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Francis NK, Curtis NJ, Weegenaar C, Boorman PA, Brook A, Thorpe G, Keogh K, Grainger J, Davies J, Wheeler J, Brown SR, Steele RJ, Dawson P. Developing a national colorectal educational agenda: a survey of the Association of Coloproctology of Great Britain and Ireland. Colorectal Dis 2018; 20:68-73. [PMID: 28682454 DOI: 10.1111/codi.13804] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 05/02/2017] [Accepted: 05/17/2017] [Indexed: 02/06/2023]
Abstract
AIM In order to develop its education agenda, the Association of Coloproctology of Great Britain and Ireland (ACPGBI) sought the opinion of its members on current coloproctology training needs. The aims of this study were to canvass multidisciplinary needs and explore the perceived gaps and barriers to meeting them. METHOD A learner-needs analysis was performed between July 2015 and October 2016. A bespoke electronic survey was sent to 1453 colorectal healthcare professionals [ACPGBI membership (1173), colorectal nurse specialists and allied health professionals (NAHPs) (261) and regional chapter-leads (19)] seeking their needs, experiences and barriers to training across the coloproctology disciplines. RESULTS In all, 390 responses were received [26.8% overall; 180 consultants/trainees (15%); 196 NAHPs (75%); 14 (74%) chapter-leads]. Lack of funding and difficulties in obtaining study leave were the most frequently reported barriers to course and conference attendance. Transanal total mesorectal excision and laparoscopic training were the top educational needs for consultants and trainees respectively. 79% of NAHP respondents reported education gaps on a broad range of clinical and non-clinical topics. NAHPs lacked information on relevant training opportunities and 27% felt available courses were insufficient to meet their educational needs. Wide heterogeneity in ACPGBI chapter composition and activity was reported. All groups felt the ACPGBI should increase the number of courses offered with coloproctology knowledge updates commonly requested. CONCLUSION A series of training needs across the coloproctology disciplines have been identified. These will underpin the development of the educational agenda for the ACPGBI.
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Gubits D, Shinn M, Wood M, Brown SR, Dastrup SR, Bell SH. What Interventions Work Best for Families Who Experience Homelessness? Impact Estimates from the Family Options Study. JOURNAL OF POLICY ANALYSIS AND MANAGEMENT : [THE JOURNAL OF THE ASSOCIATION FOR PUBLIC POLICY ANALYSIS AND MANAGEMENT] 2018; 37:735-766. [PMID: 30272428 PMCID: PMC6168747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
What housing and service interventions work best to reduce homelessness for families in the United States? The Family Options Study randomly assigned 2,282 families recruited in homeless shelters across 12 sites to priority access to one of three active interventions or to usual care in their communities. The interventions were long-term rent subsidies, short-term rent subsidies, and transitional housing in supervised programs with intensive psychosocial services. In two waves of follow-up data collected 20and 37 months later, priority access to long-term rent subsidies reduced homelessness sand food insecurity and improved other aspects of adult and child well-being relative to usual care, at a cost 9 percent higher. The other interventions had little effect. The study provides support for the view that homelessness for most families is an economic problem that long-term rent subsidies resolve and does not support the view that families must address psychosocial problems to succeed in housing. It has implications for focusing government resources on this important social problem.
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Fowler GE, Baker DM, Lee MJ, Brown SR. A systematic review of online resources to support patient decision-making for full-thickness rectal prolapse surgery. Tech Coloproctol 2017; 21:853-862. [PMID: 29101494 PMCID: PMC5701040 DOI: 10.1007/s10151-017-1708-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 09/19/2017] [Indexed: 12/27/2022]
Abstract
Background The internet is becoming an increasingly popular resource to support patient decision-making outside of the clinical encounter. The quality of online health information is variable and largely unregulated. The aim of this study was to assess the quality of online resources to support patient decision-making for full-thickness rectal prolapse surgery. Methods This systematic review was registered on the PROSPERO database (CRD42017058319). Searches were performed on Google and specialist decision aid repositories using a pre-defined search strategy. Sources were analysed according to three measures: (1) their readability using the Flesch–Kincaid Reading Ease score, (2) DISCERN score and (3) International Patient Decision Aids Standards (IPDAS) minimum standards criteria score (IPDASi, v4.0). Results Overall, 95 sources were from Google and the specialist decision aid repositories. There were 53 duplicates removed, and 18 sources did not meet the pre-defined eligibility criteria, leaving 24 sources included in the full-text analysis. The mean Flesch–Kincaid Reading Ease score was higher than recommended for patient education materials (48.8 ± 15.6, range 25.2–85.3). Overall quality of sources supporting patient decision-making for full-thickness rectal prolapse surgery was poor (median DISCERN score 1/5 ± 1.18, range 1–5). No sources met minimum decision-making standards (median IPDASi score 5/12 ± 2.01, range 1–8). Conclusions Currently, easily accessible online health information to support patient decision-making for rectal surgery is of poor quality, difficult to read and does not support shared decision-making. It is recommended that professional bodies and medical professionals seek to develop decision aids to support decision-making for full-thickness rectal prolapse surgery.
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Lee MJ, Heywood N, Adegbola S, Tozer P, Sahnan K, Fearnhead NS, Brown SR. Systematic review of surgical interventions for Crohn's anal fistula. BJS Open 2017; 1:55-66. [PMID: 29951607 PMCID: PMC5989984 DOI: 10.1002/bjs5.13] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Accepted: 07/06/2017] [Indexed: 12/14/2022] Open
Abstract
Background Anal fistula occurs in approximately one in three patients with Crohn's disease and is typically managed through a multimodal approach. The optimal surgical therapy is not yet clear. The aim of this systematic review was to identify and assess the literature on surgical treatments of Crohn's anal fistula. Methods A systematic review was conducted that analysed studies relating to surgical treatment of Crohn's anal fistula published on MEDLINE, Embase and Cochrane databases between January 1995 and March 2016. Studies reporting specific outcomes of patients treated for Crohn's anal fistula were included. The primary outcome was fistula healing rate. Bias was assessed using the Cochrane ROBINS‐I and ROB tool as appropriate. Results A total of 1628 citations were reviewed. Sixty‐three studies comprising 1584 patients were ultimately selected in the analyses. There was extensive reporting on the use of setons, advancement flaps and fistula plugs. Randomized trials were available only for stem cells and fistula plugs. There was inconsistency in outcome measures across studies, and a high degree of bias was noted. Conclusion Data describing surgical intervention for Crohn's anal fistula are heterogeneous with a high degree of bias. There is a clear need for standardization of outcomes and description of study cohorts for better understanding of treatment options.
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Grossi U, Knowles CH, Mason J, Lacy-Colson J, Brown SR. Surgery for constipation: systematic review and practice recommendations: Results II: Hitching procedures for the rectum (rectal suspension). Colorectal Dis 2017; 19 Suppl 3:37-48. [PMID: 28960927 DOI: 10.1111/codi.13773] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
AIM To assess the outcomes of rectal suspension procedures (forms of rectopexy) in adults with chronic constipation. METHOD Standardised methods and reporting of benefits and harms were used for all CapaCiTY reviews that closely adhered to PRISMA 2016 guidance. Main conclusions were presented as summary evidence statements with a summative Oxford Centre for Evidence-Based Medicine (2009) level. RESULTS Eighteen articles were identified, providing data on outcomes in 1238 patients. All studies reported only on laparoscopic approaches. Length of procedures ranged between 1.5 to 3.5 h, and length of stay between 4 to 5 days. Data on harms were inconsistently reported and heterogeneous, making estimates of harm tentative and imprecise. Morbidity rates ranged between 5-15%, with mesh complications accounting for 0.5% of patients overall. No mortality was reported after any procedures in a total of 1044 patients. Although inconsistently reported, good or satisfactory outcome occurred in 83% (74-91%) of patients; 86% (20-97%) of patients reported improvements in constipation after laparoscopic ventral mesh rectopexy (LVMR). About 2-7% of patients developed anatomical recurrence. Patient selection was inconsistently documented. As most common indication, high grade rectal intussusception was corrected in 80-100% of cases after robotic or LVMR. Healing of prolapse-associated solitary rectal ulcer syndrome occurred in around 80% of patients after LVMR. CONCLUSION Evidence supporting rectal suspension procedures is currently derived from poor quality studies. Methodologically robust trials are needed to inform future clinical decision making.
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Shinn M, Brown SR, Gubits D. Can Housing and Service Interventions Reduce Family Separations for Families Who Experience Homelessness? AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2017; 60:79-90. [PMID: 28012168 DOI: 10.1002/ajcp.12111] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
Family break-up is common in families experiencing homelessness. This paper examines the extent of separations of children from parents and of partners from each other and whether housing and service interventions reduced separations and their precursors among 1,857 families across 12 sites who participated in the Family Options Study. Families in shelters were randomized to offers of one of three interventions: permanent housing subsidies that reduce expenditures for rent to 30% of families' income, temporary rapid re-housing subsidies with some services directed at housing and employment, and transitional housing in supervised facilities with extensive psychosocial services. Each group was compared to usual care families who were eligible for that intervention but received no special offer. Twenty months later, permanent housing subsidies almost halved rates of child separation and more than halved rates of foster care placements; the other interventions did not affect separations significantly. Predictors of separation were primarily homelessness and drug abuse (all comparisons), and alcohol dependence (one comparison). Although housing subsidies reduced homelessness, alcohol dependence, intimate partner violence, and economic stressors, the last three variables had no association with child separations in the subsidy comparison; thus subsidies had indirect effects via reductions in homelessness. No intervention reduced partner separations.
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Knowles CH, Grossi U, Horrocks EJ, Pares D, Vollebregt PF, Chapman M, Brown SR, Mercer-Jones M, Williams AB, Hooper RJ, Stevens N, Mason J. Surgery for constipation: systematic review and clinical guidance: Paper 1: Introduction & Methods. Colorectal Dis 2017; 19 Suppl 3:5-16. [PMID: 28960925 DOI: 10.1111/codi.13774] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
AIM This manuscript provides the introduction and detailed methodology used in subsequent reviews to assess the outcomes of surgical interventions with the primary intent of treating chronic constipation in adults and to develop recommendations for practice. METHOD PRISMA guidance was adhered to throughout. A literature search was performed in public databases between January 1960 and February 2016. Studies that fulfilled strictly-defined PICOS (patients, interventions, controls, outcome, and study design) criteria were included. The process involved two groups of participants: (i): 'a clinical guidance group' of 18 UK experts (including junior support) who performed the systematic reviews and produced summary evidence statements (SES) based strictly on data synthesis in each review. The same group then produced prototype graded practice recommendations (GPRs) based on coalescence of SES and expert opinion; (ii): a European Consensus group of 18 ESCP (European Society of Coloproctology) nominated experts from nine European countries evaluated the appropriateness of each prototype GPR based on published RAND/UCLA methodology. RESULTS An overview of the search results is provided in this manuscript. A total of 156 studies from 307 full text articles (from 2551 initially screened records) were included, providing data on procedures characterized by: (i) colonic resection (n = 40); (ii) rectal suspension (n = 18); (iii) rectal wall excision (n = 44); (iv) rectovaginal septum reinforcement (n = 47); (v) sacral nerve stimulation (n = 7). The overall quality of evidence was poor with 113/156 (72.4%) studies providing only Oxford level IV evidence. The best evidence was extracted for rectal excisional procedures, where the majority of studies were Oxford level I or II. The five subsequent reviews provide a total of 99 SES (reflecting perioperative variables, efficacy, harms and prognostic variables) that contributed to 100 prototype GPRs covering patient selection, procedural considerations and patient counselling. The final manuscript details the 85/100 GPRs that were deemed appropriate by European Consensus (remaining 15 were all uncertain) and future research recommendations. CONCLUSION This manuscript and the following 6 papers suggest that the evidence base for surgical management of chronic constipation is currently poor although some expert consensus exists on best practice. Further studies are required to inform future commissioning of treatments and of research funding.
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Wang H, Brown SR. The effects of total ankle replacement on ankle joint mechanics during walking. JOURNAL OF SPORT AND HEALTH SCIENCE 2017; 6:340-345. [PMID: 30356570 PMCID: PMC6189001 DOI: 10.1016/j.jshs.2016.01.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Revised: 12/15/2014] [Accepted: 09/21/2015] [Indexed: 06/04/2023]
Abstract
BACKGROUND End-stage ankle arthritis impairs joint function and patients' mobility. Total ankle replacement is a surgical procedure to treat severe ankle arthritis. Salto Talaris Anatomic AnkleTM (STAA) was designed to mimic the normal ankle anatomy and flexion/extension of the ankle movement. The purpose of this study was to examine the effect of an STAA ankle replacement on ankle joint function and mechanics during gait. METHODS Five patients with end-stage unilateral ankle arthritis were recruited. Patients performed level walking in a laboratory setting on 2 occasions, prior to and 3 months after the STAA ankle surgeries. American Orthopedic Foot and Ankle Society (AOFAS) hindfoot score was obtained. A 12-camera motion capture system was used to perform walking analysis. Gait temporo-spatial parameters and ankle joint mechanics were evaluated. Paired Student's t tests and non-parametric Wilcoxon matched tests were performed to examine the differences in biomechanical variables between the pre- and post-surgery walking conditions. RESULTS Compared to the pre-surgical condition, at 3 months of post-STAA surgery, patients experienced greater improvement in AOFAS hindfoot score (p = 0.0001); the STAA ankle demonstrated a 31% increase in ankle joint excursion (p = 0.045), a 22% increase in ankle plantarflexor moment (p = 0.075), a 60% increase in ankle power absorption (p = 0.023), and a 68% increase in ankle power production (p = 0.039). Patients also demonstrated a 26% increase in walking speed (p = 0.005), a 20% increase in stride length (p = 0.013), a 15% decrease in double support time (p = 0.043), and a 5% decrease in total stance time (p = 0.055). CONCLUSION Three months after surgeries, the STAA patients experienced improvements in ankle function and gait parameters. The STAA ankle demonstrated improved ankle mechanics during daily activities such as walking.
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Drake TM, Lee MJ, Senapati A, Brown SR. Resource variation in colorectal surgery: a national centre level analysis. Colorectal Dis 2017; 19:641-648. [PMID: 28052574 DOI: 10.1111/codi.13596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Accepted: 11/20/2016] [Indexed: 02/08/2023]
Abstract
AIM Delivery of quality colorectal surgery requires adequate resources. We set out to assess the relationship between resources and outcomes in English colorectal units. METHOD Data were extracted from the Association of Coloproctology of Great Britain and Ireland resource questionnaire to profile resources. This was correlated with Hospital Episode Statistics outcome data including 90-day mortality and readmissions. Patient satisfaction measures were extracted from the Cancer Experience Patient Survey and compared at unit level. Centres were divided by workload into low, middle and top tertile. RESULTS Completed questionnaires were received from 75 centres in England. Service resources were similar between low and top tertiles in access to Confidential Enquiry into Patient Outcome and Death (CEPOD) theatre, level two or three beds per 250 000 population or the likelihood of having a dedicated colorectal ward. There was no difference in staffing levels per 250 000 unit of population. Each 10% increase in the proportion of cases attempted laparoscopically was associated with reduced 90-day unplanned readmission (relative risk 0.94, 95% CI 0.91-0.97, P < 0.001). The presence of a dedicated colorectal ward (relative risk 0.85, 95% CI 0.73-0.99, P = 0.040) was also associated with a significant reduction in unplanned readmissions. There was no association between staffing or service factors and patient satisfaction. CONCLUSION Resource levels do not vary based on unit of population. There is benefit associated with increased use of laparoscopy and a dedicated surgical ward. Alternative measures to assess the relationship between resources and outcome, such as failure to rescue, should be explored in UK practice.
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Braithwaite GC, Lee MJ, Hind D, Brown SR. Prognostic factors affecting outcomes in fistulating perianal Crohn's disease: a systematic review. Tech Coloproctol 2017. [PMID: 28639073 PMCID: PMC5550543 DOI: 10.1007/s10151-017-1647-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND One in three patients with Crohn's disease will develop a perianal fistulae, and one third of these will achieve long-term healing or closure. A barrier to conducting well-designed clinical trials for these patients is a lack of understanding of prognostic factors. This systematic review sets out to identify factors associated with prognosis of perianal Crohn's fistulae. METHODS This review was registered on the PROSPERO database (CRD42016050316) and conducted in line with PRISMA guidelines along a predefined protocol. English-language studies assessing baseline factors related to outcomes of fistulae treatment in adult patients were included. Searches were performed on MEDLINE and Embase databases. Screening of abstracts and full texts for eligibility was performed prior to extraction of data into predesigned forms. Bias was assessed using the QUIPS tool. RESULTS Searches identified 997 papers. Following removal of duplicates and secondary searches, 923 were screened for inclusion. Forty-seven papers were reviewed at full-text level and 13, 2 of which were randomised trials, were included in the final qualitative review. Two studies reported distribution of Crohn's disease as a prognostic factor for healing. Two studies found that CARD15 mutations decreased response of fistulae to antibiotics. Complexity of fistulae anatomy was implicated in prognosis by 4 studies. CONCLUSIONS This systematic review has identified potential prognostic markers, including genetic factors and disease behaviour. We cannot, however, draw robust conclusions from this heterogeneous group of studies; therefore, we recommend that a prospective cohort study of well-characterised patients with Crohn's perianal fistulae is undertaken.
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Lee MJ, Heywood N, Sagar PM, Brown SR, Fearnhead NS. Association of Coloproctology of Great Britain and Ireland consensus exercise on surgical management of fistulating perianal Crohn's disease. Colorectal Dis 2017; 19:418-429. [PMID: 28387062 DOI: 10.1111/codi.13672] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Accepted: 01/04/2017] [Indexed: 02/08/2023]
Abstract
AIM Management of fistulating perianal Crohn's disease (fpCD) is a significant challenge for a colorectal surgeon. A recent survey of surgical practice in this condition showed variation in management approaches. As a result we set out to devise recommendations for practice for UK colorectal surgeons. METHOD Results from a national survey were used to devise a set of potential consensus statements. Consultant colorectal surgeons were invited to participate in the exercise via the previous survey and the mailing list of the professional society. Iterative voting was performed on each statement using a five-point Likert scale and electronic voting, with opportunity for discussion and refinement between each vote. Consensus was defined as > 80% agreement. RESULTS Seventeen surgeons and two patient representatives voted upon 51 statements. Consensus was achieved on 39 items. Participants advocated a patient-centred approach by a colorectal specialist, within strong multidisciplinary teamworking. The use of anti-TNFα therapy is advocated. Where definitive surgical techniques are considered they should be carefully selected to avoid adverse impact on function. Ano/rectovaginal fistulas should be managed by specialists in fistulating disease. Stoma or proctectomy could be discussed earlier in a patient's treatment pathway to improve choice, as they may improve quality of life. CONCLUSION This consensus provides principles and guidance for best practice in managing patients with fpCD.
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Helms ER, Storey A, Cross MR, Brown SR, Lenetsky S, Ramsay H, Dillen C, Zourdos MC. RPE and Velocity Relationships for the Back Squat, Bench Press, and Deadlift in Powerlifters. J Strength Cond Res 2017; 31:292-297. [PMID: 27243918 DOI: 10.1519/jsc.0000000000001517] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Helms, ER, Storey, A, Cross, MR, Browm, SR, Lenetsky, S, Ramsay, H, Dillen, C, and Zourdos, MC. RPE and velocity relationships for the back squat, bench press, and deadlift in powerlifters. J Strength Cond Res 31(2): 292-297, 2017-The purpose of this study was to compare average concentric velocity (ACV) and rating of perceived exertion (RPE) based on repetitions in reserve on the squat, bench press, and deadlift. Fifteen powerlifters (3 women and 12 men, mean age 28.4 ± 8.5 years) worked up to a one repetition maximum (1RM) on each lift. Rating of perceived exertion was recorded on all sets, and the ACV was recorded for all sets performed at 80% of estimated 1RM and higher, up to 1RM. Rating of perceived exertion at 1RM on squat, bench press, and deadlift was 9.6 ± 0.5, 9.7 ± 0.4, and 9.6 ± 0.5, respectively and was not significantly different (p > 0.05). The ACV at 1RM on squat, bench press and deadlift was 0.23 ± 0.05, 0.10 ± 0.04, and 0.14 ± 0.05 m·second, respectively. Squat was faster than both bench press and deadlift (p > 0.001), and deadlift was faster than bench press (p = 0.05). Very strong relationships (r = 0.88-0.91) between percentage 1RM and RPE were observed on each lift. The ACV showed strong (r = -0.79 to -0.87) and very strong (r = -0.90 to 92) inverse relationships with RPE and percentage 1RM on each lift, respectively. We conclude that RPE may be a useful tool for prescribing intensity for squat, bench press, and deadlift in powerlifters, in addition to traditional methods such as percentage of 1RM. Despite high correlations between percentage 1RM and ACV, a "velocity load profile" should be developed to prescribe intensity on an individual basis with appropriate accuracy.
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Lee MJ, Heywood N, Sagar PM, Brown SR, Fearnhead NS. Surgical management of fistulating perianal Crohn's disease: a UK survey. Colorectal Dis 2017; 19:266-273. [PMID: 27423057 DOI: 10.1111/codi.13462] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Accepted: 06/08/2016] [Indexed: 12/13/2022]
Abstract
AIM Around one-third of patients with Crohn's disease are affected by Crohn's fistula-in-ano (pCD). It typically follows a chronic course and patients undergo long-term medical and surgical therapy. We set out to describe current surgical practice in the management of pCD in the UK. METHOD A survey of surgical management of pCD was designed by an expert group of colorectal surgeons and gastroenterologists. This assessed acute, elective, multidisciplinary and definitive surgical management. A pilot of the questionnaire was undertaken at the 2015 meeting of the Digestive Disease Federation. The survey was refined and distributed nationally through the trainee collaborative networks. RESULTS National rollout obtained responses from 133 of 179 surgeons approached (response rate 74.3%). At first operation, 32% of surgeons would always consider drainage of sepsis and 31.1% would place a draining seton. At first elective operation, 66.6% would routinely insert of draining seton, and 84.4% would avoid cutting seton. An IBD multidisciplinary team was available to 87.6% of respondents, although only 25.1% routinely discussed pCD patients. Anti-tumour necrosis factor-alpha therapy was routinely considered by 64.2%, although 44.2% left medical management to gastroenterologists. Common definitive procedures were removal of the seton only (70.7%), fistulotomy (57.1%), advancement flap (38.9%), fistula plug (36.4%) and ligation of intersphincteric track (LIFT) procedure (31.8%). Indications for diverting stoma or proctectomy were intractable sepsis, incontinence and poor quality of life. CONCLUSION This survey has demonstrated areas of common practice, but has also highlighted divergent practice including choices of definitive surgery and multimodal management. Practical guidelines are required to support colorectal surgeons in the UK.
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Hume P, Theadom A, Lewis GN, Quarrie KL, Brown SR, Hill R, Marshall SW. COGNITION IN FORMER RUGBY UNION PLAYERS AND IMPACT OF CONCUSSION HISTORY. Br J Sports Med 2017. [DOI: 10.1136/bjsports-2016-097372.125] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Lewis GN, Hume PA, Stavric V, Brown SR, Taylor D. New Zealand rugby health study: motor cortex excitability in retired elite and community level rugby players. THE NEW ZEALAND MEDICAL JOURNAL 2017; 130:34-44. [PMID: 28081555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
AIMS Rugby union is a high contact sport in which players frequently experience brain injuries. Acute brain injury is associated with altered corticomotor function. However, it is uncertain if long-term exposure to rugby is associated with any alterations in corticomotor function. The aim of the study was to assess measures of corticomotor excitability and inhibition in retired rugby players in comparison to retired non-contact sport players. METHODS The design was a cross-sectional study with three groups of retired athletes: elite rugby (n=23), community level rugby (n=28) and non-contact sport control (n=22). Assessments of corticomotor excitability were made using transcranial magnetic stimulation. RESULTS Resting motor threshold was significantly higher and long-interval intracortical inhibition was greater in the elite rugby group compared to the control group. Participants in the two rugby groups had sustained significantly more concussions than the control group. CONCLUSIONS We provide some evidence of altered corticomotor excitation and inhibition in retired elite rugby players in comparison to retired non-contact sport players. Given the absence of findings in the community rugby group, who had experienced a similar number of concussions, the association with previous brain injury is unclear.
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Shinn M, Brown SR, Spellman BE, Wood M, Gubits D, Khadduri J. Mismatch Between Homeless Families and the Homelessness Service System. CITYSCAPE (WASHINGTON, D.C.) 2017; 19:293-307. [PMID: 29326756 PMCID: PMC5760190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The enrollment phase of the Family Options Study provides information about the mismatch of the homeless service system and the needs and desires of families experiencing homelessness in 12 communities. One-fourth (25.8 percent) of the 2,490 families screened for the study after shelter stays of a week were deemed ineligible for one or more of the interventions at initial screening, with ineligibility highest for those screened for transitional housing programs (28.9 percent) and lower for short- and long-term rental subsidies (9.2 and 4.1 percent). Families given priority offers of housing and service interventions for which they appeared eligible faced additional screening by programs and made decisions about whether to enroll. Considering all stages of this process, families were least likely to be eligible for and subsequently choose to enroll (within 9 months) in transitional housing programs (32.5 percent of those initially screened) and most likely to be eligible for and subsequently lease up with long-term subsidies (73.4 percent) with short-term subsidies in between (51.0 percent). Homeless system interventions systematically screen out families with housing and employment barriers, despite the presumption that these families are the families who need interventions in order to achieve housing and economic stability.
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Brown SR. Hubble trial: time to stick to basics for treatment of haemorrhoids? Tech Coloproctol 2016; 21:65-67. [PMID: 27699495 DOI: 10.1007/s10151-016-1535-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2016] [Accepted: 08/14/2016] [Indexed: 11/28/2022]
Abstract
The results of the Hubble trial, a randomised controlled trial comparing haemorrhoidal artery ligation with rubber band ligation for early-grade prolapsing haemorrhoids, are discussed. The difficulties in defining treatment success are debated along with the trial design highlighting the pitfalls of previous research. A finding that haemorrhoidal artery ligation is not necessarily superior to cheap alternatives has implications for current practice and future commissioning of surgeons.
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Gunner CK, Senapati A, Northover JMA, Brown SR. Life after PROSPER. What do people do for external rectal prolapse? Colorectal Dis 2016; 18:811-4. [PMID: 27481719 DOI: 10.1111/codi.13255] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2015] [Accepted: 11/20/2015] [Indexed: 02/08/2023]
Abstract
AIM A questionnaire completed by members of the ACPGBI in 1997 was a precursor to the PROSPER trial. It showed a significant variation in favoured practice for the surgical treatment of external rectal prolapse. We repeated the same questionnaire to assess how practice has changed since the completion of the trial and its publication. METHOD An online survey was circulated to all members of the ACPGBI with identical questions to those used in the original in 1997. RESULTS Similar numbers of recipients responded (122/791 [15.4%] in 2014;153/600 [25.5%] in 1997). The median number of operations per surgeon per year was unchanged (6 [0-30] vs 6 [0-25]). The percentage of surgeons who favoured an abdominal approach in fit patients in 1997 rose significantly from 63.5% to 81.7% in 2014 (P < 0.01). Delorme's remains the most popular perineal procedure (78.5% vs 93.3%), but the Altemeier procedure increased from 14.9% to 39.3%. Ventral rectopexy was the preferred abdominal approach in 2014 (48.6% vs 5.9% [P < 0.01]), with 96.3% of these being performed laparoscopically. The number of surgeons carrying out posterior rectopexy decreased from 92.6% to 45.9% (P < 0.01). Only 9.9% of surgeons still undertook resection rectopexy compared with 39.7% in 1997 (P < 0.01). The numbers of surgeons favouring a perineal approach decreased (18.3% vs 36.5%) although the use of a perineal procedure in elderly or unfit patients was unchanged (38.5% vs 37.9%). CONCLUSION The surgical management of external rectal prolapse had changed. More surgeons favoured a laparoscopic abdominal approach in 2014 than in 1997 and the use of perineal approaches had decreased. Of these Delorme's operation remained the most popular but the incidence of the use of Altmeier's procedure had increased.
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Shinn M, Brown SR, Wood M, Gubits D. Housing and Service Interventions for Families Experiencing Homelessness in the United States: An Experimental Evaluation. EUROPEAN JOURNAL OF HOMELESSNESS 2016; 10:13-30. [PMID: 30214709 PMCID: PMC6133270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
This paper examines the housing and service interventions that work best to end family homelessness and to promote housing stability, adult and child well-being, family and self-sufficiency in the United States. It is based on the short-term (20-month) results of the Family Options Study, which recruited 2,282 families in emergency homeless shelters across 12 sites and randomized them to one of three housing and service interventions or to usual care in their communities. The approaches test both theoretical propositions about the nature of family homelessness and practical efforts to end it. Permanent housing subsidies were most successful at ending homelessness and promoting housing stability and had radiating impacts on all the other domains, suggesting that homelessness among families in the United States is centrally a problem of housing affordability. Project-based transitional housing, which attempts to address families' psychosocial needs in supervised settings, and temporary 'rapid re-housing' subsidies had little effect.
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Kelly SL, Radley SC, Brown SR. Does percutaneous tibial nerve stimulation improve global pelvic function in women with faecal incontinence? Colorectal Dis 2016; 18:O158-63. [PMID: 26970061 DOI: 10.1111/codi.13329] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 02/11/2016] [Indexed: 02/08/2023]
Abstract
AIM Percutaneous tibial nerve stimulation (PTNS) is a minimally invasive treatment for faecal incontinence. Many patients with faecal incontinence have coexisting pelvic floor disorders such as urinary incontinence and vaginal symptoms. We utilized a pelvic floor assessment tool to analyse any effect of PTNS on global pelvic floor function. METHODS Patients with faecal incontinence attending our institution who had failed to respond sufficiently to biofeedback were offered a course of PTNS. Patients underwent pre- and post-stimulation assessment with a validated electronic Personal Assessment Questionnaire - Pelvic Floor (ePAQ-PF) for pelvic floor disorders. Scores were compared to assess the effect of treatment on global pelvic floor function. RESULTS During the study period pre- and post-stimulation ePAQ-PF data were available for 60 patients (55% of all patients starting PTNS). In this cohort there was a significant improvement in bowel continence, bowel related quality of life, irritable bowel syndrome and bowel evacuation with a large effect size for continence and bowel related quality of life. There was also a significant improvement in non-bowel related symptoms, including urinary pain and stress incontinence, urinary related quality of life and bowel related sexual function. Sixty-five per cent of those who answered the question reported improvement in global health after stimulation. CONCLUSION For patients presenting with faecal incontinence, PTNS appears to have a positive effect on bowel related function in approximately two-thirds of patients. However, for treatment responders, improvement appears to relate mainly to improvement in bowel related function rather than a global pelvic floor effect.
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Brown SR, Watson A. Comments to 'Rubber band ligation versus excisional haemorrhoidectomy for haemorrhoids'. Tech Coloproctol 2016; 20:659-61. [PMID: 27023348 DOI: 10.1007/s10151-016-1461-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 03/08/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To review the efficacy and safety of the two most popular conventional methods of haemorrhoidal treatment, rubber band ligation and excisional haemorrhoidectomy (EH). The original study has now been updated using the same search strategy. SEARCH METHODS We searched MEDLINE, EMBASE, CENTRAL, and CINAHL up to October 2010. SELECTION CRITERIA Randomised controlled trials comparing rubber band ligation with EH for symptomatic haemorrhoids in adult human patients were included. DATA COLLECTION AND ANALYSIS We extracted data on to a previously designed data extraction sheet. Dichotomous data were presented as relative risk and 95 % confidence intervals, and continuous outcomes as weighted mean difference and 95 % confidence intervals. MAIN RESULTS Three trials (of poor methodological quality) met the inclusion criteria. Complete remission of haemorrhoidal symptom was better with EH (three studies, 202 patients, RR 1.68, 95 % CI 1.00-2.83). There was a significant heterogeneity between the studies (I2 = 90.5 %; P = 0.0001). Similar analysis based on the grading of haemorrhoids revealed the superiority of EH over RBL for grade III haemorrhoids (prolapse that needs manual reduction) (two trials, 116 patients, RR 1.23, CI 1.04-1.45; P = 0.01). However, no significant difference was noticed in grade II haemorrhoids (prolapse that reduces spontaneously on cessation of straining) (one trial, 32 patients, RR 1.07, CI 0.94-1.21; P = 0.32). Fewer patients required re-treatment after EH (three trials, RR 0.20, CI 0.09-0.40; P < 0.00001). Patients undergoing EH were at significantly higher risk of post-operative pain (three trials, fixed effect; 212 patients, RR 1.94, 95 % CI 1.62-2.33, P < 0.00001) and of delayed complications (three trials, 204 patients, RR 6.32, CI 1.15-34.89; P = 0.03). AUTHORS' CONCLUSIONS The present systematic review confirms the long-term efficacy of EH, at least for grade III haemorrhoids, compared to the less invasive technique of RBL but at the expense of increased pain, higher complications and more time off work. However, despite these disadvantages of EH, patient satisfaction and patient's acceptance of the treatment modalities seem to be similar following both the techniques implying patient's preference for complete long-term cure of symptoms and possibly less concern for minor complications. So, RBL can be adopted as the choice of treatment for grade II haemorrhoids with similar results but without the side effects of EH while reserving EH for grade III haemorrhoids or recurrence after RBL. More robust study is required to make definitive conclusions.
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McKenzie CR, Brughelli M, Whatman C, Brown SR. The Influence of Optimal Handheld Load on the Technical Ability to Apply Ground Reaction Forces during Horizontal Jumping in Female Netball Players. Int J Sports Med 2015; 37:318-23. [PMID: 26667926 DOI: 10.1055/s-0035-1565052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Handheld load has been reported to enhance horizontal jump performance, however little is known about its influence on ground reaction forces (GRF), especially in female athletes. This study investigated the effects of individualized optimal handheld loading on the technical and physical ability to apply GRF during horizontal jumping in female netball players. Maximal effort, single standing, horizontal jumps were performed by 13 female netballers. Participants performed the jumps under 2 conditions: 1) unloaded, and 2) loaded. Eccentric mean horizontal GRF significantly increased with loading (p<0.05; Effect Size [ES]= 0.74). The ratio of horizontal-to-total GRF significantly increased (p<0.05; ES=0.57), however resultant GRF did not, suggesting that the technical ability to apply force in the direction of intended movement may be of greater importance than the magnitude of force applied. Jump distance also increased from 188.2±16.1 cm to 196.4±13.6 cm (p<0.01; ES=0.55) with handheld load. In conclusion, individualized optimal handheld loading improved single horizontal jump performance in this population of athletes; most likely through various mechanisms that allowed for increased eccentric horizontal GRFs and the technical ability of force application. Findings could have practical implications for the strength and conditioning coach, trainer and athlete.
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Cronin JB, Brughelli M, Gamble P, Brown SR, Mckenzie C. Acute kinematic and kinetic augmentation in horizontal jump performance using haltere type handheld loading. J Strength Cond Res 2015; 28:1559-64. [PMID: 24196795 DOI: 10.1519/jsc.0000000000000312] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The purposes of this study were to investigate the effects of haltere/handheld loading on the kinematics and kinetics of horizontal jumping and to determine if an optimum relative load (% body mass [BM]) exists to maximize jump distance. A repeated measures analysis of variance with post hoc contrasts was used to determine the effects of haltere loading (no external loading, 6, 8, 12, and 16 kg) on the horizontal jump performance of 16 sportsmen as quantified by an in-ground force plate. The haltere loads of 6 and 8 kg elicited significant (p < 0.05) increases in jump distance (effect size [ES] = 0.22-0.37). The incremental loads also resulted in significant increases in jump duration (ES = 1.22-1.83), peak vertical ground reaction force (GRF) (ES = 0.20-0.37), and vertical (ES = 0.69-1.22) and horizontal (ES = 0.70-0.88) impulse. There was a significant reduction in jump distance with the 16 kg load (ES = 0.45). Significant decreases in mean horizontal GRF were likewise observed with the 12 and 16 kg loads. The optimum relative load for enhancing jump distance was 9.2 ± 3.4% of BM, which resulted in a predicted augmented horizontal jump of 13.6 ± 7.7 cm (ES = 0.56). The findings clearly indicate that haltere/handheld loading augments vertical and horizontal force and impulses. This could have a number of interesting training implications if the strength profiling of athletes identify horizontal and/or vertical deficits in force production. Further longitudinal investigation is warranted to establish what chronic adaptations result with repeated application of this type of training.
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Shinn M, Gibbons-Benton J, Brown SR. Poverty, Homelessness, and Family Break-Up. CHILD WELFARE 2015; 94:105-122. [PMID: 29326481 PMCID: PMC5760188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
This study examines the extent and correlates of family separations in families experiencing homelessness. Of 2,307 parents recruited in family shelters across 12 sites, a tenth were separated from partners and a quarter from one or more children. Additional separations before and after shelter entry and reasons, from parents' perspectives, were documented in qualitative interviews with a subsample of 80 parents. Separations were associated with economic hardship, shelter conditions, and family characteristics.
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Brown SR, Wang H, Dickin DC, Weiss KJ. The relationship between leg preference and knee mechanics during sidestepping in collegiate female footballers. Sports Biomech 2014; 13:351-61. [PMID: 25204331 DOI: 10.1080/14763141.2014.955047] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
This study examined the relationship between leg preference and knee mechanics in females during sidestepping. Three-dimensional data were recorded on 16 female collegiate footballers during a planned 45° sidestep manoeuvre with their preferred and non-preferred kicking leg. Knee kinematics and kinetics during initial contact, weight acceptance, peak push-off, and final push-off phases of sidestepping were analysed in both legs. The preferred leg showed trivial to small increases (ES = 0.19-0.36) in knee flexion angle at initial contact, weight acceptance, and peak push-off, and small increases (ES = 0.21-0.34) in peak power production and peak knee extension velocity. The non-preferred leg showed a trivial increase (ES = 0.10) in knee abduction angle during weight acceptance; small to moderate increases (ES = 0.22-0.64) in knee internal rotation angle at weight acceptance, peak push-off, and final push-off; a small increase (ES = 0.22) in knee abductor moment; and trivial increases (ES = 0.09-0.14) in peak power absorption and peak knee flexion velocity. The results of this study show that differences do exist between the preferred and non-preferred leg in females. The findings of this study will increase the knowledge base of anterior cruciate ligament injury in females and can aid in the design of more appropriate neuromuscular, plyometric, and strength training protocols for injury prevention.
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