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1. 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, and Daniel Doherty

Subjects
AAA, COVID-19, PAD, Survey, Vascular surgery, Diseases of the circulatory (Cardiovascular) system, RC666-701, Surgery, RD1-811
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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2. Making surgical wards safer for patients with diabetes: reducing hypoglycaemia and insulin errors

Author

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

Subjects
Medicine (General), R5-920
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
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4. 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

5. 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

6. 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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