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

Author

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

Subjects
AAA, COVID-19, PAD, Survey, Vascular surgery, Diseases of the circulatory (Cardiovascular) system, RC666-701, Surgery, RD1-811
Abstract

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

Published
2022
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2. Groin Wound Infection after Vascular Exposure (GIVE) Risk Prediction Models: Development, Internal Validation, and Comparison with Existing Risk Prediction Models Identified in a Systematic Literature Review

Author

Brenig L. Gwilym, Graeme K. Ambler, Athanasios Saratzis, David C. Bosanquet, Philip Stather, Aminder Singh, Enrico Mancuso, Mohedin Arifi, Mohamed Altabal, Ahmed Elhadi, Abdulmunem Althini, Hazem Ahmed, Huw Davies, Madhu Rangaraju, Maciej Juszczak, Jonathan Nicholls, Nicholas Platt, James Olivier, Emily Kirkham, David Cooper, Iain Roy, Gareth Harrison, James Ackah, Devender Mittapalli, Ian Barry, Toby Richards, Ahmed Elbasty, Hayley Moore, Adnan Bajwa, Andrew Duncan, Andrew Batchelder, Tryfon Vanias, Matthew Brown, Trixie Yap, Lucy Green, George Smith, Katherine Hurst, Daniel U. Rodriguez, Ella Schofield, Hannah Danbury, Tom Wallace, James Forsyth, Amy Stimpson, Luke Hopkins, Kamran Mohiuddin, Sandip Nandhra, Ghazaleh Mohammadi-Zaniani, Konstantinos Tigkiropoulos, Ahmed Shalan, Khalid Bashar, Rachel Sam, Craig Forrest, Samuel Debono, Keith Hussey, Rachel Falconer, Salil Korambayil, Ciaran Brennan, Thomas Wilson, Aled Jones, Tom Hardy, Hannah Burton, Andrew Cowan, Ummul Contractor, Elaine Townsend, Olivia Grant, Michelle Cronin, Michael Rocker, Danielle Lowry, Annie Clothier, Dafydd Locker, Rachael Forsythe, Olivia McBride, Calvin Eng, Russell Jamieson, Nishath Altaf, Fernando Picazo, Kishore Sieunarine, Ruth A. Benson, Alexander Crichton, Nikesh Dattani, Tasleem Akhtar, Helen Suttenwood, Francesca Guest, Bethany Wardle, George Dovell, Natasha Chinai, David Bosanquet, Robert Hinchliffe, Timothy Beckitt, Arsalan Wafi, Ankur Thapar, Paul Moxey, Tristan Lane, Ryan Preece, Kamil Naidoo, Benjamin Patterson, Claire Perrott, Joseph Shalhoub, Thomas Aherne, Ahmed Hassanin, Emily Boyle, Bridget Egan, Sean Tierney, Shaneel Patel, Panagiota Birmpili, Sandhir Kandola, Simon Neequaye, Muhammed Elhadi, Ahmed Msherghi, Ala Khaled, Lewis Meecham, Owain Fisher, Asif Mahmood, David Milgrom, Kerry Burke, Faris Saleh, and Tariq Al-Samarneh

Subjects
Male, medicine.medical_specialty, Multivariate analysis, Groin, Risk Assessment, Risk Factors, Blood vessel prosthesis, medicine, Humans, Surgical Wound Infection, Povidone-Iodine, Statistic, Aged, Probability, business.industry, Chlorhexidine, Endovascular Procedures, Regression analysis, Middle Aged, Blood Vessel Prosthesis, Observational Studies as Topic, Logistic Models, medicine.anatomical_structure, Systematic review, ROC Curve, Area Under Curve, Multivariate Analysis, Cohort, Emergency medicine, Anti-Infective Agents, Local, Regression Analysis, Female, Surgery, Cardiology and Cardiovascular Medicine, business, Cohort study
Abstract

Objective This study aimed to develop and internally validate risk prediction models for predicting groin wound surgical site infections (SSIs) following arterial intervention and to evaluate the utility of existing risk prediction models for this outcome. Methods Data from the Groin wound Infection after Vascular Exposure (GIVE) multicentre cohort study were used. The GIVE study prospectively enrolled 1 039 consecutive patients undergoing an arterial procedure through 1 339 groin incisions. An overall SSI rate of 8.6% per groin incision, and a deep/organ space SSI rate of 3.8%, were reported. Eight independent predictors of all SSIs, and four independent predictors of deep/organ space SSIs were included in the development and internal validation of two risk prediction models. A systematic search of the literature was conducted to identify relevant risk prediction models for their evaluation. Results The “GIVE SSI risk prediction model” (“GIVE SSI model”) and the “GIVE deep/organ space SSI risk prediction model” (“deep SSI model”) had adequate discrimination (C statistic 0.735 and 0.720, respectively). Three other groin incision SSI risk prediction models were identified; both GIVE risk prediction models significantly outperformed these other risk models in this cohort (C statistic 0.618 – 0.629; p Conclusion Two models were created and internally validated that performed acceptably in predicting “all” and “deep” groin SSIs, outperforming current existing risk prediction models in this cohort. Future studies should aim to externally validate the GIVE models.

Published
2021
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3. Paclitaxel and Mortality Following Peripheral Angioplasty: An Adjusted and Case Matched Multicentre Analysis

Author

Athanasios Diamantopoulos, Athanasios Saratzis, Nikos Saratzis, Benedict Thomson, Talia Lea, Robert J.O. Davies, Trixie Yap, Andrew Batchelder, Hany Zayed, and Prakash Saha

Subjects
Male, medicine.medical_specialty, Time Factors, Databases, Factual, Paclitaxel, medicine.medical_treatment, Prosthesis Design, Risk Assessment, Peripheral Arterial Disease, Coated Materials, Biocompatible, Risk Factors, Median follow-up, Internal medicine, Angioplasty, medicine, Humans, Popliteal Artery, Stage (cooking), Aged, Retrospective Studies, Aged, 80 and over, Greece, Proportional hazards model, business.industry, Mortality rate, Cardiovascular Agents, Drug-Eluting Stents, Retrospective cohort study, Intermittent Claudication, Middle Aged, Intermittent claudication, Femoral Artery, Treatment Outcome, England, Female, Surgery, medicine.symptom, Cardiology and Cardiovascular Medicine, Claudication, business, Angioplasty, Balloon
Abstract

Objective Paclitaxel based drug coated balloons (DCBs) and drug eluting stents (DESs) may be associated with increased mortality in patients with peripheral arterial occlusive disease (PAOD), based on a recent meta-analysis. This study, however, had a number of limitations, which have been discussed at great length among the vascular community. The aim of this research was to assess the association between paclitaxel based endovascular treatment (PTX) in the femoropopliteal (F–P) segment and mortality, adjusting for relevant risk factors and including patients with chronic limb threatening ischaemia (CLTI). Methods This was a retrospective cohort study of a prospectively maintained multicentre (three sites) database of patients with claudication or CLTI. Patients having F–P angioplasty between 1 January 2014 and 30 May 2019 with or without PTX were included. Survival was compared in Cox regression analyses adjusted for parameters of the Charlson comorbidity index. A separate nested case matched (based on each individual's Charlson index) analysis was performed to compare mortality rates between those who received PTX and those who did not. Results A total of 2 071 patients were analysed: 966 patients (46.6%) were treated with PTX (952 [46%] had CLTI and 1 119 [54%] severe claudication [Rutherford stage 3]). Over a 24 month median follow up, 456 (22.1%) patients died. Using multivariable Cox regression, PTX was not associated with mortality (HR 0.94, p = .46), even when assessed separately for those with intermittent claudication (HR 1.30, p = .15) or CLTI (HR 0.81, p = .060). In the case matched analysis (885 matched pairs of patients), PTX was not associated with mortality (HR 0.89, p = .17). Paclitaxel dose and use of a DCB or DES were not associated with mortality in any subanalysis. Conclusion When relevant risk factors were taken into account, there were no associations between PTX and mid term mortality in patients with PAOD.

Published
2020
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4. Editor's Choice – Acute Kidney Injury (AKI) in Aortic Intervention: Findings From the Midlands Aortic Renal Injury (MARI) Cohort Study

Author

Athanasios Saratzis, Shivam Joshi, Ruth A. Benson, David Bosanquet, Nikesh Dattani, Andrew Batchelder, Owain Fisher, Eva Ioannidou, Matthew J. Bown, Christopher H. Imray, David Sidloff, George Dovell, Rachael Forsythe, Loretta Barnett, Henrietta Barnet, Julie Wollaston, Stephen Goodyear, Asif Mahmood, Nicholas Matharu, Seamus Harrison, Jonathan Boyle, Emma Parker, Abigail Carlin, Mandy Burrows, Tristan Lane, Joseph Shalhoub, Andrew Garnham, Safia Begum, Phil Stather, Jessica Thrush, Terry Martin, Jack Fairhead, Julien Al Shakarchi, Tom Wallace, Elaine Wall, Christopher Twine, Wissam Al-Jundi, Huw Davies, Tom Barker, and Edward Lopez

Subjects
Male, medicine.medical_specialty, medicine.medical_treatment, Urology, Renal function, 030204 cardiovascular system & hematology, 030230 surgery, Kidney, urologic and male genital diseases, Risk Assessment, Endovascular aneurysm repair, 03 medical and health sciences, Postoperative Complications, 0302 clinical medicine, Risk Factors, medicine, Humans, Prospective Studies, Renal replacement therapy, Prospective cohort study, Dialysis, Aged, business.industry, Incidence, Endovascular Procedures, Age Factors, Acute kidney injury, Acute Kidney Injury, medicine.disease, Creatinine, Female, Surgery, Cardiology and Cardiovascular Medicine, business, Aortic Aneurysm, Abdominal, Glomerular Filtration Rate, Cohort study, Kidney disease
Abstract

Objectives The incidence of acute kidney injury (AKI) after open (OAR) or endovascular (EVAR) aortic repair is unknown. This research assessed the proportion of patients who develop AKI after aortic intervention using validated criteria, and explored AKI risk factors. Methods This was a multicentre national prospective cohort study. Eleven centres recruited patients undergoing EVAR or OAR (September 2017–December 2018). Serum creatinine (SCr) and urine outputs were measured over a minimum of 48 h or throughout the index inpatient stay to define post-operative AKI using the Kidney Disease Improving Global Outcomes (KDIGO) criteria. Renal decline at 30 days was calculated using estimated glomerular filtration rate (eGFR) and the Major Adverse Kidney Events (MAKE) 30 day composite endpoint (consisting of: death, new dialysis, > 25% eGFR decline). Results 300 patients (mean age: 71 years, standard deviation [SD] 4 years; 9% females) were included, who underwent: infrarenal endovascular aneurysm repair (EVAR) 139 patients, fenestrated EVAR (fEVAR) 30, branched EVAR (bEVAR) seven, infrarenal open aneurysm repair (OAR) 98, juxtarenal OAR 26. Overall, 24% of patients developed stage 1 AKI (defined at 48 h as per KDIGO), 2.7% stage 2 AKI and 1% needed renal replacement therapy before discharge. AKI proportions per intervention were: infrarenal EVAR 18%; fEVAR 27%; bEVAR 71%; infrarenal OAR 41%; juxtarenal OAR 63%. Older age (odds ratio [OR] 1.44 for EVAR, 1.58 for OAR), lower baseline eGFR (OR 0.88 EVAR, 0.74 OAR), and ischaemic heart disease (OR 4.42 EVAR, 5.80 OAR) were the main predictors of AKI for infrarenal EVAR and OAR. Overall, 24% developed the MAKE30 endpoint. All patients who died (0.6%) or developed a major cardiac event (5.6%) at one year had developed AKI. Conclusion AKI and short term renal decline after aortic intervention are common. Age, renal function, and cardiovascular disease are the main risk factors. Research should now focus on AKI prevention in this high risk group.

Published
2020
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5. Defining Patient Safety: a Student Perspective

Author

Liz Anderson and Andrew Batchelder

Subjects
Medical education, business.industry, media_common.quotation_subject, education, Medicine (miscellaneous), Ambiguity, Focus group, Education, Patient safety, Perception, Health care, ComputingMilieux_COMPUTERSANDEDUCATION, Thematic analysis, business, Psychology, Curriculum, Competence (human resources), media_common, Original Research
Abstract

BACKGROUND: Patient safety is recognised as an important aspect of the undergraduate medical curriculum. However, packed medical curricula have been slow to evolve despite repeated mandates and large-scale tragedies resulting from unlearnt lessons. The aim of this work was to explore students’ perspectives on patient safety to inform curriculum re-design. METHODS: Using a qualitative approach, medical students from year 2 and year 4 of the undergraduate course were invited to participate in focus groups to consider: their personal conceptualisation of patient safety, their perceptions of patient safety education in the existing curriculum and their collective preferences for future teaching in this area. Transcripts of the focus groups were subjected to thematic analysis. RESULTS: Six focus groups were convened with a total of 77 students. Thirteen major themes were identified which included conceptual ambiguity, healthcare culture, error theory, specific safety topics (such as infection prevention and control, medication safety, technical/procedural safety, communication and other non-technical skills), self-awareness, patient-centredness, low student morale and raising concerns. Students were more aware of technical than non-technical competence. They wanted learning aligned to the realities of practice, a clearer concept of patient safety and improved visibility of patient safety topics within an integrated curriculum. CONCLUSIONS: Students are keen to engage with safety topics but frequently feel disempowered as future change agents. Educators need to advocate a clear definition of patient safety and consider the implication of the theory-practice gap on students’ evolving attitudes.

Published
2021

6. The Development of an Inventory to Explore Study Group Function

Author

Holly Morris and Andrew Batchelder

Subjects
Student perceptions, Medical education, media_common.quotation_subject, 05 social sciences, Medicine (miscellaneous), Focus group, Group function, Education, 03 medical and health sciences, Team-based learning, 0302 clinical medicine, Problem-based learning, Perception, 0502 economics and business, Cohort, ComputingMilieux_COMPUTERSANDEDUCATION, 030212 general & internal medicine, Psychology, Curriculum, 050203 business & management, media_common
Abstract

Courses for undergraduate medical students, particularly those with a problem-based learning curriculum, use small study groups as a key learning modality. Our aim was to design and validate an inventory to measure students’ perceptions of the functioning of their study group. The initial items were derived from focus group discussions with four domains subsequently generated by the authors from the data. Students in years one and two were invited to respond to each item without being aware of the domain names. Collated responses were scrutinised and allocation of items to each domain was considered by each author with duplicate or ambiguous items being discounted. The resulting inventory was used to evaluate the perceptions of students in the succeeding year. The items were triangulated alongside the student perceptions by eliciting the opinions of small group teachers and personal tutors. Forty-seven items were derived from four focus group discussions and an initial pilot. Subsequently 49.2% (n = 472) of year one and two students completed the first version of the inventory. After analysis of their responses, 24 items were allocated to four domains. When used with 32 study groups in the succeeding cohort of 274 first-year students, the inventory ranked them in order. The lowest scoring groups were also identified by tutors and teachers as problematic. We have developed an inventory to evaluate students’ learning experiences in small groups to meet a need for medical schools that wish to monitor this aspect of their courses. Furthermore, the results have the potential to enhance the function of small study groups.

Published
2018
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7. Global impact of the first coronavirus disease 2019 (COVID-19) pandemic wave on vascular services

Author

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

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

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

Published
2020

8. Rapid Clinical Pharmacology

Author

Charlene M.C. Rodrigues, Adrian G. Stanley, Ziad Alrifai, and Andrew Batchelder

Subjects
medicine.medical_specialty, Clinical pharmacology, law, business.industry, Medicine, Formulary, business, Intensive care medicine, law.invention
Published
2018
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9. Risk of Erectile Dysfunction and Retrograde Ejaculation Associated with Thulium Laser Vaporesection of the Prostate for Bladder Outflow Obstruction: A Retrospective Study

Author

Masood A. Khan, Carol Ling Sze Yee, Raj P. Pal, and Andrew Batchelder

Subjects
Male, Retrograde ejaculation, medicine.medical_specialty, Time Factors, Ejaculation, Urology, medicine.medical_treatment, Prostatic Hyperplasia, Lasers, Solid-State, Erectile Dysfunction, Prostate, Humans, Medicine, Aged, Retrospective Studies, Aged, 80 and over, Prostatectomy, Chi-Square Distribution, business.industry, Urinary retention, Incidence, Penile Erection, Retrospective cohort study, Equipment Design, Middle Aged, medicine.disease, Surgery, Urinary Bladder Neck Obstruction, Neck of urinary bladder, Treatment Outcome, medicine.anatomical_structure, Erectile dysfunction, England, Thulium, Laser Therapy, medicine.symptom, business
Abstract

Objective: The aim of this study was to determine the incidence of erectile dysfunction and retrograde ejaculation following thulium:yttrium-aluminium-garnet (Tm:YAG) laser prostate vaporesection (ThuVaRP). Patients and Methods: Between January 2009 and June 2010, 113 consecutive patients underwent ThuVaRP for bladder outflow obstruction. Of these, 54 (48%) were included in the study as they were able to maintain an erection for sexual intercourse prior to undergoing ThuVaRP. All patients had benign pathology and had not undergone previous bladder neck surgery. The incidence of erectile dysfunction and retrograde ejaculation was reported at a mean follow-up period of 12 months post-operatively. Results: The mean patient age was 71 years (range 46–90). The mean follow-up period was 12 months (range 4–21). 11 (20%) patients experienced worsening erectile function with 3 (6%) noticing an improvement. A total of 30 patients (56%) experienced some degree of retrograde ejaculation. 4 patients (7%) noticed an improvement in their ejaculation. Retrograde ejaculation was more common in patients with an indwelling catheter in situ for refractory urinary retention (43 vs. 17%, p = 0.04) and in diabetic patients (27 vs. 4%, p = 0.03). There was an increased trend of erectile dysfunction in men aged ≧70 years, with hypertension and with hypercholesterolaemia, but this was not significant. Conclusion: Our retrospective study has demonstrated that the overall risk of erectile dysfunction and retrograde ejaculation associated with ThuVaRP is 20 and 56%, respectively.

Published
2012
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10. The role of students as teachers: Four years’ experience of a large-scale, peer-led programme

Author

Christopher Johnson, Li-Ying Lin, Joshua E. Elias, Andrew Batchelder, Peter M. Hickey, and Charlene M.C. Rodrigues

Subjects
Self-Assessment, Medical education, Students, Medical, business.industry, Teaching, education, Significant difference, General Medicine, Peer Group, United Kingdom, Education, Likert scale, Scale (social sciences), Preparedness, Pedagogy, Humans, Medicine, Perception, Educational Measurement, business, Education, Medical, Undergraduate, Program Evaluation
Abstract

This study set out to explore whether a teaching programme developed and delivered by medical students yielded an improvement of attendees' examination performance or their experience of preparing for the target assessment.Over 4 years all students were invited to consent to use of their official examination data. Students were ranked for baseline performance and again for performance in the target assessment. Change in rank was compared for attendees and non-attenders. Additionally, a questionnaire was distributed to students before and after the peer-led programme. Attendees' responses were compared to those of non-attenders.No statistically significant difference in change in rank was observed between the two groups on evaluation of quantitative performance data. The majority of students (81.0%) scored the programme four or five in terms of perceived usefulness on a five-point Likert scale. Attendees reported statistically significant increases in preparedness for the examination (p=0.001) and in familiarity with the style of examination questions (p=0.004) compared to students who did not attend.This study suggests that teaching from peers may improve students' perception of their preparedness for official assessments. However, such interventions may be limited in their ability to produce a demonstrable benefit in terms of examination performance.

Published
2010
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11. Pre-Discharge Duplex Ultrasound Scans Detect Endoleaks Not Seen on Completion Angiography After Endovascular Aneurysm Repair

Author

Robert D. Sayers, Andrew Batchelder, R.M. Sandford, and Matthew J. Bown

Subjects
Male, Reoperation, medicine.medical_specialty, Time Factors, Aortography, medicine.medical_treatment, Endovascular aneurysm repair, Blood Vessel Prosthesis Implantation, Aortic aneurysm, Predictive Value of Tests, Blood vessel prosthesis, medicine, Humans, Radiology, Nuclear Medicine and imaging, Ultrasonography, Doppler, Color, Aged, Retrospective Studies, Aged, 80 and over, medicine.diagnostic_test, business.industry, Ultrasound, Middle Aged, medicine.disease, Patient Discharge, Abdominal aortic aneurysm, Aortic Aneurysm, Blood Vessel Prosthesis, Prosthesis Failure, Surgery, Treatment Outcome, England, Elective Surgical Procedures, Angiography, Female, Stents, Radiology, Tomography, X-Ray Computed, Cardiology and Cardiovascular Medicine, Elective Surgical Procedure, business
Abstract

Purpose To determine whether a pre-discharge duplex ultrasound scan detects early endoleaks that would not otherwise have been identified. Methods A retrospective review was conducted of all patients undergoing elective infrarenal endovascular aneurysm repair (EVAR) at our center. These patients underwent intraoperative completion angiography, had a duplex ultrasound scan prior to hospital discharge, and were followed at 1, 3, and 6 months and at 6-month intervals thereafter. The outcome of any patients found to have an endoleak on a pre-discharge scan was studied. Results There were 52 EVAR patients (50 men; mean age 76 years, range 61-87) with endoleak on the pre-discharge duplex: 17 (2.8%) type I, 28 (4.6%) type II, and 8 (1.3%) type III. Of these, only 7 of the type I and 2 of the type II leaks had been detected on completion angiography. Among the patients with type I endoleaks, 5 had resolution of the leak, 10 required further endovascular interventions, and 2 had open repair (1 died of aneurysm rupture). Two patients with failed endovascular repairs of the leak also had open repair. Fifteen of the 28 type II endoleaks resolved, 4 were treated with endovascular procedures, 1 had open repair, 7 are being observed, and 1 was lost to follow-up. Six of the 8 type III leaks resolved, 1 required open repair for an enlarging sac, and 1 is being observed. Conclusion Despite routine completion angiography, new endoleaks may be identified postoperatively, which suggests that more rigorous imaging at the point of completion angiography is required.

Published
2010
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12. Rapid Clinical Pharmacology : A Student Formulary

Author

Andrew Batchelder, Charlene Rodrigues, Ziad Alrifai, Andrew Batchelder, Charlene Rodrigues, and Ziad Alrifai

Subjects
Clinical pharmacology--Handbooks, manuals, etc
Abstract

This pocket reference guide is a must for all medical students and junior doctors preparing for exams in pharmacology or needing a rapid reminder during a clinical attachment. In light of the growing pressures on those who prescribe drugs to patients, increasing emphasis has been placed on the importance of pharmacology in the undergraduate medical curriculum. Rapid Clinical Pharmacology, with its concise, easy-to-use approach, offers an appealing format for students to use in both clinical practice and exam preparation and its ‘one-page per drug/class'layout easily facilitates the generation of a personal student formulary. Each chapter of the book mirrors each section of the BNF to allow easy cross-referencing and then each chapter is divided into consistent sections as per other books in the Rapid series. Rapid Clinical Pharmacology will also be available as a mobile application for iPhone, iPod Touch, iPad and Blackberry. See wiley.com/go/mededapps for further details.

Published
2011

13. 2014 INCIDENCE OF ERECTILE DYSFUNCTION AND RETROGRADE EJACULATION FOLLOWING THULIUM LASER VAPORESECTION OF THE PROSTATE FOR BENIGN BLADDER OUTFLOW OBSTRUCTION

Author

Raj P. Pal, Andrew Batchelder, Masood A. Khan, and Sze Yee Carol Ling

Subjects
Retrograde ejaculation, medicine.medical_specialty, business.industry, Urology, Incidence (epidemiology), Bladder outflow obstruction, medicine.disease, Thulium laser, medicine.anatomical_structure, Erectile dysfunction, Prostate, medicine, business
Published
2012
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