scholarly journals Determining universal processes related to best outcome in emergency abdominal surgery: a multicentre, international, prospective cohort study

BMJ Open ◽  
2014 ◽  
Vol 4 (10) ◽  
pp. e006239 ◽  
Author(s):  
Aneel Bhangu ◽  
J Edward Fitzgerald ◽  
Stuart Fergusson ◽  
Chetan Khatri ◽  
Hampus Holmer ◽  
...  
Keyword(s):  
Cohort Study ◽  
Abdominal Surgery ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Outcome Measure ◽  
Secondary Outcome ◽  
Secondary Outcome Measure ◽  
Perioperative Mortality ◽  
Acute Surgery ◽  
Emergency Abdominal Surgery

IntroductionEmergency abdominal surgery outcomes represent an internationally important marker of healthcare quality and capacity. In this study, a novel approach to investigating global surgical outcomes is proposed, involving collaborative methodology using ‘snapshot’ clinical data collection over a 2-week period. The primary aim is to identify internationally relevant, modifiable surgical practices (in terms of modifiable process, equipment and clinical management) associated with best care for emergency abdominal surgery.Methods and analysisThis is a multicentre, international, prospective cohort study. Any hospital in the world performing acute surgery can participate, and any patient undergoing emergency intraperitoneal surgery is eligible to enter the study. Centres will collect observational data on patients for a 14-day period during a 5-month window and required data points will be limited to ensure practicality for collaborators collecting data. The primary outcome measure is the 24 h perioperative mortality, with 30-day perioperative mortality as a secondary outcome measure. During registration, participants will undertake a survey of available resources and capacity based on the WHO Tool for Situational Analysis.Ethics and disseminationThe study will not affect clinical care and has therefore been classified as an audit by the South East Scotland Research Ethics Service in Edinburgh, Scotland. Baseline outcome measurement in relation to emergency abdominal surgery has not yet been undertaken at an international level and will provide a useful indicator of surgical capacity and the modifiable factors that influence this. This novel methodological approach will facilitate delivery of a multicentre study at a global level, in addition to building international audit and research capacity.Trial registration numberThe study has been registered with ClinicalTrials.gov (Identifier: NCT02179112).

scholarly journals Frailty and functional decline after emergency abdominal surgery in the elderly: a prospective cohort study

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Hwee Leong Tan ◽  
Shermain Theng Xin Chia ◽  
Nivedita Vikas Nadkarni ◽  
Shin Yuh Ang ◽  
Dennis Chuen Chai Seow ◽  
...  
Keyword(s):  
Cohort Study ◽  
Abdominal Surgery ◽  
Elderly Patients ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
The Elderly ◽  
Functional Independence ◽  
Surgery In The Elderly ◽  
The Impact ◽  
Emergency Abdominal Surgery

Abstract Background Frailty has been associated with an increased risk of adverse postoperative outcomes in elderly patients. We examined the impact of preoperative frailty on loss of functional independence following emergency abdominal surgery in the elderly. Methods This prospective cohort study was performed at a tertiary hospital, enrolling patients 65 years of age and above who underwent emergency abdominal surgery from June 2016 to February 2018. Premorbid variables, perioperative characteristics and outcomes were collected. Two frailty measures were compared in this study—the Modified Fried’s Frailty Criteria (mFFC) and Modified Frailty Index-11 (mFI-11). Patients were followed-up for 1 year. Results A total of 109 patients were prospectively recruited. At baseline, 101 (92.7%) were functionally independent, of whom seven (6.9%) had loss of independence at 1 year; 28 (25.7%) and 81 (74.3%) patients were frail and non-frail (by mFFC) respectively. On univariate analysis, age, Charlson Comorbidity Index and frailty (mFFC) (univariate OR 13.00, 95% CI 2.21–76.63, p < 0.01) were significantly associated with loss of functional independence at 1 year. However, frailty, as assessed by mFI-11, showed a weaker correlation than mFFC (univariate OR 4.42, 95% CI 0.84–23.12, p = 0.06). On multivariable analysis, only premorbid frailty (by mFFC) remained statistically significant (OR 15.63, 95% CI 2.12–111.11, p < 0.01). Conclusions The mFFC is useful for frailty screening amongst elderly patients undergoing emergency abdominal surgery and is a predictor for loss of functional independence at 1 year. Including the risk of loss of functional independence in perioperative discussions with patients and caregivers is important for patient-centric emergency surgical care. Early recognition of this at-risk group could help with discharge planning and priority for post-discharge support should be considered.

scholarly journals Endothelial dysfunction and myocardial injury after major emergency abdominal surgery: a prospective cohort study

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Sarah Ekeloef ◽  
Jakob Ohm Oreskov ◽  
Andreas Falkenberg ◽  
Jakob Burcharth ◽  
Anne Marie V. Schou-Pedersen ◽  
...  
Keyword(s):  
Cohort Study ◽  
Endothelial Dysfunction ◽  
Abdominal Surgery ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Myocardial Injury ◽  
Emergency Abdominal Surgery

scholarly journals Nurse-led PrEP-RN clinic: a prospective cohort study exploring task-Shifting HIV prevention to public health nurses

BMJ Open ◽  
2021 ◽  
Vol 11 (1) ◽  
pp. e040817
Author(s):  
Patrick O'Byrne ◽  
Amanda Vandyk ◽  
Lauren Orser ◽  
Marlene Haines
Keyword(s):  
Public Health ◽  
Cohort Study ◽  
High Risk ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Secondary Outcome ◽  
Bivariate Analysis ◽  
Transmitted Infection ◽  
Sexually Transmitted ◽  
Risk Criteria

ObjectiveTo report the results of a nurse-led pre-exposure prophylaxis (PrEP) delivery service.DesignThis was a prospective cohort study conducted from 5 August 2018 to 4 March 2020. It involved manual chart review to collect data. Variables were described using frequencies and percentages and analysed using χ2 testing. Those significant in bivariate analysis were retained and entered into a binary multiple logistic regression. Hierarchical modelling was used, and only significant factors were retained.SettingThis study occurred in an urban public health unit and community-based sexually transmitted infection (STI) clinic in Ottawa, Canada.ParticipantsOf all persons who were diagnosed with a bacterial STI in Ottawa and everyone who presented to our STI clinic during the study period, there were 347 patients who met our high-risk criteria for PrEP; these criteria included patients who newly presented with any of the following: HIV contacts, diagnosed with a bacterial STI or single use of HIV PEP. Further, eligibility could be determined based on clinical judgement. Patients who met the foregoing criteria were appropriate for PrEP-RN, while lower-risk patients were referred to elsewhere. Of the 347 patients who met our high-risk criteria, 47% accepted and 53% declined. Of those who accepted, 80% selected PrEP-registered nurse (RN).Primary and secondary outcome measuresUptake, acceptance, engagement and attrition factors of participants who obtained PrEP through PrEP-RN.Findings69% of participants who were eligible attended their intake PrEP-RN visit. 66% were retained in care. Half of participants continued PrEP and half were lost to follow-up. We found no significant differences in the uptake, acceptance, engagement and attrition factors of participants who accessed PrEP-RN regarding reason for referral, age, ethnicity, sexual orientation, annual income, education attainted, insurance status, if they have a primary care provider, presence or absence of depression or anxiety and evidence of newly acquired STI during the study period.ConclusionsNurse-led PrEP is an appropriate strategy for PrEP delivery.

scholarly journals Can delirium research activity impact on routine delirium recognition? A prospective cohort study

BMJ Open ◽  
2018 ◽  
Vol 8 (10) ◽  
pp. e023386 ◽  
Author(s):  
Carly Welch ◽  
Thomas A Jackson
Keyword(s):  
Cohort Study ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
University Teaching ◽  
Secondary Outcome ◽  
Research Activity ◽  
Statistical Manual ◽  
Diagnostic And Statistical Manual ◽  
Improve Patient ◽  
Discharge Summaries

ObjectiveTo assess if ongoing delirium research activity within an acute admissions unit impacts on prevalent delirium recognition.DesignProspective cohort study.SettingSingle-site tertiary university teaching hospital.Participants125 patients with delirium, as diagnosed by an expert using Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition reference criteria, were recruited to a prospective cohort study investigating use of informant tools to detect unrecognised dementia. This study evaluated recognition of delirium and documentation of delirium by medical staff.InterventionsThe main study followed an observational design; the intervention discussed was the implementation of this study itself.Primary and secondary outcome measuresThe primary outcome was recognition of delirium by the admitting medical team prior to study diagnosis. Secondary outcomes included recording of or description of delirium in discharge summaries, and factors which may be associated with unrecognised delirium.ResultsDelirium recognition improved between the first half (48%) and second half (71%) of recruitment (p=0.01). There was no difference in recording of delirium or description of delirium in the text of discharge summaries.ConclusionDelirium research activity can improve recognition of delirium. This has the potential to improve patient outcomes.

scholarly journals Meniscal tear outcome Study (METRO Study): a study protocol for a multicentre prospective cohort study exploring the factors which affect outcomes in patients with a meniscal tear

BMJ Open ◽  
2020 ◽  
Vol 10 (7) ◽  
pp. e038681
Author(s):  
Imran Ahmed ◽  
Mike Bowes ◽  
Charles E Hutchinson ◽  
Nicholas Parsons ◽  
Sophie Staniszewska ◽  
...  
Keyword(s):  
Cohort Study ◽  
Research Ethics ◽  
Outcome Measures ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Meniscal Tear ◽  
Ethics Committee ◽  
Secondary Outcome ◽  
Research Ethics Committee ◽  
Baseline Characteristics

IntroductionThis study is designed to explore the baseline characteristics of patients under 55 years of age with a meniscal tear, and to describe the relationship between the baseline characteristics and patient-reported outcome measures (PROMs) over 12 months. Research has highlighted the need for a trial to investigate the effectiveness of arthroscopic meniscectomy in younger patients. Before this trial, we need to understand the patient population in greater detail.Methods and analysisThis is a multicentre prospective cohort study. Participants aged between 18 and 55 years with an MRI confirmed meniscal tear are eligible for inclusion. Baseline characteristics including age, body mass index, gender, PROMs duration of symptoms and MRI will be collected. The primary outcome measure is the Western Ontario Meniscal Evaluation Tool at 12 months. Secondary outcome measures will include PROMs such as EQ5D, Knee Injury and Osteoarthritis Outcome Score and patient global impression of change score at 3, 6 and 12 months.Ethics and disseminationThe study obtained approval from the National Research Ethics Committee West Midlands—Black Country research ethics committee (19/WM/0079) on 12 April 2019. The study is sponsored by the University of Warwick. The results will be disseminated via peer-reviewed publication.Trial registration numberUHCW R&D Reference: IA428119. University of Warwick Sponsor ID: SC.08/18–19

scholarly journals Adherence to childhood cancer treatment: a prospective cohort study from Northern Vietnam

BMJ Open ◽  
2019 ◽  
Vol 9 (8) ◽  
pp. e026863
Author(s):  
Bui Ngoc Lan ◽  
Anders Castor ◽  
Thomas Wiebe ◽  
Jacek Toporski ◽  
Christian Moëll ◽  
...  
Keyword(s):  
Cohort Study ◽  
Cancer Treatment ◽  
Childhood Cancer ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Cox Model ◽  
Secondary Outcome ◽  
Northern Vietnam ◽  
Family Decision ◽  
Treatment Abandonment

ObjectivesGlobal incidence and attention to childhood cancer is increasing and treatment abandonment is a major cause of treatment failure in low- and middle-income countries. The purpose of this study was to gain an understanding of factors contributing to non-adherence to treatment.DesignA prospective cohort study with 2 year follow-up of incidence, family-reported motives and risk factors.SettingThe largest tertiary paediatric oncology centre in Northern Vietnam.ParticipantsAll children offered curative cancer treatment, from January 2008 to December 2009.Primary and secondary outcome measuresFamily decision to start treatment was analysed with multivariable logistic regression, and family decision to continue treatment was analysed with a multivariable Cox model. This assessment of non-adherence is thereby methodologically consistent with the accepted definitions and recommended practices for evaluation of treatment abandonment.ResultsAmong 731 consecutively admitted patients, 677 were eligible for treatment and were followed for a maximum 2 years. Almost half the parents chose to decline curative care (45.5%), either before (35.2%) or during (10.3%) the course of treatment. Most parents reported perceived poor prognosis as the main reason for non-adherence, followed by financial constraints and traditional medicine preference. The odds of starting treatment increased throughout the study-period (OR 1.04 per month (1.01 to 1.07), p=0.002), and were independently associated with prognosis (OR 0.51 (0.41 to 0.64), p=<0.0001) and travel distance to hospital (OR 0.998 per km (0.996 to 0.999), p=0.004). The results also suggest that adherence to initiated treatment was significantly higher among boys than girls (HR 1.69 (1.05 to 2.73), p=0.03).ConclusionsNon-adherence influenced the prognosis of childhood cancer, and was associated with cultural and local perceptions of cancer and the economic power of the affected families. Prevention of abandonment is a prerequisite for successful cancer care, and a crucial early step in quality improvements to care for all children with cancer.

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