BackgroundMultidisciplinary team (MDT) meetings have been endorsed by the Department of Health as... more BackgroundMultidisciplinary team (MDT) meetings have been endorsed by the Department of Health as the core model for managing chronic diseases. However, the evidence for their effectiveness is mixed and the degree to which they have been absorbed into clinical practice varies widely across conditions and settings. We aimed to identify the key characteristics of chronic disease MDT meetings that are associated with decision implementation, a measure of effectiveness, and to derive a set of feasible modifications to MDT meetings to improve decision-making.MethodsWe undertook a mixed-methods prospective observational study of 12 MDTs in the London and North Thames area, covering cancer, heart failure, mental health and memory clinic teams. Data were collected by observation of 370 MDT meetings, completion of the Team Climate Inventory (TCI) by 161 MDT members, interviews with 53 MDT members and 20 patients, and review of 2654 patients’ medical records. We examined the influence of pati...
Aim New and modified surgical procedures and devices are often introduced into clinical practice ... more Aim New and modified surgical procedures and devices are often introduced into clinical practice without adequate evidence of their safety and efficacy. To promote systematic evaluation of surgical innovations, the IDEAL and IDEAL-D frameworks outline recommendations for study design and governance for procedures and devices according to their stage of innovation. However, determining stage of innovation can be difficult, hindering use of such frameworks. There is a need for a detailed understanding of what stage of innovation means, and how it can be determined. The aim of this study is to understand the concept of stage of innovation as reported in the literature. Method A systematic review is being conducted. Searches of Ovid Medline and Embase databases have been performed. Articles were screened by title and, then by full text. s and foreign language articles were excluded. Data will be extracted verbatim regarding approaches to evaluating surgical innovations and determining s...
Aim Little is known about the electronic collection and clinical feedback of patient reported out... more Aim Little is known about the electronic collection and clinical feedback of patient reported outcomes (ePROs) post-surgical discharge. This review summarised the evidence on the collection and uses of electronic systems to collect PROs after discharge from hospital following surgery. Method Systematic searches of Medline, Embase, PsycINFO, CINAHL and Cochrane Central were undertaken from database inception to July 2019 using terms for “patient reported outcomes”, “electronic”, “surgery” and “at home”. Primary research of all study designs was included if they used electronic systems to collect PRO data away from formal health care settings. Only studies in adult patients admitted for surgery then discharged from hospital were eligible. Results From 9,474 records identified, 15 studies were reviewed including three randomised controlled trials. Seven studies were in orthopaedic surgery. Most studies used commercial ePRO systems (n = 9/12). Six studies reported types of electronic de...
IntroductionBurn care represents a healthcare and economic burden to patients internationally. Ch... more IntroductionBurn care represents a healthcare and economic burden to patients internationally. Choice of the most clinically effective treatment strategies requires evidence which is best obtained through high-quality randomised controlled trials (RCT). The number of published RCTs of burn care is increasing. However, trial quality and reporting standards are unclear. This study will assess the risk of bias and adequacy of reporting in recent burn care RCTs using tools endorsed by the Cochrane Collaboration.Methods and analysisA systematic literature review will be undertaken, assessing parallel group RCTs evaluating therapeutic interventions for patients with cutaneous burns. Literature searches will use Ovid Medline, Ovid Embase, Web of Science and the Cochrane Library. Separate searches for each database will include medical subject heading and free text terms including ‘burn’, ‘scald’, ‘thermal injury’ and ‘RCT’. Two reviewers will independently assess each study for inclusion. ...
A comprehensive evaluation of bariatric surgery is required to inform decision-making. This will ... more A comprehensive evaluation of bariatric surgery is required to inform decision-making. This will include measures of benefit and risk. It is possible that stakeholders involved with surgery value these outcomes differently, although this has not previously been explored. This study aimed to investigate and compare how professionals and patients prioritise outcomes of bariatric surgery. Systematic reviews and qualitative interviews created an exhaustive list of outcomes. This informed the development of a 130-item questionnaire, structured in four sections (complications of surgery; clinical effectiveness; signs, symptoms, and other measures; quality of life). Health professionals and patients rated the importance of each item on a 1-9 scale. Items rated 8-9 by at least 70 % of the participants were considered prioritised. Items prioritised in each section were compared between professionals and patients and interrater agreement assessed using kappa statistics (ĸ). One hundred sixty-...
Introduction In order to detect all cases of Barrett's oesophagus (BE) in the population, wit... more Introduction In order to detect all cases of Barrett's oesophagus (BE) in the population, with the aim of reducing adenocarcinoma associated mortality, screening needs to be considered. Unsedated transnasal endoscopy (TNE) can potentially offer a safer and less expensive alternative to conventional sedated endoscopy (CE) for detecting BE. Aims (1) To evaluate the sensitivity and specificity of TNE in diagnosing BE compared with CE. (2) To assess patient acceptability of TNE for a future multicentre screening trial. Methods Patients with known BE under surveillance and those referred for routine endoscopy for other reasons underwent both TNE and CE in a randomised cross-over design. TNE findings of endoscopic BE, biopsy size and presence of intestinal metaplasia (IM) were compared against CE, which was used as gold standard. Pre and post endoscopy short-form spielberger state-trait questionnaires (SF6), a visual analogue scale and a single question addressing preference for endoscopy type were used to measure patient acceptability of the procedures. Results Of 57 patients randomised, 50 completed the study. All 22 BE cases with columnar lined epithelium (CLE) on CE were correctly diagnosed by TNE. Although the biopsy size of TNE was significantly smaller compared to CE (mean size 2.59 vs 4.74 p<0.0001), it detected an equal number of IM cases and there was one case of low grade dysplasia which interestingly was not picked up by CE. Abstract 019 shows sensitivity, specificity and diagnostic accuracy (including Pearson-Clopper CI) for diagnosing BE and IM using TNE compared with CE as the gold standard. The mean difference between the two procedures in determining the length of BE was 0.02. The 95% Bland and Altman limits of agreement was between −2.08 and 2.13 with 49 cases (98%) falling within the pre-determined level of agreement of ±1.5 cm. The mean pre and post procedure anxiety score for TNE (13.3 vs 14.0) and CE (13.2 vs 13.5) were not significantly different (p=0.15). The post endoscopy experience of TNE was comparable to CE (mean 5.0 vs 4.9, p=0.77). Abstract PTU-019 Sensitivity Specificity Diagnostic Accuracy BE 100 (85–100) 100 (88–100) 100 (93–100) IM 100 (81–100) 100 (89–100) 100 (93–100) Conclusion TNE is accurate in diagnosing BE and detecting IM. Despite the smaller biopsy size, it detected an equal number of IM cases and showed potential to detect dysplasia. It was well tolerated and preferred by patients and may be an efficient screening method for BE.
BackgroundMultidisciplinary team (MDT) meetings have been endorsed by the Department of Health as... more BackgroundMultidisciplinary team (MDT) meetings have been endorsed by the Department of Health as the core model for managing chronic diseases. However, the evidence for their effectiveness is mixed and the degree to which they have been absorbed into clinical practice varies widely across conditions and settings. We aimed to identify the key characteristics of chronic disease MDT meetings that are associated with decision implementation, a measure of effectiveness, and to derive a set of feasible modifications to MDT meetings to improve decision-making.MethodsWe undertook a mixed-methods prospective observational study of 12 MDTs in the London and North Thames area, covering cancer, heart failure, mental health and memory clinic teams. Data were collected by observation of 370 MDT meetings, completion of the Team Climate Inventory (TCI) by 161 MDT members, interviews with 53 MDT members and 20 patients, and review of 2654 patients’ medical records. We examined the influence of pati...
Aim New and modified surgical procedures and devices are often introduced into clinical practice ... more Aim New and modified surgical procedures and devices are often introduced into clinical practice without adequate evidence of their safety and efficacy. To promote systematic evaluation of surgical innovations, the IDEAL and IDEAL-D frameworks outline recommendations for study design and governance for procedures and devices according to their stage of innovation. However, determining stage of innovation can be difficult, hindering use of such frameworks. There is a need for a detailed understanding of what stage of innovation means, and how it can be determined. The aim of this study is to understand the concept of stage of innovation as reported in the literature. Method A systematic review is being conducted. Searches of Ovid Medline and Embase databases have been performed. Articles were screened by title and, then by full text. s and foreign language articles were excluded. Data will be extracted verbatim regarding approaches to evaluating surgical innovations and determining s...
Aim Little is known about the electronic collection and clinical feedback of patient reported out... more Aim Little is known about the electronic collection and clinical feedback of patient reported outcomes (ePROs) post-surgical discharge. This review summarised the evidence on the collection and uses of electronic systems to collect PROs after discharge from hospital following surgery. Method Systematic searches of Medline, Embase, PsycINFO, CINAHL and Cochrane Central were undertaken from database inception to July 2019 using terms for “patient reported outcomes”, “electronic”, “surgery” and “at home”. Primary research of all study designs was included if they used electronic systems to collect PRO data away from formal health care settings. Only studies in adult patients admitted for surgery then discharged from hospital were eligible. Results From 9,474 records identified, 15 studies were reviewed including three randomised controlled trials. Seven studies were in orthopaedic surgery. Most studies used commercial ePRO systems (n = 9/12). Six studies reported types of electronic de...
IntroductionBurn care represents a healthcare and economic burden to patients internationally. Ch... more IntroductionBurn care represents a healthcare and economic burden to patients internationally. Choice of the most clinically effective treatment strategies requires evidence which is best obtained through high-quality randomised controlled trials (RCT). The number of published RCTs of burn care is increasing. However, trial quality and reporting standards are unclear. This study will assess the risk of bias and adequacy of reporting in recent burn care RCTs using tools endorsed by the Cochrane Collaboration.Methods and analysisA systematic literature review will be undertaken, assessing parallel group RCTs evaluating therapeutic interventions for patients with cutaneous burns. Literature searches will use Ovid Medline, Ovid Embase, Web of Science and the Cochrane Library. Separate searches for each database will include medical subject heading and free text terms including ‘burn’, ‘scald’, ‘thermal injury’ and ‘RCT’. Two reviewers will independently assess each study for inclusion. ...
A comprehensive evaluation of bariatric surgery is required to inform decision-making. This will ... more A comprehensive evaluation of bariatric surgery is required to inform decision-making. This will include measures of benefit and risk. It is possible that stakeholders involved with surgery value these outcomes differently, although this has not previously been explored. This study aimed to investigate and compare how professionals and patients prioritise outcomes of bariatric surgery. Systematic reviews and qualitative interviews created an exhaustive list of outcomes. This informed the development of a 130-item questionnaire, structured in four sections (complications of surgery; clinical effectiveness; signs, symptoms, and other measures; quality of life). Health professionals and patients rated the importance of each item on a 1-9 scale. Items rated 8-9 by at least 70 % of the participants were considered prioritised. Items prioritised in each section were compared between professionals and patients and interrater agreement assessed using kappa statistics (ĸ). One hundred sixty-...
Introduction In order to detect all cases of Barrett's oesophagus (BE) in the population, wit... more Introduction In order to detect all cases of Barrett's oesophagus (BE) in the population, with the aim of reducing adenocarcinoma associated mortality, screening needs to be considered. Unsedated transnasal endoscopy (TNE) can potentially offer a safer and less expensive alternative to conventional sedated endoscopy (CE) for detecting BE. Aims (1) To evaluate the sensitivity and specificity of TNE in diagnosing BE compared with CE. (2) To assess patient acceptability of TNE for a future multicentre screening trial. Methods Patients with known BE under surveillance and those referred for routine endoscopy for other reasons underwent both TNE and CE in a randomised cross-over design. TNE findings of endoscopic BE, biopsy size and presence of intestinal metaplasia (IM) were compared against CE, which was used as gold standard. Pre and post endoscopy short-form spielberger state-trait questionnaires (SF6), a visual analogue scale and a single question addressing preference for endoscopy type were used to measure patient acceptability of the procedures. Results Of 57 patients randomised, 50 completed the study. All 22 BE cases with columnar lined epithelium (CLE) on CE were correctly diagnosed by TNE. Although the biopsy size of TNE was significantly smaller compared to CE (mean size 2.59 vs 4.74 p<0.0001), it detected an equal number of IM cases and there was one case of low grade dysplasia which interestingly was not picked up by CE. Abstract 019 shows sensitivity, specificity and diagnostic accuracy (including Pearson-Clopper CI) for diagnosing BE and IM using TNE compared with CE as the gold standard. The mean difference between the two procedures in determining the length of BE was 0.02. The 95% Bland and Altman limits of agreement was between −2.08 and 2.13 with 49 cases (98%) falling within the pre-determined level of agreement of ±1.5 cm. The mean pre and post procedure anxiety score for TNE (13.3 vs 14.0) and CE (13.2 vs 13.5) were not significantly different (p=0.15). The post endoscopy experience of TNE was comparable to CE (mean 5.0 vs 4.9, p=0.77). Abstract PTU-019 Sensitivity Specificity Diagnostic Accuracy BE 100 (85–100) 100 (88–100) 100 (93–100) IM 100 (81–100) 100 (89–100) 100 (93–100) Conclusion TNE is accurate in diagnosing BE and detecting IM. Despite the smaller biopsy size, it detected an equal number of IM cases and showed potential to detect dysplasia. It was well tolerated and preferred by patients and may be an efficient screening method for BE.
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