliability. Clinician feedback was positive. In one study, the introduction of a discussion checklist improved MDT ability to reach a decision from 82.2 to 92.7%. Improvement was also noted in the quality of information presented and the quality of teamwork. Conclusions: Several tools for assessment and guidance of MDTs are available. Although limited, current evidence indicates sufficient rigour in their development and their potential for quality improvement. Trial registration: PROSPERO ID: CRD42021234326 .
MeSH term(s)	Checklist ; Humans ; Interdisciplinary Communication ; Medical Oncology/methods ; Neoplasms/therapy ; Patient Care Team ; Quality of Health Care/standards ; Reproducibility of Results
Language	English
Publishing date	2022-03-17
Publishing country	England
Document type	Journal Article ; Systematic Review
ZDB-ID	2041352-X
ISSN	1471-2407 ; 1471-2407
ISSN (online)	1471-2407
ISSN	1471-2407
DOI	10.1186/s12885-022-09369-8
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Article ; Online: Gender representation in the authorship of general surgery journals.

Arshad, Serish R / Gallivan, Elisha R / Skinner, Helen / Burke, Joshua R / Young, Alastair L

The British journal of surgery

2023 Volume 110, Issue 4, Page(s) 513–514

MeSH term(s)	Humans ; Authorship ; Periodicals as Topic ; Publishing ; Sex Factors
Language	English
Publishing date	2023-03-31
Publishing country	England
Document type	Journal Article
ZDB-ID	2985-3
ISSN	1365-2168 ; 0263-1202 ; 0007-1323 ; 1355-7688
ISSN (online)	1365-2168
ISSN	0263-1202 ; 0007-1323 ; 1355-7688
DOI	10.1093/bjs/znad047
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Article ; Online: Gender representation in leadership roles in UK surgical societies.

Skinner, Helen / Burke, Joshua R / Young, Alastair L / Adair, Robert A / Smith, Andrew M

International journal of surgery (London, England)

2019 Volume 67, Page(s) 32–36

Abstract: Introduction: Despite making up more than half of new doctors, women are underrepresented in most surgical specialties. Various reasons have been suggested for this including issues with work-life balance, discrimination and a lack of female role models ...

Abstract	Introduction: Despite making up more than half of new doctors, women are underrepresented in most surgical specialties. Various reasons have been suggested for this including issues with work-life balance, discrimination and a lack of female role models in the specialty. We sought to quantify the extent of gender discrimination in leadership roles in surgical societies in the UK. Methods: All major Surgical Specialty Organisations were identified via the Royal College of Surgeons Website. Leadership and committee information was collected via organisation websites on 5th September 2018. All societies were then contacted requesting data including total membership, their stage of training and the gender split. Results: Of the twenty-four organisations contacted, eighteen were able to provide data. Women accounted for 11.8% (2446/20 803) of consultant and 34.3% (5267/15 366) of trainee members. 2/24 presidents; 3/26 of vice presidents; 18.1% (39/215) of executive committees and 13.5% (49/364) of wider committee members were female. Thirty-four committee members were not included as they were not surgeons (23 female; 11 male). Discussion: Despite accounting for 27% of the surgical workforce and indeed 24% of surgical society members, women account for only 2 of 24 Presidents and 18.1% (39/215) of the executive committees of surgical societies in the UK. Action should be taken so women are fairly represented in leadership roles in surgical societies with one of the benefits being more visible role models for prospective female surgeons.
MeSH term(s)	Female ; Gender Identity ; Humans ; Leadership ; Male ; Prospective Studies ; Societies, Medical/organization & administration ; Specialties, Surgical/organization & administration ; Surgeons/supply & distribution ; United Kingdom
Language	English
Publishing date	2019-05-20
Publishing country	England
Document type	Journal Article
ZDB-ID	2212038-5
ISSN	1743-9159 ; 1743-9191
ISSN (online)	1743-9159
ISSN	1743-9191
DOI	10.1016/j.ijsu.2019.05.007
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Article: Surgical Management of Non-Metastatic Pancreatic Cancer in the United Kingdom: Results of a Nationwide Survey on Current Practice.

Gemenetzis, Georgios / McKay, Siobhan / Pathak, Samir / Moir, John / Laing, Richard / Jamieson, Nigel B / Young, Alastair L / Chatzizacharias, Nikolaos A / Giovinazzo, Francesco / Roberts, Keith J

Frontiers in oncology

2021 Volume 11, Page(s) 791946

Abstract: Background: It is presently unclear what clinical pathways are followed for patients with non-metastatic PDAC in specialised centres for pancreatic surgery across the United Kingdom (UK).: Methods: Between August 2019 and August 2020 an electronic ... ...

Abstract	Background: It is presently unclear what clinical pathways are followed for patients with non-metastatic PDAC in specialised centres for pancreatic surgery across the United Kingdom (UK). Methods: Between August 2019 and August 2020 an electronic survey was conducted aiming at a national cohort of pancreatic surgeons in the UK. Participants replied to a list of standardised questions and clinical vignettes, and data were collected and analysed focusing on management preferences, resectability criteria, and contraindications to surgery. Results: Within the study period, 65 pancreatic surgeons from 27 specialist centres in the UK (96%) completed the survey. Multidisciplinary team meetings are utilised universally for the management of patients with PDAC, however, different staging systems for resectability classification are being applied. In borderline resectable PDAC, most surgeons were keen to proceed with surgical exploration post NAT, but differences were noted in preferred chemotherapy regimens. Surgeons from standard volume institutions performed fewer vein resections annually and were more likely to deem patients with locally advanced PDAC as unresectable. Intra-institutional variability in patient management was also present and ranging between 20-80%. Conclusions: Significant variability in the surgical management of non-metastatic PDAC was identified both on inter- and intra-institutional level.
Language	English
Publishing date	2021-12-23
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2649216-7
ISSN	2234-943X
ISSN	2234-943X
DOI	10.3389/fonc.2021.791946
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Article ; Online: Posterior Superior Mesenteric Artery First Dissection Versus Classical Approach in Pancreaticoduodenectomy: Outcomes of a Case-Matched Study.

Vallance, Abigail E / Young, Alastair L / Pandanaboyana, Sanjay / Lodge, Jeremy Peter / Smith, Andrew M

Pancreas

2017 Volume 46, Issue 2, Page(s) 276–281

Abstract: Objectives: Posterior superior mesenteric artery (SMA) first dissection in pancreaticoduodenectomy (PD) may allow for early assessment of resectability and aberrant anatomy. Study objectives were to compare resection margins, perioperative outcomes, ... ...

Abstract	Objectives: Posterior superior mesenteric artery (SMA) first dissection in pancreaticoduodenectomy (PD) may allow for early assessment of resectability and aberrant anatomy. Study objectives were to compare resection margins, perioperative outcomes, disease-free survival (DFS) and overall survival (OS) in patients undergoing a posterior SMA first dissection PD to a classical technique PD. Methods: Patients (n = 77) who underwent a posterior SMA first PD for adenocarcinoma were case matched for patient and tumor characteristics with patients undergoing a classical approach PD from 2006 to 2014 (n = 177). Results: The SMA first patients had an improved negative resection margin rate (27 [35.1%] vs 14 [18.2%], P = 0.042) and a higher lymph node yield (median 28 [22-34] vs 21 [17-27], P < 0.001) compared with the classical approach group. No difference was demonstrated in serious complications or 30-day mortality between the SMA first and classical approach patients (Clavien-Dindo 3/4 16 [20.8%] vs 11 [14.3%], P = 0.336; 30-day mortality 3 [3.9%] vs 3 [3.9%], P = 1.00 respectively). Median DFS and OS was similar in SMA first compared with classical approach patients (DFS, 1.6 vs 1.1 years, P = 0.122; OS, 2.5 vs 1.5 years, P = 0.220 respectively). Conclusions: A posterior SMA first approach is a comparably safe technique that may improve oncological results in PD compared with classical approach dissection.
Language	English
Publishing date	2017-02
Publishing country	United States
Document type	Journal Article
ZDB-ID	632831-3
ISSN	1536-4828 ; 0885-3177
ISSN (online)	1536-4828
ISSN	0885-3177
DOI	10.1097/MPA.0000000000000748
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Article ; Online: Variation in the Use of Resection for Colorectal Cancer Liver Metastases.

Fenton, Hayley M / Taylor, John C / Lodge, J Peter A / Toogood, Giles J / Finan, Paul J / Young, Alastair L / Morris, Eva J A

Annals of surgery

2019 Volume 270, Issue 5, Page(s) 892–898

Abstract: Objective: The aim of this study was to investigate variation in the frequency of resections for colorectal cancer liver metastases across the English NHS.: Background: Previous research has shown significant variation in access to liver resection ... ...

Abstract	Objective: The aim of this study was to investigate variation in the frequency of resections for colorectal cancer liver metastases across the English NHS. Background: Previous research has shown significant variation in access to liver resection surgery across the English NHS. This study uses more recent data to identify whether inequalities in access to liver resection still persist. Methods: All adults who underwent a major resection for colorectal cancer in an NHS hospital between 2005 and 2012 were identified in the COloRECTal cancer data Repository (CORECT-R). All episodes of care, occurring within 3 years of the initial bowel operation, corresponding to liver resection were identified. Result: During the study period 157,383 patients were identified as undergoing major resection for a colorectal tumor, of whom 7423 (4.7%) underwent ≥1 liver resections. The resection rate increased from 4.1% in 2005, reaching a plateau around 5% by 2012. There was significant variation in the rate of liver resection across hospitals (2.1%-12.2%). Patients with synchronous metastases who have their primary colorectal resection in a hospital with an onsite specialist hepatobiliary team were more likely to receive a liver resection (odds ratio 1.22; 95% confidence interval, 1.10-1.35) than those treated in one without. This effect was absent in resection for metachronous metastases. Conclusions: This study presents the largest reported population-based analysis of liver resection rates in colorectal cancer patients. Significant variation has been observed in patient and hospital characteristics and the likelihood of patients receiving a liver resection, with the data showing that proximity to a liver resection service is as important a factor as deprivation.
MeSH term(s)	Adult ; Aged ; Cohort Studies ; Colectomy/methods ; Colorectal Neoplasms/pathology ; Colorectal Neoplasms/surgery ; Disease-Free Survival ; Female ; Hepatectomy/methods ; Hepatectomy/statistics & numerical data ; Humans ; Incidence ; Kaplan-Meier Estimate ; Liver Neoplasms/mortality ; Liver Neoplasms/secondary ; Liver Neoplasms/surgery ; Logistic Models ; Male ; Middle Aged ; Neoplasm Invasiveness/pathology ; Neoplasm Staging ; Prognosis ; Registries ; Retrospective Studies ; Risk Assessment ; Survival Analysis ; United Kingdom
Language	English
Publishing date	2019-09-28
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	340-2
ISSN	1528-1140 ; 0003-4932
ISSN (online)	1528-1140
ISSN	0003-4932
DOI	10.1097/SLA.0000000000003534
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Article ; Online: Calculating the risk of a pancreatic fistula after a pancreaticoduodenectomy: a systematic review.

Vallance, Abigail E / Young, Alastair L / Macutkiewicz, Christian / Roberts, Keith J / Smith, Andrew M

HPB : the official journal of the International Hepato Pancreato Biliary Association

2015 Volume 17, Issue 11, Page(s) 1040–1048

Abstract: Background: A post-operative pancreatic fistula (POPF) is a major cause of morbidity and mortality after a pancreaticoduodenectomy (PD). This systematic review aimed to identify all scoring systems to predict POPF after a PD, consider their clinical ... ...

Abstract	Background: A post-operative pancreatic fistula (POPF) is a major cause of morbidity and mortality after a pancreaticoduodenectomy (PD). This systematic review aimed to identify all scoring systems to predict POPF after a PD, consider their clinical applicability and assess the study quality. Method: An electronic search was performed of Medline (1946-2014) and EMBASE (1996-2014) databases. Results were screened according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, and quality assessed according to the QUIPS (quality in prognostic studies) tool. Results: Six eligible scoring systems were identified. Five studies used the International Study Group on Pancreatic Fistula (ISGPF) definition. The proposed scores feature between two and five variables and of the 16 total variables, the majority (12) featured in only one score. Three scores could be fully completed pre-operatively whereas 1 score included intra-operative and two studies post-operative variables. Four scores were internally validated and of these, two scores have been subject to subsequent multicentre review. The median QUIPS score was 38 out of 50 (range 16-50). Conclusion: These scores show potential in calculating the individualized patient risk of POPF. There is, however, much variation in current scoring systems and further validation in large multicentre cohorts is now needed.
MeSH term(s)	Global Health ; Humans ; Incidence ; Pancreatic Fistula/diagnosis ; Pancreatic Fistula/epidemiology ; Pancreatic Fistula/etiology ; Pancreaticoduodenectomy/adverse effects ; Postoperative Complications/diagnosis ; Postoperative Complications/epidemiology ; Postoperative Complications/etiology ; Prognosis ; Risk Assessment/methods ; Risk Factors
Language	English
Publishing date	2015-11
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	2131251-5
ISSN	1477-2574 ; 1365-182X
ISSN (online)	1477-2574
ISSN	1365-182X
DOI	10.1111/hpb.12503
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Article ; Online: The effect of Liver Transplantation on the quality of life of the recipient's main caregiver - a systematic review.

Young, Alastair L / Rowe, Ian A / Absolom, Kate / Jones, Rebecca L / Downing, Amy / Meader, Nick / Glaser, Adam / Toogood, Giles J

Liver international : official journal of the International Association for the Study of the Liver

2017 Volume 37, Issue 6, Page(s) 794–801

Abstract: Liver transplantation (LT) is a transformative, life-saving procedure with life-long sequale for patients and their caregivers. The impact of LT on the patient's main caregiver can be underestimated. We carried out a systematic review of the impact of LT ...

Abstract	Liver transplantation (LT) is a transformative, life-saving procedure with life-long sequale for patients and their caregivers. The impact of LT on the patient's main caregiver can be underestimated. We carried out a systematic review of the impact of LT on the Health-Related Quality of Life (HRQL) of LT patients' main caregivers. We searched 13 medical databases from 1996 to 2015. We included studies with HRQL data on caregivers of patients following LT then quality assessed and narratively synthesized the findings from these studies. Of 7076 initial hits, only five studies fell within the scope of this study. In general, they showed caregiver burden persisted in the early period following LT. One study showed improvements, however, the other four showed caregiver's levels of stress, anxiety and depression, remained similar or got worse post-LT and remained above that of the normal population. It was suggested that HRQL of the patient impacted on the caregiver and vice versa and may be linked to patient outcomes. No data were available investigating which groups were at particular risk of low HRQL following LT or if any interventions could improve this. The current information about LT caregivers' needs and factors that impact on their HRQL are not adequately defined. Large studies are needed to examine the effects of LT on the patients' family and caregivers to understand the importance of caregiver support to maximize outcomes of LT for the patient and their caregivers.
Language	English
Publishing date	2017-06
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	2102783-3
ISSN	1478-3231 ; 1478-3223
ISSN (online)	1478-3231
ISSN	1478-3223
DOI	10.1111/liv.13333
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Article ; Online: The impact of advancing age on incidence of hepatectomy and post-operative outcomes in patients with colorectal cancer liver metastases: a population-based cohort study.

Vallance, Abigail E / Young, Alastair L / Kuryba, Angela / Braun, Michael / Hill, James / Jayne, David G / van der Meulen, Jan / Lodge, Jeremy P / Walker, Kate

HPB : the official journal of the International Hepato Pancreato Biliary Association

2018 Volume 21, Issue 2, Page(s) 167–174

Abstract: Background: Clinical outcomes for elderly patients undergoing liver resection for colorectal cancer (CRC) liver metastases are poorly characterised. This study aimed to investigate the impact of advancing age on the incidence of liver resection and post- ...

Abstract	Background: Clinical outcomes for elderly patients undergoing liver resection for colorectal cancer (CRC) liver metastases are poorly characterised. This study aimed to investigate the impact of advancing age on the incidence of liver resection and post-operative outcomes. Methods: Patients in the National Bowel Cancer Audit undergoing major CRC resection from 2010 to 2016 in England were included. Liver resection was identified from linked Hospital Episode Statistics data. A Cox-proportional hazards model was used to compare 3-year mortality. Results: Of 117,005 patients, 6081 underwent liver resection. For patients <65 years there was 1 liver resection per 12 cases, 65-74, 1 per 17, and ≥75, 1 per 40. 90-day mortality after liver resection increased with advancing age (<65 0.9% (26/2829), 65-74 2.8% (57/2070), ≥75 4.0% (47/1182); P < 0.001). Age was an independent risk factor for 3-year mortality. Patients 65-74 did not have adjusted mortality higher than those <65, yet age ≥75 was associated with increased overall mortality (Hazard ratio (HR) 1.47 (95% CI 1.30-1.68)) and cancer-specific mortality (HR 1.30 (95% CI 1.13-1.49)). Conclusion: Although advancing age was associated with higher rates of 90-day mortality following liver resection, 3-year mortality for patients 65-74 years was comparable to younger patients. These results will aid clinicians and patients in pre-operative decision-making.
MeSH term(s)	Age Factors ; Aged ; Clinical Decision-Making ; Colorectal Neoplasms/mortality ; Colorectal Neoplasms/pathology ; Databases, Factual ; England/epidemiology ; Hepatectomy/adverse effects ; Hepatectomy/mortality ; Humans ; Incidence ; Liver Neoplasms/mortality ; Liver Neoplasms/secondary ; Liver Neoplasms/surgery ; Middle Aged ; Patient Selection ; Risk Assessment ; Risk Factors ; Time Factors ; Treatment Outcome
Language	English
Publishing date	2018-07-31
Publishing country	England
Document type	Comparative Study ; Journal Article
ZDB-ID	2131251-5
ISSN	1477-2574 ; 1365-182X
ISSN (online)	1477-2574
ISSN	1365-182X
DOI	10.1016/j.hpb.2018.06.1808
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Article ; Online: Implantable versus cuffed external central venous catheters for the management of children and adolescents with acute lymphoblastic leukaemia.

White, Alan D / Othman, Diaa / Dawrant, Michael J / Sohrabi, Soroush / Young, Alastair L / Squire, Roly

Pediatric surgery international

2012 Volume 28, Issue 12, Page(s) 1195–1199

Abstract: Purpose: The aim of this study was to determine if there is a difference between complications for totally implantable central venous catheters (ports) and tunnelled external central venous catheters (external CVCs) that result in early removal of the ... ...

Abstract	Purpose: The aim of this study was to determine if there is a difference between complications for totally implantable central venous catheters (ports) and tunnelled external central venous catheters (external CVCs) that result in early removal of the central venous catheter (CVC) in children and adolescents with acute lymphoblastic leukaemia (ALL). Methods: All children hospitalised between November 1996 and December 2007 with ALL who had a CVC were included retrospectively. We analysed data regarding the patient's first CVC. Results: We included 322 patients. 254 received a port and 68 received an external CVC. There were 102 CVC complications that required removal of the CVC prior to the completion of chemotherapy (65 in patients with ports, 37 in patients with external CVCs). Overall complications requiring CVC removal were significantly less likely to occur in the patient's with ports (p < 0.001). Ports were significantly less likely to require removal prior to the end of treatment overall (p < 0.001) and for specific complications such as infection (p < 0.001) and dislodgement (p = 0.001). However, when adjusted for disease severity there is no difference in premature CVC removal rates. Conclusion: When patients are risk-stratified for disease severity there is no difference in rates of CVC removal prior to completion of treatment.
MeSH term(s)	Adolescent ; Catheterization, Central Venous/adverse effects ; Catheterization, Central Venous/instrumentation ; Catheters, Indwelling/adverse effects ; Child ; Child, Preschool ; Equipment Design ; Female ; Humans ; Infant ; Male ; Precursor Cell Lymphoblastic Leukemia-Lymphoma/drug therapy ; Retrospective Studies ; Young Adult
Language	English
Publishing date	2012-11-23
Publishing country	Germany
Document type	Comparative Study ; Journal Article
ZDB-ID	632773-4
ISSN	1437-9813 ; 0179-0358
ISSN (online)	1437-9813
ISSN	0179-0358
DOI	10.1007/s00383-012-3213-4
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