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  • 1
    Online Resource
    Online Resource
    Monday, 27 August 2012
    Oxford University Press (OUP) ; 2012
    In:  European Heart Journal Vol. 33, No. suppl 1 ( 2012-08-02), p. 339-653
    Details
    In: European Heart Journal, Oxford University Press (OUP), Vol. 33, No. suppl 1 ( 2012-08-02), p. 339-653
    Type of Medium: Online Resource
    ISSN: 0195-668X , 1522-9645
    URL: Article
    DOI: 10.1093/eurheartj/ehs282
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2012
    detail.hit.zdb_id: 2001908-7
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  • 2
    Online Resource
    Online Resource
    Poster session 2
    Oxford University Press (OUP) ; 2012
    In:  Cardiovascular Research Vol. 93, No. suppl 1 ( 2012-03-15), p. S52-S87
    Details
    In: Cardiovascular Research, Oxford University Press (OUP), Vol. 93, No. suppl 1 ( 2012-03-15), p. S52-S87
    Type of Medium: Online Resource
    ISSN: 0008-6363
    URL: Article
    DOI: 10.1093/cvr/cvr334
    RVK:
    WA 15000
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2012
    detail.hit.zdb_id: 1499917-1
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  • 3
    Online Resource
    Online Resource
    Measurement properties of the WHO Disability Assessment Schedule 2.0 for evaluating functional status after inpatient surgery
    Oxford University Press (OUP) ; 2022
    In:  British Journal of Surgery Vol. 109, No. 10 ( 2022-09-09), p. 968-976
    Details
    In: British Journal of Surgery, Oxford University Press (OUP), Vol. 109, No. 10 ( 2022-09-09), p. 968-976
    Abstract: Expert recommendations propose the WHO Disability Assessment Schedule (WHODAS) 2.0 as a core outcome measure in surgical studies, yet data on its long-term measurement properties remain limited. These were evaluated in a secondary analysis of the Measurement of Exercise Tolerance before Surgery (METS) prospective cohort. Methods Participants were adults (40 years of age or older) who underwent inpatient non-cardiac surgery. The 12-item WHODAS and EQ-5DTM-3L questionnaires were administered preoperatively (in person) and 1 year postoperatively (by telephone). Responsiveness was characterized using standardized response means (SRMs) and correlation coefficients between change scores. Construct validity was evaluated using correlation coefficients between 1-year scores and comparisons of WHODAS scores across clinically relevant subgroups. Results The analysis included 546 patients. There was moderate correlation between changes in WHODAS and various EQ-5DTM subscales. The strongest correlation was between changes in WHODAS and changes in the functional domains of the EQ-5D-3L—for example, mobility (Spearman’s rho 0.40, 95 per cent confidence interval [c.i.] 0.32 to 0.48) and usual activities (rho 0.45, 95 per cent c.i. 0.30 to 0.52). When compared across quartiles of EQ-5D index change, median WHODAS scores followed expected patterns of change. In subgroups with expected functional status changes, the WHODAS SRMs ranged from ‘small’ to ‘large’ in the expected directions of change. At 1 year, the WHODAS demonstrated convergence with the EQ-5D-3L functional domains, and good discrimination between patients with expected differences in functional status. Conclusion The WHODAS questionnaire has construct validity and responsiveness as a measure of functional status at 1 year after major surgery.
    Type of Medium: Online Resource
    ISSN: 0007-1323 , 1365-2168
    URL: Article
    DOI: 10.1093/bjs/znac263
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2022
    detail.hit.zdb_id: 2006309-X
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  • 4
    Online Resource
    Online Resource
    Risks to healthcare workers following tracheal intubation of patients with COVID‐19: a prospective international multicentre cohort study
    Wiley ; 2020
    In:  Anaesthesia Vol. 75, No. 11 ( 2020-11), p. 1437-1447
    Details
    In: Anaesthesia, Wiley, Vol. 75, No. 11 ( 2020-11), p. 1437-1447
    Abstract: 기관 삽관과 같은 에어로졸을 생성하는 시술에 관여하는 의 료 종사자는 COVID‐19에 걸릴 위험이 높아질 수 있다. 그러 나 그 위험의 크기는 알려져 있지 않다. 저자들은 COVID‐19 가 의심되거나 확인된 환자의 기관 삽관에 참여한 의료 종사 자를 모집하는 전향적 국제 다기관 코호트 연구를 수행하였 다. 기관 삽관 에피소드, 개인 보호장비 사용 및 이후 시술자 건강 상태에 대한 정보를 자가 보고(self‐reporting)를 통해 수집하였다. 일차 평가변수는 기관 삽관 후 자가 격리 또는 입 원이 필요한 검사실 확인 COVID‐19 진단(laboratory‐con‐ firmed COVID‐19 diagnosis) 또는 새로운 증상의 발현이었 다. 일차 평가변수와 의료 종사자 특성, 시술 관련 요인 및 개 인 보호장비 사용과의 연관성을 콕스 회귀분석(Cox regres‐ sion analysis)을 이용하여 조사하였다. 2020년 3월 23일부터 6월 2일까지 17개국의 503개 병원에서 1718명의 의료 종사자 들이 기관 삽관 에피소드 5148건을 보고하였다. 일차 평가변 수의 전체 발생률은 32일의 중앙값(사분범위[범위]: 18‐48일 [0‐116일] ) 추적관찰 동안 10.7%였다. 첫 번째 기관 삽관 이후, 7일, 14일, 21일 이내 누적 발생률은 각각 3.6%, 6.1%, 8.5%였 다. 일차 평가변수의 위험은 국가별로 다양하였으며 여성에서 더 높았지만, 다른 요인과는 관련이 없었다. COVID‐19가 의심 되거나 확인된 환자의 기관 삽관에 관여한 의료 종사자 10명 중 약 1명은 후속적으로 COVID‐19 결과를 보고하였다. 이는 필수적인 의료 서비스를 제공할 수 있는 기관 역량에 대한 인 적 자원 측면의 영향과 COVID‐19 전파에 대한 더욱 광범위한 사회적 영향을 미친다.
    Type of Medium: Online Resource
    ISSN: 0003-2409 , 1365-2044
    URL: Issue
    URL: Article
    DOI: 10.1111/anae.v75.11
    DOI: 10.1111/anae.15170
    Language: English
    Publisher: Wiley
    Publication Date: 2020
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  • 5
    Online Resource
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    Machine learning to predict myocardial injury and death after non‐cardiac surgery
    Wiley ; 2023
    In:  Anaesthesia Vol. 78, No. 7 ( 2023-07), p. 853-860
    Details
    In: Anaesthesia, Wiley, Vol. 78, No. 7 ( 2023-07), p. 853-860
    Abstract: Myocardial injury due to ischaemia within 30 days of non‐cardiac surgery is prognostically relevant. We aimed to determine the discrimination, calibration, accuracy, sensitivity and specificity of single‐layer and multiple‐layer neural networks for myocardial injury and death within 30 postoperative days. We analysed data from 24,589 participants in the Vascular Events in Non‐cardiac Surgery Patients Cohort Evaluation study. Validation was performed on a randomly selected subset of the study population. Discrimination for myocardial injury by single‐layer vs. multiple‐layer models generated areas (95%CI) under the receiver operating characteristic curve of: 0.70 (0.69–0.72) vs. 0.71 (0.70–0.73) with variables available before surgical referral, p  〈  0.001; 0.73 (0.72–0.75) vs. 0.75 (0.74–0.76) with additional variables available on admission, but before surgery, p  〈  0.001; and 0.76 (0.75–0.77) vs. 0.77 (0.76–0.78) with the addition of subsequent variables, p  〈  0.001. Discrimination for death by single‐layer vs. multiple‐layer models generated areas (95%CI) under the receiver operating characteristic curve of: 0.71 (0.66–0.76) vs. 0.74 (0.71–0.77) with variables available before surgical referral, p = 0.04; 0.78 (0.73–0.82) vs. 0.83 (0.79–0.86) with additional variables available on admission but before surgery, p = 0.01; and 0.87 (0.83–0.89) vs. 0.87 (0.85–0.90) with the addition of subsequent variables, p = 0.52. The accuracy of the multiple‐layer model for myocardial injury and death with all variables was 70% and 89%, respectively.
    Type of Medium: Online Resource
    ISSN: 0003-2409 , 1365-2044
    URL: Issue
    URL: Article
    DOI: 10.1111/anae.v78.7
    DOI: 10.1111/anae.16024
    Language: English
    Publisher: Wiley
    Publication Date: 2023
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  • 6
    Online Resource
    Online Resource
    Intra‐operative protective mechanical ventilation in lung transplantation: a randomised, controlled trial
    Wiley ; 2017
    In:  Anaesthesia Vol. 72, No. 8 ( 2017-08), p. 993-1004
    Details
    In: Anaesthesia, Wiley, Vol. 72, No. 8 ( 2017-08), p. 993-1004
    Abstract: Primary graft dysfunction occurs in up to 25% of patients after lung transplantation. Contributing factors include ventilator‐induced lung injury, cardiopulmonary bypass, ischaemia‐reperfusion injury and excessive fluid administration. We evaluated the feasibility, safety and efficacy of an open‐lung protective ventilation strategy aimed at reducing ventilator‐induced lung injury. We enrolled adult patients scheduled to undergo bilateral sequential lung transplantation, and randomly assigned them to either a control group (volume‐controlled ventilation with 5 cmH 2 O, positive end‐expiratory pressure, low tidal volumes (two‐lung ventilation 6 ml.kg −1 , one‐lung ventilation 4 ml.kg −1 )) or an alveolar recruitment group (regular step‐wise positive end‐expiratory pressure‐based alveolar recruitment manoeuvres, pressure‐controlled ventilation set at 16 cmH 2 O with 10 cmH 2 O positive end‐expiratory pressure). Ventilation strategies were commenced from reperfusion of the first lung allograft and continued for the duration of surgery. Regular PaO 2 / F I O 2 ratios were calculated and venous blood samples collected for inflammatory marker evaluation during the procedure and for the first 24 h of intensive care stay. The primary end‐point was the PaO 2 / F I O 2 ratio at 24 h after first lung reperfusion. Thirty adult patients were studied. The primary outcome was not different between groups (mean ( SD ) PaO 2 / F I O 2 ratio control group 340 (111) vs. alveolar recruitment group 404 (153); adjusted p = 0.26). Patients in the control group had poorer mean ( SD ) PaO 2 / F I O 2 ratios at the end of the surgical procedure and a longer median ( IQR [range]) time to tracheal extubation compared with the alveolar recruitment group (308 (144) vs. 402 (154) (p = 0.03) and 18 (10–27 [5–468] ) h vs. 15 (11–36 [5–115]) h (p = 0.01), respectively). An open‐lung protective ventilation strategy during surgery for lung transplantation is feasible, safe and achieves favourable ventilation parameters.
    Type of Medium: Online Resource
    ISSN: 0003-2409 , 1365-2044
    URL: Issue
    URL: Article
    DOI: 10.1111/anae.2017.72.issue-8
    DOI: 10.1111/anae.13964
    Language: English
    Publisher: Wiley
    Publication Date: 2017
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  • 7
    Online Resource
    Online Resource
    Enhanced Recovery after Surgery Program for Elective Abdominal Surgery at Three Victorian Hospitals
    SAGE Publications ; 2012
    In:  Anaesthesia and Intensive Care Vol. 40, No. 3 ( 2012-05), p. 450-459
    Details
    In: Anaesthesia and Intensive Care, SAGE Publications, Vol. 40, No. 3 ( 2012-05), p. 450-459
    Abstract: The aim of this study was to evaluate the anaesthesia care of an enhanced recovery after surgery (ERAS) program for patients having abdominal surgery in Victorian hospitals. The main outcome measure was the number of ERAS items implemented following introduction of the ERAS program. Secondary endpoints included process of care measures, outcomes and hospital stay. We used a before-and-after design; the control group was a prospective cohort (n=154) representing pre-existing practice for elective abdominal surgical patients from July 2009. The introduction of a comprehensive ERAS program took place over two months and included the education of surgeons, anaesthetists, nurses and allied health professionals. A postimplementation cohort (n=169) was enrolled in early 2010. From a total of 14 ERAS-recommended items, there were significantly more implemented in the post-ERAS period, median 8 (interquartile range 7 to 9) vs 9 (8 to 10), P 〈 0.0001. There were, however, persistent low rates of intravenous fluid restriction (25%) and early removal of urinary catheter (31%) in the post-ERAS period. ERAS patients had less pain and faster recovery parameters, and this was associated with a reduced hospital stay, geometric mean (SD) 5.7 (2.5) vs 7.4 (2.1) days, P=0.006. We found that perioperative anaesthesia practices can be readily modified to incorporate an enhanced recovery program in Victorian hospitals.
    Type of Medium: Online Resource
    ISSN: 0310-057X , 1448-0271
    URL: Article
    DOI: 10.1177/0310057X1204000310
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2012
    detail.hit.zdb_id: 2053705-0
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  • 8
    Online Resource
    Online Resource
    Communication deficiencies in research and monitoring by ethics committees
    Wiley ; 2006
    In:  Internal Medicine Journal Vol. 36, No. 2 ( 2006-02), p. 86-91
    Details
    In: Internal Medicine Journal, Wiley, Vol. 36, No. 2 ( 2006-02), p. 86-91
    Abstract: Aim: To assess the range of issues that arise for researchers, research participants and ethics committee members in the setting of a hospital‐based research environment and to develop a tool that could be used to assist in the process of monitoring. Methods: A qualitative phase comprising focus group sessions and interviews involving research participants, researchers and ethics committee members of a public teaching hospital and a quantitative phase involving distribution of a questionnaire to research participants and researchers. The data from the qualitative phase were used to assist with the development of the quantitative instrument. Descriptive statistics were derived to describe the various attitudes and practices with respect to the conduct of research. Results: The qualitative study identified issues concerning monitoring procedures and the quality of communication between researchers and study participants. The quantitative analysis showed that parts of the Explanatory Statement (also known as the Participant Information Statement) were incomprehensible to 21% of research participants; the Explanatory Statement was considered too long by 34% of researchers; 6% of researchers believed that explicit consent was not always necessary; of the participants who were out of pocket for attending a study, 53% were offered compensation; and 44% of research participants were unaware of the existence of the ethics committee. In addition, 12% of researchers felt that the quality of monitoring should be improved. Conclusions: Improvements are necessary in the communication between ethics committees and researchers and research participants, and there is a need for more effective monitoring by ethics committees of research practices. The questionnaire designed for this study could be applied in a prospective manner as a useful tool for monitoring the conduct of research.
    Type of Medium: Online Resource
    ISSN: 1444-0903 , 1445-5994
    URL: Issue
    URL: Article
    DOI: 10.1111/imj.2006.36.issue-2
    DOI: 10.1111/j.1445-5994.2006.01016.x
    Language: English
    Publisher: Wiley
    Publication Date: 2006
    detail.hit.zdb_id: 2044081-9
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  • 9
    Online Resource
    Online Resource
    Perioperative Mortality Risk Score using Pre- and Post-operative Risk Factors in Older Patients
    SAGE Publications ; 2009
    In:  Anaesthesia and Intensive Care Vol. 37, No. 3 ( 2009-05), p. 392-398
    Details
    In: Anaesthesia and Intensive Care, SAGE Publications, Vol. 37, No. 3 ( 2009-05), p. 392-398
    Abstract: We developed a risk score for 30-day postoperative mortality: the Perioperative Mortality risk score. We used a derivation cohort from a previous study of surgical patients aged 70 years or more at three large metropolitan teaching hospitals, using the significant risk factors for 30-day mortality from multivariate analysis. We summed the risk score for each of six factors creating an overall Perioperative Mortality score. We included 1012 patients and the 30-day mortality was 6%. The three preoperative factors and risk scores were (“three A's”): 1) age, years: 70 to 79=1, 80 to 89=3, 90+=6; 2) ASA physical status: ASA I or II=0, ASA III=3, ASA IV=6, ASA V=15; and 3) preoperative albumin 〈 30 g/l=2.5. The three postoperative factors and risk scores were (“three I's”) 1) unplanned intensive care unit admission =4.0; 2) systemic inflammation =3; and 3) acute renal impairment=2.5. Scores and mortality were: 〈 5=1%, 5 to 9.5=7% and ≥10=26%. We also used a preliminary validation cohort of 256 patients from a regional hospital. The area under the receiver operating characteristic curve (C-statistic) for the derivation cohort was 0.80 (95% CI 0.74 to 0.86) similar to the validation C-statistic: 0.79 (95% CI 0.70 to 0.88), P=0.88. The Hosmer-Lemeshow test (P=0.35) indicated good calibration in the validation cohort. The Perioperative Mortality score is straightforward and may assist progressive risk assessment and management during the perioperative period. Risk associated with surgical complexity and urgency could be added to this baseline patient factor Perioperative Mortality score.
    Type of Medium: Online Resource
    ISSN: 0310-057X , 1448-0271
    URL: Article
    DOI: 10.1177/0310057X0903700310
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2009
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  • 10
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    Online Resource
    Postoperative systemic inflammation after major abdominal surgery: patient‐centred outcomes
    Wiley ; 2023
    In:  Anaesthesia
    Details
    In: Anaesthesia, Wiley
    Abstract: Postoperative systemic inflammation is strongly associated with surgical outcomes, but its relationship with patient‐centred outcomes is largely unknown. Detection of excessive inflammation and patient and surgical factors associated with adverse patient‐centred outcomes should inform preventative treatment options to be evaluated in clinical trials and current clinical care. This retrospective cohort study analysed prospectively collected data from 3000 high‐risk, elective, major abdominal surgery patients in the restrictive vs. liberal fluid therapy for major abdominal surgery (RELIEF) trial from 47 centres in seven countries from May 2013 to September 2016. The co‐primary endpoints were persistent disability or death up to 90 days after surgery, and quality of recovery using a 15‐item quality of recovery score at days 3 and 30. Secondary endpoints included: 90‐day and 1‐year all‐cause mortality; septic complications; acute kidney injury; unplanned admission to intensive care/high dependency unit; and total intensive care unit and hospital stays. Patients were assigned into quartiles of maximum postoperative C‐reactive protein concentration up to day 3, after multiple imputations of missing values. The lowest (reference) group, quartile 1, C‐reactive protein ≤ 85 mg.l ‐1 , was compared with three inflammation groups: quartile 2 〉  85 mg.l ‐1 to 140 mg.l ‐1 ; quartile 3  〉  140 mg.l ‐1 to 200 mg.l ‐1 ; and quartile 4  〉  200 mg.l ‐1 to 587 mg.l ‐1 . Greater postoperative systemic inflammation had a higher adjusted risk ratio (95%CI) of persistent disability or death up to 90 days after surgery, quartile 4 vs. quartile 1 being 1.76 (1.31–2.36), p  〈  0.001. Increased inflammation was associated with increasing decline in risk‐adjusted estimated medians (95%CI) for quality of recovery, the quartile 4 to quartile 1 difference being ‐14.4 (‐17.38 to ‐10.71), p  〈  0.001 on day 3, and ‐5.94 (‐8.92 to ‐2.95), p  〈  0.001 on day 30. Marked postoperative systemic inflammation was associated with increased risk of complications, poor quality of recovery and persistent disability or death up to 90 days after surgery.
    Type of Medium: Online Resource
    ISSN: 0003-2409 , 1365-2044
    URL: Article
    DOI: 10.1111/anae.16104
    Language: English
    Publisher: Wiley
    Publication Date: 2023
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