70 research outputs found
An assessment of decision-making by surgeons in management of colorectal cancer. International controversies and national practice.
No full textPapers 1,2 and 3 of this thesis are not available in Munin: 1. Augestad KM, Lindsetmo RO, Stulberg JJ, Reynolds H, Senagore AJ, Champagne B, Heriot AG, Leblanc F and Delaney CP.: 'International preoperative rectal cancer management: staging, neoadjuvant treatment, and impact of multidisciplinary teams', World Journal of Surgery (2010), vol. 34:2689-2700. Available at http://dx.doi.org/10.1007/s00268-010-0738-3 2. Augestad KM, Lindsetmo RO, Stulberg JJ, Reynolds H, Senagore AJ, Champagne B, Heriot AG, Leblanc F and Delaney CP.: 'International trends in surgical treatment of rectal cancer', American Journal of Surgery (2011), vol. 201:353–358. Available at http://dx.doi.org/10.1016/j.amjsurg.2010.08.030 3. Augestad KM, Lindsetmo RO, Stulberg J, Reynolds H, Champagne B, Senagore AJ and Delaney CP.: 'System-based factors influencing intraoperative decision-making in rectal cancer by surgeons. An international assessment', Colorectal Disease (2012), vol. 14(10):e679-88. Available at http://dx.doi.org/10.1111/j.1463-1318.2012.03093.x</a
Should the surgeon or the general practitioner (GP) follow up patients after surgery for colon cancer? A randomized controlled trial protocol focusing on quality of life, cost-effectiveness and serious clinical events.
No full textThis trial has been registered at ClinicalTrials.gov. The trial registration number is: NCT00572143.© 2008 Augestad et al; licensee BioMed Central Ltd.This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0),which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited
Global wealth disparities drive adherence to COVID-safe pathways in head and neck cancer surgery
No full textBackground During the initial COVID-19 outbreak up to 28.4 million elective operations were cancelled worldwide, in part owing to concerns that it would be unsustainable to maintain elective surgery capacity because of COVID-19-related surgeon absence. Although many hospitals are now recovering, surgical teams need strategies to prepare for future outbreaks. This study aimed to develop a framework to predict elective surgery capacity during future COVID-19 outbreaks. Methods An international cross-sectional study determined real-world COVID-19-related absence rates among surgeons. COVID-19-related absences included sickness, self-isolation, shielding, and caring for family. To estimate elective surgical capacity during future outbreaks, an expert elicitation study was undertaken with senior surgeons to determine the minimum surgical staff required to provide surgical services while maintaining a range of elective surgery volumes (0, 25, 50 or 75 per cent). Results Based on data from 364 hospitals across 65 countries, the COVID-19-related absence rate during the initial 6 weeks of the outbreak ranged from 20.5 to 24.7 per cent (mean average fortnightly). In weeks 7–12, this decreased to 9.2–13.8 per cent. At all times during the COVID-19 outbreak there was predicted to be sufficient surgical staff available to maintain at least 75 per cent of regular elective surgical volume. Overall, there was predicted capacity for surgeon redeployment to support the wider hospital response to COVID-19. Conclusion This framework will inform elective surgical service planning during future COVID-19 outbreaks. In most settings, surgeon absence is unlikely to be the factor limiting elective surgery capacity
Tailored Treatment of Colorectal Cancer: Surgical, Molecular, and Genetic Considerations
No full textColorectal cancer (CRC) is a complex cancer disease, and approximately 40% of the surgically cured patients will experience cancer recurrence within 5 years. During recent years, research has shown that CRC treatment should be tailored to the individual patient due to the wide variety of risk factors, genetic factors, and surgical complexity. In this review, we provide an overview of the considerations that are needed to provide an individualized, patient-tailored treatment. We emphasize the need to assess the predictors of CRC, and we summarize the latest research on CRC genetics and immunotherapy. Finally, we provide a summary of the significant variations in the colon and rectal anatomy that is important to consider in an individualized surgical approach. For the individual patient with CRC, a tailored treatment approach is needed in the preoperative, operative, and postoperative phase
Overcoming Distance: Video-Conferencing as a Clinical and Educational Tool Among Surgeons
No full textACT2
No full textAKERSHUS CLINICAL TRIAL (ACT) 2: SINGLE-CENTER, PSEUDO-RANDOMIZED TRIAL TO ASSESS WHETHER PREHABILITATION IMPROVES OUTCOME IN PATIENTS SURGICALLY TREATED FOR COLORECTAL CANCE
Outcomes after perioperative SARS-CoV-2 infection in patients with proximal femoral fractures: an international cohort study
No full textObjectives Studies have demonstrated high rates of mortality in people with proximal femoral fracture and SARS-CoV-2, but there is limited published data on the factors that influence mortality for clinicians to make informed treatment decisions. This study aims to report the 30-day mortality associated with perioperative infection of patients undergoing surgery for proximal femoral fractures and to examine the factors that influence mortality in a multivariate analysis.
Setting Prospective, international, multicentre, observational cohort study.
Participants Patients undergoing any operation for a proximal femoral fracture from 1 February to 30 April 2020 and with perioperative SARS-CoV-2 infection (either 7 days prior or 30-day postoperative).
Primary outcome 30-day mortality. Multivariate modelling was performed to identify factors associated with 30-day mortality.
Results This study reports included 1063 patients from 174 hospitals in 19 countries. Overall 30-day mortality was 29.4% (313/1063). In an adjusted model, 30-day mortality was associated with male gender (OR 2.29, 95% CI 1.68 to 3.13, p80 years (OR 1.60, 95% CI 1.1 to 2.31, p=0.013), preoperative diagnosis of dementia (OR 1.57, 95% CI 1.15 to 2.16, p=0.005), kidney disease (OR 1.73, 95% CI 1.18 to 2.55, p=0.005) and congestive heart failure (OR 1.62, 95% CI 1.06 to 2.48, p=0.025). Mortality at 30 days was lower in patients with a preoperative diagnosis of SARS-CoV-2 (OR 0.6, 95% CI 0.6 (0.42 to 0.85), p=0.004). There was no difference in mortality in patients with an increase to delay in surgery (p=0.220) or type of anaesthetic given (p=0.787).
Conclusions Patients undergoing surgery for a proximal femoral fracture with a perioperative infection of SARS-CoV-2 have a high rate of mortality. This study would support the need for providing these patients with individualised medical and anaesthetic care, including medical optimisation before theatre. Careful preoperative counselling is needed for those with a proximal femoral fracture and SARS-CoV-2, especially those in the highest risk groups
Implementation of an electronic surgical referral service. Collaboration, consensus and cost of the surgeon – general practitioner Delphi approach
No full textBackground: Poor coordination between levels of care plays a central role in determining the quality and cost of health care. To improve patient coordination, systematic structures, guidelines, and processes for creating, transferring, and recognizing information are needed to facilitate referral routines.
Methods: Prospective observational survey of implementation of electronic medical record (EMR)-supported guidelines for surgical treatment.
Results: One university clinic, two local hospitals, 31 municipalities, and three EMR vendors participated in the implementation project. Surgical referral guidelines were developed using the Delphi method; 22 surgeons and seven general practitioners (GPs) needed 109 hours to reach consensus. Based on consensus guidelines, an electronic referral service supported by a clinical decision support system, fully integrated into the GPs’ EMR, was developed. Fifty-five information technology personnel and 563 hours were needed (total cost 67,000 £) to implement a guideline supported system in the EMR for 139 GPs. Economical analyses from a hospital and societal perspective, showed that 504 (range 401–670) and 37 (range 29–49) referred patients, respectively, were needed to provide a cost-effective service.
Conclusion: A considerable amount of resources were needed to reach consensus on the surgical referral guidelines. A structured approach by the Delphi method and close collaboration between IT personnel, surgeons and primary care physicians were needed to reach consensus.© 2014 Augestad et al. This work is published by Dove Medical Press Limited, and licensed under Creative Commons Attribution – Non Commercial (unported, v3.0) License. The full terms of the License are available at http://creativecommons.org/licenses/by-nc/3.0/. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. Permissions beyond the scope of the License are administered by Dove Medical Press Limited. Information on how to request permission may be found at: http://www.dovepress.com/permissions.ph
A prospective analysis of false positive events in a National Colon Cancer Surveillance Program
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