70 research outputs found
Systematic review and meta-analysis of long-term oncological outcomes of lateral lymph node dissection for metastatic nodes after neoadjuvant chemoradiotherapy in rectal cancer
No full textAvailable online 29 April 2022Abstract not availableHidde M. Kroon, Lotje A. Hoogervorst, Nicole Hanna-Rivero, Luke Traeger, Nagendra N. Dudi-Venkata, Sergei Bedrikovetski, Miranda Kusters, George J. Chang, Michelle L. Thomas, Tarik Sammou
Human Performance Lab Newsletter, March 2015
No full textContents for this issue include: Kelly\u27s Corner by David Bacharach Maintaining a Healthy Weight in a Land of Plenty by Glenn Street Exercise in the Heat and Thermoregulation by Luke Weyrauch Exercise and the Mind by Jeff Bohlman Parkinson’s Disease by Brian Traeger Heel Height and Pain in the Lower Back by Ke Sh
Clinical predictors of rectal cancer response after neo-adjuvant (Chemo)Radiotherapy in Australia and New Zealand: Analysis of the Bi-National Colorectal Cancer Audit (BCCA)
No full textAvailable online 9 September 2023Pathological complete response (pCR) is observed in 11–26% of locally advanced rectal cancers undergoing neoadjuvant chemoradiotherapy (nCRT). This study aims to determine pCR rates and clinicopathological predictors in the Australian and New Zealand (ANZ) cohort. The Bi-National Colorectal Cancer Audit (BCCA) was interrogated for all rectal cancer patients who underwent nCRT prior to surgical resection between 2007 and 2020. Patients were divided in two groups: pCR (AJCC tumour regression grade 0) and partial/no response (pPR, regression grade 1,2 or 3). In total, 3230 patients were included. Rates of pCR and pPR were 704 (21.8%) and 2526 (78.2%), respectively. Long-course nCRT (p < 0.0001), lower clinical tumour stage (cT; p < 0.0001), and nodal stage (cN; p = 0.003) were associated with pCR on univariate analysis. On multivariable analysis, cN0 stage and long-course nCRT remained independent factors for a pCR. Awareness of these predictors provides valuable information when counseling patients regarding prognosis and treatment options.Jianliang Liu, Justin Y.T. Lee, Sergei Bedrikovetski, Luke Traeger, James W. Moore, Joanne L. Perry, Hidde M. Kroon, Tarik Sammou
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Essays in Environmental Economics
No full textEfficiently addressing climate change and waning our dependence on fossil fuels will prove central to ensuring a viable habitat for humanity in the coming centuries. Chapter 1 analyzes stabilization targets - widely employed and well-intentioned environmental policies that ultimately reduce global welfare. Chapter 2 quantifies a healthcare externality stemming from surface mining of coal. Chapter 3 uses a new, novel approach to estimating how the coal mining industry affects markets for residential real estate in three Appalachian counties.</p
Pyridostigmine to enhance gastrointestinal recovery after colorectal surgery
No full textPostoperative ileus (POI) refers to the delayed return of gastrointestinal (GI) function and is a common complication following colorectal surgery. POI increases morbidity, mortality, and healthcare costs. The cholinergic anti-inflammatory pathway (CAIP) is crucial in developing POI, but limited preventive strategies target this pathway. This thesis examines acetylcholinesterase inhibitors (ACIs), such as pyridostigmine and neostigmine, as a method to impact the CAIP and improve GI recovery, culminating in a novel randomised controlled trial (RCT). This thesis comprises seven papers, beginning with a comprehensive literature review summarising the current applications of ACIs in abdominal surgery, including neuromuscular reversal during anaesthesia, resolving acute colonic pseudo-obstruction, and POI. A systemic review of RCTs examines ACIs efficacy in improving GI recovery after abdominal surgery, revealing that five of eight studies had a reduction in time to first stool. Despite variations in methodology and bias concerns, the evidence supported using ACIs to improve GI function recovery. However, it emphasises the need for an RCT embedded in a modern enhanced recovery protocol (ERP), especially for colorectal surgery patients. Additionally, in a 335-patient cohort study, neostigmine/glycopyrrolate administration during neuromuscular reversal delayed GI function recovery (GI-2 (validated measure of time to first stool and tolerance of oral diet) median 3 vs. 2 days, p=0.035) without affecting POI rates. Furthermore, we investigate the financial impact of POI, providing Australian first data for 415 colorectal patients, revealing an increase in total hospital cost by 26.4% (AU29,822, p<0.001) due to increased length of stay and complications. Giving a broader perspective, we present the first meta-analysis examining the global financial burden of POI following abdominal surgery, demonstrating a 66.3% increase (95%CI [34.8-97.9], p<0.0001, I2=98.4%) in total hospital cost. This study estimates POI amounts to a US$4.1 billion burden annually in the USA, underscoring the need to reduce its incidence with adjunctive therapies. The primary study of this thesis is the first double blinded RCT that evaluates the addition of pyridostigmine to the current ERP following colorectal surgery. With 130 patients, the study shows a significant reduction in time to GI-2 with the addition of pyridostigmine (2 (IQR 1-3) vs. 3 (2-4) days; p=0.015), supporting the hypothesis that it improves GI recovery. However, no significant differences were observed in POI, length of hospital stay or 30-day complications. Furthermore, we employed machine learning techniques to identify new POI risk factors and guide preventative strategies. Using multivariate logistic regression and comparing it to machine learning models, particularly radial basis function, decision trees and multiple layer perceptron (MLP), MLP outperformed the other models and identified sarcopenia as a potentially modifiable risk factor for POI. This thesis provides novel findings, highlighting the significant financial burden of POI following abdominal surgery. It provides evidence for the efficacy of pyridostigmine in improving GI recovery. These findings contribute to understanding GI recovery and emphasise the importance of targeted prevention strategies to reduce the incidence of POI.Thesis (Ph.D.) -- University of Adelaide, Adelaide Medical School, 202
The impact of acetylcholinesterase inhibitors on ileus and gut motility following abdominal surgery: a clinical review
No full textPostoperative ileus is a common complication in the days following colorectal surgery occurring in up to 50% of patients. When prolonged, this complication results in significant morbidity and mortality, doubling the total costs of hospital stay. Postoperative ileus (POI) results from the prolonged inflammatory phase that is mediated in part by the cholinergic anti-inflammatory pathway. Acetylcholinesterase inhibitors, such as neostigmine and pyridostigmine, delay the degradation of acetylcholine at the synaptic cleft. This increase in acetylcholine has been shown to increase gut motility. They have been effective in the treatment of acute colonic pseudo-obstruction, but there is limited evidence for the use of these medications for reducing the incidence of POI. This review was conducted to summarise the evidence of acetylcholinesterase inhibitors’ effect on gut motility and discuss their potential use as part of an enhanced recovery protocols to prevent or treat POI.Luke Traeger, Hidde M. Kroon, Sergei Bedrikovetski, James W. Moore, and Tarik Sammou
Effects of pre‐operative isolation on postoperative pulmonary complications after elective surgery: an international prospective cohort study
No full textThis article is accompanied by an editorial by Charlesworth & Grossman. Anaesthesia 2021; 76: 1439–41.We aimed to determine the impact of pre-operative isolation on postoperative pulmonary complications after elective surgery during the global SARS-CoV-2 pandemic. We performed an international prospective cohort study including patients undergoing elective surgery in October 2020. Isolation was defined as the period before surgery during which patients did not leave their house or receive visitors from outside their household. The primary outcome was postoperative pulmonary complications, adjusted in multivariable models for measured confounders. Pre-defined sub-group analyses were performed for the primary outcome. A total of 96,454 patients from 114 countries were included and overall, 26,948 (27.9%) patients isolated before surgery. Postoperative pulmonary complications were recorded in 1947 (2.0%) patients of which 227 (11.7%) were associated with SARS-CoV-2 infection. Patients who isolated pre-operatively were older, had more respiratory comorbidities and were more commonly from areas of high SARS-CoV-2 incidence and high-income countries. Although the overall rates of postoperative pulmonary complications were similar in those that isolated and those that did not (2.1% vs 2.0%, respectively), isolation was associated with higher rates of postoperative pulmonary complications after adjustment (adjusted OR 1.20, 95%CI 1.05–1.36, p = 0.005). Sensitivity analyses revealed no further differences when patients were categorised by: pre-operative testing; use of COVID-19-free pathways; or community SARS-CoV-2 prevalence. The rate of postoperative pulmonary complications increased with periods of isolation longer than 3 days, with an OR (95%CI) at 4–7 days or ≥ 8 days of 1.25 (1.04– 1.48), p = 0.015 and 1.31 (1.11–1.55), p = 0.001, respectively. Isolation before elective surgery might be associated with a small but clinically important increased risk of postoperative pulmonary complications. Longer periods of isolation showed no reduction in the risk of postoperative pulmonary complications. These findings have significant implications for global provision of elective surgical care.COVIDSurg Collaborative and GlobalSurg Collaborative (Australia: Daniel Cox ... Nagendra Dudi-Venkata ... Hidde M Kroon ... Luke Traeger ... et al.
What can action learning offer a beleaguered system? A narrative representing the relationship
No full text
Purpose
This is an attempt to write an account of action learning that is as close to the ground on which it was practised as the author can make it. In that sense, the reader can read what follows below as a kind of autoethnography, a “representation as relationship” as Gergen and Gergen (2002, p. 11) call it. This is because in the opportunity of telling a story about his practice as an action learning facilitator, the author hopes to evoke that which is more akin to the contactful environment of quality action learning than any amount of abstract theorising.
Design/methodology/approach
This is an example of “narrative inquiry”, best judged, according to Sparkes (2002), in terms of the ability of such accounts to “contribute to sociological understanding in ways that, amongst others are self-knowing, self-respecting, self-sacrificing and self-luminous”.
Findings
As the author re-tells this partial account, he has a sense of the massive wider structures around him, but all he can see in his dim lamp is the fleeting glimpse of the local strata. The author traces his hand along the seams, not intending to dig them out, but simply to witness them, or even, in a spirit of yearning, to give them a witnessing of themselves.
Originality/value
To the author, this is about portraying what action learning feels like, rather than thinks like, for his own and for the benefit of other practitioners.
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