scholarly journals Distance travelled to hospital for emergency laparotomy and the effect of travel time on mortality: cohort study

2020 ◽  
pp. bmjqs-2019-010747
Author(s):  
Tom Salih ◽  
Peter Martin ◽  
Tom Poulton ◽  
Charles M Oliver ◽  
Mike G Bassett ◽  
...  
Keyword(s):  
Cohort Study ◽  
Travel Time ◽  
Gastrointestinal Surgery ◽  
Postoperative Mortality ◽  
Continuous Variable ◽  
Emergency Laparotomy ◽  
Logistic Regression Models ◽  
Urgent Surgery ◽  
National Cohort ◽  
The Uk

ObjectivesTo evaluate whether distance and estimated travel time to hospital for patients undergoing emergency laparotomy is associated with postoperative mortality.DesignNational cohort study using data from the National Emergency Laparotomy Audit.Setting171 National Health Service hospitals in England and Wales.Participants22 772 adult patients undergoing emergency surgery on the gastrointestinal tract between 2013 and 2016.Main outcome measuresMortality from any cause and in any place at 30 and 90 days after surgery.ResultsMedian on-road distance between home and hospital was 8.4 km (IQR 4.7–16.7 km) with a median estimated travel time of 16 min. Median time from hospital admission to operating theatre was 12.7 hours. Older patients live on average further from hospital and patients from areas of increased socioeconomic deprivation live on average less far away.We included estimated travel time as a continuous variable in multilevel logistic regression models adjusting for important confounders and found no evidence for an association with 30-day mortality (OR per 10 min of travel time=1.02, 95% CI 0.97 to 1.06, p=0.512) or 90-day mortality (OR 1.02, 95 % CI 0.97 to 1.06, p=0.472).The results were similar when we limited our analysis to the subgroup of 5386 patients undergoing the most urgent surgery. 30-day mortality: OR=1.02 (95% CI 0.95 to 1.10, p=0.574) and 90-day mortality: OR=1.01 (95% CI 0.94 to 1.08, p=0.858).ConclusionsIn the UK NHS, estimated travel time between home and hospital was not a primary determinant of short-term mortality following emergency gastrointestinal surgery.

scholarly journals 606 Mortality and Pulmonary Complications in Patients Undergoing Upper Extremity Surgery at The Peak of the SARS-Cov-2 Pandemic in the UK: A National Cohort Study Presented on Behalf of The Corona Hands Collaborative

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
B Dean ◽  
J Duncan
Keyword(s):  
Cohort Study ◽  
Upper Limb ◽  
Complication Rate ◽  
Postoperative Mortality ◽  
Primary Outcome Measure ◽  
Pulmonary Complications ◽  
Related Complication ◽  
Urgent Surgery ◽  
Upper Limb Surgery ◽  
The Uk

Abstract Introduction This study reports the 30-day mortality, SARS-CoV-2 complication rate and SARS-CoV-2 related hospital processes at the peak of the first wave of the pandemic in the UK. Method This national, multicentre, cohort study at 74 centres in the UK included all patients undergoing any surgery below the elbow at the peak of the UK pandemic. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. Results This analysis includes 1093 patients who underwent upper limb surgery from the 1st to the 14th of April 2020. The overall 30-day mortality was 0.09% and the mortality of day case surgery was zero. The SARS-CoV-2 complication rate was 0.18% (2 pneumonias) and the overall complication rate 6.6% (72 patients). Both SARS-CoV-2 related complications occurred in patients who had been hospitalised for a prolonged period before their surgery and a total of 19 patients (1.7%) were SARS-CoV-2 positive. Conclusions The SARS-CoV-2 related complication rate for upper limb surgery even at the peak of the UK pandemic was low at 0.18% and the mortality was zero for patients admitted on the day of surgery. Urgent surgery should not be delayed pending the results of SARS-CoV-2 testing.

scholarly journals Intracranial haemorrhage in children with inherited bleeding disorders in the UK 2003-2015: A national cohort study

Haemophilia ◽  
2018 ◽  
Vol 24 (4) ◽  
pp. 641-647 ◽  
Author(s):  
E. A. Chalmers ◽  
J. Alamelu ◽  
P. W. Collins ◽  
M. Mathias ◽  
J. Payne ◽  
...  
Keyword(s):  
Cohort Study ◽  
Intracranial Haemorrhage ◽  
Bleeding Disorders ◽  
National Cohort ◽  
The Uk

scholarly journals Relationship between travel time to primary and tertiary care centres and survival in glioblastoma: the NHS Grampian experience.

2019 ◽  
Vol 21 (Supplement_4) ◽  
pp. iv17-iv17
Author(s):  
Damjan Veljanoski ◽  
Raphae Barlas ◽  
Aimun Jamjoom ◽  
Phyo Myint
Keyword(s):  
Travel Time ◽  
Cohort Analysis ◽  
Tertiary Care ◽  
Healthcare Facility ◽  
Tertiary Care Centre ◽  
Logistic Regression Models ◽  
Retrospective Cohort Analysis ◽  
Treatment Type ◽  
One Year ◽  
The Uk

Abstract Background Studies have demonstrated a distance-decay effect, whereby patients who live further away from their healthcare facility have poorer health outcomes. The geographical catchment area served by the neurosurgical unit in Aberdeen, Grampian region, Scotland is one of the largest in the UK. We aimed to examine the relationship between travel time as a proxy of distance travelled, and survival outcome for glioblastoma. Methods We conducted a retrospective, cohort analysis of patients with glioblastoma referred for treatment from January 2009 to December 2018. Travel time was calculated from the patients’ home to their general practitioner (GP) and to the neurosurgical unit. Logistic regression models were constructed to estimate survival at three, six and 12 months, as well as treatment within 62 days of GP referral, and within 31 days of diagnosis controlling for age, sex and treatment type. Results There were 195 patients (mean age (SD) 64.4 ± 12.9 years)57.9% were men, 65.1% were treated surgically, and 48.2% were alive after one year. Longer time travelled to GP, but not to tertiary care centre, was associated with reduced odds of mortality at three months (OR 0.88 95%CI 0.79–0.98; p=0.005) and six months (OR 0.92 95%CI 0.85–0.99; p=0.01), for each incremental increase in one minute. Conclusions Patients with glioblastoma with longer travel times to their GP were more likely to be alive at three months and six months. Further work is required to identify other factors, including degrees of socio-economic deprivation and rurality, which may influence this finding.

scholarly journals Defining the older patient population that require, but do not undergo emergency laparotomy: an observational cohort study protocol

2021 ◽  
Author(s):  
Nicola Reeves ◽  
Susan Chandler ◽  
Elizabeth McLennan ◽  
Angeline Price ◽  
Jemma Boyle ◽  
...  
Keyword(s):  
Older Adults ◽  
Decision Making ◽  
Cohort Study ◽  
Emergency Laparotomy ◽  
Ageing Population ◽  
Older Patient ◽  
Vulnerable Patient ◽  
The Uk ◽  
National Emergency ◽  
Vulnerable Patient Group

<p><strong>Background: </strong>Despite older adults (65 years and above) accounting for almost half of emergency laparotomies and an ageing population, there remains a paucity of research in the older adult emergency surgery population. One key clinical area that requires urgent assessment is the older patient who presents with acute abdominal pathology treatable by laparotomy, but who does not undergo surgery (NoLAP). <strong></strong></p><p><strong>Methods: </strong>This multicentre prospective cohort study [defining the denominator: emergency laparotomy and frailty study 2 (ELF2)] will recruit consecutive older adults that require but do not undergo emergency laparotomy (NoLAP). We will recruit from 47 national health service hospitals over a 3-month timeframe. The same criteria as NELA for inclusion and exclusion will be applied. The primary aim is 90-day mortality. Secondary aims include characterisation of the NoLAP group, frailty and sarcopenia with comparison to those older adults that have undergone emergency laparotomy (ELAP). Decision-making will also be explored. Assuming a NoLAP rate of 32% and 10% dropout, a minimum of 700 patients are required for 95% power (alpha=0.05).</p><p><strong>Conclusions: </strong>The UK national emergency laparotomy audit has provided vital information on those patients undergoing emergency laparotomy and driven standards in operative and perioperative care. However, little is known of outcomes in those patients who do not undergo emergency laparotomy.  Improved understanding of this NoLAP population would aid shared decision-making and improve standards for this otherwise poorly understood vulnerable patient group.</p><p><strong>Trial registration:</strong> This study is registered online at www.clinicaltrial.gov (Reg number: ISRCTN14556210).</p><p><strong> </strong></p>

scholarly journals Does ‘online confidence’ predict application success and later academic performance in medical school? A UK-based national cohort study

BMJ Open ◽  
2019 ◽  
Vol 9 (12) ◽  
pp. e034437
Author(s):  
Paul A Tiffin ◽  
Lewis W Paton
Keyword(s):  
Academic Performance ◽  
Cohort Study ◽  
Academic Success ◽  
Cognitive Performance ◽  
First Year ◽  
High Stakes ◽  
National Cohort ◽  
Two Measures ◽  
The Uk ◽  
Medical Selection

ObjectivesThe UK Clinical Aptitude Test (UKCAT) previously piloted an assessment of ‘online confidence’, where candidates were asked to indicate how confident they were with their answers. This study examines the relationship between these ratings, the odds of receiving an offer to study medicine and subsequent undergraduate academic performance.DesignNational cohort study.SettingUK undergraduate medical selection.Participants56 785 UKCAT candidates who sat the test between 2013 and 2016 and provided valid responses to the online confidence pilot study.Primary outcome measuresTwo measures of ‘online confidence’ were derived: the well-established ‘confidence bias’, and; a novel ‘confidence judgement’ measure, developed using Item Response Theory in order to derive a more sophisticated metric of the ability to evaluate one’s own performance on a task. Regression models investigated the relationships between these confidence measures, application success and academic performance.ResultsOnline confidence was inversely related to cognitive performance. Relative underconfidence was associated with increased odds of receiving an offer to study medicine. For ‘confidence bias’ this effect was independent of potential confounders (OR 1.48, 1.15 to 1.91, p=0.002). While ‘confidence judgement’ was also a univariable predictor of application success (OR 1.22, 1.01 to 1.47, p=0.04), it was not an independent predictor. ‘Confidence bias’, but not ‘confidence judgement’, predicted the odds of passing the first year of university at the first attempt, independently of cognitive performance, with relative underconfidence positively related to academic success (OR 3.24, 1.08 to 9.72, p=0.04). No non-linear effects were observed, suggesting no ‘sweet spot’ exists in relation to online confidence and the outcomes studied.ConclusionsApplicants who either appear underconfident, or are better at judging their own performance on a task, are more likely to receive an offer to study medicine. However, online confidence estimates had limited ability to predict subsequent academic achievement. Moreover, there are practical challenges to evaluating online confidence in high-stakes selection.

scholarly journals Characteristics and outcomes of pregnant women hospitalised with confirmed SARS-CoV-2 infection in the UK: a national cohort study using the UK Obstetric Surveillance System (UKOSS)

2020 ◽  
Author(s):  
Marian Knight ◽  
Kathryn Bunch ◽  
Nicola Vousden ◽  
Eddie Morris ◽  
Nigel Simpson ◽  
...  
Keyword(s):  
Cohort Study ◽  
Pregnant Women ◽  
Surveillance System ◽  
Perinatal Death ◽  
Strong Association ◽  
Population Based ◽  
Overweight And Obesity ◽  
National Cohort ◽  
Level 3 ◽  
The Uk

AbstractObjectiveTo describe a national cohort of pregnant women hospitalised with SARS-CoV-2 infection in the UK, identify factors associated with infection and describe outcomes, including transmission of infection, for mother and infant.DesignProspective national population-based cohort study using the UK Obstetric Surveillance System (UKOSS).SettingAll 194 obstetric units in the UKParticipants427 pregnant women admitted to hospital with confirmed Sars-CoV-2 infection between 01/03/2020 and 14/04/2020. 694 comparison women who gave birth between 01/11/2017 and 31/10/2018.Main outcome measuresIncidence of maternal hospitalisation, infant infection. Rates of maternal death, level 3 critical care unit admission, preterm birth, stillbirth, early neonatal death, perinatal death; odds ratios for infected versus comparison women.ResultsEstimated incidence of hospitalisation with confirmed SARS-CoV-2 in pregnancy 4.9 per 1000 maternities (95%CI 4.5-5.4). The median gestation at symptom onset was 34 weeks (IQR 29-38). Black or other minority ethnicity (aOR 4.49, 95%CI 3.37-6.00), older maternal age (aOR 1.35, 95%CI 1.01-1.81 comparing women aged 35+ with those aged 30-34), overweight and obesity (aORs 1.91, 95%CI 1.37-2.68 and 2.20, 95%CI 1.56-3.10 respectively compared to women with a BMI<25kg/m2) and pre-existing comorbidities (aOR 1.52, 95%CI 1.12-2.06) were associated with admission with SARS-CoV-2 during pregnancy. 247 women (58%) gave birth or had a pregnancy loss; 180 (73%) gave birth at term. 40 (9%) hospitalised women required respiratory support. Twelve infants (5%) tested positive for SARS-CoV-2 RNA, six of these infants within the first 12 hours after birth.ConclusionsThe majority of pregnant women hospitalised with SARS-CoV-2 were in the late second or third trimester, supporting guidance for continued social distancing measures in later pregnancy. Most had good outcomes and transmission of SARS-CoV-2 to infants was uncommon. The strong association between admission with infection and black or minority ethnicity requires urgent investigation and explanation.Study RegistrationISRCTN 40092247

EP.FRI.8 Hajibandeh index predicts nature of peritoneal contamination and risk of postoperative mortality in patients with acute abdominal pathology: A multicentre cohort study

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Shahab Hajibandeh ◽  
Shahin Hajibandeh ◽  
Jigar Shah ◽  
Moustafa Mansour
Keyword(s):  
Cohort Study ◽  
Validation Cohort ◽  
Postoperative Mortality ◽  
Operative Management ◽  
Emergency Laparotomy ◽  
Roc Curve Analysis ◽  
Peritoneal Contamination ◽  
Multicentre Cohort Study ◽  
Non Operative Management ◽  
Multicentre Cohort

Abstract Aims To develop and validate intraperitoneal contamination index, Hajibandeh Index (HI), derived from combined levels of CRP, lactate, neutrophils, lymphocytes and albumin in predicting the nature of peritoneal contamination and risk of postoperative mortality in patients with acute abdominal pathology. Methods A multicentre cohort study was conducted to develop and validate an index to predict presence of purulent and feculent contamination and risk of postoperative mortality in patients with acute abdominal pathology. All adult patients with acute abdominal pathology requiring emergency laparotomy between 2014 and 2020 were included. The index was developed in a primary cohort and was validated in retrospective and prospective validation cohorts. ROC curve analysis was performed to determine discrimination of the index and cut-off values of HI that could predict nature of peritoneal contamination and postoperative mortality. Results 737 patients were included (234 in primary cohort, 234 in retrospective validation cohort, and 269 in prospective validation cohort). The analyses identified HI of 24.76 as cut-off value for purulent contamination (AUC:0.78,P&lt;0.0001;sensitivity:82.4%,specificity:60.9%); HI of 33.84 as cut-off value for feculent contamination (AUC:0.78, P&lt;0.0001;sensitivity:82%,specificity:67.8%), and HI of 33.47 as cut-off value for postoperative mortality (AUC:0.70,P&lt;0.0001;sensitivity:72.7%, specificity:58.47%). The results of the primary cohort and validation cohorts were comparable. Conclusions HI predicts presence of purulent and feculent contamination in patients with acute abdominal pathology and risk of postoperative mortality in patients undergoing emergency laparotomy. Future studies should investigate the effect of HI on accuracy of preoperative prognostic scoring tools and on patient selection for operative or non-operative management of underlying abdominal pathology.

scholarly journals Prevalence and predictors of US medical graduates’ federal F32, mentored-K, and R01 awards: a national cohort study

2017 ◽  
Vol 66 (2) ◽  
pp. 340-350 ◽  
Author(s):  
Donna B Jeffe ◽  
Dorothy A Andriole
Keyword(s):  
Cohort Study ◽  
Medical School ◽  
Logistic Regression Models ◽  
Medical Graduates ◽  
Medical Licensing ◽  
School Research ◽  
National Cohort ◽  
Experiential Interventions ◽  
Research Workforce ◽  
To Receive

The size and diversity of the physician-scientist workforce are issues of national concern. In this retrospective, national cohort study of US medical school matriculants who graduated in 1997–2004, we describe the prevalence and predictors of federal F32, mentored-K, and R01 awards among physicians. In multivariable logistic regression models, we identified demographic, educational, and professional development variables independently associated with each award through August 2014, reporting adjusted odds ratios and 95% confidence intervals (AOR (95% CI)). Among 117,119 graduates with complete data (97.7% of 119,906 graduates in 1997–2004), 509 (0.4%) received F32, 1740 (1.5%) received mentored-K, and 597 (0.5%) received R01 awards. Adjusting for all variables except US Medical Licensing Examination Step 1 scores, black (vs white) graduates were less likely to receive F32 (0.48 (0.28–0.82)), mentored-K (0.56 (0.43–0.72)), and R01 (0.48 (0.28–0.82)) awards; Hispanic graduates were less likely to receive mentored-K awards (0.68 (0.52–0.88)), and women less likely to receive F32 (0.81 (0.67–0.98)) and R01 (0.59 (0.49–0.71)) awards. After adding Step 1 scores, these race/ethnicity effects were not significant, but women (0.62 (0.51–0.75)) were still less likely to receive R01 awards. Graduates reporting both (vs neither) medical school research elective and authorship were more likely to receive F32 (1.89 (1.45–2.48)), mentored-K (2.48 (2.13–2.88)), and R01 (2.00 (1.54–2.60)) awards. Prior F32 (2.17 (1.46–3.21)) and mentored-K (28.08 (22.94–34.38)) awardees more likely received R01 awards. Findings highlight the need for research-experiential interventions along the medical education continuum to promote greater participation and diversity of US medical graduates in the federally funded, biomedical research workforce.

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