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Jamjoom AAB, Joannides AJ, Poon MTC, Chari A, Zaben M, Abdulla MAH, Roach J, Glancz LJ, Solth A, Duddy J, Brennan PM, Bayston R, Bulters DO, Mallucci CL, Jenkinson MD, Gray WP, Kandasamy J, Hutchinson PJ, Kolias AG, Ahmed AI. Prospective, multicentre study of external ventricular drainage-related infections in the UK and Ireland. J Neurol Neurosurg Psychiatry 2018; 89:120-126. [PMID: 29070645 PMCID: PMC5800336 DOI: 10.1136/jnnp-2017-316415] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 09/16/2017] [Accepted: 10/09/2017] [Indexed: 11/14/2022]
Abstract
OBJECTIVES External ventricular drain (EVD) insertion is a common neurosurgical procedure. EVD-related infection (ERI) is a major complication that can lead to morbidity and mortality. In this study, we aimed to establish a national ERI rate in the UK and Ireland and determine key factors influencing the infection risk. METHODS A prospective multicentre cohort study of EVD insertions in 21 neurosurgical units was performed over 6 months. The primary outcome measure was 30-day ERI. A Cox regression model was used for multivariate analysis to calculate HR. RESULTS A total of 495 EVD catheters were inserted into 452 patients with EVDs remaining in situ for 4700 days (median 8 days; IQR 4-13). Of the catheters inserted, 188 (38%) were antibiotic-impregnated, 161 (32.5%) were plain and 146 (29.5%) were silver-bearing. A total of 46 ERIs occurred giving an infection risk of 9.3%. Cox regression analysis demonstrated that factors independently associated with increased infection risk included duration of EVD placement for ≥8 days (HR=2.47 (1.12-5.45); p=0.03), regular sampling (daily sampling (HR=4.73 (1.28-17.42), p=0.02) and alternate day sampling (HR=5.28 (2.25-12.38); p<0.01). There was no association between catheter type or tunnelling distance and ERI. CONCLUSIONS In the UK and Ireland, the ERI rate was 9.3% during the study period. The study demonstrated that EVDs left in situ for ≥8 days and those sampled more frequently were associated with a higher risk of infection. Importantly, the study showed no significant difference in ERI risk between different catheter types.
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Affiliation(s)
- Aimun A B Jamjoom
- Department of Clinical Neuroscience, Western General Hospital, Edinburgh, UK
| | - Alexis J Joannides
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge and Addenbrooke's Hospital, Cambridge, UK
| | | | - Aswin Chari
- Department of Neurosurgery, Royal London Hospital, London, UK
| | - Malik Zaben
- Department of Neurosurgery, University Hospital of Wales, Cardiff, UK
| | - Mutwakil A H Abdulla
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge and Addenbrooke's Hospital, Cambridge, UK
- Department of Neurosurgery, University Hospital of Wales, Cardiff, UK
| | - Joy Roach
- Wessex Neurological Centre, University Hospitals Southampton, Southampton, UK
| | | | - Anna Solth
- Department of Neurosurgery, Royal Victoria Infirmary, Newcastle, UK
| | - John Duddy
- Department of Neurosurgery, Beaumont Hospital, Dublin, Ireland
| | - Paul M Brennan
- Department of Clinical Neuroscience, Western General Hospital, Edinburgh, UK
| | - Roger Bayston
- Division of Rheumatology, Orthopaedics and Dermatology, The University of Nottingham, Nottingham, UK
| | - Diederik O Bulters
- Department of Neurosurgery, Alder Hey Children's NHS Trust, Liverpool, UK
| | - Conor L Mallucci
- Department of Neurosurgery, Alder Hey Children's NHS Trust, Liverpool, UK
| | - Michael D Jenkinson
- Department of Neurosurgery, The Walton Centre, Liverpool, UK
- Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - William P Gray
- Department of Neurosurgery, University Hospital of Wales, Cardiff, UK
| | - Jothy Kandasamy
- Department of Clinical Neuroscience, Western General Hospital, Edinburgh, UK
| | - Peter J Hutchinson
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge and Addenbrooke's Hospital, Cambridge, UK
| | - Angelos G Kolias
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge and Addenbrooke's Hospital, Cambridge, UK
| | - Aminul I Ahmed
- Wessex Neurological Centre, University Hospitals Southampton, Southampton, UK
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Chari A, Jamjoom AA, Edlmann E, Ahmed AI, Coulter IC, Ma R, May P, Brennan PM, Hutchinson PJA, Kolias AG. The British Neurosurgical Trainee Research Collaborative: Five years on. Acta Neurochir (Wien) 2018; 160:23-28. [PMID: 29101466 PMCID: PMC5735202 DOI: 10.1007/s00701-017-3351-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 10/02/2017] [Indexed: 01/24/2023]
Abstract
Since its inception in 2012, the British Neurosurgical Trainee Research Collaborative (BNTRC) has established itself as a robust example of a trainee-led research collaborative. This article summarises the work of the collaborative over its first 5 years of existence, outlining the structure, its research projects, impact and future directions.
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Affiliation(s)
- Aswin Chari
- Department of Neurosurgery, Royal London Hospital, London, UK
| | - Aimun A Jamjoom
- Division of Neurosurgery, Department of Clinical Neuroscience, Western General Hospital, Edinburgh, UK
| | - Ellie Edlmann
- Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital and University of Cambridge, Cambridge, CB2 0QQ, UK
| | - Aminul I Ahmed
- Department of Neurosurgery, Wessex Neurological Centre and University of Southampton, Southampton, UK
| | - Ian C Coulter
- Department of Neurosurgery, Royal Victoria Infirmary, Newcastle, UK
| | - Ruichong Ma
- Department of Neurosurgery, John Radcliffe Hospital, Oxford, UK
| | - Paul May
- Department of Neurosurgery, The Walton Centre, Liverpool, UK
| | - Paul M Brennan
- Division of Neurosurgery, Department of Clinical Neuroscience, Western General Hospital, Edinburgh, UK
| | - Peter J A Hutchinson
- Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital and University of Cambridge, Cambridge, CB2 0QQ, UK
- Surgery Theme, Cambridge Clinical Trials Unit, Cambridge Biomedical Campus, Cambridge, UK
| | - Angelos G Kolias
- Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital and University of Cambridge, Cambridge, CB2 0QQ, UK.
- Surgery Theme, Cambridge Clinical Trials Unit, Cambridge Biomedical Campus, Cambridge, UK.
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Jamjoom AAB, Phan PNH, Hutchinson PJ, Kolias AG. Surgical trainee research collaboratives in the UK: an observational study of research activity and publication productivity. BMJ Open 2016; 6:e010374. [PMID: 26846898 PMCID: PMC4746473 DOI: 10.1136/bmjopen-2015-010374] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To analyse the research activity and publication output of surgical trainee research collaboratives in the UK. SETTING Surgical trainee research collaboratives in the UK. PARTICIPANTS A total of 24 collaboratives were included in this study from 33 identified organisations. We excluded one group that focused purely on systematic review of the literature and eight groups for which we could not identify suitable data sources (website or trainee committee contact). PRIMARY AND SECONDARY OUTCOME Primary data-points were identified for each collaborative including surgical subspeciality, numbers and types of projects. For published articles, secondary outcomes including study population size, journal impact factor, number of citations and evidence level were collected. RESULTS A total of 24 collaboratives met our inclusion criteria with a portfolio of 80 projects. The project types included audit (46%), randomised clinical trial (16%), surveys (16%), cohort studies (10%), systematic reviews (2.5%) and other or unidentifiable (9.5%). A total of 35 publications were identified of which just over half (54%) were original research articles. The median size of studied population was 540 patients with a range from 108 to 3138. The published works provided a varied compilation of evidence levels ranging from 1b (individual RCT) to 5 (expert opinion) with a median level of 2b (individual cohort study). The West Midlands Research Collaborative had the highest number of publications (13), citations (130) and h-index (5). CONCLUSIONS The experience of UK-based trainee research collaboratives provides useful insights for trainees and policymakers in global healthcare systems on the value and feasibility of trainee-driven high quality surgical research.
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Affiliation(s)
- Aimun A B Jamjoom
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Pho N H Phan
- Medical School, University of Warwick, Coventry, UK
| | - Peter J Hutchinson
- Division of Neurosurgery, Addenbrooke's Hospital & University of Cambridge, Cambridge, UK
- Surgery Theme, Cambridge Clinical Trials Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Angelos G Kolias
- Division of Neurosurgery, Addenbrooke's Hospital & University of Cambridge, Cambridge, UK
- Surgery Theme, Cambridge Clinical Trials Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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