ORCID Profile
0000-0003-2413-5690
Current Organisations
St James's University Hospital
,
University of Leeds
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Publisher: Wiley
Date: 30-11-2020
DOI: 10.1111/CODI.14899
Abstract: Gastrointestinal recovery describes the restoration of normal bowel function in patients with bowel disease. This may be prolonged in two common clinical settings: postoperative ileus and small bowel obstruction. Improving gastrointestinal recovery is a research priority but researchers are limited by variation in outcome reporting across clinical studies. This protocol describes the development of core outcome sets for gastrointestinal recovery in the contexts of postoperative ileus and small bowel obstruction. An international Steering Group consisting of patient and clinician representatives has been established. As overlap between clinical contexts is anticipated, both outcome sets will be co-developed and may be combined to form a common output with disease-specific domains. The development process will comprise three phases, including definition of outcomes relevant to postoperative ileus and small bowel obstruction from systematic literature reviews and nominal-group stakeholder discussions online-facilitated Delphi surveys via international networks and a consensus meeting to ratify the final output. A nested study will explore if the development of overlapping outcome sets can be rationalized. The final output will be registered with the Core Outcome Measures in Effectiveness Trials initiative. A multi-faceted, quality improvement c aign for the reporting of gastrointestinal recovery in clinical studies will be launched, targeting international professional and patient groups, charitable organizations and editorial committees. Success will be explored via an updated systematic review of outcomes 5 years after registration of the core outcome set.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-2017
Publisher: Wiley
Date: 10-02-2020
DOI: 10.1111/CODI.14957
Publisher: Oxford University Press (OUP)
Date: 04-08-2014
DOI: 10.1002/BJS.9614
Abstract: Recent evidence has suggested an association between postoperative non-steroidal anti-inflammatory drugs (NSAIDs) and increased operation-specific complications. This study aimed to determine the safety profile following gastrointestinal surgery across a multicentre setting in the UK. This multicentre study was carried out during a 2-week interval in September–October 2013. Consecutive adults undergoing elective or emergency gastrointestinal resection were included. The study was powered to detect a 10 per cent increase in major complications (grade III–V according to the Dindo–Clavien classification). The effect of administration of NSAIDs on the day of surgery or the following 2 days was risk-adjusted using propensity score matching and multivariable logistic regression to produce adjusted odds ratios (ORs). The type of NSAID and the dose were registered. Across 109 centres, early postoperative NSAIDs were administered to 242 (16·1 per cent) of 1503 patients. Complications occurred in 981 patients (65·3 per cent), which were major in 257 (17·1 per cent) and minor (Dindo–Clavien grade I–II) in 724 (48·2 per cent). Propensity score matching created well balanced groups. Treatment with NSAIDs was associated with a reduction in overall complications (OR 0·72, 95 per cent confidence interval 0·52 to 0·99 P = 0·041). This effect predominately comprised a reduction in minor complications with high-dose NSAIDs (OR 0·57, 0·39 to 0·89 P = 0·009). Early use of NSAIDs is associated with a reduction in postoperative adverse events following major gastrointestinal surgery.
Publisher: Springer Science and Business Media LLC
Date: 05-04-2018
DOI: 10.1007/S00464-018-6064-9
Abstract: Appendicitis is the most common abdominal surgical emergency worldwide. Differences between high- and low-income settings in the availability of laparoscopic appendectomy, alternative management choices, and outcomes are poorly described. The aim was to identify variation in surgical management and outcomes of appendicitis within low-, middle-, and high-Human Development Index (HDI) countries worldwide. This is a multicenter, international prospective cohort study. Consecutive s ling of patients undergoing emergency appendectomy over 6 months was conducted. Follow-up lasted 30 days. 4546 patients from 52 countries underwent appendectomy (2499 high-, 1540 middle-, and 507 low-HDI groups). Surgical site infection (SSI) rates were higher in low-HDI (OR 2.57, 95% CI 1.33–4.99, p = 0.005) but not middle-HDI countries (OR 1.38, 95% CI 0.76–2.52, p = 0.291), compared with high-HDI countries after adjustment. A laparoscopic approach was common in high-HDI countries (1693/2499, 67.7%), but infrequent in low-HDI (41/507, 8.1%) and middle-HDI (132/1540, 8.6%) groups. After accounting for case-mix, laparoscopy was still associated with fewer overall complications (OR 0.55, 95% CI 0.42–0.71, p 0.001) and SSIs (OR 0.22, 95% CI 0.14–0.33, p 0.001). In propensity-score matched groups within low-/middle-HDI countries, laparoscopy was still associated with fewer overall complications (OR 0.23 95% CI 0.11–0.44) and SSI (OR 0.21 95% CI 0.09–0.45). A laparoscopic approach is associated with better outcomes and availability appears to differ by country HDI. Despite the profound clinical, operational, and financial barriers to its widespread introduction, laparoscopy could significantly improve outcomes for patients in low-resource environments. Trial registration: NCT02179112.
Publisher: Oxford University Press (OUP)
Date: 08-03-2022
DOI: 10.1093/BJS/ZNAC052
Publisher: Oxford University Press (OUP)
Date: 09-10-2019
DOI: 10.1002/BJS.11326
Abstract: Ileus is common after elective colorectal surgery, and is associated with increased adverse events and prolonged hospital stay. The aim was to assess the role of non-steroidal anti-inflammatory drugs (NSAIDs) for reducing ileus after surgery. A prospective multicentre cohort study was delivered by an international, student- and trainee-led collaborative group. Adult patients undergoing elective colorectal resection between January and April 2018 were included. The primary outcome was time to gastrointestinal recovery, measured using a composite measure of bowel function and tolerance to oral intake. The impact of NSAIDs was explored using Cox regression analyses, including the results of a centre-specific survey of compliance to enhanced recovery principles. Secondary safety outcomes included anastomotic leak rate and acute kidney injury. A total of 4164 patients were included, with a median age of 68 (i.q.r. 57–75) years (54·9 per cent men). Some 1153 (27·7 per cent) received NSAIDs on postoperative days 1–3, of whom 1061 (92·0 per cent) received non-selective cyclo-oxygenase inhibitors. After adjustment for baseline differences, the mean time to gastrointestinal recovery did not differ significantly between patients who received NSAIDs and those who did not (4·6 versus 4·8 days hazard ratio 1·04, 95 per cent c.i. 0·96 to 1·12 P = 0·360). There were no significant differences in anastomotic leak rate (5·4 versus 4·6 per cent P = 0·349) or acute kidney injury (14·3 versus 13·8 per cent P = 0·666) between the groups. Significantly fewer patients receiving NSAIDs required strong opioid analgesia (35·3 versus 56·7 per cent P & 0·001). NSAIDs did not reduce the time for gastrointestinal recovery after colorectal surgery, but they were safe and associated with reduced postoperative opioid requirement.
Publisher: Wiley
Date: 07-06-2022
DOI: 10.1002/LEAP.1463
Abstract: AMSTAR‐2 is a critical appraisal instrument for systematic reviews and may have a role in editorial processes. This study explored whether associations exist between AMSTAR‐2 assessments and editorial decisions. A retrospective, cross‐sectional study of manuscripts submitted to a single journal between 2015 and 2017 was undertaken. All submissions that reported an eligible systematic review were assessed using AMSTAR‐2 by two assessors. Inter‐rater agreement (IRR) was calculated for all AMSTAR‐2 items. Associations between AMSTAR‐2 assessments and the editorial decision, final publication status in any journal, and measures of impact were explored. One hundred and twenty‐two manuscripts were included. Across all AMSTAR‐2 items, the IRR varied from 0.03 (slight agreement) to 0.82 (substantial agreement). All submissions contained at least two critical methodological weaknesses. There was no difference in the number of weaknesses (median: 4 IQR: 3–5 vs. median: 4 IQR: 3.5–4.5 p = 0.482) between accepted and rejected submissions. Neither was there a difference between rejected submissions published elsewhere and those which remained unpublished (median: 4 IQR: 3.5–4.5 vs. median: 4 IQR: 4.5–5 p = 0.103). The number of weaknesses was not associated with academic impact. There was no association with AMSTAR‐2 assessments and editorial outcomes. Further work is required to explore whether the instrument can be prospectively operationalized for use during editorial processes.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-2020
DOI: 10.1097/DCR.0000000000001583
Abstract: Low anterior resection syndrome is pragmatically defined as disordered bowel function after rectal resection leading to a detriment in quality of life. This broad characterization does not allow for precise estimates of prevalence. The low anterior resection syndrome score was designed as a simple tool for clinical evaluation of low anterior resection syndrome. Although the low anterior resection syndrome score has good clinical utility, it may not capture all important aspects that patients may experience. The aim of this collaboration was to develop an international consensus definition of low anterior resection syndrome that encompasses all aspects of the condition and is informed by all stakeholders. This international patient-provider initiative used an online Delphi survey, regional patient consultation meetings, and an international consensus meeting. Three expert groups participated: patients, surgeons, and other health professionals from 5 regions (Australasia, Denmark, Spain, Great Britain and Ireland, and North America) and in 3 languages (English, Spanish, and Danish). The primary outcome measured was the priorities for the definition of low anterior resection syndrome. Three hundred twenty-five participants (156 patients) registered. The response rates for successive rounds of the Delphi survey were 86%, 96%, and 99%. Eighteen priorities emerged from the Delphi survey. Patient consultation and consensus meetings refined these priorities to 8 symptoms and 8 consequences that capture essential aspects of the syndrome. S ling bias may have been present, in particular, in the patient panel because social media was used extensively in recruitment. There was also dominance of the surgical panel at the final consensus meeting despite attempts to mitigate this. This is the first definition of low anterior resection syndrome developed with direct input from a large international patient panel. The involvement of patients in all phases has ensured that the definition presented encompasses the vital aspects of the patient experience of low anterior resection syndrome. The novel separation of symptoms and consequences may enable greater sensitivity to detect changes in low anterior resection syndrome over time and with intervention.
Publisher: Oxford University Press (OUP)
Date: 24-01-2020
DOI: 10.1002/BJS.11422
Abstract: Ileus is common after colorectal surgery and is associated with an increased risk of postoperative complications. Identifying features of normal bowel recovery and the appropriateness for hospital discharge is challenging. This study explored the safety of hospital discharge before the return of bowel function. A prospective, multicentre cohort study was undertaken across an international collaborative network. Adult patients undergoing elective colorectal resection between January and April 2018 were included. The main outcome of interest was readmission to hospital within 30 days of surgery. The impact of discharge timing according to the return of bowel function was explored using multivariable regression analysis. Other outcomes were postoperative complications within 30 days of surgery, measured using the Clavien–Dindo classification system. A total of 3288 patients were included in the analysis, of whom 301 (9·2 per cent) were discharged before the return of bowel function. The median duration of hospital stay for patients discharged before and after return of bowel function was 5 (i.q.r. 4–7) and 7 (6–8) days respectively (P & 0·001). There were no significant differences in rates of readmission between these groups (6·6 versus 8·0 per cent P = 0·499), and this remained the case after multivariable adjustment for baseline differences (odds ratio 0·90, 95 per cent c.i. 0·55 to 1·46 P = 0·659). Rates of postoperative complications were also similar in those discharged before versus after return of bowel function (minor: 34·7 versus 39·5 per cent major 3·3 versus 3·4 per cent P = 0·110). Discharge before return of bowel function after elective colorectal surgery appears to be safe in appropriately selected patients.
Location: United Kingdom of Great Britain and Northern Ireland
Location: United Kingdom of Great Britain and Northern Ireland
Location: United Kingdom of Great Britain and Northern Ireland
No related grants have been discovered for Stephen Chapman.