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Biomedical subjects

S A M Nashef

Publications and source records attributed to S A M Nashef.

8 recordsLinked to original sources
PubMed2006

Local clinical quality monitoring for detection of excess operative deaths.

A monitoring system for cardiac surgery has been in use at Papworth Hospital for 10 years. We wished to determine whether this system would have detected an increase in deaths associated with a single practitioner, whether a poorly performing doctor or a serial killer such as Dr Harold Shipman, whose activities went undetected in the absence of a monitoring system for nearly a quarter of a century. Random extra deaths were artificially introduced into the practice of a surgeon and an anaesthetist in a way that broadly reproduced Shipman's pattern. The standard monitoring system was then used to analyse the hypothetical data thus generated. Using the current standard monitoring, the excess deaths would have been detected in less than 10 months. Suspicions would have been raised even earlier. Robust local quality monitoring of risk-adjusted outcomes is possible and, in our opinion, essential.

Anesthesia↗
PubMed2005

Octogenarians undergoing cardiac surgery outlive their peers: a case for early referral.

OBJECTIVE: To examine short and long term outcomes of octogenarians having heart operations and to analyse the interaction between patient and treatment factors. METHODS: Multivariate analysis of prospectively collected data and a survival comparison with an age and sex matched national population. The outcomes were base in-hospital mortality, risk stratified by logistic EuroSCORE (European system for cardiac operative risk evaluation), and long term survival. RESULTS: 12,461 consecutive patients (706 over 80 years) operated on between 1996 and 2003 in a regional UK unit were studied. Octogenarians more often had impaired ventricular function, pulmonary hypertension, and valve operations. They also included a higher proportion of women, had a higher serum creatinine concentration, and had a trend towards more unstable angina. Younger patients had a higher prevalence of previous cardiac operation, previous myocardial infarction, and diabetes. The in-hospital mortality rate was 3.9% for all patients (EuroSCORE predicted 6.1%, p < 0.001) and 9.8% for octogenarians (predicted 14.1%, p = 0.002). Long bypass time and non-elective surgery increased the risk of death above EuroSCORE prediction in both groups. A greater proportion of octogenarians stayed in intensive care more than 24 hours (37% v 23%, p < 0.001). Long term survival was significantly better in the study patients than in a general population with the same age-sex distribution (survival rate at five years 82.1% v 55.9%, p < 0.001). CONCLUSIONS: Cardiac surgery in a UK population of octogenarians produced excellent results. Elective referrals should be encouraged in all age groups.

Age Factors↗
PubMed2004

Computer tools to assist the monitoring of outcomes in surgery.

OBJECTIVE: In recent years, there has been increasing use of analytical and graphical methods to assist the monitoring of outcomes in adult cardiac surgery. In this paper, we present extensions to the basic VLAD methodology that add flexibility and assist in its interpretation. METHODS: Using techniques from probability theory, we have devised graphical tools whereby deviations from expected outcomes can be monitored to see how likely they are to have occurred by chance. The methods are based upon pre-operative assessments of risk and use exact analytical techniques. RESULTS: These tools allow deviations from expected outcomes to be readily assessed and compared with the distribution of chance outcomes. Appropriate colour coding allows interpretation in terms of a temperature gradient. CONCLUSIONS: Exact analysis methods based on the use of pre-operative risk assessment provide a useful means for assisting the interpretation of VLAD charts. Such analysis has the advantage that it is applicable even for relatively short series of operations. Also, it takes specific account of the heterogeneity of case mix when quantifying the variability that is expected. By displaying the overall history of outcomes in a visually intuitive manner, it complements the more formal tools for detecting isolated good and bad runs that are available.

Cardiovascular Surgical Procedures↗
PubMed2003

Anatomic feasibility of creating an inferior epigastric arterio-venous fistula to develop the internal thoracic artery with a view to coronary grafting.

Arterio-venous fistulae increase the diameter of their feeding artery. It may be advantageous to increase the diameter of the internal thoracic artery before its use for coronary grafting. A fistula applied directly to the internal thoracic artery may compromise its subsequent use as a coronary graft and is technically difficult and invasive. However, in view of the continuity between the internal thoracic artery and the inferior epigastric artery, it is possible to achieve the same effect by constructing a fistula on the latter. The purpose of this work was to determine, in a cadaveric study, the feasibility of carrying out an arterio-venous fistula on the inferior epigastric artery so as to increase the caliber of the internal thoracic artery before coronary grafting. A morphologic study of the inferior epigastric artery and its vein and their relations as well as the feasibility of such a fistula was carried out on 10 cadavers. The epigastric artery measured 12.35+/-1.2 cm in length. Its diameter decreased from its origin towards it termination from 3.16+/-0.26 cm to 1.76+/-0.18 cm. There was a constant connection between the inferior and superior epigastric arteries. This connection was single in 30% of cases, double in 50% and through an anastomotic plexus of more than two vessels in 20%. The mean number of anastomotic connections was 1.8. The epigastric vein was constant with a diameter of 0.75+/-0.06 mm at its origin and only sufficiently large to carry out a fistula at its termination (2.6+/-0.9 mm). In conclusion, this study indicates that it should be relatively simple to create a fistula between the inferior epigastric artery and either the inferior epigastric vein or the external iliac vein.

Aged↗
PubMed2003

The SoS trial.

Explore the source record for details and available documents.

Angioplasty, Balloon, Coronary↗
PubMed2003

Boxer's pericardium.

A 65-year-old retired professional boxer presented with progressively worsening shortness of breath, peripheral oedema and mild abdominal swelling over a period of 6 months. His only past medical history was hypertension. Subsequent investigations revealed chylous ascites, pericardial constriction and bilateral chylothorax. He had uneventful pericardectomy, and post-operatively the chylothorax resolved only after administration of octreotide for 10 days. The histopathological features of fibrosis, haemosiderin deposition in the pericardium and abundant haemosiderin-laden macrophages are consistent with chronic resolving haemopericardium. These findings suggested that the cause of pericardial constriction was repeated chest trauma from boxing.

Aged↗