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17 results on '"Rajaretnam, Niroshini"'

1. Characterisation of older patients that require, but do not undergo, emergency laparotomy: a multicentre cohort study

Author

Shearer, Rosalyn, Mekhail, Peter, Ramsay, George, Nessa, Ashrafun, Iqbal, Rizwan, Maskell, Perry, Majeed, Mudassar, Dai, Nick, Bhojwani, Deepika, Anyomih, Theophilus, Lunevicius, Raimundas, Elkalbash, Rema, Shahzad, Khalid, Ahmed, Salma, Gahunia, Sukhpreet, Hopley, Philip, Nair, Dheepa, Reddington, Anne, Wilson, Jeremy, Lovett, Bryony, Iqbal, Muhammad Rafaih, Ramadan, Wafaa, Affify, Emma, Khan, Fatima, Tan, Silvian, Dawson, Joy, Eltarhoni, Khadiga, Young, Jamie, Lockwood, Sonia, Yiasemidou, Marina, Orchard, Melanie, Orchard, Phillipa, Randall, Jonathan, Barrow, Hannah, Dixon, Steve, Eardley, Nicola, Rajput, Kunal, Santoro, Giovanni, Mason, Sabrina, Bagnall, Nigel Mark, Kourdouli, Amar, Rajain, Sakshi, Curley, Daniel, Chandima Halahakoon, Vijitha, Thrikandiyur, Anu, Worsfold, James, Chouari, Tarak, Dent, Paul, Zhao, Sarah, Belgaumkar, Ajay, Maher, Sarah, Oyewole, Bankole, Weller, Sam, Davis, Mark, Fox, Katherine, Burton, Sarah, Iosif, Evangelia, Tobbal, Muhammed, Abdelkarim, Mostafa, Duvnjak, Haris, Morgan, Richard, Murali, Sreedutt, Murji, Bhaven, Venkatesan, Gowtham, Boardley, Rachael, Carson, Daniel, Galbraith, Norman, MacTier, Mhairi, Mailley, Keir, Meney, Laura, Persson, Pia, Stevenson, Richard, Haigh, Andrew, Kelly, Diane, Mellor, Samantha, Niaz, Muhammad Adnan, Peter, Mark, Smith, Douglas, Perin, Giordano, Hanbali, Nabih, Blackwell, James, Daliya, Prita, Herrod, Philip, Jibreel, Mohammed, Malcolm, Francesca, Photiou, Dana, Al-Khaddar, Ziad, Amir, Farhat, Bughio, Mumtaz, Gardiner, Felicity, Joyce, Nikki, Kennedy-Dalby, Andrew, Khan, Usman, McCoy, Sharon, Smart, Christopher J., Ward, Simon, Abdelsaid, Kirolos, AbdulAal, Yasser, Berski, Michael, Jayasankar, Balaji, Sandhu, Banher, Akhteruzzaman, Tahiyyah, Chan, Shirley, Dickson-Lowe, Richard, Kocsis, Anna Maria, Allen, Rhian, Bateman, Kellie, Shovelton, Charmaine, Smyth, Edward, Taylor, Daniel, Tennant, Anna, Chang, Jessica, Dowdeswell, Megan, Karri, Santosh, Neophytou, Chris, Yassin, Nuha, Bibi, Saira, Ulain, Noor, Evans, Luke, Cross, Katie, Fakhrul-aldeen, Mohammed, Jones, Stacey, Sarveswaran, Janahan, Aljarad, Feras, Collins, Amy, Eves, Joshua, Patel, Maleene, Sharieff, Imran, Smith, Emma, Treus, Estefania, McGuigan, Mari-Claire, Nicholoson, Gary, Pickering, Stacey, Husain, Najam, Narayanasamy, Sangara, Pradeep, Thomas, Rajebhosale, Ramprasad, Ravi, Prabhu, Elabbassy, Islam, Hao, Juen, Mak, Richard, Oliphant, Raymond, Powezka, Katarzyna, Asaad, Peter, Downs, Karen, Hylton, Jackie, Jalali, Uzma, Math, Suraj, Kourounis, Georgios, Mcilveen, Erin, Ng, Hwei Jene, Pope, Oscar, Argyropoulos, Susannah, Faulkner, Gemma, Spurring, Eleanor, Anis, Fady, Javanmard-Emamghissi, Hannah, Lee, Rachel, Redfern, Victoria, Saravanan, Nivetha, Tierney, Gill, Cullen, William, Kantola, Venla, Massey, Lisa, Orabi, Amira, Park, Linda, Rajaretnam, Niroshini, Smart, Neil, Ambler, Olivia, Damaskos, Dimitrios, Ewing, Anne, Mehta, Maithili, Skipworth, Richard, Alagaratnam, Swethan, Chowdhury, Shihad, Gupta, Aayush, Jones, Gareth, Mohamed, Guleed, Varcarda, Massimo, Abdel-dayem, Mahmoud, Mazumdar, Eshan, Miller, Bethany, Shah, Parin, Gupta, Sapna, Hawkings, Nancy, Herbert, Geraint, Indika, Kalhar, Mallison, Georgia, Smith, Laurie, Tolley, Thomas, Williams, Gethin, Burton, Keira, Cavallaro, Davide, Henry, Jayde, Parkin, Edward, Redfern, Jennifer, Sekhar, Hema, Murray, Hannah, Redman, Amelia, Thompson, Dolapo, Thornton, Sophie, Blake, Natalie, Mcleod, Ross, Pressler, Marc, Read, Howard, Shehata, Zak, Thomas, Michael, Walker, Cerys, Brown, Steven, Daniels, Sarah, Hawkins, Debby, Steele, Caroline, Berry, David, Dimitrova, Nora, Massella, Virginia, Mathew, Priya, Patel, Rikhilroy, Bakewell, Zoe, Collins, Alma, Fowler, George, Lawday, Samuel, McCarthy, Kathryn, Sheldon, James, Papakonstantinou, Dimitrios, Cox, Kofi, Kenington, Cleo, Mitchell, Robert, Thrumurthy, Sri, Clifford, Rachael, Kalaiselvan, Ramya, Leptidis, Ioannis, Connolly, Thomas, Evans, William, Kumar, Anil, Malik, Isfand, Nulty, Callula, Rai, Sajal, Brown, Ashley, Chew, Misha, Okpala, Amalachukwu, Tan, Yanyu, Magee, Cathy, Rossborough, Catherine, Manda, Vijay, McColl, Gillian, Norton, William, Ray, Christopher, Abdelrahman, Byrne, Clare, Caddick, Virginia, Ghanem, Ahmed, Marchese, Salvatore, Patel, Sabina, Singh, Kaushiki, Smith, Eleanor, Zarog, Mohamed, Caswell, Jack, Lukaszewicz, Alex, Manson, David, McKnight, Gerard, Duncan, Trish, Brown, Leo, Lam Chan, Deona Mei, Robertson, John, Al-Aqaileh, Ahmad, Chandratreya, Nitya, El-qudah, Jazal, Philip, Ken, Ben Hmida, Rami, Chohda, Ezzat, Gilbert, Kayleigh, Alqallaf, Addullah, Kamarizan, Mohamad, Ben Sassi, Abozed, Amin, Mohamed, Lim, Michael, Longbotham, David, Moussa, Ahmed, Sheridan, Kelda, Wilkins, Alex, Carter, Ben, Hewitt, Jonathan, Price, Angeline, McLennan, Elizabeth, Knight, Stephen R., Reeves, Nicola, Chandler, Susan, Boyle, Jemma, Pearce, Lyndsay, and Moug, Susan J.

Published
2024
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2. CLosure of Abdominal MidlineS Survey (CLAMSS): A national survey investigating current practice in the closure of abdominal midline incisions in UK surgical practice.

Author

Messenger, David E., Rajaretnam, Niroshini, Slade, Dominic A. J., Basu, Sanjoy, Hammond, Toby, Lee, Matthew, Smart, Neil, Mehta, Akash, Harries, Rhiannon, Byrne, Benjamin E., Blencowe, Natalie, Pathak, Samir, Layfield, David, Rolls, Natasha, Sayers, Adele, Siddika, Arifa, Warren, Oliver, Hodgkinson, Jonathan, Bullock, Jackie, and Chandler, Susan

Subjects
*PHYSICIAN practice patterns, *ABDOMINAL wall, *RANDOMIZED controlled trials, *SURGICAL site, *SURGEONS, *NEEDLES & pins
Abstract

Aim: Incisional herniation (IH) is a frequent complication following midline abdominal closure with significant associated morbidity. Randomized controlled trials have demonstrated that the small bites technique (SBT) and prophylactic mesh augmentation (PMA) may reduce IH compared to mass closure techniques, but data are lacking on their implementation in contemporary surgical practice. This survey aimed to evaluate the use of the SBT and PMA and to identify factors associated with their adoption. Method: Between 22 January 2023 and 16 March 2023, consultant surgeons across the UK were asked to complete a 25‐question survey on closure of an elective primary midline incision. Results: Responses were received from 267 of 675 eligible surgeons (39.6%) in 38 NHS Trusts. Respondents were evenly split between tertiary centres (47.6%) and district general hospitals (49.4%). SBT and PMA were used by 19.9% and 3.0% of respondents, respectively. Compared to other techniques, surgeons using the SBT were more likely to close the anterior aponeurotic layer only, use single suture filaments, 2–0 gauge sutures and sharp needle points and routinely dissect abdominal layers to aid closure (all p < 0.001). Attendance at lectures/conferences on SBT (p = 0.043) and basing practice on available evidence (p < 0.001) were independently associated with use of the SBT. The commonest barriers to adopting SBT were a perceived lack of evidence (23.8%) and belief that personal IH rates were low (16.8%). Conclusion: A minority of UK consultant surgeons have adopted the SBT or PMA. Practice change should be driven by more widespread dissemination of current evidence and procedural information. [ABSTRACT FROM AUTHOR]

Published
2024
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10. Understanding the influences on successful quality improvement in emergency general surgery: learning from the RCS Chole-QuIC project

Author

Stephens, Timothy J., Bamber, Jonathan R., Beckingham, Ian J., Duncan, Ellie, Quiney, Nial F., Abercrombie, John F., Martin, Graham, Abraham, Jenny, Ahmad, Jawad, Ahmed, Ibrahim, Andrews, Melanie, Appleton, Barry, Asif, Mohammad, Bolton, Russell, Briggs, Christopher, Bumagat, Uchihara, Burchfield, Simon, Cochrane, Gemma, Dewi, Ffion, Dovell, George, Dyer, Sarah, Edge, Jemma, Edwards, Rachel, Fabre, Ismay, Gemmill, Elizabeth, Griffiths, Ewen, Hariharan, Deepak, Harrington-Patel, Emma, Hassn, Ahmed, Hepworth, Michael, Hewes, James, Hine, Sarah, Hollyman, Marianne, Ide, Kelly, Jenner, Deborah, Johnson, Richard, Jordan, Simon, Karamanakos, Stavros, Kovoor, Joshua, Kukreja, Neil, Marangoni, Gabriele, Metcalfe, Nicola, Morcous, Paul, Needham, Paul, Patel, Niv, Qureshi, Nabeel, Rajaretnam, Niroshini, Rajendran, Ilayaraja, Sabah, Yousuf, Sanders, David L., Sandison, Andrew, Sansom, Jennifer, Seth, Rashmi, Shetty, Vinutha, Sollei, Tomas, Strong, Sean, Sullivan, Laura, Sutcliffe, Robert P., Talbot, Lee, Taylor, Gillian, Varadarajan, Viju, Villatoro, Edward, Wardale, Judith, Weaver, Simon, Wiggins, Tom, Wood, Alexander, Stephens, Timothy J. [0000-0002-0206-0280], and Apollo - University of Cambridge Repository

Subjects
Service improvement, Normalisation process theory, Research, Gallstone disease, Breakthrough collaborative, Quality improvement, Evaluation
Abstract

Background: Acute gallstone disease is the highest volume Emergency General Surgical presentation in the UK. Recent data indicate wide variations in the quality of care provided across the country, with national guidance for care delivery not implemented in most UK hospitals. Against this backdrop, the Royal College of Surgeons of England set up a 13-hospital quality improvement collaborative (Chole-QuIC) to support clinical teams to reduce time to surgery for patients with acute gallstone disease requiring emergency cholecystectomy. Methods: Prospective, mixed-methods process evaluation to answer the following: (1) how was the collaborative delivered by the faculty and received, understood and enacted by the participants; (2) what influenced teams’ ability to improve care for patients requiring emergency cholecystectomy? We collected and analysed a range of data including field notes, ethnographic observations of meetings, and project documentation. Analysis was based on the framework approach, informed by Normalisation Process Theory, and involved the creation of comparative case studies based on hospital performance during the project. Results: Chole-QuIC was delivered as planned and was well received and understood by participants. Four hospitals were identified as highly successful, based upon a substantial increase in the number of patients having surgery in line with national guidance. Conversely, four hospitals were identified as challenged, achieving no significant improvement. The comparative analysis indicate that six inter-related influences appeared most associated with improvement: (1) achieving clarity of purpose amongst site leads and key stakeholders; (2) capacity to lead and effective project support; (3) ideas to action; (4) learning from own and others’ experience; (5) creating additional capacity to do emergency cholecystectomies; and (6) coordinating/managing the patient pathway. Conclusion: Collaborative-based quality improvement is a viable strategy for emergency surgery but success requires the deployment of effective clinical strategies in conjunction with improvement strategies. In particular, achieving clarity of purpose about proposed changes amongst key stakeholders was a vital precursor to improvement, enabling the creation of additional surgical capacity and new pathways to be implemented effectively. Protected time, testing ideas, and the ability to learn quickly from data and experience were associated with greater impact within this cohort.

Published
2020
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16. Laparotomy

Author

Rajaretnam N, Okoye E, and Burns B

Abstract

The word laparotomy is derived from the Greek words lapara , meaning flank , and tomy,  meaning cut . In surgical practice, this translates to a big cut in the abdomen to gain access to the peritoneal cavity. Usually, a standard laparotomy is a cut made in the midline along the linea alba. In the United Kingdom, this is a common procedure with approximately 30,000 to 50,000 performed annually., (Copyright © 2022, StatPearls Publishing LLC.)

Published
2022

17. Ileostomy

Author

Rajaretnam N and Lieske B

Abstract

An ileostomy is when the lumen of the ileum (small bowel) is brought through the abdominal wall via a surgical opening (created by an operation). This can either be temporary or permanent, an end or a loop. The purpose of an ileostomy is to evacuate stool from the body via the ileum rather than the usual route of the anus. The output from an ileostomy consists of loose or porridge-like stool consistent with that expected to pass through the small bowel (as it is the large bowel that is responsible for making the stool more solid dependent upon water absorption). The output from an ileostomy can vary but typically ranges from 200 to 700 ml per day, and an Ileostomy is typically formed on the right side of the abdomen., (Copyright © 2022, StatPearls Publishing LLC.)

Published
2022

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