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Hoffmann C, Avery K, Macefield R, Dvořák T, Snelgrove V, Blazeby J, Hopkins D, Hickey S, Gibbison B, Rooshenas L, Williams A, Aning J, Bekker HL, McNair AG. Usability of an Automated System for Real-Time Monitoring of Shared Decision-Making for Surgery: Mixed Methods Evaluation. JMIR Hum Factors 2024; 11:e46698. [PMID: 38598276 PMCID: PMC11043934 DOI: 10.2196/46698] [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: 02/21/2023] [Revised: 10/02/2023] [Accepted: 03/02/2024] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND Improving shared decision-making (SDM) for patients has become a health policy priority in many countries. Achieving high-quality SDM is particularly important for approximately 313 million surgical treatment decisions patients make globally every year. Large-scale monitoring of surgical patients' experience of SDM in real time is needed to identify the failings of SDM before surgery is performed. We developed a novel approach to automating real-time data collection using an electronic measurement system to address this. Examining usability will facilitate its optimization and wider implementation to inform interventions aimed at improving SDM. OBJECTIVE This study examined the usability of an electronic real-time measurement system to monitor surgical patients' experience of SDM. We aimed to evaluate the metrics and indicators relevant to system effectiveness, system efficiency, and user satisfaction. METHODS We performed a mixed methods usability evaluation using multiple participant cohorts. The measurement system was implemented in a large UK hospital to measure patients' experience of SDM electronically before surgery using 2 validated measures (CollaboRATE and SDM-Q-9). Quantitative data (collected between April 1 and December 31, 2021) provided measurement system metrics to assess system effectiveness and efficiency. We included adult patients booked for urgent and elective surgery across 7 specialties and excluded patients without the capacity to consent for medical procedures, those without access to an internet-enabled device, and those undergoing emergency or endoscopic procedures. Additional groups of service users (group 1: public members who had not engaged with the system; group 2: a subset of patients who completed the measurement system) completed user-testing sessions and semistructured interviews to assess system effectiveness and user satisfaction. We conducted quantitative data analysis using descriptive statistics and calculated the task completion rate and survey response rate (system effectiveness) as well as the task completion time, task efficiency, and relative efficiency (system efficiency). Qualitative thematic analysis identified indicators of and barriers to good usability (user satisfaction). RESULTS A total of 2254 completed surveys were returned to the measurement system. A total of 25 service users (group 1: n=9; group 2: n=16) participated in user-testing sessions and interviews. The task completion rate was high (169/171, 98.8%) and the survey response rate was good (2254/5794, 38.9%). The median task completion time was 3 (IQR 2-13) minutes, suggesting good system efficiency and effectiveness. The qualitative findings emphasized good user satisfaction. The identified themes suggested that the measurement system is acceptable, easy to use, and easy to access. Service users identified potential barriers and solutions to acceptability and ease of access. CONCLUSIONS A mixed methods evaluation of an electronic measurement system for automated, real-time monitoring of patients' experience of SDM showed that usability among patients was high. Future pilot work will optimize the system for wider implementation to ultimately inform intervention development to improve SDM. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1136/bmjopen-2023-079155.
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Affiliation(s)
- Christin Hoffmann
- National Institute for Health and Care Research Bristol Biomedical Research Centre, Bristol Centre for Surgical Research, Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Kerry Avery
- National Institute for Health and Care Research Bristol Biomedical Research Centre, Bristol Centre for Surgical Research, Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Rhiannon Macefield
- National Institute for Health and Care Research Bristol Biomedical Research Centre, Bristol Centre for Surgical Research, Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Tadeáš Dvořák
- National Institute for Health and Care Research Bristol Biomedical Research Centre, Bristol Centre for Surgical Research, Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, United Kingdom
| | | | - Jane Blazeby
- National Institute for Health and Care Research Bristol Biomedical Research Centre, Bristol Centre for Surgical Research, Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, United Kingdom
| | | | - Shireen Hickey
- Improvement Academy, Bradford Royal Infirmary, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, United Kingdom
| | - Ben Gibbison
- National Institute for Health and Care Research Bristol Biomedical Research Centre, Bristol Centre for Surgical Research, Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, United Kingdom
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom
| | - Leila Rooshenas
- National Institute for Health and Care Research Bristol Biomedical Research Centre, Bristol Centre for Surgical Research, Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, United Kingdom
| | | | | | - Hilary L Bekker
- Leeds Unit of Complex Intervention Development (LUCID), Leeds Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, United Kingdom
- The Research Centre for Patient Involvement (ResCenPI), Department of Public Health, Aarhus University, Central Denmark Region, Denmark
| | - Angus Gk McNair
- National Institute for Health and Care Research Bristol Biomedical Research Centre, Bristol Centre for Surgical Research, Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, United Kingdom
- North Bristol NHS Trust, Bristol, United Kingdom
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Hossaini S, Hoffmann C, Cousins S, Blencowe N, McNair AGK, Blazeby JM, Avery KNL, Potter S, Macefield R. Development of a conceptual framework for reporting modifications in surgical innovation: scoping review. BJS Open 2023; 7:7145934. [PMID: 37104755 PMCID: PMC10139440 DOI: 10.1093/bjsopen/zrad020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 01/20/2023] [Accepted: 01/28/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND Innovative surgical procedures and devices are often modified throughout their development and introduction into clinical practice. A systematic approach to reporting modifications may support shared learning and foster safe and transparent innovation. Definitions of 'modifications', and how they are conceptualized and classified so they can be reported and shared effectively, however, are lacking. This study aimed to explore and summarize existing definitions, perceptions, classifications and views on modification reporting to develop a conceptual framework for understanding and reporting modifications. METHODS A scoping review was conducted in accordance with PRISMA Extension for Scoping Reviews (PRISMA-ScR) guidelines. Targeted searches and two database searches were performed to identify relevant opinion pieces and review articles. Included were articles relating to modifications to surgical procedures/devices. Data regarding definitions, perceptions and classifications of modifications, and views on modification reporting were extracted verbatim. Thematic analysis was undertaken to identify themes, which informed development of the conceptual framework. RESULTS Forty-nine articles were included. Eight articles included systems for classifying modifications, but no articles reported an explicit definition of modifications. Some 13 themes relating to perception of modifications were identified. The derived conceptual framework comprises three overarching components: baseline data about modifications, details about modifications and impact/consequences of modifications. CONCLUSION A conceptual framework for understanding and reporting modifications that occur during surgical innovation has been developed. This is a first necessary step to support consistent and transparent reporting of modifications, to facilitate shared learning and incremental innovation of surgical procedures/devices. Testing and operationalization is now needed to realize the value of this framework.
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Affiliation(s)
- Sina Hossaini
- Department of Population Health Sciences, National Institute for Health and Care Research Bristol Biomedical Research Centre, Bristol Centre for Surgical Research, Bristol Medical School, University of Bristol, Bristol, UK
| | - Christin Hoffmann
- Department of Population Health Sciences, National Institute for Health and Care Research Bristol Biomedical Research Centre, Bristol Centre for Surgical Research, Bristol Medical School, University of Bristol, Bristol, UK
| | - Sian Cousins
- Department of Population Health Sciences, National Institute for Health and Care Research Bristol Biomedical Research Centre, Bristol Centre for Surgical Research, Bristol Medical School, University of Bristol, Bristol, UK
| | - Natalie Blencowe
- Department of Population Health Sciences, National Institute for Health and Care Research Bristol Biomedical Research Centre, Bristol Centre for Surgical Research, Bristol Medical School, University of Bristol, Bristol, UK
- Department of Gastrointestinal Surgery, North Bristol NHS Trust, Bristol, UK
| | - Angus G K McNair
- Department of Population Health Sciences, National Institute for Health and Care Research Bristol Biomedical Research Centre, Bristol Centre for Surgical Research, Bristol Medical School, University of Bristol, Bristol, UK
- Department of Gastrointestinal Surgery, North Bristol NHS Trust, Bristol, UK
| | - Jane M Blazeby
- Department of Population Health Sciences, National Institute for Health and Care Research Bristol Biomedical Research Centre, Bristol Centre for Surgical Research, Bristol Medical School, University of Bristol, Bristol, UK
- Division of Surgery, Bristol Royal Infirmary, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Kerry N L Avery
- Department of Population Health Sciences, National Institute for Health and Care Research Bristol Biomedical Research Centre, Bristol Centre for Surgical Research, Bristol Medical School, University of Bristol, Bristol, UK
| | - Shelley Potter
- Department of Population Health Sciences, National Institute for Health and Care Research Bristol Biomedical Research Centre, Bristol Centre for Surgical Research, Bristol Medical School, University of Bristol, Bristol, UK
- Bristol Breast Care Centre, North Bristol NHS Trust, Bristol, UK
| | - Rhiannon Macefield
- Department of Population Health Sciences, National Institute for Health and Care Research Bristol Biomedical Research Centre, Bristol Centre for Surgical Research, Bristol Medical School, University of Bristol, Bristol, UK
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Fowler GE, Blencowe NS, Hardacre C, Callaway MP, Smart NJ, Macefield R. Artificial intelligence as a diagnostic aid in cross-sectional radiological imaging of surgical pathology in the abdominopelvic cavity: a systematic review. BMJ Open 2023; 13:e064739. [PMID: 36878659 PMCID: PMC9990659 DOI: 10.1136/bmjopen-2022-064739] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/08/2023] Open
Abstract
OBJECTIVES There is emerging use of artificial intelligence (AI) models to aid diagnostic imaging. This review examined and critically appraised the application of AI models to identify surgical pathology from radiological images of the abdominopelvic cavity, to identify current limitations and inform future research. DESIGN Systematic review. DATA SOURCES Systematic database searches (Medline, EMBASE, Cochrane Central Register of Controlled Trials) were performed. Date limitations (January 2012 to July 2021) were applied. ELIGIBILITY CRITERIA Primary research studies were considered for eligibility using the PIRT (participants, index test(s), reference standard and target condition) framework. Only publications in the English language were eligible for inclusion in the review. DATA EXTRACTION AND SYNTHESIS Study characteristics, descriptions of AI models and outcomes assessing diagnostic performance were extracted by independent reviewers. A narrative synthesis was performed in accordance with the Synthesis Without Meta-analysis guidelines. Risk of bias was assessed (Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2)). RESULTS Fifteen retrospective studies were included. Studies were diverse in surgical specialty, the intention of the AI applications and the models used. AI training and test sets comprised a median of 130 (range: 5-2440) and 37 (range: 10-1045) patients, respectively. Diagnostic performance of models varied (range: 70%-95% sensitivity, 53%-98% specificity). Only four studies compared the AI model with human performance. Reporting of studies was unstandardised and often lacking in detail. Most studies (n=14) were judged as having overall high risk of bias with concerns regarding applicability. CONCLUSIONS AI application in this field is diverse. Adherence to reporting guidelines is warranted. With finite healthcare resources, future endeavours may benefit from targeting areas where radiological expertise is in high demand to provide greater efficiency in clinical care. Translation to clinical practice and adoption of a multidisciplinary approach should be of high priority. PROSPERO REGISTRATION NUMBER CRD42021237249.
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Affiliation(s)
- George E Fowler
- NIHR Bristol Biomedical Research Centre, Population Health Sciences, Bristol Medical School. University of Bristol, Bristol, UK
| | - Natalie S Blencowe
- NIHR Bristol Biomedical Research Centre, Population Health Sciences, Bristol Medical School. University of Bristol, Bristol, UK
| | - Conor Hardacre
- Bristol Medical School, University of Bristol, Bristol, UK
| | - Mark P Callaway
- Department of Clinical Radiology, University Hospital Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Neil J Smart
- Exeter Surgical Health Services Research Unit (HeSRU), Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Rhiannon Macefield
- NIHR Bristol Biomedical Research Centre, Population Health Sciences, Bristol Medical School. University of Bristol, Bristol, UK
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Avery KNL, Wilson N, Macefield R, McNair A, Hoffmann C, Blazeby JM, Potter S. A Core Outcome Set for Seamless, Standardized Evaluation of Innovative Surgical Procedures and Devices (COHESIVE): A Patient and Professional Stakeholder Consensus Study. Ann Surg 2023; 277:238-245. [PMID: 34102667 PMCID: PMC9831031 DOI: 10.1097/sla.0000000000004975] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [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] [Indexed: 01/14/2023]
Abstract
OBJECTIVE To develop a COS, an agreed minimum set of outcomes to measure and report in all studies evaluating the introduction and evaluation of novel surgical techniques. SUMMARY OF BACKGROUND DATA Agreement on the key outcomes to measure and report for safe and efficient surgical innovation is lacking, hindering transparency and risking patient harm. METHODS (I) Generation of a list of outcome domains from published innovation-specific literature, policy/regulatory body documents, and surgeon interviews; (II) Prioritization of identified outcome domains using an international, multi-stakeholder Delphi survey; (III) Consensus meeting to agree the final COS. Participants were international stakeholders, including patients/public, surgeons, device manufacturers, regulators, trialists, methodologists, and journal editors. RESULTS A total of 7972 verbatim outcomes were identified, categorized into 32 domains, and formatted into survey items/questions. Four hundred ten international participants (220 professionals, 190 patients/public) completed at least one round 1 survey item, of which 153 (69.5%) professionals and 116 (61.1%) patients completed at least one round 2 item. Twelve outcomes were scored "consensus in" ("very important" by ≥70% of patients and professionals) and 20 "no consensus." A consensus meeting, involvingcontext: modifications, unexpected disadvantages, device problems, technical procedure completion success, patients' experience relating to the procedure being innovative, surgeons'/operators' experience. Other domains relate to intended benefits, whether the overall desired effect was achieved and expected disadvantages. CONCLUSIONS The COS is recommended for use in all studies before definitive randomized controlled trial evaluation to promote safe, transparent, and efficient surgical innovation.
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Affiliation(s)
- Kerry N L Avery
- National Institute for Health Research Bristol Biomedical Research Centre, Bristol Centre for Surgical Research, Bristol Medical School: Population Health Sciences, University of Bristol, Clifton, Bristol, UK
| | - Nicholas Wilson
- National Institute for Health Research Bristol Biomedical Research Centre, Bristol Centre for Surgical Research, Bristol Medical School: Population Health Sciences, University of Bristol, Clifton, Bristol, UK
| | - Rhiannon Macefield
- National Institute for Health Research Bristol Biomedical Research Centre, Bristol Centre for Surgical Research, Bristol Medical School: Population Health Sciences, University of Bristol, Clifton, Bristol, UK
| | - Angus McNair
- National Institute for Health Research Bristol Biomedical Research Centre, Bristol Centre for Surgical Research, Bristol Medical School: Population Health Sciences, University of Bristol, Clifton, Bristol, UK
- Gastrointestinal Surgery, North Bristol NHS Trust, Bristol, UK
| | - Christin Hoffmann
- National Institute for Health Research Bristol Biomedical Research Centre, Bristol Centre for Surgical Research, Bristol Medical School: Population Health Sciences, University of Bristol, Clifton, Bristol, UK
| | - Jane M Blazeby
- National Institute for Health Research Bristol Biomedical Research Centre, Bristol Centre for Surgical Research, Bristol Medical School: Population Health Sciences, University of Bristol, Clifton, Bristol, UK
- Division of Surgery, Bristol Royal Infirmary, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Shelley Potter
- National Institute for Health Research Bristol Biomedical Research Centre, Bristol Centre for Surgical Research, Bristol Medical School: Population Health Sciences, University of Bristol, Clifton, Bristol, UK
- Bristol Breast Care Centre, North Bristol NHS Trust, Southmead Road, Bristol, UK
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Hoffmann C, Kobetic M, Alford N, Blencowe N, Ramirez J, Macefield R, Blazeby JM, Avery KNL, Potter S. Shared Learning Utilizing Digital Methods in Surgery to Enhance Transparency in Surgical Innovation: Protocol for a Scoping Review. JMIR Res Protoc 2022; 11:e37544. [PMID: 36074555 PMCID: PMC9501681 DOI: 10.2196/37544] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 08/11/2022] [Accepted: 08/16/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Surgical innovation can lead to important improvements in patient outcomes. Currently, information and knowledge about novel procedures and devices are disseminated informally and in an unstandardized way (eg, through social media). This can lead to ineffective and inefficient knowledge sharing among surgeons, which can result in the harmful repetition of mistakes and delay in the uptake of promising innovation. Improvements are needed in the way that learning in surgical innovation is shared through the development of novel, real-time methods, informed by a contemporary and comprehensive investigation of existing methods. OBJECTIVE The aim of this scoping review is to explore the application of existing digital methods for training/education and feedback to surgeons in the context of performing invasive surgical procedures. This work will (1) summarize existing methods for shared learning in surgery and how they are characterized and operationalized, (2) examine the impact of their application, and (3) explore their benefits and barriers to implementation. The findings of this scoping review will inform the development of novel, real-time methods to optimize shared learning in surgical innovation. METHODS This study will adhere to the recommended guidelines for conducting scoping reviews. A total of 6 different searches will be conducted within multiple sources (2 electronic databases, journals, social media, gray literature, commercial websites, and snowball searches) to comprehensively identify relevant articles and data. Searches will be limited to articles published in the English language within the last 5 years. Wherever possible, a 2-stage study selection process will be followed whereby the eligibility of articles will be assessed through the title, abstract, and full-text screening independently by 2 reviewers. Inclusion criteria will be articles providing data on (1) fully qualified theater staff involved in performing invasive procedures, (2) one or more methods for shared learning (ie, digital means for training/education and feedback), and (3) qualitative or quantitative evaluations of this method. Data will be extracted (10% double data extraction by an independent reviewer) into a piloted proforma and analyzed using descriptive statistics, narrative summaries, and principles of thematic analysis. RESULTS The study commenced in October 2021 and is planned to be completed in 2023. To date, systematic searches were applied to 2 electronic databases (MEDLINE and Web of Science) and returned a total of 10,093 records. The results of this scoping review will be published as open access in a peer-reviewed journal. CONCLUSIONS This scoping review of methods for shared learning in surgery is, to our knowledge, the most comprehensive and up-to-date investigation that maps current information on this topic. Ultimately, efficient and effective sharing of information and knowledge of novel procedures and devices has the potential to optimize the evaluation of early-phase surgical research and reduce harmful innovation. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/37544.
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Affiliation(s)
- Christin Hoffmann
- National Institute for Health and Care Research, Bristol Biomedical Research Centre, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Matthew Kobetic
- National Institute for Health and Care Research, Bristol Biomedical Research Centre, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Natasha Alford
- National Institute for Health and Care Research, Bristol Biomedical Research Centre, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Natalie Blencowe
- National Institute for Health and Care Research, Bristol Biomedical Research Centre, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- Division of Surgery, Bristol Royal Infirmary, University Hospitals Bristol and Weston National Health Service Foundation Trust, Bristol, United Kingdom
| | - Jozel Ramirez
- National Institute for Health and Care Research, Bristol Biomedical Research Centre, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Rhiannon Macefield
- National Institute for Health and Care Research, Bristol Biomedical Research Centre, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Jane M Blazeby
- National Institute for Health and Care Research, Bristol Biomedical Research Centre, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- Division of Surgery, Bristol Royal Infirmary, University Hospitals Bristol and Weston National Health Service Foundation Trust, Bristol, United Kingdom
| | - Kerry N L Avery
- National Institute for Health and Care Research, Bristol Biomedical Research Centre, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Shelley Potter
- National Institute for Health and Care Research, Bristol Biomedical Research Centre, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- Bristol Breast Care Centre, North Bristol National Health Service Trust, Bristol, United Kingdom
- Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
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Hardacre C, Fowler G, Quek FF, Skilton A, Blencowe N, Macefield R. 713 The Application of Artificial Intelligence for Digital Imaging in the Operating Theatre: A Systematic Review and Narrative Synthesis. Br J Surg 2022. [DOI: 10.1093/bjs/znac268.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Abstract
Introduction
Promising applications of artificial intelligence (AI) in healthcare are emerging. This systematic review aims to identify and synthesise applications of digital-imaging AI in surgery and inform future work.
Method
Systematic database searches (Medline, Embase, CENTRAL) were undertaken. Studies concerning digital-imaging AI within the operating theatre were identified from title and abstract screening. Selection was further refined to identify video-based AI models with direct supportive output to the surgeon within the operating theatre.
Results
48 studies were included. Studies spanned 13 specialty groupings, with n=42 utilising a pre-specified dataset and the remaining n=6 using AI with human participants. The most common field using AI was urology (n=9 studies). Applications were most commonly for navigation and visualisation support (n=26 studies across 10 surgical specialties) and AI-based intelligent detection systems, intended to identify and highlight useful surgical information using computer-vision pattern recognition (n=18 articles across n=6 specialties). Other applications included video-processing algorithms (n=3 studies across 2 specialties), and a novel imaging modality for visualising blood perfusion (n=1 study), proposing operating theatre-based application. High-performance models were identified across a range of pathologies. This manifested as minimal overlay errors and acceptable frame rates for navigation tools, and high diagnostic performance for detection systems (determined by area-under-the-receiver-operating-characteristic-curve, sensitivity/specificity, negative/positive predictive values).
Conclusions
There is evidence to suggest AI for intraoperative surgeon-support has potential, particularly through augmented-reality navigation and AI-enabled information awareness. Further research and optimisations are required to produce clinically robust models, which remain high-performance despite case variability. Such AI may support improved surgical access, efficiency, and outcomes.
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Affiliation(s)
- Conor Hardacre
- Bristol Centre for Surgical Research, Population Health Sciences, Bristol Medical School, University of Bristol , Bristol , United Kingdom
| | - George Fowler
- Bristol Centre for Surgical Research, Population Health Sciences, Bristol Medical School, University of Bristol , Bristol , United Kingdom
| | - Fang Fang Quek
- Bristol Centre for Surgical Research, Population Health Sciences, Bristol Medical School, University of Bristol , Bristol , United Kingdom
| | - Anni Skilton
- Bristol Centre for Surgical Research, Population Health Sciences, Bristol Medical School, University of Bristol , Bristol , United Kingdom
| | - Natalie Blencowe
- Bristol Centre for Surgical Research, Population Health Sciences, Bristol Medical School, University of Bristol , Bristol , United Kingdom
| | - Rhiannon Macefield
- Bristol Centre for Surgical Research, Population Health Sciences, Bristol Medical School, University of Bristol , Bristol , United Kingdom
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Pickles T, Horton M, Christensen KB, Phillips R, Gillespie D, Macefield R, Aiyegbusi OL, Beecher C, Choy E. P089 Patient-reported outcome measures for rheumatoid arthritis disease activity: a systematic review following COSMIN guidelines. Rheumatology (Oxford) 2022. [DOI: 10.1093/rheumatology/keac133.088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background/Aims
The standard measurement instruments for assessing Rheumatoid Arthritis (RA) disease activity (DA) are the Disease Activity Score with 28-Joint Count, Simple Disease Activity Index and Clinical Disease Activity Index, which all require a laboratory test and a joint count undertaken by a health care professional. The current standard of care in RA is “Treat-to-Target”, in which regular assessment of RA DA is an integral part. Few healthcare providers have the capacity to assess patients as frequently as stipulated by NICE or EULAR guidelines and thus treatment is not adjusted sufficiently. The SARS-COV-2 pandemic has made the problem more conspicuous with remote rather than face-to-face consultations. Previous research has suggested that Patient Reported Outcome Measures (PROMs) are the most informative way to assess RA DA, and that they allow for a more efficient use of NHS resource. We therefore aimed to assess all PROMs for RA DA against the internationally recognised COSMIN guidelines for rating PROMs.
Methods
PROSPERO registered as CRD42020176176. This review built on a previous systematic review in the same area, with the PubMed and EMBASE searches expanded to include all articles up to January 2019 (rather than the previous June 2014 date) and those before January 1994. Some articles from the previous review were excluded as they involved biomarker and/or healthcare professional assessments. All identified articles were rated by two independent researchers, where identified PROMs were assessed for Content validity, Quality of Measurement property and related Risk of bias following the COSMIN guidelines, leading to recommendations for use.
Results
702 abstracts were retrieved: 310 from both PubMed and EMBASE, 230 from PubMed alone and 162 from EMBASE alone. 34 from the previous review were given full article review, of which 21 were included in the final selection. Of the remaining 668, 128 were selected for abstract review; 58 for full article review; and 10 for the final selection, giving 31 articles in total. 10 PROMs were identified: RADAI, RADAI-SF, RADAI5, PDAS2, PAS, PAS-II, RAPID3, RAPID4, PRO-CLARA and GAS. Following the application of COSMIN guidelines to these 31 articles, none of the identified PROMs could be recommended for use, as none had sufficient evidence for content validity. 5 PROMs had the potential to be recommended but the other five could not be recommended.
Conclusion
The lack of content validity is a major drawback for these PROMs, but it is worth noting that all of these were developed before the COSMIN guidelines were created, and COSMIN have only recently updated their guidelines to increase the relevance of content validity. A 2019 American College of Rheumatology review recommended two of the identified PROMs based on different criteria. Future research on PROMs for RA DA must look to evidence content validity.
Disclosure
T. Pickles: None. M. Horton: None. K. Christensen: None. R. Phillips: None. D. Gillespie: None. R. Macefield: None. O. Aiyegbusi: None. C. Beecher: None. E. Choy: None.
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Affiliation(s)
- Tim Pickles
- Centre for Trials Research, Cardiff University, Cardiff, UNITED KINGDOM
| | - Mike Horton
- Psychometric Laboratory for Health Sciences, University of Leeds, Leeds, UNITED KINGDOM
| | | | - Rhiannon Phillips
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, UNITED KINGDOM
| | - David Gillespie
- Centre for Trials Research, Cardiff University, Cardiff, UNITED KINGDOM
| | - Rhiannon Macefield
- NIHR Biomedical Research Centre, University of Bristol, Bristol, UNITED KINGDOM
| | - Olalekan Lee Aiyegbusi
- Centre for Patient Reported Outcomes Research, University of Birmingham, Birmingham, UNITED KINGDOM
| | - Claire Beecher
- School of Nursing and Midwifery, National University of Ireland, Galway, IRELAND
| | - Ernest Choy
- Division of Infection and Immunity, Cardiff University, Cardiff, UNITED KINGDOM
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Pickles T, Macefield R, Aiyegbusi OL, Beecher C, Horton M, Christensen KB, Phillips R, Gillespie D, Choy E. Patient Reported Outcome Measures for Rheumatoid Arthritis Disease Activity: a systematic review following COSMIN guidelines. RMD Open 2022; 8:e002093. [PMID: 35351807 PMCID: PMC8966547 DOI: 10.1136/rmdopen-2021-002093] [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] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 03/03/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND The current standard of care in rheumatoid arthritis (RA) requires regular assessment of disease activity (DA). All standard RA DA measurement instruments require joint counts to be undertaken by a healthcare professional with/without a blood test. Few healthcare providers have the capacity to assess patients as frequently as stipulated by guidelines. Patient Reported Outcome Measures (PROMs) could be an efficient and informative way to assess RA DA, which is highlighted by the SARS-COV-2 pandemic, as most consultations are remote rather than face-to-face. We aimed to assess all PROMs for RA DA against the internationally recognised COSMIN guidelines to provide evidence-based recommendations to select the most suitable PROMs. METHODS Review registered on PROSPERO as CRD42020176176. The search strategy was based on a previous similar systematic review and expanded to include all articles up to January 2019. All identified articles were rated by two independent assessors following the COSMIN guidelines. RESULTS 668 abstracts were identified, with 10 articles included. A further 21 were identified from a previous review. Ten PROMs were identified. There was insufficient evidence to place any of the identified PROMs into recommendation for use category A due to lack of evidence for content validity, as stipulated by the COSMIN guidelines. CONCLUSION Lack of evidence of content validity limits suitable PROM selection, therefore none can be recommended for use. It is acknowledged that all included PROMs were developed before the COSMIN guidelines were published. Future research on PROMs for RA DA must provide evidence of content validity.
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Affiliation(s)
- Tim Pickles
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Rhiannon Macefield
- Bristol Centre for Surgical Research, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Olalekan Lee Aiyegbusi
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- NIHR Applied Research Collaboration West Midlands, Birmingham, UK
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Brmingham, UK
- NIHR Birmingham Biomedical Research Centre, NIHR Surgical Reconstruction and Microbiology Research Centre, University of Birmingham, Birmingham, UK
| | - Claire Beecher
- School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland
- Evidence Synthesis Ireland and Cochrane Ireland, National University of Ireland Galway, Galway, Ireland
- Health Research Board - Trials Methodology Research Network, National University of Ireland, Galway, Ireland
| | - Mike Horton
- Psychometric Laboratory for Health Sciences, University of Leeds, Leeds, UK
| | | | - Rhiannon Phillips
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, UK
| | | | - Ernest Choy
- Department of Infection and Immunity, Cardiff University, Cardiff, UK
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9
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Hossaini S, Blencowe N, Elliott D, Macefield R, Potter S. P-O16 A framework for reporting modifications in robotic surgery: a systematic review and case study in robotic cholecystectomy. Br J Surg 2021. [DOI: 10.1093/bjs/znab430.126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Background
Surgical innovations, such as robotic surgery, are critical to advancing surgical care. Innovation in the absence of supporting frameworks and effective evaluation risks patient safety and may hinder efficient innovation. The adoption of robotic surgery across the United Kingdom has increased dramatically over the past decade. Its use in upper gastrointestinal surgery remains innovative and continues to evolve. In the early stages of innovation, procedures tend to be modified or refined. Modifications to procedures could be beneficial, ineffective or harmful. There is currently limited understanding of modifications, and no standardized way to report or share modifications. Ineffective reporting of modifications could prevent shared learning in evolving innovative surgical procedures. Furthermore, the National Institute for Health and Care Excellence (NICE) requires ‘major modifications’ to procedures or technologies to potentially undergo re-evaluation to establish safety and efficacy, yet classifications for types of modifications are lacking. This study aimed to examine current reporting of modifications in robotic surgery through a systematic review and qualitative case study in robotic cholecystectomy. The findings were used to develop a conceptual framework for reporting modifications in robotic surgery.
Methods
A systematic review was performed to identify studies on robotic cholecystectomy. Comprehensive search strategies were developed with a specialist librarian. The OVID SP version of MEDLINE and Cochrane Controlled Trials Register were searched using keywords for i) robotics and ii) cholecystectomy. Searches were limited to human studies published in the English language, up to and including April 2021. Abstracts and conference reports were excluded. Titles and abstracts of records were screened for eligibility by two reviewers with a clinical background. References of retrieved articles were manually searched to identify potentially relevant further studies. All published primary research studies reporting on robotic cholecystectomy for any indication, except biliary malignancy, were eligible for inclusion. Full-text articles were retrieved and examined for details of reporting modifications. Any data on modifications were extracted verbatim using a standardized proforma. A broad working definition of ‘modification’ was developed by the study team for the purposes of this study. Characteristics of published studies were summarized with descriptive statistics. A qualitative grounded-theory approach was taken for data analysis. Thematic analysis of the extracted data was undertaken to inductively generate themes and make comparisons across studies. Themes were organized into a conceptual framework for reporting modifications in robotic cholecystectomy.
Results
A total of 2,048 records were identified in total. After de-duplication of results, titles and abstracts of 1,499 records were screened, of which 1,185 were excluded. The remaining 314 records were assessed for eligibility by reviewing full-text articles, of which 219 were excluded. A total of 95 articles reporting robotic cholecystectomy were included in the analysis. The majority of studies were single-centre (n = 86, 90.5%); most were from North America (n = 43, 45.3%). Comparative studies (n = 47, 49.5%) and case series (n = 40, 42.1%) accounted for over 90% of all study types. Of the 95 studies, half (n = 48, 51%) contained data pertaining to modifications, many of which were case series (n = 27, 56.3%). Thematic analysis generated four overarching themes: ‘Descriptions of Modifications’, ‘Rationale for Modifications’, ‘Planned or Unplanned Modifications’ and ‘Outcomes of Modifications.’ These themes informed a conceptual framework for reporting modifications.
Conclusions
The current reporting and sharing of modifications in robotic cholecystectomy are unstandardised and inconsistent. Findings from this study have informed a proposed framework to support a more systematic approach to reporting and sharing modifications in robotic cholecystectomy. Further work is now needed to evaluate the acceptability of such a framework to surgeon innovators and its generalisability to other robotic procedures.
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Affiliation(s)
- Sina Hossaini
- National Institute for Health Research Bristol Biomedical Research Centre (Surgical Innovation Theme), Bristol, United Kingdom
| | - Natalie Blencowe
- National Institute for Health Research Bristol Biomedical Research Centre (Surgical Innovation Theme), Bristol, United Kingdom
| | - Daisy Elliott
- National Institute for Health Research Bristol Biomedical Research Centre (Surgical Innovation Theme), Bristol, United Kingdom
| | - Rhiannon Macefield
- National Institute for Health Research Bristol Biomedical Research Centre (Surgical Innovation Theme), Bristol, United Kingdom
| | - Shelley Potter
- National Institute for Health Research Bristol Biomedical Research Centre (Surgical Innovation Theme), Bristol, United Kingdom
- North Bristol NHS Trust, Bristol
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10
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Hoffmann C, Hossaini S, Cousins S, Blencowe N, McNair AGK, Blazeby JM, Avery KNL, Potter S, Macefield R. Reporting Modifications in Surgical Innovation: A Systematic Scoping Review Protocol. Int J Surg Protoc 2021; 25:250-256. [PMID: 34825118 PMCID: PMC8588892 DOI: 10.29337/ijsp.167] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 10/07/2021] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Innovation in surgery drives improvements to patient care. New surgical procedures and devices typically undergo a series of modifications as they are developed and refined during their introduction into clinical practice. These changes should ideally be reported and shared between surgeon-innovators to promote efficient, safe and transparent innovation. Currently, agreement on how modifications should be defined, conceptualised and classified, so they can be reported and shared efficiently and transparently, is lacking. The aim of this review is to examine and summarise existing literature on definitions, perceptions and classifications of modifications to surgical procedures/devices, including views on how to measure and report them. The findings will inform future work to standardise reporting and sharing of modifications in surgical innovation. MATERIALS AND METHODS A systematic scoping review will be conducted adhering to PRISMA-ScR guidelines. Included articles will focus on review articles and opinion pieces relevant to modifications to new surgical procedures or devices introduced to clinical practice. Methods to identify relevant literature will include systematic searches in MEDLINE (Ovid version), targeted internet searches (Google Scholar) and snowball searches. A two-stage screening process (titles/abstracts/keywords and full-texts) will use specified exclusion/inclusion criteria to identify eligible articles. Data on how modifications are i) defined, ii) perceived, and iii) classified, and iv) views on how modifications should be measured and reported, will be extracted verbatim. Inductive thematic analysis will be applied to extracted data where appropriate. Results will be presented as a narrative summary including descriptive characteristics of included articles. Findings will inform a preliminary conceptual framework to facilitate the systematic reporting and sharing of modifications to novel procedures and devices. HIGHLIGHTS This work will generate an in-depth understanding of how modifications are currently defined, perceived and classified, and views on how they may be reported, in the context of surgical innovation.Rigorous and comprehensive search methods will be applied to identify a wide range of diverse data sources for inclusion in the review.A summary of existing relevant literature on modifications is a necessary step to inform development of a framework for transparent, real-time reporting and sharing of modifications in future studies of innovative invasive procedures/devices.
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Affiliation(s)
- Christin Hoffmann
- National Institute for Health Research Bristol Biomedical Research Centre (Surgical Innovation Theme), Centre for Surgical Research, Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, UK
| | - Sina Hossaini
- National Institute for Health Research Bristol Biomedical Research Centre (Surgical Innovation Theme), Centre for Surgical Research, Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, UK
| | - Sian Cousins
- National Institute for Health Research Bristol Biomedical Research Centre (Surgical Innovation Theme), Centre for Surgical Research, Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, UK
| | - Natalie Blencowe
- National Institute for Health Research Bristol Biomedical Research Centre (Surgical Innovation Theme), Centre for Surgical Research, Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, UK
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Angus G. K. McNair
- National Institute for Health Research Bristol Biomedical Research Centre (Surgical Innovation Theme), Centre for Surgical Research, Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, UK
- North Bristol NHS Trust, Bristol, UK
| | - Jane M. Blazeby
- National Institute for Health Research Bristol Biomedical Research Centre (Surgical Innovation Theme), Centre for Surgical Research, Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, UK
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Kerry N. L. Avery
- National Institute for Health Research Bristol Biomedical Research Centre (Surgical Innovation Theme), Centre for Surgical Research, Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, UK
| | - Shelley Potter
- National Institute for Health Research Bristol Biomedical Research Centre (Surgical Innovation Theme), Centre for Surgical Research, Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, UK
- North Bristol NHS Trust, Bristol, UK
| | - Rhiannon Macefield
- National Institute for Health Research Bristol Biomedical Research Centre (Surgical Innovation Theme), Centre for Surgical Research, Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, UK
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11
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Chetter I, Arundel C, Martin BC, Hewitt C, Fairhurst C, Joshi K, Mott A, Rodgers S, Goncalves PS, Torgerson D, Wilkinson J, Blazeby J, Macefield R, Dixon S, Henderson E, Oswald A, Dumville J, Lee M, Pinkney T, Stubbs N, Wilson L. Negative pressure wound therapy versus usual care for surgical wounds healing by secondary intention (SWHSI-2 trial): study protocol for a pragmatic, multicentre, cross surgical specialty, randomised controlled trial. Trials 2021; 22:739. [PMID: 34696784 PMCID: PMC8543414 DOI: 10.1186/s13063-021-05662-2] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 09/27/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The majority of surgical wounds are closed (for example with sutures or staples) and so heal by primary intention. Where closure is not possible, or the wound subsequently breaks down, wounds may be left to heal from the bottom up (healing by secondary intention). Surgical wound healing by secondary intention (SWHSI) frequently presents a significant management challenge. Additional treatments are often required during the course of healing, and thus a significant financial burden is associated with treating these wounds. Increasingly, negative pressure wound therapy (NPWT) is used in the management of SWHSI. This wound dressing system provides a negative pressure (vacuum) to the wound, removing fluid into a canister, which is believed to be conducive to wound healing. Despite the increasing use of NPWT, there is limited robust evidence for the effectiveness of this device. A well-designed and conducted randomised controlled trial is now required to ascertain if NPWT is a clinically and cost-effective treatment for SWHSI. METHODS SWHSI-2 is a pragmatic, multi-centre, cross surgical specialty, two arm, parallel group, randomised controlled superiority trial. Adult patients with a SWHSI will be randomised to receive either NPWT or usual care (no NPWT) and will be followed up for 12 months. The primary outcome will be time to healing (defined as full epithelial cover in absence of a scab) in number of days since randomisation. Secondary outcomes will include key clinical events (hospital admission or discharge, treatment status, reoperation, amputation, antibiotic use and death), wound infection, wound pain, health-related quality of life, health utility and resource use. DISCUSSION Given the increasing use of NPWT, despite limited high-quality supporting evidence, the SWHSI-2 Trial will provide robust evidence on the clinical and cost-effectiveness of NPWT in the management of SWHSI. The SWHSI-2 Trial opened to recruitment in May 2019 and is currently recruiting across 20 participating centres. TRIAL REGISTRATION ISRCTN 26277546 . Prospectively registered on 25 March 2019.
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Affiliation(s)
- Ian Chetter
- York Trials Unit, Department of Health Sciences, Faculty of Science, University of York, Lower Ground Floor ARRC Building, York, YO10 5DD, UK
| | - Catherine Arundel
- York Trials Unit, Department of Health Sciences, Faculty of Science, University of York, Lower Ground Floor ARRC Building, York, YO10 5DD, UK.
| | - Belen Corbacho Martin
- York Trials Unit, Department of Health Sciences, Faculty of Science, University of York, Lower Ground Floor ARRC Building, York, YO10 5DD, UK
| | - Catherine Hewitt
- York Trials Unit, Department of Health Sciences, Faculty of Science, University of York, Lower Ground Floor ARRC Building, York, YO10 5DD, UK
| | - Caroline Fairhurst
- York Trials Unit, Department of Health Sciences, Faculty of Science, University of York, Lower Ground Floor ARRC Building, York, YO10 5DD, UK
| | - Kalpita Joshi
- York Trials Unit, Department of Health Sciences, Faculty of Science, University of York, Lower Ground Floor ARRC Building, York, YO10 5DD, UK
| | - Andrew Mott
- York Trials Unit, Department of Health Sciences, Faculty of Science, University of York, Lower Ground Floor ARRC Building, York, YO10 5DD, UK
| | - Sara Rodgers
- York Trials Unit, Department of Health Sciences, Faculty of Science, University of York, Lower Ground Floor ARRC Building, York, YO10 5DD, UK
| | - Pedro Saramago Goncalves
- York Trials Unit, Department of Health Sciences, Faculty of Science, University of York, Lower Ground Floor ARRC Building, York, YO10 5DD, UK
| | - David Torgerson
- York Trials Unit, Department of Health Sciences, Faculty of Science, University of York, Lower Ground Floor ARRC Building, York, YO10 5DD, UK
| | - Jacqueline Wilkinson
- York Trials Unit, Department of Health Sciences, Faculty of Science, University of York, Lower Ground Floor ARRC Building, York, YO10 5DD, UK
| | - Jane Blazeby
- York Trials Unit, Department of Health Sciences, Faculty of Science, University of York, Lower Ground Floor ARRC Building, York, YO10 5DD, UK
| | - Rhiannon Macefield
- York Trials Unit, Department of Health Sciences, Faculty of Science, University of York, Lower Ground Floor ARRC Building, York, YO10 5DD, UK
| | - Stephen Dixon
- York Trials Unit, Department of Health Sciences, Faculty of Science, University of York, Lower Ground Floor ARRC Building, York, YO10 5DD, UK
| | - Eileen Henderson
- York Trials Unit, Department of Health Sciences, Faculty of Science, University of York, Lower Ground Floor ARRC Building, York, YO10 5DD, UK
| | - Angela Oswald
- York Trials Unit, Department of Health Sciences, Faculty of Science, University of York, Lower Ground Floor ARRC Building, York, YO10 5DD, UK
| | - Jo Dumville
- York Trials Unit, Department of Health Sciences, Faculty of Science, University of York, Lower Ground Floor ARRC Building, York, YO10 5DD, UK
| | - Matthew Lee
- York Trials Unit, Department of Health Sciences, Faculty of Science, University of York, Lower Ground Floor ARRC Building, York, YO10 5DD, UK
| | - Thomas Pinkney
- York Trials Unit, Department of Health Sciences, Faculty of Science, University of York, Lower Ground Floor ARRC Building, York, YO10 5DD, UK
| | - Nikki Stubbs
- York Trials Unit, Department of Health Sciences, Faculty of Science, University of York, Lower Ground Floor ARRC Building, York, YO10 5DD, UK
| | - Lyn Wilson
- York Trials Unit, Department of Health Sciences, Faculty of Science, University of York, Lower Ground Floor ARRC Building, York, YO10 5DD, UK
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12
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Alford N, Shah M, Hudson E, Mutanga I, Macefield R. 794 A Systematic Review Measuring and Reporting the Surgical Learning Curve in Early Phase Studies of Surgical Innovation. Br J Surg 2021. [DOI: 10.1093/bjs/znab135.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Introduction
Community learning is a key component for the progression of surgical innovation, which is itself crucial to advancing surgical practice. Assessment of learning curve’s (LCs) allow rigorous evaluation of new surgical procedures/devices and their introduction into clinical practice. The Idea–Development–Exploration–Assessment–Long-term (IDEAL) framework provides recommendations for the evaluation of new surgical procedures and devices throughout the stages of innovation. This study aimed to identify the current reporting practice of LCs in IDEAL studies.
Method
A systematic review was conducted to identify author-reported IDEAL/IDEAL-D studies of any IDEAL stage and surgical specialty. LC outcomes were extracted including information relating to surgeons’ experience and training, and methods for measuring and assessing the LC.
Results
Searches yielded 1411 publications, of which 59 studies met the eligibility criteria. Of these, 31 (53%) reported information on the LC, with only 3 (5%) studies measuring or reporting on LC in detail. 21 (36%) studies reported training for surgeons and 16 (27%) reported support or performance monitoring.
Conclusions
Despite IDEAL recommendations, reporting the LC was found to be rare in the included studies. Reporting of the LC in future studies is recommended to facilitate robust evaluation of new surgical procedures and devices.
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Affiliation(s)
- N Alford
- University of Bristol Medical School, Bristol, United Kingdom
- National Institute for Health Research (NIHR), Bristol, United Kingdom
| | - M Shah
- University of Bristol Medical School, Bristol, United Kingdom
- National Institute for Health Research (NIHR), Bristol, United Kingdom
| | - E Hudson
- University of Bristol Medical School, Bristol, United Kingdom
- National Institute for Health Research (NIHR), Bristol, United Kingdom
| | - I Mutanga
- University of Bristol Medical School, Bristol, United Kingdom
- National Institute for Health Research (NIHR), Bristol, United Kingdom
| | - R Macefield
- National Institute for Health Research (NIHR), Bristol, United Kingdom
- Bristol Biomedical Research Centre (BRC), Bristol, United Kingdom
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13
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Robertson H, Huttman M, Dixon L, Macefield R, Hossaini S, Scroggie D. P106 Robotic Roux-en-Y gastric bypass: A systematic review to examine reporting of a surgical innovation. BJS Open 2021. [DOI: 10.1093/bjsopen/zrab032.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Roux-en-Y gastric bypass (RYGB) is one of the most commonly performed bariatric procedures, and robotic methods are increasingly used. Perceived benefits of robotic surgery include improved visualisation and ergonomics, fewer complications, and shorter hospital stay. Rigorous processes that facilitate the safe transition of surgical innovations such as robotic RYGB into clinical practice are currently lacking. This may place patients at risk, and lead to research waste. The IDEAL Collaboration has produced guidance on the reporting of surgical innovations, but it is not known how robotic RYGB has been reported. This project aims to summarise technique description, governance arrangements and outcome reporting in robotic RYGB.
Methods
A systematic review is being conducted, using PRISMA guidance. A search of Embase, Ovid Medline, the Cochrane Library and Web of Science was performed to identify primary studies reporting outcomes of robotic RYGB. Data will be extracted on study characteristics, governance and ethical arrangements, descriptions of technique, and outcomes. The data will be evaluated in relation to IDEAL principles.
Results
The literature search yielded 1012 studies; 754 remained after de-duplication. Following screening by abstract, 229 full texts were screened. 67 studies will undergo extraction of data. A descriptive summary of the data will be presented, with a critique of the findings.
Conclusion
This study will summarise and appraise how robotic RYGB has been reported. This will contribute towards the development of a standardised and methodical process for the introduction of surgical innovation into clinical practice.
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14
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Davies CF, Macefield R, Avery K, Blazeby JM, Potter S. Patient-Reported Outcome Measures for Post-mastectomy Breast Reconstruction: A Systematic Review of Development and Measurement Properties. Ann Surg Oncol 2021; 28:386-404. [PMID: 32602063 PMCID: PMC7752876 DOI: 10.1245/s10434-020-08736-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Breast reconstruction (BR) is performed to improve outcomes for patients undergoing mastectomy. A recently developed core outcome set for BR includes six patient-reported outcomes that should be measured and reported in all future studies. It is vital that any instrument used to measure these outcomes as part of a core measurement set be robustly developed and validated so data are reliable and accurate. The aim of this systematic review is to evaluate the development and measurement properties of existing BR patient-reported outcome measures (PROMs) to inform instrument selection for future studies. METHODS A PRISMA-compliant systematic review of development and validation studies of BR PROMs was conducted to assess their measurement properties. PROMs with adequate content validity were assessed using three steps: (1) the methodological quality of each identified study was assessed using the COSMIN Risk of Bias checklist; (2) criteria were applied for assessing good measurement properties; and (3) evidence was summarized and the quality of evidence assessed using a modified GRADE approach. RESULTS Fourteen articles reported the development and measurement properties of six PROMs. Of these, only three (BREAST-Q, BRECON-31, and EORTC QLQ-BRECON-23) were considered to have adequate content validity and proceeded to full evaluation. This showed that all three PROMs had been robustly developed and validated and demonstrated adequate quality. CONCLUSIONS BREAST-Q, BRECON-31, and EORTC QLQ-BRECON-23 have been well-developed and demonstrate adequate measurement properties. Work with key stakeholders is now needed to generate consensus regarding which PROM should be recommended for inclusion in a core measurement set.
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Affiliation(s)
- C F Davies
- Bristol Centre for Surgical Research, Population Health Sciences, Bristol Medical School, Bristol, UK.
| | - R Macefield
- Bristol Centre for Surgical Research, Population Health Sciences, Bristol Medical School, Bristol, UK
| | - K Avery
- Bristol Centre for Surgical Research, Population Health Sciences, Bristol Medical School, Bristol, UK
| | - J M Blazeby
- Bristol Centre for Surgical Research, Population Health Sciences, Bristol Medical School, Bristol, UK
- University Hospitals Bristol Foundation NHS Trust, Bristol, UK
| | - S Potter
- Bristol Centre for Surgical Research, Population Health Sciences, Bristol Medical School, Bristol, UK
- Bristol Breast Care Centre, North Bristol NHS Trust, Bristol, UK
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15
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Coulman KD, Nicholson A, Shaw A, Daykin A, Selman LE, Macefield R, Shorter GW, Cramer H, Sydes MR, Gamble C, Pick ME, Taylor G, Lane JA. Understanding and optimising patient and public involvement in trial oversight: an ethnographic study of eight clinical trials. Trials 2020; 21:543. [PMID: 32552907 PMCID: PMC7302397 DOI: 10.1186/s13063-020-04495-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 06/10/2020] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Trial oversight is important for trial governance and conduct. Patients and/or lay members of the public are increasingly included in trial oversight committees, influenced by international patient and public involvement (PPI) initiatives to improve the quality and relevance of research. However, there is a lack of guidance on how to undertake PPI in trial oversight and tokenistic PPI remains an issue. This paper explores how PPI functions in existing trial oversight committees and provides recommendations to optimise PPI in future trials. This was part of a larger study investigating the role and function of oversight committees in trials facing challenges. METHODS Using an ethnographic study design, we observed oversight meetings of eight UK trials and conducted semi-structured interviews with members of their trial steering committees (TSCs) and trial management groups (TMGs) including public contributors, trial sponsors and funders. Thematic analysis of data was undertaken, with findings integrated to provide a multi-perspective account of how PPI functions in trial oversight. RESULTS Eight TSC and six TMG meetings from eight trials were observed, and 66 semi-structured interviews conducted with 52 purposively sampled oversight group members, including three public contributors. PPI was reported as beneficial in trial oversight, with public members contributing a patient voice and fulfilling a patient advocacy role. However, public contributors were not always active at oversight meetings and were sometimes felt to have a tokenistic role, with trialists reporting a lack of understanding of how to undertake PPI in trial oversight. To optimise PPI in trial oversight, the following areas were highlighted: the importance of planning effective strategies to recruit public contributors; considering the level of oversight and stage(s) of trial to include PPI; support for public contributors by the trial team between and during oversight meetings. CONCLUSIONS We present evidence-based recommendations to inform future PPI in trial oversight. Consideration should be given at trial design stage on how to recruit and involve public contributors within trial oversight, as well as support and mentorship for both public contributors and trialists (in how to undertake PPI effectively). Findings from this study further strengthen the evidence base on facilitating meaningful PPI within clinical trials.
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Affiliation(s)
- K D Coulman
- MRC ConDuCT-II Hub for Trials Methodology Research, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 2PS, UK.
| | - A Nicholson
- MRC ConDuCT-II Hub for Trials Methodology Research, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 2PS, UK
| | - A Shaw
- MRC ConDuCT-II Hub for Trials Methodology Research, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 2PS, UK
| | - A Daykin
- MRC ConDuCT-II Hub for Trials Methodology Research, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 2PS, UK
| | - L E Selman
- MRC ConDuCT-II Hub for Trials Methodology Research, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 2PS, UK
| | - R Macefield
- MRC ConDuCT-II Hub for Trials Methodology Research, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 2PS, UK
| | - G W Shorter
- Centre for Improving Health Related Quality of Life, School of Psychology, Queen's University Belfast, Belfast, BT9 5BN, UK
| | - H Cramer
- MRC ConDuCT-II Hub for Trials Methodology Research, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 2PS, UK
| | - M R Sydes
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, University College London, London, WC1J 6JL, UK
- MRC London Hub for Trial Methodology Research, London, UK
| | - C Gamble
- MRC North West Hub for Trials Methodology Research, Institute of Translational Medicine, University of Liverpool, Liverpool, L69 3BX, UK
| | - M E Pick
- Bristol Randomised Trials Collaboration, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 2PS, UK
| | - G Taylor
- Bristol Randomised Trials Collaboration, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 2PS, UK
| | - J A Lane
- MRC ConDuCT-II Hub for Trials Methodology Research, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 2PS, UK
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16
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Davies C, Macefield R, Avery K, Potter S. P102: A systematic review of the development and psychometric properties of patient-reported outcome measures for reconstructive breast surgery. Eur J Surg Oncol 2020. [DOI: 10.1016/j.ejso.2020.03.141] [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: 11/26/2022] Open
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17
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McNair AGK, Whistance RN, Main B, Forsythe R, Macefield R, Rees J, Pullyblank A, Avery K, Brookes S, Thomas MG, Sylvester PA, Russell A, Oliver A, Morton D, Kennedy R, Jayne D, Huxtable R, Hackett R, Dutton S, Coleman MG, Card M, Brown J, Blazeby J. Development of a core information set for colorectal cancer surgery: a consensus study. BMJ Open 2019; 9:e028623. [PMID: 31727644 PMCID: PMC6886994 DOI: 10.1136/bmjopen-2018-028623] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [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: 12/27/2022] Open
Abstract
OBJECTIVE 'Core information sets' (CISs) represent baseline information, agreed by patients and professionals, to stimulate individualised patient-centred discussions. This study developed a CIS for use before colorectal cancer (CRC) surgery. DESIGN Three phase consensus study: (1) Systematic literature reviews and patient interviews to identify potential information of importance to patients, (2) UK national Delphi survey of patients and professionals to rate the importance of the information, (3) international consensus meeting to agree on the final CIS. SETTING UK CRC centres. PARTICIPANTS Purposive sampling was conducted to ensure CRC centre representation based upon geographical region and caseload volume. Responses were received from 63/81 (78%) centres (90 professionals). Adult patients who had undergone CRC surgery were eligible, and purposive sampling was conducted to ensure representation based on age, sex and cancer location (rectum, left and right colon). Responses were received from 97/267 (35%) patients with a wide age range (29-87), equal sex ratio and cancer location. Attendees of the international Tripartite Colorectal Conference were eligible for the consensus meeting. OUTCOMES Phase 1: Information of potential importance to patients was extracted verbatim and operationalised into a Delphi questionnaire. Phase 2: Patients and professionals rated the importance information on a 9-point Likert scale, and resurveyed following group feedback. Information rated of low importance were discarded using predefined criteria. Phase 3: A modified nominal group technique was used to gain final consensus in separate consensus meetings with patients and professionals. RESULTS Data sources identified 1216 pieces of information that informed a 98-item questionnaire. Analysis led to 50 and 23 information domains being retained after the first and second surveys, respectively. The final CIS included 11 concepts including specific surgical complications, short and long-term survival, disease recurrence, stoma and quality of life issues. CONCLUSIONS This study has established a CIS for professionals to discuss with patients before CRC surgery.
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Affiliation(s)
- Angus G K McNair
- Centre for Surgical Research, Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, UK
- GI Surgery, North Bristol NHS Trust, Bristol, UK
| | - Robert N Whistance
- Centre for Surgical Research, Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, UK
| | - Barry Main
- Centre for Surgical Research, Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, UK
| | - Rachael Forsythe
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Rhiannon Macefield
- Centre for Surgical Research, Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, UK
| | - Jonathan Rees
- Division of Surgery, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
- Centre for Surgical Research, University of Bristol, Bristol, UK
| | - Anne Pullyblank
- GI Surgery, North Bristol NHS Trust, Bristol, UK
- West of England Academic Health Science Network, Bristol, UK
| | - Kerry Avery
- Centre for Surgical Research, Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, UK
| | - Sara Brookes
- Cancer Research UK Clinical Trials Unit, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Michael G Thomas
- Division of Surgery, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Paul A Sylvester
- Division of Surgery, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Ann Russell
- Consumer Liaison Group, National Cancer Research Institute, London, UK
| | - Alfred Oliver
- Consumer Liaison Group, National Cancer Research Institute, London, UK
| | - Dion Morton
- Academic Department of Surgery, University of Birmingham, Birmingham, UK
| | - Robin Kennedy
- Department of Surgery, St Mark's Hospital, London, UK
| | - David Jayne
- Department of Academic Surgery, Leeds Institute of Biological and Clinical Sciences, Leeds Teaching Hospitals, Leeds, UK
| | - Richard Huxtable
- Centre for Ethics in Medicine, Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, UK
| | - Roland Hackett
- Colorectal Site Specific Group, South West Cancer Network, Bristol, UK
| | | | - Mark G Coleman
- Department of Surgery, University Hospitals Plymouth NHS Trust, Derriford Hospital, Plymouth, UK
| | - Mia Card
- Division of Surgery, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Julia Brown
- Consultant Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Jane Blazeby
- Centre for Surgical Research, Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, UK
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Avery K, Blazeby J, Wilson N, Macefield R, Cousins S, Main B, Blencowe NS, Zahra J, Elliott D, Hinchliffe R, Potter S. Development of reporting guidance and core outcome sets for seamless, standardised evaluation of innovative surgical procedures and devices: a study protocol for content generation and a Delphi consensus process (COHESIVE study). BMJ Open 2019; 9:e029574. [PMID: 31515426 PMCID: PMC6747635 DOI: 10.1136/bmjopen-2019-029574] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Rigorous evaluation of innovative invasive procedures and medical devices is uncommon and lacks reporting standardisation. Devices may therefore enter routine practice without thorough evaluation, resulting in patient harm. Detailed guidance on how to select and report outcomes at each stage of evaluation is lacking. Development of reporting guidance and core outcome sets (COS) is one strategy to promote safe and transparent evaluation. METHODS AND ANALYSIS A COS, comprising outcome domains applicable to all phases of evaluation of procedure/device introduction and modification and, if necessary, supplementary domains relevant to specific phases or types of innovation (procedure or device), will be developed according to principles outlined by Core Outcome Measures in Effectiveness Trials (COMET) and Core Outcome Set-Standards for Development (COS-STAD) guidelines. Reporting guidance will be developed concurrently. The study will have the following three phases:1. Generation of a list of relevant outcome domains and reporting items identified from (a) published studies, (b) hospital policy documentation, (c) regulatory body documentation and (d) stakeholder qualitative interviews. Identified items/domains will be categorised using a conceptual framework and formatted into Delphi consensus survey questionnaire items.2. Key stakeholders, including 50 patients and 150 professionals (surgeons, researchers, device manufacturers, regulatory representatives, journal editors) sampled from multinational sources, will complete a Delphi survey to score the importance of each reporting item and outcome.3. A consensus meeting with key stakeholders will discuss and agree the final content of the reporting guidance and COS(s). ETHICS AND DISSEMINATION Ethical approval has been granted by North East-Newcastle and North Tyneside 1 Health Research Authority Research Ethics Committee (18/NE/0378). Dissemination strategies include scientific meeting presentations, peer-reviewed journal publications, development of plain English summaries/materials, patient engagement events, development of a social media identity, workshops and other events.
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Affiliation(s)
- Kerry Avery
- Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, UK
| | - Jane Blazeby
- Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, UK
- Division of Surgery, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Nicholas Wilson
- Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, UK
| | - Rhiannon Macefield
- Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, UK
| | - Sian Cousins
- Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, UK
| | - Barry Main
- Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, UK
- Division of Surgery, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Natalie S Blencowe
- Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, UK
- Division of Surgery, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Jesmond Zahra
- Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, UK
| | - Daisy Elliott
- Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, UK
| | - Robert Hinchliffe
- Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, UK
- Vascular Services, North Bristol NHS Trust, Bristol, UK
| | - Shelley Potter
- Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, UK
- Bristol Breast Care Centre, North Bristol NHS Trust, Bristol, UK
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Macefield R, Brookes S, Blazeby J, Avery K. Development of a 'universal-reporter' outcome measure (UROM) for patient and healthcare professional completion: a mixed methods study demonstrating a novel concept for optimal questionnaire design. BMJ Open 2019; 9:e029741. [PMID: 31446412 PMCID: PMC6720518 DOI: 10.1136/bmjopen-2019-029741] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVES To describe the novel concept of, and methods for developing, a 'universal-reporter' outcome measure (UROM); a single questionnaire for completion by patients and/or healthcare professionals (HCPs) when views on the same subject are required. DESIGN A mixed methods study with three phases-phase I: identification of relevant content domains from existing clinical tools, patient questionnaires and in-depth interviews with multistakeholders; phase II: item development using a novel approach that considered plain language in conjunction with medical terminology; and phase III: pretesting with multistakeholders using cognitive interviews. SETTING A case study in surgical wound assessment undertaken in two UK hospital trusts and one university setting. PARTICIPANTS Patients who had recently undergone general abdominal surgery and healthcare professionals involved in post-surgical wound care. RESULTS Phase I: In the example case study, 19 relevant content domains were identified from two clinical tools, two patient questionnaires and 19 multistakeholder interviews (nine patients, 10 HCPs). Phase II: Domains were operationalised into items and subitems (secondary components to collect further information, if relevant). The version after pretesting had 16 items, five of which included further subitems. Plain language in conjunction with medical terminology was applicable in nine (27%) items/subitems. Phase III: Pretesting with 28 patients and 14 HCPs found that the UROM was acceptable to both respondent groups. An unanticipated secondary finding of the study was that the combined use of plain language and medical terminology during questionnaire development may be a useful, novel technique for evaluating item interpretation and thereby identifying items with inadequate content validity. CONCLUSION UROMs are a novel approach to outcome assessment that are acceptable to both patients and HCPs. Combining plain language and medical terminology during item development is a recommended technique to improve accuracy of item interpretation and content validity during questionnaire design. More work is needed to further validate this novel approach and explore the application of UROMs to other settings.
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Affiliation(s)
- Rhiannon Macefield
- The MRC ConDuCT-II Hub for Trials Methodology Research, Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, UK
- National Institute for Health Research Bristol Biomedical Research Centre, Bristol Centre for Surgical Research, Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, UK
| | - Sara Brookes
- The MRC ConDuCT-II Hub for Trials Methodology Research, Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, UK
| | - Jane Blazeby
- The MRC ConDuCT-II Hub for Trials Methodology Research, Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, UK
- National Institute for Health Research Bristol Biomedical Research Centre, Bristol Centre for Surgical Research, Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, UK
- Division of Surgery, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Kerry Avery
- The MRC ConDuCT-II Hub for Trials Methodology Research, Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, UK
- National Institute for Health Research Bristol Biomedical Research Centre, Bristol Centre for Surgical Research, Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, UK
- Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, UK
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20
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Lane JA, Er V, Avery KNL, Horwood J, Cantwell M, Caro GP, Crozier A, Smith GD, Donovan JL, Down L, Hamdy FC, Gillatt D, Holly J, Macefield R, Moody H, Neal DE, Walsh E, Martin RM, Metcalfe C. ProDiet: A Phase II Randomized Placebo-controlled Trial of Green Tea Catechins and Lycopene in Men at Increased Risk of Prostate Cancer. Cancer Prev Res (Phila) 2018; 11:687-696. [PMID: 30309839 DOI: 10.1158/1940-6207.capr-18-0147] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 07/11/2018] [Accepted: 09/21/2018] [Indexed: 11/16/2022]
Abstract
Epidemiologic studies suggest that diet can alter prostate cancer risk. This study aimed to establish the feasibility and acceptability of dietary modification in men at increased risk of prostate cancer. Men were invited with a PSA level of 2.0-2.95 ng/mL or 3.0-19.95 ng/mL with negative prostate biopsies. Randomization (3 × 3 factorial design) to daily green tea and lycopene: green tea drink (3 cups, unblinded) or capsules [blinded, 600 mg flavan-3-ol ()-epigallocatechin-3-gallate (EGCG) or placebo] and lycopene-rich foods (unblinded) or capsules (blinded, 15 mg lycopene or placebo) for 6 months. Primary endpoints were randomization rates and intervention adherence (blinded assessment of metabolites) at 6 months with secondary endpoints of acceptability (from interviews), safety, weight, blood pressure, and PSA. A total of 133 of 469 (28.4%) men approached agreed to be randomized and 132 were followed-up (99.2%). Mean lycopene was 1.28 [95% confidence intervals (CI), 1.09-1.50, P = 0.003] times higher in the lycopene capsule group and 1.42 (95% CI, 1.21-1.66; P < 0.001) times higher in the lycopene-enriched diet group compared with placebo capsules. Median EGCG was 10.7 nmol/L (95% CI, 7.0-32.0) higher in in the active capsule group and 20.0 nmol/L (95% CI, 0.0-19.0) higher in the green tea drink group compared with placebo capsules (both P < 0.001). All interventions were acceptable and well tolerated although men preferred the capsules. Dietary prevention is acceptable to men at risk of prostate cancer. This intervention trial demonstrates that a chemoprevention clinical trial is feasible. Cancer Prev Res; 11(11); 687-96. ©2018 AACR.
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Affiliation(s)
- J Athene Lane
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom. .,NIHR Biomedical Research Centre at University Hospitals Bristol NHS Foundation Trust and the University of Bristol, Bristol, United Kingdom.,Bristol Randomised Trials Collaboration, University of Bristol, Bristol, United Kingdom
| | - Vanessa Er
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom.,NIHR Biomedical Research Centre at University Hospitals Bristol NHS Foundation Trust and the University of Bristol, Bristol, United Kingdom
| | - Kerry N L Avery
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Jeremy Horwood
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom.,Bristol Randomised Trials Collaboration, University of Bristol, Bristol, United Kingdom.,Collaboration for Leadership in Applied Health Research and Care West at University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
| | - Marie Cantwell
- Institute for Global Food Security, School of Biological Sciences, Queen's University Belfast, Belfast, United Kingdom
| | - Gema P Caro
- Department of Food and Health, IFAPA-Alameda del Obispo, Cordoba, Spain
| | - Alan Crozier
- Department of Nutrition, University of California Davis, Davis, California
| | - George Davey Smith
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom.,Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, United Kingdom
| | - Jenny L Donovan
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom.,Collaboration for Leadership in Applied Health Research and Care West at University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
| | - Liz Down
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Freddie C Hamdy
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom
| | - David Gillatt
- Bristol Urological Institute, North Bristol Trust, Bristol, United Kingdom
| | - Jeff Holly
- IGFs and Metabolic Endocrinology Group, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Rhiannon Macefield
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Hilary Moody
- Bristol Urological Institute, North Bristol Trust, Bristol, United Kingdom
| | - David E Neal
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom
| | - Eleanor Walsh
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Richard M Martin
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom.,NIHR Biomedical Research Centre at University Hospitals Bristol NHS Foundation Trust and the University of Bristol, Bristol, United Kingdom.,Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, United Kingdom
| | - Chris Metcalfe
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom.,Bristol Randomised Trials Collaboration, University of Bristol, Bristol, United Kingdom
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21
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Daykin A, Selman LE, Cramer H, McCann S, Shorter GW, Sydes MR, Gamble C, Macefield R, Lane JA, Shaw A. 'We all want to succeed, but we've also got to be realistic about what is happening': an ethnographic study of relationships in trial oversight and their impact. Trials 2017; 18:612. [PMID: 29273060 PMCID: PMC5741863 DOI: 10.1186/s13063-017-2305-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 11/01/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The oversight and conduct of a randomised controlled trial involves several stakeholders, including a Trial Steering Committee (TSC), Trial Management Group (TMG), Data Monitoring Committee (DMC), funder and sponsor. We aimed to examine how the relationships between these stakeholders affect the trial oversight process and its rigour, to inform future revision of Good Clinical Practice guidelines. METHODS Using an ethnographic study design, we observed the oversight processes of eight trials and conducted semi-structured interviews with members of the trials' TSCs and TMGs, plus other relevant informants, including sponsors and funders of trials. Data were analysed thematically, and findings triangulated and integrated to give a multi-perspective account of current oversight practices in the UK. RESULTS Eight TSC and six TMG meetings from eight trials were observed and audio-recorded, and 66 semi-structured interviews conducted with 52 purposively sampled key informants. Five themes are presented: (1) Collaboration within the TMG and role of the CTU; (2) Collaboration and conflict between oversight committees; (3) Priorities; (4) Communication between trial oversight groups and (5) Power and accountability. There was evidence of collaborative relationships, based on mutual respect, between CTUs, TMGs and TSCs, but also evidence of conflict. Relationships between trial oversight committees were influenced by stakeholders' priorities, both organisational and individual. Good communication following specific, recognised routes played a central role in ensuring that relationships were productive and trial oversight efficient. Participants described the possession of power over trials as a shifting political landscape, and there was lack of clarity regarding the roles and accountability of each committee, the sponsor and funder. Stakeholders' perceptions of their own power over a trial, and the power of others, influenced relationships between those involved in trial oversight. CONCLUSIONS Recent developments in trial design and conduct have been accompanied by changes in roles and relationships between trial oversight groups. Recognising and respecting the value of differing priorities among those involved in running trials is key to successful relationships between committees, funders and sponsors. Clarity regarding appropriate lines of communication, roles and accountability is needed. We present 10 evidence-based recommendations to inform updates to international trial guidance, particularly the Medical Research Council guidelines.
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Affiliation(s)
- Anne Daykin
- MRC ConDuCT Hub for Trials Methodology Research, Population Health Sciences, University of Bristol, Bristol, UK
| | - Lucy E. Selman
- MRC ConDuCT Hub for Trials Methodology Research, Population Health Sciences, University of Bristol, Bristol, UK
- Bristol Randomised Trials Collaboration, University of Bristol, Bristol, UK
| | - Helen Cramer
- MRC ConDuCT Hub for Trials Methodology Research, Population Health Sciences, University of Bristol, Bristol, UK
| | - Sharon McCann
- Formerly: Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Gillian W. Shorter
- Psychotraumatology, Mental Health and Suicidal Behaviour, Psychology Research Institute, Ulster University, Belfast, UK
- School of Health and Social Care, Teesside University, Middlesbrough, UK
| | - Matthew R. Sydes
- MRC Clinical Trials Unit at UCL, London, UK
- MRC London Hub for Trial Methodology Research, London, UK
| | - Carrol Gamble
- MRC North West Hub for Trials Methodology Research, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Rhiannon Macefield
- MRC ConDuCT Hub for Trials Methodology Research, Population Health Sciences, University of Bristol, Bristol, UK
| | - J. Athene Lane
- MRC ConDuCT Hub for Trials Methodology Research, Population Health Sciences, University of Bristol, Bristol, UK
- Bristol Randomised Trials Collaboration, University of Bristol, Bristol, UK
| | - Alison Shaw
- MRC ConDuCT Hub for Trials Methodology Research, Population Health Sciences, University of Bristol, Bristol, UK
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22
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Dumville JC, Gray TA, Walter CJ, Sharp CA, Page T, Macefield R, Blencowe N, Milne TKG, Reeves BC, Blazeby J. Dressings for the prevention of surgical site infection. Cochrane Database Syst Rev 2016; 12:CD003091. [PMID: 27996083 PMCID: PMC6464019 DOI: 10.1002/14651858.cd003091.pub4] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Surgical wounds (incisions) heal by primary intention when the wound edges are brought together and secured, often with sutures, staples, or clips. Wound dressings applied after wound closure may provide physical support, protection and absorb exudate. There are many different types of wound dressings available and wounds can also be left uncovered (exposed). Surgical site infection (SSI) is a common complication of wounds and this may be associated with using (or not using) dressings, or different types of dressing. OBJECTIVES To assess the effects of wound dressings compared with no wound dressings, and the effects of alternative wound dressings, in preventing SSIs in surgical wounds healing by primary intention. SEARCH METHODS We searched the following databases: the Cochrane Wounds Specialised Register (searched 19 September 2016); the Cochrane Central Register of Controlled Trials (CENTRAL; the Cochrane Library 2016, Issue 8); Ovid MEDLINE (including In-Process & Other Non-Indexed Citations, MEDLINE Daily and Epub Ahead of Print; 1946 to 19 September 2016); Ovid Embase (1974 to 19 September 2016); EBSCO CINAHL Plus (1937 to 19 September 2016).There were no restrictions based on language, date of publication or study setting. SELECTION CRITERIA Randomised controlled trials (RCTs) comparing wound dressings with wound exposure (no dressing) or alternative wound dressings for the postoperative management of surgical wounds healing by primary intention. DATA COLLECTION AND ANALYSIS Two review authors performed study selection, 'Risk of bias' assessment and data extraction independently. MAIN RESULTS We included 29 trials (5718 participants). All studies except one were at an unclear or high risk of bias. Studies were small, reported low numbers of SSI events and were often not clearly reported. There were 16 trials that included people with wounds resulting from surgical procedures with a 'clean' classification, five trials that included people undergoing what was considered 'clean/contaminated' surgery, with the remaining studies including people undergoing a variety of surgical procedures with different contamination classifications. Four trials compared wound dressings with no wound dressing (wound exposure); the remaining 25 studies compared alternative dressing types, with the majority comparing a basic wound contact dressing with film dressings, silver dressings or hydrocolloid dressings. The review contains 11 comparisons in total. PRIMARY OUTCOME SSIIt is uncertain whether wound exposure or any dressing reduces or increases the risk of SSI compared with alternative options investigated: we assessed the certainty of evidence as very low for most comparisons (and low for others), with downgrading (according to GRADE criteria) largely due to risk of bias and imprecision. We summarise the results of comparisons with meta-analysed data below:- film dressings compared with basic wound contact dressings following clean surgery (RR 1.34, 95% CI 0.70 to 2.55), very low certainty evidence downgraded once for risk of bias and twice for imprecision.- hydrocolloid dressings compared with basic wound contact dressings following clean surgery (RR 0.91, 95% CI 0.30 to 2.78), very low certainty evidence downgraded once for risk of bias and twice for imprecision.- hydrocolloid dressings compared with basic wound contact dressings following potentially contaminated surgery (RR 0.57, 95% CI 0.22 to 1.51), very low certainty evidence downgraded twice for risk of bias and twice for imprecision.- silver-containing dressings compared with basic wound contact dressings following clean surgery (RR 1.11, 95% CI 0.47 to 2.62), very low certainty evidence downgraded once for risk of bias and twice for imprecision.- silver-containing dressings compared with basic wound contact dressings following potentially contaminated surgery (RR 0.83, 95% CI 0.51 to 1.37), very low certainty evidence downgraded twice for risk of bias and twice for imprecision. Secondary outcomesThere was limited and low or very low certainty evidence on secondary outcomes such as scarring, acceptability of dressing and ease of removal, and uncertainty whether wound dressings influenced these outcomes. AUTHORS' CONCLUSIONS It is uncertain whether covering surgical wounds healing by primary intention with wound dressings reduces the risk of SSI, or whether any particular wound dressing is more effective than others in reducing the risk of SSI, improving scarring, reducing pain, improving acceptability to patients, or is easier to remove. Most studies in this review were small and at a high or unclear risk of bias. Based on the current evidence, decision makers may wish to base decisions about how to dress a wound following surgery on dressing costs as well as patient preference.
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Affiliation(s)
- Jo C Dumville
- University of ManchesterDivision of Nursing, Midwifery & Social Work, School of Health Sciences, Faculty of Biology, Medicine & HealthManchesterUKM13 9PL
| | - Trish A Gray
- University of ManchesterDivision of Nursing, Midwifery & Social Work, School of Health Sciences, Faculty of Biology, Medicine & HealthManchesterUKM13 9PL
| | - Catherine J Walter
- Gloucestershire NHS Foundation TrustColorectal SurgeryCheltenham GeneralSandford RoadCheltenhamUKGL53 7AN
| | - Catherine A Sharp
- The Wound CentrePO Box 3207BlakehurstSydneyNew South WalesAustralia2221
| | - Tamara Page
- Royal Adelaide HospitalLevel 4, Margaret Graham BuildingNorth TerraceAdelaideAustraliaSA5000
- University of AdelaideLevel 3, Eleanor Harrald BuildingNorth TerraceAdelaideAustraliaSA 5000
| | - Rhiannon Macefield
- University of BristolUniversity of Bristol, School of Social and Community MedicineCanynge Hall, 39 Whatley RoadBristolUKBS28 2PS
| | - Natalie Blencowe
- University of BristolUniversity of Bristol, School of Social and Community MedicineCanynge Hall, 39 Whatley RoadBristolUKBS28 2PS
| | - Thomas KG Milne
- University of BristolUniversity of Bristol, School of Social and Community MedicineCanynge Hall, 39 Whatley RoadBristolUKBS28 2PS
| | - Barnaby C Reeves
- University of BristolSchool of Clinical SciencesLevel 7, Bristol Royal InfirmaryMarlborough StreetBristolUKBS2 8HW
| | - Jane Blazeby
- University of BristolBristol Centre for Surgical Research, School of Social & Community MedicineCanynge Hall39 Whatley RoadBristolUKBS8 2PS
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23
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McNair AGK, Whistance RN, Forsythe RO, Macefield R, Rees J, Pullyblank AM, Avery KNL, Brookes ST, Thomas MG, Sylvester PA, Russell A, Oliver A, Morton D, Kennedy R, Jayne DG, Huxtable R, Hackett R, Dutton SJ, Coleman MG, Card M, Brown J, Blazeby JM. Core Outcomes for Colorectal Cancer Surgery: A Consensus Study. PLoS Med 2016; 13:e1002071. [PMID: 27505051 PMCID: PMC4978448 DOI: 10.1371/journal.pmed.1002071] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Colorectal cancer (CRC) is a major cause of worldwide morbidity and mortality. Surgical treatment is common, and there is a great need to improve the delivery of such care. The gold standard for evaluating surgery is within well-designed randomized controlled trials (RCTs); however, the impact of RCTs is diminished by a lack of coordinated outcome measurement and reporting. A solution to these issues is to develop an agreed standard "core" set of outcomes to be measured in all trials to facilitate cross-study comparisons, meta-analysis, and minimize outcome reporting bias. This study defines a core outcome set for CRC surgery. METHODS AND FINDINGS The scope of this COS includes clinical effectiveness trials of surgical interventions for colorectal cancer. Excluded were nonsurgical oncological interventions. Potential outcomes of importance to patients and professionals were identified through systematic literature reviews and patient interviews. All outcomes were transcribed verbatim and categorized into domains by two independent researchers. This informed a questionnaire survey that asked stakeholders (patients and professionals) from United Kingdom CRC centers to rate the importance of each domain. Respondents were resurveyed following group feedback (Delphi methods). Outcomes rated as less important were discarded after each survey round according to predefined criteria, and remaining outcomes were considered at three consensus meetings; two involving international professionals and a separate one with patients. A modified nominal group technique was used to gain the final consensus. Data sources identified 1,216 outcomes of CRC surgery that informed a 91 domain questionnaire. First round questionnaires were returned from 63 out of 81 (78%) centers, including 90 professionals, and 97 out of 267 (35%) patients. Second round response rates were high for all stakeholders (>80%). Analysis of responses lead to 45 and 23 outcome domains being retained after the first and second surveys, respectively. Consensus meetings generated agreement on a 12 domain COS. This constituted five perioperative outcome domains (including anastomotic leak), four quality of life outcome domains (including fecal urgency and incontinence), and three oncological outcome domains (including long-term survival). CONCLUSION This study used robust consensus methodology to develop a core outcome set for use in colorectal cancer surgical trials. It is now necessary to validate the use of this set in research practice.
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Affiliation(s)
- Angus G. K. McNair
- Centre for Surgical Research, School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
- Severn School of Surgery, Bristol, United Kingdom
- * E-mail:
| | - Robert N. Whistance
- Centre for Surgical Research, School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
- Division of Surgery Head and Neck, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
| | - Rachael O. Forsythe
- Centre for Surgical Research, School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
- Division of Surgery Head and Neck, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
| | - Rhiannon Macefield
- Centre for Surgical Research, School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
| | - Jonathan Rees
- Centre for Surgical Research, School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
| | - Anne M. Pullyblank
- Department of General Surgery, North Bristol NHS Trust, Bristol, United Kingdom
| | - Kerry N. L. Avery
- Centre for Surgical Research, School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
| | - Sara T. Brookes
- Centre for Surgical Research, School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
| | - Michael G. Thomas
- Division of Surgery Head and Neck, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
| | - Paul A. Sylvester
- Division of Surgery Head and Neck, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
| | - Ann Russell
- Colorectal Consumer Liaison Group, National Cancer Research Institute, London, United Kingdom
| | - Alfred Oliver
- Colorectal Consumer Liaison Group, National Cancer Research Institute, London, United Kingdom
| | - Dion Morton
- Academic Department of Surgery, University of Birmingham, Birmingham, United Kingdom
| | - Robin Kennedy
- Department of Surgery, St Mark’s Hospital and Academic Institute, Harrow, United Kingdom
| | - David G. Jayne
- Academic Surgical Unit, St James’ University Hospital NHS Trust, Leeds, United Kingdom
| | - Richard Huxtable
- Centre for Ethics in Medicine, University of Bristol, Bristol, United Kingdom
| | - Roland Hackett
- Colorectal Site Specific Group, Somerset, Wiltshire, Avon & Gloucestershire, South West Cancer Network, Bristol, United Kingdom
| | - Susan J. Dutton
- Centre for Statistics in Medicine and Oxford Clinical Trials Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Mark G. Coleman
- Department of Colorectal Surgery, Plymouth Hospitals NHS Trust, Plymouth, United Kingdom
| | - Mia Card
- Division of Surgery Head and Neck, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
| | - Julia Brown
- Clinical Trials Research Unit, University of Leeds, Leeds, United Kingdom
| | - Jane M. Blazeby
- Centre for Surgical Research, School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
- Division of Surgery Head and Neck, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
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McNair AGK, Brookes ST, Whistance RN, Forsythe RO, Macefield R, Rees J, Jones J, Smith G, Pullyblank AM, Avery KNL, Thomas MG, Sylvester PA, Russell A, Oliver A, Morton D, Kennedy R, Jayne DG, Huxtable R, Hackett R, Dutton SJ, Coleman MG, Card M, Brown J, Blazeby JM. Trial outcomes and information for clinical decision-making: a comparative study of opinions of health professionals. Trials 2016; 17:344. [PMID: 27456848 PMCID: PMC4960891 DOI: 10.1186/s13063-016-1492-0] [Citation(s) in RCA: 2] [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: 12/28/2015] [Accepted: 07/07/2016] [Indexed: 11/16/2022] Open
Abstract
Background Trials are robust sources of data for clinical practice; however, trial outcomes may not reflect what is important to communicate for decision-making. The study compared clinicians’ views of outcomes to include in a core outcome set for colorectal cancer (CRC) surgery, with what clinicians considered important information for clinical practice (core information). Methods Potential outcome/information domains were identified through systematic literature reviews, reviews of hospital information leaflets and interviews with patients. These were organized into six categories and used to design a questionnaire survey that asked surgeons and nurses from a sample of CRC centers to rate the importance of each domain as an outcome or as information on a nine-point Likert scale. Respondents were re-surveyed (round 2) following group feedback (Delphi methods). Comparisons were made by calculating the difference in mean scores between the outcomes and information domains, and paired t tests were used to explore the difference between mean scores of the six outcome/information categories. Results Data sources identified 1216 outcome/information items for CRC surgery that informed a 94-item questionnaire. First-round questionnaires were returned from 63/81 (78 %) of centers. Clinicians rated 76/94 (84 %) domains of higher importance to measure in trials than information to communicate to patients in round 1. This was reduced to 24/47 (51 %) in round 2. The greatest difference was evident in domains regarding survival, which was rated much more highly as a trial outcome than an important piece of information for decision-making (difference in mean 2.3, 95 % CI 1.9 to 2.8, p <0.0001). Specific complications and quality-of-life domains were rated similarly (difference in mean 0.18, 95 % CI −0.1 to 0.4, p = 0.2 and difference in mean 0.2, 95 % CI −0.1 to 0.5, p = 0.2, respectively). Conclusions Whilst clinicians want to measure key outcomes in trials, they rate these as less important to communicate in decision-making with patients. This discrepancy needs to be explored and addressed to maximize the impact of trials on clinical practice.
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Affiliation(s)
- Angus G K McNair
- Centre for Surgical Research, School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK. .,Severn School of Surgery, Bristol, UK.
| | - Sara T Brookes
- Centre for Surgical Research, School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Robert N Whistance
- Centre for Surgical Research, School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.,Division of Surgery Head and Neck, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Rachael O Forsythe
- Centre for Surgical Research, School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.,Division of Surgery Head and Neck, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Rhiannon Macefield
- Centre for Surgical Research, School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Jonathan Rees
- Centre for Surgical Research, School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - James Jones
- Colorectal Cancer Patient Representative, North Bristol NHS Trust, Bristol, UK
| | - George Smith
- Colorectal Cancer Patient Representative, North Bristol NHS Trust, Bristol, UK
| | | | - Kerry N L Avery
- Centre for Surgical Research, School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Michael G Thomas
- Colorectal Surgery Unit, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Paul A Sylvester
- Colorectal Surgery Unit, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Anne Russell
- Colorectal Consumer Liaison Group, National Cancer Research Institute, London, UK
| | - Alfred Oliver
- Colorectal Consumer Liaison Group, National Cancer Research Institute, London, UK
| | - Dion Morton
- Academic Department of Surgery, University of Birmingham, Birmingham, UK
| | - Robin Kennedy
- Department of Surgery, St Mark's Hospital and Academic Institute, Harrow, UK
| | - David G Jayne
- Academic Surgical Unit, St James' University Hospital NHS Trust, Leeds, UK
| | - Richard Huxtable
- Centre for Ethics in Medicine, University of Bristol, Bristol, UK
| | - Rowland Hackett
- Colorectal Site Specific Group, Somerset, Wiltshire, Avon and Gloucestershire, South West Cancer Network, Taunton, UK
| | - Susan J Dutton
- Centre for Statistics in Medicine and Oxford Clinical Trials Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Mark G Coleman
- Department of Colorectal Surgery, Plymouth Hospitals NHS Trust, Plymouth, UK
| | - Mia Card
- Colorectal Surgery Unit, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Julia Brown
- Clinical Trials Research Unit, University of Leeds, Leeds, UK
| | - Jane M Blazeby
- Centre for Surgical Research, School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.,Division of Surgery Head and Neck, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
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Daykin A, Selman LE, Cramer H, McCann S, Shorter GW, Sydes MR, Gamble C, Macefield R, Lane JA, Shaw A. What are the roles and valued attributes of a Trial Steering Committee? Ethnographic study of eight clinical trials facing challenges. Trials 2016; 17:307. [PMID: 27369866 PMCID: PMC4930562 DOI: 10.1186/s13063-016-1425-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 06/03/2016] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Clinical trials oversight by a Trial Steering Committee (TSC) is mandated by Good Clinical Practice. This study used qualitative methods to explore the role and valued attributes of the TSC to inform planned updates of Medical Research Council guidance and TSC terms of reference. METHODS An ethnographic study was conducted during 2013-2014. TSC and Trial Management Group meetings from eight trials were observed and audio-recorded, and semi-structured interviews conducted with purposively sampled key informants: independent and non-independent TSC members, trial sponsor representatives, funder representatives and chief investigators. The selected trials were currently recruiting and dealing with challenging scenarios. Data were analysed thematically and findings triangulated and integrated to give a multi-perspective account of the role and valued attributes of a TSC. RESULTS Eight TSC meetings and six Trial Management Group meetings were observed. Sixty-five interviews were conducted with 51 informants. The two main roles played by the TSC were quality assurance and patient advocacy. Quality assurance involved being a 'critical friend' or a provider of 'tough love'. Factors influencing the ability of the TSC to fulfil this role included the TSC Chair, other independent TSC members and the model of the TSC and its fit with the trial subject. The role of the TSC as an advocate for patient well-being was perceived as paramount. Two attributes of TSC members emerged as critical: experience (of running a trial, trial oversight or in a clinical/methodological area) and independence. While independence was valued for giving impartiality, the lack of consensus about its definition and strict requirements of some funders made it difficult to operationalise. CONCLUSIONS We found tensions and ambiguities in the roles expected of TSCs and the attributes valued of TSC members. In particular, the requirements of independence and experience could conflict, impacting the TSCs' quality assurance role. Concerns were raised regarding whose interests are served by funders' criteria of independence; in particular, funders' selection of TSC members was thought to potentially inhibit TSCs' ability to fulfil their patient advocacy role. These findings should be incorporated in revising guidance and terms of reference for TSCs.
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Affiliation(s)
- Anne Daykin
- MRC ConDuCT Hub for Trials Methodology Research, School of Social and Community Medicine, University of Bristol, Bristol, BS8 2PS, UK.
| | - Lucy E Selman
- MRC ConDuCT Hub for Trials Methodology Research, School of Social and Community Medicine, University of Bristol, Bristol, BS8 2PS, UK
| | - Helen Cramer
- MRC ConDuCT Hub for Trials Methodology Research, School of Social and Community Medicine, University of Bristol, Bristol, BS8 2PS, UK
| | - Sharon McCann
- Formerly: Health Services Research Unit, University of Aberdeen, Aberdeen, AB25 2ZD, UK
| | - Gillian W Shorter
- Trinity Centre for Practice and Healthcare Innovation, School of Nursing and Midwifery, Trinity College Dublin, Belfast, BT12 6BJ, UK
- National Institute for Mental Health Research, ANU College of Medicine Biology & Environment, The Australian National University, Canberra, ACT 0200, Australia
| | - Matthew R Sydes
- MRC Clinical Trials Unit at UCL, London, WC2B 6NH, UK
- MRC London Hub for Trial Methodology Research, London, UK
| | - Carrol Gamble
- MRC North West Hub for Trials Methodology Research, Institute of Translational Medicine, University of Liverpool, Liverpool, L69 3BX, UK
| | - Rhiannon Macefield
- MRC ConDuCT Hub for Trials Methodology Research, School of Social and Community Medicine, University of Bristol, Bristol, BS8 2PS, UK
| | - J Athene Lane
- MRC ConDuCT Hub for Trials Methodology Research, School of Social and Community Medicine, University of Bristol, Bristol, BS8 2PS, UK
| | - Alison Shaw
- MRC ConDuCT Hub for Trials Methodology Research, School of Social and Community Medicine, University of Bristol, Bristol, BS8 2PS, UK
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McNair A, Whistance R, Forsythe R, Macefield R, Brookes S, Blazeby J. Core outcomes for randomized trials and core information for clinical decision-making: implications for outcome selection. Trials 2015. [PMCID: PMC4660343 DOI: 10.1186/1745-6215-16-s2-p65] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Macefield R, Nicholson A, Milne T, Pinkney T, Calvert M, Avery K, Reeves B, Blazeby J. Development of a single, practical measure of surgical site infection (SSI) for patient self-report and observer completion: a novel method of questionnaire design. Trials 2015. [PMCID: PMC4659328 DOI: 10.1186/1745-6215-16-s2-o6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Brookes S, Macefield R, Williamson P, McNair A, Potter S, Blencowe N, Strong S, Blazeby J. Three nested RCTs of dual or single stakeholder feedback within Delphi surveys during core outcome and information set development. Trials 2015. [PMCID: PMC4660116 DOI: 10.1186/1745-6215-16-s2-p51] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Nicholson A, Daykin A, Macefield R, McCann S, Shorter G, Sydes M, Gamble C, Shaw A, Lane JA. Enhancing public involvement in trial oversight committees through qualitative research with eight trials facing challenges. Trials 2015. [PMCID: PMC4660224 DOI: 10.1186/1745-6215-16-s2-p78] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Chalmers K, Avery K, Coulman K, Blencowe N, Macefield R, Metcalfe C, Blazeby J, Brookes S. What is the effect of patient-reported outcome (PRO) item order on prioritisation of PROs in the development of a core outcome set? Trials 2015. [PMCID: PMC4658780 DOI: 10.1186/1745-6215-16-s2-o73] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Blazeby J, Rooshenas L, Macefield R, Townsend D, Milne T. Methods for selecting health concepts and domains from in-depth qualitative interviews for the development of patient reported outcome measures (PROMS): a case study. Trials 2015. [PMCID: PMC4659312 DOI: 10.1186/1745-6215-16-s2-o5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
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Avery K, Chalmers K, Whale K, Blencowe N, Macefield R, Brookes S, Metcalfe C, Blazeby J. The importance of stakeholder selection in core outcome set development: how surveying different health professionals may influence outcome selection. Trials 2015. [PMCID: PMC4659317 DOI: 10.1186/1745-6215-16-s2-p47] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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McNair AGK, Whistance RN, Forsythe RO, Macefield R, Rees J, Jones JE, Smith G, Pullyblank AM, Avery KNL, Brookes ST, Thomas MG, Sylvester PA, Russell A, Oliver A, Morton D, Kennedy R, Jayne DG, Huxtable R, Hackett R, Dutton S, Coleman MG, Card M, Brown J, Blazeby JM. The development of a colorectal cancer surgery core outcome set. Trials 2015. [PMCID: PMC4460715 DOI: 10.1186/1745-6215-16-s1-p12] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Blazeby JM, Macefield R, Blencowe NS, Jacobs M, McNair AGK, Sprangers M, Brookes ST. Core information set for oesophageal cancer surgery. Br J Surg 2015; 102:936-43. [PMID: 25980524 DOI: 10.1002/bjs.9840] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Revised: 12/17/2014] [Accepted: 03/31/2015] [Indexed: 11/06/2022]
Abstract
BACKGROUND Surgeons provide patients with information before surgery, although standards of information are lacking and practice varies. The development and use of a 'core information set' as baseline information before surgery may improve understanding. A core set is a minimum set of information to use in all consultations before a specific procedure. This study developed a core information set for oesophageal cancer surgery. METHODS Information was identified from the literature, observations of clinical consultations and patient interviews. This was integrated to create a questionnaire survey. Stakeholders (patients and professionals) were surveyed twice to assess views on importance of information from 'not essential' to 'absolutely essential' using Delphi methods. Items not meeting predefined criteria were discarded after each survey and the final retained items were voted on, in separate patient and professional stakeholder meetings, to agree the core set. RESULTS Some 67 information items were identified initially from multiple sources. Survey response rates were 76·5 per cent (185 of 242) and 54·8 per cent (126 of 230) for patients and professionals respectively (first round), and over 83 per cent in both groups thereafter. Health professionals rated short-term clinical outcomes most highly (technical complications), whereas patients prioritized information related to long-term benefits. The consensus meetings agreed the final set, which consisted of: in-hospital milestones to recovery, rates of open-and-close surgery, in-hospital mortality, major complications (reoperation), milestones in recovery after discharge, longer-term eating and drinking and overall quality of life, and chances of survival. CONCLUSION This study has established a core information set for surgery for oesophageal cancer.
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Affiliation(s)
- J M Blazeby
- Centre for Surgical Research, School of Social and Community Medicine, University of Bristol.,Division of Surgery, Head and Neck, University Hospitals NHS Foundation Trust, Bristol, UK
| | - R Macefield
- Centre for Surgical Research, School of Social and Community Medicine, University of Bristol
| | - N S Blencowe
- Centre for Surgical Research, School of Social and Community Medicine, University of Bristol.,Division of Surgery, Head and Neck, University Hospitals NHS Foundation Trust, Bristol, UK
| | - M Jacobs
- Department of Medical Psychology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - A G K McNair
- Centre for Surgical Research, School of Social and Community Medicine, University of Bristol
| | - M Sprangers
- Department of Medical Psychology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - S T Brookes
- Centre for Surgical Research, School of Social and Community Medicine, University of Bristol
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Daykin A, Heawood A, Lane A, Macefield R, Gamble C, McCann S, Shorter G, Sydes MR. An ethnographic study of group decision making to understand and improve how trial steering committees contribute to trial conduct. Trials 2013. [PMCID: PMC3980686 DOI: 10.1186/1745-6215-14-s1-o79] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Macefield R, Blencowe N, Brookes S, Jacobs M, Sprangers M, Williamson P, Blazeby J. Core outcome set development: the effect of Delphi panel composition and feedback on prioritisation of outcomes. Trials 2013. [PMCID: PMC3980343 DOI: 10.1186/1745-6215-14-s1-p77] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Lane JA, Davis M, Down E, Macefield R, Neal D, Hamdy F, Donovan J, Taylor H. Evaluation of source data verification in a multicentre cancer trial (PROTECT). Trials 2013. [PMCID: PMC3981621 DOI: 10.1186/1745-6215-14-s1-o80] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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