146 results on '"Colin Royse"'
Search Results
2. Automatic deep learning-based pleural effusion segmentation in lung ultrasound images
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Damjan Vukovic, Andrew Wang, Maria Antico, Marian Steffens, Igor Ruvinov, Ruud JG van Sloun, David Canty, Alistair Royse, Colin Royse, Kavi Haji, Jason Dowling, Girija Chetty, and Davide Fontanarosa
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Point-of-Care Ultrasound ,Lung Ultrasound ,Deep Learning ,Pleural Effusion / diagnostic imaging ,Computer applications to medicine. Medical informatics ,R858-859.7 - Abstract
Abstract Background Point-of-care lung ultrasound (LUS) allows real-time patient scanning to help diagnose pleural effusion (PE) and plan further investigation and treatment. LUS typically requires training and experience from the clinician to accurately interpret the images. To address this limitation, we previously demonstrated a deep-learning model capable of detecting the presence of PE on LUS at an accuracy greater than 90%, when compared to an experienced LUS operator. Methods This follow-up study aimed to develop a deep-learning model to provide segmentations for PE in LUS. Three thousand and forty-one LUS images from twenty-four patients diagnosed with PE were selected for this study. Two LUS experts provided the ground truth for training by reviewing and segmenting the images. The algorithm was then trained using ten-fold cross-validation. Once training was completed, the algorithm segmented a separate subset of patients. Results Comparing the segmentations, we demonstrated an average Dice Similarity Coefficient (DSC) of 0.70 between the algorithm and experts. In contrast, an average DSC of 0.61 was observed between the experts. Conclusion In summary, we showed that the trained algorithm achieved a comparable average DSC at PE segmentation. This represents a promising step toward developing a computational tool for accurately augmenting PE diagnosis and treatment.
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- 2023
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3. Survival Benefit of Multiple Arterial Revascularization With and Without Supplementary Saphenous Vein Graft
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Justin Ren, David H. Tian, Mario Gaudino, Stephen Fremes, Christopher M. Reid, Michael Vallely, Julian A. Smith, Nilesh Srivastav, Colin Royse, and Alistair Royse
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coronary surgery ,multiple arterial grafting ,single arterial grafting ,survival ,total arterial revascularization ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Background It is unknown if the presence of saphenous vein grafting (SVG) adversely affects late survival following coronary surgery with multiple arterial grafting (MAG) versus single arterial grafting. Methods and Results A retrospective, observational, multicenter cohort study from 2001 to 2020 was conducted using the Australian and New Zealand Society of Cardiac and Thoracic Surgeons Database linked to the National Death Index. Patients undergoing primary isolated coronary artery bypass grafting with ≥2 grafts were included, and exclusions were patients aged
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- 2023
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4. Automatic deep learning-based consolidation/collapse classification in lung ultrasound images for COVID-19 induced pneumonia
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Nabeel Durrani, Damjan Vukovic, Jeroen van der Burgt, Maria Antico, Ruud J. G. van Sloun, David Canty, Marian Steffens, Andrew Wang, Alistair Royse, Colin Royse, Kavi Haji, Jason Dowling, Girija Chetty, and Davide Fontanarosa
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Medicine ,Science - Abstract
Abstract Our automated deep learning-based approach identifies consolidation/collapse in LUS images to aid in the identification of late stages of COVID-19 induced pneumonia, where consolidation/collapse is one of the possible associated pathologies. A common challenge in training such models is that annotating each frame of an ultrasound video requires high labelling effort. This effort in practice becomes prohibitive for large ultrasound datasets. To understand the impact of various degrees of labelling precision, we compare labelling strategies to train fully supervised models (frame-based method, higher labelling effort) and inaccurately supervised models (video-based methods, lower labelling effort), both of which yield binary predictions for LUS videos on a frame-by-frame level. We moreover introduce a novel sampled quaternary method which randomly samples only 10% of the LUS video frames and subsequently assigns (ordinal) categorical labels to all frames in the video based on the fraction of positively annotated samples. This method outperformed the inaccurately supervised video-based method and more surprisingly, the supervised frame-based approach with respect to metrics such as precision-recall area under curve (PR-AUC) and F1 score, despite being a form of inaccurate learning. We argue that our video-based method is more robust with respect to label noise and mitigates overfitting in a manner similar to label smoothing. The algorithm was trained using a ten-fold cross validation, which resulted in a PR-AUC score of 73% and an accuracy of 89%. While the efficacy of our classifier using the sampled quaternary method significantly lowers the labelling effort, it must be verified on a larger consolidation/collapse dataset, our proposed classifier using the sampled quaternary video-based method is clinically comparable with trained experts’ performance.
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- 2022
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5. Early Supervised Incremental Resistance Training (ESpIRiT) following cardiac surgery via a median sternotomy: a study protocol of a multicentre randomised controlled trial
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Doa El-Ansary, Md Ali Katijjahbe, Mohd Rizal Abdul Manaf, Colin Royse, Alistair Royse, Nur Ayub Md Ali, Mohd Ramzisham Abdul Rahman, Suriah Ahmad, Chong Tze Huat, Mohamad Arif Muhammad Nor, Jeswant Dillon, Hairulfaizi Haron, and Muhamad Ishamudin Ismail
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Medicine - Abstract
Introduction There is no consistency in current practice pertaining to the prescription and progression of upper limb resistance exercise following cardiac surgery via median sternotomy. The aim of this study is to investigate whether less restrictive sternal precautions with the addition of early-supervised resistance training exercise improves upper limb function and facilitates recovery following median sternotomy.Methods and analysis This is double-blind randomised controlled trial, with parallel group, concealed allocation, blinding of patients and assessors, and intention-to-treat analysis. 240 adult participants who had median sternotomy from eight hospitals in Malaysia will be recruited. Sample size calculations were based on the unsupported upper limb test. All participants will be randomised to receive either standard or early supervised incremental resistance training. The primary outcomes are upper limb function and pain. The secondary outcomes will be functional capacity, multidomain recovery (physical and psychological), length of hospital stay, incidence of respiratory complications and quality of life. Descriptive statistics will be used to summarise data. Data will be analysed using the intention-to-treat principle. The primary hypothesis will be examined by evaluating the change from baseline to the 4-week postoperative time point in the intervention arm compared with the usual care arm. For all tests to be conducted, a p value of
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- 2023
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6. Surgery for rheumatic heart disease in the Northern Territory, Australia, 1997–2016: what have we gained?
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Clare Heal, Nadarajah Kangaharan, Marcus Ilton, Andrew Webster, Rosemary Wyber, Bo Remenyi, Zhiqiang Wang, Robert A Baker, Alan Cass, Ross Roberts-Thomson, Nigel Gray, Malcolm McDonald, James Doran, David Canty, Karen Dempsey, Georgie Brunsdon, Colin Royse, Alistair Royse, Jacqueline Mein, Jayme Bennetts, Maida Stewart, Steven Sutcliffe, Benjamin Reeves, Upasna Doran, Patricia Rankine, Richard Fejo, Elisabeth Heenan, Ripudaman Jalota, Jason King, Jonathan Doran, and Joshua Hanson
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Medicine (General) ,R5-920 ,Infectious and parasitic diseases ,RC109-216 - Abstract
Background Between 1964 and 1996, the 10-year survival of patients having valve replacement surgery for rheumatic heart disease (RHD) in the Northern Territory, Australia, was 68%. As medical care has evolved since then, this study aimed to determine whether there has been a corresponding improvement in survival.Methods A retrospective study of Aboriginal patients with RHD in the Northern Territory, Australia, having their first valve surgery between 1997 and 2016. Survival was examined using Kaplan-Meier and Cox regression analysis.Findings The cohort included 281 adults and 61 children. The median (IQR) age at first surgery was 31 (18–42) years; 173/342 (51%) had a valve replacement, 113/342 (33%) had a valve repair and 56/342 (16%) had a commissurotomy. There were 93/342 (27%) deaths during a median (IQR) follow-up of 8 (4–12) years. The overall 10-year survival was 70% (95% CI: 64% to 76%). It was 62% (95% CI: 53% to 70%) in those having valve replacement. There were 204/281 (73%) adults with at least 1 preoperative comorbidity. Preoperative comorbidity was associated with earlier death, the risk of death increasing with each comorbidity (HR: 1.3 (95% CI: 1.2 to 1.5), p50 mm Hg before surgery (HR 1.9 (95% CI: 1.2 to 3.1) p=0.007) were independently associated with death.Interpretation Survival after valve replacement for RHD in this region of Australia has not improved. Although the patients were young, many had multiple comorbidities, which influenced long-term outcomes. The increasing prevalence of complex comorbidity in the region is a barrier to achieving optimal health outcomes.
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- 2023
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7. Clinical relevance of a multiorgan focused clinical ultrasound in internal medicine
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Ximena Cid-Serra, Alistair Royse, David Canty, and Colin Royse
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Medical physics. Medical radiology. Nuclear medicine ,R895-920 - Published
- 2022
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8. The validation of a Japanese language version of the postoperative quality of recovery scale: a prospective observational study
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Koki Yamashita, Stuart Boggett, Yoshifumi Kodama, Isao Tsuneyoshi, and Colin Royse
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Postoperative quality of recovery ,Validation ,Feasibility ,Bilingual translation ,Anesthesiology ,RD78.3-87.3 ,Medical emergencies. Critical care. Intensive care. First aid ,RC86-88.9 - Abstract
Abstract Background The Postoperative Quality of Recovery Scale (PostopQRS) is a survey-based tool that measures quality of the postoperative recovery in multiple domains over multiple time periods. The purpose of this study is to validate the Japanese version of the PostopQRS. Methods A prospective observational study using bilingual healthy volunteers was conducted in Australia to assess equivalence of the test values between the two languages. To assess the feasibility and discriminant validity of the PostopQRS in a Japanese population, an observational study was conducted on patients undergoing ear-nose-throat and orthopedic surgery in Japan, with measurements performed prior to surgery, 2 h, and 1, 3, and 7 days following surgery. The survey was conducted face-to-face while in hospital and via the telephone following discharge. Results Sixty-eight volunteers participated in the validation study. The scores in the Japanese version were similar to the English version in all domains at all timepoints. In the cognitive domain, there were no differences between the Japanese and English versions for word recall and word generation tasks. For digits forwards and digits backwards the values were skewed to the maximal value, and although significantly different, the absolute difference was
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- 2021
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9. Multi-organ point-of-care ultrasound for COVID-19 (PoCUS4COVID): international expert consensus
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Arif Hussain, Gabriele Via, Lawrence Melniker, Alberto Goffi, Guido Tavazzi, Luca Neri, Tomas Villen, Richard Hoppmann, Francesco Mojoli, Vicki Noble, Laurent Zieleskiewicz, Pablo Blanco, Irene W. Y. Ma, Mahathar Abd. Wahab, Abdulmohsen Alsaawi, Majid Al Salamah, Martin Balik, Diego Barca, Karim Bendjelid, Belaid Bouhemad, Pablo Bravo-Figueroa, Raoul Breitkreutz, Juan Calderon, Jim Connolly, Roberto Copetti, Francesco Corradi, Anthony J. Dean, André Denault, Deepak Govil, Carmela Graci, Young-Rock Ha, Laura Hurtado, Toru Kameda, Michael Lanspa, Christian B. Laursen, Francis Lee, Rachel Liu, Massimiliano Meineri, Miguel Montorfano, Peiman Nazerian, Bret P. Nelson, Aleksandar N. Neskovic, Ramon Nogue, Adi Osman, José Pazeli, Elmo Pereira-Junior, Tomislav Petrovic, Emanuele Pivetta, Jan Poelaert, Susanna Price, Gregor Prosen, Shalim Rodriguez, Philippe Rola, Colin Royse, Yale Tung Chen, Mike Wells, Adrian Wong, Wang Xiaoting, Wang Zhen, and Yaseen Arabi
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COVID-19 ,SARS-CoV-2 ,Point-of-care ultrasound (PoCUS) ,Focused cardiac ultrasound (FoCUS) ,Lung ultrasound (LUS) ,Echocardiography ,Medical emergencies. Critical care. Intensive care. First aid ,RC86-88.9 - Abstract
Abstract COVID-19 has caused great devastation in the past year. Multi-organ point-of-care ultrasound (PoCUS) including lung ultrasound (LUS) and focused cardiac ultrasound (FoCUS) as a clinical adjunct has played a significant role in triaging, diagnosis and medical management of COVID-19 patients. The expert panel from 27 countries and 6 continents with considerable experience of direct application of PoCUS on COVID-19 patients presents evidence-based consensus using GRADE methodology for the quality of evidence and an expedited, modified-Delphi process for the strength of expert consensus. The use of ultrasound is suggested in many clinical situations related to respiratory, cardiovascular and thromboembolic aspects of COVID-19, comparing well with other imaging modalities. The limitations due to insufficient data are highlighted as opportunities for future research.
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- 2020
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10. Patency of conduits in patients who received internal mammary artery, radial artery and saphenous vein grafts
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Alistair Royse, William Pamment, Zulfayandi Pawanis, Sandy Clarke-Errey, David Eccleston, Andrew Ajani, William Wilson, David Canty, and Colin Royse
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(Max 10) patency ,Arterial ,Saphenous vein ,Radial artery ,Internal mammary artery ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Abstract Background Where each patient has all three conduits of internal mammary artery (IMA), saphenous vein graft (SVG) and radial artery (RA), most confounders affecting comparison between conduits can be mitigated. Additionally, since SVG progressively fails over time, restricting patient angiography to the late period only can mitigate against early SVG patency that may have occluded in the late period. Methods Research protocol driven conventional angiography was performed for patients with at least one of each conduit of IMA, RA and SVG and a minimum of 7 years postoperative. The primary analysis was perfect patency and secondary analysis was overall patency including angiographic evidence of conduit lumen irregularity from conduit atheroma. Multivariable generalized linear mixed model (GLMM) was used. Patency excluded occluded or “string sign” conduits. Perfect patency was present in patent grafts if there was no lumen irregularity. Results Fifty patients underwent coronary angiography at overall duration postoperative 13.1 ± 2.9, and age 74.3 ± 7.0 years. Of 196 anastomoses, IMA 62, RA 77 and SVG 57. Most IMA were to the left anterior descending territory and most RA and SVG were to the circumflex and right coronary territories. Perfect patency RA 92.2% was not different to IMA 96.8%, P = 0.309; and both were significantly better than SVG 17.5%, P
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- 2020
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11. Impact of point-of-care ultrasound on the hospital length of stay for internal medicine inpatients with cardiopulmonary diagnosis at admission: study protocol of a randomized controlled trial—the IMFCU-1 (Internal Medicine Focused Clinical Ultrasound) study
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Ximena Cid, David Canty, Alistair Royse, Andrea B. Maier, Douglas Johnson, Doa El-Ansary, Sandy Clarke-Errey, Timothy Fazio, and Colin Royse
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Randomized controlled trial ,Echocardiography ,Focused assessment sonography ,Lung ultrasound ,Internal medicine ,Medicine (General) ,R5-920 - Abstract
Abstract Background Point-of-care ultrasound (POCUS) is emerging as a reliable and valid clinical tool that impacts diagnosis and clinical decision-making as well as timely intervention for optimal patient management. This makes its utility in patients admitted to internal medicine wards attractive. However, there is still an evidence gap in all the medical setting of how its use affects clinical variables such as length of stay, morbidity, and mortality. Methods/design A prospective randomized controlled trial assessing the effect of a surface POCUS of the heart, lungs, and femoral and popliteal veins performed by an internal medicine physician during the first 24 h of patient admission to the unit with a presumptive cardiopulmonary diagnosis. The University of Melbourne iHeartScan, iLungScan, and two-point venous compression protocols are followed to identify left and right ventricular function, significant valvular heart disease, pericardial and pleural effusion, consolidation, pulmonary edema, pneumothorax, and proximal deep venous thrombosis. Patient management is not commanded by the protocol and is at the discretion of the treating team. A total of 250 patients will be recruited at one tertiary hospital. Participants are randomized to receive POCUS or no POCUS. The primary outcome measured will be hospital length of stay. Secondary outcomes include the change in diagnosis and management, 30-day hospital readmission, and healthcare costs. Discussion This study will evaluate the clinical impact of multi-organ POCUS in internal medicine patients admitted with cardiopulmonary diagnosis on the hospital length of stay. Recruitment of participants commenced in September 2018 and is estimated to be completed by March 2020. Trial registration Australian and New Zealand Clinical Trial Registry, ACTRN12618001442291. Registered on 28 August 2018.
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- 2020
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12. The Sternal Management Accelerated Recovery Trial (S.M.A.R.T) – standard restrictive versus an intervention of modified sternal precautions following cardiac surgery via median sternotomy: study protocol for a randomised controlled trial
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Md Ali Katijjahbe, Linda Denehy, Catherine L. Granger, Alistair Royse, Colin Royse, Rebecca Bates, Sarah Logie, Sandy Clarke, and Doa El-Ansary
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Randomised controlled trial ,Cardiac Surgery ,Median Sternotomy ,Sternal Precautions ,Physiotherapy ,Medicine (General) ,R5-920 - Abstract
Abstract Background The routine implementation of sternal precautions to prevent sternal complications that restrict the use of the upper limbs is currently worldwide practice following a median sternotomy. However, evidence is limited and drawn primarily from cadaver studies and orthopaedic research. Sternal precautions may delay recovery, prolong hospital discharge and be overly restrictive. Recent research has shown that upper limb exercise reduces post-operative sternal pain and results in minimal micromotion between the sternal edges as measured by ultrasound. The aims of this study are to evaluate the effects of modified sternal precautions on physical function, pain, recovery and health-related quality of life after cardiac surgery. Methods/design This study is a phase II, double-blind, randomised controlled trial with concealed allocation, blinding of patients and assessors, and intention-to-treat analysis. Patients (n = 72) will be recruited following cardiac surgery via a median sternotomy. Sample size calculations were based on the minimal important difference (two points) for the primary outcome: Short Physical Performance Battery. Thirty-six participants are required per group to counter dropout (20%). All participants will be randomised to receive either standard or modified sternal precautions. The intervention group will receive guidelines encouraging the safe use of the upper limbs. Secondary outcomes are upper limb function, pain, kinesiophobia and health-related quality of life. Descriptive statistics will be used to summarise data. The primary hypothesis will be examined by repeated-measures analysis of variance to evaluate the changes from baseline to 4 weeks post-operatively in the intervention arm compared with the usual-care arm. In all tests to be conducted, a p value
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- 2017
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13. A randomized trial of desflurane or sevoflurane on postoperative quality of recovery after knee arthroscopy.
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Stuart Boggett, Jared Ou-Young, Johan Heiberg, Richard De Steiger, Martin Richardson, Zelda Williams, and Colin Royse
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Medicine ,Science - Abstract
BackgroundStudies have described different recovery profiles of sevoflurane and desflurane typically early after surgery.MethodsWe conducted a randomized superiority trial to determine whether Overall Recovery 3 days after knee arthroscopy would be superior with desflurane. Adult participants undergoing knee arthroscopic surgery with general anesthesia were randomized to either desflurane or sevoflurane general anesthesia. Intraoperative and postoperative drugs and analgesics were administered at the discretion of the anesthesiologist. Postoperative quality of recovery was assessed using the "Postoperative Quality of Recovery Scale". The primary outcome was Overall Recovery 3 days after surgery and secondary outcomes were individual recovery domains at 15 minutes, 40 minutes, 1 day, 3 days, 1 month, and 3 months. Patients and researchers were blinded.Results300 patients were randomized to sevoflurane or desflurane (age 51.7±14.1 vs. 47.3±13.5 years; duration of anesthesia 24.9±11.1 vs. 23.3±8.3 minutes). The proportion achieving baseline or better scores in all domains increased over the follow-up period in both groups but was not different at day 3 (sevoflurane 43% vs. desflurane 37%, p = 0.314). Similarly, rates of recovery increased over time in the five subdomains, with no differences between groups for physiological, p = 0.222; nociceptive, p = 0.391; emotive, p = 0.30; Activities-of-daily-living, p = 0.593; and cognitive recovery, p = 0.877.ConclusionNo significant difference in the quality of recovery scale could be shown using sevoflurane or desflurane general anesthesia after knee arthroscopy in adult participants.
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- 2019
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14. Coronary Artery Bypass Surgery Without Saphenous Vein Grafting
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Alistair Royse, Justin Ren, Colin Royse, David H. Tian, Stephen Fremes, Mario Gaudino, Umberto Benedetto, Y. Joseph Woo, Andrew B. Goldstone, Piroze Davierwala, Michael Borger, Michael Vallely, Christopher M. Reid, Rodolfo Rocha, David Glineur, Juan Grau, Richard Shaw, Hugh Paterson, Doa El-Ansary, Stuart Boggett, Nilesh Srivastav, Zulfayandi Pawanis, David Canty, and Rinaldo Bellomo
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Cardiology and Cardiovascular Medicine - Published
- 2022
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15. Health‐related quality of life after restrictive versus liberal RBC transfusion for cardiac surgery: Sub‐study from a randomized clinical trial
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Raymond T. Hu, Alistair G. Royse, Colin Royse, David A. Scott, Andrea Bowyer, Stuart Boggett, Peter Summers, and Cyril David Mazer
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Hemoglobins ,Immunology ,Australia ,Quality of Life ,Humans ,Immunology and Allergy ,Hematology ,Cardiac Surgical Procedures ,Erythrocyte Transfusion - Abstract
Transfusion Requirements in Cardiac Surgery III (TRICS III), a multi-center randomized controlled trial, demonstrated clinical non-inferiority for restrictive versus liberal RBC transfusion for patients undergoing cardiac surgery. However, it is uncertain if transfusion strategy affects long-term health-related quality of life (HRQOL).In this planned sub-study of Australian patients in TRICS III, we sought to determine the non-inferiority of restrictive versus liberal transfusion strategy on long-term HRQOL and to describe clinical outcomes 24 months postoperatively. The restrictive strategy involved transfusing RBCs when hemoglobin was7.5 g/dl; the transfusion triggers in the liberal group were: 9.5 g/L intraoperatively,9.5 g/L in intensive care, or8.5 g/dl on the ward. HRQOL assessments were performed using the 36-item short form survey version 2 (SF-36v2). Primary outcome was non-inferiority of summary measures of SF-36v2 at 12 months, (non-inferiority margin: -0.25 effect size; restrictive minus liberal scores). Secondary outcomes included non-inferiority of HRQOL at 18 and 24 months.Six hundred seventeen Australian patients received allocated randomization; HRQOL data were available for 208/311 in restrictive and 217/306 in liberal group. After multiple imputation, non-inferiority of restrictive transfusion at 12 months was not demonstrated for HRQOL, and the estimates were directionally in favor of liberal transfusion. Non-inferiority also could not be concluded at 18 and 24 months. Sensitivity analyses supported these results. There were no differences in quality-adjusted life years or composite clinical outcomes up to 24 months after surgery.The non-inferiority of a restrictive compared to a liberal transfusion strategy was not established for long-term HRQOL in this dataset.
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- 2022
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16. Outcomes of Postoperative Overnight High-Acuity Care in Medium-Risk Patients Undergoing Elective and Unplanned Noncardiac Surgery
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Guy Ludbrook, Michael P. W. Grocott, Kathy Heyman, Sandy Clarke-Errey, Colin Royse, Jamie Sleigh, and L. Bogdan Solomon
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Surgery - Abstract
ImportancePostoperative complications are increasing, risking patients’ health and health care sustainability. High-acuity postoperative units may benefit outcomes, but existing data are very limited.ObjectiveTo evaluate whether a new high-acuity postoperative unit, advanced recovery room care (ARRC), reduces complications and health care utilization compared with usual ward care (UC).Design, Setting, and ParticipantsIn this observational cohort study, adults who were undergoing noncardiac surgery at a single-center tertiary adult hospital, anticipated to stay in hospital for 2 or more nights, were scheduled for postoperative ward care, and at medium risk (defined as predicted 30-day mortality of 0.7% to 5% by the National Safety Quality Improvement Program risk calculator) were included. Allocation to ARRC was based on bed availability. From 2405 patients assessed for eligibility with National Safety Quality Improvement Program risk scoring, 452 went to ARRC and 419 to UC, with 8 lost to 30-day follow-up. Propensity scoring identified 696 patients with matched pairs. Patients were treated between March and November 2021, and data were analyzed from January to September 2022.InterventionsARRC is an extended postanesthesia care unit (PACU), staffed by anesthesiologists and nurses (1 nurse to 2 patients) collaboratively with surgeons, with capacity for invasive monitoring and vasoactive infusions. ARRC patients were treated until the morning after surgery, then transferred to surgical wards. UC patients were transferred to surgical wards after usual PACU care.Main Outcome and MeasuresThe primary end point was days at home at 30 days. Secondary end points were health facility utilization, medical emergency response (MER)–level complications, and mortality. Analyses compared groups before and after propensity scoring matching.ResultsOf 854 included patients, 457 (53.5%) were male, and the mean (SD) age was 70.0 (14.4) years. Days at home at 30 days was greater with ARRC compared with UC (mean [SD] time, 17 [11] vs 15 [11] days; P = .04). During the first 24 hours, more patients were identified with MER-level complications in ARRC (43 [12.4%] vs 13 [3.7%]; P P = .03). Length of hospital stay, hospital readmissions, emergency department visits, and mortality were similar.Conclusions and RelevanceFor medium-risk patients, brief high-acuity care with ARRC allowed enhanced detection and management of early MER-level complications, which was followed by a decreased incidence of subsequent MER-level complications after discharge to the ward and by increased days at home at 30 days.
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- 2023
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17. Long-Term Survival of Multiple Versus Single Arterial Coronary Bypass Grafting in Elderly Patients
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Justin Ren, Colin Royse, Nilesh Srivastav, Oscar Lu, and Alistair Royse
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surgery ,coronary artery bypass grafting ,age ,elderly ,multiple arterial grafting ,total arterial revascularization ,radial artery ,internal mammary artery ,General Medicine - Abstract
Multiple arterial grafting (MAG) utilizes more than one arterial graft with any additional grafts being saphenous vein grafts (SVG). It remains an infrequently used coronary surgical revascularization technique, especially in elderly patients. Our study aims to evaluate the age-related association with the relative outcomes of multiple versus single arterial grafting (SAG). The Australian and New Zealand national registry was used to identify adult patients undergoing primary isolated CABG with at least two grafts. Exclusion criteria included reoperations, concomitant or previous cardiac surgery, and the absence of arterial grafting. Propensity score matching was used to match patient groups. The primary outcome was all-cause late mortality and the secondary outcomes were 30-day mortality and 30-day hospital readmission. We selected 69,624 eligible patients with a mean (standard deviation) age of 65.0 (10.2) years old. Matching between MAG and SAG generated 16,882 pairs of patients < 70 years old and 10,921 pairs of patients ≥ 70 years old. At a median [interquartile range] follow-up duration of 5.9 [3.2–9.6] years, MAG was associated with significantly reduced mortality compared to SAG (hazard ratio [HR], 0.73; 95% confidence interval [CI], 0.68–0.78; p < 0.001) in the younger subgroup as well as the elderly subgroup (HR, 0.84; 95% CI, 0.79–0.88; p < 0.001). In conclusion, MAG offers a survival benefit over SAG, in both younger and elderly patients.
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- 2023
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18. Survival of Multiple Arterial Grafting in Diabetic Populations: A Twenty-Year National Experience
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Justin Ren, Colin Royse, David H Tian, Aashray Gupta, and Alistair Royse
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Pulmonary and Respiratory Medicine ,Surgery ,General Medicine ,Cardiology and Cardiovascular Medicine - Abstract
Structured abstract Objectives Diabetics may have diminished survival after coronary artery bypass grafting even with multiple arterial revascularization. We compared multi-arterial versus single-arterial grafting survival in diabetic and non-diabetic patients undergoing primary isolated bypass surgery. Methods This is a retrospective analysis of the Australian and New Zealand Society of Cardiac-Thoracic Surgical Database from June 2001 to January 2020. Patients were classified as having either single or multiple arterial grafting irrespective of the number of venous grafts. The end-points were long-term all-cause mortality and 30-day clinical outcomes, which was compared in 1:1 propensity score matched patients. Cox regression model was used to assess interactions between diabetes and the treatment effect of multi-arterial grafting, reported as hazard ratios and confidence intervals. Short-term outcomes were compared with McNemar’s paired t-test. Results From 69,624 patients, matching generated 17,474 non-diabetic and 10,989 diabetic patient pairs. At a median [interquartile range] of 5.9 [3.2–9.6] years postoperative, mortality was significantly lower after multi-arterial grafting for both diabetic (hazard ratio, 0.83; 95% confidence interval, 0.76–0.90, P Conclusions Multi-arterial grafting was associated with improved overall survival compared to single arterial grafting for both non-diabetic and diabetic patients.
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- 2023
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19. SAfety and Feasibility of EArly Resistance Training After Median Sternotomy: The SAFE-ARMS Study
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Jacqueline Pengelly, Stuart Boggett, Adam Bryant, Colin Royse, Alistair Royse, Gavin Williams, and Doa El-Ansary
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Male ,Feasibility Studies ,Humans ,Pain ,Reproducibility of Results ,Resistance Training ,Physical Therapy, Sports Therapy and Rehabilitation ,Sternotomy - Abstract
Objective The purpose of this study was to determine the safety and feasibility of subacute upper limb resistance exercise on sternal micromotion and pain and the reliability of sternal ultrasound assessment following cardiac surgery via median sternotomy. Methods This experimental study used a pretest–posttest design to investigate the effects of upper limb resistance exercise on the sternum in patients following their first cardiac surgery via median sternotomy. Six bilateral upper limb machine-based exercises were commenced at a base resistance of 20 lb (9 kg) and progressed for each participant. Sternal micromotion was assessed using ultrasound at the mid and lower sternum at 2, 8, and 14 weeks postsurgery. Intrarater and interrater reliability was calculated using intraclass correlation coefficients (ICCs). Participant-reported pain was recorded at rest and with each exercise using a visual analogue scale. Results Sixteen adults (n = 15 males; 71.3 [SD = 6.2] years of age) consented to participate. Twelve participants completed the study, 2 withdrew prior to the 8-week assessment, and 2 assessments were not completed at 14 weeks due to assessor unavailability. The highest median micromotion at the sternal edges was observed during the bicep curl (median = 1.33 mm; range = −0.8 to 2.0 mm) in the lateral direction and the shoulder pulldown (median = 0.65 mm; range = −0.8 to 1.6 mm) in the anterior–posterior direction. Furthermore, participants reported no increase in pain when performing any of the 6 upper limb exercises. Interrater reliability was moderate to good for both lateral–posterior (ICC = 0.73; 95% CI = 0.58 to 0.83) and anterior–posterior micromotion (ICC = 0.83; 95% CI = 0.73 to 0.89) of the sternal edges. Conclusion Bilateral upper limb resistance exercises performed on cam-based machines do not result in sternal micromotion exceeding 2.0 mm or an increase in participant-reported pain. Impact Upper limb resistance training commenced as early as 2 weeks following cardiac surgery via median sternotomy and performed within the safe limits of pain and sternal micromotion appears to be safe and may accelerate postoperative recovery rather than muscular deconditioning.
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- 2022
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20. Long-term observational angiographic patency and perfect patency of radial artery compared with saphenous vein or internal mammary artery in coronary bypass surgery
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Justin Ren, Colin Royse, Christopher Siderakis, Nilesh Srivastav, and Alistair Royse
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Pulmonary and Respiratory Medicine ,Surgery ,Cardiology and Cardiovascular Medicine - Abstract
It is uncertain if the long-term biological behavior of the radial artery as a conduit for coronary bypass surgery has a similar resistance to the development of atherosclerosis as for the internal mammary artery. We aimed to examine long-term angiographic patency and disease-free patency (perfect patency) for internal mammary artery, radial artery, and saphenous vein grafts.A retrospective, single-center, individual patient cohort study of angiographic observations from patients' latest postoperative angiogram from 1997 to 2020 was performed. Analysis was per anastomosis and assessed for patency and perfect patency. A generalized linear mixed model premised upon logistic regression was used to minimize confounding bias.A total of 983 patients with 3064 grafts were included, with a median follow-up of 8.6 (interquartile range, 4.4-12.6) years after the operation. Multivariable analysis revealed differences for radial (patency, 86.9%; perfect patency, 86.4%) and internal mammary artery (patency, 93.9%; perfect patency, 93.5%) versus saphenous vein graft (patency, 72.8%; perfect patency, 46.2%). There were no differences between the 2 arterial conduits for patency (odds ratio, 1.40; 95% CI, 0.85-2.33; P = .189) and perfect patency (odds ratio, 1.14; 95% CI, 0.71-1.84; P = .578). If a conduit was patent, then 99.4% of radial artery, 99.6% of internal mammary artery, and 63.5% of saphenous vein graft were reported as perfectly patent.Radial artery and internal mammary artery had similar patency and perfect patency while both were superior to saphenous vein graft.
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- 2022
21. Point‐of‐care lung ultrasound in the assessment of patients with COVID‐19: A tutorial
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Alistair Royse, Lynda Tivendale, Xiaoqiang Li, David Canty, André Y. Denault, Darsim Haji, Kyle Brooks, Johan Heiberg, Doa El-Ansary, Xiaobo Hu, Andrew Wang, Ximena Anaite Cid, Kavi Haji, Colin Royse, and Yang Yang
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medicine.medical_specialty ,Radiography ,pandemics ,Education ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,coronavirus infections ,0302 clinical medicine ,medicine ,Medical imaging ,Radiology, Nuclear Medicine and imaging ,Lung cancer ,Point of care ,Pneumonitis ,030219 obstetrics & reproductive medicine ,Lung ,Radiological and Ultrasound Technology ,business.industry ,Ultrasound ,COVID-19 ,ultrasonography ,respiratory system ,medicine.disease ,respiratory tract diseases ,medicine.anatomical_structure ,Pneumothorax ,Radiology Nuclear Medicine and imaging ,Radiology ,business ,point-of-care systems - Abstract
The adoption of point-of-care lung ultrasound for both suspected and confirmed COVID-19 patients highlights the issues of accessibility to ultrasound training and equipment. Lung ultrasound is more sensitive than chest radiography in detecting viral pneumonitis and preferred over computed tomography for reasons including its portability, reduced healthcare worker exposure and repeatability. The main lung ultrasound findings in COVID-19 patients are interstitial syndrome, irregular pleural line and subpleural consolidations. Consolidations are most likely found in critical patients in need of ventilatory support. Hence, lung ultrasound may be used to timely triage patients who may have evolving pneumonitis. Other respiratory pathology that may be detected by lung ultrasound includes pulmonary oedema, pneumothorax, consolidation and large effusion. A key barrier to incorporate lung ultrasound in the assessment of COVID-19 patients is adequate decontamination of ultrasound equipment to avoid viral spread. This tutorial provides a practical method to learn lung ultrasound and a cost-effective method of preventing contamination of ultrasound equipment and a practical method for performing and interpreting lung ultrasound.
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- 2020
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22. A proposed lung ultrasound and phenotypic algorithm for the care of COVID-19 patients with acute respiratory failure
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Yiorgos Alexandros Cavayas, Caroline E. Gebhard, Martin Girard, Colin Royse, Alistair Royse, Etienne J. Couture, André Y. Denault, Ximena Cid Serra, Nicolas Peschanski, Stephan Langevin, David Canty, Stéphane Delisle, Paul Ouellet, Université de Montréal (UdeM), CHU Pontchaillou [Rennes], Richard I. Kaufman Endowment Fund in Anesthesia and Critical Care, and Montreal Heart Institute Foundation
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and oxygenation index ,medicine.medical_specialty ,Respiratory rate ,Point-of-Care Systems ,[SDV]Life Sciences [q-bio] ,medicine.medical_treatment ,Pneumonia, Viral ,respiratory rate ,Special Article ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Anesthesiology ,Humans ,Medicine ,Intubation ,Respiratory system ,Lung ,Pandemics ,Ultrasonography ,lung ultrasound ,business.industry ,Ultrasound ,respiratory failure ,COVID-19 ,030208 emergency & critical care medicine ,General Medicine ,medicine.disease ,3. Good health ,Oxygen ,Pneumonia ,Phenotype ,Anesthesiology and Pain Medicine ,medicine.anatomical_structure ,030228 respiratory system ,Respiratory failure ,Anesthesia ,Acute Disease ,Cardiology ,Coronavirus Infections ,Respiratory Insufficiency ,business ,Algorithms - Abstract
Pulmonary complications are the most common clinical manifestations of coronavirus disease (COVID-19). From recent clinical observation, two phenotypes have emerged: a low elastance or L-type and a high elastance or H-type. Clinical presentation, pathophysiology, pulmonary mechanics, radiological and ultrasound findings of these two phenotypes are different. Consequently, the therapeutic approach also varies between the two. We propose a management algorithm that combines the respiratory rate and oxygenation index with bedside lung ultrasound examination and monitoring that could help determine earlier the requirement for intubation and other surveillance of COVID-19 patients with respiratory failure.RéSUMé: Les complications pulmonaires du coronavirus (COVID-19) constituent ses manifestations cliniques les plus fréquentes. De récentes observations cliniques ont fait émerger deux phénotypes : le phénotype à élastance faible ou type L (low), et le phénotype à élastance élevée, ou type H (high). La présentation clinique, la physiopathologie, les mécanismes pulmonaires, ainsi que les observations radiologiques et échographiques de ces deux différents phénotypes sont différents. L’approche thérapeutique variera par conséquent selon le phénotype des patients atteints de COVID-19 souffrant d’insuffisance respiratoire.
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- 2020
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23. Patency of conduits in patients who received internal mammary artery, radial artery and saphenous vein grafts
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William Wilson, Colin Royse, David Eccleston, Andrew E. Ajani, David Canty, Sandy Clarke-Errey, Zulfayandi Pawanis, William Pamment, and Alistair Royse
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Male ,medicine.medical_specialty ,lcsh:Diseases of the circulatory (Cardiovascular) system ,Time Factors ,Lumen (anatomy) ,Coronary Artery Disease ,030204 cardiovascular system & hematology ,Anastomosis ,Coronary Angiography ,Coronary artery disease ,(Max 10) patency ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,medicine.artery ,Internal medicine ,medicine ,Vascular Patency ,Humans ,Circumflex ,Prospective Studies ,Radial artery ,Coronary Artery Bypass ,Mammary Arteries ,Aged ,Aged, 80 and over ,medicine.diagnostic_test ,business.industry ,Internal mammary artery ,Graft Occlusion, Vascular ,Saphenous vein ,Middle Aged ,medicine.disease ,Cardiac surgery ,Treatment Outcome ,030228 respiratory system ,lcsh:RC666-701 ,Angiography ,Cardiology ,Arterial ,Female ,Cardiology and Cardiovascular Medicine ,business ,Research Article - Abstract
Background Where each patient has all three conduits of internal mammary artery (IMA), saphenous vein graft (SVG) and radial artery (RA), most confounders affecting comparison between conduits can be mitigated. Additionally, since SVG progressively fails over time, restricting patient angiography to the late period only can mitigate against early SVG patency that may have occluded in the late period. Methods Research protocol driven conventional angiography was performed for patients with at least one of each conduit of IMA, RA and SVG and a minimum of 7 years postoperative. The primary analysis was perfect patency and secondary analysis was overall patency including angiographic evidence of conduit lumen irregularity from conduit atheroma. Multivariable generalized linear mixed model (GLMM) was used. Patency excluded occluded or “string sign” conduits. Perfect patency was present in patent grafts if there was no lumen irregularity. Results Fifty patients underwent coronary angiography at overall duration postoperative 13.1 ± 2.9, and age 74.3 ± 7.0 years. Of 196 anastomoses, IMA 62, RA 77 and SVG 57. Most IMA were to the left anterior descending territory and most RA and SVG were to the circumflex and right coronary territories. Perfect patency RA 92.2% was not different to IMA 96.8%, P = 0.309; and both were significantly better than SVG 17.5%, P P = 0.169, and both arterial conduits were significantly higher than SVG 82.5%, P = 0.029. Grafting according to coronary territory was not significant for perfect patency, P = 0.997 and patency P = 0.289. Coronary stenosis predicted perfect patency for RA only, P = 0.030 and for patency, RA, P = 0.007, and SVG, P = 0.032. When both arterial conduits were combined, perfect patency, P P = 0.017, were superior to SVG. Conclusions All but one patent internal mammary artery or radial artery grafts had perfect patency and had superior perfect patency and overall patency compared to saphenous vein grafts.
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- 2020
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24. Effect of Midazolam in Addition to Propofol and Opiate Sedation on the Quality of Recovery After Colonoscopy: A Randomized Clinical Trial
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Ann Vandeleur, Tony Rahman, Colin Royse, Sweta Sriram, Cindy Hill, Zelda Williams, Stuart Boggett, Usha Gurunathan, Jennifer Harch, and Andrea Bowyer
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Adult ,Male ,Time Factors ,Victoria ,Midazolam ,Sedation ,Colonoscopy ,Placebo ,Fentanyl ,03 medical and health sciences ,Cognition ,0302 clinical medicine ,Double-Blind Method ,030202 anesthesiology ,Ambulatory Care ,medicine ,Humans ,Hypnotics and Sedatives ,Propofol ,Aged ,medicine.diagnostic_test ,business.industry ,Recovery of Function ,Length of Stay ,Middle Aged ,medicine.disease ,Analgesics, Opioid ,Anesthesiology and Pain Medicine ,Patient Satisfaction ,Anesthesia ,Anesthesia Recovery Period ,Female ,Queensland ,medicine.symptom ,business ,Postoperative cognitive dysfunction ,Anesthetics, Intravenous ,030217 neurology & neurosurgery ,medicine.drug - Abstract
BACKGROUND: There is a concern that midazolam, when used as a component of sedation for colonoscopy, may impair cognition and prolong recovery. We aimed to identify whether midazolam produced short- and longer-term effects on multiple dimensions of recovery including cognition.METHODS: A 2-center double-blinded, placebo-controlled, parallel-group, randomized, phase IV study with a 1:1 allocation ratio was conducted in adults >= 18 years of age undergoing elective outpatient colonoscopy, with sufficient English language proficiency to complete the Postoperative Quality of Recovery Scale (PostopQRS). Participants were administered either midazolam (0.04 mg.kg(-1)) or an equivalent volume of 0.9% saline before sedation with propofol with or without an opiate. The primary outcome was incidence of recovery in the cognitive domain of the PostopQRS on day 3 after colonoscopy, which was analyzed using a chi(2) test. Secondary outcomes included recovery in other domains of the PostopQRS over time, time to eye-opening, and hospital stay, and patient and endoscopist satisfaction. All hypotheses were defined before recruitment.RESULTS: During September 2015 to June 2018, 406 patients were allocated to either midazolam (n = 201) or placebo (n = 205), with one withdrawn before allocation. There was no significant difference in recovery in the cognitive domain of the PostopQRS on day 3 after colonoscopy (midazolam 86.8% vs placebo 88.7%, odds ratio, 0.838; 95% confidence interval [CI], 0.42-1.683; P = .625). Furthermore, there was no difference in recovery over time in the cognitive domain of the PostopQRS (P = .534). Overall recovery of the PostopQRS increased over time but was not different between groups. Furthermore, there were no differences between groups for nociceptive, emotive, activities-of-daily-living domains of the PostopQRS. Patient and endoscopist satisfaction were high and not different. There were no differences in time to eye-opening (midazolam 9.4 +/- 12.8 minutes vs placebo 7.3 +/- 0.7 minutes; P = .055), or time to hospital discharge (midazolam 103.4 +/- 1.4 minutes vs placebo 98.4 +/- 37.0 minutes; P = .516).CONCLUSIONS: The addition of midazolam 0.04 mg.kg(-1) as adjunct to propofol and opiate sedation for elective colonoscopy did not show evidence of any significant differences in recovery in the cognitive domain of the PostopQRS, overall quality of recovery as measured by the PostopQRS, or emergence and hospital discharge times. The use of midazolam should be determined by the anesthesiologist.
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- 2020
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25. Perioperative Doppler ultrasound assessment of portal vein flow pulsatility in high-risk cardiac surgery patients: a multicentre prospective cohort study
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André Denault, Etienne J. Couture, Étienne De Medicis, Jae-Kwang Shim, Michael Mazzeffi, Reney A. Henderson, Stephan Langevin, Richa Dhawan, Martin Michaud, Dominik P. Guensch, David Berger, Joachim M. Erb, Caroline E. Gebhard, Colin Royse, David Levy, Yoan Lamarche, François Dagenais, Alain Deschamps, Georges Desjardins, and William Beaubien-Souligny
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Cohort Studies ,Anesthesiology and Pain Medicine ,Postoperative Complications ,Portal Vein ,Humans ,Ultrasonography, Doppler ,Prospective Studies ,Cardiac Surgical Procedures ,610 Medicine & health - Abstract
BACKGROUND Portal vein Doppler ultrasound pulsatility measured by transoesophageal echocardiography is a marker of the haemodynamic impact of venous congestion in cardiac surgery. We investigated whether the presence of abnormal portal vein flow pulsatility is associated with a longer duration of invasive life support and postoperative complications in high-risk patients. METHODS In this multicentre cohort study, pulsed-wave Doppler ultrasound assessments of portal vein flow were performed during anaesthesia before initiation of cardiopulmonary bypass (before CPB) and after separation of cardiopulmonary bypass (after CPB). Abnormal pulsatility was defined as portal pulsatility fraction (PPF) ≥50% (PPF50). The primary outcome was the cumulative time in perioperative organ dysfunction (TPOD) requiring invasive life support during 28 days. Secondary outcomes included major postoperative complications. RESULTS 373 patients, 71 (22.0%) had PPF50 before CPB and 77 (24.9%) after CPB. PPF50 was associated with longer duration of TPOD (median [inter-quartile range]; before CPB: 27 h [11-72] vs 19 h [8.5-42], P=0.02; after CPB: 27 h [11-61] vs 20 h [8-42], P=0.006). After adjusting for confounders, PPF50 before CPB showed significant association with TPOD. PPF50 after CPB was associated with a higher rate of major postoperative complications (36.4% vs 20.3%, P=0.006). CONCLUSIONS Abnormal portal vein flow pulsatility before cardiopulmonary bypass was associated with longer duration of life support therapy after cardiac surgery in high-risk patients. Abnormal portal vein flow pulsatility after cardiopulmonary bypass separation was associated with a higher risk of major postoperative complications although this association was not independent of other factors. CLINICAL TRIAL REGISTRATION NCT03656263.
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- 2022
26. Long-term survival after coronary bypass surgery with multiple versus single arterial grafts
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Alistair Royse, Colin Royse, and Justin Ren
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Pulmonary and Respiratory Medicine ,Humans ,Saphenous Vein ,Surgery ,General Medicine ,Coronary Artery Bypass ,Cardiology and Cardiovascular Medicine - Published
- 2022
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27. Surgery for Rheumatic Heart Disease in the Northern Territory, Australia 1997-2016: What Have We Gained?
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James Doran, David Canty, Karen Dempsey, Alan Cass, Nadarajah Kangaharan, Bo Remenyi, Georgie Brunsdon, Malcolm McDonald, Clare Heal, Zhiqiang Wang, Colin Royse, Alistair Royse, Nigel Gray, Jayme Bennetts, Robert A. Baker, Maida Stewart, Benjamin Reeves, Ripudaman Jalota, Ross Roberts-Thomson, Rosemary Wyber, Jonathan Doran, Andrew MD Webster, Jacqueline Mein, Ian Wright, Steven Sutcliffe, Upasna Doran, Marcus Ilton, Jason King, and Josh Hanson
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History ,Polymers and Plastics ,Business and International Management ,Industrial and Manufacturing Engineering - Published
- 2022
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28. Late Clinical Outcomes of Total Arterial Revascularization or Multiple Arterial Grafting Compared to Conventional Single Arterial with Saphenous Vein Grafting for Coronary Surgery
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Justin Ren, Colin Royse, and Alistair Royse
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General Medicine - Abstract
Coronary surgery provides better long-term outcomes than percutaneous coronary intervention. Conventional practice is to use a single arterial conduit supplemented by saphenous vein grafts. The use of multiple arterial revascularization (MAG), or exclusive arterial revascularization (TAR), however, is reported as having improved late survival. Survival is a surrogate for graft failure that may lead to premature death, and improved survival reflects fewer graft failures in the non-conventional strategy groups. The reasons for not using MAG or TAR may be due to perceived technical difficulties, a lack of definitive large-scale randomized evidence, a lack of confidence in arterial conduits, or resources or time constraints. Most people consider radial artery (RA) grafting to be new, with use representing approximately 2–5% worldwide, despite select centers reporting routine use in most patients for decades with improved results. In conclusion, the current body of evidence supports more extensive use of total and multiple arterial revascularization procedures in the absence of contraindications.
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- 2023
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29. Surgery for rheumatic heart disease in the Northern Territory, Australia, 1997–2016: what have we gained?
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James Doran, David Canty, Karen Dempsey, Alan Cass, Nadarajah Kangaharan, Bo Remenyi, Georgie Brunsdon, Malcolm McDonald, Clare Heal, Zhiqiang Wang, Colin Royse, Alistair Royse, Jacqueline Mein, Nigel Gray, Jayme Bennetts, Robert A Baker, Maida Stewart, Steven Sutcliffe, Benjamin Reeves, Upasna Doran, Patricia Rankine, Richard Fejo, Elisabeth Heenan, Ripudaman Jalota, Marcus Ilton, Ross Roberts-Thomson, Jason King, Rosemary Wyber, Jonathan Doran, Andrew Webster, and Joshua Hanson
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Health Policy ,Public Health, Environmental and Occupational Health - Abstract
BackgroundBetween 1964 and 1996, the 10-year survival of patients having valve replacement surgery for rheumatic heart disease (RHD) in the Northern Territory, Australia, was 68%. As medical care has evolved since then, this study aimed to determine whether there has been a corresponding improvement in survival.MethodsA retrospective study of Aboriginal patients with RHD in the Northern Territory, Australia, having their first valve surgery between 1997 and 2016. Survival was examined using Kaplan-Meier and Cox regression analysis.FindingsThe cohort included 281 adults and 61 children. The median (IQR) age at first surgery was 31 (18–42) years; 173/342 (51%) had a valve replacement, 113/342 (33%) had a valve repair and 56/342 (16%) had a commissurotomy. There were 93/342 (27%) deaths during a median (IQR) follow-up of 8 (4–12) years. The overall 10-year survival was 70% (95% CI: 64% to 76%). It was 62% (95% CI: 53% to 70%) in those having valve replacement. There were 204/281 (73%) adults with at least 1 preoperative comorbidity. Preoperative comorbidity was associated with earlier death, the risk of death increasing with each comorbidity (HR: 1.3 (95% CI: 1.2 to 1.5), p50 mm Hg before surgery (HR 1.9 (95% CI: 1.2 to 3.1) p=0.007) were independently associated with death.InterpretationSurvival after valve replacement for RHD in this region of Australia has not improved. Although the patients were young, many had multiple comorbidities, which influenced long-term outcomes. The increasing prevalence of complex comorbidity in the region is a barrier to achieving optimal health outcomes.
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- 2023
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30. Composite Total Arterial Revascularization Techniques Comparing the Second Internal Mammary Artery and Radial Artery
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Colin Royse, Alistair Royse, and Hugh S. Paterson
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Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,business.industry ,Internal medicine ,medicine.artery ,Radial Artery ,Arterial revascularization ,Myocardial Revascularization ,medicine ,Mammary artery ,Cardiology ,Humans ,Surgery ,Coronary Artery Bypass ,Mammary Arteries ,Radial artery ,Cardiology and Cardiovascular Medicine ,business ,Internal Mammary-Coronary Artery Anastomosis - Published
- 2022
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31. Restrictive versus liberal transfusion in patients with diabetes undergoing cardiac surgery: An open-label, randomized, blinded outcome evaluation trial
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Alistair Royse, François Martin Carrier, Elaine E. Tseng, Daniela Filipescu, Christella S. Alphonsus, Gregory M. T. Hare, Kevin E. Thorpe, Juan Carlos Villar, Subodh Verma, Chirag Mehta, Duminda N. Wijeysundera, Colin Royse, Nikhil Mistry, C. David Mazer, Paula Carmona, Nadine Shehata, Daniel Bolliger, Peter Jüni, Trics Investigators, Raymond Hu, Dennis T. Ko, Alexander J. Gregory, and Tarit Saha
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medicine.medical_specialty ,Endocrinology, Diabetes and Metabolism ,medicine.medical_treatment ,Myocardial Infarction ,030204 cardiovascular system & hematology ,law.invention ,03 medical and health sciences ,Hemoglobins ,0302 clinical medicine ,Endocrinology ,law ,Internal medicine ,Diabetes mellitus ,Internal Medicine ,Diabetes Mellitus ,Medicine ,Humans ,030212 general & internal medicine ,Myocardial infarction ,Cardiac Surgical Procedures ,Stroke ,Dialysis ,business.industry ,EuroSCORE ,medicine.disease ,Intensive care unit ,3. Good health ,Cardiac surgery ,Clinical trial ,business ,Erythrocyte Transfusion - Abstract
AIM To characterize the association between diabetes and transfusion and clinical outcomes in cardiac surgery, and to evaluate whether restrictive transfusion thresholds are harmful in these patients. MATERIALS AND METHODS The multinational, open-label, randomized controlled TRICS-III trial assessed a restrictive transfusion strategy (haemoglobin [Hb] transfusion threshold
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- 2021
32. Comparison of learning outcomes for teaching focused cardiac ultrasound to physicians: A supervised human model course versus an eLearning guided self- directed simulator course
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Jennifer Barth, Colin Royse, Andrew J. Palmer, Alistair Royse, Nathan Peters, David Canty, and Yang Yang
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Adult ,Male ,Critical Care ,Image quality ,education ,Cardiology ,Computer-Assisted Instruction ,Focused cardiac ultrasound ,Critical Care and Intensive Care Medicine ,Electronic learning ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Medical imaging ,Humans ,Medicine ,Prospective Studies ,Supervised training ,Simulation ,business.industry ,Teaching ,Heart ,030208 emergency & critical care medicine ,Middle Aged ,030228 respiratory system ,Echocardiography ,Education, Medical, Graduate ,Female ,Clinical Competence ,Clinical competence ,Radiology ,business - Abstract
Focused cardiac ultrasound (FCU) training in critical care is restricted by availability of instructors. Supervised training may be substituted by self-directed learning with an ultrasound simulator guided by automated electronic learning, enabling scalability.We prospectively compared learning outcomes in novice critical care physicians after completion of a supervised one-and-a-half-day workshop model with a self-guided course utilizing a simulator over four weeks. Both groups had identical pre-workshop on-line learning (20h). Image quality scores were compared using FCU performed on humans without pathology. Interpretive knowledge was compared using 20MCQ tests.Of 161 eligible, 145 participants consented. Total Image quality scores were higher in the Simulator group (95.2% vs. 66.0%, P .001) and also higher for each view (all P .001). Interpretive knowledge was not different before (78.6% vs. 79.0%) and after practical training (74.7% vs. 76.1%) and at 3 months (81.0% vs. 77.0%, all P .1). Including purchase of the simulator and ultrasound equipment, the simulator course required lower direct costs (AUD$796 vs. $1724 per participant) and instructor time (0.5 vs.1.5 days) but similar participant time (2.8 vs. 3.0 days).Self-directed learning with ultrasound simulators may be a scalable alternative to conventional supervised teaching with human models.
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- 2019
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33. Effects of 12-Week Supervised Early Resistance Training (SEcReT) Versus Aerobic-Based Rehabilitation on Cognitive Recovery Following Cardiac Surgery via Median Sternotomy: A Pilot Randomised Controlled Trial
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Colin Royse, Doa El-Ansary, Jacqueline Pengelly, Adam L. Bryant, Alistair Royse, Sandy Clarke-Errey, and Gavin Williams
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Pulmonary and Respiratory Medicine ,Adult ,medicine.medical_specialty ,medicine.medical_treatment ,Pilot Projects ,law.invention ,Cognition ,Randomized controlled trial ,law ,medicine ,Humans ,Prospective Studies ,Cognitive decline ,Cardiac Surgical Procedures ,Rehabilitation ,business.industry ,Resistance training ,Resistance Training ,Sternotomy ,Cardiac surgery ,Treatment Outcome ,Median sternotomy ,Sample size determination ,Anesthesia ,Quality of Life ,Cardiology and Cardiovascular Medicine ,business - Abstract
Aims To investigate the effects of a 12-week early moderate-intensity resistance training program compared to aerobic-based rehabilitation on postoperative cognitive recovery following cardiac surgery via median sternotomy. Methods This was a multicentre, prospective, pragmatic, non-blinded, pilot randomised controlled trial (1:1 randomisation) of two parallel groups that compared a 12-week early moderate-intensity resistance training group to a control group, receiving aerobic-based rehabilitation. English-speaking adults (≥18 years) undergoing elective cardiac surgery via median sternotomy were randomised using sealed envelopes, with allocation revealed before surgery. The primary outcome was cognitive function, assessed using the Alzheimer’s Disease Assessment Scale-cognitive subscale (ADAS-cog), at baseline, 14 weeks and 6 months postoperatively. Results The ADAS-cog score at 14 weeks was significantly better for the resistance training group (n=14, 7.2±1.4; 95% CI 4.3, 10.2, vs n=17, 9.2±1.3; 95% CI 6.6, 11.9, p=0.010). At 14 weeks postoperatively, 53% of the aerobic-based rehabilitation group (n=9/17) experienced cognitive decline by two points or more from baseline ADAS-cog score, compared to 0% of the resistance training group (n=0/14; p=0.001). Conclusion Early resistance training appears to be safe and may improve cognitive recovery compared to standard, aerobic-based rehabilitation following cardiac surgery via median sternotomy, however as this was a pilot study, the sample size was small and further research is needed to determine a causal relationship.
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- 2021
34. The Impact on 30-Day Mortality From a Brief Focused Ultrasound-Guided Management Protocol Immediately Before Emergency Noncardiac Surgery in Critically Ill Patients: A Multicenter Randomized Controlled Trial
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Longyan Li, Yan'na Si, Stuart Boggett, Hui Yu, Colin Royse, Jin Liu, Tao Hu, David Canty, Ya Chen, Xuze Li, Ke Chen, Lai Wei, Qiang Li, Xiaoqiang Li, Kejian Lu, Min Li, Xuan Yu, ChunLin Gu, Jiao Chen, Xin He, Huanghui Wu, Shuanjun Zhang, Yiri Du, Jianqiang Song, and Yu Mao
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Mechanical ventilation ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Critical Illness ,Hemodynamics ,Odds ratio ,Intensive care unit ,Respiration, Artificial ,Confidence interval ,law.invention ,Anesthesiology and Pain Medicine ,Blood pressure ,Respiratory failure ,Randomized controlled trial ,law ,Emergency medicine ,Medicine ,Humans ,Cardiology and Cardiovascular Medicine ,business ,Ultrasonography, Interventional - Abstract
To determine whether brief ultrasound-guided treatment of hemodynamic shock and respiratory failure immediately before emergency noncardiac surgery reduced 30-day mortality.Parallel, nonblinded, randomized trial with 1:1 allocation to control and intervention groups.Twenty-eight major hospitals within China.Six-hundred sixty patients ≥14 years of age, scheduled for emergency noncardiac surgery with evidence of shock (heart rate120 beat/min, systolic blood pressure90 mmHg or requiring inotrope infusion), or respiratory failure (Pulse Oxygen Saturation92%, respiratory rate20 beat/min, or requiring mechanical ventilation).A brief (15 minutes) focused ultrasound of ventricular filling and function, lung, and peritoneal spaces, with predefined treatment recommendation based on the ultrasound was performed before surgery or standard care.The primary outcome was 30-day mortality. Secondary outcomes included changes in medical or surgical diagnosis and management due to ultrasound, intensive care unit, and hospital stay and cost, and Short Form-8 quality-of-life scores. Although there were frequent changes in diagnosis (82%) and management (49%) after the ultrasound, mortality at 30 days was not different between groups (50 [15.7%] v 53 [16.3%]; odds ratio 1.05, 0.69-1.6, p = 0.826). There were no differences in the secondary outcomes of the days spent in the hospital (mean 13.8 days, 95% confidence interval [CI] 12.1-15.6 v 14.4 d, 11.8-17.1, p = 0.718) or intensive care unit (mean 9.3 days, 95% CI 7.7-11.0 v 8.7 d, 7.2-10.2, p = 0.562), hospital cost (USD$14.5K, 12.2-16.7 v 13.7, 11.5-15.9, p = 0.611) or Short Form-8 scores at one year (mean 80.9, 95% CI 78.4-83.3 v 79.7, 76.9-82.5, p = 0.54) between participants allocated to the ultrasound and control groups.In critically ill patients with hemodynamic shock or respiratory failure, a focused ultrasound-guided management did not reduce 30-day mortality but led to frequent changes in diagnosis and patient management.
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- 2021
35. Multi-organ point-of-care ultrasound for COVID-19 (PoCUS4COVID):international expert consensus
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Christian B. Laursen, Carmela Graci, Emanuele Pivetta, Philippe Rola, Peiman Nazerian, Colin Royse, Adrian Wong, Ramon Nogue, Jim Connolly, Miguel Montorfano, Shalim J Rodríguez, Alberto Goffi, André Y. Denault, Martin Balik, Mahathar Abd Wahab, José Pazeli, Tomás Villén, Rachel Liu, Susanna Price, Richard Hoppmann, Luca Neri, Elmo Pereira-Junior, Majid Al Salamah, Gabriele Via, Laurent Zieleskiewicz, Gregor Prosen, Aleksandar N. Neskovic, Pablo Blanco, Juan Jose Calderon, Irene W. Y. Ma, Wang Zhen, Karim Bendjelid, Guido Tavazzi, Wang Xiaoting, Yale Tung Chen, Francesco Mojoli, Roberto Copetti, Vicki E. Noble, Abdulmohsen Alsaawi, Yaseen M. Arabi, Toru Kameda, Massimiliano Meineri, Arif Hussain, Diego Barca, Pablo Bravo-Figueroa, Young Rock Ha, Jan Poelaert, Mike Wells, Raoul Breitkreutz, Michael J. Lanspa, Belaid Bouhemad, Bret P. Nelson, Laura Hurtado, Deepak Govil, Tomislav Petrovic, Anthony J. Dean, Francis Chun Yue Lee, Adi Osman, Lawrence Melniker, Francesco Corradi, Anesthesiology research group, Supporting clinical sciences, Anesthesiology, and Faculty of Medicine and Pharmacy
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COVID-19 / diagnostic imaging ,Echocardiography / standards ,Internationality ,Expert Testimony / methods ,Review ,030204 cardiovascular system & hematology ,Critical Care and Intensive Care Medicine ,surgery ,0302 clinical medicine ,Lung ,Ultrasonography ,Point-of-Care Systems / standards ,ddc:617 ,Point of care ultrasound ,Ultrasound ,lcsh:Medical emergencies. Critical care. Intensive care. First aid ,COVID-19 / therapy ,Focused cardiac ultrasound (FoCUS) ,Echocardiography ,Thromboembolism / diagnostic imaging ,medicine.medical_specialty ,Consensus ,Coronavirus disease 2019 (COVID-19) ,Lung / diagnostic imaging ,Point-of-Care Systems ,Point-of-care ultrasound (PoCUS) ,Lung ultrasound (LUS) ,Triage / standards ,COVID-19 ,SARS-CoV-2 ,Expert Testimony ,Humans ,Thromboembolism ,Triage ,03 medical and health sciences ,Thromboembolism / therapy ,medicine ,Medical imaging ,Intensive care medicine ,Echocardiography / methods ,Ultrasonography / standards ,business.industry ,Expert consensus ,030208 emergency & critical care medicine ,lcsh:RC86-88.9 ,Multi organ ,Triage / methods ,Lung ultrasound ,Anesthesiology and Pain Medicine ,Expert Testimony / standards ,business - Abstract
COVID-19 has caused great devastation in the past year. Multi-organ point-of-care ultrasound (PoCUS) including lung ultrasound (LUS) and focused cardiac ultrasound (FoCUS) as a clinical adjunct has played a significant role in triaging, diagnosis and medical management of COVID-19 patients. The expert panel from 27 countries and 6 continents with considerable experience of direct application of PoCUS on COVID-19 patients presents evidence-based consensus using GRADE methodology for the quality of evidence and an expedited, modified-Delphi process for the strength of expert consensus. The use of ultrasound is suggested in many clinical situations related to respiratory, cardiovascular and thromboembolic aspects of COVID-19, comparing well with other imaging modalities. The limitations due to insufficient data are highlighted as opportunities for future research. post-print 2.282 KB
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- 2020
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36. Reliability of lumbar multifidus and iliocostalis lumborum thickness and echogenicity measurements using ultrasound imaging
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Alistair Royse, Joshua Farragher, Colin Royse, Adrian Pranata, Doa El-Ansary, Selina M Parry, Gavin Williams, Adam L. Bryant, and Molly O'Donohue
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Radiological and Ultrasound Technology ,business.industry ,Intraclass correlation ,education ,Ultrasound ,Echogenicity ,Original Articles ,Iliocostalis lumborum ,behavioral disciplines and activities ,humanities ,Confidence interval ,Standard error ,Lumbar ,Medicine ,Radiology, Nuclear Medicine and imaging ,Nuclear medicine ,business ,Reliability (statistics) - Abstract
PURPOSE: To establish the test–retest and inter‐rater reliability of lumbar multifidus (LM) and iliocostalis lumborum (IL) muscle thickness and echogenicity as derived using ultrasound imaging. METHODS: Ultrasound images of the LM and IL were collected from 11 healthy participants on two occasions, 1 week apart, by two independent assessors. Measures of LM and IL thickness and echogenicity were subject to test–retest and inter‐rater reliability, which was assessed by calculation of an F statistic, the interclass correlation coefficient (ICC), the standard error of measurement, 95% confidence intervals and Bland–Altman plots. This study was given approval by The University of Melbourne Behavioural and Social Sciences Human Ethics Sub‐Committee (ref: 1749845). RESULTS: Assessors A and B showed good to excellent test–retest reliability for LM thickness (ICC(3,3) A: 0.89 and B: 0.98), LM echogenicity (ICC(3,3) A: 0.93 and B: 0.95) and IL echogenicity (ICC(3,3) A: 0.87 and B: 0.83). Test–retest reliability for IL thickness was poor for Assessor A but excellent for Assessor B. Both assessors demonstrated excellent inter‐rater reliability for LM thickness and echogenicity (ICC(2,3): 0.79 and 0.94), but poor reliability for IL thickness and echogenicity (ICC(2,3): 0.00 and 0.39). CONCLUSIONS: Inter‐rater and test–retest reliability was excellent for LM but was less reliable for measures of the IL muscle.
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- 2020
37. Automatic deep learning-based pleural effusion classification in lung ultrasound images for respiratory pathology diagnosis
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Chung-Han Tsai, Jeroen M. A. van der Burgt, Colin Royse, Davide Fontanarosa, Kavi Haji, Jason Dowling, Libertario Demi, Alistair Royse, David Canty, Andrew Wang, Nancy Kaur, Girija Chetty, and Damjan Vukovic
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medicine.medical_specialty ,Coronavirus disease 2019 (COVID-19) ,Pleural effusion ,Biophysics ,General Physics and Astronomy ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Deep Learning ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Lung ,Pneumonitis ,Ultrasonography ,Ground truth ,business.industry ,SARS-CoV-2 ,Deep learning ,COVID-19 ,General Medicine ,medicine.disease ,Lung ultrasound ,Pleural Effusion ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,Test set ,Artificial intelligence ,Radiology ,business - Abstract
Lung ultrasound (LUS) imaging as a point-of-care diagnostic tool for lung pathologies has been proven superior to X-ray and comparable to CT, enabling earlier and more accurate diagnosis in real-time at the patient's bedside. The main limitation to widespread use is its dependence on the operator training and experience. COVID-19 lung ultrasound findings predominantly reflect a pneumonitis pattern, with pleural effusion being infrequent. However, pleural effusion is easy to detect and to quantify, therefore it was selected as the subject of this study, which aims to develop an automated system for the interpretation of LUS of pleural effusion. A LUS dataset was collected at the Royal Melbourne Hospital which consisted of 623 videos containing 99,209 2D ultrasound images of 70 patients using a phased array transducer. A standardized protocol was followed that involved scanning six anatomical regions providing complete coverage of the lungs for diagnosis of respiratory pathology. This protocol combined with a deep learning algorithm using a Spatial Transformer Network provides a basis for automatic pathology classification on an image-based level. In this work, the deep learning model was trained using supervised and weakly supervised approaches which used frame- and video-based ground truth labels respectively. The reference was expert clinician image interpretation. Both approaches show comparable accuracy scores on the test set of 92.4% and 91.1%, respectively, not statistically significantly different. However, the video-based labelling approach requires significantly less effort from clinical experts for ground truth labelling.
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- 2020
38. Location and Patterns of Persistent Pain Following Cardiac Surgery
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Colin Royse, Mohd Ali Katijjahbe, Alistair Royse, Kathryn King-Shier, Doa El-Ansary, Catherine L Granger, Linda Denehy, Mohd Ramzisham Abdul Rahman, and Nur Ayub Md Ali
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Pulmonary and Respiratory Medicine ,Adult ,medicine.medical_specialty ,medicine.medical_treatment ,Population ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Medicine ,Humans ,030212 general & internal medicine ,Prospective Studies ,Cardiac Surgical Procedures ,Prospective cohort study ,education ,Pain Measurement ,education.field_of_study ,Pain, Postoperative ,business.industry ,Incidence (epidemiology) ,Persistent pain ,Middle Aged ,Sternotomy ,Cardiac surgery ,medicine.anatomical_structure ,Median sternotomy ,Anesthesia ,Cardiology and Cardiovascular Medicine ,business ,Surgical incision ,Artery - Abstract
OBJECTIVES: To investigate the specific clinical features of pain following cardiac surgery and evaluate the information derived from different pain measurement tools used to quantify and describe pain in this population. METHODS: A prospective observational study was undertaken at two tertiary care hospitals in Australia. Seventy-two (72) adults (mean age, 63±11 years) were included following cardiac surgery via a median sternotomy. Participants completed the Patient Identified Cardiac Pain using numeric and visual prompts (PICP), the McGill Pain Questionnaire-Short Form version 2 (MPQ-2) and the Medical Outcome Study 36-item version 2 (SF-36v2) Bodily Pain domain (BP), which were administered prior to hospital discharge, 4 weeks and 3 months postoperatively. RESULTS: Participants experienced a high incidence of mild (n=45, 63%) to moderate (n=22, 31%) pain prior to discharge, which reduced at 4 weeks postoperatively: mild (n=28, 41%) and moderate (n=5, 7%) pain; at 3 months participants reported mild (n=14, 20%) and moderate (n=2, 3%) pain. The most frequent location of pain was the anterior chest wall, consistent with the location of the surgical incision and graft harvest. Most participants equated "pressure/weight" to "aching" or a "heaviness" in the chest region (based on descriptor of pain in the PICP) and the pain topography was persistent at 4 weeks and 3 months postoperatively. Each pain measurement tool provided different information on pain location, severity and description, with significant change (p
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- 2020
39. Effects of Supervised Early Resistance Training versus standard care on cognitive recovery following cardiac surgery via median sternotomy (the SEcReT study): protocol for a randomised controlled pilot study
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David Canty, Gavin Williams, Alistair Royse, Jacqueline Pengelly, Adam L. Bryant, Lynda Tivendale, Colin Royse, Timothy J Dettmann, and Doa El-Ansary
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medicine.medical_specialty ,medicine.medical_treatment ,Population ,Medicine (miscellaneous) ,Pilot Projects ,Physical exercise ,030204 cardiovascular system & hematology ,law.invention ,Study Protocol ,03 medical and health sciences ,Cognition ,0302 clinical medicine ,Patient satisfaction ,Randomized controlled trial ,Recovery ,law ,medicine ,Humans ,Aerobic exercise ,Pharmacology (medical) ,Prospective Studies ,Cardiac Surgical Procedures ,Cognitive decline ,education ,Exercise ,Randomized Controlled Trials as Topic ,lcsh:R5-920 ,education.field_of_study ,Rehabilitation ,business.industry ,Australia ,Cardiac surgery ,Sternotomy ,Exercise Therapy ,Resistance training ,Clinical trial ,Treatment Outcome ,Median sternotomy ,Quality of Life ,Physical therapy ,lcsh:Medicine (General) ,business ,030217 neurology & neurosurgery - Abstract
Introduction Mild cognitive impairment is considered a precursor to dementia and significantly impacts upon quality of life. The prevalence of mild cognitive impairment is higher in the post-surgical cardiac population than in the general population, with older age and comorbidities further increasing the risk of cognitive decline. Exercise improves neurogenesis, synaptic plasticity and inflammatory and neurotrophic factor pathways, which may help to augment the effects of cognitive decline. However, the effects of resistance training on cognitive, functional and overall patient-reported recovery have not been investigated in the surgical cardiac population. This study aims to determine the effect of early moderate-intensity resistance training, compared to standard care, on cognitive recovery following cardiac surgery via a median sternotomy. The safety, feasibility and effect on functional recovery will also be examined. Methods This study will be a prospective, pragmatic, pilot randomised controlled trial comparing a standard care group (low-intensity aerobic exercise) and a moderate-intensity resistance training group. Participants aged 18 years and older with coronary artery and/or valve disease requiring surgical intervention will be recruited pre-operatively and randomised 1:1 to either the resistance training or standard care group post-operatively. The primary outcome, cognitive function, will be assessed using the Alzheimer’s Disease Assessment Scale and cognitive subscale. Secondary measures include safety, feasibility, muscular strength, physical function, multiple-domain quality of recovery, dynamic balance and patient satisfaction. Assessments will be conducted at baseline (pre-operatively) and post-operatively at 2 weeks, 8 weeks, 14 weeks and 6 months. Discussion The results of this pilot study will be used to determine the feasibility of a future large-scale randomised controlled trial that promotes the integration of early resistance training into existing aerobic-based cardiac rehabilitation programs in Australia. Trial registration Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12617001430325p. Registered on 9 October 2017. Universal Trial Number (UTN): U1111-1203-2131.
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- 2020
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40. Routine Intraoperative Inhaled Milrinone and Iloprost Reduces Inotrope Use in Patients Undergoing Cardiac Surgery: A Retrospective Cohort Pilot Study
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Colin Royse, James Anstey, Alistair Royse, Xiaobo Hu, Yang Yang, Wang Chun-Ting, Xiaoqiang Li, and Stuart Boggett
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Inotrope ,Male ,medicine.medical_specialty ,Cardiotonic Agents ,Vasodilator Agents ,Pilot Projects ,law.invention ,Cohort Studies ,03 medical and health sciences ,0302 clinical medicine ,030202 anesthesiology ,law ,Anesthesiology ,Administration, Inhalation ,medicine ,Humans ,Iloprost ,Cardiac Surgical Procedures ,Intraoperative Complications ,Aged ,Retrospective Studies ,Intraoperative Care ,business.industry ,Retrospective cohort study ,Perioperative ,Middle Aged ,Intensive care unit ,Myocardial Contraction ,Cardiac surgery ,Anesthesiology and Pain Medicine ,Anesthesia ,Milrinone ,Female ,business ,030217 neurology & neurosurgery ,medicine.drug - Abstract
BACKGROUND: Catecholamine inotropes are frequently used after cardiopulmonary bypass (CPB) but may have undesirable effects. The aim was to identify whether the routine use of inhaled pulmonary vasodilators might reduce the requirement for inotrope drugs after cardiac surgery. METHODS: Retrospective cohort study of sequential patients undergoing cardiac surgery at the Royal Melbourne Hospital performed by a single surgeon and anesthesia care team, within 14 months before and after routine implementation of inhaled pulmonary vasodilators, August 2017. Milrinone 4 mg and iloprost 20 µg were inhaled using a vibrating mesh nebulizer (Aerogen) before initiation of CPB and at chest closure. Other aspects of clinical management were unaltered over the time period. Two investigators blinded to each other extracted data from electronic and written medical records. The primary outcome was any use of inotropes in the perioperative period; a Fisher exact test was used to analyze any differences between the 2 groups. Demographic data, hemodynamic data, and use of inotropes and vasopressors were collected from induction of anesthesia to 36 hours postoperative in the intensive care unit (ICU). Hospital and ICU length of stay, cost, and complications were collected. RESULTS: Any use of inotropes was significantly lower with inhaled pulmonary dilators (62.5% vs 86.8%, odds ratio [95% confidence interval {CI}], 0.253 (0.083-0.764); P = .011), including intraoperative inotrope use (37.5% vs 86.8%, odds ratio [95% CI], 0.091 (0.03-0.275); P < .001). ICU length of stay was significantly lower with inhaled pulmonary dilators (45 hours, interquartile range [IQR], 27-65 vs 50 hours, IQR, 45-74; P = .026). There were no significant differences among major postoperative complications or costs between groups. CONCLUSIONS: Routine use of inhaled milrinone 4 mg and iloprost 20 µg before and after CPB is associated with reduced postoperative inotrope use.
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- 2020
41. Why and how to achieve total arterial revascularisation in coronary surgery
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Zulfayandi Pawanis, Colin Royse, Alistair Royse, Sandy Clarke-Errey, and Stuart Boggett
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medicine.medical_specialty ,business.industry ,Internal medicine ,medicine.artery ,Cardiology ,Medicine ,Coronary surgery ,Radial artery ,business - Published
- 2020
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42. Utility of lung ultrasound in the management of COVID-19 respiratory infection
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X Li, Ximena Cid Serra, Andrew Wang, Xiaobo Hu, Lindsay Bridgford, André Y. Denault, Alistair Royse, David Canty, Doa El-Ansary, and Colin Royse
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medicine.medical_specialty ,Coronavirus disease 2019 (COVID-19) ,business.industry ,Disease progression ,Respiratory infection ,Context (language use) ,respiratory system ,medicine.disease ,Triage ,respiratory tract diseases ,Lung ultrasound ,Pulmonary embolism ,Prone position ,medicine ,Intensive care medicine ,business - Abstract
In the context of the coronavirus disease 2019 (COVID-19) pandemic, lung ultrasound has emerged as an accurate and reliable alternative for assessment of lung pathology. The main lung ultrasound findings in COVID-19 patients are interstitial syndrome, irregular and broken aspect of the pleural line, and sub-pleural consolidation. Consolidations are usually a late finding appearing during the second week since symptoms onset. Translating into the practice, lung ultrasound can improve diagnostic accuracy and contribute with relevant information to the triage of these patients. It can be used as part of the routinely assessment of patients admitted to the medical ward allowing early identification of disease progression. Among patients mechanically ventilated, it is useful evaluating response to prone position and/or recruiting maneuvers. Finally, in all the previous scenarios, lung ultrasound may also detect common complications seen in these patients such as cardiogenic pulmonary edema and pulmonary embolism. In this review, we have summarized the information available and suggest simple algorithm to incorporate lung ultrasound into the assessment of COVID-19 patients.
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- 2020
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43. Measurement of Recovery Within ERAS
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Colin Royse and Andrea Bowyer
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medicine.medical_specialty ,business.industry ,media_common.quotation_subject ,Context (language use) ,Perioperative ,Outcome (game theory) ,Contextual variable ,Medicine ,Quality (business) ,Construct (philosophy) ,business ,Intensive care medicine ,Baseline (configuration management) ,Enhanced recovery after surgery ,media_common - Abstract
Obtaining quality of recovery is an abstract construct that is the ultimate goal of each perioperative experience. Modern recovery has progressed from being defined as a purely unidimensional, short-term outcome to a multidimensional concept that is occurring along a time trajectory and which extends beyond the traditional immediate postoperative period. Meta-analyses and systemic reviews have revealed the most commonly reported outcome measures used to evaluate enhanced recovery after surgery (ERAS) pathways to be hospital length of stay and 30-day readmission rates. Concept analyses and the rise of patient-centered care have led to a call for measurement of recovery within ERAS programs to be extended to include both patient-centric and contextual variables through which to assess these traditional outcomes. Recovery assessment variables may be objective or subjective and are prone to bias due to lack of context or susceptibility to response shift, respectively. Recovery assessment infers a comparison of a patient to a preoperative comparator—ideally their own preoperative baseline. Ideally, recovery is assessed using a multidimensional dichotomous recovery assessment tool that has the infrastructure to provide recovery outcomes to both patient and clinician in real time.
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- 2020
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44. Perioperative ultrasound-assisted clinical evaluation - A case based review
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Daniel I. Sessler, David Canty, and Colin Royse
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medicine.medical_specialty ,Radiological and Ultrasound Technology ,business.industry ,Ultrasound ,Vascular access ,030208 emergency & critical care medicine ,Review Article ,Perioperative ,Transoesophageal echocardiography ,Ultrasound assisted ,Cardiac surgery ,03 medical and health sciences ,0302 clinical medicine ,030202 anesthesiology ,Intensive care ,Medicine ,Radiology, Nuclear Medicine and imaging ,business ,Intensive care medicine ,Clinical evaluation - Abstract
Ultrasound is increasingly being adopted into anaesthesia and intensive care practice. The range of ultrasound examination has also increased from transoesophageal echocardiography in cardiac surgery and ultrasound-guided nerve blocks and vascular access, to examination of the heart, lungs, abdomen and deep veins. Typically, the use of ultrasound is focused or basic, designed to be performed by the anaesthetist at the patient's bedside in real time to answer clinical questions and to direct therapy. Ultrasound is not performed in isolation, but used to complement clinical evaluation, and accordingly can be considered as 'ultrasound-assisted perioperative evaluation'. Whilst there is good evidence that ultrasound improves diagnostic accuracy and in turn alters management, there are few data examining whether ultrasound leads to improved clinical outcomes. This review will examine multiple uses of perioperative ultrasound with case studies to illustrate potential utility.
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- 2018
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45. A matter of perspective – Objective versus subjective outcomes in the assessment of quality of recovery
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Colin Royse and Andrea Bowyer
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Postoperative Care ,business.industry ,Applied psychology ,Recovery of Function ,Patient-centered care ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Anesthesiology and Pain Medicine ,Patient satisfaction ,Enhanced recovery ,Randomized controlled trial ,Observer Bias ,030202 anesthesiology ,law ,Patient-Centered Care ,Recall bias ,Humans ,Medicine ,030212 general & internal medicine ,Performance indicator ,business ,Objectivity (science) ,Quality of Health Care - Abstract
Current post-operative recovery assessment exists as a dichotomy, maintaining objectivity whilst providing relevance to patient-centred care. Both objective and subjective measures are utilised in modern recovery assessment and are best viewed as complimentary. At institutional and provider levels, performance indicators are utilised as surrogates for quality of recovery but only if these indicators are assessed in the clinical context from which they are derived. Patient-reported outcomes prioritise the patient's perspective of symptoms and care, which are the most important aspects at the time of assessment but are limited by their susceptibility to response shift and recall bias. Ideally, quality of recovery is assessed using objective measures in concert with measures of clinical complexity and in parallel with patient-reported outcomes.
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- 2018
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46. Approaches to the measurement of post-operative recovery
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Colin Royse and Andrea Bowyer
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Postoperative Care ,medicine.medical_specialty ,business.industry ,Recovery of Function ,Outcome (game theory) ,Restitution ,03 medical and health sciences ,0302 clinical medicine ,Anesthesiology and Pain Medicine ,Physical medicine and rehabilitation ,Enhanced recovery ,Surgical recovery ,030202 anesthesiology ,medicine ,Humans ,Postoperative Period ,Precision Medicine ,Post operative ,business ,030217 neurology & neurosurgery - Abstract
Modern recovery assessment has progressed from that which addressed purely physiological restitution in the immediate post-operative period to that which is a multi-dimensional construct existing as a continuum and which follows a predictable trajectory. Recovery tools differ in their derivation, validation and scope of assessment. Importantly, few are validated for repeat measures, an aspect crucial when assessing the temporal nature of modern recovery. Recovery can be assessed as a continuous or dichotomous outcome and as occurring within an individual patient or within a group. Dichotomisation of recovery assessment mandates that a threshold be determined, above which recovery is deemed to have occurred. Ideally, recovery is assessed as a dichotomous outcome using the patient as their own pre-operative comparator, thus allowing recovery assessment at an individual patient, as well as group, level and overall as well as within each recovery domain.
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- 2018
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47. The patient's surgical journey and consequences of poor recovery
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Colin Royse
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Value (ethics) ,medicine.medical_specialty ,Best practice ,media_common.quotation_subject ,03 medical and health sciences ,0302 clinical medicine ,030202 anesthesiology ,Patient-Centered Care ,medicine ,Humans ,Quality (business) ,030212 general & internal medicine ,Functional ability ,Cognitive decline ,Intensive care medicine ,media_common ,Postoperative Care ,business.industry ,Recovery of Function ,Anesthesiology and Pain Medicine ,General Surgery ,Scale (social sciences) ,Patient Care ,Metric (unit) ,Construct (philosophy) ,business - Abstract
Quality of recovery is a multidimensional construct that affects individual patients in different ways and during different time periods. The evaluation of quality of recovery requires patient-reported outcome measurement tools that are sensitive in detecting change with time and are preferably objective rather than subjective by nature. Current surgical outcomes are still predominantly focused on the avoidance of complications and reduced cost. The new era of 'value-based care' implies that outcomes of importance to the patient should be a vital metric in determining quality of surgical care. However, it is critical to maintain the high standards of surgical safety and cost containment as we move forward to address value-based care. An apparently successful surgery can result in poor recovery outcomes such as cognitive decline, persistent pain, reduced functional ability, loss of independence or inability to return to work. The special edition of Best Practice will focus on the multidimensional construct of quality of recovery, how to measure it and how it may apply in different populations.
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- 2018
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48. Validation of the cognitive recovery assessments with the Postoperative Quality of Recovery Scale in patients with low‐baseline cognition
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Colin Royse, Johan Heiberg, Andrea Bowyer, Stanton Newman, Daniel I. Sessler, and Alistair Royse
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Male ,medicine.medical_specialty ,BF ,Neuropsychological Tests ,RT ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,030202 anesthesiology ,Anesthesiology ,medicine ,Humans ,Dementia ,030212 general & internal medicine ,Aged ,Face validity ,business.industry ,Neuropsychology ,Discriminant validity ,Reproducibility of Results ,Cognition ,medicine.disease ,Anesthesiology and Pain Medicine ,Anesthesia Recovery Period ,Physical therapy ,Female ,Cognition Disorders ,business ,Neurocognitive - Abstract
Patients with pre-surgery cognitive impairment cannot currently be assessed for cognitive recovery after surgery using the Postoperative Quality of Recovery Scale (PostopQRS), as they would mathematically be scored as recovered. We aimed to validate a novel method to score cognitive recovery in patients with low-baseline cognition, using the number of low-score tests rather than their numerical values. Face validity was demonstrated in 86 participants in whom both the Postoperative Quality of Recovery Scale and an 11-item neuropsychological battery were performed. The Postoperative Quality of Recovery Scale agreed with neuropsychological categorisation of low vs. normal cognition 74% of the time, with all but five incorrectly coded participants deviating by only one neurocognitive test. Cognitive recovery over time was comparable for groups with differing baseline cognitive function, irrespective of whether the Postoperative Quality of Recovery Scale or neuropsychological methods were used. Discriminant validation was demonstrated in a post-hoc analysis of the steroids in cardiac surgery substudy by allocating groups to normal (n = 246) or low-baseline cognition (n = 231) stratified by cognitive recovery on day 1. Recovery was similar for participants with low and normal baseline cognition. Postoperative length of stay was longer in patients with failed cognitive recovery whether they had normal mean (SD) (10.4 (10.0) vs. 8.0 (5.9) days, p = 0.02) or low-baseline cognition (12.0 (11.1) vs. 8.2 (4.7) days, p < 0.01). Overall quality, as well as cognitive, emotive and physiological recovery was independent of baseline cognition. The modified scoring method for the Postoperative Quality of Recovery Scale cognitive domain demonstrates acceptable face and discriminant validity.
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- 2018
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49. The impact of heart, lung and diaphragmatic ultrasound on prediction of failed extubation from mechanical ventilation in critically ill patients: a prospective observational pilot study
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David Canty, Darsim Haji, Alistair Royse, Colin Royse, Kavi Haji, and Cameron Green
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lcsh:Medical physics. Medical radiology. Nuclear medicine ,medicine.medical_specialty ,medicine.medical_treatment ,lcsh:R895-920 ,Diaphragm ,Intensivist ,Diaphragmatic breathing ,Weaning ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Ultrasound ,Medicine ,Pulmonary wedge pressure ,Lung ,Positive end-expiratory pressure ,Mechanical ventilation ,Ejection fraction ,Radiological and Ultrasound Technology ,business.industry ,030208 emergency & critical care medicine ,RSBI ,030228 respiratory system ,Echocardiography ,Rapid shallow breathing index ,Cardiology ,Breathing ,Original Article ,business - Abstract
Background Failed extubation from mechanical ventilation in critically ill patients is multifactorial, complex and not well understood. We aimed to identify whether combined transthoracic echocardiography, lung and diaphragmatic ultrasound can predict extubation failure in critically ill patients. Results Fifty-three participants who were intubated > 48 h and deemed by the treating intensivist ready for extubation underwent a 60-min pre-extubation weaning trial (pressure support ≤ 10 cmH2O and positive end expiratory pressure 5 cmH2O). Prior to extubation, data collected included ultrasound assessment of left ventricular ejection fraction, left atrial area, early diastolic trans-mitral flow velocity wave (E), early diastolic trans-mitral flow velocity wave/late diastolic trans-mitral flow velocity wave (E/A), early diastolic trans-mitral flow velocity wave/early diastolic mitral annulus velocity (E/E′), interatrial septal motion, lung loss of aeration score and diaphragm movement. At the end of the weaning trial, the rapid shallow breathing index and serum B-type natriuretic peptide concentration were measured. Success and failure of weaning was assessed by defined criteria. Decision to extubate was at the discretion of the treating intensivist. Failure of extubation was defined as re-intubation, non-invasive ventilation or death within 48 h after extubation. Of 53 extubated participants, 11 failed extubation. Failed extubation was associated with diabetes, ischaemic heart disease, higher E/E′ (OR 1.27, 95% CI 1.05–1.54), left atrial area (OR 1.14, CI 1.02–1.28), fixed rightward curvature of the interatrial septum (OR 12.95, CI 2.73–61.41), and higher loss of aeration score of anterior and lateral regions of the lungs (OR 1.41, CI 1.01–1.82). Conclusions Failed extubation in mechanically ventilated patients is more prevalent if markers of left ventricular diastolic dysfunction and loss of lung aeration are present.
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- 2018
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50. The effect on survival from the use of a saphenous vein graft during coronary bypass surgery: a large cohort study†
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Colin Royse, Christopher M. Reid, Andrew E. Ajani, Alistair Royse, Jared Ou-Young, Rinaldo Bellomo, Zulfayandi Pawanis, David Eccleston, and David Canty
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Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Internal thoracic artery ,030204 cardiovascular system & hematology ,03 medical and health sciences ,Coronary artery bypass surgery ,0302 clinical medicine ,medicine.artery ,Internal medicine ,medicine ,Humans ,Saphenous Vein ,030212 general & internal medicine ,Coronary Artery Bypass ,Radial artery ,Retrospective Studies ,business.industry ,Hazard ratio ,Australia ,Retrospective cohort study ,General Medicine ,Confidence interval ,Treatment Outcome ,Bypass surgery ,Propensity score matching ,Cardiology ,Surgery ,Cardiology and Cardiovascular Medicine ,business ,New Zealand - Abstract
OBJECTIVES: Saphenous vein graft (SVG) remains the predominant conduit used in coronary surgery. The internal mammary artery has higher later term patency and confers superior survival. Current debate focuses on the increased use of arterial conduits rather than eradication of venous conduits. METHODS: Patient data extracted from the Australian and New Zealand Society of Cardiothoracic Surgeons database from 2001-2013 were linked to the national death registry held by the Australian Institute of Health and Welfare for all-cause mortality with censor date 7 October 2014. The dataset was divided according to use of SVG rather than the arterial conduit. Analyses of SVG ≥ 1 or SVG = 1 were compared to SVG = 0. Additionally, groups of 3, 4 or 5 grafts were subjected to multiple analyses testing the mortality hazard with increasing use of SVG. Propensity score matched analyses were conducted using 24 variables. RESULTS: Of 51 113 primary coronary surgery patients, unmatched survival at up to 12.5 years was significantly lower for SVG ≥ 1, n = 33 359, mortality hazard ratio (HR) 1.24 [95% confidence interval (CI) 1.18-1.30], P
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- 2018
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