Publications by authors named "Angus McNair"

Objective: To synthesize evidence of surgical treatment intensity, defined as a measure of the quantity of invasive procedures, received by patients in patients with cancer within a defined time period around the 'end of life' (EoL).

Background: Concern regarding overly 'aggressive' care or high health care utilization at the EoL, particularly in cancer, is growing. The contribution surgery makes to the quality and cost of EoL care in cancer has not yet been quantified.

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  • Degenerative cervical myelopathy (DCM) affects about 2% of adults, and there is a lack of standardized outcomes in clinical research, leading to inconsistencies in study results; creating a standardized minimum data set could enhance comparability.* -
  • The study used a modified Delphi method to develop a core outcome set (COS), core data elements (CDEs), and a core measurement set (CMS) for DCM research, with input from an international stakeholder group.* -
  • In total, 28 outcomes were identified across 6 key domains, culminating in a structured data set that can be utilized in future clinical trials to ensure consistency and improve measurement accuracy in DCM research.*
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  • High clinical practice variation may signal uncertainty and indicate potential low-value surgical care, prompting the need for clearer identification methods.
  • A national study analyzed surgical procedure data in England from 2014 to 2019, focusing on the fastest-growing and most varied procedures among clinical commissioning groups.
  • The research identified six procedures with significant growth and four exhibiting notable geographical variation, highlighting uncertainty around efficacy for the majority, suggesting routine variation analysis could help pinpoint low-value surgical interventions.
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Background: Improving shared decision-making (SDM) for patients has become a health policy priority in many countries. Achieving high-quality SDM is particularly important for approximately 313 million surgical treatment decisions patients make globally every year. Large-scale monitoring of surgical patients' experience of SDM in real time is needed to identify the failings of SDM before surgery is performed.

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This study aims to review the status of the clinical use of monoclonal antibodies (mAbs) that have completed or are in ongoing clinical trials for targeted fluorescence-guided surgery (T-FGS) for the intraoperative identification of the tumor margins of extra-hematological solid tumors. For each of them, the targeted antigen, the mAb generic/commercial name and format, and clinical indications are presented, together with utility, doses, and the timing of administration. Based on the current scientific evidence in humans, the top three mAbs that could be prepared in a GMP-compliant bank ready to be delivered for surgical purposes are proposed to speed up the translation to the operating room and produce a few readily available "off-the-shelf" injectable fluorescent probes for safer and more effective solid tumor resection.

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Introduction: High-quality shared decision-making (SDM) is a priority of health services, but only achieved in a minority of surgical consultations. Improving SDM for surgical patients may lead to more effective care and moderate the impact of treatment consequences. There is a need to establish effective ways to achieve sustained and large-scale improvements in SDM for all patients whatever their background.

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  • This study looked at how invasive procedures (IPs) are used for patients with colorectal cancer who are nearing the end of their life.
  • Researchers wanted to understand when these procedures are done to ensure patients don't get too much or too little treatment.
  • They found that younger patients and those with less serious illness were more likely to have these procedures, especially in the weeks leading up to death.
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  • Health systems are having a hard time keeping services running with limited resources, so a program called Evidence-Based Interventions (EBI) tried to cut down on unnecessary medical procedures in England.
  • In 2019, EBI published guidelines for 17 procedures, but research showed that the number of these procedures was already going down before EBI started and continued the same way afterwards.
  • The study found no big changes after EBI was introduced, and there’s a need for more research to figure out why some health care practices stick around even when they shouldn't.
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Objectives: To explore whether a James Lind Alliance Priority Setting Partnership could provide insights on knowledge translation within the field of degenerative cervical myelopathy (DCM).

Design: Secondary analysis of a James Lind Alliance Priority Setting Partnership process for DCM.

Participants And Setting: DCM stake holders, including spinal surgeons, people with myelopathy and other healthcare professionals, were surveyed internationally.

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Background: Individuals with lifelong illnesses need access to adequate information about their condition to make optimal health decisions. Degenerative Cervical Myelopathy (DCM) is the most common form of spinal cord dysfunction in adults worldwide. Its chronic and debilitating nature, varied impact, clinical trajectory, and management options necessitate appropriate informational support to sustain effective clinical and self-directed care strategies.

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Background: Innovative surgical procedures and devices are often modified throughout their development and introduction into clinical practice. A systematic approach to reporting modifications may support shared learning and foster safe and transparent innovation. Definitions of 'modifications', and how they are conceptualized and classified so they can be reported and shared effectively, however, are lacking.

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Introduction: AO Spine RECODE-DCM was a multi-stakeholder priority setting partnership (PSP) to define the top ten research priorities for degenerative cervical myelopathy (DCM). Priorities were generated and iteratively refined using a series of surveys administered to surgeons, other healthcare professionals (oHCP) and people with DCM (PwDCM). The aim of this work was to utilise word clouds to enable the perspectives of people with the condition to be heard earlier in the PSP process than is traditionally the case.

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Background: At the onset of the COVID-19 pandemic, elective surgical provision was severely affected by the need for hospital reorganization to care for critically ill patients. In response, National Health Service (NHS) England issued national guidance proposing acceptable time intervals for postponing different types of surgical procedure. This study reports healthcare professionals' private accounts of the strategies adopted to manage the imbalance of demand and resource, using colorectal cancer surgery as a case study.

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Objective: During development of complex surgical innovations, modifications occur to optimize safety and efficacy. Operators' experiences (how professionals feel undertaking the innovation) drive this process but comprehensive overviews of measures of this concept are lacking. This study identified and appraised measures to assess operators' experience of surgical innovation.

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  • The study explores how patients are informed about innovative surgical procedures and their uncertain outcomes, highlighting a gap between national guidelines and actual communication practices.
  • Interviews with clinicians indicated a desire to inform patients neutrally, but there were challenges in balancing honesty with the need to avoid distressing patients.
  • Postoperative interviews revealed that many patients misunderstood the experimental nature of these procedures, often believing they were more established than they really were, suggesting a need for better training in patient communication for clinicians.
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Introduction: Progress in degenerative cervical myelopathy (DCM) is hindered by inconsistent measurement and reporting. This impedes data aggregation and outcome comparison across studies. This limitation can be reversed by developing a core measurement set (CMS) for DCM research.

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Background: Degenerative cervical myelopathy (DCM) is a chronic neurological condition estimated to affect 1 in 50 adults. Due to its diverse impact, trajectory and management options, patient-centred care and shared decision making are essential. In this scoping review, we aim to explore whether information needs in DCM are currently being met in available DCM educational resources.

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Objective: Outcome selection and reporting in studies of novel surgical procedures and devices lacks standardisation, hindering safe and effective evaluation. A core outcome set (COS) to measure and report in all studies of surgical innovation is needed. We explored outcomes in a specific sample of innovative surgical device case studies to identify outcome domains specifically relevant to innovation to inform the development of a COS.

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Objectives: To evaluate the measurement properties of outcome measures currently used in the assessment of degenerative cervical myelopathy (DCM) for clinical research.

Design: Systematic review DATA SOURCES: MEDLINE and EMBASE were searched through 4 August 2020.

Eligibility Criteria: Primary clinical research published in English and whose primary purpose was to evaluate the measurement properties or clinically important differences of instruments used in DCM.

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Study Design: Survey.

Introduction: AO Spine Research Objectives and Common Data Elements for Degenerative Cervical Myelopathy (AO Spine RECODE-DCM) is an international initiative that aims to accelerate knowledge discovery and improve outcomes by developing a consensus framework for research. This includes defining the top research priorities, an index term and a minimum data set (core outcome set and core data elements set - core outcome set (COS)/core data elements (CDE)).

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Introduction: The development of innovative invasive procedures and devices are essential to improving outcomes in healthcare. However, how these are introduced into practice has not been studied in detail. The Lotus study will follow a wide range of 'case studies' of new procedures and/or devices being introduced into NHS trusts to explore what information is communicated to patients, how procedures are modified over time and how outcomes are selected and reported.

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Introduction: Innovation in surgery drives improvements to patient care. New surgical procedures and devices typically undergo a series of modifications as they are developed and refined during their introduction into clinical practice. These changes should ideally be reported and shared between surgeon-innovators to promote efficient, safe and transparent innovation.

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Objectives: AO Spine REsearch objectives and Common Data Elements for Degenerative Cervical Myelopathy [RECODE-DCM] is a multi-stakeholder consensus process aiming to promote research efficiency in DCM. It aims to establish the top 10 research uncertainties, through a James Lind Alliance Priority Setting Partnership [PSP]. Through a consensus process, research questions are generated and ranked.

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Objective: To develop a COS, an agreed minimum set of outcomes to measure and report in all studies evaluating the introduction and evaluation of novel surgical techniques.

Summary Of Background Data: Agreement on the key outcomes to measure and report for safe and efficient surgical innovation is lacking, hindering transparency and risking patient harm.

Methods: (I) Generation of a list of outcome domains from published innovation-specific literature, policy/regulatory body documents, and surgeon interviews; (II) Prioritization of identified outcome domains using an international, multi-stakeholder Delphi survey; (III) Consensus meeting to agree the final COS.

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Article Synopsis
  • The study aimed to review existing patient-reported outcome measures (PROMs) for colorectal cancer and inflammatory bowel disease (IBD), while also creating a plan to develop a core outcome set through social media engagement.
  • It involved collaborative input from various stakeholders—including patients, healthcare professionals, and organizations—gathering insights via Twitter, and ultimately presented and discussed five commonly used PROMs in the field.
  • A new general psycho-physical well-being score was proposed, with survey results indicating strong agreement on its importance, demonstrating innovative ways to involve patients in clinical research despite some limitations of this initial exploratory study.
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