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Durrand JW, Moore J, Danjoux G. Prehabilitation and preparation for surgery: has the digital revolution arrived? Anaesthesia 2021; 77:635-639. [PMID: 34793598 DOI: 10.1111/anae.15622] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2021] [Indexed: 12/24/2022]
Affiliation(s)
- J W Durrand
- Northern School of Anaesthesia and Intensive care Medicine, Health Education England-North East, Newcastle-upon-Tyne, UK.,Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle-upon-Tyne, UK
| | - J Moore
- Department of Anaesthesia and Intensive Care Medicine, Manchester University NHS Foundation Trust, Manchester, UK.,Greater Manchester Cancer Clinical Director for Prehab and Recovery, Manchester, UK
| | - G Danjoux
- Department of Peri-operative and Sleep Medicine, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK.,Hull York Medical School, York, UK
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McDonald S, Yates D, Durrand JW, Kothmann E, Sniehotta FF, Habgood A, Colling K, Hollingsworth A, Danjoux G. Exploring patient attitudes to behaviour change before surgery to reduce peri-operative risk: preferences for short- vs. long-term behaviour change. Anaesthesia 2019; 74:1580-1588. [PMID: 31637700 DOI: 10.1111/anae.14826] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2019] [Indexed: 01/13/2023]
Abstract
Pre-operative intervention to improve general health and readiness for surgery is known as prehabilitation. Modification of risk factors such as physical inactivity, smoking, hazardous alcohol consumption and an unhealthy weight can reduce the risk of peri-operative morbidity and improve patient outcomes. Interventions may need to target multiple risk behaviours. The acceptability to patients is unclear. We explored motivation, confidence and priority for changing health behaviours before surgery for short-term peri-operative health benefits in comparison with long-term general health benefits. A total of 299 participants at three UK hospital Trusts completed a structured questionnaire. We analysed participant baseline characteristics and risk behaviour profiles using independent sample t-tests and odds ratios. Ratings of motivation, confidence and priority were analysed using paired sample t-tests. We identified a substantial prevalence of risk behaviours in this surgical population, and clustering of multiple behaviours in 42.1% of participants. Levels of motivation, confidence and priority for increasing physical activity, weight management and reducing alcohol consumption were higher for peri-operative vs. longer term benefits. There was no difference for smoking cessation, and participants reported lower confidence for achieving this compared with other behaviours. Participants were also more confident than motivated in reducing their alcohol consumption pre-operatively. Overall, confidence ratings were lower than motivation levels in both the short- and long-term. This study identifies both substantial patient desire to modify behaviours for peri-operative benefit and the need for structured pre-operative support. These results provide objective evidence in support of a 'pre-operative teachable moment', and of patients' desire to change behaviours for health benefits in the short term.
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Affiliation(s)
- S McDonald
- The Centre for Clinical Research, The University of Queensland, Brisbane, QLD, Australia
| | - D Yates
- Department of Anaesthesia, York Teaching Hospitals NHS Foundation Trust, York, UK
| | - J W Durrand
- Department of Anaesthesia, James Cook University Hospital, Middlesbrough, UK
| | - E Kothmann
- Department of Anaesthesia, University Hospitals of North Tees and Hartlepool, Stockton-on-Tees, UK
| | - F F Sniehotta
- Institute of Health and Society, Newcastle University, Newcastle, UK
| | - A Habgood
- Department of Anaesthesia, Northumbria Healthcare NHS Foundation Trust, Northern Deanery, UK
| | - K Colling
- Department of Anaesthesia, James Cook University Hospital, Middlesbrough, UK
| | - A Hollingsworth
- Academic Department of Military Surgery & Trauma, Royal Center for Defence Medicine, Birmingham, UK
| | - G Danjoux
- Department of Anaesthesia, James Cook University Hospital, Middlesbrough, UK
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Hepple DJ, Durrand JW, Bouamra O, Godfrey P. Impact of a physician-led pre-hospital critical care team on outcomes after major trauma. Anaesthesia 2018; 74:473-479. [DOI: 10.1111/anae.14501] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2018] [Indexed: 01/22/2023]
Affiliation(s)
- D. J. Hepple
- Northern School of Anaesthesia and Intensive Care Medicine; Newcastle UK
| | - J. W. Durrand
- Northern School of Anaesthesia and Intensive Care Medicine; Newcastle UK
| | - O. Bouamra
- The Trauma Audit and Research Network; Faculty of Biology Medicine and Health; The University of Manchester; UK
| | - P. Godfrey
- Department of Anaesthesia; James Cook University Hospital; Middlesbrough UK
- Great North Air Ambulance Service; Darlington UK
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Durrand JW, Wagstaff K, Kasim A, Cawthorn L, Danjoux GR, Kothmann E. Reliability of repeated arm-crank cardiopulmonary exercise tests in patients with small abdominal aortic aneurysm. Anaesthesia 2018; 73:967-971. [PMID: 29727012 DOI: 10.1111/anae.14312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2018] [Indexed: 11/28/2022]
Abstract
Arm-crank ergometry may be useful in patients unable to pedal, for instance due to peripheral arterial disease. Twenty participants with small abdominal aortic aneurysm undertook two serial arm-crank tests and then a pedal test, four of whom had indeterminate anaerobic thresholds, precluding analysis. The mean (SD) peak arm and leg oxygen consumptions in 16 participants were 13.71 (2.62) ml.kg-1 .min-1 and 16.82 (4.44) ml.kg-1 .min-1 , with mean (SD) individual differences of 3.11 (2.48) ml.kg-1 .min-1 , p = 0.0001. The respective values at the anaerobic thresholds were 7.83 (1.58) ml O2 .kg-1 .min-1 and 10.09 (3.15) ml O2 .kg-1 .min-1 , with mean (SD) individual differences of 2.26 (2.34) ml O2 .kg-1 .min-1 , p = 0.0001. The correlation coefficients (95%CI) for peak oxygen consumption and anaerobic threshold were 0.88 (0.62-1.0) and 0.70 (0.32-1.0). There were no significant differences in serial arm-crank tests, with intracluster correlations (95%CI) of 0.87 (0.86-0.88) and 0.65 (0.61-0.69) for peak oxygen consumption and anaerobic threshold, respectively.
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Affiliation(s)
- J W Durrand
- Northern School of Anaesthesia and Intensive Care Medicine, Health Education North East, Newcastle-upon-Tyne, UK
| | - K Wagstaff
- Department of Anaesthesia, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - A Kasim
- Wolfson Research Institute for Health and Wellbeing, Durham University, Durham, UK
| | - L Cawthorn
- Department of Anaesthesia, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
| | - G R Danjoux
- Department of Anaesthesia, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK.,Health and Social Care Institute, Teesside University, Middlesbrough, UK
| | - E Kothmann
- Department of Anaesthesia, North Tees and Hartlepool NHS Foundation Trust, Middlesbrough, UK
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O'Neill BR, Batterham AM, Hollingsworth AC, Durrand JW, Danjoux GR. Do first impressions count? Frailty judged by initial clinical impression predicts medium-term mortality in vascular surgical patients. Anaesthesia 2016; 71:684-91. [PMID: 27018374 DOI: 10.1111/anae.13404] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2016] [Indexed: 01/01/2023]
Abstract
Recognising frailty during pre-operative assessment is important. Frail patients experience higher mortality rates and are less likely to return to baseline functional status following the physiological insult of surgery. We evaluated the association between an initial clinical impression of frailty and all-cause mortality in 392 patients attending our vascular pre-operative assessment clinic. Prevalence of frailty assessed by the initial clinical impression was 30.6% (95% CI 26.0-35.2%). There were 133 deaths in 392 patients over a median follow-up period of 4 years. Using Cox regression, adjusted for age, sex, revised cardiac risk index and surgery (yes/no), the hazard ratio for mortality for frail vs. not-frail was 2.14 (95% CI 1.51-3.05). The time to 20% mortality was 16 months in the frail group and 33 months in the not-frail group. The initial clinical impression is a useful screening tool to identify frail patients in pre-operative assessment.
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Affiliation(s)
- B R O'Neill
- Department of Anaesthesia, Royal Liverpool and Broadgreen University Hospitals, Liverpool, UK
| | - A M Batterham
- Health and Social Care Institute, Teesside University, Middlesbrough, UK
| | - A C Hollingsworth
- Department of General & Vascular Surgery, James Cook University Hospital, Middlesbrough, UK
| | - J W Durrand
- Northern School of Anaesthesia and Intensive Care Medicine, Health Education North East, Newcastle-upon-Tyne, UK
| | - G R Danjoux
- Department of Academic Anaesthesia, James Cook University Hospital, Middlesbrough, UK.,Health and Social Care Institute, Teesside University, Middlesbrough, UK
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Affiliation(s)
- J W Durrand
- Department of Academic Anaesthesia, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
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Durrand JW, Batterham AM, O'Neill BR, Danjoux GR. Prevalence and implications of a difference in systolic blood pressure between one arm and the other in vascular surgical patients. Anaesthesia 2013; 68:1247-52. [PMID: 24147883 DOI: 10.1111/anae.12452] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/04/2013] [Indexed: 11/28/2022]
Abstract
Inter-arm differences in blood pressure may confound haemodynamic management in vascular surgery. We evaluated 898 patients in the vascular pre-assessment clinic to determine the prevalence of inter-arm differences in systolic and mean arterial pressure, quantify the consequent risk of clinical error in siting monitoring peri-operatively and evaluate systolic inter-arm difference as a predictor of all-cause mortality (median follow-up 49 months). The prevalence of a systolic inter-arm difference ≥ 15 mmHg was 26% (95% CI 23-29%). The prevalence of an inter-arm mean arterial pressure difference ≥ 10 mmHg was 26% (95% CI 23-29%) and 11% (95% CI 9-13%) for a difference ≥ 15 mmHg. Monitoring could be erroneously sited in an arm reading lower for systolic pressure once in every seven to nine patients. The hazard ratio for a systolic inter-arm difference ≥ 15 mmHg vs < 15 mmHg was 1.03 (95% CI 0.78-1.36, p = 0.84). Large inter-arm blood pressure differences are common in this population, with a high potential for monitoring errors. Systolic inter-arm difference was not associated with medium-term mortality. [Correction added on 17 October 2013, after first online publication: In the Summary the sentence beginning 'We evaluated 898 patients' was corrected from (median (IQR [range]) follow-up 49 months) to read (median follow up 49 months)].
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Affiliation(s)
- J W Durrand
- Department of Academic Anaesthesia, James Cook University Hospital, Middlesbrough, UK
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