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1. Vascular Surgery Workforce: Evaluation and Estimation of Future Demand in the United Kingdom

Author

Aoife Kiernan, Fiona Boland, Denis W. Harkin, Sarah Alzayyat, Áine Ryan, Sophie Renton, Lucy Wales, and Christopher Imray

Subjects
Surgery, General Medicine, Cardiology and Cardiovascular Medicine
Abstract

Vascular disease is a common cause of death and disability in our growing elderly population and the demand for vascular procedures is increasing worldwide. Workforce planning is essential to meet future demand and provide safe vascular services. Our aim was to evaluate the current workforce in the United Kingdom and estimate future demand for vascular surgeons.From November 2020 to January 2021, we surveyed UK vascular surgeons for information on their work patterns. We estimated current vascular surgery (VS) workforce using the National Vascular Registry (NVR) data and population data from the Office for National Statistics. To estimate future demand, we interrogated Hospital Episode Statistic (HES) data using Hospital Admitted Patient Care Activity (HAPCA) and linear trend analysis.NVR data estimate that currently there are 518 consultant VS in the United Kingdom, or 1 per 128,951 population, lower than international comparisons. HAPCA data (2012-2020) suggests VS Finished Consultant Episodes (FCE), admissions, and waiting lists are growing by approximately 2% per year, and we estimate the workforce will need to grow by more than 50% over the next 10 years to meet this demand and Vascular Society of Great Britain and Ireland recommendation.The UK has a shortage of vascular surgeons at a time when vascular activity is increasing. The VS workforce, both VS consultant and vascular surgeons in training numbers need to expand to address the ongoing shortage and maintain a safe level of service.

Published
2022

2. Documenting the Recovery of Vascular Services in European Centres Following the Initial COVID-19 Pandemic Peak: Results from a Multicentre Collaborative Study

Author

Ruth A. Benson, Maria Antonella Ruffino, Sharon Chan, Patrick Coughlin, Ayoola Awopetu, Philip Stather, Tristan Lane, Dimitrios Theodosiou, Mohamed Abozeid Ahmed, Thodur Vasudevan, Mohammed Ibrahim, Faraj Al Maadany, Mohamed Eljareh, Fatimah Saad Alkhafeefi, Raphael Coscas, Ertekin Utku Ünal, Raffaele Pulli, Sergio Zacà, Domenico Angiletta, Thomas Kotsis, Magdy Moawad, Matteo Tozzi, Nikolaos Patelis, Andreas M. Lazaris, Jason Chuen, Alexander Croo, Elpiniki Tsolaki, Gladiol Zenunaj, Dhafer Kamal, Mahmoud MH. Tolba, Martin Maresch, Vipul Khetarpaul, Joseph Mills, Gaurav Gangwani, Mohamed Elahwal, Rana Khalil, Mohammed A. Azab, Anver Mahomed, Richard Whiston, Ummul Contractor, Davide Esposito, Carlo Pratesi, Elena Giacomelli, Martín Veras Troncoso, Stephane Elkouri, Flavia Gentile Johansson, Ilias Dodos, Marie Benezit, José Vidoedo, João Rocha-Neves, António Henrique Pereira-Neves, Marina Felicidade Dias-Neto, Ana Filipa Campos Jácome, Luis Loureiro, Ivone Silva, Rodrigo Garza-Herrera, Victor Canata, Charlotte Bezard, Kathryn Bowser, Jorge Felipe Tobar, Carlos Gomez Vera, Carolina Salinas Parra, Eugenia Lopez, Yvis Gadelha Serra, Juan Varela, Vanessa Rubio, Gerardo Victoria, Adam Johnson, Leigh Ann O’Banion, Ragai Makar, Tamer Ghatwary Tantawy, Martin Storck, Vincent Jongkind, Orwa falah, Olivia McBride, Arda Isik, Athanasios Papaioannou, Paulo Eduardo Ocke Reis, Umberto Marcello Bracale, Ellie Atkins, Giovanni Tinelli, Emma Scott, Lucy Wales, Ashwin Sivaharan, Georgia Priona, Craig Nesbitt, Tabitha Grainger, Lauren Shelmerdine, Patrick Chong, Adnan Bajwa, Luke Arwynck, Nancy Hadjievangelou, Ahmed Elbasty, Oscar Rubio, Michael Ricardo, Jorge H. Ulloa, Marcos Tarazona, Manuel Pabon, Georgios Pitoulias, Kevin Corless, Orestis Ioannidis, Oliver Friedrich, Isabelle Van Herzeele, Badri Vijaynagar, Tina Cohnert, Rachel Bell, Hayley Moore, Prakash Saha, Edward Gifford, Matti Laine, Adel Barkat, Christos Karkos, Lenny Suryani Binti Safri, Gabriel Buitron, Javier Del Castillo, Paul Carrera, Nilson Salinas, Rodrigo Bruno Biagioni, Sergio Benites, César Andrés Mafla, Putera Mas Pian, Pereira Albino, Ernesto Serrano, Andres Marin, Marco González, Marsha Foreroga, Alejandro Russo, Andrés Reyes, Daniel Guglielmone, Lorena Grillo, Ronald Flumignan, Francisco Gomez Palones, Pierre Galvagni Silveira, Rosnelifaizur Bin Ramely, Sara Edeiken, Ian Chetter, Lucy Green, Abhilash Sudarsanam, Oliver Lyons, Gary Lemmon, Richard Neville, Mariano Castelli, Carlos A. Hinojosa, Rubén Rodríguez Carvajal, Aksim Rivera, Peng Wong, Laura Drudi, Jeremy Perkins, Kishore Sieunarine, Doaa Attia, Mahmoud Atef, Lostoridis Eftychios, Fred Weaver, Leong Chuo Ren, Mohannad Alomari, Reda Jamjoom, Qusai Aljarrah, Ayman Abbas, Faris Alomran, Ambrish Kumar, Abdulmajeed Altoijri, Kareem T. ElSanhoury, Ahmed Alhumaid, Tamer Fekry, Raghuram Sekhar, Panagiotis Theodoridis, Theodoridis Panagiotis, Konstantinos Roditis, Paraskevi Tsiantoula, Afroditi Antoniou, Raphael Soler, Natasha Hasemaki, Efstratia Baili, Eustratia Mpaili, Bella Huasen, Tom Wallace, Andrew Duncan, Matthew Metcalfe, Kristyn Mannoia, Carlos F. Bechara, Nikolaos Tsilimparis, Nathan Aranson, David Riding, Mariano Palena, Ciarán McDonnell, Nicolas J. Mouawad, Shonda Banegas, Peter Rossi, Taohid Oshodi, Rodney Diaz, Rana Afifi, Shiva Dindyal, Ankur Thapar, Ali Kordzadeh, Gonzalo Pullas, Stephanie Lin, Chris Davies, Katy Darvall, Akio Kodama, Thushan Gooneratne, Nalaka Gunawansa, Alberto Munoz, Ng Jun Jie, Nicholas Bradley, Wissam Al-Jundi, Felicity Meyer, Cheong Lee, Martin Malina, Sophie Renton, Dennis Lui, Andrew Batchelder, Grzegorz Oszkinis, Antonio Freyrie, Jacopo Giordano, Nikolaos Saratzis, Konstantinos Tigkiropoulos, Stavridis Kyriakos, Guriy Popov, Muhammad Usman Cheema, Pierfrancesco Lapolla, Yih Chun Ling Patricia, Raed Ennab, Brant W. Ullery, Ketino Pasenidou, Jacky Tam, Gabriel Sidel, Vivek Vardhan Jayaprakash, Lisa Bennett, Simon Hardy, Emma Davies, Sara Baker, Lasantha Wijesinghe, Adam Tam, Ken McCune, Manik Chana, Chris Lowe, Aaron Goh, Katarzyna Powezka, Ioanna Kyrou, Nishath Altaf, Denis Harkin, Hannah Travers, James Cragg, Atif sharif, Tasleem Akhtar, José Antonio Chávez, Claudia Ordonez, Martin Mazzurco, Edward Choke, Imran Asghar, Virginia Summerour, Paul Dunlop, Rachel Morley, Thomas Hardy, Paul Bevis, Robert Cuff, Konstantinos Stavroulakis, Efthymios Beropoulis, Angeliki Argyriou, Ian Loftus, Bilal Azhar, Sharvil Sheth, Marco Virgilio Usai, Asad Choudhry, Kira Nicole, Emily Boyle, Doireann Joyce, Mohammed Hassan Abdelaty Hassan, Alberto Saltiel, Gert Frahm-Jensen, George Antoniou, Muhammed Elhadi, Ali Kimyaghalam, Rafael Malgor, Leigh Ann O'Banion, Diego Telve, Andrej Isaak, Jürg Schmidli, Kevin McKevitt, Tam Siddiqui, Giuseppe Asciutto, Nikolaos Floros, George Papadopoulos, Alexandros Kafetzakis, Stylianos G. Koutsias, Petroula Nana, Athanasios Giannoukas, Stavros Kakkos, Konstantinos G. Moulakakis, Natasha Shafique, Arkadiusz Jawien, Matthew Popplewell, Chris Imray, Kumar Abayasekara, Timothy Rowlands, Ganesh Kuhan, Sriram Rajagopalan, Anthony Jaipersad, Uzma Sadia, Isaac Kobe, Devender Mittapalli, Ibrahim Enemosah, Christian-Alexander Behrendt, Adam Beck, Muayyad Almudhafer, Stefano Ancetti, Donald Jacobs, Priya Jayakumar, Fatemeh Malekpour, Sherene Shalhub, Boboyor Keldiyorov, Meryl Simon, Manar Khashram, Nicole Rich, Amanda Shepherd, Lewis Meecham, Daniel Doherty, Surgery, ACS - Atherosclerosis & ischemic syndromes, ACS - Microcirculation, Benson, Ruth A, Bracale, Umberto Marcello, Ruffino M.A., Chan S., Coughlin P., Awopetu A., Stather P., Lane T., Theodosiou D., Ahmed M.A., Vasudevan T., Ibrahim M., Al Maadany F., Eljareh M., Alkhafeefi F.S., Coscas R., Unal E.U., Pulli R., Zaca S., Angiletta D., Kotsis T., Moawad M., Tozzi M., Patelis N., Lazaris A.M., Chuen J., Croo A., Tsolaki E., Zenunaj G., Kamal D., Tolba M.M., Maresch M., Khetarpaul V., Mills J., Gangwani G., Elahwal M., Khalil R., Azab M.A., Mahomed A., Whiston R., Contractor U., Esposito D., Pratesi C., Giacomelli E., Troncoso M.V., Elkouri S., Johansson F.G., Dodos I., Benezit M., Vidoedo J., Rocha-Neves J., Pereira-Neves A.H., Dias-Neto M.F., Campos Jacome A.F., Loureiro L., Silva I., Garza-Herrera R., Canata V., Bezard C., Bowser K., Tobar J.F., Vera C.G., Parra C.S., Lopez E., Serra Y.G., Varela J., Rubio V., Victoria G., Johnson A., O'Banion L.A., Makar R., Tantawy T.G., Storck M., Jongkind V., falah O., McBride O., Isik A., Papaioannou A., Ocke Reis P.E., Bracale U.M., Atkins E., Tinelli G., Scott E., Wales L., Sivaharan A., Priona G., Nesbitt C., Grainger T., Shelmerdine L., Chong P., Bajwa A., Arwynck L., Hadjievangelou N., Elbasty A., Rubio O., Ricardo M., Ulloa J.H., Tarazona M., Pabon M., Pitoulias G., Corless K., Ioannidis O., Friedrich O., Van Herzeele I., Vijaynagar B., Cohnert T., Bell R., Moore H., Saha P., Gifford E., Laine M., Barkat A., Karkos C., Binti Safri L.S., Buitron G., Del Castillo J., Carrera P., Salinas N., Biagioni R.B., Benites S., Mafla C.A., Pian P.M., Albino P., Serrano E., Marin A., Gonzalez M., Foreroga M., Russo A., Reyes A., Guglielmone D., Grillo L., Flumignan R., Palones F.G., Silveira P.G., Ramely R.B., Edeiken S., Chetter I., Green L., Sudarsanam A., Lyons O., Lemmon G., Neville R., Castelli M., Hinojosa C.A., Carvajal R.R., Rivera A., Wong P., Drudi L., Perkins J., Sieunarine K., Attia D., Atef M., Eftychios L., Weaver F., Ren L.C., Alomari M., Jamjoom R., Aljarrah Q., Abbas A., Alomran F., Kumar A., Altoijri A., ElSanhoury K.T., Alhumaid A., Fekry T., Sekhar R., Theodoridis P., Panagiotis T., Roditis K., Tsiantoula P., Antoniou A., Soler R., Hasemaki N., Baili E., Mpaili E., Huasen B., Wallace T., Duncan A., Metcalfe M., Mannoia K., Bechara C.F., Tsilimparis N., Aranson N., Riding D., Palena M., McDonnell C., Mouawad N.J., Banegas S., Rossi P., Oshodi T., Diaz R., Afifi R., Dindyal S., Thapar A., Kordzadeh A., Pullas G., Lin S., Davies C., Darvall K., Kodama A., Gooneratne T., Gunawansa N., Munoz A., Jie N.J., Bradley N., Al-Jundi W., Meyer F., Lee C., Malina M., Renton S., Lui D., Batchelder A., Oszkinis G., Freyrie A., Giordano J., Saratzis N., Tigkiropoulos K., Kyriakos S., Popov G., Cheema M.U., Lapolla P., Ling Patricia Y.C., Ennab R., Ullery B.W., Pasenidou K., Tam J., Sidel G., Jayaprakash V.V., Bennett L., Hardy S., Davies E., Baker S., Wijesinghe L., Tam A., McCune K., Chana M., Lowe C., Goh A., Powezka K., Kyrou I., Altaf N., Harkin D., Travers H., Cragg J., sharif A., Akhtar T., Chavez J.A., Ordonez C., Mazzurco M., Choke E., Asghar I., Summerour V., Dunlop P., Morley R., Hardy T., Bevis P., Cuff R., Stavroulakis K., Beropoulis E., Argyriou A., Loftus I., Azhar B., Sheth S., Usai M.V., Choudhry A., Nicole K., Boyle E., Joyce D., Abdelaty Hassan M.H., Saltiel A., Frahm-Jensen G., Antoniou G., Elhadi M., Kimyaghalam A., Malgor R., Telve D., Isaak A., Schmidli J., McKevitt K., Siddiqui T., Asciutto G., Floros N., Papadopoulos G., Kafetzakis A., Koutsias S.G., Nana P., Giannoukas A., Kakkos S., Moulakakis K.G., Shafique N., Jawien A., Popplewell M., Imray C., Abayasekara K., Rowlands T., Kuhan G., Rajagopalan S., Jaipersad A., Sadia U., Kobe I., Mittapalli D., Enemosah I., Behrendt C.-A., Beck A., Almudhafer M., Ancetti S., Jacobs D., Jayakumar P., Malekpour F., Shalhub S., Keldiyorov B., Simon M., Khashram M., Rich N., Shepherd A., Meecham L., Doherty D., and Benson R.A.

Subjects
Vascular surgery, Peripheral artery disease, Settore MED/11 - MALATTIE DELL'APPARATO CARDIOVASCOLARE, Abdominal aortic aneurysm, COVID-19, 610 Medicine & health, Surgery, AAA, Cardiology and Cardiovascular Medicine, Survey, Settore MED/22 - CHIRURGIA VASCOLARE, PAD
Abstract

OBJECTIVE To document the recovery of vascular services in Europe following the first COVID-19 pandemic peak. METHODS An online structured vascular service survey with repeated data entry between 23 March and 9 August 2020 was carried out. Unit level data were collected using repeated questionnaires addressing modifications to vascular services during the first peak (March - May 2020, "period 1"), and then again between May and June ("period 2") and June and July 2020 ("period 3"). The duration of each period was similar. From 2 June, as reductions in cases began to be reported, centres were first asked if they were in a region still affected by rising cases, or if they had passed the peak of the first wave. These centres were asked additional questions about adaptations made to their standard pathways to permit elective surgery to resume. RESULTS The impact of the pandemic continued to be felt well after countries' first peak was thought to have passed in 2020. Aneurysm screening had not returned to normal in 21.7% of centres. Carotid surgery was still offered on a case by case basis in 33.8% of centres, and only 52.9% of centres had returned to their normal aneurysm threshold for surgery. Half of centres (49.4%) believed their management of lower limb ischaemia continued to be negatively affected by the pandemic. Reduced operating theatre capacity continued in 45.5% of centres. Twenty per cent of responding centres documented a backlog of at least 20 aortic repairs. At least one negative swab and 14 days of isolation were the most common strategies used for permitting safe elective surgery to recommence. CONCLUSION Centres reported a broad return of services approaching pre-pandemic "normal" by July 2020. Many introduced protocols to manage peri-operative COVID-19 risk. Backlogs in cases were reported for all major vascular surgeries.

Published
2022
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3. Vascular Surgeon Burnout and Resilience in the United Kingdom: A Report from the Vascular Society Workforce Committee

Author

Denis Harkin, Sarah Alzayyat, Aoife Kiernan, Áine Ryan, Fiona Boland, Sophie Renton, Lucy Wales, and Christopher Imray

Subjects
Adult, Male, Surgeons, General Medicine, Burnout, Psychological, Middle Aged, United Kingdom, Cross-Sectional Studies, Treatment Outcome, Surveys and Questionnaires, Workforce, Humans, Surgery, Female, Cardiology and Cardiovascular Medicine, Burnout, Professional
Abstract

Occupational burnout is a growing concern in frontline roles such as vascular surgery, and is associated with medical errors and shortened careers. Our aim is to measure burnout, resilience, and associated risk factors among vascular surgeons (VS) in the United Kingdom (UK).We carried out an electronic survey of active VS in the UK using validated self-report questionnaires, including the following: Copenhagen Burnout Inventory (CBI), Brief Resilience Scale (BRS), and information on job characteristics, health, and well-being. Univariate regression analysis looked at potential risk factors.One hundred forty-eight VS responded (49% participation rate), and after excluding retirees and nonconsultants, 133 VS practicing in the UK were analyzed. Mean age was 49.9 ± 7.19 years; the majority (83.5%) were male. In total, 81.3% recorded ethnic identity as White. In addition, 93.2% worked full time; 74.8% were contracted above 10 programmed activities and 87.9% worked more than 40 hr/week. On-call was 1 in 6, or above, for 87.4%. Overall, 38.4% of VS had high burnout on the CBI. Resilience was also high, with BRS mean (standard deviation) of 3.6 (0.69) and median (interquartile range) of 3.7 (3-4). Univariate regression analysis found no significant risk factor associated with high burnout or resilience.VS in the UK have high levels of burnout and work long hours. Resilience levels were also high, which may offer some protection. However, policymakers and our surgical leaders should address contributing factors and excessive working hours and establish measures to identify and support surgeon well-being for optimal surgeon and patient safety.

Published
2021

4. Second asymptomatic carotid surgery trial (ACST-2): a randomised comparison of carotid artery stenting versus carotid endarterectomy

Author

Alison Halliday, Richard Bulbulia, Leo H Bonati, Johanna Chester, Andrea Cradduck-Bamford, Richard Peto, Hongchao Pan, John Potter, Hans Henning Eckstein, Barbara Farrell, Marcus Flather, Averil Mansfield, Boby Mihaylova, Kazim Rahimi, David Simpson, Dafydd Thomas, Peter Sandercock, Richard Gray, Andrew Molyneux, Cliff P Shearman, Peter Rothwell, Anna Belli, Will Herrington, Parminder Judge, Peter Leopold, Marion Mafham, Michael Gough, Piergiorgio Cao, Sumaira MacDonald, Vasha Bari, Clive Berry, S Bradshaw, Wojciech Brudlo, Alison Clarke, Robin Cox, Susan Fathers, Kamran Gaba, Mo Gray, Elizabeth Hayter, Constance Holliday, Rijo Kurien, Michael Lay, Steffi le Conte, Jessica McManus, Zahra Madgwick, Dylan Morris, Andrew Munday, Sandra Pickworth, Wiktor Ostasz, Michiel Poorthuis, Sue Richards, Louisa Teixeira, Sergey Tochlin, Lynda Tully, Carol Wallis, Monique Willet, Alan Young, Renato Casana, Chiara Malloggi, Andrea Odero Jr, Vincenzo Silani, Gianfranco Parati, Giuseppe Malchiodi, Giovanni Malferrari, Francesco Strozzi, Nicola Tusini, Enrico Vecchiati, Gioacchino Coppi, Antonio Lauricella, Roberto Moratto, Roberto Silingardi, Jessica Veronesi, Andrea Zini, Emanuele Ferrero, Michelangelo Ferri, Andrea Gaggiano, Carmelo Labate, Franco Nessi, Daniele Psacharopulo, Andrea Viazzo, Giovanni Malacrida, Daniela Mazzaccaro, Giovanni Meola, Alfredo Modafferi, Giovanni Nano, Maria Teresa Occhiuto, Paolo Righini, Silvia Stegher, Stefano Chiarandini, Filippo Griselli, Sandro Lepidi, Fabio Pozzi Mucelli, Marcello Naccarato, Mario D'Oria, Barbara Ziani, Andrea Stella, Mortalla Dieng, Gianluca Faggioli, Mauro Gargiulo, Sergio Palermo, Rodolfo Pini, Giovanni Maria Puddu, Andrea Vacirca, Domenico Angiletta, Claudio Desantis, Davide Marinazzo, Giovanni Mastrangelo, Guido Regina, Raffaele Pulli, Paolo Bianchi, Lea Cireni, Elisabetta Coppi, Rocco Pizzirusso, Filippo Scalise, Giovanni Sorropago, Valerio Tolva, Valeria Caso, Enrico Cieri, Paola DeRango, Luca Farchioni, Giacomo Isernia, Massimo Lenti, Gian Battista Parlani, Guglielmo Pupo, Grazia Pula, Gioele Simonte, Fabio Verzini, Federico Carimati, Maria Luisa Delodovici, Federico Fontana, Gabriele Piffaretti, Matteo Tozzi, Efrem Civilini, Giorgio Poletto, Bernhard Reimers, Barbara Praquin, Sonia Ronchey, Laura Capoccia, Wassim Mansour, Enrico Sbarigia, Francesco Speziale, Pasqualino Sirignano, Danilo Toni, Roberto Galeotti, Vincenzo Gasbarro, Francesco Mascoli, Tiberio Rocca, Elpiniki Tsolaki, Giulia Bernardini, Ester DeMarco, Alessia Giaquinta, Francesco Patti, Massimiliano Veroux, Pierfrancesco Veroux, Carla Virgilio, Nicola Mangialardi, Matteo Orrico, Vincenzo Di Lazzaro, Nunzio Montelione, Francesco Spinelli, Francesco Stilo, Carlo Cernetti, Sandro Irsara, Giuseppe Maccarrone, Diego Tonello, Adriana Visonà, Beniamino Zalunardo, Emiliano Chisci, Stefano Michelagnoli, Nicola Troisi, Maela Masato, Massimo Dei Negri, Andrea Pacchioni, Salvatore Saccà, Giovanni Amatucci, Alfredo Cannizzaro, Federico Accrocca, Cesare Ambrogi, Renzo Barbazza, Giustino Marcucci, Andrea Siani, Guido Bajardi, Giovanni Savettieri, Angelo Argentieri, Riccardo Corbetta, Attilio Odero, Pietro Quaretti, Federico Z Thyrion, Alessandro Cappelli, Domenico Benevento, Gianmarco De Donato, Maria Agnese Mele, Giancarlo Palasciano, Daniela Pieragalli, Alessandro Rossi, Carlo Setacci, Francesco Setacci, Domenico Palombo, Maria Cecilia Perfumo, Edoardo Martelli, Aldo Paolucci, Santi Trimarchi, Viviana Grassi, Luigi Grimaldi, Giuliana La Rosa, Domenico Mirabella, Matteo Scialabba, Leonildo Sichel, Costantino L D'Angelo, Gian Franco Fadda, Holta Kasemi, Mario Marino, Francesco Burzotta, Francesco Alberto Codispoti, Angela Ferrante, Giovanni Tinelli, Yamume Tshomba, Claudio Vincenzoni, Deborah Amis, Dawn Anderson, Martin Catterson, Mike Clarke, Michelle Davis, Anand Dixit, Alexander Dyker, Gary Ford, Ralph Jackson, Sreevalsan Kappadath, David Lambert, Tim Lees, Stephen Louw, James McCaslin, Noala Parr, Rebecca Robson, Gerard Stansby, Lucy Wales, Vera Wealleans, Lesley Wilson, Michael Wyatt, Hardeep Baht, Ibrahim Balogun, Ilse Burger, Tracy Cosier, Linda Cowie, Gunaratnam Gunathilagan, David Hargroves, Robert Insall, Sally Jones, Hannah Rudenko, Natasha Schumacher, Jawaharlal Senaratne, George Thomas, Audrey Thomson, Tom Webb, Ellen Brown, Bernard Esisi, Ali Mehrzad, Shane MacSweeney, Norman McConachie, Alison Southam, Wayne Sunman, Ahmed Abdul-Hamiq, Jenny Bryce, Ian Chetter, Duncan Ettles, Raghuram Lakshminarayan, Kim Mitchelson, Christopher Rhymes, Graham Robinson, Paul Scott, Alison Vickers, Ray Ashleigh, Stephen Butterfield, Ed Gamble, Jonathan Ghosh, Charles N McCollum, Mark Welch, Sarah Welsh, Leszek Wolowczyk, Mary Donnelly, Stephen D'Souza, Anselm A Egun, Bindu Gregary, Thomas Joseph, Christine Kelly, Shuja Punekar, M Asad Rahi, Sonia Raj, Dare Seriki, George Thomson, James Brown, Ragunath Durairajan, Iris Grunwald, Paul Guyler, Paula Harman, Matthew Jakeways, Christopher Khuoge, Ashish Kundu, Thayalini Loganathan, Nisha Menon, Raji O Prabakaran, Devesh Sinha, Vicky Thompson, Sharon Tysoe, Dennis Briley, Chris Darby, Linda Hands, Dominic Howard, Wilhelm Kuker, Ursula Schulz, Rachel Teal, David Barer, Andrew Brown, Susan Crawford, Paul Dunlop, Ramesh Krishnamurthy, Nikhil Majmudar, Duncan Mitchell, Min P Myint, Richard O'Brien, Janice O'Connell, Naweed Sattar, Shanmugam Vetrivel, Jonathan Beard, Trevor Cleveland, Peter Gaines, John Humphreys, Alison Jenkins, Craig King, Daniel Kusuma, Ralph Lindert, Robbie Lonsdale, Raj Nair, Shah Nawaz, Faith Okhuoya, Douglas Turner, Graham Venables, Paul Dorman, Andrea Hughes, Deborah Jones, David Mendelow, Helen Rodgers, Aidas Raudoniitis, Peter Enevoldson, Hans Nahser, Imelda O'Brien, Francesco Torella, Dave Watling, Richard White, Pauline Brown, Dipankar Dutta, Lorraine Emerson, Paula Hilltout, Sachin Kulkarni, Jackie Morrison, Keith Poskitt, Fiona Slim, Sarah Smith, Amanda Tyler, Joanne Waldron, Mark Whyman, Milda Bajoriene, Lucy Baker, Amanda Colston, Bekky Eliot-Jones, Gita Gramizadeh, Catherine Lewis-Clarke, Laura McCafferty, Deborah Oliver, Debbie Palmer, Abhijeet Patil, Suzannah Pegler, Gopi Ramadurai, Aisling Roberts, Tracey Sargent, Shivaprasad Siddegowda, Ravi Singh-Ranger, Akintunde Williams, Lucy Williams, Steve Windebank, Tadas Zuromskis, Lanka Alwis, Jane Angus, Asaipillai Asokanathan, Caroline Fornolles, Diana Hardy, Sophy Hunte, Frances Justin, Duke Phiri, Marie Mitabouana-Kibou, Lakshmanan Sekaran, Sakthivel Sethuraman, Margaret L Tate, Joyce Akyea-Mensah, Stephen Ball, Angela Chrisopoulou, Elizabeth Keene, Alison Phair, Steven Rogers, John V Smyth, Colin Bicknell, Jeremy Chataway, Nicholas Cheshire, Andrew Clifton, Caroline Eley, Richard Gibbs, Mohammad Hamady, Beth Hazel, Alex James, Michael Jenkins, Nyma Khanom, Austin Lacey, Maz Mireskandari, Joanna O'Reilly, Antony Pereira, Tina Sachs, John Wolfe, Philip Davey, Gill Rogers, Gemma Smith, Gareth Tervit, Ian Nichol, Andrew Parry, Gavin Young, Simon Ashley, James Barwell, Francis Dix, Azlisham M Nor, Chris Parry, Angela Birt, Paul Davies, Jim George, Anne Graham, Leon Jonker, Nicci Kelsall, Caroline Potts, Toni Wilson, Jamie Crinnion, Larissa Cuenoud, Nikola Aleksic, Srdan Babic, Nenad Ilijevski, Đorde Radak, Dragan Sagic, Slobodan Tanaskovic, Momcilo Colic, Vladimir Cvetic, Lazar Davidovic, Dejana R Jovanovic, Igor Koncar, Perica Mutavdžic, Miloš Sladojevic, Ivan Tomic, Eike S Debus, Ulrich Grzyska, Dagmar Otto, Götz Thomalla, Jessica Barlinn, Johannes Gerber, Kathrin Haase, Christian Hartmann, Stefan Ludwig, Volker Pütz, Christian Reeps, Christine Schmidt, Norbert Weiss, Sebastian Werth, Simon Winzer, Janine Gemper, Albrecht Günther, Bianka Heiling, Elisabeth Jochmann, Panagiota Karvouniari, Carsten Klingner, Thomas Mayer, Julia Schubert, Friederike Schulze-Hartung, Jürgen Zanow, Yvonne Bausback, Franka Borger, Spiridon Botsios, Daniela Branzan, Sven Bräunlich, Henryk Hölzer, Janin Lenzer, Christopher Piorkowski, Nadine Richter, Johannes Schuster, Dierk Scheinert, Andrej Schmidt, Holger Staab, Matthias Ulrich, Martin Werner, Hermann Berger, Gábor Biró, Hans-Henning Eckstein, Michael Kallmayer, Kornelia Kreiser, Alexander Zimmermann, Bärbel Berekoven, Klaus Frerker, Vera Gordon, Giovanni Torsello, Sebastian Arnold, Cora Dienel, Martin Storck, Bernhard Biermaier, Hans Martin Gissler, Christof Klötzsch, Tomas Pfeiffer, Ralph Schneider, Leander Söhl, Michael Wennrich, Angelika Alonso, Michael Keese, Christoph Groden, Andreas Cöster, Andreas Engelhardt, Christoph-Maria Ratusinski, Bengt Berg, Martin Delle, Johan Formgren, Peter Gillgren, Lotta Jarl, Torbjörn B Kall, Peter Konrad, Niklas Nyman, Claes Skiöldebrand, Johnny Steuer, Rabbe Takolander, Jonas Malmstedt, Stefan Acosta, Katarina Björses, Kerstin Brandt, Nuno Dias, Anders Gottsäter, Jan Holst, Thorarinn Kristmundsson, Tobias Kühme, Tilo Kölbel, Bengt Lindblad, Mats Lindh, Martin Malina, Tomas Ohrlander, Tim Resch, Viola Rönnle, Björn Sonesson, 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Staffa, Robert Vlachovský, Bohuslav Vojtíšek, Tomáš Hrbác, Martin Kuliha, Václav Procházka, Martin Roubec, David Školoudík, David Netuka, Anna Šteklácová, Vladimír Beneš III, Pavel Buchvald, Ladislav Endrych, Miroslav Šercl, Walter Campos Jr, Ivan B Casella, Nelson de Luccia, André E V Estenssoro, Calógero Presti, Pedro Puech-Leão, Celso R B Neves, Erasmo S da Silva, Cid J Sitrângulo Jr, José A T Monteiro, Gisela Tinone, Marcelo Bellini Dalio, Edwaldo E Joviliano, Octávio M Pontes Neto, Mauricio Serra Ribeiro, Patrick Cras, Jeroen M H Hendriks, Mieke Hoppenbrouwers, Patrick Lauwers, Caroline Loos, Laetitia Yperzeele, Mia Geenens, Dimitri Hemelsoet, Isabelle van Herzeele, Frank Vermassen, Parla Astarci, Frank Hammer, Valérie Lacroix, André Peeters, Robert Verhelst, Silvana Cirelli, Pol Dormal, Annelies Grimonprez, Bart Lambrecht, Philipe Lerut, Eddy Thues, Guy De Koster, Quentin Desiron, Alain Maertens de Noordhout, Danielle Malmendier, Mireille Massoz, Georges Saad, Marc Bosiers, Joren Callaert, Koen Deloose, Estrella Blanco Cañibano, Beatriz García Fresnillo, Mercedes Guerra Requena, Pilar C Morata Barrado, Miguel Muela Méndez, Antonio Yusta Izquierdo, Fernando Aparici Robles, Paula Blanes Orti, Luis García Dominguez, Rafael Martínez López, Manuel Miralles Hernández, José I Tembl Ferrairo, Ángel Chamorro, Juan Macho, Víctor Obach, Vincent Riambau, Luis San Román, Frank J Ahlhelm, Kristine Blackham, Stefan Engelter, Thomas Eugster, Henrik Gensicke, Lorenz Gürke, Philippe Lyrer, Luigi Mariani, Marina Maurer, Edin Mujagic, Mandy Müller, Marios Psychogios, Peter Stierli, Christoph Stippich, Christopher Traenka, Thomas Wolff, Benjamin Wagner, Martina M Wiegert, Sandra Clarke, Michael Diepers, Ernst Gröchenig, Philipp Gruber, Andrej Isaak, Timo Kahles, Regula Marti, Krassen Nedeltchev, Luca Remonda, Nadir Tissira, Martina Valença Falcão, Gert J de Borst, Rob H Lo, Frans L Moll, Raechel Toorop, Bart H van der Worp, Evert J Vonken, Jaap L Kappelle, Ommid Jahrome, Floris 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S., Lambert D., Lees T., Louw S., McCaslin J., Parr N., Robson R., Stansby G., Wales L., Wealleans V., Wilson L., Wyatt M., Baht H., Balogun I., Burger I., Cosier T., Cowie L., Gunathilagan G., Hargroves D., Insall R., Jones S., Rudenko H., Schumacher N., Senaratne J., Thomas G., Thomson A., Webb T., Brown E., Esisi B., Mehrzad A., MacSweeney S., McConachie N., Southam A., Sunman W., Abdul-Hamiq A., Bryce J., Chetter I., Ettles D., Lakshminarayan R., Mitchelson K., Rhymes C., Robinson G., Scott P., Vickers A., Ashleigh R., Butterfield S., Gamble E., Ghosh J., McCollum C.N., Welch M., Welsh S., Wolowczyk L., Donnelly M., D'Souza S., Egun A.A., Gregary B., Joseph T., Kelly C., Punekar S., Rahi M.A., Raj S., Seriki D., Thomson G., Brown J., Durairajan R., Grunwald I., Guyler P., Harman P., Jakeways M., Khuoge C., Kundu A., Loganathan T., Menon N., Prabakaran R.O., Sinha D., Thompson V., Tysoe S., Briley D., Darby C., Hands L., Howard D., Kuker W., Schulz U., Teal R., Barer D., Brown A., Crawford S., Dunlop P., Krishnamurthy R., Majmudar N., Mitchell D., Myint M.P., O'Brien R., O'Connell J., Sattar N., Vetrivel S., Beard J., Cleveland T., Gaines P., Humphreys J., Jenkins A., King C., Kusuma D., Lindert R., Lonsdale R., Nair R., Nawaz S., Okhuoya F., Turner D., Venables G., Dorman P., Hughes A., Jones D., Mendelow D., Rodgers H., Raudoniitis A., Enevoldson P., Nahser H., O'Brien I., Torella F., Watling D., White R., Brown P., Dutta D., Emerson L., Hilltout P., Kulkarni S., Morrison J., Poskitt K., Slim F., Smith S., Tyler A., Waldron J., Whyman M., Bajoriene M., Baker L., Colston A., Eliot-Jones B., Gramizadeh G., Lewis-Clarke C., McCafferty L., Oliver D., Palmer D., Patil A., Pegler S., Ramadurai G., Roberts A., Sargent T., Siddegowda S., Singh-Ranger R., Williams A., Williams L., Windebank S., Zuromskis T., Alwis L., Angus J., Asokanathan A., Fornolles C., Hardy D., Hunte S., Justin F., Phiri D., Mitabouana-Kibou M., Sekaran L., Sethuraman S., Tate M.L., Akyea-Mensah 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S., Branzan D., Braunlich S., Holzer H., Lenzer J., Piorkowski C., Richter N., Schuster J., Scheinert D., Schmidt A., Staab H., Ulrich M., Werner M., Berger H., Biro G., Eckstein H.-H., Kallmayer M., Kreiser K., Zimmermann A., Berekoven B., Frerker K., Gordon V., Torsello G., Arnold S., Dienel C., Storck M., Biermaier B., Gissler H.M., Klotzsch C., Pfeiffer T., Schneider R., Sohl L., Wennrich M., Alonso A., Keese M., Groden C., Coster A., Engelhardt A., Ratusinski C.-M., Berg B., Delle M., Formgren J., Gillgren P., Jarl L., Kall T.B., Konrad P., Nyman N., Skioldebrand C., Steuer J., Takolander R., Malmstedt J., Acosta S., Bjorses K., Brandt K., Dias N., Gottsater A., Holst J., Kristmundsson T., Kuhme T., Kolbel T., Lindblad B., Lindh M., Malina M., Ohrlander T., Resch T., Ronnle V., Sonesson B., Warvsten M., Zdanowski Z., Campbell E., Kjellin P., Lindgren H., Nyberg J., Petersen B., Plate G., Parsson H., Qvarfordt P., Ignatenko P., Karpenko A., Starodubtsev V., Chernyavsky M.A., Golovkova M.S., Komakha B.B., Zherdev N.N., Belyasnik A., Chechulov P., Kandyba D., Stepanishchev I., Csobay-Novak C., Dosa E., Entz L., Nemes B., Szeberin Z., Barzo P., Bodosi M., Fako E., Fulop B., Nemeth T., Pazdernyik S., Skoba K., Voros E., Chatzinikou E., Giannoukas A., Karathanos C., Koutsias S., Kouvelos G., Matsagkas M., Ralli S., Rountas C., Rousas N., Spanos K., Brountzos E., Kakisis J.D., Lazaris A., Moulakakis K.G., Stefanis L., Tsivgoulis G., Vasdekis S., Antonopoulos C.N., Bellenis I., Maras D., Polydorou A., Polydorou V., Tavernarakis A., Ioannou N., Terzoudi M., Lazarides M., Mantatzis M., Vadikolias K., Dzieciuchowicz L., Gabriel M., Krasinski Z., Oszkinis G., Pukacki F., Slowinski M., Stanisic M.-G., Staniszewski R., Tomczak J., Zielinski M., Myrcha P., Rozanski D., Drelichowski S., Iwanowski W., Koncewicz K., Bialek P., Biejat Z., Czepel W., Czlonkowska A., Dowzenko A., Jedrzejewska J., Kobayashi A., Leszczynski J., Malek A., Polanski J., Proczka R., Skorski M., Szostek M., Andziak P., Dratwicki M., Gil R., Nowicki M., Pniewski J., Rzezak J., Seweryniak P., Dabek P., Juszynski M., Madycki G., Pacewski B., Raciborski W., Slowinski P., Staszkiewicz W., Bombic M., Chlouba V., Fiedler J., Hes K., Kostal P., Sova J., Kriz Z., Privara M., Reif M., Staffa R., Vlachovsky R., Vojtisek B., Hrbac T., Kuliha M., Prochazka V., Roubec M., Skoloudik D., Netuka D., Steklacova A., Benes III V., Buchvald P., Endrych L., Sercl M., Campos W., Casella I.B., de Luccia N., Estenssoro A.E.V., Presti C., Puech-Leao P., Neves C.R.B., da Silva E.S., Sitrangulo C.J., Monteiro J.A.T., Tinone G., Bellini Dalio M., Joviliano E.E., Pontes Neto O.M., Serra Ribeiro M., Cras P., Hendriks J.M.H., Hoppenbrouwers M., Lauwers P., Loos C., Yperzeele L., Geenens M., Hemelsoet D., van Herzeele I., Vermassen F., Astarci P., Hammer F., Lacroix V., Peeters A., Verhelst R., Cirelli S., Dormal P., Grimonprez A., Lambrecht B., Lerut P., Thues E., De Koster G., Desiron Q., Maertens de Noordhout A., Malmendier D., Massoz M., Saad G., Bosiers M., Callaert J., Deloose K., Blanco Canibano E., Garcia Fresnillo B., Guerra Requena M., Morata Barrado P.C., Muela Mendez M., Yusta Izquierdo A., Aparici Robles F., Blanes Orti P., Garcia Dominguez L., Martinez Lopez R., Miralles Hernandez M., Tembl Ferrairo J.I., Chamorro A., Macho J., Obach V., Riambau V., San Roman L., Ahlhelm F.J., Blackham K., Engelter S., Eugster T., Gensicke H., Gurke L., Lyrer P., Mariani L., Maurer M., Mujagic E., Muller M., Psychogios M., Stierli P., Stippich C., Traenka C., Wolff T., Wagner B., Wiegert M.M., Clarke S., Diepers M., Grochenig E., Gruber P., Isaak A., Kahles T., Marti R., Nedeltchev K., Remonda L., Tissira N., Valenca Falcao M., de Borst G.J., Lo R.H., Moll F.L., Toorop R., van der Worp B.H., Vonken E.J., Kappelle J.L., Jahrome O., Vos F., Schuiling W., van Overhagen H., Keunen R.W.M., Knippenberg B., Wever J.J., Lardenoije J.W., Reijnen M., Smeets L., van Sterkenburg S., Fraedrich G., Gizewski E., Gruber I., Knoflach M., Kiechl S., Rantner B., Abdulamit T., Bergeron P., Padovani R., Trastour J.-C., Cardon J.-M., Le Gallou-Wittenberg A., Allaire E., Becquemin J.-P., Cochennec-Paliwoda F., Desgranges P., Hosseini H., Kobeiter H., Marzelle J., Almekhlafi M.A., Bal S., Barber P.A., Coutts S.B., Demchuk A.M., Eesa M., Gillies M., Goyal M., Hill M.D., Hudon M.E., Jambula A., Kenney C., Klein G., McClelland M., Mitha A., Menon B.K., Morrish W.F., Peters S., Ryckborst K.J., Samis G., Save S., Smith E.E., Stys P., Subramaniam S., Sutherland G.R., Watson T., Wong J.H., Zimmel L., Flis V., Matela J., Miksic K., Milotic F., Mrdja B., Stirn B., Tetickovic E., Gasparini M., Grad A., Kompara I., Milosevic Z., Palmiste V., Toomsoo T., Aidashova B., Kospanov N., Lyssenko R., Mussagaliev D., Beyar R., Hoffman A., Karram T., Kerner A., Nikolsky E., Nitecki S., Andonova S., Bachvarov C., Petrov V., Cvjetko I., Vidjak V., Haluzan D., Petrunic M., Liu B., Liu C.-W., Bartko D., Beno P., Rusnak F., Zelenak K., Ezura M., Inoue T., Kimura N., Kondo R., Matsumoto Y., Shimizu H., Endo H., Furui E., Bakke S., Krohg-Sorensen K., Nome T., Skjelland M., Tennoe B., Albuquerque e Castro J., Alves G., Bastos Goncalves F., de Aragao Morais J., Garcia A.C., Valentim H., Vasconcelos L., Belcastro F., Cura F., Zaefferer P., Abd-Allah F., Eldessoki M.H., Heshmat Kassem H., Soliman Gharieb H., Colgan M.P., Haider S.N., Harbison J., Madhavan P., Moore D., Shanik G., Kazan V., Nazzal M., Ramsey-Williams V., and Gargiulo M

Subjects
Male, medicine.medical_specialty, Time Factors, Time Factor, medicine.medical_treatment, Carotid Stenosi, MEDLINE, Carotid endarterectomy, Rate ratio, Risk Assessment, Asymptomatic, law.invention, Randomized controlled trial, law, Risk Factors, carotid artery stenting (CAS), carotid endarterectomy (CEA), Stent, medicine, Humans, Carotid Stenosis, Stroke, Endarterectomy, Aged, Endarterectomy, Carotid, business.industry, carotid artery, Risk Factor, Articles, General Medicine, trial, medicine.disease, Settore MED/22 - CHIRURGIA VASCOLARE, Surgery, Stenosis, Treatment Outcome, Settore MED/11 - MALATTIE DELL'APPARATO CARDIOVASCOLARE, Female, Stents, Human medicine, medicine.symptom, business, Human
Abstract

Summary Background Among asymptomatic patients with severe carotid artery stenosis but no recent stroke or transient cerebral ischaemia, either carotid artery stenting (CAS) or carotid endarterectomy (CEA) can restore patency and reduce long-term stroke risks. However, from recent national registry data, each option causes about 1% procedural risk of disabling stroke or death. Comparison of their long-term protective effects requires large-scale randomised evidence. Methods ACST-2 is an international multicentre randomised trial of CAS versus CEA among asymptomatic patients with severe stenosis thought to require intervention, interpreted with all other relevant trials. Patients were eligible if they had severe unilateral or bilateral carotid artery stenosis and both doctor and patient agreed that a carotid procedure should be undertaken, but they were substantially uncertain which one to choose. Patients were randomly allocated to CAS or CEA and followed up at 1 month and then annually, for a mean 5 years. Procedural events were those within 30 days of the intervention. Intention-to-treat analyses are provided. Analyses including procedural hazards use tabular methods. Analyses and meta-analyses of non-procedural strokes use Kaplan-Meier and log-rank methods. The trial is registered with the ISRCTN registry, ISRCTN21144362. Findings Between Jan 15, 2008, and Dec 31, 2020, 3625 patients in 130 centres were randomly allocated, 1811 to CAS and 1814 to CEA, with good compliance, good medical therapy and a mean 5 years of follow-up. Overall, 1% had disabling stroke or death procedurally (15 allocated to CAS and 18 to CEA) and 2% had non-disabling procedural stroke (48 allocated to CAS and 29 to CEA). Kaplan-Meier estimates of 5-year non-procedural stroke were 2·5% in each group for fatal or disabling stroke, and 5·3% with CAS versus 4·5% with CEA for any stroke (rate ratio [RR] 1·16, 95% CI 0·86–1·57; p=0·33). Combining RRs for any non-procedural stroke in all CAS versus CEA trials, the RR was similar in symptomatic and asymptomatic patients (overall RR 1·11, 95% CI 0·91–1·32; p=0·21). Interpretation Serious complications are similarly uncommon after competent CAS and CEA, and the long-term effects of these two carotid artery procedures on fatal or disabling stroke are comparable. Funding UK Medical Research Council and Health Technology Assessment Programme.

Published
2021

5. The power is in our hands: a QI project for sustainable hand hygiene

Author

Lucy Wales and Ghazaleh Mohammadi-Zaniani

Subjects
Data collection, Quality management, business.industry, media_common.quotation_subject, Audit, medicine.disease, Surgical department, Hygiene, Hospital-acquired infection, medicine, General Materials Science, Methicillin sensitive, Medical emergency, business, PDCA, media_common
Abstract

Background Methicillin Sensitive Staphylococcus Aureus (MSSA) is a commensal associated with hospital acquired infection (HAI). MSSA HAI is associated with significant morbidity, and hand hygiene has been identified as a prominent component of HAI prevention strategies. Methods A project using Quality Improvement methodology was devised to improve rates within the surgical department: a locally identified MSSA HAI hotspot. Baseline monitoring was done using WHO checklists and departmental education presented on hand hygiene. Continued weekly auditing and feedback was carried out by the multidisciplinary team (MDT) on one ward over a four-month period, and adherence was prompted by verbal reminders and departmental education. A long-term strategy was employed for regular monitoring with a nominated member of the MDT to maintain improvements. Results Baseline audit revealed adherence of 10-52% for registrar-led rounds, and 22-62% for consultant-led, across the 5 points of hand hygiene. Particular weakness was noted before patient contact and entry to clinical areas, which was addressed with departmental education. Initial adherence after education was low (6-38%), but subsequent improvement was seen the following month (74-93%). Some of this was maintained over the final two months of data collection (50%-100%), and a PDSA cycle was employed to address this variability. As such, an MDT-wide monitoring schedule was put in place at the end of the data collection period. Conclusion This QI project sought to achieve sustainable change in adherence to hand hygiene. An MDT-wide system of monitoring and education effected this, and may prove an effective strategy in similar inpatient settings.

Published
2020
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6. Global impact of the first coronavirus disease 2019 (COVID-19) pandemic wave on vascular services

Author

Ruth A Benson, Sandip Nandhra, Joseph Shalhoub, Nikesh Dattani, Graeme K Ambler, David C Banquet, David C Bosanquet, Rachael Forsythe, Sarah Onida, George Dovell, Louise Hitchman, Ryan Preece, Athanasios Saratzis, Chris Imray, Adam Johnson, Andrew Choong, Jun Jie Ng, Sarah Aitken, Jana-Lee Moss, Abhilash Sudarsanam, Adam Tam, Adam W Beck, Adel Barkat, Adnan Bajwa, Ahmed Elbasty, A I Awopetu, Akio Kodama, Aksim G Rivera, Alberto Munoz, Alberto Saltiel, Alejandro Russo, Alex Rolls, Alexandros Kafetzakis, Ali Kimyaghalam, Ali Kordzadeh, Amanda Shepherd, Aminder Singh, Andrea Mingoli, Andreas M Lazaris, Andrej Isaak, Andres Marin, Andrés Reyes Valdivia, Andrew Batchelder, Andrew Duncan, Angeliki Argyriou, Anthony S Jaipersad, Antonio Freyrie, António Pereira-Neves, Anver Mahomed, Arda Isik, Arkadiusz Jawien, Asad J Choudhry, Ashwin Sivaharan, Athanasios Giannoukas, Athanasios Papaioannou, Ayman Abbas, Bakoyiannis Christos, Bekir Bogachan Akkaya, Bella Huasen, Bibombe Patrice, Mwipatayi, Bilal Azhar, Boboyor Keldiyorov, Brant W Ullery, Carlo Pratesi, Carlos A Hinojosa, Carlos F Bechara, Carolina Salinas Parra, Charalabopoulos Alexandros, Charlotte Bezard, Cheong Jun Lee, Chris Davies, Christian-Alexander Behrendt, Christopher Lowe, Christos D Karkos, Chun Ling Patricia Yih, Ciarán McDonnell, Claudia Ordonez, Craig Nesbitt, Croo Alexander, Daniel Guglielmone, Daniel T Doherty, David M Riding, Davide Esposito, Denis Harkin, Dennis H Lui, Dhafer M Kamal, Diego Telve, Dimitrios Theodosiou, Domenico Angiletta, Donald Jacobs, Edward Choke, Edward D Gifford, Efthymios Beropoulis, Eftychios Lostoridis, Eleanor Atkins, Elena Giacomelli, Elpiniki Tsolaki, Emma Davies, Emma Scott, Emmanouil Katsogridakis, Ernesto Serrano, Ertekin Utku Unal, Eugenia Lopez, Eustratia Mpaili, Fabrizio Minelli, Fatemeh Malekpour, Fatma Mousa, Felicity Meyer, Felipe Tobar, Filipa Jácome, Flavia Gentile Johansson, Fred Weaver, Gabriel Ab Proaño, Gabriel Sidel, Ganesh Kuhan, Gary Lemmon, George A Antoniou, George Papadopoulos, Georgios Pitoulias, Georgopoulos Sotirios, Gerardo Victoria, Gert Frahm-Jensen, Giovanni Tinelli, Giuseppe Asciutto, Gladiol Zenunaj, Gómez Vera Carlos Eduardo, Gonzalo Pullas, Grzegorz Oszkinis, Guriy Popov, Hakkı Zafer İscan, Hannah C Travers, Hashem Barakat, Hayrettin Levent Mavioglu, Ian Chetter, Ian Loftus, Ilias Dodos, Imran Asghar, Isabelle Van Herzeele, Jacopo Giordano, James Cragg, Jason Chuen, Javier Del Castillo Orrego, Jeremy Perkins, João Rocha-Neves, Jorge H Ulloa, José Antonio Chávez, José Vidoedo, Joseph Faraj, Joseph Mills, Juan Varela, Jürg Schmidli, Kakavia Kiriaki, Katarzyna Powezka, Kathryn Bowser, Katy Darvall, Kenneth McCune, Ketino Pasenidou, Kevin Corless, Kevin McKevitt, Kira Nicole Long, Konstantinos G Moulakakis, Konstantinos Roditis, Konstantinos Stavroulakis, Konstantinos Tigkiropoulos, Kristyn Mannoia, Kumar Abayasekara, Lalithapriya Jayakumar, Lasantha Wijesinghe, Laura Drudi, Lauren Shelmerdine, Leigh Ann O'Banion, Lewis Meecham, Lisa F Bennett, Lorena Grillo, Lucy Green, Lucy Wales, Luís Loureiro, Luis Mariano Palena, Mahmoud Mh Tolba, Manar Khashram, Manik Chana, Manuel Pabon, Marco González, Marco Virgilio Usai, Marcos Tarazona, Maria A Ruffino, Mariano Castelli, Marie Benezit, Marina Dias-Neto, Martin Malina, Martin Maresch, Martin Mazzurco, Martin Storck, Martín Veras Troncoso, Matt Popplewell, Matteo Tozzi, Matthew Metcalfe, Matti Laine, Mhammed Rawhi, Michael Ricardo, Mingzheng Aaron Goh, Mohamed Abozeid Ahmed, Mohammed Ibrahim, Mohannad Alomari, Muayyad Almudhafer, Muhammed Elhadi, Nalaka Gunawansa, Nancy Hadjievangelou, Natasha Hasemaki, Natasha Shafique, Nathan Aranson, Nicholas Bradley, Nicolas J Mouawad, Nicole C Rich, Nikolaos Floros, Nikolaos Patelis, Nikolaos Saratzis, Nikolaos Tsilimparis, Nilson Salinas, Nishath Altaf, Oliver Friedrich, Oliver Lyons, Olivia M B McBride, Orestis Ioannidis, Orwa Falah, Panagiotis Theodoridis, Paolo Sapienza, Paraskevi Tsiantoula, Patrick Chong, Patrick Coughlin, Paul Bevis, Paul Carrera, Paul Dunlop, Peng Foo Wong, Pereira Albino, Peter Rossi, Petroula Nana, Philip W Stather, Pierfrancesco Lapolla, Pierre Galvagni Silveira, Prakash Saha, Pranav Somaiya, Putera Mas Pian, Rachael L Morley, Rachel Bell, Raed M Ennab, Rafael Malgor, Raffaele Pulli, Ragai Makar, Raghuram Sekhar, Rana Afifi, Raphael Coscas, Raphael Soler, Robert F Cuff, Rodney Diaz, Rodrigo Biagioni, Rosnelifaizur Bin Ramely, Rubén Rodríguez Carvajal, Sandeep Jhajj, Sara Edeiken, Sergio Benites, Sergio Zacà, Sharath Paravastu, Sharon Chan, Sharvil Sheth, Sherene Shalhub, Shiva Dindyal, Shonda Banegas, Simon Hardy, Simona Sica, Siu Chung Tam, Sivaram Premnath, Sophie Renton, Sriram Rajagopalan, Stavridis Kyriakos, Stavros Kakkos, Stefano Ancetti, Stephane Elkouri, Stephanie Lin, Stephen Wing Keung Cheng, Stylianos G Koutsias, Tabitha Grainger, Tamer Fekry, Tamer Ghatwary Tantawy, Tamim Siddiqui, Taohid Oshodi, Tasleem Akhtar, Thomas James Hardy, Thomas Kotsis, Thushan Gooneratne, Timothy Rowlands, Tina U Cohnert, Tom Wallace, Tristan R A Lane, Umberto Marcello Bracale, Usman Cheema, Uzma Sadia, Vanessa Rubio, Victor Canata, Vincent Jongkind, Vipul Khetarpaul, Virginia Summerour, Walter Dorigo, Wissam Al-Jundi, Xun Luo, Yamume Tshomba, Yvis Gadelha Serra, A Benson, Ruth, Nandhra, Sandip, Shalhoub, Joseph, Dattani, Nikesh, K Ambler, Graeme, C Banquet, David, C Bosanquet, David, Forsythe, Rachael, Onida, Sarah, Dovell, George, Hitchman, Louise, Preece, Ryan, Saratzis, Athanasio, Imray, Chri, Johnson, Adam, Choong, Andrew, Jie Ng, Jun, Aitken, Sarah, Moss, Jana-Lee, Sudarsanam, Abhilash, Tam, Adam, W Beck, Adam, Barkat, Adel, Bajwa, Adnan, Elbasty, Ahmed, I Awopetu, A, Kodama, Akio, G Rivera, Aksim, Munoz, Alberto, Saltiel, Alberto, Russo, Alejandro, Rolls, Alex, Kafetzakis, Alexandro, Kimyaghalam, Ali, Kordzadeh, Ali, Shepherd, Amanda, Singh, Aminder, Mingoli, Andrea, M Lazaris, Andrea, Isaak, Andrej, Marin, Andre, Reyes Valdivia, André, Batchelder, Andrew, Duncan, Andrew, Argyriou, Angeliki, S Jaipersad, Anthony, Freyrie, Antonio, Pereira-Neves, António, Mahomed, Anver, Isik, Arda, Jawien, Arkadiusz, J Choudhry, Asad, Sivaharan, Ashwin, Giannoukas, Athanasio, Papaioannou, Athanasio, Abbas, Ayman, Christos, Bakoyianni, Bogachan Akkaya, Bekir, Huasen, Bella, Patrice, Bibombe, Mwipatayi, Azhar, Bilal, Keldiyorov, Boboyor, W Ullery, Brant, Pratesi, Carlo, A Hinojosa, Carlo, F Bechara, Carlo, Salinas Parra, Carolina, Alexandros, Charalabopoulo, Bezard, Charlotte, Jun Lee, Cheong, Davies, Chri, Behrendt, Christian-Alexander, Lowe, Christopher, D Karkos, Christo, Ling Patricia Yih, Chun, Mcdonnell, Ciarán, Ordonez, Claudia, Nesbitt, Craig, Alexander, Croo, Guglielmone, Daniel, T Doherty, Daniel, M Riding, David, Esposito, Davide, Harkin, Deni, H Lui, Denni, M Kamal, Dhafer, Telve, Diego, Theodosiou, Dimitrio, Angiletta, Domenico, Jacobs, Donald, Choke, Edward, D Gifford, Edward, Beropoulis, Efthymio, Lostoridis, Eftychio, Atkins, Eleanor, Giacomelli, Elena, Tsolaki, Elpiniki, Davies, Emma, Scott, Emma, Katsogridakis, Emmanouil, Serrano, Ernesto, Utku Unal, Ertekin, Lopez, Eugenia, Mpaili, Eustratia, Minelli, Fabrizio, Malekpour, Fatemeh, Mousa, Fatma, Meyer, Felicity, Tobar, Felipe, Jácome, Filipa, Gentile Johansson, Flavia, Weaver, Fred, Ab Proaño, Gabriel, Sidel, Gabriel, Kuhan, Ganesh, Lemmon, Gary, A Antoniou, George, Papadopoulos, George, Pitoulias, Georgio, Sotirios, Georgopoulo, Victoria, Gerardo, Frahm-Jensen, Gert, Tinelli, Giovanni, Asciutto, Giuseppe, Zenunaj, Gladiol, Vera Carlos Eduardo, Gómez, Pullas, Gonzalo, Oszkinis, Grzegorz, Popov, Guriy, Zafer İscan, Hakkı, C Travers, Hannah, Barakat, Hashem, Levent Mavioglu, Hayrettin, Chetter, Ian, Loftus, Ian, Dodos, Ilia, Asghar, Imran, Van Herzeele, Isabelle, Giordano, Jacopo, Cragg, Jame, Chuen, Jason, Del Castillo Orrego, Javier, Perkins, Jeremy, Rocha-Neves, João, H Ulloa, Jorge, Antonio Chávez, José, Vidoedo, José, Faraj, Joseph, Mills, Joseph, Varela, Juan, Schmidli, Jürg, Kiriaki, Kakavia, Powezka, Katarzyna, Bowser, Kathryn, Darvall, Katy, Mccune, Kenneth, Pasenidou, Ketino, Corless, Kevin, Mckevitt, Kevin, Nicole Long, Kira, G Moulakakis, Konstantino, Roditis, Konstantino, Stavroulakis, Konstantino, Tigkiropoulos, Konstantino, Mannoia, Kristyn, Abayasekara, Kumar, Jayakumar, Lalithapriya, Wijesinghe, Lasantha, Drudi, Laura, Shelmerdine, Lauren, Ann O'Banion, Leigh, Meecham, Lewi, F Bennett, Lisa, Grillo, Lorena, Green, Lucy, Wales, Lucy, Loureiro, Luí, Mariano Palena, Lui, Mh Tolba, Mahmoud, Khashram, Manar, Chana, Manik, Pabon, Manuel, González, Marco, Virgilio Usai, Marco, Tarazona, Marco, A Ruffino, Maria, Castelli, Mariano, Benezit, Marie, Dias-Neto, Marina, Malina, Martin, Maresch, Martin, Mazzurco, Martin, Storck, Martin, Veras Troncoso, Martín, Popplewell, Matt, Tozzi, Matteo, Metcalfe, Matthew, Laine, Matti, Rawhi, Mhammed, Ricardo, Michael, Aaron Goh, Mingzheng, Abozeid Ahmed, Mohamed, Ibrahim, Mohammed, Alomari, Mohannad, Almudhafer, Muayyad, Elhadi, Muhammed, Gunawansa, Nalaka, Hadjievangelou, Nancy, Hasemaki, Natasha, Shafique, Natasha, Aranson, Nathan, Bradley, Nichola, J Mouawad, Nicola, C Rich, Nicole, Floros, Nikolao, Patelis, Nikolao, Saratzis, Nikolao, Tsilimparis, Nikolao, Salinas, Nilson, Altaf, Nishath, Friedrich, Oliver, Lyons, Oliver, B McBride, Olivia M, Ioannidis, Oresti, Falah, Orwa, Theodoridis, Panagioti, Sapienza, Paolo, Tsiantoula, Paraskevi, Chong, Patrick, Coughlin, Patrick, Bevis, Paul, Carrera, Paul, Dunlop, Paul, Foo Wong, Peng, Albino, Pereira, Rossi, Peter, Nana, Petroula, W Stather, Philip, Lapolla, Pierfrancesco, Galvagni Silveira, Pierre, Saha, Prakash, Somaiya, Pranav, Mas Pian, Putera, L Morley, Rachael, Bell, Rachel, M Ennab, Raed, Malgor, Rafael, Pulli, Raffaele, Makar, Ragai, Sekhar, Raghuram, Afifi, Rana, Coscas, Raphael, Soler, Raphael, F Cuff, Robert, Diaz, Rodney, Biagioni, Rodrigo, Bin Ramely, Rosnelifaizur, Rodríguez Carvajal, Rubén, Jhajj, Sandeep, Edeiken, Sara, Benites, Sergio, Zacà, Sergio, Paravastu, Sharath, Chan, Sharon, Sheth, Sharvil, Shalhub, Sherene, Dindyal, Shiva, Banegas, Shonda, Hardy, Simon, Sica, Simona, Chung Tam, Siu, Premnath, Sivaram, Renton, Sophie, Rajagopalan, Sriram, Kyriakos, Stavridi, Kakkos, Stavro, Ancetti, Stefano, Elkouri, Stephane, Lin, Stephanie, Wing Keung Cheng, Stephen, G Koutsias, Styliano, Grainger, Tabitha, Fekry, Tamer, Ghatwary Tantawy, Tamer, Siddiqui, Tamim, Oshodi, Taohid, Akhtar, Tasleem, James Hardy, Thoma, Kotsis, Thoma, Gooneratne, Thushan, Rowlands, Timothy, U Cohnert, Tina, Wallace, Tom, A Lane, Tristan R, Bracale, UMBERTO MARCELLO, Cheema, Usman, Sadia, Uzma, Rubio, Vanessa, Canata, Victor, Jongkind, Vincent, Khetarpaul, Vipul, Summerour, Virginia, Dorigo, Walter, Al-Jundi, Wissam, Luo, Xun, Tshomba, Yamume, and Gadelha Serra, Yvis

Subjects
Global Health, Health Care Surveys, Health Services Accessibility, Humans, Pandemics, Practice Patterns, Physicians', Prospective Studies, Vascular Surgical Procedures, COVID-19, Physicians', Pandemic, Practice Patterns, Settore MED/22 - CHIRURGIA VASCOLARE, Prospective Studie, Global health, health care surveys, health services accessibility, humans, pandemics, practice patterns, physicians', prospective studies, vascular surgical procedures, Health Care Survey, Rapid Research Communication, Human, Vascular Surgical Procedure
Abstract

Graphical Abstract This online structured survey has demonstrated the global impact of the COVID-19 pandemic on vascular services. The majority of centres have documented marked reductions in operating and services provided to vascular patients. In the months during recovery from the resource restrictions imposed during the pandemic peaks, there will be a significant vascular disease burden awaiting surgeons. Graphical Abstract One of the most affected specialties

Published
2020

7. Making surgical wards safer for patients with diabetes: reducing hypoglycaemia and insulin errors

Author

Lucy Wales, Aminder A. Singh, Angela Adams, Lauren E Jones, Bethany Dudley, and Eliza Davison

Subjects
medicine.medical_specialty, Leadership and Management, medicine.medical_treatment, Psychological intervention, 030209 endocrinology & metabolism, Audit, quality improvement, surgery, 03 medical and health sciences, 0302 clinical medicine, Diabetes mellitus, medicine, 030212 general & internal medicine, business.industry, Health Policy, Insulin, Mortality rate, Public Health, Environmental and Occupational Health, BMJ Quality Improvement report, Guideline, Perioperative, Vascular surgery, medicine.disease, Emergency medicine, diabetes mellitus, audit and feedback, business, PDSA
Abstract

High-quality perioperative diabetes care is essential to improve surgical outcomes for patients with diabetes. Inadequate perioperative diabetes care is associated with increased wound complications, higher mortality rates and increased length of hospital stay. Despite national guidelines, surgical wards remain a high-risk area for poor diabetes care. An initial baseline audit in 2014 of vascular patients with diabetes undergoing major lower limb amputation identified poor glycaemic control in 90% of patients, with high rates of hypoglycaemia and insulin management errors in 75%. Less than 15% of patients received specialist diabetes input and 20% required third-party assistance for hypoglycaemia. This quality improvement project aimed to reduce hypoglycaemia, insulin management errors and patient harm events by 50% in vascular surgery patients over a 3-year period. Key interventions over three successive Plan, Do, Study, Act cycles included educational and guideline initiatives (2015), establishing a diabetes in-reach service (2016) and implementing a whiteboard sugar cube alert system for poor glycaemic control (2017). The final introduction of the whiteboard sugar cube alert system delivered the greatest impact in reducing hypoglycaemia rates by more than 50%, insulin management errors by 70% and patient harm events by 75%.

Published
2018

9. Go West: surgical fellowships in the US

Author

Lucy Wales and Matt Freudmann

Subjects
Transplantation, medicine.medical_specialty, Transplant surgery, Nursing, business.industry, education, Medicine, General Medicine, Vascular surgery, business, Surgical training, humanities, health care economics and organizations
Abstract

As a final-year trainee in vascular surgery, I was working at the West London Renal and Transplant Centre for Professor Nadey Hakim and Vassilios Papalois. I am very grateful to both of them for encouraging me to apply for a visiting fellowship to the United States, enabling me to experience some of the benefits of surgical training abroad and to broaden my perspectives in transplantation. I was awarded a visiting fellowship to the University of Minnesota Transplant Center by Professor David Sutherland, head of the division of transplant surgery.

Published
2008
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10. End-stage vascular access: direct intra-atrial insertion of a dialysis catheter

Author

Lucy, Wales, Jon R, Anderson, Albert, Power, Tariq, Dosani, and Nadey S, Hakim

Subjects
Male, Peripheral Vascular Diseases, Catheters, Indwelling, Renal Dialysis, Humans, Kidney Failure, Chronic, Coronary Artery Bypass, Middle Aged
Abstract

Central venous occlusions are a frequent problem in hemodialysis patients. We describe the case of a patient with end-stage vascular access in whom we successfully inserted a direct intra-atrial dialysis line during coronary artery bypass grafting. This technique could be a significant contribution to patients in whom alternative vascular access options are exhausted.

Published
2008

11. Justifying a third pancreas transplant: a case report

Author

Lucy, Wales, Ruben, Canelo, Tariq, Dosani, Nazar, Mustafa, and Nadey S, Hakim

Subjects
Graft Rejection, Male, Reoperation, Diabetes Mellitus, Type 1, Humans, Pancreas Transplantation, Middle Aged, Kidney Transplantation
Abstract

Early pancreas graft failure after simultaneous pancreas-kidney transplant can occur in up to 20% of recipients. Results after pancreas retransplant continue to improve, with results comparable to primary pancreas transplants. We describe an unusual case of a third pancreas transplant in which a remnant of a previous arterial Y-graft was used for the arterial anastomosis, and we discuss the factors used to justify the decision to do a third pancreas transplant.

Published
2008

12. Arterio-ureteric fistula following iliac angioplasty

Author

Nikolaos Papadakos, Matthew Thompson, Graham Munneke, Ian M. Loftus, Lucy Wales, and Alexander Aarvold

Subjects
medicine.medical_specialty, Urinary Fistula, medicine.medical_treatment, Fistula, Arterial Occlusive Diseases, Ureteric fistula, urologic and male genital diseases, Iliac Artery, Risk Assessment, medicine.artery, Angioplasty, medicine, Humans, Ureteral Diseases, Radiology, Nuclear Medicine and imaging, cardiovascular diseases, Vascular Fistula, medicine.diagnostic_test, urogenital system, business.industry, Urinary diversion, External iliac artery, Interventional radiology, Middle Aged, medicine.disease, Surgery, body regions, Radiation therapy, Radiography, surgical procedures, operative, Treatment Outcome, Female, Radiology, Cardiology and Cardiovascular Medicine, business, Complication, Follow-Up Studies
Abstract

Arterio-ureteric fistulae are rare but can be associated with significant morbidity and mortality. We describe a novel case in which an arterio-ureteric fistula occurred as a complication following external iliac artery angioplasty and stenting, in a patient who had undergone previous pelvic surgery, radiotherapy, ureteric stenting, and urinary diversion surgery. Prompt recognition enabled successful endovascular management using a covered stent.

Published
2007

13. Delayed presentation of right ventricular bullet embolus

Author

Peter L. C. Smith, Lucy Wales, and David P Jenkins

Subjects
Pulmonary and Respiratory Medicine, Thorax, Adult, Male, medicine.medical_specialty, Heart disease, Thoracic Injuries, Heart Ventricles, Embolism, Irritability, Embolus, Foreign-Body Migration, medicine, Humans, Scattering, Radiation, business.industry, medicine.disease, Surgery, body regions, medicine.anatomical_structure, Ventricle, cardiovascular system, Wounds, Gunshot, medicine.symptom, Gunshot wound, Cardiology and Cardiovascular Medicine, Complication, business, Artifacts, Tomography, X-Ray Computed
Abstract

Venous bullet embolism to the heart is a rare complication of penetrating gunshot trauma. There are little data regarding long-term follow-up of missiles retained in the right ventricle. We report a rare case of right ventricular bullet embolus following a left-sided thoracic gunshot wound. The patient presented with delayed onset of cardiac irritability symptoms 4 years after injury.

Published
2001

15. The potassium channel opener levcromakalim causes expansive remodelling of experimental vein grafts

Author

Graham W. Taylor, Alun H. Davies, Martin Gosling, Lucy Wales, and Janet T. Powell

Subjects
Male, Cromakalim, medicine.medical_specialty, Potassium Channels, Intimal hyperplasia, Vasodilator Agents, medicine.medical_treatment, Lumen (anatomy), Vena Cava, Inferior, Vascular remodelling in the embryo, Random Allocation, Double-Blind Method, Restenosis, Angioplasty, Internal medicine, Image Processing, Computer-Assisted, medicine, Animals, Aorta, Vascular Patency, business.industry, medicine.disease, Rats, Surgery, medicine.anatomical_structure, Bypass surgery, Rats, Inbred Lew, Cardiology, Vascular resistance, Potassium channel opener, Cardiology and Cardiovascular Medicine, business
Abstract

Background: Maintenance of luminal area is essential for the optimal performance of venous bypass grafts. However, injury and response to the arterial circulation evoke vascular remodelling that favors intimal hyperplasia, with luminal encroachment and inward remodelling. Potassium channel-opening drugs reduce tissue workload and peripheral vascular resistance and through these mechanisms could favor outward or expansive remodelling of vein grafts. We tested the hypothesis that levcromakalim, a potassium channel opener, would enhance expansive remodelling in vein grafts. Methods: A randomized, double-blind, placebo-controlled trial was conducted in 33 rats with vena cava-to-aorta bypass grafts. Drugs were administered via osmotic pump for 7 days after surgery. Half the cohort had bromodeoxyuridine (BrdU) infused at day 6. Morphometric analysis was conducted of pressure perfusion-fixed grafts harvested at 1 week and 4 weeks. Results: At 1 week, lumen area was similar in both groups (1.82 ± 0.39 mm2 placebo vs 1.85 ± 0.36 mm2 levcromakalim), although medial cell density and BrdU staining were significantly increased in the placebo group. At 4 weeks, lumen area was unchanged in the placebo group (1.88 ± 0.51 mm2) but had increased to 2.32 ± 0.46 mm2 in the levcromakalim group (P = .039 vs 1 week), with a very significant reduction in the intimal area (levcromakalim, 0.06 ± 0.02 mm2 vs placebo, 0.33 ± 0.17 mm2; P = .001). Conclusions: Early, short-term treatment with levcromakalim favors expansive remodelling of experimental vein grafts to mimic the effect of external stenting. This expansive remodelling was associated with a reduction in medial cell proliferation at 1 week. Clinical Relevance: Critical limb ischemia can be treated by bypass surgery or angioplasty, but inward remodelling with restenosis is a common problem. There has been little previous experimental work to identify treatments associated with expansive remodelling, which would increase the chances of vessel patency. Here, in a randomized trial, we show that short-term treatment with a potassium channel opener (a class of drug that can be used to treat hypertension) results in strong, expansive remodelling, with increases the lumen area and graft size of experimental vein grafts by >25%. © 2006 The Society for Vascular Surgery.

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16. Navaho Material Culture

Author

Lucy Wales Kluckhohn, W. W. Hill, Clyde Kluckhohn, and Robert C. Euler

Subjects
History, General Earth and Planetary Sciences, General Environmental Science
Published
1972
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