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Tom Treasure

Publications and source records attributed to Tom Treasure.

At least 19 recordsLinked to original sources
PubMed2006

FDG-PET maximum standardised uptake value is associated with variation in survival: analysis of 498 lung cancer patients.

We sought to establish the extent to which tumour uptake of [18F]-fluoro2-deoxy-glucose is associated with survival in patients with primary lung cancer. From our analysis of data concerning 498 lung cancer patients, including surgical and non-surgical cases, we conclude that there is a clear association between higher tumour uptake of glucose and worse survival.

Aged↗
PubMed2006

Off-pump surgery is associated with reduced occurrence of stroke and other morbidity as compared with traditional coronary artery bypass grafting: a meta-analysis of systematically reviewed trials.

BACKGROUND AND PURPOSE: There is growing enthusiasm for coronary artery bypass grafting (CABG) without cardiopulmonary bypass (CPB). Although deleterious effects of CPB are known, it remains to be proven that avoiding CPB will result in reduction in morbidity. We sought to determine whether off-pump surgery is associated with reduced occurrence of adverse outcomes as compared with CABG with CPB. METHODS: Studies were identified by searching the MEDLINE, EMBASE and the Cochrane Register 1980 to 2006 (February). We also searched the reference lists of randomized clinical trials (RCT) and reviews to look for additional studies. STUDY SELECTION: RCTs comparing off-pump surgery to CABG with CPB. No restriction applied on the size of the trial or end point reports. DATA EXTRACTION: 2 reviewers independently searched for studies, read abstracts and abstracted all data. DATA SYNTHESIS: combined estimates were obtained using fixed or random effect meta-analyses. Relative risks and risk differences were calculated. Heterogeneity was assessed using chi(2) and I(2) values. RESULTS: There were 3996 patients enrolled in 41 RCTs (mean age 62, 22% female). No study reported information on race. Off-pump CABG was associated with a 50% reduction in the relative risk of stroke (95% CI, 7% to 73%), 30% reduction in atrial fibrillation (AF; 95% CI, 16% to 43%) and 48% reduction in wound infection (95% CI, 26% to 63%) with no heterogeneity among RCTs. This translated into avoidance of 10 strokes, 80 cases of AF and 40 infections per 1000 CABG. Fewer distal grafts were performed and there was evidence for >10 reinterventions per 1000 with off-pump CABG. Long-term follow-up is not yet reported in the trials. CONCLUSIONS: Off-pump CABG is associated with reduced risk of stroke, AF and infections as compared with CABG with CPB. Evidence should be generalized taking into account RCT enrollment limitations, drawbacks related to training requirements, propensity to perform fewer grafts and likely reinterventions after off-pump surgery.

Aged↗
PubMed2006

Informing decisions concerning adjuvant chemotherapy following surgical resection for non-small cell lung cancer: a mathematical modelling study.

Faced with the problem of giving individualised advice about adjuvant chemotherapy to patients who have had an apparently curative lung cancer resection, we propose a model to help clarify the choices being made. This would inform the clinician, help the patient and be an explicit basis on which to initiate the discussion.

Antineoplastic Agents↗
PubMed2006

The evidence on the effectiveness of management for malignant pleural effusion: a systematic review.

The aim of this study was to review systematically the available evidence on pleurodesis for malignant effusion, focusing on the choice of the agents, route of delivery and other strategies to improve outcomes. Four electronic databases (MEDLINE, EMBASE, Web of Science and Cochrane Controlled Trials Register) were searched, reference lists checked and letters requesting details of unpublished trials and data sent to authors of previous trials. Studies of malignant pleural effusion in humans were selected with no language restrictions applied. Criteria for randomised clinical trial (RCT) eligibility were random allocation of patients and non-concurrent use of another experimental medication or device. Methodological quality evaluation of the trials was based on randomisation, blinding, allocation concealment and intention to treat analysis. A random effect model was used to combine the relative risk estimates of the treatment effects whenever pooling for an overall effect was considered appropriate. Forty-six RCTs with a total of 2053 patients with malignant pleural effusions were reviewed for effectiveness of pleurodesis. Talc tended to be associated with fewer recurrences when compared to bleomycin (RR, 0.64; 95% CI, 0.34-1.20) and, with more uncertainty, to tetracycline (RR, 0.50; 95% CI, 0.06-4.42). Tetracycline (or doxycycline) was not superior to bleomycin (RR, 0.92; 95% CI, 0.61-1.38). When compared with bedside talc slurry, thoracoscopic talc insufflation was associated with a reduction in recurrence (RR, 0.21; 95% CI, 0.05-0.93). Strategies such as rolling the patient after instillation of the sclerosing agent, protracted drainage of the effusion and use of larger chest tubes were not found to have any substantial advantages. Talc appears to be effective and should be the agent of choice for pleurodesis. Thoracoscopic talc insufflation is associated with fewer recurrences of effusions compared with bedside talc slurry, but this is based on two small studies. Where thoracoscopy is unavailable bedside talc pleurodesis has a high success rate and is the next best option.

Chest Tubes↗
PubMed2006

MADCAP: a graphical method for assessing risk scoring systems.

OBJECTIVE: We set out to develop a method for assessing the performance of clinical risk models over the spectrum of risks and to assess the performance of the EuroSCORE risk model used in cardiac surgery. METHODS: We developed a graphical method for assessing the performance of clinical risk models over the spectrum of risks. To illustrate the technique, we analysed retrospective data concerning 9268 patients that underwent cardiac surgery and for whom both the additive EuroSCORE prediction of risk of morality and vital status at 30 days were available. RESULTS: The graphical tool developed, called MADCAP (Mean Adjusted Deaths Compared Against Predictions), can be used to highlight systematic features of the performance of a clinical risk model. Its use in the current study indicates that the additive version of the EuroSCORE model seems to underestimate risk amongst low-risk cases (0% and 1%). Otherwise the score systematically favours risk avoiding behaviour as the risk model underestimates mortality for 2--6% prediction but not at 7% and above. CONCLUSION: The robustness of case-mix adjusted audit is dependent on the performance of the risk scoring system over the entire spectrum of risk. If we are to use risk adjustment of mortality rates when comparing outcomes obtained by different units or individual surgeons, it is essential that we continually review the performance of the risk adjustment method. The MADCAP method presented here provides a useful tool to this end.

Cardiac Surgical Procedures↗
PubMed2006

Recursive partitioning-based preoperative risk stratification for atrial fibrillation after coronary artery bypass surgery.

BACKGROUND: Knowledge of the risk of atrial fibrillation (AF) for patients undergoing coronary artery bypass graft surgery (CABG) can guide decisions about prophylactic therapy. Accordingly, we sought to use tree-based methods to stratify patients into groups that will have similar risk of AF after CABG and informed decision making regarding aggressive prophylaxis of AF. METHODS: We studied 1209 consecutive patients with isolated CABG performed in 1998-1999 at Yale-New Haven Hospital. Patients with preoperative AF were excluded. Tree-based analysis was carried out to stratify patients into similar groups regarding the risk of AF. Relative risks (RRs) and 95% CIs were calculated at each level of stratification. RESULTS: Age was the most important variable. The importance of other risk factors seemed to be different for younger and older patients. Although in the younger age group (< or =60 years) severity of coronary artery disease (RR 2.19, 95% CI 1.12-3.34) followed by hypertension (RR 1.82, 95% CI 1.23-2.68) were important predictors, in the older age subgroups (61-69 and > or =70 years), nothing or only ejection fraction <40% (RR 1.31, 95% CI 1.08-1.59) was important. In the highest-risk group, AF occurrence was 55% and, in the lowest-risk group, it was 10%. In the low-risk groups, aggressive prophylaxis may not be justified in light of the smaller number of events that would be prevented, possible adverse events, and costs. CONCLUSION: Age and variables related to heart disease severity are predictors of AF. The tree-based method may be a useful tool for clinicians who seek to determine who is more or less likely to benefit from aggressive arrhythmia prophylaxis.

Aged↗
PubMed2006

Appendicectomy: who performs it, when and how?

A comparative review of changing patterns between 1997 and 2002 of who performs appendicectomy and a snapshot of the surgical approaches in use. It also indicates the stage at which competency in appendicectomy may be achieved by contemporary trainees in surgery and anaesthesia.

Adolescent↗
PubMed2005

The European Thoracic Surgery Database project: modelling the risk of in-hospital death following lung resection.

OBJECTIVE: To identify pre-operative factors associated with in-hospital mortality following lung resection and to construct a risk model that could be used prospectively to inform decisions and retrospectively to enable fair comparisons of outcomes. METHODS: Data were submitted to the European Thoracic Surgery Database from 27 units in 14 countries. We analysed data concerning all patients that had a lung resection. Logistic regression was used with a random sample of 60% of cases to identify pre-operative factors associated with in-hospital mortality and to build a model of risk. The resulting model was tested on the remaining 40% of patients. A second model based on age and ppoFEV1% was developed for risk of in-hospital death amongst tumour resection patients. RESULTS: Of the 3426 adult patients that had a first lung resection for whom mortality data were available, 66 died within the same hospital admission. Within the data used for model development, dyspnoea (according to the Medical Research Council classification), ASA (American Society of Anaesthesiologists) score, class of procedure and age were found to be significantly associated with in-hospital death in a multivariate analysis. The logistic model developed on these data displayed predictive value when tested on the remaining data. CONCLUSIONS: Two models of the risk of in-hospital death amongst adult patients undergoing lung resection have been developed. The models show predictive value and can be used to discern between high-risk and low-risk patients. Amongst the test data, the model developed for all diagnoses performed well at low risk, underestimated mortality at medium risk and overestimated mortality at high risk. The second model for resection of lung neoplasms was developed after establishing the performance of the first model and so could not be tested robustly. That said, we were encouraged by its performance over the entire range of estimated risk. The first of these two models could be regarded as an evaluation based on clinically available criteria while the second uses data obtained from objective measurement. We are optimistic that further model development and testing will provide a tool suitable for case mix adjustment.

Adult↗