8 results on '"Titcomb, DR"'
Search Results
2. Understanding surgical interventions in RCTs: the need for better methodology
- Author
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Avery, KN, primary, Barham, CP, additional, Berrisford, R, additional, Blazeby, JM, additional, Blencowe, NS, additional, Donovan, J, additional, Elliott, J, additional, Falk, SJ, additional, Goldin, R, additional, Hanna, G, additional, Hollowood, AD, additional, Metcalfe, C, additional, Noble, S, additional, Sanders, G, additional, Streets, CG, additional, Titcomb, DR, additional, and Wheatley, T, additional
- Published
- 2013
- Full Text
- View/download PDF
3. Effect of Preoperative Weight Loss and Baseline Comorbidity on Short-Term Complications and Reoperations After Laparoscopic Roux-en-Y Gastric Bypass in 2,067 Patients.
- Author
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Wiggins T, Pournaras DJ, Priestman E, Osborne A, Titcomb DR, Finlay I, Hopkins J, Hollyman M, Mason M, Noble H, Mahon D, and Welbourn R
- Subjects
- Body Mass Index, Comorbidity, Female, Humans, Male, Middle Aged, Reoperation, Retrospective Studies, Treatment Outcome, Weight Loss, Gastric Bypass adverse effects, Laparoscopy, Obesity, Morbid surgery
- Abstract
Purpose: Decreasing popularity of Roux-en-Y gastric bypass (RYGB) in bariatric-metabolic surgery may be due to higher perceived peri-operative complications. There are few studies on whether preoperative weight loss can reduce complications or reoperations following RYGB. We investigated this using a standardised operative technique., Materials and Methods: Retrospective single-centre study of RYGB from 2004 to 2019 using a prospective database. Preoperative behavioural management included intentional weight loss. Maximum preoperative weight, weight on the day of operation, and Obesity-Surgery Mortality Risk Score (OS-MRS) class were recorded. Short-term outcomes (post-operative stay, 30-day complication and reoperation rates) were analysed., Results: In 2,067 RYGB patients (1,901 primary and 166 revisional), median preoperative total body weight loss (TWL) was 6.2% (IQR: 2.5-10.7%). The median age was 46 (interquartile range (IQR) 38-54) and 80.4% were female (n=1,661). For primary surgery, the median body mass index (BMI) was 47.6 kg/m
2 (IQR: 43.1-53.3). Excluding the 100-procedure learning curve, the complication rate for primary cases was 4.4% and reoperation rate of 2.8% and one peri-operative mortality (0.06%). OS-MRS ≥2 (class B or C) predicted higher risk of complications (6.1%) compared to those with a score <2 (class A) (3.8%, p=0.021), but not reoperations. Five percent preoperative TWL did not decrease complications compared to <5% TWL. Patients with ≥10% TWL had greater baseline risk and had an increased risk of complications (6.6% vs 3.7%, p=0.017) and reoperations (4.5% vs 2.7%, p<0.001)., Conclusions: RYGB performed using a standardised technique has low overall risk. The influence of preoperative weight loss on outcomes was inconsistent.- Published
- 2021
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4. The feasibility of a randomized controlled trial of esophagectomy for esophageal cancer--the ROMIO (Randomized Oesophagectomy: Minimally Invasive or Open) study: protocol for a randomized controlled trial.
- Author
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Avery KN, Metcalfe C, Berrisford R, Barham CP, Donovan JL, Elliott J, Falk SJ, Goldin R, Hanna G, Hollowood AA, Krysztopik R, Noble S, Sanders G, Streets CG, Titcomb DR, Wheatley T, and Blazeby JM
- Subjects
- Clinical Protocols, Cost-Benefit Analysis, England, Esophageal Neoplasms economics, Esophageal Neoplasms pathology, Esophagectomy adverse effects, Esophagectomy economics, Feasibility Studies, Female, Health Care Costs, Humans, Male, Pilot Projects, Treatment Outcome, Esophageal Neoplasms surgery, Esophagectomy methods, Laparoscopy adverse effects, Laparoscopy economics, Research Design, Thoracotomy adverse effects, Thoracotomy economics
- Abstract
Background: There is a need for evidence of the clinical effectiveness of minimally invasive surgery for the treatment of esophageal cancer, but randomized controlled trials in surgery are often difficult to conduct. The ROMIO (Randomized Open or Minimally Invasive Oesophagectomy) study will establish the feasibility of a main trial which will examine the clinical and cost-effectiveness of minimally invasive and open surgical procedures for the treatment of esophageal cancer., Methods/design: A pilot randomized controlled trial (RCT), in two centers (University Hospitals Bristol NHS Foundation Trust and Plymouth Hospitals NHS Trust) will examine numbers of incident and eligible patients who consent to participate in the ROMIO study. Interventions will include esophagectomy by: (1) open gastric mobilization and right thoracotomy, (2) laparoscopic gastric mobilization and right thoracotomy, and (3) totally minimally invasive surgery (in the Bristol center only). The primary outcomes of the feasibility study will be measures of recruitment, successful development of methods to monitor quality of surgery and fidelity to a surgical protocol, and development of a core outcome set to evaluate esophageal cancer surgery. The study will test patient-reported outcomes measures to assess recovery, methods to blind participants, assessments of surgical morbidity, and methods to capture cost and resource use. ROMIO will integrate methods to monitor and improve recruitment using audio recordings of consultations between recruiting surgeons, nurses, and patients to provide feedback for recruiting staff., Discussion: The ROMIO study aims to establish efficient methods to undertake a main trial of minimally invasive surgery versus open surgery for esophageal cancer., Trial Registration: The pilot trial has Current Controlled Trials registration number ISRCTN59036820(25/02/2013) at http://www.controlled-trials.com; the ROMIO trial record at that site gives a link to the original version of the study protocol.
- Published
- 2014
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5. Assessment and comparison of recovery after open and minimally invasive esophagectomy for cancer: an exploratory study in two centers.
- Author
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Parameswaran R, Titcomb DR, Blencowe NS, Berrisford RG, Wajed SA, Streets CG, Hollowood AD, Krysztopik R, Barham CP, and Blazeby JM
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- Adenocarcinoma complications, Adenocarcinoma drug therapy, Aged, Aged, 80 and over, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Blood Loss, Surgical, Carcinoma, Squamous Cell complications, Carcinoma, Squamous Cell drug therapy, Chemotherapy, Adjuvant, Cisplatin administration & dosage, Esophageal Neoplasms complications, Esophageal Neoplasms drug therapy, Esophagectomy adverse effects, Female, Fluorouracil administration & dosage, Humans, Laparoscopy adverse effects, Male, Middle Aged, Minimally Invasive Surgical Procedures adverse effects, Neoadjuvant Therapy, Operative Time, Surveys and Questionnaires, Activities of Daily Living, Adenocarcinoma surgery, Carcinoma, Squamous Cell surgery, Esophageal Neoplasms surgery, Esophagectomy methods, Fatigue etiology
- Abstract
Background: Minimally invasive esophagectomy (MIE) may lead to early restoration of health-related quality of life, but few prospective comparative studies have been performed. This exploratory study compared recovery between totally minimally invasive esophagectomy (MIE), laparoscopically assisted esophagectomy (LAE) and open surgery (OE)., Methods: A prospective study in 2 specialist centers recruited consecutive patients undergoing OE, LAE, or MIE for high-grade dysplasia or cancer. Patients completed validated questionnaires, the Multi-Dimensional Fatigue Inventory (MFI-20), modified Katz Scale, and modified Lawton and Brody Scale (assessing activities of daily living) before and 6 weeks and 3 and 6 months after surgery., Results: A total of 97 patients (26 women; median age 64 years) were scheduled for surgery that was abandoned in 11 due to occult low-volume metastatic disease. In the remaining 86 (OE = 19, LAE = 31, and MIE = 36), there were 4 in-hospital deaths (4 %), and 54 postoperative complications (OE = 12, LAE = 19, and MIE = 23). Overall questionnaire compliance was high (77 %) and baseline scores similar in all groups, although clinical differences between groups were observed with earlier tumors and more squamous cell cancers selected for MIE. Following surgery fatigue levels increased dramatically and activity levels reduced in all groups. These gradually recovered to baseline following MIE and LAE within 6 months, but the ability to perform activities of daily living and most parameters of fatigue had not returned to baseline levels in the OE group., Conclusions: This exploratory prospective nonrandomized study of recovery after different types of surgery for esophageal cancer showed possible small benefits to MIE. A much larger study is needed to confirm these findings.
- Published
- 2013
- Full Text
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6. Demonstration of the IDEAL recommendations for evaluating and reporting surgical innovation in minimally invasive oesophagectomy.
- Author
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Blazeby JM, Blencowe NS, Titcomb DR, Metcalfe C, Hollowood AD, and Barham CP
- Subjects
- Adenocarcinoma drug therapy, Aged, Carcinoma, Squamous Cell drug therapy, Chemotherapy, Adjuvant, Diffusion of Innovation, Esophageal Neoplasms drug therapy, Female, Humans, Length of Stay, Male, Middle Aged, Prospective Studies, Surgicenters, Adenocarcinoma surgery, Carcinoma, Squamous Cell surgery, Esophageal Neoplasms surgery, Esophagectomy methods, Esophagoscopy methods
- Abstract
Background: The Idea, Development, Evaluation, Assessment and Long term study (IDEAL) framework makes recommendations for evaluating and reporting surgical innovation and adoption, but remains untested., Methods: A prospective database was created for the introduction of minimally invasive techniques for oesophagectomy. IDEAL stages of development and evaluation were examined retrospectively in a series of patients undergoing laparoscopically assisted oesophagectomy (LAO), two- or three-phase minimally invasive oesophagectomy (MIO) and open oesophagectomy., Results: A total of 192 patients were involved. In IDEAL stages 1 and 2a, LAO in 16 patients was uneventful, but two-phase MIO in six patients was abandoned following consecutive technical complications. Two-phase MIO was modified to a three-phase MIO procedure, and the results of LAO (67 patients), three-phase MIO (35) and open techniques (68) were studied in IDEAL stage 2b. Major complications (Clavien-Dindo grades III and IV) occurred in 12 (18 per cent), nine (26 per cent) and 14 (21 per cent) LAO, three-phase MIO and open procedures respectively. There were four in-hospital deaths (2 LAO and 2 open)., Conclusion: The IDEAL framework is a feasible method for documenting the development and implementation of a procedure. MIO should now be compared with open surgery in a randomized controlled trial (IDEAL stage 3)., (Copyright © 2011 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.)
- Published
- 2011
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7. Three hundred laparoscopic Roux-en-Y gastric bypasses: managing the learning curve in higher risk patients.
- Author
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Pournaras DJ, Jafferbhoy S, Titcomb DR, Humadi S, Edmond JR, Mahon D, and Welbourn R
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- Adult, Body Mass Index, Female, Gastric Bypass statistics & numerical data, Humans, Intraoperative Complications epidemiology, Intraoperative Period, Learning, Male, Mentors, Postoperative Complications epidemiology, Prospective Studies, Reoperation statistics & numerical data, Risk Factors, Time Factors, Treatment Outcome, Clinical Competence, Gastric Bypass education, Gastric Bypass standards, Laparoscopy, Obesity, Morbid surgery
- Abstract
Background: Bariatric surgery is expanding and the increasing workload needs to be undertaken safely in new surgical centres with no previous bariatric experience. The laparoscopic Roux-en-Y gastric bypass (LRYGB) has a steep learning curve with documented high risk. We present the results for the first 300 cases of LRYGB in a new centre., Methods: Three hundred consecutive patients underwent LRYGB performed by a single surgeon. Four external surgeons mentored eight cases in the first 50. Demographic characteristics, body mass index (BMI) and operative time were collected prospectively and the Obesity Surgery Mortality Risk Score was used for risk stratification., Results: The mean BMI of the patients increased during the series from 49.0 for the first group to 50.2 for the second group and to 51.0 for the third group (p < 0.05). The number of high-risk patients measured with the OS-MRS was 19/300 (6.3%) in the whole series. The mean operative time decreased from 163 min for the first 100 patients to 119 min for the second 100 and 94 for the third (p < 0.0001). In the first group, there were nine reoperations and two conversions to open surgery, compared to two reoperations and one conversion in the second group (p < 0.05). In the whole series, there were 12 early complications requiring re-operation, four conversions to open surgery and one mortality (patient 110, heart failure within 24 h)., Conclusions: A mentoring process ensures that LRYGB can be done safely in a newly established bariatric centre. The operative time reduces markedly after the learning curve.
- Published
- 2010
- Full Text
- View/download PDF
8. Evaluation of a radiographer-provided barium enema service.
- Author
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Law RL, Titcomb DR, Carter H, Longstaff AJ, Slack N, and Dixon AR
- Subjects
- Contrast Media, Enema, Humans, Mass Screening, Observer Variation, Radiography, Radiology, Sensitivity and Specificity, United Kingdom, Workforce, Barium Sulfate, Colorectal Neoplasms diagnostic imaging, Technology, Radiologic
- Abstract
Aim: Radiographers performed and reported 5516 double contrast barium enemas (RDCBEs) over 4 years to October 2001. This study was undertaken to assess the accuracy of RDCBE and the sensitivity for diagnosing colorectal cancer (CRC)., Method: A total of 224 consecutive outpatient RDCBEs were reported; normal (C1), diverticulosis (C2), diverticulosis with filling defect (C3), diverticulosis & other pathology (C4) and abnormal (C5). RDCBEs were then reported by a radiologist (AL, NS) and the two reports compared. Of 450 CRCs, 153 had undergone DCBE; 152 RDCBEs. Reports were analysed to establish concurrence between radiographer and radiologist and final CRC diagnosis., Results: By category: C1 - 37%, C2 - 31%, C3 - 21%, C4 - 11%, C5 - 0%. C4s included polyps (50%), cancer (12.5%), disrupted anastomosis (8%) and colitis (4%). There was no discrepancy between RDCBE and radiologist reports. Radiology and CRC diagnosis agreed in 145 of 152 DCBEs. There were three exclusions: DCBEs occurred outside the study period (2), one only with raised possibility of malignancy. Of eight remaining RDCBEs, seven were false negatives and one false positive. Sensitivity score for RDCBE was 94.5%. Double reporting by a radiologist did not improve sensitivity., Conclusion: RDCBEs are as accurate as those performed by radiologists and have a very high sensitivity for CRC. In a time of ever increasing demands for complex staging investigations for CRC and interventional radiology, the ACPGBI needs to reconsider its guidelines on radiographers not only performing but also reporting DCBE.
- Published
- 2008
- Full Text
- View/download PDF
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