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1. Factors Associated with Days Alive and at Home within 30 Days (DAH30) Scores Following Surgery: A Systematic Review

Author: Jenna Bartyn, James Morkaya, Sascha Karunaratne, Tian You Chen, Michael Solomon, Cherry Koh, Charbel Sandroussi, and Daniel Steffens
Subjects: DAH30, surgery, decision-making, predictors, Medicine, Diseases of the digestive system. Gastroenterology, RC799-869
Abstract: Background/Objectives: Days Alive and at Home within 30 days (DAH30) is a patient-centred measurement tool designed to assist with the decision-making and management of patients undergoing surgery. Thus, identifying factors associated with better DAH30 scores would support healthcare providers to optimise patient care and outcomes. This systematic review aimed to determine factors associated with DAH30 scores following surgery. Methods: A sensitive electronic search was conducted in MEDLINE, Embase, Scopus, Web of Science and CINAHL databases in September 2022. Eligible studies included patients undergoing surgery and reporting the association of preoperative and/or postoperative factors and DAH30. Risk of bias was assessed using the QUIPs tool. Results: Of the 14 studies identified, the majority (n = 13, 93%) were cohort studies, presenting moderate or high (n = 8, 60%) risk of bias. This review identified a number of factors influencing DAH30 scores in patients undergoing surgery. ASA Physical Status and surgery duration were the most common factors influencing DAH30 scores. Conclusions: Optimising patients’ health prior to surgery and reducing surgical time have the potential to improve patients’ recovery.
Published: 2024
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2. The achievement of pre-operative expectations in patients undergoing knee arthroplasty: a cohort study evaluating unique patient goals

Author: Sascha Karunaratne, Ian Andrew Harris, Mark Horsley, Lyndal Trevena, and Michael Solomon
Subjects: Patient expectation, Knee arthroplasty, Osteoarthritis, Objectives/Goals, Public aspects of medicine, RA1-1270
Abstract: Abstract Background Total knee arthroplasty (TKA) is a common procedure employed to treat end-stage osteoarthritis. While TKA is generally believed to have acceptable outcomes, many patients report pain or functional deficits not in line with their expectation following the procedure. It has been postulated that patient’s pre-operative expectations regarding post-operative treatment outcomes play a significant role in satisfaction. It is therefore important to assess if the outcomes of surgery truly align with patient’s individual expectations. Thus, the purpose of this study was to determine the degree to which patient expectations of TKA are achieved and the contribution of TKA to achieving patient goals one year after surgery. Methods A consecutive sample of 110 patients booked for total knee arthroplasty were asked to identify their most important goals to inform the Direct Questioning of Objectives Index (DQO Index, range 0 to 1) and identify their surgical goals and grade their expectation that a knee arthroplasty would achieve each goal on an 11-point scale. One year after surgery, the DQO Index was repeated to assess their current ability to achieve each pre-operative goal, and asked to estimate the contribution of their knee arthroplasty in achieving each goal. Mean differences between baseline and one year follow-up were calculated regarding the DQO Index and expected achievement of pre-operative goals. Results According to the DQO Index at one year, patients improved from a poor quality of life pre-operatively (mean ± standard deviation: 0.20 ± 0.18) to moderately high quality of life (mean ± standard deviation: 0.71 ± 0.21) reflecting a large improvement in ability to achieve each goal. Although achievement improved, for each goal, the patient estimates of the extent to which the knee arthroplasty had contributed to achieving the goal was lower than their initial expectation provided pre-operatively (mean difference range: 0.6 to 1.9 on an 11-point scale). Conclusion Patients undergoing TKA have high expectations that their surgery will address their primary goals. Despite surgery largely achieving these goals (improved pain and function), the extent to which the goals were achieved was lower than patients had expected pre-operatively.
Published: 2024
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3. Codesign of health technology interventions to support best-practice perioperative care and surgical waitlist management

Author: Vasi Naganathan, Angus Ritchie, Michael Solomon, Henry Pleass, Nicole Phillips, Sophie James, Sarah Joy Aitken, Kate McBride, Amy Lawrence, Anthony Glover, Janani Thillianadesan, Sue Monaro, Kerry Hitos, Hector Blamey, Carina Cutmore, Lilijana Gorringe, Cherry Leslie, Andrew Marks, Robert Sanders, and Danielle Slater
Subjects: Computer applications to medicine. Medical informatics, R858-859.7
Abstract: Objectives This project aimed to determine where health technology can support best-practice perioperative care for patients waiting for surgery.Methods An exploratory codesign process used personas and journey mapping in three interprofessional workshops to identify key challenges in perioperative care across four health districts in Sydney, Australia. Through participatory methodology, the research inquiry directly involved perioperative clinicians. In three facilitated workshops, clinician and patient participants codesigned potential digital interventions to support perioperative pathways. Workshop output was coded and thematically analysed, using design principles.Results Codesign workshops, involving 51 participants, were conducted October to November 2022. Participants designed seven patient personas, with consumer representatives confirming acceptability and diversity. Interprofessional team members and consumers mapped key clinical moments, feelings and barriers for each persona during a hypothetical perioperative journey. Six key themes were identified: ‘preventative care’, ‘personalised care’, ‘integrated communication’, ‘shared decision-making’, ‘care transitions’ and ‘partnership’. Twenty potential solutions were proposed, with top priorities a digital dashboard and virtual care coordination.Discussion Our findings emphasise the importance of interprofessional collaboration, patient and family engagement and supporting health technology infrastructure. Through user-based codesign, participants identified potential opportunities where health technology could improve system efficiencies and enhance care quality for patients waiting for surgical procedures. The codesign approach embedded users in the development of locally-driven, contextually oriented policies to address current perioperative service challenges, such as prolonged waiting times and care fragmentation.Conclusion Health technology innovation provides opportunities to improve perioperative care and integrate clinical information. Future research will prototype priority solutions for further implementation and evaluation.
Published: 2024
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4. Developing a Core Outcome Set for Cytoreductive Surgery for Colorectal Cancer with Peritoneal Metastases: A Mixed-Method Study Protocol

Author: Pratik Raichurkar, Kilian Brown, Nabila Ansari, Cherry Koh, Nima Ahmadi, Michael Solomon, Brendan Moran, and Daniel Steffens
Subjects: cytoreductive surgery, colorectal cancer, core outcomes, Medicine, Diseases of the digestive system. Gastroenterology, RC799-869
Abstract: As the number of centres offering cytoreductive surgery (CRS) for colorectal cancer with peritoneal metastases (CPMs) is increasing worldwide, research is focused on establishing better patient selection and ensuring that new techniques have positive impacts on survival. However, high-impact comparative research in this field is limited by the heterogeneity of outcome measurement and reporting. Additionally, as there are comparatively few randomised controlled trials reporting comprehensive patient-reported outcomes, it is possible that key stakeholders such as patients and carers are underrepresented in the current literature. A core outcome set (COS) for CRS with or without intraperitoneal chemotherapy for the treatment of CPMs, supported by clinicians and patients, will promote homogenous comparison across trials and optimise the utility of research findings. We have established a comprehensive protocol based on the Core Outcome Measures in Effectiveness Trials (COMETs) method to facilitate this. A systematic review will identify all the outcomes reported in the literature, whereas a semi-structured interview will identify outcomes considered important by patients and carers. The identified outcomes will populate an international Delhi survey, distributed to patients, carers, surgeons, oncologists, nurses, and allied health clinicians. Outcomes reaching international consensus of importance will be further discussed in a face-to-face workshop between patients, carers, and clinicians. This process will inform the development of a final COS for CRS for patients with CPMs.
Published: 2024
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5. Outcomes and associated factors of traumatic brain injury among adult patients treated in Amhara regional state comprehensive specialized hospitals

Author: G/Michael, Solomon, Terefe, Bewuketu, Asfaw, Marye Getnet, and Liyew, Bikis
Published: 2023
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6. Sparse L1-Autoencoders for Scientific Data Compression.

Author: Matthias Chung, Rick Archibald, Paul J. Atzberger, and Jack Michael Solomon
Published: 2024
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7. High and low value care recommended and undertaken prior to knee or hip arthroplasty: a survey study

Author: Kathryn Mills, Anne-Marie Brewster, Danella Hackett, Chris Cheung, Michael Solomon, and Justine Naylor
Subjects: Osteoarthritis, Non-surgical care, Quality of care, Implementation, Social determinants, Diseases of the musculoskeletal system, RC925-935
Abstract: Abstract Introduction National and international clinical practice guidelines have stratified the value of osteoarthritis (OA) interventions. Interventions with strong evidence supporting effectiveness and benefit are ‘high value care’. Appointment attendance, audits and practitioner surveys are widely used to determine frequency of recommendations and adherence to high value care. Greater patient reported data is needed in this evidence base. Objective To describe the frequency of high and low value care being recommended and undertaken by individuals awaiting OA-related lower limb arthroplasty. To examine sociodemographic or disease-related variables associated with being recommended different levels of care. Methods A cross-sectional survey of 339 individuals was conducted in metropolitan and regional hospitals and surgeon consultation rooms across New South Wales (NSW), Australia. Individuals attending pre-arthroplasty clinics/appointments for primary arthroplasty of the hip and/or knee were invited to participate. Respondents were asked what intervention(s) they were recommended by healthcare practitioners, or other sources of information, and what they had undertaken within two years prior to hip or knee arthroplasty. Interventions were classified as core, recommended, and low value care aligned with the Osteoarthritis Research Society International (OARSI) guidelines. We considered core and recommended interventions high value. The proportion of recommended and undertaken interventions were calculated. We used backwards stepwise multivariate multinomial regression to address aim three. Results Simple analgesics were most frequently recommended (68% [95% CI 62.9 to 73.1]). 24.8% [20.2 to 29.7] of respondents were recommended high value care only. 75.2% [70.2 to 79.7] of respondents were recommended at least one low value intervention. More than 75% of recommended interventions were undertaken. Respondents awaiting hip arthroplasty, living outside a major city and without private health insurance had greater odds of recommended rather than core interventions being advised. Conclusion While high value interventions are being recommended to individuals living with OA, in most cases they are combined with recommendations for low value care. This is concerning given the high rates of uptake for recommended interventions. Based on patient reported data, disease-related and sociodemographic variables influence the level of care recommended.
Published: 2023
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8. Development of a risk prediction tool for patients with locally advanced and recurrent rectal cancer undergoing pelvic exenteration: protocol for a mixed-methods study

Author: Phyllis Butow, Charbel Sandroussi, Kate Mahon, Wendy Brown, Michael Solomon, Lisa Horvath, Daniel Steffens, Kate White, Paul Sutton, Jane Young, Sharon Carey, David Yeo, Kilian Brown, Kheng-Seong Ng, Cherry Koh, Nabila Ansari, Alix Dumitrescu, Kate McBride, Glen Salkeld, and Des Winter
Subjects: Medicine
Abstract: Introduction Pelvic exenteration (PE) surgery represents the only potentially curative treatment option for patients with locally advanced or recurrent rectal cancer (LARRC). Given the potential morbidity, whether or not PE should be recommended for an individual patient presents a major decisional conflict. This study aims to identify the outcomes of PE for which there is consensus among patients, carers and clinicians regarding their importance in guiding treatment decision-making, and to develop a risk prediction tool which predicts these outcomes.Methods and analysis This study will be conducted at a specialist PE centre, and employ a mixed-methods study design, divided into three distinct phases. In phase 1, outcomes of PE will be identified through a comprehensive systematic review of the literature (phase 1a), followed by exploration of the experiences of individuals who have undergone PE for LARRC and their carers (phase 1b, target sample size 10–20 patients and 5–10 carers). In phase 2, a survey of patients, their carers and clinicians will be conducted using Delphi methodology to explore consensus around the outcomes of highest priority and the level of influence each outcome should have on treatment decision-making. In phase 3 a, risk prediction tool will be developed using data from a single PE referral centre (estimated sample size 500 patients) to predict priority outcomes using multivariate modelling, and externally validated using data from an international PE collaboration.Ethics and dissemination Ethical approval has been granted for phases 1 and 2 (X22-0422 and 2022/ETH02659) and for maintenance of the database used in phase 3 (X13-0283 and HREC/13/RPAH/504). Informed consent will be obtained from participants in phases 1b and 2; a waiver of consent for secondary use of data in phase 3 will be sought. Study results will be submitted for publication in international and/or national peer reviewed journals.PROSPERO registration number CRD42022351909.
Published: 2023
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9. Acceptability, safety and tolerability of antidepressant repetitive transcranial magnetic stimulation for adolescents: A mixed-methods investigation

Author: Wallman, Emily Jean, Segrave, Rebecca Anne, Gordon, Michael Solomon, Fraser, Maxwell James Oliver Barnett, Pavlou, Chris, and Melvin, Glenn Alexander
Published: 2022
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10. Lynch syndrome testing of colorectal cancer patients in a high-income country with universal healthcare: a retrospective study of current practice and gaps in seven australian hospitals

Author: Julia Steinberg, Priscilla Chan, Emily Hogden, Gabriella Tiernan, April Morrow, Yoon-Jung Kang, Emily He, Rebecca Venchiarutti, Leanna Titterton, Lucien Sankey, Amy Pearn, Cassandra Nichols, Skye McKay, Anne Hayward, Natasha Egoroff, Alexander Engel, Peter Gibbs, Annabel Goodwin, Marion Harris, James G Kench, Nicholas Pachter, Bonny Parkinson, Peter Pockney, Abiramy Ragunathan, Courtney Smyth, Michael Solomon, Daniel Steffens, James Wei Tatt Toh, Marina Wallace, Karen Canfell, Anthony Gill, Finlay Macrae, Kathy Tucker, and Natalie Taylor
Subjects: Lynch syndrome, Mismatch repair, Tumour testing, Genetics services referral, Bottleneck, Gap, Neoplasms. Tumors. Oncology. Including cancer and carcinogens, RC254-282, Genetics, QH426-470
Abstract: Abstract Background To inform effective genomic medicine strategies, it is important to examine current approaches and gaps in well-established applications. Lynch syndrome (LS) causes 3–5% of colorectal cancers (CRCs). While guidelines commonly recommend LS tumour testing of all CRC patients, implementation in health systems is known to be highly variable. To provide insights on the heterogeneity in practice and current bottlenecks in a high-income country with universal healthcare, we characterise the approaches and gaps in LS testing and referral in seven Australian hospitals across three states. Methods We obtained surgery, pathology, and genetics services data for 1,624 patients who underwent CRC resections from 01/01/2017 to 31/12/2018 in the included hospitals. Results Tumour testing approaches differed between hospitals, with 0–19% of patients missing mismatch repair deficiency test results (total 211/1,624 patients). Tumour tests to exclude somatic MLH1 loss were incomplete at five hospitals (42/187 patients). Of 74 patients with tumour tests completed appropriately and indicating high risk of LS, 36 (49%) were missing a record of referral to genetics services for diagnostic testing, with higher missingness for older patients (0% of patients aged ≤ 40 years, 76% of patients aged > 70 years). Of 38 patients with high-risk tumour test results and genetics services referral, diagnostic testing was carried out for 25 (89%) and identified a LS pathogenic/likely pathogenic variant for 11 patients (44% of 25; 0.7% of 1,624 patients). Conclusions Given the LS testing and referral gaps, further work is needed to identify strategies for successful integration of LS testing into clinical care, and provide a model for hereditary cancers and broader genomic medicine. Standardised reporting may help clinicians interpret tumour test results and initiate further actions.
Published: 2022
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11. A development study of drain fluid gastrografin as a biomarker of anastomotic leak

Author: David A. Clark, Edward Yeoh, Aleksandra Edmundson, Craig Harris, Andrew Stevenson, Daniel Steffens, and Michael Solomon
Subjects: gastrografin, biomarkers, anastomotic leak, dual-energy computed tomography, drain fluid, Diseases of the digestive system. Gastroenterology, RC799-869
Abstract: Purpose Anastomotic leakage (AL) is the anathema of colorectal surgery. Its occurrence leads to increased morbidity and mortality and a prolonged hospital stay. Much work has gone into studying various biomarkers in drain fluid to facilitate early detection of AL. This stage 2a development study aims to assess the safety and feasibility of reliably detecting the iodine in Gastrografin (GG; Bayer Australia Ltd.) in drain fluid and stool samples by dual-energy computed tomography (DECT). Methods This is a prospective, observational, controlled, consecutive cohort study establishing the safety and feasibility of the detection of GG in surgical drain fluid and stool as a biomarker of AL when patients with a low pelvic colorectal anastomosis undergo luminal flushing of the rectal tube with GG. Results Ten consecutive patients were allocated to the saline flush group and the following 10 to the GG flush group. Three patients in the saline flush group developed an AL. One patient in the GG flush group developed an AL. An elevation in the drain fluid GG was detected using DECT on the day of clinical deterioration. None of the patients in the control group were found to have a positive result on DECT. Conclusion This study demonstrates the safety of a novel approach to the early detection of AL from extraperitoneal colorectal anastomoses. The technique requires validation in a larger cohort and a multicenter study is planned to investigate the efficacy of GG rectal tube flushes as an early biomarker of AL in low pelvic anastomoses.
Published: 2022
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12. PRehabIlitatiOn with pReoperatIve exercise and educaTion for patients undergoing major abdominal cancer surgerY: protocol for a multicentre randomised controlled TRIAL (PRIORITY TRIAL)

Author: Daniel Steffens, Jane Young, Bernhard Riedel, Rachael Morton, Linda Denehy, Alexander Heriot, Cherry Koh, Qiang Li, Adrian Bauman, Charbel Sandroussi, Hilmy Ismail, Mbathio Dieng, Nabila Ansari, Neil Pillinger, Sarah O’Shannassy, Sam McKeown, Derek Cunningham, Kym Sheehan, Gino Iori, Jenna Bartyn, and Michael Solomon
Subjects: Preoperative, Prehabilitation, Exercise, Education, Cancer, Surgery, Neoplasms. Tumors. Oncology. Including cancer and carcinogens, RC254-282
Abstract: Abstract Background Radical surgery is the mainstream treatment for patients presenting with advanced primary or recurrent gastrointestinal cancers; however, the rate of postoperative complications is exceptionally high. The current evidence suggests that improving patients’ fitness during the preoperative period may enhance postoperative recovery. Thus, the primary aim of this study is to establish the effectiveness of prehabilitation with a progressive, individualised, preoperative exercise and education program compared to usual care alone in reducing the proportion of patients with postoperative in-hospital complications. The secondary aims are to investigate the effectiveness of the preoperative intervention on reducing the length of intensive care unit and hospital stay, improving quality of life and morbidity, and reducing costs. Methods This is a multi-centre, assessor-blinded, pragmatic, comparative, randomised controlled trial. A total of 172 patients undergoing pelvic exenteration, cytoreductive surgery, oesophagectomy, hepatectomy, gastrectomy or pancreatectomy will be recruited. Participants will be randomly allocated to prehabilitation with a preoperative exercise and education program (intervention group), delivered over 4 to 8 weeks before surgery by community physiotherapists/exercise physiologists, or usual care alone (control group). The intervention will comprise 12 to 24 individualised, progressive exercise sessions (including aerobic/anaerobic, resistance, and respiratory exercises), recommendations of home exercises (16 to 32 sessions), and daily incidental physical activity advice. Outcome measures will be collected at baseline, the week prior to surgery, during the hospital stay, and on the day of discharge from hospital, and 1 month and 1 months postoperatively. The primary outcome will be the development of in-hospital complications. Secondary outcomes include the length of intensive care unit and hospital stay, quality of life, postoperative morbidity and costs. Discussion The successful completion of this trial will provide robust and high-quality evidence on the efficacy of a preoperative community- and home-based exercise and education intervention on important postoperative outcomes of patients undergoing major gastrointestinal cancer surgery. Trial registration This trial was registered prospectively with the Australian New Zealand Clinical Trials Registry ( ACTRN12621000617864 ) on 24th May 2021.
Published: 2022
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13. Surgeon Estimations of Acetabular Cup Orientation Using Intraoperative Fluoroscopic Imagining Are Unreliable

Author: Parker L. Brush, MD, Adrian Santana, BS, Gregory R. Toci, MD, Eric Slotkin, DO, Michael Solomon, MD, Tristan Jones, MPT, MBA, and Arjun Saxena, MD, MBA
Subjects: Total hip arthroplasty, direct anterior approach, intraoperative fluoroscopy, acetabular anteversion, acetabular inclination, Orthopedic surgery, RD701-811
Abstract: Background: Accurate acetabular cup orientation is associated with decreased revision rates and improved outcomes of primary total hip arthroplasty. This study assesses surgeon’s ability to estimate both the acetabular component inclination and anteversion angles via intraoperative fluoroscopy (IF) images. Methods: We surveyed orthopedic surgeons to estimate acetabular component inclination and anteversion based on 20 IF images of total hip arthroplasty through a direct anterior approach. Postoperative computed-tomography scans were used to calculate the true inclination and anteversion component angles. The absolute difference between the true and estimated values was calculated to determine the mean and standard deviation of the survey results. Interrater reliability was determined through interclass correlation coefficients. Results: A majority of surgeons preferred the direct anterior approach (83.3%) and utilized IF during surgery (70%). Surgeons surveyed were on average 5.9° away from the true value of inclination (standard deviation = 4.7) and 8.8° away from the true value of anteversion (standard deviation = 6.0). Respondents were within 5° of both inclination and anteversion in 19.7% of cases, and within 10° in 57.3% of cases. All surgeons were determined to have poor reliability in estimating anteversion (interclass correlation coefficient < 0.5). Only 2 surgeons were determined to have moderate reliability when estimating inclination. Conclusions: Surgeons, when solely relying on IF for the estimation of anteversion and inclination, are unreliable. Utilization of other techniques in conjunction with IF would improve observer reliability.
Published: 2023
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14. Pharmacological emergency management of agitation in children and young people: protocol for a randomised controlled trial of oral medication (PEAChY-O)

Author: Franz E Babl, Simon Craig, Meredith L Borland, Amit Kochar, Shefali Jani, Shane George, Andrew Davidson, Katherine Lee, Deborah Shellshear, Chidambaram Prakash, Jonathan C Knott, Elyssia M Bourke, Kent Perkins, Doris Tham, Michael Solomon Gordon, and Kate Klein
Subjects: Medicine
Abstract: Introduction Acute severe behavioural disturbance (ASBD) is a condition seen with increasing frequency in emergency departments (EDs) in adults and young people. Despite the increasing number of presentations and significant associated risks to patients, families and caregivers, there is limited evidence to guide the most effective pharmacological management in children and adolescents. The aim of this study is to determine whether a single dose of oral olanzapine is more effective than a dose of oral diazepam at successfully sedating young people with ASBD.Methods and analysis This study is a multicentre, open-label, superiority randomised controlled trial. Young people aged between 9 years and 17 years and 364 days presenting to an ED with ASBD who are deemed to require medication for behavioural containment will be recruited to the study. Participants will be randomised in a 1:1 allocation between a single weight-based dose of oral olanzapine and oral diazepam. The primary outcome is the proportion of participants who achieve successful sedation at 1-hour post randomisation without the need for additional sedation. Secondary outcomes will include assessing for adverse events, additional medications provided in the ED, further episodes of ASBD, length of stay in the ED and hospital and satisfaction with management.Effectiveness will be determined using an intention-to-treat analysis, with medication efficacy determined as part of the secondary outcomes using a per-protocol analysis. The primary outcome of successful sedation at 1 hour will be presented as a percentage within each treatment group, with comparisons presented as a risk difference with its 95% CIs.Ethics and dissemination Ethics approval was received from the Royal Children’s Hospital Human Research Ethics Committee (HREC/66478/RCHM-2020). This incorporated a waiver of informed consent for the study. The findings will be disseminated in a peer-reviewed journal and at academic conferences.Trial registration number ACTRN12621001236886.
Published: 2023
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15. Pharmacological Emergency management of Agitation in Children and Young people: protocol for a randomised controlled trial of intraMuscular medication (PEAChY-M)

Author: Franz E Babl, Simon Craig, Meredith L Borland, Amit Kochar, Shefali Jani, Shane George, Andrew Davidson, Katherine Lee, Deborah Shellshear, Chidambaram Prakash, Jonathan C Knott, Elyssia M Bourke, Kent Perkins, Doris Tham, Michael Solomon Gordon, and Kate Klein
Subjects: Medicine
Abstract: Introduction Acute severe behavioural disturbance (ASBD) is a condition seen with increasing frequency in emergency departments (EDs) in adults and young people. Despite the increasing number of presentations and significant associated risks to patients, families and caregivers, there is limited evidence to guide the most effective pharmacological management in children and adolescents. The aim of this study is to determine whether a single dose of intramuscular olanzapine is more effective than intramuscular droperidol at successfully sedating young people with ASBD requiring intramuscular sedation.Methods and analysis This study is a multicentre, open-label, superiority randomised controlled trial. Young people aged between 9 and 17 years and 364 days presenting to an ED with ASBD who are deemed to require medication for behavioural containment will be recruited to the study. Participants will be randomised in a 1:1 allocation between a single weight-based dose of intramuscular olanzapine and intramuscular droperidol. The primary outcome is the proportion of participants who achieve successful sedation at 1-hour post randomisation without the need for additional sedation. Secondary outcomes will include assessing for adverse events, additional medications provided in the ED, further episodes of ASBD, length of stay in the ED and hospital and satisfaction with management.Effectiveness will be determined using an intention-to-treat analysis, with medication efficacy determined as part of the secondary outcomes using a per-protocol analysis. The primary outcome of successful sedation at 1 hour will be presented as a percentage within each treatment group, with comparisons presented as a risk difference with its 95% CIs.Ethics and dissemination Ethics approval was received from the Royal Children’s Hospital Human Research Ethics Committee (HREC/69948/RCHM-2021). This incorporated a waiver of informed consent for the study. The findings will be disseminated in a peer-reviewed journal and at academic conferences.Trial registration number ACTRN12621001238864.
Published: 2023
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16. Image reconstructions using sparse dictionary representations and implicit, non-negative mappings.

Author: Elizabeth Newman, Jack Michael Solomon, and Matthias Chung
Published: 2023
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17. Geographical Variation in the Use of Diverting Loop Ileostomy in Australia and New Zealand Colorectal Surgeons

Author: David A. Clark, Bree Stephensen, Aleksandra Edmundson, Daniel Steffens, and Michael Solomon
Subjects: ileostomy, trans anal tube, anastomotic leak, pelvic drain, restorative proctocolectomy, Diseases of the digestive system. Gastroenterology, RC799-869
Abstract: Purpose Anastomotic leak (AL) after a low pelvic anastomosis is a devastating complication, with short- and long-term morbidity and increased mortality. Surgeons may employ various adjuncts in an attempt to reduce AL rates or mitigate their impact. These include the use of temporary diverting ileostomy (TDI), transanal or rectal tubes and pelvic drains. This questionnaire evaluates the preferences and routine use of these adjuncts in Australasian colorectal surgeons. Methods A cross-sectional survey was administered to Australian and New Zealand colorectal surgeons on September 20, 2018. The study survey consisted of 15 questions exploring basic demographics and the number of rectal resections and ileal pouches performed in 12 months, along with the surgeon’s preference for the use of diverting stomas, rectal tubes, and pelvic drains. Results There were 90 respondents to the survey (31.6%). Surgeons in Western Australia (71.4%) were more likely to use a mandatory TDI in colorectal extraperitoneal anastomoses than surgeons in Queensland (14.3%). South Australian surgeons are more likely to employ a mandatory TDI (100%) for ileal pouches than Queensland surgeons (42.9%). Rectal tubes are not commonly utilized (40.0% never use them), and pelvic drains are (45.6% in all cases). Surgeons consider a median AL rate of 15% was felt to justify the use of a TDI in low pelvic anastomoses and a median AL rate of 10% for ileal pouches Conclusion There is considerable geographical variation in colorectal surgical practice throughout Australia and New Zealand. While surgeons interrogate the same literature, there are presumably other factors that see translation into variations in clinical practice.
Published: 2021
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18. Human papillomavirus self-sampling versus standard clinician-sampling for cervical cancer screening in sub-Saharan Africa: a systematic review and meta-analysis of randomized controlled trials

Author: Hanna Amanuel Tesfahunei, Michael Solomon Ghebreyesus, Dawit Getachew Assefa, Eden Dagnachew Zeleke, Joan Acam, Michele Joseph, Emnet Getachew, Violet Dismas Kajogoo, Delayehu Bekele, and Tsegahun Manyazewal
Subjects: Human papillomavirus (HPV), Self-sampling, Cervical cancer screening, Sub-Saharan Africa, Randomized controlled trial, Systematic review and meta-analysis, Neoplasms. Tumors. Oncology. Including cancer and carcinogens, RC254-282, Infectious and parasitic diseases, RC109-216
Abstract: Abstract Background Human papillomavirus (HPV) infection remains a major health threat in sub-Saharan Africa (SSA). HPV self-sampling could help find and treat cervical cancer at an early stage. We aimed to evaluate the effectiveness of HPV self-sampling over the standard health facility-based clinician-sampling for cervical cancer screening through a systematic review and meta-analysis of available randomized controlled trials. Method We searched PubMed, Cochrane Central Register of Controlled Trials, ClinicalTrial.gov, and the WHO Global Health Library for articles in SSA published as of 31 May 2020. We followed the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) 2015 guidelines for the design and reporting of the results. We included randomized control trials that compared HPV self-sampling with the standard of care. The primary endpoint was uptake of cervical cancer screening service. The secondary endpoints were linkage to care, acceptability, screening frequency, and adverse events. We used RevMan V.5.3 software for statistical analysis. We computed random-effect model to provide pooled estimates of available data and I-squared (I2) test to assess heterogeneity. Result Of 77 citations, we included four trials from Nigeria, Ethiopia, Kenya, and Uganda, encompassing 8200 participants with age ranging from 25 to 65 years. The pooled analysis showed significantly higher uptake of cervical cancer screening in women who used HPV self-sampling (risk ratio [RR] 1.72, 95% CI 1.58–1.87; p = 0.01), while this had a considerable heterogeneity as explained by subgroup analysis. Uptake was higher in women who were offered sampling kit at home or work (RR 2.05, 95% CI 1.80–2.33) and those who’s kit was mailed to or invited to a nearby health center (RR 1.65, 95% CI 1.58–1.72, I2 = 0%) than those screened with the standard of care. There was no difference between the two groups in the rate of linkage to care of positive cases (RR 1.30, 95% CI 0.90–2.74, I2 = 91%). HPV self-sampling was acceptable and easy to use. None of the trials compared the frequency of screening or adverse events. Conclusion HPV self-sampling is an effective and feasible alternative to the standard health facility-based clinician-sampling for cervical cancer screening in SSA. It could improve the uptake of cervical cancer screening and harness the global strategy towards elimination of cervical cancer by 2030.
Published: 2021
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19. Detailed cost of robotic-assisted surgery in the Australian public health sector: from implementation to a multi-specialty caseload

Author: Kate McBride, Daniel Steffens, Christina Stanislaus, Michael Solomon, Teresa Anderson, Ruban Thanigasalam, Scott Leslie, and Paul G. Bannon
Subjects: Robotic-assisted surgery, Cost analysis, Public sectors, minimally invasive surgery, Healthcare financing, Public aspects of medicine, RA1-1270
Abstract: Abstract Background A barrier to the uptake of robotic-assisted surgery (RAS) continues to be the perceived high costs. A lack of detailed costing information has made it difficult for public hospitals in particular to determine whether use of the technology is justified. This study aims to provide a detailed description of the patient episode costs and the contribution of RAS specific costs for multiple specialties in the public sector. Methods A retrospective descriptive costing review of all RAS cases undertaken at a large public tertiary referral hospital in Sydney, Australia from August 2016 to December 2018 was completed. This included RAS cases within benign gynaecology, cardiothoracic, colorectal and urology, with the total costs described utilizing various inpatient costing data, and RAS specific implementation, maintenance and consumable costs. Results Of 211 RAS patients, substantial variation was found between specialties with the overall median cost per patient being $19,269 (Interquartile range (IQR): $15,445 to $32,199). The RAS specific costs were $8828 (46%) made up of fixed costs including $4691 (24%) implementation and $2290 (12%) maintenance, both of which are volume dependent; and $1848 (10%) RAS consumable costs. This was in the context of 37% robotic theatre utilisation. Conclusions There is considerable variation across surgical specialties for the cost of RAS. It is important to highlight the different cost components and drivers associated with a RAS program including its dependence on volume and how it fits within funding systems in the public sector.
Published: 2021
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20. Feasibility and acceptability of a preoperative exercise program for patients undergoing major cancer surgery: results from a pilot randomized controlled trial

Author: Daniel Steffens, Jane Young, Paula R. Beckenkamp, James Ratcliffe, Freya Rubie, Nabila Ansari, Neil Pillinger, Cherry Koh, Phillip A. Munoz, and Michael Solomon
Subjects: Preoperative exercise, Pilot randomized controlled trial, Cancer, Surgery, Feasibility, Acceptability, Medicine (General), R5-920
Abstract: Abstract Objective To establish the feasibility and acceptability of a preoperative exercise program, and to obtain pilot data on the likely difference in key surgical outcomes to inform the sample size calculation for a full-scale trial. Design Pilot randomized controlled trial. Setting Royal Prince Alfred Hospital, Sydney, Australia. Subjects We included patients undergoing elective pelvic exenteration or cytoreductive surgery aged 18 to 80 years, who presented to the participating gastrointestinal surgeon at least 2 weeks prior to surgery. Patients presenting cognitive impairment, co-morbidity preventing participation in exercise, inadequate English language, currently participating in an exercise program or unable to attend the exercise program sessions were excluded. Methods Participants were randomized to a 2–6 weeks preoperative, face-to-face, individualised exercise program or to usual care. Feasibility was assessed with consent rates to the study, and for the intervention group, retention and adherence rates to the preoperative exercise program. Acceptability of the exercise program was assessed with a semi-structured questionnaire exploring the advice received and the amount, duration and intensity of the exercise program. In addition, postoperative complication rates (Clavien-Dindo), length of hospital stay and self-reported measures of health-related quality of life (SF-36v2) were collected at baseline, day before surgery and in-hospital up to discharge from hospital. Results Of 122 patients screened, 26 (21%) were eligible and 22 (85%) accepted to participate in the trial and were randomized to the intervention (11; 50%) or control group (11; 50%). The median age of the include participants was 63 years. Adherence to the preoperative exercise sessions was 92.7%, with all participants either satisfied (33%) or extremely satisfied (67%) with the overall design of the preoperative exercise program. No significant differences in outcomes were found between groups. Conclusions The results of our pilot trial demonstrate that a preoperative exercise program is feasible and acceptable to patients undergoing major abdominal cancer surgery. There is an urgent need for a definite trial investigating the effectiveness of a preoperative exercise program on postoperative outcomes in patients undergoing major abdominal cancer surgery. This could potentially reduce postoperative complication rates, length of hospital stay and subsequently overall health care costs. Trial registration ACTRN12617001129370. Registered on August 1, 2017, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=373396&showOriginal=true&isReview=true
Published: 2021
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21. Return to work following laparoscopic‐assisted resection or open resection for rectal cancer: Findings from AlaCaRT—Australasian Laparoscopic Cancer of the Rectum Trial

Author: Chi Kin Law, Kate Brewer, Chris Brown, Kate Wilson, Lisa Bailey, Wendy Hague, John R. Simes, Andrew Stevenson, Michael Solomon, Rachael L. Morton, and the Australasian Gastro‐Intestinal Trials Group (AGITG) ALaCaRT investigators
Subjects: clinical trial, income, laparoscopy, open abdomen techniques, rectal neoplasms, return to work, Neoplasms. Tumors. Oncology. Including cancer and carcinogens, RC254-282
Abstract: Abstract Background Maintaining employment for adults with cancer is important, however, little is known about the impact of surgery for rectal cancer on an individual's capacity to return to work (RTW). This study aimed to determine the impact of laparoscopic vs. open resection on RTW at 12 months. Methods Analyses were undertaken among participants randomized in the Australian Laparoscopic Cancer of the Rectum Trial (ALaCaRT), with work status available at baseline (presurgery), and 12 months. Multivariable logistic regression, adjusted for sociodemographic and clinical characteristics estimated the effect of surgery on RTW in any capacity, or return to preoperative work status at 12 months. Results About 228 of 449 (51%) surviving trial participants at 12 months completed work status questionnaires; mean age was 62 years, 66% males, 117 of these received laparoscopic resection (51%). Of 228, 120 were employed at baseline (90 full‐time, 30 part‐time). Overall RTW in 120 participants in paid work at baseline was 78% (84% laparoscopic, 70% open surgery). Those employed full‐time were more likely to RTW at 12 months (OR, 3.55; 95% CI, 1.02–12.31). Those with distant metastases at baseline were less likely to RTW (OR, 0.07; 95% CI,
Published: 2021
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22. Preliminary evidence for physical activity following pelvic exenteration: a pilot longitudinal cohort study

Author: Daniel Steffens, Jane M. Young, Michael Solomon, Paula R. Beckenkamp, Cherry Koh, Kenneth Vuong, Matthew A. Brodie, and Kim Delbaere
Subjects: Cancer, Physical activity, Surgery, Surgical outcomes, Neoplasms. Tumors. Oncology. Including cancer and carcinogens, RC254-282
Abstract: Abstract Background The physical activity (PA) level of patients undergoing major cancer surgery remains unclear. This pilot study aimed to: (i) Compare preoperative PA level between patients undergoing major cancer surgery and the general population; (ii) describe PA trajectories following major cancer surgery; (iii) Compare objective versus subjective PA measures in patients undergoing major cancer surgery; and (iv) Investigate the association between preoperative PA level and postoperative outcomes. Methods Patients undergoing pelvic exenteration between September/2016 and September/2017 were included and followed at preoperative, 6-weeks and 6-months postoperative. PA was measured using the International Physical Activity Questionnaire Short-Form and McRoberts activity monitor. Analyses were performed using SPSS. Results This pilot study included 16 patients. When compared to the general population, patients undergoing major cancer surgery presented a reduced preoperative PA level. PA levels decreased at 6 weeks but returned to preoperative levels at 6 months postoperative. Objective and subjective measures of PA were comparable, with some variables presenting strong correlations. A higher preoperative level PA was associated with an absence of postoperative complications and better quality of life outcomes. Conclusions Patients undergoing major cancer surgery demonstrated lower PA levels when compared to the general population. PA trajectories decreased at 6 weeks postoperative, returning to preoperative levels within 6-months. In this cohort, it seems that higher preoperative PA level may improve postoperative surgical outcomes; however, this preliminary evidence should be confirmed in a larger cohort.
Published: 2019
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23. Game Changer: How to Be 10x in the Talent Economy

Author: Michael Solomon, Rishon Blumberg, Daniel Weizmann
Published: 2020

24. Accelerated free-breathing 3D T1ρ cardiovascular magnetic resonance using multicoil compressed sensing

Author: Srikant Kamesh Iyer, Brianna Moon, Eileen Hwuang, Yuchi Han, Michael Solomon, Harold Litt, and Walter R. Witschey
Subjects: Parametric mapping, T1ρ, Compressed sensing, Multicoil reconstruction, Fast minimization, Endogenous contrast techniques, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract: Abstract Background Endogenous contrast T1ρ cardiovascular magnetic resonance (CMR) can detect scar or infiltrative fibrosis in patients with ischemic or non-ischemic cardiomyopathy. Existing 2D T1ρ techniques have limited spatial coverage or require multiple breath-holds. The purpose of this project was to develop an accelerated, free-breathing 3D T1ρ mapping sequence with whole left ventricle coverage using a multicoil, compressed sensing (CS) reconstruction technique for rapid reconstruction of undersampled k-space data. Methods We developed a cardiac- and respiratory-gated, free-breathing 3D T1ρ sequence and acquired data using a variable-density k-space sampling pattern (A = 3). The effect of the transient magnetization trajectory, incomplete recovery of magnetization between T1ρ-preparations (heart rate dependence), and k-space sampling pattern on T1ρ relaxation time error and edge blurring was analyzed using Bloch simulations for normal and chronically infarcted myocardium. Sequence accuracy and repeatability was evaluated using MnCl2 phantoms with different T1ρ relaxation times and compared to 2D measurements. We further assessed accuracy and repeatability in healthy subjects and compared these results to 2D breath-held measurements. Results The error in T1ρ due to incomplete recovery of magnetization between T1ρ-preparations was T1ρhealthy = 6.1% and T1ρinfarct = 10.8% at 60 bpm and T1ρhealthy = 13.2% and T1ρinfarct = 19.6% at 90 bpm. At a heart rate of 60 bpm, error from the combined effects of readout-dependent magnetization transients, k-space undersampling and reordering was T1ρhealthy = 12.6% and T1ρinfarct = 5.8%. CS reconstructions had improved edge sharpness (blur metric = 0.15) compared to inverse Fourier transform reconstructions (blur metric = 0.48). There was strong agreement between the mean T1ρ estimated from the 2D and accelerated 3D data (R 2 = 0.99; P
Published: 2019
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25. Effect of timing on baseline quality of life scores among surgical cancer patients

Author: Daniel Steffens, Michael Solomon, Kenneth Vuong, Lyndal Alchin, Rachael Roberts, Cherry Koh, and Jane Young
Subjects: Quality of life, Preoperative, Postoperative, Surgery, SF-36, Cancer, Medicine, Biology (General), QH301-705.5, Science (General), Q1-390
Abstract: Abstract Objectives To investigate differences between quality of life (QoL) scores obtained preoperatively or recalled in the early postoperative period amongst patients undergoing major cancer surgery. Results Of the 283 patients included, 133 completed their baseline QoL questionnaire preoperatively and 150 postoperatively. Patient groups were broadly comparable in terms of age however the preoperative group had a lower proportion of patients from non-English speaking backgrounds. There were important and statistically significant differences between mean scores for physical health (overall physical health, physical functioning and role physical domains) and mental health (overall mental health and mental health domains) between pre- and postoperative groups. There were no differences for other domain-specific scores (bodily pain, general health, vitality, social functioning and role emotional).
Published: 2018
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26. Establishing a state‐wide pelvic exenteration multidisciplinary team meeting in South Australia

Author: Tracy Fitzsimmons, Michelle Thomas, Darren Tonkin, Elizabeth Murphy, Paul Hollington, Michael Solomon, Tarik Sammour, and Andrew Luck
Subjects: Surgery, General Medicine
Abstract: Pelvic exenteration surgery is complex, necessitating co-ordinated multidisciplinary input and improved referral pathways. A state-wide pelvic exenteration multidisciplinary team (MDT) meeting was established in SA and the outcomes of this were audited and compared with historical data.All patients referred for discussion between August 2021 and July 2022 to the SA State-wide Pelvic Exenteration MDT were included in this study. MDT discussion centred around disease resectability, risk versus benefit of surgery, and need for local or interstate referral. Prospective data collection included patient demographics and MDT recommendations of surgery, palliation, or referral. Patients referred for surgery locally or interstate were compared with a retrospective patient cohort treated previously between January and December 2020.Over 12 months, 91 patients were discussed (including nine multiple times), by a mean of 18 meeting participants each month. Forty-eight patients (58.5%) had primary malignancy, 25 (30.5%) recurrent malignancy, and 9 (11.0%) had non-malignant disease. Colorectal cancer was the most common presentation (56.1%), followed by gynaecological (30.5%) and urological (6.1%) malignancy. Pelvic exenteration surgery was recommended to be performed locally in 53.7% of patients and the remainder for non-surgical treatment, palliation, or re-discussion. During this time, 44 patients underwent surgery locally (versus 34 in 2020) and only 4 referred interstate (versus 8 in 2020).The establishment of a dedicated state-wide pelvic exenteration MDT has resulted in better coordination of care for patients with locally advanced pelvic malignancy in SA, and significantly reduced the need for interstate referral.
Published: 2022
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27. Multivariate models of Fx and yield curve movements applied to value-at-risk

Author: Khabie-Zeitoune, David Michael Solomon
Subjects: 332, Banking
Published: 2001

28. Analysis of the indexing gain when searching in spontaneous wireless networks.

Author: Michael Solomon Desta, Esa Hyytiä, and Jörg Ott
Published: 2016

29. Feasibility and acceptability of PrE-operative Physical Activity to improve patient outcomes After major cancer surgery: study protocol for a pilot randomised controlled trial (PEPA Trial)

Author: Daniel Steffens, Jane Young, Paula R. Beckenkamp, James Ratcliffe, Freya Rubie, Nabila Ansari, Neil Pillinger, and Michael Solomon
Subjects: Feasibility, Acceptability, RCT, Pre-operative, Exercise, Surgery, Medicine (General), R5-920
Abstract: Abstract Background There is a need for evidence of the effectiveness of pre-operative exercise for patients undergoing major cancer surgery; however, recruitment to such trials can be challenging. The PrE-operative Physical Activity (PEPA) Trial will establish the feasibility and acceptability of a pre-operative exercise programme aimed to improve patient outcomes after cytoreductive surgery and pelvic exenteration. The secondary aim is to obtain pilot data on the likely difference in key outcomes (post-operative complications, length of hospital stay, post-operative functional capacity and quality of life) to inform the sample size calculation for the substantive randomised clinical trial. Methods/design Twenty patients undergoing cytoreductive surgery and pelvic exenteration at the Royal Prince Alfred Hospital, Sydney will be recruited and randomly allocated (1:1 ratio) to either 2 to 6 weeks’ pre-operative exercise programme (intervention group) or usual care (control group). Those randomised to the intervention group will receive up to six individualised, 1-h physiotherapy sessions (including aerobic and endurance exercises, respiratory muscle exercises, stretching and flexibility exercises), home exercises (instruction and recommendations on how to progress the exercises at home) and encouragement to be more active by using an activity tracker to measure the number of steps walked daily. Patients allocated to the control group will not receive any specific advice about exercise training. Feasibility will be assessed with consent rates to the study, and for the intervention group, retention and adherence rates to the exercise programme. Acceptability of the exercise programme will be assessed with a semi-structured questionnaire. The following measures of the effectiveness of the intervention will be collected at baseline (2 to 6 weeks pre-operative), a week before surgery, during hospital stay and pre hospital discharge: post-operative complication rates (Clavien-Dindo), post-operative functional capacity (Six-minute Walk Test) and quality of life (SF-36v2®) and length of hospital stay. Functional status will be additionally measured using Cardiopulmonary Exercise Testing (CPET), at baseline and within a week before surgery. Discussion The PEPA Trial will provide important information about the feasibility and acceptability of a pre-operative exercise programme for patients undergoing major cancer surgery. Data from the PEPA Trial will be used to inform the design, methodology and to calculate sample size required for a larger, definitive trial. Trial registration Australian New Zealand Clinical Trials Registry, ID: ACTRN12617001129370. Registered on 1 August 2017.
Published: 2018
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30. Multicentre randomised double-blind placebo controlled trial of combination vancomycin and cefazolin surgical antibiotic prophylaxis: the Australian surgical antibiotic prophylaxis (ASAP) trial

Author: Allen C Cheng, Catherine McDougall, Allen Cheng, An Tran-Duy, Janine Roney, Kirsty Buising, Peter Choong, Michelle Dowsey, Trisha Peel, Sarah Astbury, David Paterson, Richard S de Steiger, Ross Crawford, Richard de Steiger, Philip Clarke, Peter Rehfisch Ben Howden, Robert Molnar, Sam Adie, Glenn Boyce, Jonathon Mulford, Michael Solomon, Tiffany Harris-Brown, Anton Peleg, Jessica Wisniewski, Stephanie Pereira, and Zweena Badoordeen
Subjects: Medicine
Abstract: Introduction Resistant Gram-positive organisms, such as methicillin-resistant staphylococci, account for a significant proportion of infections following joint replacement surgery. Current surgical antimicrobial prophylaxis guidelines recommend the use of first-generation or second-generation cephalosporin antibiotics, such as cefazolin. Cefazolin, however, does not prevent infections due to these resistant organisms; therefore, new prevention strategies need to be examined. One proposed strategy is to combine a glycopeptide antibiotic with cefazolin for prophylaxis. The clinical benefit and cost-effectiveness of this combination therapy compared with usual therapy, however, have not been established.Methods and analysis This randomised, double-blind, parallel, superiority, placebo-controlled, phase 4 trial will compare the incidence of all surgical site infections (SSIs) including superficial, deep and organ/space (prosthetic joint) infections, safety and cost-effectiveness of surgical prophylaxis with cefazolin plus vancomycin to that with cefazolin plus placebo. The study will be performed in patients undergoing joint replacement surgery. In the microbiological sub-studies, we will examine the incidence of SSIs in participants with preoperative staphylococci colonisation (Sub-Study 1) and incidence of VRE acquisition (Sub-Study 2). The trial will recruit 4450 participants over a 4-year period across 13 orthopaedic centres in Australia. The primary outcome is the incidence of SSI at 90 days post index surgery. Secondary outcomes include the incidence of SSI according to joint and microorganism and other healthcare associated infections. Safety endpoints include the incidence of acute kidney injury, hypersensitivity reactions and all-cause mortality. The primary and secondary analysis will be a modified intention-to-treat analysis consisting of all randomised participants who undergo eligible surgery. We will also perform a per-protocol analysis.Ethics and dissemination The study protocol was reviewed and approved by The Alfred Hospital Human Research Ethics Committee (HREC/18/Alfred/102) on 9 July 2018. Study findings will be disseminated in the printed media, and learnt forums.Trial registration number ACTRN12618000642280
Published: 2019
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31. SOLAR RADIATION FORECASTING USING ADAPTIVE NEURO FUZZY INFERENCE SYSTEM (ANFIS)

Author: Asia'u T. Belgore, Ruth A. Onyohi, Najashi B. Gafai, and Michael Solomon Ighodalo
Subjects: Solar Energy, Adaptive Neuro Fuzzy Inference System (ANFIS). Solar Forecasting, Artificial Neural Network (ANN)
Abstract: Hybrid intelligent systems have previously been centered on forecasting solar energy using meteorological data parameters; nevertheless, such forecasting approaches have yielded unreliable results. The goal of this research is to design and develop ANFIS model for forecasting solar energy based on widely shifting environmental factors utilizing experimental data collected in Abuja. This is accomplished by developing a system that predicts solar energy generation using an Artificial Neural Network (ANN) and fuzzy logic. This research examines four Adaptive Neuro Fuzzy Inference System (ANFIS) models that were developed and tested in Abuja, Nigeria, for horizontal sun radiation prediction. These models were generated by varying the number of inputs for each model with the output being solar radiation. Data set of 30 years were collected from the National Space Research Development Agency (NASDRA) and procured for the presented simulation study. Simulation using ANFIS methodology was carried out using MATLAB Tool. The obtained data was divided into two categories: training and testing with training having 70% and testing 30% of the data sets. The simulation results were checked against the data and confirmed to be within allowable limits. The coefficients of determination (R2), correlation coefficient(R), Mean Square Error (MSE), Root Mean Square Error (RMSE) were calculated to demonstrate the effectiveness of the proposed machine learning models. It can be safely concluded that model 4 gave an accurate result with high efficiency and less error.
Published: 2023
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32. Semen culture and the assessment of genitourinary tract infections

Author: Michael Solomon and Ralf Henkel
Subjects: Diseases of the genitourinary system. Urology, RC870-923
Abstract: The male factor contributes approximately 50% to infertility-related cases in couples with an estimated 12%–35% of these cases attributable to male genital tract infections. Depending on the nature of the infection, testicular sperm production, sperm transport, and sperm function can be compromised. Yet, infections are potentially treatable causes of infertility. Male genital tract infections are increasingly difficult to detect. Moreover, they often remain asymptomatic (“silent”) with the result that they are then passed on to the relevant sexual partner leading to fertilization and pregnancy failure as well as illness of the offspring. With the worldwide increasing problem of antibiotic resistance of pathogens, proper diagnosis and therapy of the patient is important. This testing, however, should include not only aerobic microbes but also anaerobic as these can be found in almost all ejaculates with about 71% being potentially pathogenic. Therefore, in cases of any indication of a male genital tract infection, a semen culture should be carried out, particularly in patients with questionable semen quality. Globally, an estimate of 340 million new infections with sexually transmitted pathogens is recorded annually. Among these, the most prevalent pathogens including Chlamydia trachomatis, Ureaplasma urealyticum, Neisseria gonorrhoeae, and Mycoplasma hominis. Escherichia coli are considered the most common nonsexually transmitted urogenital tract microbes. These pathogens cause epididymitis, epididymo-orchitis, or prostatitis and contribute to increased seminal leukocyte concentrations.
Published: 2017
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33. Stoma-free Survival After Rectal Cancer Resection With Anastomotic Leakage: Development and Validation of a Prediction Model in a Large International Cohort

Author: Nynke G, Greijdanu, Kiedo, Wienholt, Sander, Ubel, Kevin, Talboom, Gerjon, Hannink, Albert, Wolthui, Francisco B, de Lacy, Jérémie H, Lefevre, Michael, Solomon, Matteo, Frasson, Nicolas, Rotholtz, Quentin, Denost, Rodrigo O, Perez, Tsuyoshi, Konishi, Yves, Pani, Martin, Rutegård, Roel, Hompe, Camiel, Rosman, Frans, van Workum, Pieter J, Tani, Wilt, De, H W, Johanne, A Bremers, Andreas J, T Ferenschild, Flori, de Vriendt, Stefanie, D'Hoore, André, Bislenghi, Gabriele, Farguell, Jordi, M Lacy, Antonio, González Atienza, Paula, S van Kessel, Charlotte, Parc, Yann, Voron, Thibault, K Collard, Maxime, Sancho Muriel, Jorge, Cholewa, Hannia, A Mattioni, Laura, Frontali, Alice, W Polle, Sebastiaan, Polat, Fatih, J Obihara, Ndidi, B Vailati, Bruna, Kusters, Miranda, B Tuynmann, Jurriaan, A Hazen, Sanne J, J Grüter, Alexander A, Amano, Takahiro, Fujiwara, Hajime, Salomon, Mario, Ruiz, Hernán, Gonzalez, Ricardo, Estefanía, Diego, Avellaneda, Nicola, Carrie, Augusto, Santillan, Mateo, A Pantoja Pachajoa, Diana, Parodi, Matia, Gielis, Manuel, Binder, Alf-Dorian, Gürtler, Thoma, Riedl, Peter, Badiani, Sarit, Berney, Christophe, Morgan, Matthew, Hollington, Paul, da Silva, Nigel, Nair, Gavin, M Ho, Yiu, Lamparelli, Michael, Kapadia, Raj, M Kroon, Hidde, N Dudi-Venkata, Nagendra, Liu, Jianliang, Sammour, Tarik, Flamey, Nicola, Pattyn, Paul, Chaoui, Ahmed, Vansteenbrugge, Loui, J van den Broek, Nathalie E, Vanclooster, Patrick, de Gheldere, Charle, Pletinckx, Pieter, Defoort, Barbara, Dewulf, Maxime, Slavchev, Mihail, Belev, Nikolay, Atanasov, Boyko, Krastev, Panche, Sokolov, Manol, Maslyankov, Svilen, Gribnev, Petar, Pavlov, Vasil, Ivanov, Tsvetomir, Karamanliev, Martin, Filipov, Emil, Tonchev, Pencho, Aigner, Felix, Mitteregger, Martin, Allmer, Caterina, Seitinger, Gerald, Colucci, Nicola, Buchs, Nicola, Ris, Frédéric, Toso, Christian, Gialamas, Eleftherio, Vuagniaux, Aurélie, Chautems, Roland, Sauvain, Marc-Olivier, Daester, Silvio, von Flüe, Marku, Guenin, Marc-Olivier, Taha-Mehlitz, Stephanie, F Hess, Gabriel, Martínek, Lubomír, Skrovina, Matej, Machackova, Maria, Benčurik, Vladimir, Uluk, Deniz, Pratschke, Johann, S Dittrich, Luca, Guel-Klein, Safak, Perez, Daniel, Grass, Julia-Kristin, Melling, Nathaniel, Mueller, Simone, H Iversen, Lene, D Eriksen, Jacob, Baatrup, Gunnar, Al-Najami, Issam, Bjørsum-Meyer, Thoma, Teras, Jüri, M Teras, Roland, A Monib, Fatma, Eldin Abu Elnga Ahmed, Nagm, Alkady, Eithar, K Ali, Ahmed, Abd Elatti Khedr, Gehan, Samir Abdelaal, Ahmed, M Bassyouni Ashoush, Fouad, Ewedah, Moataz, M Elshennawy, Eslam, Hussein, Mohamed, Fernández-Martínez, Daniel, J García-Flórez, Lui, Fernández-Hevia, María, Suárez-Sánchez, Aida, Del Hoyo Aretxabala, Izaskun, Losada Docampo, Iria, Gómez Zabala, Jesú, Tejedor, Patricia, T Morales Bernaldo de Quirós, Javier, Bodega Quiroga, Ignacio, Navarro-Sánchez, Antonio, Soto Darias, Iván, López Fernández, Cristina, de La Cruz Cuadrado, Cristina, Sánchez-Guillén, Lui, López-Rodríguez-Arias, Francisco, Soler-Silva, Álvaro, Arroyo, Antonio, C Bernal-Sprekelsen, Juan, Á Gómez-Abril, Segundo, Gonzálvez, Paula, T Torres, María, Rubio Sánchez, Teresa, Blanco Antona, Francisco, E Sánchez Lara, Juan, A Alcázar Montero, José, Colás-Ruiz, Enrique, M Tasende-Presedo, Marta, Fernández-Hurtado, Ignacio, A Cifuentes-Ródenas, José, Castro Suárez, Marta, Losada, Manuel, Hernández, Miguel, Alonso, Alfredo, Diéguez, Beatriz, Serralta, Daniel, E Medina Quintana, Rita, M Gil Lopez, Jose, Lima Pinto, Francisca, Nieto-Moreno, Elena, Correa Bonito, Alba, Cerdán Santacruz, Carlo, Bermejo Marcos, Elena, García Septiem, Javier, Calero-Lillo, Aránzazu, Alanez-Saavedra, Javier, Muñoz-Collado, Salvador, López-Lara, Manuel, Labalde Martínez, María, Ferrero Herrero, Eduardo, Javier García Borda, Francisco, García Villar, Óscar, Escartín, Jorge, L Blas, Juan, Ferrer, Rocío, García Egea, Jorge, Rodríguez-Infante, Antonio, Mínguez-Ruiz, Germán, Carreño-Villarreal, Guillermo, Pire-Abaitua, Gerardo, Dziakova, Jana, Sáez-Cazallas Rodríguez, Carlo, J Pizarro Aranda, María, M Muguerza Huguet, José, Borda-Arrizabalaga, Nerea, M Enriquez-Navascués, José, Elorza Echaniz, Garazi, Saralegui Ansorena, Yolanda, Estaire-Gómez, Mercede, Martínez-Pinedo, Carlo, Barbero-Valenzuela, Alejandro, Ruíz-García, Pablo, Kraft, Miquel, J Gómez-Jurado, María, Pellino, Gianluca, Espín-Basany, Eloy, Cotte, Eddy, Panel, Nathalie, Goutard, Claire-Angéline, Deángelis, Nicola, Lauka, Lelde, Shaikh, Shafaque, Osborne, Laura, Ramsay, George, Nichita, Vladimir-Ion, Bhandari, Santosh, Sarmah, Panchali, M Bethune, Rob, M Pringle, Heather C, Massey, Lisa, E Fowler, George, S Hamid, Hytham K, D de Simone, Belinda, Kynaston, Jame, Bradley, Nichola, M Stienstra, Roxane, Gurjar, Shashank, Mukherjee, Tanmoy, Chandio, Ashfaq, Ahmed, Safia, Singh, Baljit, Runau, Francoi, Chaudhri, Sanjay, Siaw, Oliver, Sarveswaran, Janahan, Miu, Victor, Ashmore, Daniel, Darwich, Haitham, Singh-Ranger, Deepak, Singh, Nirbhaibir, Shaban, Mohamed, Gareb, Fahed, Petropolou, Thalia, Polydorou, Adrea, Dattani, Mit, Afzal, Asma, Bavikatte, Akshay, Sebastian, Boby, Ward, Nichola, Mishra, Amitabh, Manatakis, Dimitrio, Agalianos, Christo, Tasis, Nikolao, Antonopoulou, Maria-Ioanna, Karavokyros, Ioanni, Charalabopoulos, Alexandro, Schizas, Dimitrio, Baili, Efstratia, Syllaios, Athanasio, Karydakis, Lysandro, Vailas, Michail, Balalis, Dimitrio, Korkolis, Dimitrio, Plastiras, Ari, Rompou, Aliki, Xenaki, Sofia, Xynos, Evangelo, Chrysos, Emmanuel, Venianaki, Maria, Christodoulidis, Grigorio, Perivoliotis, Konstantino, Tzovaras, George, Baloyiannis, Ioanni, Ho, Man-Fung, Siu-Man Ng, Simon, Wing-Chung Mak, Tony, Futaba, Kaori, Šantak, Goran, Šimleša, Damir, Osić, Jurica, Zukanović, Goran, E Kelly, Michael, O Larkin, John, H McCormick, Paul, J Mehigan, Brian, M Connelly, Tara, Neary, Peter, Ryan, Jessica, Mccullough, Peter, A Al-Juaifari, Maytham, Hammoodi, Hayder, Hashim Abbood, Ali, Calabrò, Marcello, Muratore, Andrea, La Terra, Antonio, Farnesi, Francesca, V Feo, Carlo, Fabbri, Nicolò, Pesce, Antonio, Fazzin, Marta, Roscio, Francesco, Clerici, Federico, Lucchi, Andrea, Vittori, Laura, Agostinelli, Laura, Cristina Ripoli, Maria, Sambucci, Daniele, Porta, Andrea, Sinibaldi, Giovanni, Crescentini, Giacomo, Larcinese, Antonella, Picone, Emanuele, Persiani, Roberto, Biondi, Alberto, Pezzuto, Roberto, Lorenzon, Laura, Rizzo, Gianluca, Coco, Claudio, D'Agostino, Luca, Spinelli, Antonino, M Sacchi, Matteo, Carvello, Michele, Foppa, Caterina, Maroli, Annalisa, M Palini, Gian, Garulli, Gianluca, Zanini, Nicola, Delrio, Paolo, Rega, Daniela, Carbone, Fabio, Aversano, Alessia, Pirozzolo, Giovanni, Recordare, Alfonso, D'Alimonte, Lucrezia, Vignotto, Chiara, Corbellini, Carlo, M Sampietro, Gianluca, Lorusso, Leonardo, A Manzo, Carlo, Ghignone, Federico, Ugolini, Giampaolo, Montroni, Isacco, Pasini, Franceso, Pasini, Francesco, Ballabio, Michele, Bisagni, Pietro, T Armao, Francesca, Longhi, Marco, Ghazouani, Omar, Galleano, Raffaele, Tamini, Nicolò, Oldani, Massimo, Nespoli, Luca, Picciariello, Arcangelo, F Altomare, Donato, Tomasicchio, Giovanni, Lantone, Giuliano, Catena, Fausto, Giuffrida, Mario, Annicchiarico, Alfredo, Perrone, Gennaro, Grossi, Ugo, A Santoro, Giulio, Zanus, Giacomo, Iacomino, Alessandro, Novello, Simone, Passuello, Nicola, Zucchella, Martino, Puca, Lucia, Degiuli, Maurizio, Reddavid, Rossella, Scabini, Stefano, Aprile, Alessandra, Soriero, Domenico, Fioravanti, Emanuela, Rottoli, Matteo, Romano, Angela, Tanzanu, Marta, Belvedere, Angela, M Mariani, Nicolò, P Ceretti, Andrea, Opocher, Enrico, Gallo, Gaetano, Sammarco, Giuseppe, de Paola, Gilda, Pucciarelli, Salvatore, Marchegiani, Francesco, Spolverato, Gaya, Buzzi, Gianluca, Di Saverio, Salomone, Meroni, Paola, Parise, Cristiano, I Bottazzoli, Elisa, Lapolla, Pierfrancesco, Brachini, Gioia, Cirillo, Bruno, Mingoli, Andrea, Sica, Giuseppe, Siragusa, Leandro, Bellato, Vittoria, Cerbo, Daniele, A de Pasqual, Carlo, de Manzoni, Giovanni, A di Cosmo, Maria, H Alrayes, Bourhan M, M Qandeel, Mahmoud W, Bani Hani, Mohammad, Rabadi, Alexander, S El Muhtaseb, Mohammad, Abdeen, Basel, Karmi, Fahed, Žilinskas, Justa, Latkauskas, Tada, Tamelis, Algimanta, Pikūnienė, Ingrida, Šlenfuktas, Vyginta, Poskus, Toma, Kryzauskas, Mariu, Jakubauskas, Mata, Mikalauskas, Sauliu, Jakubauskiene, Lina, Y Hassan, Soha, Altrabulsi, Amani, Abdulwahed, Eman, Ghmagh, Reem, Deeknah, Abdulqudu, Alshareea, Entisar, Elhadi, Muhammed, Abujamra, Saleh, A Msherghi, Ahmed, E Tababa, Osama W, A Majbar, Mohammed, Souadka, Amine, Benkabbou, Amine, Mohsine, Raouf, Echiguer, Sabrillah, Moctezuma-Velázquez, Paulina, Salgado-Nesme, Noel, Vergara-Fernández, Omar, C Sainz-Hernández, Juan, E Alvarez-Bautista, Francisco, D Zakaria, Andee, Zakaria, Zaidi, K Wong, Michael P, Ismail, Razif, F Ibrahim, Aini, N Abdullah, Nik A, Julaihi, Rokayah, Bhat, Sameer, O'Grady, Greg, Bissett, Ian, Lamme, Ba, D Musters, Gijsbert, M Dinaux, Anne, A Grotenhuis, Brechtje, J Aalbers, Ernst J Steller Arend G, M Leeuwenburgh, Marjolein, T Rutten, Harm J, A Burger, Jacobus W, G Bloemen, Johanne, J Ketelaers, Stijn H, Waqar, Usama, Chawla, Tabish, Rauf, Hareem, Rani, Pallavi, K Talsma, Aaldert, Scheurink, Lieke, B van Praagh, Jasper, Segelman, Josefin, Nygren, Jona, Anderin, Kajsa, Tiefenthal, Marit, de Andrés, Beatriz, P Beltrán de Heredia, Juan, Vázquez, Andrea, Gómez, Tania, Golshani, Parisa, Kader, Rawaz, Mohamed, Abudi, Westerterp, Marinke, Marinelli, Andrea, Niemer, Quirine, G Doornebosch, Pascal, Shapiro, Joël, Vermaas, Maarten, R de Graaf, Eelco J, L van Westreenen, Hendrik, Zwakman, Marije, D van Dalsen, Annette, J Vles, Wouter, Nonner, Joost, R Toorenvliet, Boudewijn, J Janssen, Paul T, G Verdaasdonk, Emiel G, J Amelung, Femke, R Bahadoer, Koen C M J Peeters Renu, A Holman, Fabian, Heemskerk, Jeroen, Vosbeek, Noortje, A Leijtens, Jeroen W, M Taverne, Sophie B, M Heijnen, Bob H, El-Massoudi, Youssef, de Groot-van Veen, Irene, Hoff, Christiaan, Jou-Valencia, Daniela, J Consten, Esther C, A Burghgraef, Thij, Geitenbeek, Ritch, L Hulshof, Lorenzo G W, D Slooter, Gerrit, Reudink, Muriël, D Bouvy, Nicole, L Wildeboer, Aurelia C, Verstappen, Sonja, J Pennings, Alexander, van den Hengel, Berber, G Wijma, Allard, de Haan, Jael, F de Nes, Lindsey C, Heesink, Vera, Karsten, Tom, M Heidsma, Charlotte, J Koemans, Willem, T Dekker, Jan-Willem, J van der Zijden, Charlène, Roos, Daphne, Demirkiran, Ahmet, van der Burg, Sjirk, J Oosterling, Steven, J Hoogteijling, Tij, Wiering, Bastiaan, J Smeeing, Diederik P, Havenga, Klaa, Lutfi, Hamid, Tsimogiannis, Konstantino, Sköldberg, Filip, Folkesson, Joakim, den Boer, Frank, G van Schaik, Ted, van Gerven, Pieter, Sietses, Colin, C Hol, Jeroen, G Boerma, Evert-Jan, J Creemers, Davy M, K Schultz, Johanne, Frivold, Tone, Riis, Rolf, Gregussen, Hilde, Busund, Sondre, H Sjo, Ole, Gaard, Maria, Krohn, Nina, L Ersryd, Amanda, Leung, Edmund, Sultan, Hytham, Nabil Hajjaj, Baraa, Jehad Alhisi, Ahmed, E Khader, Ahmed A, Filipa Dias Mendes, Ana, Semião, Miguel, Queiroz Faria, Lui, Azevedo, Constança, M da Costa Devesa, Helena, Fortuna Martins, Sónia, M Rodrigues Jarimba, Aldo, M Ribeiro Marques, Sónia, Marques Ferreira, Rita, Oliveira, António, Ferreira, Cátia, Pereira, Ricardo, M Surlin, Valeriu, M Graure, Giorgiana, D Ramboiu, Stefan Patrascu Sandu, Negoi, Ionut, Ciubotaru, Cezar, Stoica, Bogdan, Tanase, Ioan, M Negoita, Valentina, Florea, Sabrina, Macau, Florin, Vasile, Mihai, Stefanescu, Victor, Dimofte, Gabriel-Mihail, Luncă, Sorinel, Roată, Cristian-Ene, Mușină, Ana-Maria, Garmanova, Tatiana, N Agapov, Mikhail, G Markaryan, Daniil, Eduard, Galliamov, Yanishev, Alexey, Abelevich, Alexander, Bazaev, Andrey, V Rodimov, Sergey, B Filimonov, Victor, A Melnikov, Andrey, A Suchkov, Igor, Drozdov, Evgeniy, N Kostromitskiy, Dmitriy, Sjöström, Olle, Matthiessen, Peter, Baban, Bayar, 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Bulut, Mehmet, B Kulle, Cemil, Kara, Yasin, Sıbıç, Osman, H Özata, İbrahim, Buğra, Dursun, Balık, Emre, Çakır, Murat, Alhardan, Ana, Colak, Elif, B CiftciEngin Aybar, Ahmet, Can Sari, Ahmet, Demirli Atici, Semra, Kaya, Tayfun, Dursun, Ayberk, Calik, Bulent, Faruk Özkan, Ömer, Şeyda Ülgür, Hanife, Düzgün, Özgül, Monson, John, George, Sarah, Woods, Kayla, Al-Eryani, Fatima, Albakry, Rudaina, Coetzee, Emile, Boutall, Adam, Herman, Ayesiga, Warden, Claire, Mugla, Naser, Forgan, Tim, Mia, Imraan, Lambrechts, Anton, Roberto Persiani (ORCID:0000-0002-1537-5097), Alberto Biondi (ORCID:0000-0002-2470-7858), Nynke G, Greijdanu, Kiedo, Wienholt, Sander, Ubel, Kevin, Talboom, Gerjon, Hannink, Albert, Wolthui, Francisco B, de Lacy, Jérémie H, Lefevre, Michael, Solomon, Matteo, Frasson, Nicolas, Rotholtz, Quentin, Denost, Rodrigo O, Perez, Tsuyoshi, Konishi, Yves, Pani, Martin, Rutegård, Roel, Hompe, Camiel, Rosman, Frans, van Workum, Pieter J, Tani, Wilt, De, H W, Johanne, A Bremers, Andreas J, T Ferenschild, Flori, de Vriendt, Stefanie, D'Hoore, André, Bislenghi, Gabriele, Farguell, Jordi, M Lacy, Antonio, González Atienza, Paula, S van Kessel, Charlotte, Parc, Yann, Voron, Thibault, K Collard, Maxime, Sancho Muriel, Jorge, Cholewa, Hannia, A Mattioni, Laura, Frontali, Alice, W Polle, Sebastiaan, Polat, Fatih, J Obihara, Ndidi, B Vailati, Bruna, Kusters, Miranda, B Tuynmann, Jurriaan, A Hazen, Sanne J, J Grüter, Alexander A, Amano, Takahiro, Fujiwara, Hajime, Salomon, Mario, Ruiz, Hernán, Gonzalez, Ricardo, Estefanía, Diego, Avellaneda, Nicola, Carrie, Augusto, Santillan, Mateo, A Pantoja Pachajoa, Diana, Parodi, Matia, Gielis, Manuel, Binder, Alf-Dorian, Gürtler, Thoma, Riedl, Peter, Badiani, Sarit, Berney, Christophe, Morgan, Matthew, Hollington, Paul, da Silva, Nigel, Nair, Gavin, M Ho, Yiu, Lamparelli, Michael, Kapadia, Raj, M Kroon, Hidde, N Dudi-Venkata, Nagendra, Liu, Jianliang, Sammour, Tarik, Flamey, Nicola, Pattyn, Paul, Chaoui, Ahmed, 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Anderin, Kajsa, Tiefenthal, Marit, de Andrés, Beatriz, P Beltrán de Heredia, Juan, Vázquez, Andrea, Gómez, Tania, Golshani, Parisa, Kader, Rawaz, Mohamed, Abudi, Westerterp, Marinke, Marinelli, Andrea, Niemer, Quirine, G Doornebosch, Pascal, Shapiro, Joël, Vermaas, Maarten, R de Graaf, Eelco J, L van Westreenen, Hendrik, Zwakman, Marije, D van Dalsen, Annette, J Vles, Wouter, Nonner, Joost, R Toorenvliet, Boudewijn, J Janssen, Paul T, G Verdaasdonk, Emiel G, J Amelung, Femke, R Bahadoer, Koen C M J Peeters Renu, A Holman, Fabian, Heemskerk, Jeroen, Vosbeek, Noortje, A Leijtens, Jeroen W, M Taverne, Sophie B, M Heijnen, Bob H, El-Massoudi, Youssef, de Groot-van Veen, Irene, Hoff, Christiaan, Jou-Valencia, Daniela, J Consten, Esther C, A Burghgraef, Thij, Geitenbeek, Ritch, L Hulshof, Lorenzo G W, D Slooter, Gerrit, Reudink, Muriël, D Bouvy, Nicole, L Wildeboer, Aurelia C, Verstappen, Sonja, J Pennings, Alexander, van den Hengel, Berber, G Wijma, Allard, de Haan, Jael, F de Nes, Lindsey C, Heesink, Vera, Karsten, Tom, M Heidsma, Charlotte, J Koemans, Willem, T Dekker, Jan-Willem, J van der Zijden, Charlène, Roos, Daphne, Demirkiran, Ahmet, van der Burg, Sjirk, J Oosterling, Steven, J Hoogteijling, Tij, Wiering, Bastiaan, J Smeeing, Diederik P, Havenga, Klaa, Lutfi, Hamid, Tsimogiannis, Konstantino, Sköldberg, Filip, Folkesson, Joakim, den Boer, Frank, G van Schaik, Ted, van Gerven, Pieter, Sietses, Colin, C Hol, Jeroen, G Boerma, Evert-Jan, J Creemers, Davy M, K Schultz, Johanne, Frivold, Tone, Riis, Rolf, Gregussen, Hilde, Busund, Sondre, H Sjo, Ole, Gaard, Maria, Krohn, Nina, L Ersryd, Amanda, Leung, Edmund, Sultan, Hytham, Nabil Hajjaj, Baraa, Jehad Alhisi, Ahmed, E Khader, Ahmed A, Filipa Dias Mendes, Ana, Semião, Miguel, Queiroz Faria, Lui, Azevedo, Constança, M da Costa Devesa, Helena, Fortuna Martins, Sónia, M Rodrigues Jarimba, Aldo, M Ribeiro Marques, Sónia, Marques Ferreira, Rita, Oliveira, António, Ferreira, Cátia, Pereira, Ricardo, M Surlin, Valeriu, M Graure, Giorgiana, D Ramboiu, Stefan Patrascu Sandu, Negoi, Ionut, Ciubotaru, Cezar, Stoica, Bogdan, Tanase, Ioan, M Negoita, Valentina, Florea, Sabrina, Macau, Florin, Vasile, Mihai, Stefanescu, Victor, Dimofte, Gabriel-Mihail, Luncă, Sorinel, Roată, Cristian-Ene, Mușină, Ana-Maria, Garmanova, Tatiana, N Agapov, Mikhail, G Markaryan, Daniil, Eduard, Galliamov, Yanishev, Alexey, Abelevich, Alexander, Bazaev, Andrey, V Rodimov, Sergey, B Filimonov, Victor, A Melnikov, Andrey, A Suchkov, Igor, Drozdov, Evgeniy, N Kostromitskiy, Dmitriy, Sjöström, Olle, Matthiessen, Peter, Baban, Bayar, Gadan, Soran, Dehlaghi Jadid, Kaveh, Staffan, Maria, M Park, Jennifer, Rydbeck, Daniel, Lydrup, Marie-Louise, Buchwald, Pamela, Jutesten, Henrik, Darlin, Lotten, Lindqvist, Ebba, Nilsson, Karl, Larsson, Per-Ander, Jangmalm, Staffan, A Košir, Jurij, Tomažič, Aleš, Grosek, Jan, Košir Božič, Tajda, Zazo, Aya, Zazo, Rama, Fares, Hala, Ayoub, Kusay, Niazi, Ammar, Mansour, Ali, Abbas, Ayman, Tantoura, Mohammad, Hamdan, Alaa, Hassan, Naya, Hasan, Bassam, Saad, Ahmad, Sebai, Amine, Haddad, Ani, Maghrebi, Houcine, Kacem, Montasser, Yalkın, Ömer, Veysi Samsa, Mehmet, Atak, İbrahim, Balci, Bengi, Haberal, Elifcan, Dogan, Lütfi, E Gecim, Ibrahim, Akyol, Cihangir, A Koc, Mehmet, Sivrikoz, Emre, Piyadeoğlu, Deniz, O Avanagh, Dara, Sökmen, Selman, Bişgin, Tayfun, Günenç, Erşan, Güzel, Melek, Leventoğlu, Sezai, Yüksel, Osman, Kozan, Ramazan, Göbüt, Hüseyin, Cengiz, Fevzi, Erdinc, Kemal, Coşgun Acar, Nihan, Kamer, Erdinc, Özgür, İlker, Aydın, Oguzhan, Keskin, Metin, Türker Bulut, Mehmet, B Kulle, Cemil, Kara, Yasin, Sıbıç, Osman, H Özata, İbrahim, Buğra, Dursun, Balık, Emre, Çakır, Murat, Alhardan, Ana, Colak, Elif, B CiftciEngin Aybar, Ahmet, Can Sari, Ahmet, Demirli Atici, Semra, Kaya, Tayfun, Dursun, Ayberk, Calik, Bulent, Faruk Özkan, Ömer, Şeyda Ülgür, Hanife, Düzgün, Özgül, Monson, John, George, Sarah, Woods, Kayla, Al-Eryani, Fatima, Albakry, Rudaina, Coetzee, Emile, Boutall, Adam, Herman, Ayesiga, Warden, Claire, Mugla, Naser, Forgan, Tim, Mia, Imraan, Lambrechts, Anton, Roberto Persiani (ORCID:0000-0002-1537-5097), and Alberto Biondi (ORCID:0000-0002-2470-7858)
Abstract: Objective:To develop and validate a prediction model (STOMA score) for 1-year stoma-free survival in patients with rectal cancer (RC) with anastomotic leakage (AL).Background:AL after RC resection often results in a permanent stoma.Methods:This international retrospective cohort study (TENTACLE-Rectum) encompassed 216 participating centres and included patients who developed AL after RC surgery between 2014 and 2018. Clinically relevant predictors for 1-year stoma-free survival were included in uni and multivariable logistic regression models. The STOMA score was developed and internally validated in a cohort of patients operated between 2014 and 2017, with subsequent temporal validation in a 2018 cohort. The discriminative power and calibration of the models' performance were evaluated.Results:This study included 2499 patients with AL, 1954 in the development cohort and 545 in the validation cohort. Baseline characteristics were comparable. One-year stoma-free survival was 45.0% in the development cohort and 43.7% in the validation cohort. The following predictors were included in the STOMA score: sex, age, American Society of Anestesiologist classification, body mass index, clinical M-disease, neoadjuvant therapy, abdominal and transanal approach, primary defunctioning stoma, multivisceral resection, clinical setting in which AL was diagnosed, postoperative day of AL diagnosis, abdominal contamination, anastomotic defect circumference, bowel wall ischemia, anastomotic fistula, retraction, and reactivation leakage. The STOMA score showed good discrimination and calibration (c-index: 0.71, 95% CI: 0.66-0.76).Conclusions:The STOMA score consists of 18 clinically relevant factors and estimates the individual risk for 1-year stoma-free survival in patients with AL after RC surgery, which may improve patient counseling and give guidance when analyzing the efficacy of different treatment strategies in future studies.
Published: 2023

34. Stoma-free survival after anastomotic leak following rectal cancer resection: worldwide cohort of 2470 patients

Author: Nynke G, Greijdanu, Kiedo, Wienholt, Sander, Ubel, Kevin, Talboom, Gerjon, Hannink, Albert, Wolthui, F Borja, de Lacy, Jérémie H, Lefevre, Michael, Solomon, Matteo, Frasson, Nicolas, Rotholtz, Quentin, Denost, Rodrigo O, Perez, Tsuyoshi, Konishi, Yves, Pani, Martin, Rutegård, Roel, Hompe, Camiel, Rosman, Frans, van Workum, Pieter J, Tani, Johannes H W, de Wilt, A Bremers, Andreas J, T Ferenschild, Flori, de Vriendt, Stefanie, D'Hoore, André, Bislenghi, Gabriele, Farguell, Jordi, M Lacy, Antonio, González Atienza, Paula, S van Kessel, Charlotte, Parc, Yann, Voron, Thibault, K Collard, Maxime, Sancho Muriel, Jorge, Cholewa, Hannia, A Mattioni, Laura, Frontali, Alice, W Polle, Sebastiaan, Polat, Fatih, J Obihara, Ndidi, B Vailati, Bruna, Kusters, Miranda, B Tuynmann, Jurriaan, A Hazen, Sanne J, J Grüter, Alexander A, Amano, Takahiro, Fujiwara, Hajime, Salomon, Mario, Ruiz, Hernán, Gonzalez, Ricardo, Estefanía, Diego, Avellaneda, Nicola, Carrie, Augusto, Santillan, Mateo, A Pantoja Pachajoa, Diana, Parodi, Matia, Gielis, Manuel, Binder, Alf-Dorian, Gürtler, Thoma, Riedl, Peter, Badiani, Sarit, Berney, Christophe, Morgan, Matthew, Hollington, Paul, da Silva, Nigel, Nair, Gavin, M Ho, Yiu, Lamparelli, Michael, Kapadia, Raj, M Kroon, Hidde, N Dudi-Venkata, Nagendra, Liu, Jianliang, Sammour, Tarik, Flamey, Nicola, Pattyn, Paul, Chaoui, Ahmed, Vansteenbrugge, Loui, J van den Broek, Nathalie E, Vanclooster, Patrick, de Gheldere, Charle, Pletinckx, Pieter, Defoort, Barbara, Dewulf, Maxime, Slavchev, Mihail, Belev, Nikolay, Atanasov, Boyko, Krastev, Panche, Sokolov, Manol, Maslyankov, Svilen, Gribnev, Petar, Pavlov, Vasil, Ivanov, Tsvetomir, Karamanliev, Martin, Filipov, Emil, Tonchev, Pencho, Aigner, Felix, Mitteregger, Martin, Allmer, Caterina, Seitinger, Gerald, Colucci, Nicola, Buchs, Nicola, Ris, Frédéric, Toso, Christian, Gialamas, Eleftherio, Vuagniaux, Aurélie, Chautems, Roland, Sauvain, Marc-Olivier, Daester, Silvio, von Flüe, Marku, Guenin, Marc-Olivier, Taha-Mehlitz, Stephanie, F Hess, Gabriel, Martínek, Lubomír, Skrovina, Matej, Machackova, Maria, Benčurik, Vladimir, Uluk, Deniz, Pratschke, Johann, S Dittrich, Luca, Guel-Klein, Safak, Perez, Daniel, Grass, Julia-Kristin, Melling, Nathaniel, Mueller, Simone, H Iversen, Lene, D Eriksen, Jacob, Baatrup, Gunnar, Al-Najami, Issam, Bjørsum-Meyer, Thoma, Teras, Jüri, M Teras, Roland, A Monib, Fatma, Eldin Abu Elnga Ahmed, Nagm, Alkady, Eithar, K Ali, Ahmed, Abd Elatti Khedr, Gehan, Samir Abdelaal, Ahmed, M Bassyouni Ashoush, Fouad, Ewedah, Moataz, M Elshennawy, Eslam, Hussein, Mohamed, Fernández-Martínez, Daniel, J García-Flórez, Lui, Fernández-Hevia, María, Suárez-Sánchez, Aida, Del Hoyo Aretxabala, Izaskun, Losada Docampo, Iria, Gómez Zabala, Jesú, Tejedor, Patricia, T Morales Bernaldo de Quirós, Javier, Bodega Quiroga, Ignacio, Navarro-Sánchez, Antonio, Soto Darias, Iván, López Fernández, Cristina, de La Cruz Cuadrado, Cristina, Sánchez-Guillén, Lui, 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Renu, A Holman, Fabian, Heemskerk, Jeroen, Vosbeek, Noortje, A Leijtens, Jeroen W, M Taverne, Sophie B, M Heijnen, Bob H, El-Massoudi, Youssef, de Groot-van Veen, Irene, Hoff, Christiaan, Jou-Valencia, Daniela, A Burghgraef, Esther C J Consten Thij, Geitenbeek, Ritch, L Hulshof, Lorenzo G W, D Slooter, Gerrit, Reudink, Muriël, D Bouvy, Nicole, L Wildeboer, Aurelia C, Verstappen, Sonja, J Pennings, Alexander, van den Hengel, Berber, G Wijma, Allard, de Haan, Jael, F de Nes, Lindsey C, Heesink, Vera, Karsten, Tom, M Heidsma, Charlotte, J Koemans, Willem, T Dekker, Jan-Willem, J van der Zijden, Charlène, Roos, Daphne, Demirkiran, Ahmet, van der Burg, Sjirk, J Oosterling, Steven, J Hoogteijling, Tij, Wiering, Bastiaan, J Smeeing, Diederik P, Havenga, Klaa, Lutfi, Hamid, J Consten, Esther C, Tsimogiannis, Konstantino, Sköldberg, Filip, Folkesson, Joakim, den Boer, Frank, G van Schaik, Ted, van Gerven, Pieter, Sietses, Colin, C Hol, Jeroen, G Boerma, Evert-Jan, J Creemers, Davy M, K 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Andrey, A Suchkov, Igor, S Drozdov, Evgeniy, N Kostromitskiy, Dmitriy, Sjöström, Olle, Matthiessen, Peter, Baban, Bayar, Gadan, Soran, Dehlaghi Jadid, Kaveh, Staffan, Maria, M Park, Jennifer, Rydbeck, Daniel, Lydrup, Marie-Louise, Buchwald, Pamela, Jutesten, Henrik, Darlin, Lotten, Lindqvist, Ebba, Nilsson, Karl, Larsson, Per-Ander, Jangmalm, Staffan, A Košir, Jurij, Tomažič, Aleš, Grosek, Jan, Košir Božič, Tajda, Zazo, Aya, Zazo, Rama, Fares, Hala, Ayoub, Kusay, Niazi, Ammar, Mansour, Ali, Abbas, Ayman, Tantoura, Mohammad, Hamdan, Alaa, Hassan, Naya, Hasan, Bassam, Saad, Ahmad, Sebai, Amine, Haddad, Ani, Maghrebi, Houcine, Kacem, Montasser, Yalkın, Ömer, Veysi Samsa, Mehmet, Atak, İbrahim, Balci, Bengi, Haberal, Elifcan, Dogan, Lütfi, E Gecim, Ibrahim, Akyol, Cihangir, A Koc, Mehmet, Sivrikoz, Emre, Piyadeoğlu, Deniz, O Avanagh, Dara, Sökmen, Selman, Bişgin, Tayfun, Günenç, Erşan, Güzel, Melek, Leventoğlu, Sezai, Yüksel, Osman, Kozan, Ramazan, Göbüt, Hüseyin, Cengiz, Fevzi, Erdinc, Kemal, Coşgun Acar, Nihan, Kamer, Erdinc, Özgür, İlker, Aydın, Oguzhan, Keskin, Metin, Türker Bulut, Mehmet, B Kulle, Cemil, Kara, Yasin, Sıbıç, Osman, H Özata, İbrahim, Buğra, Dursun, Balık, Emre, Çakır, Murat, Alhardan, Ana, Colak, Elif, B CiftciEngin Aybar, Ahmet, Can Sari, Ahmet, Demirli Atici, Semra, Kaya, Tayfun, Dursun, Ayberk, Calik, Bulent, Faruk Özkan, Ömer, Şeyda Ülgür, Hanife, Düzgün, Özgül, Monson, John, George, Sarah, Woods, Kayla, Al-Eryani, Fatima, Albakry, Rudaina, Coetzee, Emile, Boutall, Adam, Herman, Ayesiga, Warden, Claire, Mugla, Naser, Forgan, Tim, Mia, Imraan, Lambrechts, Anton, Roberto Persiani (ORCID:0000-0002-1537-5097), Alberto Biondi (ORCID:0000-0002-2470-7858), Roberto Pezzuto, Laura Lorenzon (ORCID:0000-0001-6736-0383), Gianluca Rizzo, Claudio Coco (ORCID:0000-0002-4713-7093), Nynke G, Greijdanu, Kiedo, Wienholt, Sander, Ubel, Kevin, Talboom, Gerjon, Hannink, Albert, Wolthui, F Borja, de Lacy, Jérémie H, Lefevre, Michael, Solomon, Matteo, Frasson, Nicolas, Rotholtz, Quentin, Denost, Rodrigo O, Perez, Tsuyoshi, Konishi, Yves, Pani, Martin, Rutegård, Roel, Hompe, Camiel, Rosman, Frans, van Workum, Pieter J, Tani, Johannes H W, de Wilt, A Bremers, Andreas J, T Ferenschild, Flori, de Vriendt, Stefanie, D'Hoore, André, Bislenghi, Gabriele, Farguell, Jordi, M Lacy, Antonio, González Atienza, Paula, S van Kessel, Charlotte, Parc, Yann, Voron, Thibault, K Collard, Maxime, Sancho Muriel, Jorge, Cholewa, Hannia, A Mattioni, Laura, Frontali, Alice, W Polle, Sebastiaan, Polat, Fatih, J Obihara, Ndidi, B Vailati, Bruna, Kusters, Miranda, B Tuynmann, Jurriaan, A Hazen, Sanne J, J Grüter, Alexander A, Amano, Takahiro, Fujiwara, Hajime, Salomon, Mario, Ruiz, Hernán, Gonzalez, Ricardo, Estefanía, Diego, Avellaneda, Nicola, Carrie, Augusto, Santillan, Mateo, A Pantoja Pachajoa, Diana, Parodi, Matia, Gielis, Manuel, Binder, Alf-Dorian, Gürtler, Thoma, Riedl, Peter, Badiani, Sarit, Berney, Christophe, Morgan, Matthew, Hollington, Paul, da Silva, Nigel, Nair, Gavin, M Ho, Yiu, Lamparelli, Michael, Kapadia, Raj, M Kroon, Hidde, N Dudi-Venkata, Nagendra, Liu, Jianliang, Sammour, Tarik, Flamey, Nicola, Pattyn, Paul, Chaoui, Ahmed, Vansteenbrugge, Loui, J van den Broek, Nathalie E, Vanclooster, Patrick, de Gheldere, Charle, Pletinckx, Pieter, Defoort, Barbara, Dewulf, Maxime, Slavchev, Mihail, Belev, Nikolay, Atanasov, Boyko, Krastev, Panche, Sokolov, Manol, Maslyankov, Svilen, Gribnev, Petar, Pavlov, Vasil, Ivanov, Tsvetomir, Karamanliev, Martin, Filipov, Emil, Tonchev, Pencho, Aigner, Felix, Mitteregger, Martin, Allmer, Caterina, Seitinger, Gerald, Colucci, Nicola, Buchs, Nicola, Ris, Frédéric, Toso, Christian, Gialamas, Eleftherio, Vuagniaux, Aurélie, Chautems, Roland, Sauvain, Marc-Olivier, Daester, Silvio, von Flüe, Marku, Guenin, Marc-Olivier, Taha-Mehlitz, Stephanie, F Hess, Gabriel, Martínek, Lubomír, Skrovina, Matej, Machackova, Maria, Benčurik, Vladimir, Uluk, Deniz, Pratschke, Johann, S Dittrich, Luca, Guel-Klein, Safak, Perez, Daniel, Grass, Julia-Kristin, Melling, Nathaniel, Mueller, Simone, H Iversen, Lene, D Eriksen, Jacob, Baatrup, Gunnar, Al-Najami, Issam, Bjørsum-Meyer, Thoma, Teras, Jüri, M Teras, Roland, A Monib, Fatma, Eldin Abu Elnga Ahmed, Nagm, Alkady, Eithar, K Ali, Ahmed, Abd Elatti Khedr, Gehan, Samir Abdelaal, Ahmed, M Bassyouni Ashoush, Fouad, Ewedah, Moataz, M Elshennawy, Eslam, Hussein, Mohamed, Fernández-Martínez, Daniel, J García-Flórez, Lui, Fernández-Hevia, María, Suárez-Sánchez, Aida, Del Hoyo Aretxabala, Izaskun, Losada Docampo, Iria, Gómez Zabala, Jesú, Tejedor, Patricia, T Morales Bernaldo de Quirós, Javier, Bodega Quiroga, Ignacio, Navarro-Sánchez, Antonio, Soto Darias, Iván, López Fernández, Cristina, de La Cruz Cuadrado, Cristina, Sánchez-Guillén, Lui, López-Rodríguez-Arias, Francisco, Soler-Silva, Álvaro, Arroyo, Antonio, C Bernal-Sprekelsen, Juan, Á Gómez-Abril, Segundo, Gonzálvez, Paula, T Torres, María, Rubio Sánchez, Teresa, Blanco Antona, Francisco, E Sánchez Lara, Juan, A Alcázar Montero, José, Mendoza-Moreno, Fernando, Díez-Alonso, Manuel, Matías-García, Belén, Quiroga-Valcárcel, Ana, Colás-Ruiz, Enrique, M Tasende-Presedo, Marta, Fernández-Hurtado, Ignacio, A Cifuentes-Ródenas, José, Castro Suárez, Marta, Losada, Manuel, Hernández, Miguel, Alonso, Alfredo, Diéguez, Beatriz, Serralta, Daniel, E Medina Quintana, Rita, M Gil Lopez, Jose, Lima Pinto, Francisca, Nieto-Moreno, Elena, Correa Bonito, Alba, Cerdán Santacruz, Carlo, Bermejo Marcos, Elena, García Septiem, Javier, Calero-Lillo, Aránzazu, Alanez-Saavedra, Javier, Muñoz-Collado, Salvador, López-Lara, Manuel, Labalde Martínez, María, Ferrero Herrero, Eduardo, Javier García Borda, Francisco, García Villar, Óscar, Escartín, Jorge, L Blas, Juan, Ferrer, Rocío, García Egea, Jorge, Rodríguez-Infante, Antonio, Mínguez-Ruiz, Germán, Carreño-Villarreal, Guillermo, Pire-Abaitua, Gerardo, Dziakova, Jana, Sáez-Cazallas Rodríguez, Carlo, J Pizarro Aranda, María, M Muguerza Huguet, José, Borda-Arrizabalaga, Nerea, M Enriquez-Navascués, José, Elorza Echaniz, Garazi, Saralegui Ansorena, Yolanda, Estaire-Gómez, Mercede, Martínez-Pinedo, Carlo, Barbero-Valenzuela, Alejandro, Ruíz-García, Pablo, Kraft, Miquel, J Gómez-Jurado, María, Pellino, Gianluca, Espín-Basany, Eloy, Cotte, Eddy, Panel, Nathalie, Goutard, Claire-Angéline, Deángelis, Nicola, Lauka, Lelde, Shaikh, Shafaque, Osborne, Laura, Ramsay, George, Nichita, Vladimir-Ion, Bhandari, Santosh, Sarmah, Panchali, M Bethune, Rob, M Pringle, Heather C, Massey, Lisa, E Fowler, George, S Hamid, Hytham K, D de Simone, Belinda, Kynaston, Jame, Bradley, Nichola, M Stienstra, Roxane, Gurjar, Shashank, Mukherjee, Tanmoy, Chandio, Ashfaq, Ahmed, Safia, Singh, Baljit, Runau, Francoi, Chaudhri, Sanjay, Siaw, Oliver, Sarveswaran, Janahan, Miu, Victor, Ashmore, Daniel, Darwich, Haitham, Singh-Ranger, Deepak, Singh, Nirbhaibir, Shaban, Mohamed, Gareb, Fahed, Petropolou, Thalia, Polydorou, Adrea, Dattani, Mit, Afzal, Asma, Bavikatte, Akshay, Sebastian, Boby, Ward, Nichola, Mishra, Amitabh, Manatakis, Dimitrio, Agalianos Nikolaos Tasis, Christo, Antonopoulou, Maria-Ioanna, Karavokyros, Ioanni, Charalabopoulos, Alexandro, Schizas, Dimitrio, Baili, Efstratia, Syllaios, Athanasio, Karydakis, Lysandro, Vailas, Michail, Balalis, Dimitrio, Korkolis, Dimitrio, Plastiras, Ari, Rompou, Aliki, Xenaki, Sofia, Xynos, Evangelo, Chrysos, Emmanuel, Venianaki, Maria, Christodoulidis, Grigorio, Perivoliotis, Konstantino, Tzovaras, George, Baloyiannis, Ioanni, Ho, Man-Fung, Siu-Man Ng, Simon, Wing-Chung Mak, Tony, Futaba, Kaori, Šantak, Goran, Šimleša, Damir, Ćosić, Jurica, Zukanović, Goran, E Kelly, Michael, O Larkin, John, H McCormick, Paul, J Mehigan, Brian, M Connelly, Tara, Neary, Peter, Ryan, Jessica, Mccullough, Peter, A Al-Juaifari, Maytham, Hammoodi, Hayder, Hashim Abbood, Ali, Calabrò, Marcello, Muratore, Andrea, La Terra, Antonio, Farnesi, Francesca, V Feo, Carlo, Fabbri, Nicolò, Pesce, Antonio, Fazzin, Marta, Roscio, Francesco, Clerici, Federico, Lucchi, Andrea, Vittori, Laura, Agostinelli, Laura, Cristina Ripoli, Maria, Sambucci, Daniele, Porta, Andrea, Sinibaldi, Giovanni, Crescentini, Giacomo, Larcinese, Antonella, Picone, Emanuele, Persiani, Roberto, Biondi, Alberto, Pezzuto, Roberto, Lorenzon, Laura, Rizzo, Gianluca, Coco, Claudio, D'Agostino, Luca, Spinelli, Antonino, M Sacchi, Matteo, Carvello, Michele, Foppa, Caterina, Maroli, Annalisa, M Palini, Gian, Garulli, Gianluca, Zanini, Nicola, Delrio, Paolo, Rega, Daniela, Carbone, Fabio, Aversano, Alessia, Pirozzolo, Giovanni, Recordare, Alfonso, D'Alimonte, Lucrezia, Vignotto, Chiara, Corbellini, Carlo, M Sampietro, Gianluca, Lorusso, Leonardo, A Manzo, Carlo, Ghignone, Federico, Ugolini, Giampaolo, Montroni, Isacco, Pasini, Franceso, Pasini, Francesco, Ballabio, Michele, Bisagni, Pietro, T Armao, Francesca, Longhi, Marco, Ghazouani, Omar, Galleano, Raffaele, Tamini, Nicolò, Oldani, Massimo, Nespoli, Luca, Picciariello, Arcangelo, F Altomare, Donato, Tomasicchio, Giovanni, Lantone, Giuliano, Catena, Fausto, Giuffrida, Mario, Annicchiarico, Alfredo, Perrone, Gennaro, Grossi, Ugo, A Santoro, Giulio, Zanus Alessandro Iacomino, Giacomo, Novello, Simone, Passuello, Nicola, Zucchella, Martino, Puca, Lucia, Degiuli, Maurizio, Reddavid, Rossella, Scabini, Stefano, Aprile, Alessandra, Soriero, Domenico, Fioravanti, Emanuela, Rottoli, Matteo, Romano, Angela, Tanzanu, Marta, Belvedere, Angela, M Mariani, Nicolò, P Ceretti, Andrea, Opocher, Enrico, Gallo, Gaetano, Sammarco, Giuseppe, de Paola, Gilda, Pucciarelli, Salvatore, Marchegiani, Francesco, Spolverato, Gaya, Buzzi, Gianluca, Di Saverio, Salomone, Meroni, Paola, Parise, Cristiano, I Bottazzoli, Elisa, Lapolla, Pierfrancesco, Brachini, Gioia, Cirillo, Bruno, Mingoli, Andrea, Sica, Giuseppe, Siragusa, Leandro, Bellato, Vittoria, Cerbo, Daniele, A de Pasqual, Carlo, de Manzoni, Giovanni, A di Cosmo, Maria, H Alrayes, Bourhan M, M Qandeel, Mahmoud W, Bani Hani, Mohammad, Rabadi, Alexander, S El Muhtaseb, Mohammad, Abdeen, Basel, Karmi, Fahed, Žilinskas, Justa, Latkauskas, Tada, Tamelis, Algimanta, Pikūnienė, Ingrida, Šlenfuktas, Vyginta, Poskus, Toma, Kryzauskas, Mariu, Jakubauskas, Mata, Mikalauskas, Sauliu, Jakubauskiene, Lina, Y Hassan, Soha, Altrabulsi, Amani, Abdulwahed, Eman, Ghmagh, Reem, Deeknah, Abdulqudu, Alshareea, Entisar, Elhadi, Muhammed, Abujamra, Saleh, A Msherghi, Ahmed, E Tababa, Osama W, A Majbar, Mohammed, Souadka, Amine, Benkabbou, Amine, Mohsine, Raouf, Echiguer, Sabrillah, Moctezuma-Velázquez, Paulina, Salgado-Nesme, Noel, Vergara-Fernández, Omar, C Sainz-Hernández, Juan, E Alvarez-Bautista, Francisco, D Zakaria, Andee, Zakaria, Zaidi, K Wong, Michael P, Ismail, Razif, F Ibrahim, Aini, N Abdullah, Nik A, Julaihi, Rokayah, Bhat, Sameer, O'Grady, Greg, Bissett, Ian, Lamme, Ba, D Musters, Gijsbert, M Dinaux, Anne, A Grotenhuis, Brechtje, J Aalbers, Ernst J Steller Arend G, M Leeuwenburgh, Marjolein, T Rutten, Harm J, A Burger, Jacobus W, G Bloemen, Johanne, J Ketelaers, Stijn H, Waqar, Usama, Chawla, Tabish, Rauf, Hareem, Rani, Pallavi, K Talsma, Aaldert, Scheurink, Lieke, B van Praagh, Jasper, Segelman, Josefin, Nygren, Jona, Anderin, Kajsa, Tiefenthal, Marit, de Andrés, Beatriz, P Beltrán de Heredia, Juan, Vázquez, Andrea, Gómez, Tania, Golshani, Parisa, Kader, Rawaz, Mohamed, Abudi, Westerterp, Marinke, Marinelli, Andrea, Niemer, Quirine, G Doornebosch, Pascal, Shapiro, Joël, Vermaas, Maarten, R de Graaf, Eelco J, L van Westreenen, Hendrik, Zwakman, Marije, D van Dalsen, Annette, J Vles, Wouter, Nonner, Joost, R Toorenvliet, Boudewijn, J Janssen, Paul T, G Verdaasdonk, Emiel G, J Amelung, Femke, R Bahadoer, Koen C M J Peeters Renu, A Holman, Fabian, Heemskerk, Jeroen, Vosbeek, Noortje, A Leijtens, Jeroen W, M Taverne, Sophie B, M Heijnen, Bob H, El-Massoudi, Youssef, de Groot-van Veen, Irene, Hoff, Christiaan, Jou-Valencia, Daniela, A Burghgraef, Esther C J Consten Thij, Geitenbeek, Ritch, L Hulshof, Lorenzo G W, D Slooter, Gerrit, Reudink, Muriël, D Bouvy, Nicole, L Wildeboer, Aurelia C, Verstappen, Sonja, J Pennings, Alexander, van den Hengel, Berber, G Wijma, Allard, de Haan, Jael, F de Nes, Lindsey C, Heesink, Vera, Karsten, Tom, M Heidsma, Charlotte, J Koemans, Willem, T Dekker, Jan-Willem, J van der Zijden, Charlène, Roos, Daphne, Demirkiran, Ahmet, van der Burg, Sjirk, J Oosterling, Steven, J Hoogteijling, Tij, Wiering, Bastiaan, J Smeeing, Diederik P, Havenga, Klaa, Lutfi, Hamid, J Consten, Esther C, Tsimogiannis, Konstantino, Sköldberg, Filip, Folkesson, Joakim, den Boer, Frank, G van Schaik, Ted, van Gerven, Pieter, Sietses, Colin, C Hol, Jeroen, G Boerma, Evert-Jan, J Creemers, Davy M, K Schultz, Johanne, Frivold, Tone, Riis, Rolf, Gregussen, Hilde, Busund, Sondre, H Sjo, Ole, Gaard, Maria, Krohn, Nina, L Ersryd, Amanda, Leung, Edmund, Sultan, Hytham, Nabil Hajjaj, Baraa, Jehad Alhisi, Ahmed, E Khader, Ahmed A, Filipa Dias Mendes, Ana, Semião, Miguel, Queiroz Faria, Lui, Azevedo, Constança, M da Costa Devesa, Helena, Fortuna Martins, Sónia, M Rodrigues Jarimba, Aldo, M Ribeiro Marques, Sónia, Marques Ferreira, Rita, Oliveira, António, Ferreira, Cátia, Pereira, Ricardo, M Surlin, Valeriu, M Graure, Giorgiana, D Ramboiu, Stefan Patrascu Sandu, Negoi, Ionut, Ciubotaru, Cezar, Stoica, Bogdan, Tanase, Ioan, M Negoita, Valentina, Florea, Sabrina, Macau, Florin, Vasile, Mihai, Stefanescu, Victor, Dimofte, Gabriel-Mihail, Luncă, Sorinel, Roată, Cristian-Ene, Mușină, Ana-Maria, Garmanova, Tatiana, N Agapov, Mikhail, G Markaryan, Daniil, Eduard, Galliamov, Yanishev, Alexey, Abelevich, Alexander, Bazaev, Andrey, V Rodimov, Sergey, B Filimonov, Victor, A Melnikov, Andrey, A Suchkov, Igor, S Drozdov, Evgeniy, N Kostromitskiy, Dmitriy, Sjöström, Olle, Matthiessen, Peter, Baban, Bayar, Gadan, Soran, Dehlaghi Jadid, Kaveh, Staffan, Maria, M Park, Jennifer, Rydbeck, Daniel, Lydrup, Marie-Louise, Buchwald, Pamela, Jutesten, Henrik, Darlin, Lotten, Lindqvist, Ebba, Nilsson, Karl, Larsson, Per-Ander, Jangmalm, Staffan, A Košir, Jurij, Tomažič, Aleš, Grosek, Jan, Košir Božič, Tajda, Zazo, Aya, Zazo, Rama, Fares, Hala, Ayoub, Kusay, Niazi, Ammar, Mansour, Ali, Abbas, Ayman, Tantoura, Mohammad, Hamdan, Alaa, Hassan, Naya, Hasan, Bassam, Saad, Ahmad, Sebai, Amine, Haddad, Ani, Maghrebi, Houcine, Kacem, Montasser, Yalkın, Ömer, Veysi Samsa, Mehmet, Atak, İbrahim, Balci, Bengi, Haberal, Elifcan, Dogan, Lütfi, E Gecim, Ibrahim, Akyol, Cihangir, A Koc, Mehmet, Sivrikoz, Emre, Piyadeoğlu, Deniz, O Avanagh, Dara, Sökmen, Selman, Bişgin, Tayfun, Günenç, Erşan, Güzel, Melek, Leventoğlu, Sezai, Yüksel, Osman, Kozan, Ramazan, Göbüt, Hüseyin, Cengiz, Fevzi, Erdinc, Kemal, Coşgun Acar, Nihan, Kamer, Erdinc, Özgür, İlker, Aydın, Oguzhan, Keskin, Metin, Türker Bulut, Mehmet, B Kulle, Cemil, Kara, Yasin, Sıbıç, Osman, H Özata, İbrahim, Buğra, Dursun, Balık, Emre, Çakır, Murat, Alhardan, Ana, Colak, Elif, B CiftciEngin Aybar, Ahmet, Can Sari, Ahmet, Demirli Atici, Semra, Kaya, Tayfun, Dursun, Ayberk, Calik, Bulent, Faruk Özkan, Ömer, Şeyda Ülgür, Hanife, Düzgün, Özgül, Monson, John, George, Sarah, Woods, Kayla, Al-Eryani, Fatima, Albakry, Rudaina, Coetzee, Emile, Boutall, Adam, Herman, Ayesiga, Warden, Claire, Mugla, Naser, Forgan, Tim, Mia, Imraan, Lambrechts, Anton, Roberto Persiani (ORCID:0000-0002-1537-5097), Alberto Biondi (ORCID:0000-0002-2470-7858), Roberto Pezzuto, Laura Lorenzon (ORCID:0000-0001-6736-0383), Gianluca Rizzo, and Claudio Coco (ORCID:0000-0002-4713-7093)
Abstract: Background The optimal treatment of anastomotic leak after rectal cancer resection is unclear. This worldwide cohort study aimed to provide an overview of four treatment strategies applied.Methods Patients from 216 centres and 45 countries with anastomotic leak after rectal cancer resection between 2014 and 2018 were included. Treatment was categorized as salvage surgery, faecal diversion with passive or active (vacuum) drainage, and no primary/secondary faecal diversion. The primary outcome was 1-year stoma-free survival. In addition, passive and active drainage were compared using propensity score matching (2 : 1).Results Of 2470 evaluable patients, 388 (16.0 per cent) underwent salvage surgery, 1524 (62.0 per cent) passive drainage, 278 (11.0 per cent) active drainage, and 280 (11.0 per cent) had no faecal diversion. One-year stoma-free survival rates were 13.7, 48.3, 48.2, and 65.4 per cent respectively. Propensity score matching resulted in 556 patients with passive and 278 with active drainage. There was no statistically significant difference between these groups in 1-year stoma-free survival (OR 0.95, 95 per cent c.i. 0.66 to 1.33), with a risk difference of -1.1 (95 per cent c.i. -9.0 to 7.0) per cent. After active drainage, more patients required secondary salvage surgery (OR 2.32, 1.49 to 3.59), prolonged hospital admission (an additional 6 (95 per cent c.i. 2 to 10) days), and ICU admission (OR 1.41, 1.02 to 1.94). Mean duration of leak healing did not differ significantly (an additional 12 (-28 to 52) days).Conclusion Primary salvage surgery or omission of faecal diversion likely correspond to the most severe and least severe leaks respectively. In patients with diverted leaks, stoma-free survival did not differ statistically between passive and active drainage, although the increased risk of secondary salvage surgery and ICU admission suggests residual confounding.The optimal treatment strategy for anastomotic leakage after restorative rectal cancer su
Published: 2023

35. Pharmacological emergency management of agitation in children and young people: protocol for a randomised controlled trial of oral medication (PEAChY-O)

Author: Bourke, Elyssia M, primary, Borland, Meredith L, additional, Kochar, Amit, additional, George, Shane, additional, Shellshear, Deborah, additional, Jani, Shefali, additional, Perkins, Kent, additional, Tham, Doris, additional, Gordon, Michael Solomon, additional, Klein, Kate, additional, Prakash, Chidambaram, additional, Lee, Katherine, additional, Davidson, Andrew, additional, Knott, Jonathan C, additional, Craig, Simon, additional, and Babl, Franz E, additional
Published: 2023
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36. Pharmacological Emergency management of Agitation in Children and Young people: protocol for a randomised controlled trial of intraMuscular medication (PEAChY-M)

Author: Bourke, Elyssia M, primary, Borland, Meredith L, additional, Kochar, Amit, additional, George, Shane, additional, Shellshear, Deborah, additional, Jani, Shefali, additional, Perkins, Kent, additional, Tham, Doris, additional, Gordon, Michael Solomon, additional, Klein, Kate, additional, Prakash, Chidambaram, additional, Lee, Katherine, additional, Davidson, Andrew, additional, Knott, Jonathan C, additional, Craig, Simon, additional, and Babl, Franz E, additional
Published: 2023
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37. Early‐onset colorectal cancer: why it should be high on our list of differentials

Author: Celine Garrett, Daniel Steffens, Michael Solomon, and Cherry Koh
Subjects: Adult, Incidence, Quality of Life, Humans, Surgery, General Medicine, Middle Aged, Colorectal Neoplasms, Early Detection of Cancer, United States, Retrospective Studies
Abstract: Early-onset colorectal cancer (EOCRC) (50 years) incidence has increased in Australia and worldwide. However, the diagnosis of EOCRC is often delayed. Recent research has discovered some differences from later-onset colorectal cancer (LOCRC) (50 years). An awareness of the unique features of EOCRC is crucial to reduce time from symptom onset to diagnosis.A literature search was conducted on electronic databases (MEDLINE, EMBASE and Cochrane Library) using the search terms "early onset colorectal cancer" or "young onset colorectal cancer."The American Cancer Society has reduced the colorectal cancer screening initiation age to 45 for average-risk adults whilst screening programmes in the United Kingdom and Australia remain unchanged with initiation at 60 and 50, respectively. Exposures resulting in dysbiosis (obesity, westernised diet, alcohol, antibiotic and sugar-sweetened beverage consumption) have been linked with increased EOCRC risk. EOCRC is often left-sided presenting with rectal bleeding, altered bowel habit and constitutional symptoms. EOCRC is more commonly sporadic than hereditary, harbouring different genetic mutations than LOCRC. Comparative survival outcomes of EOCRC and LOCRC are conflicting with studies suggesting either better or poorer survival. Young patients better tolerate treatment-related toxicities, which may account for their improved survival despite comparatively advanced stages and poorer histopathological features at diagnosis.Current EOCRC literature is limited by American-focused datasets and heterogenous EOCRC definitions and study designs (the greatest strength of evidence exists for EOCRC risk factor studies comprised of large retrospective cohorts). There is minimal research into the quality of life and surgical outcomes of EOCRC patients, and this area warrants further investigation.
Published: 2022
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38. Adherence by orthopaedic surgeons to AHPRA and Australian Orthopaedic Association advertising guidelines

Author: Hannah Y, Ryan, Geoffrey Y, Sun, Masiath, Monuja, Michael, Gillespie, Alexander, Burns, Michael, Solomon, and Sam, Adie
Subjects: Cross-Sectional Studies, Orthopedics, Advertising, Australia, Humans, Orthopedic Surgeons, General Medicine
Abstract: To examine adherence to Australian Health Practitioner Regulation Agency (AHPRA) and Australian Orthopaedic Association (AOA) advertising guidelines by AOA members.Cross-sectional survey, Australia.Two samples of AOA member orthopaedic surgeons: 81 randomly selected from a list of AOA members with publicly available contact details (AOA random sample); and a sample obtained by searching with Google for "orthopaedic surgeon" and the name of the major city in each of the eight Australian states and territories in turn; the top eight results for each search were considered for inclusion (AOA Google sample).Non-compliance of advertising material, by surgeon sample, with the AHPRA and AOA guidelines; associations between non-compliance and sample, state, location (metropolitan, regional), and subspecialty.Of the 81 surgeons in the AOA random sample, 52 (64%) were non-compliant with at least one aspect of the AHPRA guidelines, and 53 (65%) were non-compliant with at least one aspect of the AOA guidelines. Of the 59 surgeons in the AOA Google sample, 48 were non-compliant with the AHPRA guidelines (81%) and 46 with the AOA guidelines (78%). Incidence of non-compliance with the AHPRA guidelines was influenced by sample source (AOA Google v AOA random: incidence rate ratio [IRR], 1.37; 95% CI, 1.01-1.87), but not non-compliance with the AOA guidelines (IRR, 1.09; 95% CI, 0.77-1.55).A large proportion of AOA members who advertise online do not comply with AHPRA and AOA advertising guidelines.
Published: 2022
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39. Feasibility, Reliability, and Safety of Remote Five Times Sit to Stand Test in Patients with Gastrointestinal Cancer

Author: Collaboration, Daniel Steffens, Natasha C. Pocovi, Jenna Bartyn, Kim Delbaere, Mark J. Hancock, Cherry Koh, Linda Denehy, Kimberley S. van Schooten, Michael Solomon, and on behalf of the Priority Trial Collaboration on behalf of the Priority Trial
Subjects: five times sit to stand test, remote assessment, cancer, reliability, cross-sectional design
Abstract: Background: To determine the feasibility, reliability, and safety of the remote five times sit to stand test (5STS) test in patients with gastrointestinal cancer. Methods: Consecutive adult patients undergoing surgical treatment for lower gastrointestinal cancer at a major referral hospital in Sydney between July and November 2022 were included. Participants completed the 5STS test both face-to-face and remotely, with the order randomised. Outcomes included measures of feasibility, reliability, and safety. Results: Of fifty-five patients identified, seventeen (30.9%) were not interested, one (1.8%) had no internet coverage, and thirty-seven (67.3%) consented and completed both 5STS tests. The mean (SD) time taken to complete the face-to-face and remote 5STS tests was 9.1 (2.4) and 9.5 (2.3) seconds, respectively. Remote collection by telehealth was feasible, with only two participants (5.4%) having connectivity issues at the start of the remote assessment, but not interfering with the tests. The remote 5STS test showed excellent reliability (ICC = 0.957), with limits of agreement within acceptable ranges and no significant systematic errors observed. No adverse events were observed within either test environment. Conclusions: Remote 5STS for the assessment of functional lower extremity strength in gastrointestinal cancer patients is feasible, reliable, and safe, and can be used in clinical and research settings.
Published: 2023
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40. MP42-16 BLADDER PRESERVATION OR COMPLETE CYSTECTOMY DURING PELVIC EXENTERATION OF PATIENTS WITH RECTAL CANCER. WHAT SHOULD WE DO?

Author: Catalina Palma, Charlotte Van Kessel, Michael Solomon, Scott Leslie, Nicola Jeffery, Peter Lee, and Kirk Austin
Subjects: Urology
Published: 2023
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41. Characterizing content sharing properties for mobile users in open city squares.

Author: Michael Solomon Desta, Esa Hyytiä, Jörg Ott, and Jussi Kangasharju
Published: 2013
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42. Evaluating (Geo) content sharing with the ONE simulator.

Author: Michael Solomon Desta, Esa Hyytiä, Ari Keränen, Teemu Kärkkäinen, and Jörg Ott
Published: 2013
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43. Surgical management and long‐term functional outcomes after anastomotic leak in patients undergoing minimally invasive restorative rectal resection and without a diverting ileostomy

Author: Tony McGiffin, David A. Clark, Aleks Edmundson, Daniel Steffens, Andrew Stevenson, and Michael Solomon
Subjects: Cross-Sectional Studies, Postoperative Complications, Ileostomy, Rectal Neoplasms, Anastomosis, Surgical, Quality of Life, Humans, Anastomotic Leak, Surgery, Syndrome, General Medicine, Retrospective Studies
Abstract: Anastomotic leak (AL) is the anathema of colorectal surgery, with well-documented adverse impacts on patient morbidity and mortality. The long-term consequences of AL on bowel function and quality of life (QoL) is less well-defined after minimally invasive surgery. By omitting a temporary diverting ileostomy (TDI), it is postulated that the minimally invasive approach will lead to early diagnosis and expedient management of AL.This retrospective and cross-sectional study included patients who underwent minimally invasive restorative rectal surgery with a low pelvic colorectal anastomosis and without a TDI at two tertiary hospitals in Brisbane, Australia between 2004 and 2018. Surgical management of AL is described and long-term functional outcomes were evaluated through validated questionnaires.Two hundred and twenty-four patients met inclusion criteria. AL was associated with lesion proximity to the anal verge (P = 0.011), total mesorectal excision (TME) (P 0.001) and advanced malignant disease (P = 0.019). Twenty-four patients experienced an AL (11%) diagnosed at a median of 5.5 days post-operative. Survey responders (n = 99, 62%) included 10 (10%) AL and 89 (90%) non-AL patients, with a median follow-up of 4 and 6.4 years. SF-36 and FISI scores were comparable between groups, however AL patients had worse LARS scores (P = 0.028). Patients undergoing TME, irrespective of AL, had poorer low anterior resection syndrome (LARS) (P 0.001) and FISI scores (P = 0.001).AL in patients undergoing minimally invasive low pelvic colorectal anastomosis without a TDI does not impact long term QoL. The occurrence of LARS is dependent on the extent of resection, rather than the occurrence of AL.
Published: 2022
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44. Drain fluid amylase as a biomarker for the detection of anastomotic leakage after rectal resection without a diverting ileostomy

Author: David A. Clark, Aleksandra Edmundson, Daniel Steffens, Craig Harris, Andrew Stevenson, and Michael Solomon
Subjects: Ileostomy, Rectal Neoplasms, Amylases, Anastomosis, Surgical, Humans, Anastomotic Leak, Surgery, Prospective Studies, General Medicine, Biomarkers, Retrospective Studies
Abstract: Anastomotic leak (AL) is the anathema of colorectal surgery. Early diagnosis is an essential segue to early intervention. A temporary diverting ileostomy (TDI) does not prevent an AL and presents inherent complications of its own. Numerous drain fluid biomarkers (BM) have been studied in colorectal surgery and extravasated intraluminal substances (EILS) such as amylase have shown promise. The aim of this study was to assess drain fluid amylase (DFA) as a BM of AL after minimally invasive rectal resection without a TDI.A single centre prospective cohort study performed from 2018 to 2021. The primary outcome was DFA measured daily whilst the drain was in situ. Rectal tube amylase was also measured for the first two post-operative days to quantitate the intra-luminal levels of the enzyme. DFA was compared between patients who experienced AL and those who did not.Of the 62 patients studied, six (9.7%) experienced AL. There was a statistically significant difference in DFA between patients who experienced AL (Median:1373.5 U/L; IQR: 306-7953) and patients who did not experience an AL (Median: 27.0 U/L; IQR: 16-38); p 0.0001.The measurement of drain fluid amylase is a highly sensitive BM of early clinical anastomotic leak in patients undergoing a rectal resection with an extraperitoneal anastomosis and when a TDI is not incorporated. This simple, inexpensive and non-invasive test should be considered in all patients as an adjunct to the clinical diagnosis and differentiation of AL from other postoperative complications.
Published: 2022
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45. A comparison of a communication strategies in cooperative learning.

Author: Michael Solomon, Terence Soule, and Robert B. Heckendorn
Published: 2012
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46. Effect of Aspirin vs Enoxaparin on Symptomatic Venous Thromboembolism in Patients Undergoing Hip or Knee Arthroplasty: The CRISTAL Randomized Trial

Author: Verinder S, Sidhu, Thu-Lan, Kelly, Nicole, Pratt, Stephen E, Graves, Rachelle, Buchbinder, Sam, Adie, Kara, Cashman, Ilana, Ackerman, Durga, Bastiras, Roger, Brighton, Alexander W R, Burns, Beng Hock, Chong, Ornella, Clavisi, Maggie, Cripps, Mark, Dekkers, Richard, de Steiger, Michael, Dixon, Andrew, Ellis, Elizabeth C, Griffith, David, Hale, Amber, Hansen, Anthony, Harris, Raphael, Hau, Mark, Horsley, Dugal, James, Omar, Khorshid, Leonard, Kuo, Peter, Lewis, David, Lieu, Michelle, Lorimer, Samuel, MacDessi, Peter, McCombe, Catherine, McDougall, Jonathan, Mulford, Justine Maree, Naylor, Richard S, Page, John, Radovanovic, Michael, Solomon, Rami, Sorial, Peter, Summersell, Phong, Tran, William L, Walter, Steve, Webb, Chris, Wilson, David, Wysocki, Ian A, Harris, Sidhu, Verinder S, Kelly, Thu-Lan, Pratt, Nicole, Graves, Stephen E, and Harris, Ian A
Subjects: Male, Aspirin, aspirin, Arthroplasty, Replacement, Hip, Australia, Anticoagulants, enoxaparin, anthroplasty, General Medicine, Venous Thromboembolism, Chemoprevention, symptomatic venous thromboembolism, Postoperative Complications, Osteoarthritis, Humans, Female, Enoxaparin, Arthroplasty, Replacement, Knee, Pulmonary Embolism, Original Investigation, Aged
Abstract: ImportanceThere remains a lack of randomized trials investigating aspirin monotherapy for symptomatic venous thromboembolism (VTE) prophylaxis following total hip arthroplasty (THA) or total knee arthroplasty (TKA).ObjectiveTo determine whether aspirin was noninferior to enoxaparin in preventing symptomatic VTE after THA or TKA.Design, Setting, and ParticipantsCluster-randomized, crossover, registry-nested trial across 31 hospitals in Australia. Clusters were hospitals performing greater than 250 THA or TKA procedures annually. Patients (aged ≥18 years) undergoing hip or knee arthroplasty procedures were enrolled at each hospital. Patients receiving preoperative anticoagulation or who had a medical contraindication to either study drug were excluded. A total of 9711 eligible patients were enrolled (5675 in the aspirin group and 4036 in the enoxaparin group) between April 20, 2019, and December 18, 2020. Final follow-up occurred on August 14, 2021.InterventionsHospitals were randomized to administer aspirin (100 mg/d) or enoxaparin (40 mg/d) for 35 days after THA and for 14 days after TKA. Crossover occurred after the patient enrollment target had been met for the first group. All 31 hospitals were initially randomized and 16 crossed over prior to trial cessation.Main Outcomes and MeasuresThe primary outcome was symptomatic VTE within 90 days, including pulmonary embolism and deep venous thrombosis (DVT) (above or below the knee). The noninferiority margin was 1%. Six secondary outcomes are reported, including death and major bleeding within 90 days. Analyses were performed by randomization group.ResultsEnrollment was stopped after an interim analysis determined the stopping rule was met, with 9711 patients (median age, 68 years; 56.8% female) of the prespecified 15 562 enrolled (62%). Of these, 9203 (95%) completed the trial. Within 90 days of surgery, symptomatic VTE occurred in 256 patients, including pulmonary embolism (79 cases), above-knee DVT (18 cases), and below-knee DVT (174 cases). The symptomatic VTE rate in the aspirin group was 3.45% and in the enoxaparin group was 1.82% (estimated difference, 1.97%; 95% CI, 0.54%-3.41%). This failed to meet the criterion for noninferiority for aspirin and was significantly superior for enoxaparin (P = .007). Of 6 secondary outcomes, none were significantly better in the enoxaparin group compared with the aspirin group.Conclusions and RelevanceAmong patients undergoing hip or knee arthroplasty for osteoarthritis, aspirin compared with enoxaparin resulted in a significantly higher rate of symptomatic VTE within 90 days, defined as below- or above-knee DVT or pulmonary embolism. These findings may be informed by a cost-effectiveness analysis.Trial RegistrationANZCTR Identifier: ACTRN12618001879257
Published: 2023

47. Quality of Life and Patient‐Reported Outcome Measures Following Pelvic Exenteration

Author: Cherry E. Koh, Daniel Steffens, and Michael Solomon
Subjects: medicine.medical_specialty, Quality of life, Pelvic exenteration, business.industry, General surgery, medicine.medical_treatment, Medicine, Patient-reported outcome, business, Preoperative imaging
Published: 2021
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48. A desirability of outcome ranking (DOOR) for periprosthetic joint infection – a Delphi analysis

Author: Brenton P. Johns, David C. Dewar, Mark R. Loewenthal, Laurens A. Manning, Amit Atrey, Nipun Atri, David G. Campbell, Michael Dunbar, Christopher Kandel, Amir Khoshbin, Christopher W. Jones, Jaime Lora-Tamayo, Catherine McDougall, Dirk Jan F. Moojen, Jonathan Mulford, David L. Paterson, Trisha Peel, Michael Solomon, Simon W. Young, and Joshua S. Davis
Subjects: Infectious Diseases, Original Full-Length Article, Orthopedics and Sports Medicine, Surgery
Abstract: Background: Treatment outcomes in studies on prosthetic joint infection are generally assessed using a dichotomous outcome relating to treatment success or failure. These outcome measures neither include patient-centred outcome measures including joint function and quality of life, nor do they account for adverse effects of treatment. A desirability of outcome ranking (DOOR) measure can include these factors and has previously been proposed and validated for other serious infections. We aimed to develop a novel DOOR for prosthetic joint infections (PJIs). Methods: The Delphi method was used to develop a DOOR for PJI research. An international working group of 18 clinicians (orthopaedic surgeons and infectious disease specialists) completed the Delphi process. The final DOOR comprised the dimensions established to be most important by consensus with >75 % of participant agreement. Results: The consensus DOOR comprised four main dimensions. The primary dimension was patient-reported joint function. The secondary dimensions were infection cure and mortality. The final dimension of quality of life was selected as a tie-breaker. Discussion: A desirability of outcome ranking for periprosthetic joint infection has been proposed. It focuses on patient-centric outcome measures of joint function, cure and quality of life. This DOOR provides a multidimensional assessment to comprehensively rank outcomes when comparing treatments for prosthetic joint infection.
Published: 2022

49. Patterns of DNA mismatch repair protein expression for primary and recurrent colorectal cancer at an advanced surgical unit: A retrospective audit

Author: Charles Risbey, Timothy Fielder, Daniel Steffens, Joo‐Shik Shin, and Michael Solomon
Subjects: Gastroenterology
Abstract: Lynch syndrome is an inherited cancer syndrome associated with an increased lifetime risk of colorectal cancer (CRC) and characterized by germline mutations to one of four DNA mismatch repair (MMR) genes. Immunohistochemical (IHC) testing is used to screen for Lynch syndrome; however, despite routine completion following resection of primary CRC, it is only variably completed following resection of recurrent disease. This may be significant, as MMR protein expression can change from primary to recurrent CRC. The primary aim of this study is to investigate how MMR profiles change from primary to recurrent CRC; the secondary aim is to assess rates of MMR testing of primary and recurrent disease.We conducted a retrospective analysis of patients undergoing surgery for recurrent CRC from 2018-19 at a high-volume institution. MMR profiles were obtained following both primary and recurrent resection of CRC, and MMR protein expression was evaluated from both time points.A total of 107 patients met the inclusion criteria and IHC results were obtained for both primary and recurrent resections in 85 cases. MMR profiles changed in nine patients (10.6%), with a loss of staining from primary to recurrent disease in six (7.1%) and a gain of staining in three (3.5%). IHC testing was completed following 88.7% of primary and 39.3% of recurrent resections.MMR profiles can change from primary to recurrent CRC and repeat MMR testing for recurrent CRC is completed in only a minority of cases.
Published: 2022

50. Fear of Cancer Progression and Death Anxiety in Survivors of Advanced Colorectal Cancer: A Qualitative Study Exploring Coping Strategies and Quality of Life

Author: Chloe Yi Shing, Lim, Rebekah C, Laidsaar-Powell, Jane M, Young, Michael, Solomon, Daniel, Steffens, Prunella, Blinman, Scott, O'Loughlin, Yuehan, Zhang, and Phyllis, Butow
Subjects: Health (social science), Life-span and Life-course Studies, Critical Care and Intensive Care Medicine
Abstract: This study aimed to examine coping strategies used by advanced colorectal cancer (CRC-A) survivors to manage death anxiety and fear of cancer progression, and links between these strategies and quality of life (QoL), distress, and death acceptance. Qualitative semi-structured interviews of 38 CRC-A survivors (22 female) were analysed via framework analysis. QoL and distress were assessed through the FACT-C and Distress Thermometer. Eleven themes were identified and mapped to active avoidance (keeping busy and distracted), passive avoidance (hoping for a cure), active confrontation (managing negative emotions; reaching out to others; focusing on the present; staying resilient), meaning-making (redefining one’s identity; contributing to society; gaining perspective; remaining spiritual), and acceptance (accepting one’s situation). Active confrontation (specifically utilising informal support networks) and meaning-making appeared beneficial coping strategies; more research is needed to develop and evaluate interventions which increase CRC-A survivors’ use of these strategies to manage and cope with their death anxiety.
Published: 2022

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