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Benton B, Handuleh J, Harris K, Maruthappu M, Patel P, Godman B, Finlayson AE. Health in fragile states. Med Confl Surviv 2014; 30:19-27. [PMID: 24684020 DOI: 10.1080/13623699.2014.874185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Maruthappu M, Carty MJ, Lipsitz SR, Wright J, Orgill D, Duclos A. Patient- and surgeon-adjusted control charts for monitoring performance. BMJ Open 2014; 4:e004046. [PMID: 24440796 PMCID: PMC3902330 DOI: 10.1136/bmjopen-2013-004046] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES To determine whether an innovative graphical tool for accurate measurement of individual surgeon performance metrics, adjusted for both surgeon-specific and patient-specific factors, significantly alters interpretation of performance data. DESIGN Retrospective analysis of all total knee replacements (TKRs) conducted at the host institution between 1996 and 2009. The database was randomly divided into training and testing datasets. Using multivariate generalised estimating equation regression models, the training dataset enabled generation of patient-risk and surgeon-experience adjustment factors. To simulate prospective monitoring of individual surgeon outcomes, the testing dataset was mapped on control charts. Weighted κ statistics were calculated to measure the agreement between patient-risk adjusted and fully adjusted control charts. SETTING Tertiary care academic hospital. PARTICIPANTS All patients undergoing TKR at the host institution 1996-2009. MAIN OUTCOME MEASURE Operative efficiency. RESULTS 5313 procedures were analysed. Adjusted control charts were generated using a training dataset comprising 3756 procedures performed by 13 surgeons. The operative time gradually declined by 121 min with 25 years of experience (p<0.0001). Charts were tested by monitoring four other surgeons, performing an average of 389 procedures each. Adjustment for surgeon experience significantly altered the interpretation of operative efficiency (κ=0.29 (95% CI 0.11 to 0.47)), and enhanced assessment of a surgeon's improvement or diminishment in efficiency over time. Specifically, experience adjustment inverted the interpretation of surgeon efficiency from above average to below average, or from improving to declining performance. CONCLUSIONS Adjustment for surgeon experience is necessary for accurate interpretation of metrics over the course of a surgeon's career. Patient-adjusted and surgeon-adjusted control charts provide an accurate method of monitoring individual operative efficiency.
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Young C, Maruthappu M, Wayne RP, Leaver L. Reversible acute kidney injury requiring haemodialysis five days after starting dronedarone in a stable 71-year-old man at risk of cardiovascular polypharmacy. J R Coll Physicians Edinb 2014; 43:122-5. [PMID: 23734353 DOI: 10.4997/jrcpe.2013.207] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
We present a case of severe acute kidney injury (AKI) occurring shortly after the initiation of dronedarone therapy, which we suspect was the result of an adverse drug reaction. The mechanism of AKI cannot be definitively determined. The most probable mechanism however involves dehydration secondary to diarrhoea, and medications causing hypotension, both precipitating AKI, further exacerbated by reduced excretion of medications reducing tissue perfusion. This case adds to the growing number of reports submitted to pharmacovigilance authorities regarding the association between dronedarone and AKI. It serves as a reminder of the risks of cardiovascular polypharmacy likely to be prevalent in patients considered for dronedarone (which causes diarrhoea as a common side-effect).
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Vivekanantham S, Ravindran RP, Shanmugarajah K, Maruthappu M, Shalhoub J. Surgical safety checklists in developing countries. Int J Surg 2014; 12:2-6. [DOI: 10.1016/j.ijsu.2013.10.016] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2013] [Accepted: 10/24/2013] [Indexed: 11/26/2022]
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Nagendran M, Harding D, Teo W, Camm C, Maruthappu M, McCulloch P, Hopewell S. Poor adherence of randomised trials in surgery to CONSORT guidelines for non-pharmacological treatments (NPT): a cross-sectional study. BMJ Open 2013; 3:e003898. [PMID: 24353256 PMCID: PMC3884742 DOI: 10.1136/bmjopen-2013-003898] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To systematically assess adherence of randomised trials in surgery to Consolidated Standards of Reporting Trials (CONSORT) guidelines for non-pharmacological treatments (NPT). Surgical trials are considered more difficult to design and execute than pharmacological trials. Furthermore, the original CONSORT statement does not address some aspects that are vital to the transparent reporting of surgical trials. The CONSORT-NPT extension was designed to address these issues but adherence in medical and surgical journals has not been assessed. DESIGN Cross-sectional study. SAMPLE We identified eight general medical and eight surgical journals, indexed in PubMed and published in 2011, with the highest impact factors in their respective categories. MAIN OUTCOMES Adherence to CONSORT statement and CONSORT-NPT extension items. RESULTS We identified 54 surgical trials (22 published in medical journals and 32 in surgical journals). There were eight items for which there was less than 30% overall compliance (seven were specific to the CONSORT-NPT extension). These seven items are related to: a full description of the care providers, centres and blinding status in the abstract (n=7/54, 13%), eligibility criteria for centres performing the interventions (n=13/54, 24%), how adherence of care providers with the protocol was assessed or enhanced (n=7/54, 13%), how clustering by care providers or centres was addressed as it relates to sample size (n=3/54, 6%), how care providers were allocated to each group (n=9/54, 17%), how clustering by care providers or centres was addressed as it relates to statistical methods (n=2/54, 4%), a description of care providers (case volume, qualification, expertise, etc) and centres (volume) in each group (n=0/54, 0%). CONCLUSIONS Adherence of surgical trials to CONSORT-NPT extension items is much poorer than to the standard CONSORT statement. Adherence also appears to be superior in general medical journals compared with surgical journals. Raising awareness and conducting qualitative research to identify areas for specific intervention will be important going forward.
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Tan A, Gollop ND, Klimach SG, Maruthappu M, Smith SF. Should infected laparotomy wounds be treated with negative pressure wound therapy? Int J Surg 2013; 12:26-9. [PMID: 24246173 DOI: 10.1016/j.ijsu.2013.11.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Revised: 10/06/2013] [Accepted: 11/02/2013] [Indexed: 10/26/2022]
Abstract
A best evidence topic in surgery was written according to a structured protocol. The question addressed whether there is any benefit in treating infected laparotomy wounds with negative pressure wound therapy (NPWT). Forty-five papers were found using the reported search; of which 4 represented the best evidence to answer the question. The evidence on this subject is limited; there is a single non-randomised controlled trial, 2 prospective cohort studies, and 1 retrospective cohort study discussed in this paper. From the available literature, the use of NPWT in infected laparotomy wounds does reduce the length of hospital stay, the number of dressing changes required and promote faster wound healing.
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Barnett-Vanes A, Maruthappu M, Shalhoub J. Confronting the global burden of surgical disease: the research tools for the job. World J Surg 2013; 37:2725-6. [PMID: 23982786 DOI: 10.1007/s00268-013-2217-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Barnett-Vanes A, Hung KKC, Maruthappu M, Shalhoub J, Chan EYY. Improving health in humanitarian crises: from reactive to proactive. Lancet 2013; 382:679. [PMID: 23972802 DOI: 10.1016/s0140-6736(13)61768-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Maruthappu M, Duclos A, Carty MJ. Robotic vs laparoscopic hysterectomy. JAMA 2013; 309:2320. [PMID: 23757074 DOI: 10.1001/jama.2013.5683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Barnett-Vanes A, Maruthappu M, Shalhoub J. Integration not competition: surgical care in low-income and middle-income settings. Lancet 2013; 381:994-5. [PMID: 23668578 DOI: 10.1016/s0140-6736(13)60708-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Camm CF, Chen Y, Sunderland N, Nagendran M, Maruthappu M, Camm AJ. An assessment of the reporting quality of randomised controlled trials relating to anti-arrhythmic agents (2002-2011). Int J Cardiol 2013; 168:1393-6. [PMID: 23298560 DOI: 10.1016/j.ijcard.2012.12.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2012] [Revised: 11/06/2012] [Accepted: 12/06/2012] [Indexed: 01/01/2023]
Abstract
BACKGROUND Despite being the gold-standard for investigations, randomised controlled trials can deliver biased results if methodology is flawed. The CONSORT statements are intended to guide the reporting of trials. We assessed the reporting quality of anti-arrhythmic drug trials over the last decade. METHODS Medline and Embase databases were searched for anti-arrhythmic drug trials between 2002 and 2011. Results were searched by two authors and relevant papers selected. Papers were scored according to the 2001 and 2010 CONSORT statements by two reviewers and compared against surrogate markers of paper quality. RESULTS 694 papers were retrieved. 59 papers met the inclusion criteria. The mean CONSORT 2010 score was 15.4 out of 25 (SD 3.05). The least reported items related to abstract content (0%), randomization (6.8%), and protocol referencing (8.5%). There was a significant correlation between the CONSORT 2010 score and the annual and 5-year impact factors of the publishing journal (R=0.44 and R=0.45 respectively; p<0.001 for both). No significant correlation was found between the year of publication or number of authors, and 2010 CONSORT score. CONCLUSIONS Although several papers gained high scores, no paper successfully met all criteria laid out in either the CONSORT 2001 or 2010 statements. Correlation between CONSORT 2010 score and impact factor lends support to this as a marker for paper quality. The lack of reporting clarity found, indicates that application of the CONSORT guidelines remains incomplete within the cardiology literature. Further work is needed collectively by trial groups, funding agencies, authors, and journals to improve reporting.
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Williams C, Maruthappu M. "Healthconomic crises": public health and neoliberal economic crises. Am J Public Health 2013; 103:7-9. [PMID: 23153141 PMCID: PMC3518343 DOI: 10.2105/ajph.2012.300956] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2012] [Indexed: 11/04/2022]
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Hallifax RJ, Nagendran M, Maruthappu M, Manuel A, Wrightson JM, Maskell NA, Davies HE, Rahman NM. P124 Effusion Size on the Chest Radiograph at Day 7 Post-Pleural Drainage is a Good Predictor of Size at 3 Months, Regardless of Initial Intrapleural Therapy. Thorax 2012. [DOI: 10.1136/thoraxjnl-2012-202678.407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Rostom H, Hassan N, Nagendran M, Brown E, Srikantharajah D, Maruthappu M, Manuel A, Rahman NM. P120 The Use of Image Guided Cutting Needle Biopsy in Failed Thoracoscopy: Diagnostic Yield and Correlation with CT Results. Thorax 2012. [DOI: 10.1136/thoraxjnl-2012-202678.403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Hassan N, Rostom H, Nagendran M, Srikantharajah D, Brown E, Manuel A, Maruthappu M, Rahman NM. S19 Role of CT in Assessing Pleural Malignancy Prior to Thoracoscopy. Thorax 2012. [DOI: 10.1136/thoraxjnl-2012-202678.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Nagendran M, Hallifax RJ, Maruthappu M, Manuel A, Rahman NM. P125 Digital Measurement Strategy is Robust in Non-Expert Hands in Measuring Clinically Relevant Effusions on Chest Radiograph. Thorax 2012. [DOI: 10.1136/thoraxjnl-2012-202678.408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Maruthappu M, Williams C. Reversing the WHO crisis: transparent priority matching of global needs with donor objectives. BMJ 2012; 345:e7815. [PMID: 23166079 DOI: 10.1136/bmj.e7815] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Srikantharajah D, Ghuman A, Nagendran M, Maruthappu M. Is computed tomography follow-up of patients after lobectomy for non-small cell lung cancer of benefit in terms of survival? Interact Cardiovasc Thorac Surg 2012; 15:893-8. [PMID: 22859511 DOI: 10.1093/icvts/ivs342] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
A best evidence topic in cardiothoracic surgery was written according to a structured protocol. The question addressed was whether following up patients after lobectomy for non-small cell lung cancer (NSCLC) with computed tomography (CT) scanning is of benefit in terms of survival. Altogether, 448 papers were found using the reported search, of which five represented the best evidence to answer the clinical question and three provided supporting evidence. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. There is no general consensus in the literature. From the limited number of papers that address the effect of CT follow-up on survival following surgery for NSCLC, three showed that CT scanning may improve the survival of patients by detecting local and distant recurrences at an earlier stage when the patient is asymptomatic. One paper showed that detection by the use of low-dose CT or simultaneous chest CT plus positron emission tomography-CT led to a longer duration of survival compared with detection by clinical suspicion (2.1 ± 0.3 vs 3.6 ± 0.2 years, p = 0.002). However, two papers broadly showed that follow-up with CT does not improve survival outcomes regardless of the site of recurrence. One such study showed that there was no clinically significant difference in survival whether patients were followed up using a strict CT protocol compared with a symptom-based follow-up (median survival after recurrence: strict 7.9 months, symptom-based 6.6 months, p = 0.219). The remaining papers supported the use of CT as a screening tool for recurrence but did not comment directly on survival. Owing to the limited and contradictory evidence, there is a need for an randomized controlled trial to assess the survival outcomes of patients followed up with a CT screening protocol vs a symptom-based follow-up.
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Basu S, Nagendran M, Maruthappu M. How effective is bipolar radiofrequency ablation for atrial fibrillation during concomitant cardiac surgery? Interact Cardiovasc Thorac Surg 2012; 15:741-8. [PMID: 22815321 DOI: 10.1093/icvts/ivs311] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
A best evidence topic in cardiothoracic surgery was written according to a structured protocol. The question addressed was whether, in patients undergoing cardiac surgery, concomitant bipolar radiofrequency ablation had an acceptable success rate to justify the additional procedure. Altogether 263 papers were found using the reported search, of which 12 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. The consensus in the literature was that bipolar radiofrequency ablation was highly successful in restoring sinus rhythm. One meta-analysis of six non-randomized studies demonstrated that 76% of patients were in sinus rhythm compared with 16% in atrial fibrillation 3 months postoperatively. One randomized controlled trial found that the sinus rhythm conversion rate for any maze procedure was highly significant compared with the control group (P = 0.001). Another found that Cardioblate radiofrequency ablation was significantly better at restoring sinus rhythm at 1 year (75 vs 39% control, P = 0.019). Prospective studies showed a similar rate of sinus rhythm return at 1 year (89%). Notably some studies demonstrated a significant reduction in the New York Heart Association class when sinus rhythm was restored compared with those remaining in atrial fibrillation (P < 0.0001), demonstrating the value of this procedure beyond simply restoring sinus rhythm. In another study, the investigators found that both ablation and total procedure times were shorter with bipolar compared with monopolar ablation. These authors strongly recommend bipolar radiofrequency ablation due to a shorter procedure time, ability to avoid performing a standard left atriotomy and a greater guarantee of transmurality. With the current limited evidence, we conclude that bipolar radiofrequency ablation has a higher success rate in restoring sinus rhythm as an adjunct to cardiac surgery compared with no ablation for at least 1 year. The procedure had a high survival rate. There is randomized evidence to suggest the superiority of bipolar radiofrequency ablation over microwave ablation but limited evidence to suggest the superiority of bipolar over unipolar radiofrequency ablation. Factors found to be accurate predictors of ablation failure include a larger preoperative atrial diameter, permanent vs paroxysmal atrial fibrillation and longer duration of atrial fibrillation.
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MacDonald DRW, Maruthappu M, Nagendran M. How effective is microwave ablation for atrial fibrillation during concomitant cardiac surgery? Interact Cardiovasc Thorac Surg 2012; 15:122-7. [PMID: 22510269 DOI: 10.1093/icvts/ivs137] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
A best evidence topic in cardiothoracic surgery was written according to a structured protocol. The question addressed was whether performing microwave ablative procedures during concomitant cardiac surgical procedures is effective for the treatment of atrial fibrillation (AF). In total, 200 papers were found using the reported search, of which 12 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. Major exclusion criteria included studies exclusively using bipolar ablation, ambiguous or unspecified ablation technique, other energy modalities and studies with highly variable or undisclosed follow-up time. One study reported that 66% of patients were in sinus rhythm (SR) with follow-ups ranging from 1 to 14 months and suggested that the risk of AF recurrence was significantly increased with a larger left atrial diameter (OR = 1.21, P = 0.02) and an increased duration of preoperative AF (OR = 2.14, P = 0.03). A separate study found no significant difference in the success rate on the basis of the concomitant procedure (coronary artery bypass grafting or mitral valve surgery, P > 0.5). In the only randomized trial identified, microwave ablation delivered significantly inferior SR restoration rates to radiofrequency (RF) ablation at all time points from discharge to 24 months. There is a large degree of heterogeneity in the studies, with patients' characteristics, for example type of AF, and patient management postoperatively, for example administration of anti-arrhythmias, being inconsistent. Of the 12 studies, nine assessed SR at a mean of 6-12 months and found postoperative success rates between 62 and 87%. One study looked at the medium range follow-up of 24 months with SR restoration at 71%. Two studies looked at the long-term follow-up (5 and 5.37 years) with SR restoration at 39 and 61%, respectively. We conclude that microwave ablation, as an intervention for the treatment of AF during concomitant surgery, is not currently recommended on the limited available evidence. This is because the success rates in the longer term are less clear and the only randomized study to date has found inferior outcomes compared with RF-based ablation.
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