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Simon J. Walsh,Claudia Cosgrove,James C. Spratt,Colm G. Hanratty 대한심장학회 2019 Korean Circulation Journal Vol.49 No.7
Coronary chronic total occlusions (CTOs) are a commonly encountered lesion. These present in a diverse patient population with variable anatomy. Technical success rates of ~90% are achievable for CTO lesions in centers with appropriate expertise. Many lesions can be crossed with wire-based techniques. However, the most anatomically complex and technically challenging lesions will often require more advanced approaches such as retrograde access and/or the application of blunt dissection techniques in the vessel to safely navigate long and/or ambiguous CTO segments. Retrograde dissection and re-entry (RDR) and antegrade dissection and re-entry (ADR) strategies are often needed to treat such lesions. In many circumstances, ADR offers a safe and efficient means to successfully cross a CTO lesion. Therefore, operators must remain cognizant of the risks and benefits of differing technical approaches during CTO percutaneous coronary intervention, particularly when both ADR and RDR are feasible. This article provides an overview of the ADR technique in addition to updated approaches in contemporary clinical practice.
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What’s app? Electronic health technology in inflammatory bowel disease
Alissa Walsh,Simon Travis 대한장연구학회 2018 Intestinal Research Vol.16 No.3
Electronic health (eHealth) data collection is increasingly used in many chronic illnesses, to track pattern of disease. eHealth systems have the potential to revolutionize care. Inflammatory bowel disease (IBD) is a paradigm for such an approach: this is a chronic disease that usually affects young and technologically literate patient population, who are motivated to be involved in their own care. A range of eHealth technologies are available for IBD. This review considers the strengths and weaknesses of 7 platforms that focus on patient-provider interaction. These have been developed in Denmark, United States, the Netherlands, and the United Kingdom, demonstrating an international interest in this form of technology and interaction. Not only do these technologies aim to improve care but they also have the potential to collect large amounts of information. Information includes demographics and patient reported outcomes (symptoms, quality of life), quality of care (steroid use, among other metrics) and outcomes such as hospitalization. These data could inform quality improvement programmes to improve their focus. eHealth technology is also open to machine learning to analyze large data sets, through which personalized algorithms may be developed.
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Real-time data monitoring for ulcerative colitis: patient perception and qualitative analysis
Alissa Walsh,Lawrence Matini,Christopher Hinds,Vanashree Sexton,Oliver Brain,Satish Keshav,John Geddes,Guy Goodwin,Gary Collins,Simon Travis,Michele Peters 대한장연구학회 2019 Intestinal Research Vol.17 No.3
Background/Aims: TrueColours ulcerative colitis (TCUC) is a comprehensive web-based program that functions through email, providing direct links to questionnaires. Several similar programs are available, however patient perspectives are unexplored. Methods: A pilot study was conducted to determine feasibility, usability and patient perceptions of real-time data collection (daily symptoms, fortnightly quality of life, 3 monthly outcomes). TCUC was adapted from a web-based program for patients with relapsing-remitting bipolar disorder, using validated UC indices. A semi-structured interview was developed and audio-recorded face-to-face interviews were conducted after 6 months of interaction with TCUC. Transcripts were coded in NVivo11, a qualitative data analysis software package. An inductive approach and thematic analysis was conducted. Results: TCUC was piloted in 66 patients for 6 months. Qualitative analysis currently defies statistical appraisal beyond “data saturation,” even if it has more influence on clinical practice than quantitative data. A total of 28 face-to-face interviews were conducted. Six core themes emerged: awareness, control, decision-making, reassurance, communication and burden of treatment. There was a transcending overarching theme of patient empowerment, which cut across all aspects of the TCUC experience. Conclusions: Patient perception of the impact of real-time data collection was extremely positive. Patients felt empowered as a product of the self-monitoring format of TCUC, which may be a way of improving self-management of UC whilst also decreasing the burden on the individual and healthcare services.
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( Jin Woo Song ),( Kevin K Brown ),( Simon Lf Walsh ),( Anand Devaraj ),( Wim A Wuyts ),( Claudia Valenzuela ),( Rainer-georg Goeldner ),( Susanne Stowasser ),( Rozsa Schlenker-herceg ),( Athol U Well 대한결핵 및 호흡기학회 2020 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.128 No.-
Background Several studies have suggested that the progression of fibrosing ILDs is more rapid in patients with a usual interstitial pneumonia (UIP) pattern on HRCT. In the INBUILD trial, nintedanib slowed the rate of decline in FVC in subjects with fibrosing ILDs and a progressive phenotype. We assessed the effect of nintedanib in subgroups by HRCT pattern at baseline. Methods In the INBUILD trial, subjects (n=663) with a progressive fibrosing ILD were randomized to receive nintedanib or placebo. Randomization was stratified by HRCT pattern (UIP-like fibrotic pattern or other fibrotic patterns) based on central review. In pre-specified analyses, we assessed the effects of nintedanib in subgroups of subjects with a UIP-like fibrotic pattern and other fibrotic patterns on HRCT at baseline. Results At baseline, 62.1% of total subjects had a UIP-like fibrotic pattern on HRCT. In subjects who received placebo, the adjusted mean annual rate (SE) of decline in FVC was -209.2 (19.1) mL/year in subjects with a UIP-like fibrotic pattern on HRCT and -155.4 (23.6) mL/year in subjects with other fibrotic patterns on HRCT. The difference between the nintedanib and placebo groups in the annual rate of decline in FVC was 127.8 (95% CI: 74.3, 181.2) mL/year in subjects with a UIP-like fibrotic pattern on HRCT and 75.4 (95% CI: 9.5, 141.4) mL/year in subjects with other fibrotic patterns on HRCT (treatment-by-subgroup-by-time interaction p=0.23) (Table). The effects of nintedanib vs placebo on change from baseline in K-BILD questionnaire total score at week 52, time to acute exacerbation of ILD or death over 52 weeks, and time to death over 52 weeks between the subgroups by HRCT pattern are shown in the Table. Conclusions In the INBUILD trial, the effect of nintedanib on slowing the rate of FVC decline was consistent regardless of fibrotic pattern on HRCT.
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Pafitanis, Georgios,Hadjiandreou, Michalis,Alamri, Alexander,Uff, Christopher,Walsh, Daniel,Myers, Simon Korean Society of Plastic and Reconstructive Surge 2020 Archives of Plastic Surgery Vol.47 No.3
Background The Exoscope is a novel high-definition digital camera system. There is limited evidence signifying the use of exoscopic devices in microsurgery. This trial objectively assesses the effects of the use of the Exoscope as an alternative to the standard operating microscope (OM) on the performance of experts in a simulated microvascular anastomosis. Methods Modus V Exoscope and OM were used by expert microsurgeons to perform standardized tasks. Hand-motion analyzer measured the total pathlength (TP), total movements (TM), total time (TT), and quality of end-product anastomosis. A clinical margin of TT was performed to prove non-inferiority. An expert performed consecutive microvascular anastomoses to provide the exoscopic learning curve until reached plateau in TT. Results Ten micro sutures and 10 anastomoses were performed. Analysis demonstrated statistically significant differences in performing micro sutures for TP, TM, and TT. There was statistical significance in TM and TT, however, marginal non-significant difference in TP regarding microvascular anastomoses performance. The intimal suture line analysis demonstrated no statistically significant differences. Non-inferiority results based on clinical inferiority margin (Δ) of TT=10 minutes demonstrated an absolute difference of 0.07 minutes between OM and Exoscope cohorts. A 51%, 58%, and 46% improvement or reduction was achieved in TT, TM, TP, respectively, during the exoscopic microvascular anastomosis learning curve. Conclusions This study demonstrated that experts' Exoscope anastomoses appear non-inferior to the OM anastomoses. Exoscopic microvascular anastomosis was more time consuming but end-product (patency) in not clinically inferior. Experts' "warm-up" learning curve is steep but swift and may prove to reach clinical equality.
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( Jin Woo Song ),( Kevin R Flaherty ),( Athol U Wells ),( Vincent Cottin ),( Anand Devaraj ),( Yoshikazu Inoue ),( Luca Richeldi ),( Simon Walsh ),( Susanne Stowasser ),( Carl Coeck ),( Rainer-georg G 대한결핵 및 호흡기학회 2019 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.127 No.-
Background: Nintedanib is an approved treatment for idiopathic pulmonary fibrosis (IPF). Pre-clinical data suggest that nintedanib inhibits processes fundamental to progression of lung fibrosis irrespective of the aetiology. The INBUILD trial was designed to investigate the efficacy and safety of nintedanib in patients with various non-IPF chronic fibrosing ILDs with progressive phenotype. Methods: Eligible patients had diffuse fibrosing lung disease of >10% extent on HRCT, FVC ≥45% predicted, DLCO ≥30-<80% predicted, and met ≥1 of 4 criteria for ILD progression (Table) in the 24 months before screening, despite treatment of ILDs in clinical practice. Patients with IPF were excluded. Subjects were randomised to receive nintedanib 150 mg bid or placebo. The primary endpoint is the annual rate of decline in FVC (mL/yr) assessed over 52 weeks. There will be two co-primary analysis populations: all subjects and subjects with a UIP-like fibrotic pattern only on HRCT. Results: 663 patients were randomised and treated (Table). Mean (±SD) age was 65.8±9.8 years, FVC was 69.0±15.7% predicted, DLco was 47.6±32.2% predicted. Conclusions: The INBUILD trial will provide insights into the natural history and role of nintedanib in treating patients with various progressive fibrosing ILDs. Results will be presented at the congress.
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Jenny H. Chang,Rasha T. Kakati,Chase Wehrle,Robert Naples,Daniel Joyce,Toms Augustin,Robert Simon,R Matthew Walsh,Fadi S. Dahdaleh,Philip Spanheimer,Isabella Salti,Alessandro Parente,Samer A. Naffouje 대한내시경로봇외과학회 2024 Journal of Minimally Invasive Surgery Vol.27 No.2
Purpose: Postoperative pancreatic fistula (POPF) remains a devastating complication of pancreatoduodenectomy (PD). Minimally invasive PD (MIPD), including laparoscopic (LPD) and robotic (RPD) approaches, have comparable POPF rates to open PD (OPD). However, we hypothesize that the likelihood of having a more severe POPF, as defined as clinically relevant POPF (CR-POPF), would be higher in an MIPD relative to OPD. Methods: The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) targeted pancreatectomy dataset (2014–2020) was reviewed for any POPF after OPD. Propensity score matching (PSM) compared MIPD to OPD, and then RPD to LPD. Results: Among 3,083 patients who developed a POPF, 2,843 (92.2%) underwent OPD and 240 (7.8%) MIPD; of these, 25.0% were LPD (n = 60) and 75.0% RPD (n = 180). Grade B POPF was observed in 45.4% (n = 1,400), and grade C in 6.0% (n = 185). After PSM, MIPD patients had higher rates of CR-POPF (47.3% OPD vs. 54.4% MIPD, p = 0.037), as well as higher reoperation (9.1% vs. 15.3%, p = 0.006), delayed gastric emptying (29.2% vs. 35.8%, p = 0.041), and readmission rates (28.2% vs. 35.1%, p = 0.032). However, CR-POPF rates were comparable between LPD and RPD (56.8% vs. 49.3%, p = 0.408). Conclusion: The impact of POPF is more clinically pronounced after MIPD than OPD with a more complex postoperative course. The difference appears to be attributed to the minimally invasive environment itself as no difference was noted between LPD and RPD. A clear biological explanation of this clinical observation remains missing. Further studies are warranted.
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