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Milligan F, Whittingham C, Granitsitotis V, Simpson H, Woodfield J, Carson A, Stone J, Hoeritzauer I. Chronic idiopathic urinary retention: Comorbidity and outcome in 102 individuals. J Psychosom Res 2024; 181:111663. [PMID: 38643683 DOI: 10.1016/j.jpsychores.2024.111663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 04/04/2024] [Accepted: 04/04/2024] [Indexed: 04/23/2024]
Abstract
OBJECTIVES Chronic Idiopathic urinary retention is poorly understood. One small study suggests higher than expected rates of functional neurological disorder and pain comorbidity which may have implications for understanding the disorder. We investigated the frequency of functional neurological disorder, chronic pain other medical and psychiatric comorbidity, triggers of urinary retention, results of urodynamic assessment, medication history, management, and outcome in patients with chronic idiopathic urinary retention. METHODS A consecutive retrospective electronic notes analysis was undertaken of patients with chronic idiopathic urinary retention presenting to a secondary care urology clinic between Jan 2018-Jan 2021, with follow-up to their most recent urological appointment. RESULTS 102 patients were identified (mean age of 41.9 years, 98% female). 25% had functional neurological disorder (n = 26), most commonly limb weakness (n = 19, 19%) and functional seizures (n = 16, 16%). Chronic pain (n = 58, 57%) was a common comorbidity. Surgical and medical riggers to urinary retention were found in almost half of patients (n = 49, 48%). 81% of patients underwent urodynamic assessment (n = 83). Most frequently no specific abnormality was reported (n = 30, 29%). Hypertonic urethral sphincter was the most identified urodynamic abnormality (n = 17, 17%). We noted high levels of opioid (n = 50, 49%) and benzodiazepine (n = 27, 26%) use. Urinary retention resolved in only a small number of patients (n = 6, 6%, median follow up 54 months), in three cases spontaneously. CONCLUSION This preliminary data suggests idiopathic urinary retention is commonly comorbid with functional neurological disorder, and chronic pain, suggesting shared mechanisms.
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Affiliation(s)
- Fintan Milligan
- Centre for Clinical Brain Sciences, University of Edinburgh, UK.
| | | | - Voula Granitsitotis
- Centre for Clinical Brain Sciences, University of Edinburgh, UK; Department of Urology, Royal Victoria Hospital Kirkcaldy, UK.
| | - Helen Simpson
- Department of Urology, Western General Hospital, UK.
| | - Julie Woodfield
- Centre for Clinical Brain Sciences, University of Edinburgh, UK.
| | - Alan Carson
- Centre for Clinical Brain Sciences, University of Edinburgh, UK.
| | - Jon Stone
- Centre for Clinical Brain Sciences, University of Edinburgh, UK.
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Woodfield J, Braun KPJ, van Schooneveld MMJ, Bastin ME, Chin RFM. Efficient organisation of the contralateral hemisphere connectome is associated with improvement in intelligence quotient after paediatric epilepsy surgery. Epilepsy Behav 2023; 149:109521. [PMID: 37944287 DOI: 10.1016/j.yebeh.2023.109521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 11/02/2023] [Accepted: 11/02/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVE Aims of epilepsy surgery in childhood include optimising seizure control and facilitating cognitive development. Predicting which children will improve cognitively is challenging. We investigated the association of the pre-operative structural connectome of the contralateral non-operated hemisphere with improvement in intelligence quotient (IQ) post-operatively. METHODS Consecutive children who had undergone unilateral resective procedures for epilepsy at a single centre were retrospectively identified. We included those with pre-operative volume T1-weighted non-contrast brain magnetic resonance imaging (MRI), no visible contralateral MRI abnormalities, and both pre-operative and two years post-operative IQ assessment. The MRI of the hemisphere contralateral to the side of resection was anatomically parcellated into 34 cortical regions and the covariance of cortical thickness between regions was used to create binary and weighted group connectomes. RESULTS Eleven patients with a post-operative IQ increase of at least 10 points at two years were compared with twenty-four patients with no change in IQ score. Children who gained at least 10 IQ points post-operatively had a more efficiently structured contralateral hemisphere connectome with higher global efficiency (0.74) compared to those whose IQ did not change at two years (0.58, p = 0.014). This was consistent across thresholds and both binary and weighted networks. There were no statistically significant group differences in age, sex, age at onset of epilepsy, pre-operative IQ, mean cortical thickness, side or site of procedure, two year post-operative Engel scores or use of anti-seizure medications between the two groups. CONCLUSIONS Surgical procedures to reduce or stop seizures may allow children with an efficiently structured contralateral hemisphere to achieve their cognitive potential.
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Affiliation(s)
- Julie Woodfield
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom; Department of Clinical Neurosciences, NHS Lothian, Edinburgh, United Kingdom; Muir Maxwell Epilepsy Centre, University of Edinburgh, Edinburgh, United Kingdom.
| | - Kees P J Braun
- Department of Paediatric Neurology, University Medical Center Utrecht, Utrecht, the Netherlands; Brain Center, Utrecht University, Utrecht, the Netherlands
| | - Monique M J van Schooneveld
- Department of Paediatric Psychology, Sector of Neuropsychology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Mark E Bastin
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom; Muir Maxwell Epilepsy Centre, University of Edinburgh, Edinburgh, United Kingdom
| | - Richard F M Chin
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom; Muir Maxwell Epilepsy Centre, University of Edinburgh, Edinburgh, United Kingdom; Royal Hospital for Children and Young People, NHS Lothian, Edinburgh, United Kingdom
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Waterkeyn F, Ikwuegbuenyi CA, Woodfield J, Sommer F, Magogo J, Cheserem B, Schupper AJ, Shabani HK, Hussain I, Ahmad AA, Balsano M, Mangat H, Härtl R. Evaluating the Feasibility and Outcomes of a Scoliosis Surgical Camp in a Resource-Limited Setting in Sub-Saharan Africa. World Neurosurg 2023; 180:e550-e559. [PMID: 37778623 DOI: 10.1016/j.wneu.2023.09.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 09/23/2023] [Accepted: 09/25/2023] [Indexed: 10/03/2023]
Abstract
BACKGROUND In sub-Saharan Africa, the estimated prevalence of scoliosis ranges from 3.3% to 5.5%. The management of these deformities is restricted due to lack of infrastructure and access to deformity spine surgeons. Utilizing surgical camps has been demonstrated to be efficient in transferring skills to low-resource environments; however, this has not been documented concerning deformity surgery. METHODS We conducted a cross-sectional study. The scoliosis camp was held at a major referral spine center in East Africa. We documented information about the organization of the course. We also collected clinical and demographic patient data. Finally, we assessed the knowledge and confidence among surgeon participants on the management scoliosis. RESULTS The camp lasted 5 days and consisted of lectures and case discussions, followed by casting and surgical sessions. Five patients were operated during the camp. All the patients in the study were diagnosed with AIS, except one with a congenital deformity. The primary curve in the spine was in the thoracic region for all patients. Six months postoperative Scoliosis Research Society-22R Scoring System (SRS-22R) score ranged from 3.3-4.5/5. 87.5% of the participants found the course content satisfactory. CONCLUSIONS To the best of our knowledge, this is the first time an African scoliosis camp has been established. The study highlights the difficulty of conducting such a course and illustrates the feasibility of executing these complex surgeries in a resource-limited environment.
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Affiliation(s)
- François Waterkeyn
- Department of Neurosurgery, Weill Cornell Medicine, New-York Presbyterian, Och Spine, New York, New York, USA; Department of Neurosciences, Grand Hôpital de Charleroi, Charleroi, Belgium.
| | - Chibuikem A Ikwuegbuenyi
- Department of Neurosurgery, Weill Cornell Medicine, New-York Presbyterian, Och Spine, New York, New York, USA; Division of Neurosurgery, Muhimbili Orthopedic and Neurosurgery Institute, Dar es Salam, Tanzania
| | - Julie Woodfield
- Department of Neurosurgery, Weill Cornell Medicine, New-York Presbyterian, Och Spine, New York, New York, USA; Division of Neurosurgery, Muhimbili Orthopedic and Neurosurgery Institute, Dar es Salam, Tanzania
| | - Fabian Sommer
- Department of Neurosurgery, Weill Cornell Medicine, New-York Presbyterian, Och Spine, New York, New York, USA
| | - Juma Magogo
- Division of Neurosurgery, Muhimbili Orthopedic and Neurosurgery Institute, Dar es Salam, Tanzania
| | - Beverly Cheserem
- Department of Neurological Surgery, Aga Khan University Hospital, Nairobi, Kenya
| | - Alexander J Schupper
- Department of Neurological Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Hamisi K Shabani
- Division of Neurosurgery, Muhimbili Orthopedic and Neurosurgery Institute, Dar es Salam, Tanzania
| | - Ibrahim Hussain
- Department of Neurosurgery, Weill Cornell Medicine, New-York Presbyterian, Och Spine, New York, New York, USA
| | - Alaaeldin Azmi Ahmad
- Pediatric Orthopedic Surgery, Palestine Polytechnic University, Ramallah, Palestine
| | - Massimo Balsano
- Regional Spinal Department, UOC Ortopedia A, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Halinder Mangat
- Department of Neurology, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Roger Härtl
- Department of Neurosurgery, Weill Cornell Medicine, New-York Presbyterian, Och Spine, New York, New York, USA; Division of Neurosurgery, Muhimbili Orthopedic and Neurosurgery Institute, Dar es Salam, Tanzania
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Shayo CS, Woodfield J, Shabhay ZA, Ikwuegbuenyi CA, Mtei J, Yonah B, Ndossi MY, Massawe SL, Magawa DG, Mndeme H, Kwelukilwa D, Bureta CA, Ngeregeza J, Hoffman C, Mangat HS, Mchome LL, Härtl R, Shabani HK. Neurosurgical Education in Tanzania: The Dar es Salaam Global Neurosurgery Course. World Neurosurg 2023; 180:42-51. [PMID: 37659749 DOI: 10.1016/j.wneu.2023.08.111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 08/25/2023] [Accepted: 08/26/2023] [Indexed: 09/04/2023]
Abstract
BACKGROUND Postgraduate neurosurgical training is essential to develop a neurosurgical workforce with the skills and knowledge to address patient needs for neurosurgical care. In Tanzania, the number of neurosurgeons and neurosurgical services offered have expanded in the past 40 years. Training opportunities within the country, however, are not sufficient to meet the needs of residents, specialists, and nurses in neurosurgery, forcing many to train outside the country incurring associated costs and burdens. We report on the Dar es Salaam Global Neurosurgery Course, which aims to provide local training to neurosurgical health care providers in Tanzania and surrounding countries. METHODS We report the experience of the Global Neurosurgery Course held in March 2023 in Dar es Salaam, Tanzania. We describe the funding, planning, organization, and teaching methods along with participant and faculty feedback. RESULTS The course trained 121 participants with 63 faculty-42 from Tanzania and 21 international faculty. Training methods included lectures, hands-on surgical teaching, webinars, case discussions, surgical simulation, virtual reality, and bedside teaching. Although there were challenges with equipment and Internet connectivity, participant feedback was positive, with overall improvement in knowledge reported in all topics taught during the course. CONCLUSIONS International collaboration can be successful in delivering topic-specific training that aims to address the everyday needs of surgeons in their local setting. Suggestions for future courses include increasing training on allied topics to neurosurgery and neurosurgical subspecialty topics, reflecting the growth in neurosurgical capacity and services offered in Tanzania.
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Affiliation(s)
- Consolata S Shayo
- Department of Neurosurgery, Muhimbili Orthopaedic Institute, Dar es Salaam, Tanzania.
| | - Julie Woodfield
- Department of Neurosurgery, Muhimbili Orthopaedic Institute, Dar es Salaam, Tanzania; Department of Neurosurgery, Weill Cornell Medicine, New York, New York, USA; Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Zarina A Shabhay
- Department of Neurosurgery, Muhimbili Orthopaedic Institute, Dar es Salaam, Tanzania
| | - Chibuikem Anthony Ikwuegbuenyi
- Department of Neurosurgery, Muhimbili Orthopaedic Institute, Dar es Salaam, Tanzania; Department of Neurosurgery, Weill Cornell Medicine, New York, New York, USA
| | - John Mtei
- Department of Neurosurgery, Muhimbili Orthopaedic Institute, Dar es Salaam, Tanzania
| | - Boaz Yonah
- Department of Neurosurgery, Muhimbili Orthopaedic Institute, Dar es Salaam, Tanzania
| | - Maxigama Y Ndossi
- Department of Neurosurgery, Muhimbili Orthopaedic Institute, Dar es Salaam, Tanzania
| | - Sylvia L Massawe
- Department of Neurosurgery, Muhimbili Orthopaedic Institute, Dar es Salaam, Tanzania
| | - Dorcas G Magawa
- Department of Neurosurgery, Muhimbili Orthopaedic Institute, Dar es Salaam, Tanzania
| | - Hadija Mndeme
- Department of Neurosurgery, Muhimbili Orthopaedic Institute, Dar es Salaam, Tanzania
| | - Donatila Kwelukilwa
- Department of Neurosurgery, Muhimbili Orthopaedic Institute, Dar es Salaam, Tanzania
| | - Costansia A Bureta
- Department of Neurosurgery, Muhimbili Orthopaedic Institute, Dar es Salaam, Tanzania
| | - Japhet Ngeregeza
- Department of Neurosurgery, Muhimbili National Hospital - Mloganzila, Dar es Salaam, Tanzania
| | - Caitlin Hoffman
- Department of Neurosurgery, Weill Cornell Medicine, New York, New York, USA
| | - Halinder S Mangat
- Department of Neurosurgery, Weill Cornell Medicine, New York, New York, USA; Neurocritical Care Department, University of Kansas Medical Centre, Wichita, Kansas, USA
| | - Laurent Lemeri Mchome
- Department of Neurosurgery, Muhimbili Orthopaedic Institute, Dar es Salaam, Tanzania
| | - Roger Härtl
- Department of Neurosurgery, Weill Cornell Medicine, New York, New York, USA; New York-Presbyterian - Och Spine, New York, New York, USA
| | - Hamisi K Shabani
- Department of Neurosurgery, Muhimbili Orthopaedic Institute, Dar es Salaam, Tanzania
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Woodfield J, Chin RFM, van Schooneveld MMJ, van den Heuvel M, Bastin ME, Braun KPJ. The association of structural connectome efficiency with cognition in children with epilepsy. Epilepsy Behav 2023; 148:109462. [PMID: 37844437 DOI: 10.1016/j.yebeh.2023.109462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 09/21/2023] [Accepted: 09/26/2023] [Indexed: 10/18/2023]
Abstract
OBJECTIVE Cognitive impairment is common in children with epilepsy (CWE), but understanding the underlying pathological processes is challenging. We aimed to investigate the association of structural brain network organisation with cognition. METHODS This was a retrospective cohort study of CWE without structural brain abnormalities, comparing whole brain network characteristics between those with cognitive impairment and those with intact cognition. We created structural whole-brain connectomes from anatomical and diffusion tensor magnetic resonance imaging using the number of streamlines and tract-averaged fractional anisotropy. We assessed the differences in average path length and global network efficiency between children with cognitive impairment and those without,using multivariable analyses to account for possible clinical group differences. RESULTS Twenty-eight CWE and cognitive impairment had lower whole brain network global efficiency compared with 34 children with intact cognition (0.54, standard deviation (SD):0.003 vs. 0.56, SD:0.002, p < 0.001), which is equivalent to longer normalized network average path lengths (1.14, SD:0.05 vs. 1.10, SD:0.02, p = 0.003). In multivariable logistic regression cognitive impairment was not significantly associated with age of onset, duration of epilepsy, or number of antiseizure medications, but was independently associated with daily seizures (p = 0.04) and normalized average path length (p = 0.007). CONCLUSIONS Higher structural network average path length and lower global network efficiency may be imaging biomarkers of cognitive impairment in epilepsy. Understanding what leads to changes in structural connectivity could aid identification of modifiable risk factors for cognitive impairment. These findings are only applicable to the specific cohort studied, and further confirmation in other cohorts is required.
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Affiliation(s)
- Julie Woodfield
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom; Department of Clinical Neurosciences, NHS Lothian, Edinburgh, United Kingdom; Muir Maxwell Epilepsy Centre, University of Edinburgh, Edinburgh, United Kingdom.
| | - Richard F M Chin
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom; Muir Maxwell Epilepsy Centre, University of Edinburgh, Edinburgh, United Kingdom; Royal Hospital for Children and Young People, NHS Lothian, Edinburgh, United Kingdom
| | | | - Martijn van den Heuvel
- Center for Neurogenomics and Cognitive Research, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Mark E Bastin
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Kees P J Braun
- Department of Paediatric Neurology, University Medical Center Utrecht, Utrecht, The Netherlands
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Metcalfe D, Hoeritzauer I, Angus M, Novak A, Hutton M, Woodfield J. Diagnosis of cauda equina syndrome in the emergency department. Emerg Med J 2023; 40:787-793. [PMID: 37669831 DOI: 10.1136/emermed-2023-213151] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 08/22/2023] [Indexed: 09/07/2023]
Abstract
Cauda equina syndrome (CES) is a spinal emergency that can be challenging to identify from among the many patients presenting to EDs with low back and/or radicular leg pain. This article presents a practical guide to the assessment and early management of patients with suspected CES as well as an up-to-date review of the most important studies in this area that should inform clinical practice in the ED.
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Affiliation(s)
- David Metcalfe
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
- Emergency Medicine Research in Oxford (EMROx), Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Ingrid Hoeritzauer
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
- Department of Clinical Neurosciences, Edinburgh Royal Infirmary, Edinburgh, UK
| | - Michelle Angus
- Complex Spinal Department, Salford Royal NHS Foundation Trust, Salford, UK
| | - Alex Novak
- Emergency Medicine Research in Oxford (EMROx), Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Mike Hutton
- Exeter Spinal Surgery Unit, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Julie Woodfield
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
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Woodfield J, Statham PFX, Hoeritzauer I. Letter to the Editor Regarding Publication Trends and Hot Spots in Cauda Equina Syndrome: A Bibliometric Analysis and Visualization of Current Research. World Neurosurg 2023; 178:289. [PMID: 37803677 DOI: 10.1016/j.wneu.2023.06.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 06/12/2023] [Indexed: 10/08/2023]
Affiliation(s)
- Julie Woodfield
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, Scotland, UK.
| | | | - Ingrid Hoeritzauer
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, Scotland, UK; Department of Clinical Neurosciences, NHS Lothian, Edinburgh, Scotland, UK
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Hoeritzauer I, Paterson M, Jamjoom AAB, Srikandarajah N, Soleiman H, Poon MTC, Copley PC, Graves C, MacKay S, Duong C, Leung AHC, Eames N, Statham PFX, Darwish S, Sell PJ, Thorpe P, Shekhar H, Roy H, Woodfield J. Cauda equina syndrome. Bone Joint J 2023; 105-B:1007-1012. [PMID: 37652459 DOI: 10.1302/0301-620x.105b9.bjj-2022-1343.r1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
Aims Patients with cauda equina syndrome (CES) require emergency imaging and surgical decompression. The severity and type of symptoms may influence the timing of imaging and surgery, and help predict the patient's prognosis. Categories of CES attempt to group patients for management and prognostication purposes. We aimed in this study to assess the inter-rater reliability of dividing patients with CES into categories to assess whether they can be reliably applied in clinical practice and in research. Methods A literature review was undertaken to identify published descriptions of categories of CES. A total of 100 real anonymized clinical vignettes of patients diagnosed with CES from the Understanding Cauda Equina Syndrome (UCES) study were reviewed by consultant spinal surgeons, neurosurgical registrars, and medical students. All were provided with published category definitions and asked to decide whether each patient had 'suspected CES'; 'early CES'; 'incomplete CES'; or 'CES with urinary retention'. Inter-rater agreement was assessed for all categories, for all raters, and for each group of raters using Fleiss's kappa. Results Each of the 100 participants were rated by four medical students, five neurosurgical registrars, and four consultant spinal surgeons. No groups achieved reasonable inter-rater agreement for any of the categories. CES with retention versus all other categories had the highest inter-rater agreement (kappa 0.34 (95% confidence interval 0.27 to 0.31); minimal agreement). There was no improvement in inter-rater agreement with clinical experience. Across all categories, registrars agreed with each other most often (kappa 0.41), followed by medical students (kappa 0.39). Consultant spinal surgeons had the lowest inter-rater agreement (kappa 0.17). Conclusion Inter-rater agreement for categorizing CES is low among clinicians who regularly manage these patients. CES categories should be used with caution in clinical practice and research studies, as groups may be heterogenous and not comparable.
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Affiliation(s)
- Ingrid Hoeritzauer
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
- Department of Clinical Neurosciences, NHS Lothian, Edinburgh, UK
| | - Mhairi Paterson
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Aimun A B Jamjoom
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
- Department of Clinical Neurosciences, NHS Lothian, Edinburgh, UK
| | | | - Hamzah Soleiman
- Department of Clinical Neurosciences, NHS Lothian, Edinburgh, UK
| | - Michael T C Poon
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
- Department of Clinical Neurosciences, NHS Lothian, Edinburgh, UK
- The Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Phillip C Copley
- Department of Clinical Neurosciences, NHS Lothian, Edinburgh, UK
| | - Catriona Graves
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Sinead MacKay
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Charis Duong
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | | | - Niall Eames
- Department of Spinal Surgery, Royal Victoria Hospital, Belfast, UK
| | | | - Stacey Darwish
- Department of Spinal Surgery, Royal Victoria Hospital, Belfast, UK
| | | | | | | | - Holly Roy
- Derriford Hospital, Plymouth, UK
- University of Plymouth, Plymouth, UK
| | - Julie Woodfield
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
- Department of Clinical Neurosciences, NHS Lothian, Edinburgh, UK
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Mian SY, Mancuso-Marcello M, Kandasamy J, Jamjoom AA, Woodfield J. Comparison of external ventricular drains with ventricular access devices for the emergency management of adult hydrocephalus. World Neurosurg 2023:S1878-8750(23)00862-8. [PMID: 37380053 DOI: 10.1016/j.wneu.2023.06.091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 06/19/2023] [Indexed: 06/30/2023]
Abstract
OBJECTIVE We compared external ventricular drains (EVDs) with percutaneous continuous CSF drainage via ventricular access devices (VADs) for the acute management of hydrocephalus in adults. METHODS This was a retrospective review of all ventricular drains inserted for a new diagnosis of hydrocephalus into non-infected CSF over 4 years. We compared infection rates, return to theatre, and patient outcome between EVDs and VADs. We explored the effect of duration of drainage, frequency of sampling, hydrocephalus aetiology, and catheter location on these outcomes using multivariable logistic regression modelling. RESULTS We included 179 drains (76 EVDs and 103 VADs). EVDs were associated with a higher rate of unplanned return to theatre for replacement or revision (27/76, 36%, vs 4/103, 4%, OR:13.4 95%CI:4.3-55.8). However, infection rates were higher in VADs (13/103, 13% vs 5/76, 7%, OR:2.0, 95%CI:0.65-7.7). EVDs were 91% antibiotic impregnated whereas VADs were 98% non-impregnated. In multivariable analysis, infection was associated with duration of drainage (median:11 days prior to infection for infected drains vs 7 days total for non-infected drains), but not drain type (VADs vs EVDs OR:1.6, 95%CI:0.5-6). CONCLUSIONS EVDs had a higher rate of unplanned revisions but a lower infection rate compared to VADs. However, in multivariable analysis choice of drain type was not associated with infection. We suggest a prospective comparison of antibiotic impregnated VADs and EVDs using similar sampling protocols to assess whether VADs or EVDs for acute hydrocephalus have a lower overall complication rate.
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Affiliation(s)
- Shan Y Mian
- Department of Clinical Neurosciences, NHS Lothian, Edinburgh, UK; Imperial College London, Faculty of Medicine, Department of Surgery and Cancer, London, UK
| | | | | | - Aimun Ab Jamjoom
- Department of Clinical Neurosciences, NHS Lothian, Edinburgh, UK; Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Julie Woodfield
- Department of Clinical Neurosciences, NHS Lothian, Edinburgh, UK; Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.
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Loan JJM, Tominey S, Baweja K, Woodfield J, Chambers TJG, Haley M, Kundu SS, Tang HYJ, Wiggins AN, Poon MTC, Brennan PM. Prospective, multicentre study of screening, investigation and management of hyponatraemia after subarachnoid haemorrhage in the UK and Ireland. Stroke Vasc Neurol 2023; 8:207-216. [PMID: 36150732 PMCID: PMC10359796 DOI: 10.1136/svn-2022-001583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 09/13/2022] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Hyponatraemia often occurs after subarachnoid haemorrhage (SAH). However, its clinical significance and optimal management are uncertain. We audited the screening, investigation and management of hyponatraemia after SAH. METHODS We prospectively identified consecutive patients with spontaneous SAH admitted to neurosurgical units in the United Kingdom or Ireland. We reviewed medical records daily from admission to discharge, 21 days or death and extracted all measurements of serum sodium to identify hyponatraemia (<135 mmol/L). Main outcomes were death/dependency at discharge or 21 days and admission duration >10 days. Associations of hyponatraemia with outcome were assessed using logistic regression with adjustment for predictors of outcome after SAH and admission duration. We assessed hyponatraemia-free survival using multivariable Cox regression. RESULTS 175/407 (43%) patients admitted to 24 neurosurgical units developed hyponatraemia. 5976 serum sodium measurements were made. Serum osmolality, urine osmolality and urine sodium were measured in 30/166 (18%) hyponatraemic patients with complete data. The most frequently target daily fluid intake was >3 L and this did not differ during hyponatraemic or non-hyponatraemic episodes. 26% (n/N=42/164) patients with hyponatraemia received sodium supplementation. 133 (35%) patients were dead or dependent within the study period and 240 (68%) patients had hospital admission for over 10 days. In the multivariable analyses, hyponatraemia was associated with less dependency (adjusted OR (aOR)=0.35 (95% CI 0.17 to 0.69)) but longer admissions (aOR=3.2 (1.8 to 5.7)). World Federation of Neurosurgical Societies grade I-III, modified Fisher 2-4 and posterior circulation aneurysms were associated with greater hazards of hyponatraemia. CONCLUSIONS In this comprehensive multicentre prospective-adjusted analysis of patients with SAH, hyponatraemia was investigated inconsistently and, for most patients, was not associated with changes in management or clinical outcome. This work establishes a basis for the development of evidence-based SAH-specific guidance for targeted screening, investigation and management of high-risk patients to minimise the impact of hyponatraemia on admission duration and to improve consistency of patient care.
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Affiliation(s)
- James J M Loan
- Translational Neurosurgery, The University of Edinburgh Centre for Clinical Brain Sciences, Edinburgh, UK
- Neurosurgery, NHS Lothian, Edinburgh, UK
| | - Steven Tominey
- Neurosurgery, Institute of Neurological Sciences, Glasgow, UK
- Department of Medicine, School of Medicine, Dentisty and Nuring, University of Glasgow, Glasgow, UK
| | - Kirun Baweja
- Internal Medicine, Queen's University, Kingston, Ontario, Canada
| | - Julie Woodfield
- Translational Neurosurgery, The University of Edinburgh Centre for Clinical Brain Sciences, Edinburgh, UK
- Neurosurgery, NHS Lothian, Edinburgh, UK
| | - Thomas J G Chambers
- Centre for Discovery Brain Sciences, University of Edinburgh, Edinburgh, UK
- Edinburgh Centre for Diabetes and Endocrinology, NHS Lothian, Edinburgh, UK
| | - Mark Haley
- Radiology, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - Simran S Kundu
- Department of Medicine, Cork University Hospital, University College Cork, Cork, Ireland
| | - H Y Josephine Tang
- Department of Medicine, School of Medicine, Dentisty and Nuring, University of Glasgow, Glasgow, UK
| | | | - Michael T C Poon
- Translational Neurosurgery, The University of Edinburgh Centre for Clinical Brain Sciences, Edinburgh, UK
- Neurosurgery, NHS Lothian, Edinburgh, UK
| | - Paul M Brennan
- Translational Neurosurgery, The University of Edinburgh Centre for Clinical Brain Sciences, Edinburgh, UK
- Neurosurgery, NHS Lothian, Edinburgh, UK
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11
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Waterkeyn F, Woodfield J, Massawe SL, Mzimbiri JM, Shabhay ZA, Bureta CA, Sommer F, Mndeme H, Magawa DG, Kwelukilwa D, Ndossi MY, Kinghomella AA, Kaale AJ, Ahmed S, Mtei J, Minja F, Moses M, Medary B, Hussain I, Ikwuegbuenyi CA, Petr O, Kiloloma WO, Rutabasibwa NB, Mangat HS, Mchome LL, Härtl R, Shabani HK. The effect of the Dar es Salaam neurosurgery training course on self-reported neurosurgical knowledge and confidence. Brain Spine 2023; 3:101727. [PMID: 37383451 PMCID: PMC10293233 DOI: 10.1016/j.bas.2023.101727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 02/21/2023] [Accepted: 03/06/2023] [Indexed: 06/30/2023]
Abstract
Introduction The Muhimbili Orthopaedic Institute in collaboration with Weill Cornell Medicine organises an annual neurosurgery training course in Dar es Salaam, Tanzania. The course teaches theory and practical skills in neurotrauma, neurosurgery, and neurointensive care to attendees from across Tanzania and East Africa. This is the only neurosurgical course in Tanzania, where there are few neurosurgeons and limited access to neurosurgical care and equipment. Research question To investigate the change in self-reported knowledge and confidence in neurosurgical topics amongst the 2022 course attendees. Material and methods Course participants completed pre and post course questionnaires about their background and self-rated their knowledge and confidence in neurosurgical topics on a five point scale from one (poor) to five (excellent). Responses after the course were compared with those before the course. Results Four hundred and seventy participants registered for the course, of whom 395(84%) practiced in Tanzania. Experience ranged from students and newly qualified professionals to nurses with more than 10 years of experience and specialist doctors. Both doctors and nurses reported improved knowledge and confidence across all neurosurgical topics following the course. Topics with lower self-ratings prior to the course showed greater improvement. These included neurovascular, neuro-oncology, and minimally invasive spine surgery topics. Suggestions for improvement were mostly related to logistics and course delivery rather than content. Discussion and conclusion The course reached a wide range of health care professionals in the region and improved neurosurgical knowledge, which should benefit patient care in this underserved region.
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Affiliation(s)
- François Waterkeyn
- Muhimbili Orthopaedic Institute, Department of Neurosurgery, Dar es Salaam, Tanzania
- Weill Cornell Medicine, Department of Neurosurgery, New York, USA
- Department of Neurosciences, Grand Hôpital de Charleroi, Charleroi, Belgium
| | - Julie Woodfield
- Muhimbili Orthopaedic Institute, Department of Neurosurgery, Dar es Salaam, Tanzania
- Weill Cornell Medicine, Department of Neurosurgery, New York, USA
| | - Sylvia Leon Massawe
- Muhimbili Orthopaedic Institute, Department of Neurosurgery, Dar es Salaam, Tanzania
| | - Juma Magogo Mzimbiri
- Muhimbili Orthopaedic Institute, Department of Neurosurgery, Dar es Salaam, Tanzania
- Department of Neurosurgery, Arusha Lutheran Medical Center, Arusha, Tanzania
| | - Zarina Ali Shabhay
- Muhimbili Orthopaedic Institute, Department of Neurosurgery, Dar es Salaam, Tanzania
| | | | - Fabian Sommer
- Weill Cornell Medicine, Department of Neurosurgery, New York, USA
- University of Kansas Medical Centre, Kansas, USA
| | - Hadija Mndeme
- Muhimbili Orthopaedic Institute, Department of Neurosurgery, Dar es Salaam, Tanzania
| | - Dorcas Gidion Magawa
- Muhimbili Orthopaedic Institute, Department of Neurosurgery, Dar es Salaam, Tanzania
| | - Donatila Kwelukilwa
- Muhimbili Orthopaedic Institute, Department of Neurosurgery, Dar es Salaam, Tanzania
| | | | | | - Aingaya Jackson Kaale
- Muhimbili Orthopaedic Institute, Department of Neurosurgery, Dar es Salaam, Tanzania
| | - Shakeel Ahmed
- Muhimbili Orthopaedic Institute, Department of Neurosurgery, Dar es Salaam, Tanzania
| | - John Mtei
- Muhimbili Orthopaedic Institute, Department of Neurosurgery, Dar es Salaam, Tanzania
| | - Fidelis Minja
- Muhimbili Orthopaedic Institute, Department of Neurosurgery, Dar es Salaam, Tanzania
| | - Moses Moses
- Muhimbili Orthopaedic Institute, Department of Neurosurgery, Dar es Salaam, Tanzania
| | - Branden Medary
- Weill Cornell Medicine, Department of Neurosurgery, New York, USA
- New York-Presbyterian - Och Spine, New York, USA
| | - Ibrahim Hussain
- Weill Cornell Medicine, Department of Neurosurgery, New York, USA
| | - Chibuikem Anthony Ikwuegbuenyi
- Muhimbili Orthopaedic Institute, Department of Neurosurgery, Dar es Salaam, Tanzania
- Weill Cornell Medicine, Department of Neurosurgery, New York, USA
| | - Ondra Petr
- Charles University in Prague, Prague, Czech Republic
- Department of Neurosurgery, Medical University Innsbruck, Innsbruck, Austria
| | - Wanin Othman Kiloloma
- Muhimbili Orthopaedic Institute, Department of Neurosurgery, Dar es Salaam, Tanzania
| | | | - Halinder Singh Mangat
- Weill Cornell Medicine, Department of Neurosurgery, New York, USA
- University of Kansas Medical Centre, Kansas, USA
| | - Laurent Lemeri Mchome
- Muhimbili Orthopaedic Institute, Department of Neurosurgery, Dar es Salaam, Tanzania
| | - Roger Härtl
- Weill Cornell Medicine, Department of Neurosurgery, New York, USA
- New York-Presbyterian - Och Spine, New York, USA
| | - Hamisi Kimaro Shabani
- Muhimbili Orthopaedic Institute, Department of Neurosurgery, Dar es Salaam, Tanzania
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12
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Woodfield J, Lammy S, Jamjoom AA, Fadelalla MA, Copley PC, Arora M, Glasmacher SA, Abdelsadg M, Scicluna G, Poon MT, Pronin S, Leung AH, Darwish S, Demetriades AK, Brown J, Eames N, Statham PF, Hoeritzauer I. Demographics of Cauda Equina Syndrome: A Population-Based Incidence Study. Neuroepidemiology 2023; 56:460-468. [PMID: 36315989 PMCID: PMC9945186 DOI: 10.1159/000527727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 10/15/2022] [Indexed: 11/07/2022] Open
Abstract
INTRODUCTION Cauda equina syndrome (CES) has significant medical, social, and legal consequences. Understanding the number of people presenting with CES and their demographic features is essential for planning healthcare services to ensure timely and appropriate management. We aimed to establish the incidence of CES in a single country and stratify incidence by age, gender, and socioeconomic status. As no consensus clinical definition of CES exists, we compared incidence using different diagnostic criteria. METHODS All patients presenting with radiological compression of the cauda equina due to degenerative disc disease and clinical CES requiring emergency surgical decompression during a 1-year period were identified at all centres performing emergency spinal surgery across Scotland. Initial patient identification occurred during the emergency hospital admission, and case ascertainment was checked using ICD-10 diagnostic coding. Clinical information was reviewed, and incidence rates for all demographic and clinical groups were calculated. RESULTS We identified 149 patients with CES in 1 year from a total population of 5.4 million, giving a crude incidence of 2.7 (95% CI: 2.3-3.2) per 100,000 per year. CES occurred more commonly in females and in the 30-49 years age range, with an incidence per year of 7.2 (95% CI: 4.7-10.6) per 100,000 females age 30-39. There was no association between CES and socioeconomic status. CES requiring catheterization had an incidence of 1.1 (95% CI: 0.8-1.5) per 100,000 adults per year. The use of ICD-10 codes alone to identify cases gave much higher incidence rates, but was inaccurate, with 55% (117/211) of patients with a new ICD-10 code for CES found not to have CES on clinical notes review. CONCLUSION CES occurred more commonly in females and in those between 30 and 49 years and had no association with socioeconomic status. The incidence of CES in Scotland is at least four times higher than previous European estimates of 0.3-0.6 per 100,000 population per year. Incidence varies with clinical diagnostic criteria. To enable comparison of rates of CES across populations, we recommend using standardized clinical and radiological criteria and standardization for population structure.
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Affiliation(s)
- Julie Woodfield
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK,Department of Clinical Neurosciences, NHS Lothian, Edinburgh, UK,*Julie Woodfield,
| | - Simon Lammy
- Institute of Neurological Sciences, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Aimun A.B. Jamjoom
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK,Department of Clinical Neurosciences, NHS Lothian, Edinburgh, UK,Department of Neurosurgery, Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, UK
| | | | | | - Mohit Arora
- Department of Neurosurgery, Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, UK
| | - Stella A. Glasmacher
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK,Department of Clinical Neurosciences, NHS Lothian, Edinburgh, UK
| | - Mohamed Abdelsadg
- Institute of Neurological Sciences, NHS Greater Glasgow and Clyde, Glasgow, UK,Department of Neurosurgery, Ninewells Hospital, NHS Tayside, Dundee, UK
| | - Gabrielle Scicluna
- Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Michael T.C. Poon
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK,Department of Clinical Neurosciences, NHS Lothian, Edinburgh, UK,Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Savva Pronin
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK,Department of Clinical Neurosciences, NHS Lothian, Edinburgh, UK
| | - Andraay H.C. Leung
- Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Stacey Darwish
- Department of Trauma and Orthopaedics, Royal Victoria Hospital, Belfast, UK
| | | | - Jennifer Brown
- Institute of Neurological Sciences, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Niall Eames
- Department of Trauma and Orthopaedics, Royal Victoria Hospital, Belfast, UK
| | | | - Ingrid Hoeritzauer
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK,Department of Clinical Neurosciences, NHS Lothian, Edinburgh, UK
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13
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Woodfield J, Hoeritzauer I, Jamjoom AA, Jung J, Lammy S, Pronin S, Hannan CJ, Watts A, Hughes L, Moon RD, Darwish S, Roy H, Copley PC, Poon MT, Thorpe P, Srikandarajah N, Grahovac G, Demetriades AK, Eames N, Sell PJ, Statham PF, Abdelsadg M, Abulaila MMS, Ahmed U, Ajmi Q, Al-Mahfoudh R, Ali C, Amarouche M, Andalib A, Arora M, Arora M, Awan M, Baig Mirza A, Bateman A, Bennett I, Bhatti I, Bodkin P, Bommireddy L, Bonanos G, Borg A, Boukas A, Bourne J, Brennan R, Brown J, Brown K, Burton O, Busby C, Chiverton N, Clark S, Copley PC, Cudlip S, Cunningham Y, Dardis R, Darwish S, Davies B, Demetriades AK, Deore S, Derham C, Dherijha M, Dobson G, Duncan J, Durnford A, Durst AZE, Dyson EW, Eames N, Edlmann E, Edwards-Bailey A, Elserius A, Elson B, Fadelalla M, Fountain DM, Gardner A, Ghosh A, Gill JR, Glasmacher SA, Gordon R, Grahovac G, Grenfell R, Habeebullah A, Haliasos N, Hammett T, Hannan CJ, Hill CS, Hoeritzauer I, Holmes D, Hossain-Ibrahim K, Hughes L, Hussain M, Hussain S, Ibrahim R, Jamjoom AAB, John B, Joshi S, Jung J, Kennion O, Khan M, Klejnotowska A, Kumaria A, LaCava R, Lammy S, Lawrence A, Lea M, Leung AHC, Liew I, Luo W, MacCormac O, Manfield J, Mannion R, Merola J, Mishra P, Mohmoud KA, Moon R, Morrison R, Murray O, Nader-Sepahi A, Nnandi C, Pandit A, Patel N, Philip A, Poon MTC, Prasad KSM, Pronin S, Pujara S, Purushothaman B, Rajwani K, Rasul FT, Roy H, Sadek AR, Schramm M, Scicluna G, Sell PJ, Shafafy R, Sharma H, Sheikh A, Sivasubramaniam V, Sofela A, Spink G, Srikandarajah N, Statham PFX, Stokes S, Strachan E, Thakar C, Thanabalasundaram G, Thorpe P, Ulbricht C, Watts A, Whitcher A, White D, Whitehouse K, Wilby M, Woodfield J, Zolnourian A. Presentation, management, and outcomes of cauda equina syndrome up to one year after surgery, using clinician and participant reporting: A multi-centre prospective cohort study. Lancet Reg Health Eur 2023; 24:100545. [PMID: 36426378 PMCID: PMC9678980 DOI: 10.1016/j.lanepe.2022.100545] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 10/25/2022] [Accepted: 10/27/2022] [Indexed: 11/19/2022] Open
Abstract
Background Cauda equina syndrome (CES) results from nerve root compression in the lumbosacral spine, usually due to a prolapsed intervertebral disc. Evidence for management of CES is limited by its infrequent occurrence and lack of standardised clinical definitions and outcome measures. Methods This is a prospective multi-centre observational cohort study of adults with CES in the UK. We assessed presentation, investigation, management, and all Core Outcome Set domains up to one year post-operatively using clinician and participant reporting. Univariable and multivariable associations with the Oswestry Disability Index (ODI) and urinary outcomes were investigated. Findings In 621 participants with CES, catheterisation for urinary retention was required pre-operatively in 31% (191/615). At discharge, only 13% (78/616) required a catheter. Median time to surgery from symptom onset was 3 days (IQR:1–8) with 32% (175/545) undergoing surgery within 48 h. Earlier surgery was associated with catheterisation (OR:2.2, 95%CI:1.5–3.3) but not with admission ODI or radiological compression. In multivariable analyses catheter requirement at discharge was associated with pre-operative catheterisation (OR:10.6, 95%CI:5.8–20.4) and one-year ODI was associated with presentation ODI (r = 0.3, 95%CI:0.2–0.4), but neither outcome was associated with time to surgery or radiological compression. Additional healthcare services were required by 65% (320/490) during one year follow up. Interpretation Post-operative functional improvement occurred even in those presenting with urinary retention. There was no association between outcomes and time to surgery in this observational study. Significant healthcare needs remained post-operatively. Funding DCN Endowment Fund funded study administration. Castor EDC provided database use. No other study funding was received.
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14
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Copley PC, Tadross D, Salloum N, Woodfield J, Edlmann E, Poon M, Khan S, Brennan PM. A systematic review identifying outcome measures used in evaluating adults sustaining cervical spine fractures. Eur Spine J 2022; 31:3365-3377. [PMID: 36063214 DOI: 10.1007/s00586-022-07369-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 08/22/2022] [Accepted: 08/25/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To assess the outcome measures used in studies investigating cervical spine fractures in adults, with or without associated spinal cord injury, to inform development of a core outcome set. METHODS Medline, Embase and Scopus were searched for relevant studies until May 28, 2022, without a historic limit on study date. Study characteristics, population characteristics and outcomes reported were extracted and analyzed. RESULTS Our literature search identified 536 studies that met criteria for inclusion, involving 393,266 patients. Most studies were single center (87.3%), retrospective studies (88.9%) and involved a median of 40 patients (range 6-167,278). Treatments assessed included: surgery (55.2%), conservative (6.2%), halo immobilization (4.9%), or a mixture (33.2%). Median study duration was 84 months (range 3-564 months); the timing of clinical and/or radiological follow-up assessment after injury was reported in 56.7%. There was significant heterogeneity in outcomes used, with 79 different reported outcomes measures. Differences in use were identified between smaller/larger, retro-/prospective and single/multicenter cohorts. Over time, the use of radiological outcomes has declined with greater emphasis on patient-reported outcome measures (PROMs). Studies of conservative management were more likely to detail PROMs and mortality, whereas surgical studies reported Frankel/ASIA grade, radiological fusion, complication rates, duration of hospital stay and re-operation rates more frequently. In studies assessing the elderly population (> 65 years), use of PROMs, mortality, hospital stay and discharge destination were more common, whereas fusion was reported less often. Response rates for outcome assessments were lower in studies assessing elderly patients, and studies using PROMs. CONCLUSIONS We have classified the various outcome measures used for patients with cervical spine fractures based on the COMET outcome taxonomy. We also described the contexts in which different outcomes are more commonly employed to help guide decision-making when designing future research endeavors.
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Affiliation(s)
- Phillip C Copley
- Department of Clinical Neurosciences, Royal Infirmary of Edinburgh, Edinburgh, UK.
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.
- Department of Clinical Neurosciences, Edinburgh Spinal Surgery Outcome Studies Group, Edinburgh, UK.
| | - Daniel Tadross
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Nadia Salloum
- Department of Clinical Neurosciences, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Julie Woodfield
- Department of Clinical Neurosciences, Royal Infirmary of Edinburgh, Edinburgh, UK
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Ellie Edlmann
- Southwest Neurosurgical Centre, Derriford Hospital, Plymouth, UK
- Faculty of Health: Medicine, Dentistry and Human Sciences, University of Plymouth, Plymouth, UK
| | - Michael Poon
- Department of Clinical Neurosciences, Royal Infirmary of Edinburgh, Edinburgh, UK
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
- Department of Clinical Neurosciences, Edinburgh Spinal Surgery Outcome Studies Group, Edinburgh, UK
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Sadaquate Khan
- Department of Clinical Neurosciences, Royal Infirmary of Edinburgh, Edinburgh, UK
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
- Department of Clinical Neurosciences, Edinburgh Spinal Surgery Outcome Studies Group, Edinburgh, UK
| | - Paul M Brennan
- Department of Clinical Neurosciences, Royal Infirmary of Edinburgh, Edinburgh, UK
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
- Department of Clinical Neurosciences, Edinburgh Spinal Surgery Outcome Studies Group, Edinburgh, UK
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15
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Woodfield J, Edlmann E, Black PL, Boyd J, Copley PC, Cranswick G, Eborall H, Keerie C, Khan S, Lawton J, Lowe DJ, Norrie J, Niven A, Reed MJ, Shenkin SD, Statham P, Stoddart A, Tomlinson J, Brennan PM. Duration of External Neck Stabilisation (DENS) following odontoid fracture in older or frail adults: protocol for a randomised controlled trial of collar versus no collar. BMJ Open 2022; 12:e057753. [PMID: 35840308 PMCID: PMC9295672 DOI: 10.1136/bmjopen-2021-057753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Fractures of the odontoid process frequently result from low impact falls in frail or older adults. These are increasing in incidence and importance as the population ages. In the UK, odontoid fractures in older adults are usually managed in hard collars to immobilise the fracture and promote bony healing. However, bony healing does not always occur in older adults, and bony healing is not associated with quality of life, functional, or pain outcomes. Further, hard collars can cause complications such as skin pressure ulcers, swallowing difficulties and difficulties with personal care. We hypothesise that management with no immobilisation may be superior to management in a hard collar for older or frail adults with odontoid fractures. METHODS AND ANALYSES This is the protocol for the Duration of External Neck Stabilisation (DENS) trial-a non-blinded randomised controlled trial comparing management in a hard collar with management without a collar for older (≥65 years) or frail (Rockwood Clinical Frailty Scale ≥5) adults with a new odontoid fracture. 887 neurologically intact participants with any odontoid process fracture type will be randomised to continuing with a hard collar (standard care) or removal of the collar (intervention). The primary outcome is quality of life measured using the EQ-5D-5L at 12 weeks. Secondary outcomes include pain scores, neck disability index, health and social care use and costs, and mortality. ETHICS AND DISSEMINATION Informed consent for participation will be sought from those able to provide it. We will also include those who lack capacity to ensure representativeness of frail and acutely unwell older adults. Results will be disseminated via scientific publication, lay summary, and visual abstract. The DENS trial received a favourable ethical opinion from the Scotland A Research Ethics Committee (21/SS/0036) and the Leeds West Research Ethics Committee (21/YH/0141). TRIAL REGISTRATION NUMBER NCT04895644.
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Affiliation(s)
- Julie Woodfield
- Department of Clinical Neurosciences, NHS Lothian, Edinburgh, UK
- Translational Neurosurgery, The University of Edinburgh Centre for Clinical Brain Sciences, Edinburgh, UK
| | - Ellie Edlmann
- Southwest Neurosurgical Centre, Derriford Hospital, Plymouth, UK
- Peninsula Medical School, University of Plymouth, Plymouth, UK
| | - Polly L Black
- Emergency Medicine Research Group (EMERGE), NHS Lothian, Edinburgh, UK
| | - Julia Boyd
- Edinburgh Clinical Trials Unit, University of Edinburgh, Edinburgh, UK
| | | | - Gina Cranswick
- Edinburgh Clinical Trials Unit, University of Edinburgh, Edinburgh, UK
| | - Helen Eborall
- University of Edinburgh Usher Institute of Population Health Sciences and Informatics, Edinburgh, UK
| | - Catriona Keerie
- Edinburgh Clinical Trials Unit, University of Edinburgh, Edinburgh, UK
| | - Sadaquate Khan
- Department of Clinical Neurosciences, NHS Lothian, Edinburgh, UK
| | - Julia Lawton
- University of Edinburgh Usher Institute of Population Health Sciences and Informatics, Edinburgh, UK
| | - David J Lowe
- Department of Emergency, Queen Elizabeth University Hospital Campus, Glasgow, UK
- University of Glasgow Institute of Health and Wellbeing, Glasgow, UK
| | - John Norrie
- Edinburgh Clinical Trials Unit, University of Edinburgh, Edinburgh, UK
| | - Angela Niven
- Edinburgh Clinical Trials Unit, University of Edinburgh, Edinburgh, UK
| | - Matthew J Reed
- Emergency Medicine Research Group (EMERGE), NHS Lothian, Edinburgh, UK
- University of Edinburgh Usher Institute of Population Health Sciences and Informatics, Edinburgh, UK
| | - Susan Deborah Shenkin
- University of Edinburgh Usher Institute of Population Health Sciences and Informatics, Edinburgh, UK
- Advanced Care Research Centre, University of Edinburgh College of Medicine and Veterinary Medicine, Edinburgh, UK
| | - Patrick Statham
- Department of Clinical Neurosciences, NHS Lothian, Edinburgh, UK
| | - Andrew Stoddart
- Edinburgh Health Services Research Unit, The University Of Edinburgh, Edinburgh, UK
| | - James Tomlinson
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Paul M Brennan
- Department of Clinical Neurosciences, NHS Lothian, Edinburgh, UK
- Translational Neurosurgery, The University of Edinburgh Centre for Clinical Brain Sciences, Edinburgh, UK
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16
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Chari A, Piper RJ, Edlmann E, Woodfield J, Brennan PM, Turner C, Jenkinson MD, Hutchinson PJ, Kolias AG. Delivering Large-Scale Neurosurgical Studies in the UK: The Impact of Trainees. World Neurosurg 2022; 161:343-349. [PMID: 35505553 DOI: 10.1016/j.wneu.2021.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 09/01/2021] [Indexed: 11/17/2022]
Abstract
The UK neurosurgical community has a track record of delivering high-quality, practice-changing clinical research studies, facilitated by a robust clinical research infrastructure and close collaborations between neurosurgical centers. More recently, these large-scale studies have been conceived, developed, and delivered by neurosurgical trainees, working under the umbrella of the British Neurosurgical Trainee Research Collaborative (BNTRC). In this paper, we outline the current landscape of large-scale neurosurgical studies in the UK, focusing on the role of trainees in facilitating this research. Importantly, we focus on our experience of trainee-led studies, including the development of the network, current challenges, and future directions. We believe that a similar model can be applied in different settings and countries, which will drive up the quality of neurosurgical research, ultimately benefiting future neurosurgical patients.
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Affiliation(s)
- Aswin Chari
- Department of Neurosurgery, Great Ormond Street Hospital, London, United Kingdom; Developmental Neuroscience, Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Rory J Piper
- Department of Neurosurgery, Great Ormond Street Hospital, London, United Kingdom; Developmental Neuroscience, Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Ellie Edlmann
- Department of Neurosurgery, South West Neurosurgical Centre, University Hospitals Plymouth NHS Trust, Plymouth, United Kingdom; Faculty of Health, Peninsula Medical School, University of Plymouth, United Kingdom
| | - Julie Woodfield
- Department of Neurosurgery, NHS Lothian, Edinburgh, United Kingdom; Centre for Clinical Brain Sciences, University of Edinburgh, United Kingdom
| | - Paul M Brennan
- Department of Neurosurgery, NHS Lothian, Edinburgh, United Kingdom; Centre for Clinical Brain Sciences, University of Edinburgh, United Kingdom
| | - Carole Turner
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom; Department of Neurosurgery, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Michael D Jenkinson
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, United Kingdom; Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - Peter J Hutchinson
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom; Department of Neurosurgery, Addenbrooke's Hospital, Cambridge, United Kingdom; National Institute for Health Research Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, United Kingdom
| | - Angelos G Kolias
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom; Department of Neurosurgery, Addenbrooke's Hospital, Cambridge, United Kingdom; National Institute for Health Research Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, United Kingdom.
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17
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Tominey S, Baweja K, Woodfield J, Chambers TJG, Poon MTC, Wiggins AN, Brennan PM, Loan JJM. Investigation and management of serum sodium after subarachnoid haemorrhage (SaSH): a survey of practice in the United Kingdom and Republic of Ireland. Br J Neurosurg 2022; 36:192-195. [PMID: 33470851 DOI: 10.1080/02688697.2020.1859460] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 11/21/2020] [Accepted: 11/30/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Hyponatraemia is a common complication of aneurysmal subarachnoid haemorrhage (SAH). We aimed to determine current neurosurgical practice for the identification, investigation and management of hyponatraemia after SAH. METHODS An online questionnaire was completed by UK and Irish neurosurgical trainees and consultant collaborators in the Sodium after Subarachnoid Haemorrhage (SaSH) audit. RESULTS Between August 2019 and June 2020, 43 responses were received from 31 of 32 UK and Ireland adult neurosurgical units (NSUs). All units reported routine measurement of serum sodium either daily or every other day. Most NSUs reported routine investigation of hyponatraemia after SAH with paired serum and urinary osmolalities (94%), urinary sodium (84%), daily fluid balance (84%), but few measured glucose (19%), morning cortisol (13%), or performed a short Synacthen test (3%). Management of hyponatraemia was variable, with units reporting use of oral sodium supplementation (77%), fluid restriction (58%), hypertonic saline (55%), and fludrocortisone (19%). CONCLUSIONS Reported assessment of serum sodium after SAH was consistent between units, whereas management of hyponatraemia varied. This may reflect the lack of a specific evidence-base to inform practice.
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Affiliation(s)
- Steven Tominey
- Department of General Medicine, Queen Elizabeth University Hospital, Glasgow, UK
| | - Kirun Baweja
- Department of Surgery, Glasgow Royal Infirmary, Glasgow, UK
| | - Julie Woodfield
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
- Department of Clinical Neurosciences, NHS Lothian, Edinburgh, UK
| | - Thomas J G Chambers
- Centre for Discovery Brain Sciences, University of Edinburgh, Edinburgh, UK
- Edinburgh Centre for Diabetes and Endocrinology, NHS Lothian, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Michael T C Poon
- Department of Clinical Neurosciences, NHS Lothian, Edinburgh, UK
- Usher Institute, University of Edinburgh, Edinburgh, Edinburgh, UK
| | | | - Paul M Brennan
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
- Department of Clinical Neurosciences, NHS Lothian, Edinburgh, UK
| | - James J M Loan
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
- Department of Clinical Neurosciences, NHS Lothian, Edinburgh, UK
- Centre for Discovery Brain Sciences, University of Edinburgh, Edinburgh, UK
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18
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Mohammed R, Shah P, Durst A, Mathai NJ, Budu A, Woodfield J, Marjoram T, Sewell M. Restoration of elective spine surgery during the first wave of COVID-19 : a UK-wide British Association of Spine Surgeons (BASS) prospective, multicentre, observational study. Bone Jt Open 2021; 2:1096-1101. [PMID: 34939428 PMCID: PMC8711666 DOI: 10.1302/2633-1462.212.bjo-2021-0116.r1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Aims With resumption of elective spine surgery services in the UK following the first wave of the COVID-19 pandemic, we conducted a multicentre British Association of Spine Surgeons (BASS) collaborative study to examine the complications and deaths due to COVID-19 at the recovery phase of the pandemic. The aim was to analyze the safety of elective spinal surgery during the pandemic. Methods A prospective observational study was conducted from eight spinal centres for the first month of operating following restoration of elective spine surgery in each individual unit. Primary outcome measure was the 30-day postoperative COVID-19 infection rate. Secondary outcomes analyzed were the 30-day mortality rate, surgical adverse events, medical complications, and length of inpatient stay. Results In all, 257 patients (128 males) with a median age of 54 years (2 to 88) formed the study cohort. The mean number of procedures performed from each unit was 32 (16 to 101), with 118 procedures (46%) done as category three prioritization level. The majority of patients (87%) were low-medium “risk stratification” category and the mean length of hospital stay was 5.2 days. None of the patients were diagnosed with COVID-19 infection, nor was there any mortality related to COVID-19 during the 30-day follow-up period, with 25 patients (10%) having been tested for symptoms. Overall, 32 patients (12%) developed a total of 34 complications, with the majority (19/34) being grade 1 to 2 Clavien-Dindo classification of surgical complications. No patient required postoperative care in an intensive care setting for any unexpected complication. Conclusion This study shows that safe and effective planned spinal surgical services can be restored avoiding viral transmission, with diligent adherence to national guidelines and COVID-19-secure pathways tailored according to the resources of the individual spinal units. Cite this article: Bone Jt Open 2021;2(12):1096–1101.
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Affiliation(s)
| | - Pranav Shah
- University Hospital of Wales, UK.,Noah's Ark Children's Hospital for Wales, UK
| | | | | | | | - Julie Woodfield
- Centre for Clinical Brain Sciences Western General Hospital, NHS Lothian, Edinburgh, UK
| | - Tom Marjoram
- Ipswich Hospital, East Suffolk and North Essex NHS Foundation Trust, Ipswich, UK
| | - Matthew Sewell
- The Royal Orthopaedic Hospital and Birmingham Children's Hospital, Birmingham, UK
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19
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Edlmann E, Copley P, Hughes M, Woodfield J. Letter to the Editor. A UK perspective on gender diversity in American neurosurgery training programs. J Neurosurg 2021:1-2. [PMID: 34214978 DOI: 10.3171/2021.3.jns21548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Ellie Edlmann
- 1Peninsula Medical School, University of Plymouth, Plymouth Science Park, Plymouth, United Kingdom; South West Neurosurgical Centre, Derriford Hospital, Plymouth, United Kingdom
| | | | - Mark Hughes
- 3NHS Lothian, Edinburgh, United Kingdom; Centre for Clinical Brain Sciences, University of Edinburgh, United Kingdom
| | - Julie Woodfield
- 3NHS Lothian, Edinburgh, United Kingdom; Centre for Clinical Brain Sciences, University of Edinburgh, United Kingdom
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20
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Woodfield J, Brennan PM, Statham P, Stone J, Hoeritzauer I. Suspected cauda equina syndrome: no reduction in investigation, referral and treatment during the COVID-19 pandemic. Ann R Coll Surg Engl 2021; 103:432-437. [PMID: 33682481 DOI: 10.1308/rcsann.2021.0011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
INTRODUCTION Compression of the cauda equina can lead to bladder, bowel and sexual dysfunction with lower limb pain, numbness and weakness. Urgent surgical decompression aims to prevent progressive neurological deficit. Symptoms of cauda equina syndrome (CES), such as back pain, sciatica and bladder dysfunction are common in the population, but the majority of those investigated do not have radiological cauda equina compression. However, a missed diagnosis can have significant medical, social and legal consequences. We investigated the effect of the COVID-19 pandemic on presentation and management of suspected CES. METHODS This retrospective cohort study analysed referral, investigation and treatment of CES in a regional neurosurgical centre during the initial COVID-19 surge between March and May 2020 compared with March to May 2019. RESULTS Referrals for suspected CES were similar during the COVID-19 pandemic (n = 275) compared with 2019 (n = 261, p = 0.596) despite a significant (19%) decrease in total emergency neurosurgical referrals (1248 in 2020 vs 1544 in 2019, p < 0.001). Nineteen (7%) of the suspected CES referrals underwent decompression in 2020, similar to 16 (6%) in 2019 (p = 0.867). There were no differences in outcomes or complications and no evidence of delays in presentation or treatment. CONCLUSIONS Unlike other emergency neurosurgical conditions, the number of referrals for suspected CES and the percentage of referrals with radiological cauda equina compression were unchanged during the COVID-19 pandemic. The persistence of CES referrals when many people stayed away from hospital highlights the distress and worry caused by suspected CES and its symptoms to both patients and healthcare providers.
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Affiliation(s)
- J Woodfield
- University of Edinburgh, UK.,NHS Lothian, UK
| | - P M Brennan
- University of Edinburgh, UK.,NHS Lothian, UK
| | | | - J Stone
- University of Edinburgh, UK.,NHS Lothian, UK
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21
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Woodfield J, Copley PC, Hughes M, Edlmann E. The gender gap in European neurosurgical conference presentations. Neurosurg Focus 2021; 50:E7. [PMID: 33789241 DOI: 10.3171/2020.12.focus20885] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 12/21/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Within neurosurgery, there are fewer women than men at all levels. The authors aimed to assess whether opportunities and representation within neurosurgery are proportional to the existing gender gap. METHODS The authors analyzed the program of the 2019 joint European Association of Neurosurgical Societies (EANS)/Society of British Neurological Surgeons (SBNS) conference to assess the proportions of presentations given through abstract submission and invitation by men and women. They compared proportions to the previous joint conference in 2007 and to the gender proportions of board-certified European neurosurgeons. RESULTS Women delivered 75/577 (13%) presentations at the 2019 EANS/SBNS conference: 54/283 (19%) abstract submissions and 21/294 (7%) invited presentations. Fifteen of 152 (10%) session chairs were women. This increased significantly from 4/121 (3%) presentations delivered by women in 2007. When only presentations given by neurosurgeons (residents or consultants) were analyzed, the proportion of female speakers increased from 1/111 (1%) in 2007 to 60/545 (11%) in 2019. Pediatrics was the subspecialty with the highest proportion of invited female speakers. Across subspecialties, there were no differences in gender proportions for presentations from abstract submissions. Across the top 5 participating European countries, the proportion of female invited speakers (8%) and chairs (8%) was half the proportion of female board-certified neurosurgeons (16%). CONCLUSIONS The proportion of women delivering invited presentations and chairing sessions at a European neurosurgical conference is lower than expected from the available pool of board-certified neurosurgeons. The proportion of women participating is higher through application (abstract submission) than through invitation. The higher proportion of presentations from abstract submission may reflect submission from a pool of trainees with a higher proportion of women. The authors suggest implementation of strategies that increase invited speakers from minority groups and have been shown to be effective in other disciplines, such as improving minority group representation in organizing committees.
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Affiliation(s)
- Julie Woodfield
- 1Department of Clinical Neurosciences, NHS Lothian, Edinburgh.,2Centre for Clinical Brain Sciences, University of Edinburgh
| | | | - Mark Hughes
- 1Department of Clinical Neurosciences, NHS Lothian, Edinburgh.,2Centre for Clinical Brain Sciences, University of Edinburgh
| | - Ellie Edlmann
- 3Southwest Neurosurgical Centre, Derriford Hospital, Plymouth; and.,4University of Plymouth Faculty of Health: Medicine, Dentistry and Human Sciences, Plymouth, United Kingdom
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22
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Keane C, O'Grady G, Bissett I, Woodfield J. Comparison of bowel dysfunction between colorectal cancer survivors and a non-operative non-cancer control group. Colorectal Dis 2020; 22:806-813. [PMID: 31943637 DOI: 10.1111/codi.14966] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 12/15/2019] [Indexed: 02/08/2023]
Abstract
AIM Low anterior resection syndrome (LARS) detrimentally affects quality of life in colorectal cancer survivors. This study assessed the prevalence for LARS in colorectal cancer survivors and the same symptoms in a matched control group. METHOD Validated instruments, the LARS score and Short Form Survey 12, used to collect functional and quality of life outcomes from patients who had undergone distal colorectal resection at Auckland Hospital (2008-2015) or Dunedin Hospital (2008-2017). A matched non-operative control group was drawn from patients undergoing surveillance colonoscopy. RESULTS The response rate was 79%. Cross-sectional prevalence of major LARS in rectal cancer patients was 52% at a median follow-up of 52 months. Major LARS prevalence in the sigmoid cancer resection and non-cancer control groups was similar (25% vs 26%, P = 0.6). On univariate analysis anastomotic height [risk ratio (RR) for low anterior resection 4.6, P < 0.001; ultralow anterior resection RR = 15.5, P < 0.001], radiotherapy (RR = 2.6; P = 0.009), stoma (RR = 3.6; P = 0.001) and J pouch reconstruction (vs straight anastomosis, RR = 4.6; P = 0.008) were associated with major LARS for rectal cancer patients. These factors were not significant when the analysis was stratified for anastomotic height. Despite correlation between LARS and Short Form Survey 12 outcomes (physical ρ = -0.2; mental ρ = -0.2) there was no difference in quality of life outcomes between the groups. CONCLUSION Bowel dysfunction after low anterior resection affects the majority of rectal cancer patients. The high background rate of bowel dysfunction must be considered when assessing the prevalence of LARS.
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Affiliation(s)
- C Keane
- Department of Surgery, University of Auckland, Auckland, New Zealand.,Department of Surgery, Whangarei Hospital, Whangarei, New Zealand
| | - G O'Grady
- Department of Surgery, University of Auckland, Auckland, New Zealand.,Department of Surgery, Auckland City Hospital, Auckland, New Zealand
| | - I Bissett
- Department of Surgery, University of Auckland, Auckland, New Zealand.,Department of Surgery, Auckland City Hospital, Auckland, New Zealand
| | - J Woodfield
- Department of Surgery, Dunedin Hospital, Dunedin, New Zealand.,Department of Surgical Sciences, University of Otago, Auckland, New Zealand
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23
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Hoeritzauer I, Wood M, Copley PC, Demetriades AK, Woodfield J. What is the incidence of cauda equina syndrome? A systematic review. J Neurosurg Spine 2020; 32:1-10. [PMID: 32059184 DOI: 10.3171/2019.12.spine19839] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 12/06/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Cauda equina syndrome (CES) is a surgical emergency requiring timely operative intervention to prevent symptom progression. Accurately establishing the incidence of CES is required to inform healthcare service design and delivery, including out-of-hours imaging arrangements. METHODS A systematic literature search of MEDLINE, EMBASE, and Scopus was undertaken to identify original studies stating the incidence of CES, and the estimates were combined in a meta-analysis as described in the protocol registered with PROSPERO (registration no. CRD42017065865) and reported using the PRISMA guidelines. RESULTS A total of 1281 studies were identified, and 26 studies were included in the review. Data about CES incidence were available from 3 different populations: asymptomatic community populations, patients with nontraumatic low-back pain, and patients presenting as an emergency with suspected CES. The incidence of CES was 0.3-0.5 per 100,000 per year in 2 asymptomatic community populations, 0.6 per 100,000 per year in an asymptomatic adult population, and 7 per 100,000 per year in an asymptomatic working-age population. CES occurred in 0.08% of those with low-back pain presenting to primary care in 1 study, and a combined estimate of 0.27% was calculated for 4 studies of those with low-back pain presenting to secondary care. Across 18 studies of adults with suspected CES, 19% had radiological and clinical CES. Difficulties in comparison between studies resulted from the heterogeneous definitions of CES and lack of separation of more advanced CES with retention, which is unlikely to be reversible. In the studies of patients with suspected CES, the small sample size, the high number of single-center studies (18/18), the high number of studies from the United Kingdom (17/18), the retrospective nature of the studies, and the high number of abstracts rather than full texts (9/18) reduced the quality of the data. CONCLUSIONS From current studies, it appears that CES occurs infrequently in asymptomatic community populations and in only 19% of those presenting with symptoms. Determining accurate incidence figures and designing a bespoke service for investigation of patients with suspected CES would require a consensus clinical and radiological definition of CES and international multisite studies of patient pathways of investigation and management.
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Affiliation(s)
- Ingrid Hoeritzauer
- 2Centre for Clinical Brain Sciences, University of Edinburgh; and
- 3Edinburgh Spinal Surgery Outcome Studies Group, Department of Clinical Neurosciences, Edinburgh, United Kingdom
| | - Matthew Wood
- 1Department of Clinical Neurosciences, Western General Hospital, Edinburgh
- 2Centre for Clinical Brain Sciences, University of Edinburgh; and
| | - Phillip C Copley
- 1Department of Clinical Neurosciences, Western General Hospital, Edinburgh
- 2Centre for Clinical Brain Sciences, University of Edinburgh; and
- 3Edinburgh Spinal Surgery Outcome Studies Group, Department of Clinical Neurosciences, Edinburgh, United Kingdom
| | - Andreas K Demetriades
- 1Department of Clinical Neurosciences, Western General Hospital, Edinburgh
- 3Edinburgh Spinal Surgery Outcome Studies Group, Department of Clinical Neurosciences, Edinburgh, United Kingdom
| | - Julie Woodfield
- 1Department of Clinical Neurosciences, Western General Hospital, Edinburgh
- 2Centre for Clinical Brain Sciences, University of Edinburgh; and
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24
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Pronin S, Woodfield J, Hoeritzauer I, Carson A, Stone J, Statham PF, Demetriades AK. Does a history of lumbar spine surgery predict radiological cauda equina compression in patients undergoing MRI for suspected cauda equina syndrome? Br J Neurosurg 2019; 34:76-79. [PMID: 31718292 DOI: 10.1080/02688697.2019.1687845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background: The clinical symptoms and signs of Cauda equina syndrome (CES) are non specific and poorly predictive of cauda equina compression on MRI. We aimed to establish whether a history of lumbar spine surgery predicts cauda equina compression on MRI in those presenting with suspected CES.Methods: A retrospective electronic record review was undertaken of 276 patients referred with clinically suspected CES who underwent a lumbosacral spine MRI. Those with a history of prior lumbar surgery were compared to those without. The likelihood of cauda equina compression was compared between the two groups.Results: About 78/276 (28%) patients with suspected CES had radiological compression of the cauda equina and went on to surgical decompression. A total of 54 (20%) patients had undergone prior lumbar surgery. Patients with a history of lumbar surgery were less likely to have cauda equina compression on MRI (χ2 - p = .035). Twenty six (9%) patients presented more than once with suspected CES. Patients with a history of lumbar surgery were more likely to re-present with suspected CES (χ2 - p = .002).Conclusions: Prior lumbar surgery was associated with a higher frequency of re-presentation with clinically suspected CES but a lower frequency of radiological cauda equina compression.
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Affiliation(s)
- Savva Pronin
- Department of Clinical Neurosciences, The University of Edinburgh, Western General Hospital, Edinburgh, UK.,Edinburgh Spinal Surgery Outcome Studies Group, The University of Edinburgh, Edinburgh, UK
| | - Julie Woodfield
- Department of Clinical Neurosciences, The University of Edinburgh, Western General Hospital, Edinburgh, UK.,Edinburgh Spinal Surgery Outcome Studies Group, The University of Edinburgh, Edinburgh, UK.,Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK
| | - Ingrid Hoeritzauer
- Department of Clinical Neurosciences, The University of Edinburgh, Western General Hospital, Edinburgh, UK.,Edinburgh Spinal Surgery Outcome Studies Group, The University of Edinburgh, Edinburgh, UK.,Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK
| | - Alan Carson
- Department of Clinical Neurosciences, The University of Edinburgh, Western General Hospital, Edinburgh, UK.,Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK
| | - Jon Stone
- Department of Clinical Neurosciences, The University of Edinburgh, Western General Hospital, Edinburgh, UK.,Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK
| | - Patrick F Statham
- Department of Clinical Neurosciences, The University of Edinburgh, Western General Hospital, Edinburgh, UK.,Edinburgh Spinal Surgery Outcome Studies Group, The University of Edinburgh, Edinburgh, UK
| | - Andreas K Demetriades
- Department of Clinical Neurosciences, The University of Edinburgh, Western General Hospital, Edinburgh, UK.,Edinburgh Spinal Surgery Outcome Studies Group, The University of Edinburgh, Edinburgh, UK.,Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK
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25
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Mohan M, Islim AI, Rasul FT, Rominiyi O, deSouza RM, Poon MTC, Jamjoom AAB, Kolias AG, Woodfield J, Patel K, Chari A, Kirollos R. Subarachnoid haemorrhage with negative initial neurovascular imaging: a systematic review and meta-analysis. Acta Neurochir (Wien) 2019; 161:2013-2026. [PMID: 31410556 PMCID: PMC6739283 DOI: 10.1007/s00701-019-04025-w] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 07/25/2019] [Indexed: 02/07/2023]
Abstract
Background In patients with spontaneous subarachnoid haemorrhage (SAH), a vascular cause for the bleed is not always found on initial investigations. This study aimed to systematically evaluate the delayed investigation strategies and clinical outcomes in these cases, often described as “non-aneurysmal” SAH (naSAH). Methods A systematic review was performed in concordance with the PRISMA checklist. Pooled proportions of primary outcome measures were estimated using a random-effects model. Results Fifty-eight studies were included (4473 patients). The cohort was split into perimesencephalic naSAH (PnaSAH) (49.9%), non-PnaSAH (44.7%) and radiologically negative SAH identified on lumbar puncture (5.4%). The commonest initial vascular imaging modality was digital subtraction angiography. A vascular abnormality was identified during delayed investigation in 3.9% [95% CI 1.9–6.6]. There was no uniform strategy for the timing or modality of delayed investigations. The pooled proportion of a favourable modified Rankin scale outcome (0–2) at 3–6 months following diagnosis was 92.0% [95% CI 86.0–96.5]. Complications included re-bleeding (3.1% [95% CI 1.5–5.2]), hydrocephalus (16.0% [95% CI 11.2–21.4]), vasospasm (9.6% [95% CI 6.5–13.3]) and seizure (3.5% [95% CI 1.7–5.8]). Stratified by bleeding pattern, we demonstrate a higher rate of delayed diagnoses (13.6% [95% CI 7.4–21.3]), lower proportion of favourable functional outcome (87.2% [95% CI 80.1–92.9]) and higher risk of complications for non-PnaSAH patients. Conclusion This study highlights the heterogeneity in delayed investigations and outcomes for patients with naSAH, which may be influenced by the initial pattern of bleeding. Further multi-centre prospective studies are required to clarify optimal tailored management strategies for this heterogeneous group of patients. Electronic supplementary material The online version of this article (10.1007/s00701-019-04025-w) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Midhun Mohan
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust and University of Liverpool, Liverpool, UK
| | - Abdurrahman I Islim
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust and University of Liverpool, Liverpool, UK
| | - Fahid T Rasul
- Department of Neurosurgery, Queen's Hospital, Romford, UK
| | - Ola Rominiyi
- Department of Neurosurgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | | | | | - Aimun A B Jamjoom
- Department of Clinical Neurosciences, Western General Hospital, Edinburgh, UK
| | - Angelos G Kolias
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge and Addenbrooke's Hospital, Cambridge, UK
| | - Julie Woodfield
- Department of Clinical Neurosciences, Western General Hospital, Edinburgh, UK
| | - Krunal Patel
- Division of Neurosurgery, Krembil Research Institute, Toronto Western Hospital, University Health Network and University of Toronto, Toronto, Canada
| | - Aswin Chari
- Institute of Child Health, University College London, London, UK.
- Department of Neurosurgery, Great Ormond Street Hospital, Great Ormond Street, WC1N 3JH, London, UK.
| | - Ramez Kirollos
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge and Addenbrooke's Hospital, Cambridge, UK
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26
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Fountain DM, Davies SCL, Woodfield J, Kamel M, Majewska P, Edlmann E, Jamjoom AAB, Hoeritzauer I, Waqar M, Mahoney DE, Vyas D, Schramm MWJ, Solomou G, Dawkes FEC, Grant HK, Attwood JE, Boukas A, Ballard DJ, Toman E, Sanders MI, Cheserem B, Sinha S, Statham P. Evaluation of nationwide referral pathways, investigation and treatment of suspected cauda equina syndrome in the United Kingdom. Br J Neurosurg 2019; 0:1-11. [DOI: 10.1080/02688697.2019.1648757] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Daniel M. Fountain
- Division of Neurosurgery, Department of Clinical Neurosciences, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | | | - Julie Woodfield
- Department of Clinical Neurosciences, NHS Lothian, Edinburgh, UK
- Department of Clinical Neuroscience, Western General Hospital, Edinburgh, UK
| | - Mohammed Kamel
- Department of Neurosurgery, Nottingham University Hospitals Foundation Trust, Nottingham, UK
| | | | - Ellie Edlmann
- Division of Neurosurgery, Department of Clinical Neurosciences, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Aimun A. B. Jamjoom
- Department of Clinical Neuroscience, Western General Hospital, Edinburgh, UK
| | - Ingrid Hoeritzauer
- Department of Clinical Neuroscience, Western General Hospital, Edinburgh, UK
- Centre for Clinical Brain Sciences, University of Edinburgh, UK
| | - Mueez Waqar
- Division of Academic Neurosurgery, Manchester, UK
| | | | - Dillon Vyas
- School of Medicine, University of Leeds, Leeds, UK
| | | | | | | | | | - Jonathan E. Attwood
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK
| | - Alexandros Boukas
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK
| | - Dominic J. Ballard
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, UK
| | - Emma Toman
- Department of Neurosurgery, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | | | - Beverly Cheserem
- Department of Neurosurgery, Brighton and Sussex University Hospital, Brighton, UK
| | - Saurabh Sinha
- Department of Neurosurgery, Sheffield Teaching Hospitals, Sheffield, UK
| | - Patrick Statham
- Department of Clinical Neuroscience, Western General Hospital, Edinburgh, UK
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27
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Woodfield J, Jamjoom A, Hoeritzauer I. BNTRC: British Neurosurgical Trainee Research Collaborative Understanding Cauda Equina Syndrome. Int J Surg Protoc 2019. [DOI: 10.1016/j.isjp.2019.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Woodfield J, Hoeritzauer I, Jamjoom AAB, Pronin S, Srikandarajah N, Poon M, Roy H, Demetriades AK, Sell P, Eames N, Statham PFX. Understanding cauda equina syndrome: protocol for a UK multicentre prospective observational cohort study. BMJ Open 2018; 8:e025230. [PMID: 30552283 PMCID: PMC6303568 DOI: 10.1136/bmjopen-2018-025230] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 10/01/2018] [Accepted: 10/04/2018] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Cauda equina syndrome (CES) is a potentially devastating condition caused by compression of the cauda equina nerve roots. This can result in bowel, bladder and sexual dysfunction plus lower limb weakness, numbness and pain. CES occurs infrequently, but has serious potential morbidity and medicolegal consequences. This study aims to identify and describe the presentation and management of patients with CES in the UK. METHODS AND ANALYSIS Understanding Cauda Equina Syndrome (UCES) is a prospective and collaborative multicentre cohort study of adult patients with confirmed CES managed at specialist spinal centres in the UK. Participants will be identified using neurosurgical and orthopaedic trainee networks to screen referrals to spinal centres. Details of presentation, investigations, management and service usage will be recorded. Both patient-reported and clinician-reported outcome measures will be assessed for 1 year after surgery. This will establish the incidence of CES, current investigation and management practices, and adherence to national standards of care. Outcomes will be stratified by clinical presentation and patient management. Accurate and up to date information about the presentation, management and outcome of patients with CES will inform standards of service design and delivery for this important but infrequent condition. ETHICS AND DISSEMINATION UCES received a favourable ethical opinion from the South East Scotland Research Ethics Committee 02 (Reference: 18/SS/0047; IRAS ID: 233515). All spinal centres managing patients with CES in the UK will be encouraged to participate in UCES. Study results will be published in medical journals and shared with local participating sites. TRIAL REGISTRATION NUMBER ISRCTN16828522; Pre-results.
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Affiliation(s)
- Julie Woodfield
- Department for Clinical Neurosciences, Western General Hospital, Edinburgh, UK
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK
| | - Ingrid Hoeritzauer
- Department for Clinical Neurosciences, Western General Hospital, Edinburgh, UK
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK
| | - Aimun A B Jamjoom
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK
- Department of Neurosurgery, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Savva Pronin
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK
| | | | - Michael Poon
- Department for Clinical Neurosciences, Western General Hospital, Edinburgh, UK
| | - Holly Roy
- South West Neurosurgery Centre, Derriford Hospital, Plymouth, UK
| | | | - Philip Sell
- Centre for Spinal Studies and Surgery, Queens Medical Centre, Nottingham, UK
| | - Niall Eames
- Department of Trauma and Orthopaedics, Royal Victoria Hospital, Belfast, UK
| | - Patrick F X Statham
- Department for Clinical Neurosciences, Western General Hospital, Edinburgh, UK
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Woodfield J, Hulme-Moir M, Ly J. A comparison of the cost of primary closure or rectus abdominis myocutaneous flap closure of the perineum after abdominoperineal excision. Colorectal Dis 2017; 19:934-941. [PMID: 28436214 DOI: 10.1111/codi.13690] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Accepted: 01/30/2017] [Indexed: 12/13/2022]
Abstract
AIM Perineal wound complications following abdominoperineal resection continue to be a major challenge. The aim of this study was to compare the clinical outcomes and cost of primary closure (PC) and rectus abdominis myocutaneous (RAM) flap reconstruction. METHOD This was a retrospective case review of consecutive patients by one surgeon over 11 years. Patient demographics, risk factors, operative details and complications were identified. Inpatient and outpatient costs were calculated. RESULTS A total of 31 patients underwent a RAM reconstruction and 37 a PC. There were no significant differences in the incidence of wound complications or in the overall costs for either method of perineal closure. When there were no complications the mean costs were significantly higher in the RAM group ($20 948 vs $17 189, P = 0.005), mainly because of the longer operating time. However, the costs of perineal wound complications were greater in the PC group (8394 vs 25 911, P = 0.012). These wounds took longer to heal (median 2 months vs 5.5 months, P = 0.005) and more often required a further reconstructive surgical procedure (RAM 0 vs PC 8, P = 0.006). CONCLUSION This is the first study reporting on the cost implications of PC and RAM flap reconstruction. The overall costs were similar. This implies appropriate clinical selection when choosing between procedures. While the RAM flap is more expensive to perform, the finding that it decreases the clinical severity and cost of perineal wound complications supports its use when there is a high risk of perineal wound complications.
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Affiliation(s)
- J Woodfield
- Department of Surgical Sciences, University of Otago, Dunedin, New Zealand
| | - M Hulme-Moir
- Department of Surgery, North Shore Hospital, Waitakere District Health Board, Auckland, New Zealand
| | - J Ly
- Department of Surgery, North Shore Hospital, Waitakere District Health Board, Auckland, New Zealand
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Abstract
Reports results of research to test and analyse five different document delivery systems according to request and delivery times, costs, document quality, and coverage. The aim was to evaluate the success of the different systems according to these criteria and to assess their relative value for money. The systems tested were UMI ProQuest Direct, InfoTrac SearchBank, British Library inside, Elsevier Engineering Information EiText and the standard BLDSC service. Two sets of documents were used in the evaluation: one relating to business studies and the other to manufacturing engineering. The full-text database systems provided a more rapid service than e-mailed and faxed delivery options. BLDSC uses the slowest method of delivery. ProQuest Direct and SearchBank were generally reliable. Partial and fragmented delivery of documents was an occasional feature of EiText and British Library inside. The flat rate per document fee charged by BLDSC is at least three times cheaper than either EiText or British Library inside. BLDSC provides the most comprehensive coverage by far in the titles held and the range of subjects. SearchBank and ProQuest Direct offer the least number of titles, across a range of subjects which is broader than EiText but more limited than British Library services. Concludes that the standard BLDSC service still offers extremely good value for money if assessed on document quality, price and coverage. However, if demand for faster document delivery were to increase, then BLDSC would face greater competition albeit in a limited range of material.
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Affiliation(s)
- Anne Morris
- Department of Information Science at Loughborough University
| | | | - J. Eric Davies
- Department of Information Science at Loughborough University,
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31
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Woodfield J, Rane N, Cudlip S, Byrne JV. Value of delayed MRI in angiogram-negative subarachnoid haemorrhage. Clin Radiol 2014; 69:350-6. [DOI: 10.1016/j.crad.2013.11.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Accepted: 11/05/2013] [Indexed: 12/28/2022]
Affiliation(s)
- J Woodfield
- Department of Neurosurgery, John Radcliffe Hospital, Oxford, UK.
| | - N Rane
- Department of Neuroradiology, John Radcliffe Hospital, Oxford, UK
| | - S Cudlip
- Department of Neurosurgery, John Radcliffe Hospital, Oxford, UK
| | - J V Byrne
- Department of Neuroradiology, John Radcliffe Hospital, Oxford, UK
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Abstract
A 1-year-old girl with craniopharyngioma required external drainage of 40-50 mL/h of cerebrospinal fluid (CSF) after biopsy and cyst fenestration. She developed CSF ascites following insertion of a ventriculoperitoneal (VP) shunt and a distended painful gallbladder following ventriculogallbladder shunt insertion. Revision to a ventriculoatrial shunt was required. This is the first time a craniopharyngioma has been reported to cause increased CSF production. The potential mechanisms of CSF overproduction and the difficulties managing the large volume of CSF in a young child are discussed.
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Affiliation(s)
- Julie Woodfield
- Department of Neurosurgery, John Radcliffe Hospital, Oxford, United Kingdom
| | - Shailendra Magdum
- Department of Neurosurgery, John Radcliffe Hospital, Oxford, United Kingdom
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Abstract
Cyclizine is commonly prescribed as an anti-emetic post-operatively. We report a case of a 51-year-old woman who developed addiction to intravenous cyclizine following regular administration at recommended doses. This is the first report of cyclizine misuse post-operatively. We compare this case to cyclizine abuse reported amongst other populations. Prescribers should be aware of the potential of cyclizine as a drug of abuse.
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Affiliation(s)
- J Woodfield
- Neurosurgery Specialty Trainee, Institute of Neurological Sciences, Southern General Hospital, UK
| | - EJ St George
- Consultant Neurosurgeon, Institute of Neurological Sciences, Southern General Hospital, UK
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Woodfield J, Barnett M, Shapkov P. Softball injury causing haemoperitoneum due to ruptured Meckel's mesodiverticular band. N Z Med J 2011; 124:95-97. [PMID: 22016169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
A 16-year-old male sustained an intra-abdominal haemorrhage after diving for last base during a softball game. At laparotomy a ruptured patent mesodiverticular band supplying a large Meckel's diverticulum was found. Traumatic rupture of a mesodiverticular band leading to massive intra-abdominal haemorrhage is a rare event, and has never been reported as a single injury or in the context of a sport's injury.
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Affiliation(s)
- Julie Woodfield
- North Shore Hospital, Waitemata District Health Board, Takapuna, Auckland, New Zealand
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Sagar PM, Thekkinkattil DK, Heath RM, Woodfield J, Gonsalves S, Landon CR. Feasibility and functional outcome of laparoscopic sacrocolporectopexy for combined vaginal and rectal prolapse. Dis Colon Rectum 2008; 51:1414-20. [PMID: 18597143 DOI: 10.1007/s10350-008-9371-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2007] [Revised: 11/25/2007] [Accepted: 12/23/2007] [Indexed: 02/08/2023]
Abstract
PURPOSE Prolapse of multiple pelvic organs causes a variety of symptoms that impair a patient's quality of life. A laparoscopic procedure is described that uses a mesh fixation of the mid-compartment vagina to the sacrum with additional rectopexy to correct both the anatomical deformities and the dysfunction of the posterior compartment. METHODS Patients with significant rectal and vaginal prolapse with or without rectocele were recruited. A thorough preoperative physiological assessment of each of the compartments of the pelvic floor was carried out. Patients also completed the Pelvic Floor Distress Inventory before and six months after surgery. RESULTS Ten patients underwent the procedure of laparoscopic sacrocolporectopexy (median age 47 years, interquartile range 43-53). No mortality or morbidity occurred. Median global distress inventory scores were significantly lower postoperatively (8.3, interquartile range 0-20.8 vs. 37.5, interquartile range 16.6-60.4) P = 0.012. All three median subscales were also significantly lower postoperatively. The procedure corrected associated rectoceles and descent of the perineum on straining. CONCLUSION The described laparoscopic procedure of mesh sacrocolpopexy with rectopexy was safe and feasible and conferred good symptomatic improvement in pelvic floor dysfunction.
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Affiliation(s)
- P M Sagar
- John Goligher Department of Colorectal Surgery, Leeds General Infirmary, Leeds, United Kingdom.
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Woodfield J, Argent A. Evidence behind the WHO guidelines: hospital care for children: what is the most appropriate anti-microbial treatment for tuberculous meningitis? J Trop Pediatr 2008; 54:220-4. [PMID: 18658198 DOI: 10.1093/tropej/fmn063] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Abstract
BACKGROUND The traditional management of pyloroduodenal obstruction is open gastrojejunostomy (OGJ). More recently laparoscopic gastrojejunostomy (LGJ) and endoscopic stenting (ES) have been introduced. The aim of this study was to evaluate the three approaches to the palliation of malignant pyloroduodenal obstruction. METHODS All patients who underwent surgery (open and laparoscopic) for malignant pyloroduodenal obstruction at Auckland City Hospital between 1989 and 2002 inclusive were identified from International Classification of Diseases (ICD) 10 codes and from the Otago Surgical Audit Database. Patients who had an endoscopic stent were identified from the Endoscribe database. A review of medical records was conducted and data recorded in a structured pro forma. There were 181 patients with malignant pyloroduodenal obstruction of whom 56 patients had OGJ, 14 had LGJ and 16 had ES. Patients in the LGJ and ES groups were matched with those who underwent OGJ with respect to American Society of Anesthesiologists (ASA) grade (I-V), age (within 10 years) and level of obstruction (pylorus, first part of duodenum D1, D2, D3 and D4). The primary outcomes compared between the groups were time to starting free oral fluids and light diet, length of stay and survival. RESULTS There were no significant differences in age, sex, ASA grade and level of obstruction between the matched OGJ (n=16), LGJ (n=14) and ES (n=16) groups. There was a significant reduction in time to starting free oral fluids and light diet, and length of stay after the procedure, in the ES group. Patients who underwent surgical palliation of the obstruction had significantly more complications than those who underwent stenting (P=0.016). There were no significant differences in requirement for biliary drainage either before or after the procedure between the three groups. Survival was shortest in the ES group. CONCLUSION This matched study showed significant advantages for ES compared with OGJ and LGJ in the palliation of malignant pyloroduodenal obstruction.
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Affiliation(s)
- A Mittal
- Hepatobiliary-Pancreatic/Upper Gastrointestinal Unit, Department of General Surgery, Auckland City Hospital, Auckland, New Zealand
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Abstract
BACKGROUND Hepatic adenomas are benign tumours of the liver most commonly seen in premenopausal women. However, it is now clear that adenomas may occur in males. This small series reviews the characteristics of hepatic adenomas in males. CASE OUTLINES Three cases of solitary hepatic adenoma occurring in otherwise well male patients (age 22-48 years) are presented. Two patients presented with abnormal liver function tests while one presented with abdominal pain. Imaging of the lesions demonstrated typical appearances of hepatocellular adenoma, resection was undertaken in all cases and all patients remain alive and well. DISCUSSION Up to 20% of adenomas are documented as occurring in male patients. Most are solitary and occur in patients without recognised risk factors (steroid therapy and glycogen storage diseases types I and III). However, multiple adenomas are most commonly seen in male patients with risk factors. The imaging characteristics and presentation of adenomas in males are similar to female patients and, most importantly, intraperitoneal rupture and malignant transformation are documented in untreated adenomas in males.
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Affiliation(s)
- M Ronald
- Hepatobiliary and Upper Gastrointestinal Unit, Departments of Surgery and Radiology, Auckland HospitalAucklandNew Zealand
| | - J Woodfield
- Hepatobiliary and Upper Gastrointestinal Unit, Departments of Surgery and Radiology, Auckland HospitalAucklandNew Zealand
| | - J McCall
- Hepatobiliary and Upper Gastrointestinal Unit, Departments of Surgery and Radiology, Auckland HospitalAucklandNew Zealand
| | - J Koea
- Hepatobiliary and Upper Gastrointestinal Unit, Departments of Surgery and Radiology, Auckland HospitalAucklandNew Zealand
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Abstract
Permanent transvenous cardiac pacemakers were implanted in 40 dogs. Electrocardiographic diagnoses included persistent atrial standstill (3 dogs), sick sinus syndrome (8 dogs), and high-grade second-degree or third-degree atrioventricular (AV) block (29 dogs). Thirteen dogs were alive and well 4 to 42 months after pacemaker implantation (mean, 16.9 months). The mean and median survival times of the 26 dogs that died or were euthanatized during the study were 17.9 months and 13 months, respectively. Most of these dogs succumbed to problems unrelated to the arrhythmia and pacemaker implant. One dog was lost to follow-up. Complications associated with permanent transvenous pacemaker implantation included lead dislodgement, infection, hematoma formation, skeletal muscle stimulation, ventricular arrhythmia, migration of the pulse generator, and skin erosion. Lead dislodgement was the most common complication, occurring in 7 of 9 dogs paced using untined electrode leads and in 6 of 30 dogs paced using tined leads. Lead dislodgement did not occur in the only dog paced using an actively fixed endocardial lead. It was concluded that permanent transvenous cardiac pacing is a feasible, less traumatic alternative to epimyocardial pacing in dogs, but that successful use of this technique requires careful implantation technique and anticipation of the potential complications.
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Affiliation(s)
- D Sisson
- Department of Veterinary Clinical Medicine, College of Veterinary Medicine, University of Illinois, Urbana 61801
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Kittleson M, Keene B, Pion P, Woodfield J. Verapamil administration for acute termination of supraventricular tachycardia in dogs. J Am Vet Med Assoc 1988; 193:1525-9. [PMID: 3215811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Verapamil, a calcium channel-blocking drug, was administered IV at a dosage that ranged from 0.05 to 0.15 mg/kg of body weight to 14 dogs with supraventricular tachycardia. The dosage was titrated, administering 0.05 mg/kg every 5 to 30 minutes following the initial 0.05 mg/kg dose in all but 1 dog. The drug terminated the arrhythmia in 12 dogs and slowed the ventricular rate in 1 dog. One dog was unresponsive to verapamil administration and became transiently hypotensive after the administration of a total dose of 0.15 mg/kg over 5 to 6 minutes. Various arrhythmias occurred after verapamil administration, but none required additional treatment or caused serious sequelae. Verapamil was an effective treatment for acutely converting supraventricular tachycardia to sinus rhythm in these dogs. It appears to be safe when administered in the aforementioned dosage range.
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Affiliation(s)
- M Kittleson
- Department of Medicine, School of Veterinary Medicine, University of California, Davis 95616
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