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Tully PA, Kwa L, Buckley A, Hu R, Chen S, Long D, Weinberg L, Tan CO. Lung auscultation versus point-of-care ultrasound for assessment of basal lung excursion at maximal inspiration: An exploratory study. Anaesth Intensive Care 2022; 50:255-257. [PMID: 35282704 DOI: 10.1177/0310057x211042383] [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: 11/17/2022]
Affiliation(s)
- Patrick A Tully
- Department of Anaesthesia, 96043Austin Hospital, Austin Hospital, Heidelberg, Australia
| | - Lachlan Kwa
- Department of Anaesthesia, 96043Austin Hospital, Austin Hospital, Heidelberg, Australia
| | - Aisling Buckley
- Department of Anaesthesia, 96043Austin Hospital, Austin Hospital, Heidelberg, Australia
| | - Raymond Hu
- Department of Anaesthesia, 96043Austin Hospital, Austin Hospital, Heidelberg, Australia
| | - Stephanie Chen
- Department of Anaesthesia, 96043Austin Hospital, Austin Hospital, Heidelberg, Australia
| | - David Long
- Department of Anaesthesia, 96043Austin Hospital, Austin Hospital, Heidelberg, Australia
| | - Laurence Weinberg
- Department of Anaesthesia, 96043Austin Hospital, Austin Hospital, Heidelberg, Australia.,Department of Surgery, The University of Melbourne, Melbourne, Australia.,Department of Critical Care, The University of Melbourne, Melbourne, Australia
| | - Chong Oon Tan
- Department of Anaesthesia, 96043Austin Hospital, Austin Hospital, Heidelberg, Australia
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Weinberg L, Lee DK, Bergin H, Koshy AN, Tully PA, Meyerov J, Louis M, Yang BO, Grover-Johnson O, Scurrah N, Cosic L, Story D, Bellomo R. MEasuring the impact of Anesthetist-administered medications volumeS on intraoperative flUid balance duRing prolonged abdominal surgEry (MEASURE Study). Minerva Anestesiol 2022; 88:334-342. [PMID: 35164486 DOI: 10.23736/s0375-9393.22.15918-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND The contribution of intraoperative anesthetist-administered medications (IAAMs) to the total volume of intraoperative intravenous (IV) fluid therapy and their association with postoperative outcomes has never been formally investigated. METHODS We performed a retrospective study of adult patients undergoing pancreaticoduodenectomy. The volume of IAAMs, crystalloids and colloids, blood and blood products, blood loss, urine output and intraoperative fluid balance were collected. The contribution of IAAMs to the total intraoperative IV fluid volume and postoperative complications was evaluated. RESULTS A total of 152 consecutive patients were included. The median volume of IAAMs was 363.8 mL (interquartile range [IQR], (241.0-492.5) delivered at a median rate of 0.61 mL kg hr-1 (0.40-0.87) over a median duration of surgery of 489 minutes (416.3-605.3). This increased the total administered fluid volume by 5.2% (95% confidence intervals [CI]: 4.6, 5.9%) (Cohen's d=1.33, P<0.001). The volume of IAAMs was comparable to the intraoperative colloid volume administered (median colloid volume, 400 mL). Overall, fluid volumes correlated significantly with the severity of complications (P=0.011), and the correlation strength increased when the IAAMs volume was included (P=0.005). On addition of IAAMs, the area under the receiver operator characteristic curve for prediction of postoperative complications increased from 0.580 (95%CI: 0.458, 0.701) to 0.603 (95%CI: 0.483, 0.723), P=0.041). CONCLUSIONS IAAMs significantly increased the total administered fluid volume during pancreaticoduodenectomy. Their inclusion increases the accuracy of postoperative complications predictions. These findings support their inclusion in fluid volumes and balances in future interventional studies.
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Affiliation(s)
- Laurence Weinberg
- Department of Anesthesia, Austin Health, Victoria, Australia - .,Department of Critical Care, University of Melbourne, Victoria, Australia - .,Department of Surgery, University of Melbourne, Austin Health, Victoria, Australia -
| | - Dong-Kyu Lee
- Department of Anesthesiology and Pain Medicine, Dongguk University Ilsan Hospital, Goyang, South Korea
| | - Hannah Bergin
- Department of Anesthesia, Austin Health, Victoria, Australia
| | - Anoop N Koshy
- Department of Cardiology, Austin Health, Victoria, Australia
| | - Patrick A Tully
- Department of Anesthesia, Austin Health, Victoria, Australia
| | - Joshua Meyerov
- Department of Anesthesia, Austin Health, Victoria, Australia
| | - Maleck Louis
- Department of Anesthesia, Austin Health, Victoria, Australia
| | - Bobby Ou Yang
- Department of Anesthesia, Austin Health, Victoria, Australia
| | | | | | - Luka Cosic
- Department of Anesthesia, Austin Health, Victoria, Australia
| | - David Story
- Department of Anesthesia, Austin Health, Victoria, Australia.,Department of Critical Care, University of Melbourne, Victoria, Australia
| | - Rinaldo Bellomo
- Department of Critical Care, University of Melbourne, Victoria, Australia.,Department of Intensive Care, Austin Health, Victoria, Australia
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Tully PA, Ng B, McGagh D, Meehan N, Khachane A, Higgs J, Newman M, Morgan L, David E, McCulloch P. Improving the WHO Surgical Safety Checklist sign-out. BJS Open 2021; 5:6271349. [PMID: 33960366 PMCID: PMC8103495 DOI: 10.1093/bjsopen/zrab028] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 02/25/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The WHO Surgical Safety Checklist has been shown to reduce perioperative morbidity and mortality worldwide. There is evidence to suggest that sign-out is the most poorly performed phase of the checklist as it coincides with a period of high workload for team members. This study aimed to see whether modification of this process might result in greater compliance. METHODS A controlled longitudinal (before and after) study was performed to evaluate the effect of a modified checklist sign-out on compliance in a single surgical department. Checklist quality was evaluated by measurement of checklist completion, active participation, and team member presence. Workload assessment was performed to identify the optimal moment for the sign-out process. The sign-out process was modified through an iterative multidisciplinary approach, informed by results from the workload assessment. Feedback was obtained through staff surveys. RESULTS A total of 185 operations were used, with an intervention group in vascular surgery and a control group in orthopaedics. The optimal timing for sign-out was identified as after final wound closure. The modified sign-out process improved active participation of team members (21 of 34 versus 31 of 34; P = 0.010). In the control group, complete compliance improved (48 of 76 versus 30 of 41; P = 0.041). However, active participation decreased (53 of 76 versus 19 of 41; P = 0.022). No differences were noted between groups in team member presence. Eighteen of 21 staff questioned viewed the modifications positively. CONCLUSION The optimal sign-out timing was identified as immediately after final wound closure prior to undraping the patient.
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Affiliation(s)
- P A Tully
- Department for Continuing Education, University of Oxford, Oxford, UK.,Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK.,Patient Safety Academy, Health Education England Thames Valley, Oxford, UK
| | - B Ng
- Medical Sciences Division, University of Oxford, Oxford, UK
| | - D McGagh
- Medical Sciences Division, University of Oxford, Oxford, UK
| | - N Meehan
- Patient Safety Academy, Health Education England Thames Valley, Oxford, UK
| | - A Khachane
- Patient Safety Academy, Health Education England Thames Valley, Oxford, UK
| | - J Higgs
- Patient Safety Academy, Health Education England Thames Valley, Oxford, UK
| | - M Newman
- Patient Safety Academy, Health Education England Thames Valley, Oxford, UK
| | - L Morgan
- Patient Safety Academy, Health Education England Thames Valley, Oxford, UK
| | - E David
- Medical Sciences Division, University of Oxford, Oxford, UK
| | - P McCulloch
- Department for Continuing Education, University of Oxford, Oxford, UK.,Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK.,Patient Safety Academy, Health Education England Thames Valley, Oxford, UK
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Tully PA, Gogos AJ, Love C, Liew D, Drummond KJ, Morokoff AP. Reoperation for Recurrent Glioblastoma and Its Association With Survival Benefit. Neurosurgery 2017; 79:678-689. [PMID: 27409404 DOI: 10.1227/neu.0000000000001338] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Glioblastoma is the most common and aggressive primary brain tumor. Despite current treatment, recurrence is inevitable. There are no clear guidelines for treatment of recurrent glioblastoma. OBJECTIVE To investigate factors at initial surgery predictive of reoperation, and the prognostic variables associated with survival, including reoperation for recurrence. METHODS A retrospective cohort study was performed, including adult patients diagnosed with glioblastoma between January 2010 and December 2013. Student t test and Fisher exact test compared continuous and categorical variables between reoperation and nonreoperation groups. Univariable and Cox regression multivariable analysis was performed. RESULTS In a cohort of 204 patients with de novo glioblastoma, 49 (24%) received reoperation at recurrence. The median overall survival in the reoperation group was 20.1 months compared with 9.0 months in the nonreoperation group (P = .001). Reoperation was associated with longer overall survival in our total population (hazard ratio, 0.646; 95% confidence interval, 0.543-0.922; P = .016) but subject to selection bias. Subgroup analyses excluding patients unlikely to be considered for reoperation suggested a much less significant effect of reoperation on survival, which warrants further study with larger cohorts. Factors at initial surgery predictive for reoperation were younger age, smaller tumor size, initial extent of resection ≥50%, shorter inpatient stay, and maximal initial adjuvant therapy. When unfavorable patient characteristics are excluded, reoperation is not an independent predictor of survival. CONCLUSION Patients undergoing reoperation have favorable prognostic characteristics, which may be responsible for the survival difference observed. We recommend that a large clinical registry be developed to better aid consistent and homogenous data collection. ABBREVIATIONS ECOG, Eastern Cooperative Oncology GroupEOR, extent of resectionIDH-1, isocitrate dehydrogenase 1IP, inpatientMGMT, O-methylguanine methyltransferaseOS, overall survivalPFS, progression-free survivalRMH, Royal Melbourne Hospital.
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Affiliation(s)
- Patrick A Tully
- *Department of Neurosurgery, The Royal Melbourne Hospital, Parkville, Victoria, Australia;‡The University of Notre Dame Australia, School of Medicine, Melbourne Clinical School, Werribee, Victoria;§The Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia
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Tully PA. Cryopreserved embryos and Dignitas personae: another option? Kennedy Inst Ethics J 2012; 22:367-389. [PMID: 23420942] [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: 06/01/2023]
Abstract
Many of the thousands of human embryos currently in cryogenic storage will sooner or later be discarded, often after being experimented upon. Others will remain in storage indefinitely, left there by parents who have no plans either to bring them to term or to offer them for adoption. These facts, coupled with a commitment to the basic moral equality of all human beings at all stages of development, generate a pressing question: What should be done for these embryos whose vital activities have been suspended and whose futures look so bleak? This paper offers a case that allows some of these cryogenically stored embryos to thaw and die, allows disposal of their remains in a manner that reflects their status, and is morally acceptable in that it is consistent with the principles that many accept as governing the removal of life-sustaining treatment in end-of-life cases.
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