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1. Dietary Nitrate Supplementation Does Not Alter Exercise Efficiency at High Altitude – Further Results From the Xtreme Alps Study

Author: Philip J. Hennis, Andrew F. Cumpstey, Alasdair F. O’Doherty, Bernadette O. Fernandez, Edward T. Gilbert-Kawai, Kay Mitchell, Helen Moyses, Alexandra Cobb, Paula Meale, Helmut Pöhnl, Monty G. Mythen, Michael P. W. Grocott, Denny Z. H. Levett, Daniel S. Martin, Martin Feelisch, The Xtreme Alps Research Group, Adam Booth, Adam Sheperdigian, Alasdair O’Doherty, Alex Salam, Andrew Cumpstey, Bernadette Fernandez, Damian Mole, Daniel Grant, Daniel Martin, Denny Levett, Edith Kortekaas, Edward Gilbert, Fabio Rigat, Fiona Shrubb, Heng Yow, James Farrant, Jildou van der Kaaij, Jim Milledge, Jo Simpson, Laura Jackson, Liesl Wandrag, Lindsay Bisiker, Mark Edsell, Maryam Khosravi, Matt Sanborn, Michael Grocott, Michael Mythen, Nick Talbot, Oliver Burdall, Oliver Firth, Oliver Moses, Phil Hennis, Savini Wijesingha, Steve Dauncey, Tom Adams, Tom Woolley, Wilby Williamson, Will Jenner, and Zeyn Mahomed
Subjects: exercise, high altitude, hypoxia, nitric oxide, beetroot, nitrite, Physiology, QP1-981
Abstract: IntroductionNitrate supplementation in the form of beetroot juice (BRJ) ingestion has been shown to improve exercise tolerance during acute hypoxia, but its effect on exercise physiology remains unstudied during sustained terrestrial high altitude exposure. We hypothesized that performing exercise at high altitude would lower circulating nitrate and nitrite levels and that BRJ ingestion would reverse this phenomenon while concomitantly improving key determinants of aerobic exercise performance.MethodsTwenty seven healthy volunteers (21 male) underwent a series of exercise tests at sea level (SL, London, 75 m) and again after 5–8 days at high altitude (HA, Capanna Regina Margherita or “Margherita Hut,” 4,559 m). Using a double-blind protocol, participants were randomized to consume a beetroot/fruit juice beverage (three doses per day) with high levels of nitrate (∼0.18 mmol/kg/day) or a nitrate-depleted placebo (∼11.5 μmoles/kg/day) control drink, from 3 days prior to the exercise trials until completion. Submaximal constant work rate cycle tests were performed to determine exercise efficiency and a maximal incremental ramp exercise test was undertaken to measure aerobic capacity, using breath-by-breath pulmonary gas exchange measurements throughout. Concentrations of nitrate, nitrite and nitrosation products were quantified in plasma samples collected at 5 timepoints during the constant work rate tests. Linear mixed modeling was used to analyze data.ResultsAt both SL and HA, plasma nitrate concentrations were elevated in the nitrate supplementation group compared to placebo (P < 0.001) but did not change throughout increasing exercise work rate. Delta exercise efficiency was not altered by altitude exposure (P = 0.072) or nitrate supplementation (P = 0.836). V̇O2peak decreased by 24% at high altitude (P < 0.001) and was lower in the nitrate-supplemented group at both sea level and high altitude compared to placebo (P = 0.041). Dietary nitrate supplementation did not alter other peak exercise variables or oxygen consumption at anaerobic threshold. Circulating nitrite and S-nitrosothiol levels unexpectedly rose in a few individuals right after cessation of exercise at high altitude.ConclusionWhilst regularly consumed during an 8 days expedition to terrestrial high altitude, nitrate supplementation did not alter exercise efficiency and other exercise physiological variables, except decreasing V̇O2peak. These results and those of others question the practical utility of BRJ consumption during prolonged altitude exposure.
Published: 2022
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2. Sustained vasomotor control of skin microcirculation in Sherpas versus altitude‐naive lowlanders: Experimental evidence from Xtreme Everest 2

Author: Thomas Davies, Edward Gilbert‐Kawai, Stephen Wythe, Paula Meale, Monty Mythen, Denny Levett, Kay Mitchell, Michael Grocott, Geraldine Clough, Daniel Martin, and for the Xtreme Everest 2 Research Group
Subjects: Flowmotion, hypobaric hypoxia, laser Doppler flowmetry, microcirculation, Physiology, QP1-981
Abstract: New Findings What is the central question of this study? Do Sherpa highlanders, when exposed to graded hypobaric hypoxia, exhibit enhanced vasomotor and neurovascular control to maintain microcirculatory flux, and thus tissue oxygenation, when compared with altitude‐naive lowlanders? What is the main finding and its importance? Sherpas, when exposed to hypobaric hypoxia at high altitude, demonstrated superior preservation of their peripheral microcirculatory perfusion, a greater oxygen unloading rate and sustained microvascular reactivity with enhanced vasomotion, when compared with altitude‐naive lowlanders. These differences have not been reported previously and may improve our understanding of the multifactorial responses to sustained environmental hypoxia. Abstract Enhanced oxygen delivery, consequent to an increased microvascular perfusion, has been postulated to play a key role in the physiological adaptation of Tibetan highlanders to the hypobaric hypoxia encountered at high altitude. We tested the hypothesis that Sherpas, when exposed to graded hypobaric hypoxia, demonstrate enhanced vasomotor and neurovascular control to maintain microcirculatory flux, and thus tissue oxygenation, when compared with altitude‐naive lowlanders. Eighty‐three lowlanders [39 men and 44 women, 38.8 (13.1) years old; mean (SD)] and 61 Sherpas [28 men and 33 women, 27.9 (6.9) years old] were studied on ascent to Everest Base Camp over 11 days. Skin blood flux and tissue oxygen saturation were measured simultaneously using combined laser Doppler fluximetry and white light spectroscopy at baseline, 3500 and 5300 m. In both cohorts, ascent resulted in a decline in the sympathetically mediated microvascular constrictor response (P
Published: 2018
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3. Exercise Training Induces a Shift in Extracellular Redox Status with Alterations in the Pulmonary and Systemic Redox Landscape in Asthma

Author: Anna Freeman, Doriana Cellura, Magdalena Minnion, Bernadette O. Fernandez, Cosma Mirella Spalluto, Denny Levett, Andrew Bates, Timothy Wallis, Alastair Watson, Sandy Jack, Karl J. Staples, Michael P. W. Grocott, Martin Feelisch, and Tom M. A. Wilkinson
Subjects: asthma, exercise, oxidative stress, reactive species interactome, inflammation, Therapeutics. Pharmacology, RM1-950
Abstract: Redox dysregulation and oxidative stress have been implicated in asthma pathogenesis. Exercise interventions improve symptoms and reduce inflammation in asthma patients, but the underlying mechanisms remain unclear. We hypothesized that a personalised exercise intervention would improve asthma control by reducing lung inflammation through modulation of local and systemic reactive species interactions, thereby increasing antioxidant capacity. We combined deep redox metabolomic profiling with clinical assessment in an exploratory cohort of six female patients with symptomatic asthma and studied their responses to a metabolically targeted exercise intervention over 12 weeks. Plasma antioxidant capacity and circulating nitrite levels increased following the intervention (p = 0.028) and lowered the ratio of reduced to oxidised glutathione (p = 0.029); this was accompanied by improvements in physical fitness (p = 0.046), symptoms scores (p = 0.020), quality of life (p = 0.046), lung function (p = 0.028), airway hyperreactivity (p = 0.043), and eosinophilic inflammation (p = 0.007). Increased physical fitness correlated with improved plasma antioxidant capacity (p = 0.019), peak oxygen uptake and nitrite changes (p = 0.005), the latter also associated with reductions in peripheral blood eosinophil counts (p = 0.038). Thus, increases in “redox resilience” may underpin the clinical benefits of exercise in asthma. An improved understanding of exercise-induced alterations in redox regulation offers opportunities for greater treatment personalisation and identification of new treatment targets.
Published: 2021
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4. Caudwell Xtreme Everest: A prospective study of the effects of environmental hypoxia on cognitive functioning.

Author: Konstadina Griva, Jan Stygall, Mark H Wilson, Daniel Martin, Denny Levett, Kay Mitchell, Monty Mythen, Hugh E Montgomery, Mike P Grocott, Golnar Aref-Adib, Mark Edsell, Tracie Plant, Chris Imray, Debbie Cooke, Jane Harrington, Maryam Khosravi, Stanton P Newman, and Caudwell Xtreme Everest Research Group
Subjects: Medicine, Science
Abstract: The neuropsychological consequences of exposure to environmental hypobaric hypoxia (EHH) remain unclear. We thus investigated them in a large group of healthy volunteers who trekked to Mount Everest base camp (5,300 m).A neuropsychological (NP) test battery assessing memory, language, attention, and executive function was administered to 198 participants (age 44.5±13.7 years; 60% male). These were studied at baseline (sea level), 3,500 m (Namche Bazaar), 5,300 m (Everest Base Camp) and on return to 1,300 m (Kathmandu) (attrition rate 23.7%). A comparable control group (n = 25; age 44.5±14.1 years; 60% male) for comparison with trekkers was tested at/or near sea level over an equivalent timeframe so as to account for learning effects associated with repeat testing. The Reliable Change Index (RCI) was used to calculate changes in cognition and neuropsychological function during and after exposure to EHH relative to controls.Overall, attention, verbal ability and executive function declined in those exposed to EHH when the performance of the control group was taken into account (RCI .05 to -.95) with decline persisting at descent. Memory and psychomotor function showed decline at highest ascent only (RCI -.08 to -.56). However, there was inter-individual variability in response: whilst NP performance declined in most, this improved in some trekkers. Cognitive decline was greater amongst older people (r = .42; p < .0001), but was otherwise not consistently associated with socio-demographic, mood, or physiological variables.After correcting for learning effects, attention, verbal abilities and executive functioning declined with exposure to EHH. There was considerable individual variability in the response of brain function to sustained hypoxia with some participants not showing any effects of hypoxia. This might have implications for those facing sustained hypoxia as a result of any disease.
Published: 2017
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5. Design and conduct of Xtreme Everest 2: An observational cohort study of Sherpa and lowlander responses to graduated hypobaric hypoxia [v1; ref status: indexed, http://f1000r.es/57m]

Author: Edward Gilbert-Kawai, Adam Sheperdigian, Thomas Adams, Kay Mitchell, Martin Feelisch, Andrew Murray, Mark Peters, Grace Gilbert-Kawai, Hugh Montgomery, Denny Levett, Rajendra Kumar, Michael Mythen, Michael Grocott, and Daniel Martin
Subjects: Airway/Respiratory Physiology, Extrapulmonary Disorders & Therapeutic Interventions, Respiratory Problems in Critical Care, Medicine, Science
Abstract: Objective: Oxygen availability falls with ascent to altitude and also as a consequence of critical illness. Because cellular sequelae and adaptive processes may be shared in both circumstances, high altitude exposure (‘physiological hypoxia’) assists in the exploration of the response to pathological hypoxia. We therefore studied the response of healthy participants to progressive hypobaric hypoxia at altitude. The primary objective of the study was to identify differences between high altitude inhabitants (Sherpas) and lowland comparators. Methods: We performed an observational cohort study of human responses to progressive hypobaric hypoxia (during ascent) and subsequent normoxia (following descent) comparing Sherpas with lowlanders. Studies were conducted in London (35m), Kathmandu (1300m), Namche Bazaar (3500m) and Everest Base Camp (5300m). Of 180 healthy volunteers departing from Kathmandu, 64 were Sherpas and 116 were lowlanders. Physiological, biochemical, genetic and epigenetic data were collected. Core studies focused on nitric oxide metabolism, microcirculatory blood flow and exercise performance. Additional studies performed in nested subgroups examined mitochondrial and metabolic function, and ventilatory and cardiac variables. Of the 180 healthy participants who left Kathmandu, 178 (99%) completed the planned trek. Overall, more than 90% of planned testing was completed. Forty-four study protocols were successfully completed at altitudes up to and including 5300m. A subgroup of identical twins (all lowlanders) was also studied in detail. Conclusion: This programme of study (Xtreme Everest 2) will provide a rich dataset relating to human adaptation to hypoxia, and the responses seen on re-exposure to normoxia. It is the largest comprehensive high altitude study of Sherpas yet performed. Translational data generated from this study will be of relevance to diseases in which oxygenation is a major factor.
Published: 2015
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6. The effect of high-altitude on human skeletal muscle energetics: P-MRS results from the Caudwell Xtreme Everest expedition.

Author: Lindsay M Edwards, Andrew J Murray, Damian J Tyler, Graham J Kemp, Cameron J Holloway, Peter A Robbins, Stefan Neubauer, Denny Levett, Hugh E Montgomery, Mike P Grocott, Kieran Clarke, and Caudwell Xtreme Everest Research Group
Subjects: Medicine, Science
Abstract: Many disease states are associated with regional or systemic hypoxia. The study of healthy individuals exposed to high-altitude hypoxia offers a way to explore hypoxic adaptation without the confounding effects of disease and therapeutic interventions. Using (31)P magnetic resonance spectroscopy and imaging, we investigated skeletal muscle energetics and morphology after exposure to hypobaric hypoxia in seven altitude-naïve subjects (trekkers) and seven experienced climbers. The trekkers ascended to 5300 m while the climbers ascended above 7950 m. Before the study, climbers had better mitochondrial function (evidenced by shorter phosphocreatine recovery halftime) than trekkers: 16+/-1 vs. 22+/-2 s (mean +/- SE, p
Published: 2010
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7. A capaciflector provides continuous and accurate respiratory rate monitoring for patients at rest and during exercise

Author: Nick Hayward, Mahdi Shaban, James Badger, Isobel Jones, Yang Wei, Daniel Spencer, Stefania Isichei, Martin Knight, James Otto, Gurinder Rayat, Denny Levett, Michael Grocott, Harry Akerman, and Neil White
Subjects: Respiratory monitoring, Respiration, Capaciflector, Reproducibility of Results, Health Informatics, Critical Care and Intensive Care Medicine, Perioperative medicine, Critical care, Anesthesiology and Pain Medicine, Respiratory Rate, Humans, Original Research, Sensor, Monitoring, Physiologic
Abstract: Respiratory rate (RR) is a marker of critical illness, but during hospital care, RR is often inaccurately measured. The capaciflector is a novel sensor that is small, inexpensive, and flexible, thus it has the potential to provide a single-use, real-time RR monitoring device. We evaluated the accuracy of continuous RR measurements by capaciflector hardware both at rest and during exercise. Continuous RR measurements were made with capaciflectors at four chest locations. In healthy subjects (n = 20), RR was compared with strain gauge chest belt recordings during timed breathing and two different body positions at rest. In patients undertaking routine cardiopulmonary exercise testing (CPET, n = 50), RR was compared with pneumotachometer recordings. Comparative RR measurement bias and limits of agreement were calculated and presented in Bland–Altman plots. The capaciflector was shown to provide continuous RR measurements with a bias less than 1 breath per minute (BPM) across four chest locations. Accuracy and continuity of monitoring were upheld even during vigorous CPET exercise, often with narrower limits of agreement than those reported for comparable technologies. We provide a unique clinical demonstration of the capaciflector as an accurate breathing monitor, which may have the potential to become a simple and affordable medical device.Clinical trial number: NCT03832205 https://clinicaltrials.gov/ct2/show/NCT03832205 registered February 6th, 2019.
Published: 2022

8. Design and conduct of Xtreme Everest 2: An observational cohort study of Sherpa and lowlander responses to graduated hypobaric hypoxia [version 1; referees: 2 approved]

Author: Edward Gilbert-Kawai, Adam Sheperdigian, Thomas Adams, Kay Mitchell, Martin Feelisch, Andrew Murray, Mark Peters, Grace Gilbert-Kawai, Hugh Montgomery, Denny Levett, Rajendra Kumar, Michael Mythen, Michael Grocott, and Daniel Martin
Subjects: Study Protocol, Articles, Airway/Respiratory Physiology, Extrapulmonary Disorders & Therapeutic Interventions, Respiratory Problems in Critical Care, Hypoxia, Critical care, Sherpa, High altitude, Microcirculation, Nitric Oxide, Mitochondria
Abstract: Objective: Oxygen availability falls with ascent to altitude and also as a consequence of critical illness. Because cellular sequelae and adaptive processes may be shared in both circumstances, high altitude exposure (‘physiological hypoxia’) assists in the exploration of the response to pathological hypoxia. We therefore studied the response of healthy participants to progressive hypobaric hypoxia at altitude. The primary objective of the study was to identify differences between high altitude inhabitants (Sherpas) and lowland comparators. Methods: We performed an observational cohort study of human responses to progressive hypobaric hypoxia (during ascent) and subsequent normoxia (following descent) comparing Sherpas with lowlanders. Studies were conducted in London (35m), Kathmandu (1300m), Namche Bazaar (3500m) and Everest Base Camp (5300m). Of 180 healthy volunteers departing from Kathmandu, 64 were Sherpas and 116 were lowlanders. Physiological, biochemical, genetic and epigenetic data were collected. Core studies focused on nitric oxide metabolism, microcirculatory blood flow and exercise performance. Additional studies performed in nested subgroups examined mitochondrial and metabolic function, and ventilatory and cardiac variables. Of the 180 healthy participants who left Kathmandu, 178 (99%) completed the planned trek. Overall, more than 90% of planned testing was completed. Forty-four study protocols were successfully completed at altitudes up to and including 5300m. A subgroup of identical twins (all lowlanders) was also studied in detail. Conclusion: This programme of study (Xtreme Everest 2) will provide a rich dataset relating to human adaptation to hypoxia, and the responses seen on re-exposure to normoxia. It is the largest comprehensive high altitude study of Sherpas yet performed. Translational data generated from this study will be of relevance to diseases in which oxygenation is a major factor.
Published: 2015
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9. Perioperative Quality Initiative consensus statement on intraoperative blood pressure, risk and outcomes for elective surgery

Author: Daniel I. Sessler, Joshua A. Bloomstone, Solomon Aronson, Colin Berry, Tong J. Gan, John A. Kellum, James Plumb, Monty G. Mythen, Michael P.W. Grocott, Mark R. Edwards, Timothy E. Miller, Michael PW. Grocott, Gareth L. Ackland, Charles S. Brudney, Maurizio Cecconi, Can Ince, Michael G. Irwin, Jonathan Lacey, Michael R. Pinsky, Robert Sanders, Finton Hughes, Angela Bader, Annemarie Thompson, Andreas Hoeft, David Williams, Andrew D. Shaw, Sol Aronson, John Kellum, Joshua Bloomstone, Matthew D. McEvoy, Julie K.M. Thacker, Ruchir Gupta, Elena Koepke, Aarne Feldheiser, Denny Levett, Frederic Michard, and Mark Hamilton
Subjects: Anesthesiology and Pain Medicine
Published: 2019
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10. Perioperative Quality Initiative consensus statement on the physiology of arterial blood pressure control in perioperative medicine

Author: Gareth L. Ackland, Charles S. Brudney, Maurizio Cecconi, Can Ince, Michael G. Irwin, Jonathan Lacey, Michael R. Pinsky, Michael PW. Grocott, Monty G. Mythen, Mark R. Edwards, Timothy E. Miller, Robert Sanders, Finton Hughes, Angela Bader, Annemarie Thompson, Andreas Hoeft, David Williams, Andrew D. Shaw, Daniel I. Sessler, Sol Aronson, Colin Berry, Tong J. Gan, John Kellum, James Plumb, Joshua Bloomstone, Matthew D. McEvoy, Julie K.M. Thacker, Ruchir Gupta, Elena Koepke, Aarne Feldheiser, Denny Levett, Frederic Michard, Mark Hamilton, Intensive Care, Translational Physiology, and ACS - Microcirculation
Subjects: Delphi Technique, Physiology, Hemodynamics, Perioperative Care, law.invention, 03 medical and health sciences, 0302 clinical medicine, 030202 anesthesiology, law, medicine, Homeostasis, Humans, Arterial Pressure, Perioperative medicine, business.industry, Microcirculation, Blood Pressure Determination, Perioperative, Blood flow, Blood Pressure Monitoring, Ambulatory, Anesthesiology and Pain Medicine, Pressure measurement, medicine.anatomical_structure, Blood pressure, Vascular resistance, business, Perfusion
Abstract: Background Perioperative arterial blood pressure management is a physiologically complex challenge influenced by multiple factors. Methods A multidisciplinary, international working subgroup of the Third Perioperative Quality Initiative (POQI) consensus meeting reviewed the (patho)physiology and measurement of arterial pressure as applied to perioperative medicine. We addressed predefined questions by undertaking a modified Delphi analysis, in which primary clinical research and review articles were identified using MEDLINE. Strength of recommendations, where applicable, were graded by National Institute for Health and Care Excellence (NICE) guidelines. Results Multiple physiological factors contribute to the perioperative physiological importance of arterial pressure: (i) arterial pressure is the input pressure to organ blood flow, but is not the sole determinant of perfusion pressure; (ii) blood flow is often independent of changes in perfusion pressure because of autoregulatory changes in vascular resistance; (iii) microvascular dysfunction uncouples microvascular blood flow from arterial pressure (haemodynamic incoherence). From a practical clinical perspective, we identified that: (i) ambulatory measurement is the optimal method to establish baseline arterial pressure; (ii) automated and invasive arterial pressure measurements have inherent physiological and technical limitations; (iii) individualised arterial pressure targets may change over time, especially in the perioperative period. There remains a need for research in non-invasive, continuous arterial pressure measurements, macro- and micro-circulatory control, regional perfusion pressure measurement, and the development of sensitive, specific, and continuous measures of cellular function to evaluate blood pressure management in a physiologically coherent manner. Conclusion The multivariable, complex physiology contributing to dynamic changes in perioperative arterial pressure may be underappreciated clinically. The frequently unrecognised dissociation between arterial pressure, organ blood flow, and microvascular and cellular function requires further research to develop a more refined, contextualised clinical approach to this routine perioperative measurement.
Published: 2019
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11. Perioperative Quality Initiative consensus statement on preoperative blood pressure, risk and outcomes for elective surgery

Author: Robert D. Sanders, Fintan Hughes, Andrew Shaw, Annemarie Thompson, Angela Bader, Andreas Hoeft, David A. Williams, Michael P.W. Grocott, Monty G. Mythen, Timothy E. Miller, Mark R. Edwards, Michael PW. Grocott, Gareth L. Ackland, Charles S. Brudney, Maurizio Cecconi, Can Ince, Michael G. Irwin, Jonathan Lacey, Michael R. Pinsky, Robert Sanders, Finton Hughes, David Williams, Andrew D. Shaw, Daniel I. Sessler, Sol Aronson, Colin Berry, Tong J. Gan, John Kellum, James Plumb, Joshua Bloomstone, Matthew D. McEvoy, Julie K.M. Thacker, Ruchir Gupta, Elena Koepke, Aarne Feldheiser, Denny Levett, Frederic Michard, and Mark Hamilton
Subjects: medicine.medical_specialty, business.industry, MEDLINE, Diastole, Hemodynamics, Perioperative, medicine.disease, Discontinuation, 03 medical and health sciences, 0302 clinical medicine, Anesthesiology and Pain Medicine, Blood pressure, 030202 anesthesiology, Emergency medicine, Medicine, Myocardial infarction, Elective surgery, business
Abstract: Background A multidisciplinary international working subgroup of the third Perioperative Quality Initiative consensus meeting appraised the evidence on the influence of preoperative arterial blood pressure and community cardiovascular medications on perioperative risk. Methods A modified Delphi technique was used, evaluating papers published in MEDLINE on associations between preoperative numerical arterial pressure values or cardiovascular medications and perioperative outcomes. The strength of the recommendations was graded by National Institute for Health and Care Excellence guidelines. Results Significant heterogeneity in study design, including arterial pressure measures and perioperative outcomes, hampered the comparison of studies. Nonetheless, consensus recommendations were that (i) preoperative arterial pressure measures may be used to define targets for perioperative management; (ii) elective surgery should not be cancelled based solely upon a preoperative arterial pressure value; (iii) there is insufficient evidence to support lowering arterial pressure in the immediate preoperative period to minimise perioperative risk; and (iv) there is insufficient evidence that any one measure of arterial pressure (systolic, diastolic, mean, or pulse) is better than any other for risk prediction of adverse perioperative events. Conclusions Future research should define which preoperative arterial pressure values best correlate with adverse outcomes, and whether modifying arterial pressure in the preoperative setting will change the perioperative morbidity or mortality. Additional research should define optimum strategies for continuation or discontinuation of preoperative cardiovascular medications.
Published: 2019
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12. Elective surgery cancellations due to the COVID-19 pandemic: global predictive modelling to inform surgical recovery plans

Author: Annika Heuer, Abraham Hulst, NTIRENGANYA Faustin, Giacomo Monti, Stephen Choi, Edward J Caruana, Kresimir Oremus, Kathryn Haigh, Amanda Koh, Denis Protsenko, Ana Maria Minaya Bravo, Abegail Salvana, Mahdad Noursadeghi, Rhiannon Harries, Ayyaz Hussain, Sathish Muthu, Professor T E Madiba, Jie Wu, Maria Wittmann, Donaldo S Arteta-Arteta, Mona Momeni, Mary T. Nabukenya, Birender Balain, Irina Paziuk, Matthew Chan, TRIANTAFYLLIA KOUKOUBANI, Gabrielle Van Ramshorst, Gianluca Pellino, Haya Deeb, Daniele Sances, Salomone Di Saverio, Fernando Cordera, Olufemi Bankole, Patrice Forget, Chu Yik Tang, Daniel Conway, Alejandro Suarez de la Rica, E. Christiaan Boerma, Dion Morton, John Edwards, Markus W. Löffler, ANASTASIA SPARTINOU, Daiana Taddeo, VIKAS KAURA, David Choi, Akbar Vohra, Francesco Della Corte, Alexander Durst, Sebastian Tranca, Samuel Ford, Rajkumar Rajendram, Christina Bali, Bosede Afolabi, Nicola Petrucci, Anne Godier, Dmitri Nepogodiev, Rocco D'andrea, Dana Tomescu, Hans Lederhuber, LAURA GAVRIL, Chetan Khatri, Gabriela Droc, Rupert Pearse, Janet Martin, Ari Ercole, Ibironke Desalu, Dejan Radenkovic, Luis Martin-Villen, Alvaro Rea-Neto, Pablo Monedero, Thomas Pinkney, Stuart White, Antonino Spinelli, Manu Malbrain, Bisola Onajin-Obembe, Tom Lawton, Goran Tulic, R. Arthur Bouwman, Shaktiman Singh, Keith Couper, Benedikt Preckel, Osaid Alser, Isabel Gracia, Daniel Cox, Oumaima Outani, Luís Bento, Stephen Webb, Marzida Mansor, Florent Wallet, Konstantinos Stamatiou, Adesoji Ademuyiwa, Bodil Steen Rasmussen, James Glasbey, Nelson Barros, Adewale Adisa, Olanrewaju Akanmu, Ryckie Wade, Joana Berger-Estilita, Stefano Turi, Sigita Kazune, Ewen Harrison, Mihai Stefan, ANTHONY ADENEKAN, Dhruva Ghosh, Sohini Chakrabortee, Mary Venn, Irène Santos, Michael Sander, Vincent Minville, Francisco Javier Redondo Calvo, Naomi Wright, Ismaïl LAWANI, James Haddow, Axel R. Heller, Anders Oldner, Cesar Aldecoa, Savino Spadaro, Robert Parker, Jibril Bello, Tamas Szakmany, Dhruv Parekh, Alberto ZANGRILLO, LUC HUYGHENS, Beatriz Tena, Tom Abbott, Richard Wilkin, Ulrich Goebel, Anca Irina Ristescu, RODRIGO POVES ALVAREZ, Carlos Silva Faria, Hidde M Kroon, José Azevedo, Herman Lule, Orestis Ioannidis, Sandra Jumbe, Peter Hutchinson, Ayaz Ali, Caroline Holaubek, Luke Hopkins, Kirsten Moller, Morten Bestle, Patricia Alfaro de la Torre, Hyla-Louise Kluyts, Evgeny Grigoryev, Shaman Jhanji, Timothy Cook, Carolina Soledad Romero Garcia, Wolfgang Buhre, Denny Levett, Stefan De Hert, Bianchin Andrea, Monir Jawad, Nicoletta Fossati, Matthias Unterberg, Gianluca Castellani, Oliver Warren, Simon Burg, Jose Trenado Álvarez, Franco Ruberto, Adeline Rankin, Arash Afshari, Gerald Ekwen, Helena Barrasa, Andrew Schache, Carlos Ferrando, Johannes Doerner, Hwei Jene Ng, Ruth Blanco-Colino, Sean Ezekiel Seow, Artigas Antonio, Pablo Lozano Lominchar, Dennis Mazingi, Giovanni LANDONI, Martin Hübner, Weng Ken Chan, Hassan Mashbari, Milagros Niquen-Jimenez, Timothy Short, Mikhail Kirov, Alexander Kulikov, Abdulmueti Alhadi, Frederick Van der Merwe, Mahmoud ElFiky, Kai Henrik Wiborg Lange, Gaetano Gallo, Gustavo Mendonça Ataíde Gomes, Aneel Bhangu, Ioana Grigoras, Carlos Serón, Siobhan McKay, Ruth A Benson, Xavier Borrat, Markus Hollmann, Juan José Segura-Sampedro, Devnandan Chatterjee, and Birgitte Brandsborg
Subjects: medicine.medical_specialty, Coronavirus disease 2019 (COVID-19), business.industry, General surgery, 030230 surgery, 03 medical and health sciences, 0302 clinical medicine, Case mix index, Surgical recovery, Pandemic, medicine, Elective surgery, Elective Surgical Procedure, business, Elective caesarean, health care economics and organizations, Predictive modelling
Abstract: Background: The COVID-19 pandemic has disrupted routine hospital services globally. This study estimated the total number of adult elective operations that would be cancelled worldwide during the 12 weeks of peak disruption due to COVID-19. Methods: A global expert response study was conducted to elicit projections for the proportion of elective surgery that would be cancelled or postponed during the 12 weeks of peak disruption. A Bayesian β-regression model was used to estimate 12-week cancellation rates for 190 countries. Elective surgical case-mix data, stratified by specialty and indication (surgery for cancer versus benign disease), were determined. This case mix was applied to country-level surgical volumes. The 12-week cancellation rates were then applied to these figures to calculate the total number of cancelled operations. Results: The best estimate was that 28 404 603 operations would be cancelled or postponed during the peak 12 weeks of disruption due to COVID-19 (2 367 050 operations per week). Most would be operations for benign disease (90·2 per cent, 25 638 922 of 28 404 603). The overall 12-week cancellation rate would be 72·3 per cent. Globally, 81·7 per cent of operations for benign conditions (25 638 922 of 31 378 062), 37·7 per cent of cancer operations (2 324 070 of 6 162 311) and 25·4 per cent of elective caesarean sections (441 611 of 1 735 483) would be cancelled or postponed. If countries increased their normal surgical volume by 20 per cent after the pandemic, it would take a median of 45 weeks to clear the backlog of operations resulting from COVID-19 disruption. Conclusion: A very large number of operations will be cancelled or postponed owing to disruption caused by COVID-19. Governments should mitigate against this major burden on patients by developing recovery plans and implementing strategies to restore surgical activity safely.
Published: 2020
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13. Perioperative Quality Initiative consensus statement on postoperative blood pressure, risk and outcomes for elective surgery

Author: Matthew D. McEvoy, Ruchir Gupta, Elena J. Koepke, Aarne Feldheiser, Frederic Michard, Denny Levett, Julie K.M. Thacker, Mark Hamilton, Michael P.W. Grocott, Monty G. Mythen, Timothy E. Miller, Mark R. Edwards, Michael PW. Grocott, Gareth L. Ackland, Charles S. Brudney, Maurizio Cecconi, Can Ince, Michael G. Irwin, Jonathan Lacey, Michael R. Pinsky, Robert Sanders, Finton Hughes, Angela Bader, Annemarie Thompson, Andreas Hoeft, David Williams, Andrew D. Shaw, Daniel I. Sessler, Sol Aronson, Colin Berry, Tong J. Gan, John Kellum, James Plumb, Joshua Bloomstone, Elena Koepke, and Intensive Care
Subjects: Anesthesiology and Pain Medicine
Published: 2019

14. Critical care admission following elective surgery was not associated with survival benefit

Author: Kahan, Brennan C., Desponia, Koulenti, Kostoula, Arvaniti, Vanessa, Beavis, Douglas, Campbell, Matthew, Chan, Rui, Moreno, Pearse, Rupert M., Scott, Beattie, Pierre-Alain, Clavien, Nicolas, Demartines, Lee, A Fleisher, Mike, Grocott, James, Haddow, Andreas, Hoeft, Peter, Holt, Naomi, Pritchard, Andrew, Rhodes, Duminda, Wijeysundera, Matt, Wilson, Tahania, Ahmed, Kirsty, Everingham, Russell, Hewson, Marta, Januszewska, Rupert, M Pearse, Mandeep-Kaur, Phull, Richard, Halliwell, Mark, Shulman, Paul, Myles, Werner, Schmid, Michael, Hiesmayr, Patrick, Wouters, Stefan de Hert, Suzana, Lobo, Xiangming, Fang, Lars, Rasmussen, Emmanuel, Futier, Matthieu, Biais, Aurélien, Venara, Karem, Slim, Michael, Sander, Despoina, Koulenti, Mathew, Chan, Atul, Kulkarni, Susilo, Chandra, Aida, Tantri, Emad, Geddoa, Muntadhar, Abbas, Giorgio Della Rocca, Datin, Sivasakthi, Marzida, Mansor, Pastor, Luna, Arthur, Bouwman, Wolfgang, Buhre, Tim, Short, Tunde, Osinaike, Ricardo, Matos, Ioana, Grigoras, Mikhail, Kirov, Denis, Protsenko, Bruce, Biccard, Cesar, Aldecoa, Michelle, Chew, Christoph, Hofer, Martin, Hubner, James, Ditai, Tamas, Szakmany, Lee, Fleisher, Marissa, Ferguson, Michael, Macmahon, Ritchie, Cherian, Helen, Currow, Kathirgamanathan, Kanathiban, David, Gillespie, Edward, Pathmanathan, Katherine, Phillips, Jenifer, Reynolds, Joanne, Rowley, Jeanene, Douglas, Ross, Kerridge, Sameer, Garg, Michael, Bennett, Megha, Jain, David, Alcock, Nico, Terblanche, Rochelle, Cotter, Kate, Leslie, Marcelle, Stewart, Nicolette, Zingerle, Antony, Clyde, Oliver, Hambidge, Adam, Rehak, Sharon, Cotterell, Wilson Binh Quan Huynh, Timothy, Mcculloch, Erez, Ben-Menachem, Thomas, Egan, Jennifer, Cope, Paul, Fellinger, Simone, Haselberger, Caroline, Holaubek, Paul, Lichtenegger, Florian, Scherz, Franz, Hoffer, Veronika, Cakova, Andreas, Eichwalder, Norbert, Fischbach, Reinhold, Klug, Elisabeth, Schneider, Martin, Vesely, Reinhart, Wickenhauser, Karl Gernot Grubmueller, Marion, Leitgeb, Friedrich, Lang, Nancy, Toro, Marlene, Bauer, Friedrich, Laengle, Thomas, Mayrhofer, Christian, Buerkle, Karin, Forstner, Reinhard, Germann, Harald, Rinoesl, Elke, Schindler, Ernst, Trampitsch, Gerhard, Fritsch, Christian, Szabo, Jawad, Bidgoli, Hans, Verdoodt, Patrice, Forget, David, Kahn, Fernande, Lois, Mona, Momeni, Caroline, Prégardien, Audrey, Pospiech, Arnaud, Steyaert, Laurent, Veevaete, Dirk De Kegel, Karen De Jongh, Luc, Foubert, Carine, Smitz, Marcel, Vercauteren, Jan, Poelaert, Veerle Van Mossevelde, Jacques, Abeloos, Stefaan, Bouchez, Marc, Coppens, Luc De Baerdemaeker, Isabel, Deblaere, Ann De Bruyne, Stefan De Hert, Kristine, Fonck, Bjorn, Heyse, Tom, Jacobs, Koen, Lapage, Anneliese, Moerman, Martine, Neckebroek, Aliaksandra, Parashchanka, Nathalie, Roels, Nancy Van Den Eynde, Michael, Vandenheuvel, Jurgen Van Limmen, Ann, Vanluchene, Caroline, Vanpeteghem, Piet, Wyffels, Christel, Huygens, Punitha, Vandenbempt, Marc Van de Velde, Dimitri, Dylst, Bruno, Janssen, Evelien, Schreurs, Fábia Berganton Aleixo, Keulle, Candido, Hugo Dias Batista, Mario, Guimarães, Jaqueline, Guizeline, João, Hoffmann, Suzana, M Lobo, Francisco Ricardo Lobo, Vinícius, Nascimento, Katia, Nishiyama, Lucas, Pazetto, Daniela, Souza, Rodrigo Souza Rodrigues, Ana Maria Vilela Dos Santos, Jaquelline, Jardim, Joao, Silva, Paulo do Nascimento Junior, Thalissa Hermínia Baio, Gabriel Isaac Pereira de Castro, Henri Roger Watanabe Oliveira, Cristina Prata Amendola, Gutemberg, Cardoso, Daniela, Ortega, Ana Flavia Brotto, Mirella Cristine De Oliveira, Álvaro, Réa-Neto, Fernando, Dias, Pedro, Azambuja, Marcos Freitas Knibel, Antonio, Martins, William, Almeida, Calim Neder Neto, Maria Angela Tardelli, Eliana, Caser, Marcio, Machado, Crisitiano, Aguzzoli, Sérgio, Baldisserotto, Fernanda Beck Tabajara, Fernanda, Bettega, La Hore Correa Rodrigues Júnior, Julia de Gasperi, Lais, Faina, Marcos Farias Nolasco, Bruna Ferreira da Costa Fischer, Mariana Fosch de Campos Ferreira, Cristina, Hartmann, Marta, Kliemann, Gustavo Luis Hubert Ribeiro, Julia Merladete Fraga, Thiago Motta Netto, Laura Valduga Pozza, Paulo Rafael Wendling, Caroline, Azevedo, Juliana, Garcia, Marcel, Lopes, Bernardo, Maia, Paula, Maselli, Ralph, Melo, Weslley, Mendes, Matheus, Neves, Jacqueline, Ney, Claudio, Piras, Christopher, Applewhaite, Adrienne, Carr, Lorraine, Chow, Kaylene, Duttchen, Julena, Foglia, Michael, Greene, Ashley, Hinther, Kendra, Houston, Thomas Jared McCormick, Jennifer, Mikhayel, Sam, Montasser, Alex, Ragan, Andrew, Suen, Adrianna, Woolsey, Hai Chuan Yu, Duane, Funk, Stephen, Kowalski, Regina, Legaspi, Heather, Mcdonald, Faisal, Siddiqui, Jeremy, Pridham, Bernadette, Rowe, Sonia, Sampson, Barton, Thiessen, Geoff, Zbitnew, Andre, Bernard, Ronald, George, Philip, Jones, Rita, Moor, Naveed, Siddiqui, Alexandra, Wolfer, Diem, Tran, Denyse, Winch, Gary, Dobson, Thomas, Mccormick, Osama, Montasser, Richard, Hall, Leyla, Baghirzada, Si Yuan Dai, Gregory, Hare, Esther, Lee, Uma, Shastri, Albert, Tsui, Anmol, Yagnik, Danielle, Alvares, Stephen, Choi, Heather, Dwyer, Kathrina, Flores, Colin, Mccartney, Priya, Somascanthan, Carroll, Jo, Janneth, Pazmino-Canizares, Noam, Ami, Vincent, Chan, Anahi, Perlas, Ruth, Argue, Katie, Lavis, Kelly, Mayson, Ying, Cao, Hong, Gao, Tingju, Hu, Jie, Lv, Jian, Yang, Yang, Yang, Zhong, Yi, Jing, Zhou, Xiaohua, Zou, Miao, He, Xiaoying, Li, Dihuan, Luo, Haiying, Wang, Tian, Yu, Liyong, Chen, Lijun, Wang, Yunfei, Cai, Zhongming, Cao, Yanling, Li, Jiaxin, Lian, Haiyun, Sun, Sheng, Wang, Zhipeng, Wang, Kenru, Wang, Zhu, Yi, Xindan, Du, Hao, Fan, Yunbin, Fu, Lixia, Huang, Yanming, Huang, Haifang, Hwan, Hong, Luo, Pi-Sheng, Qu, Fan, Tao, Zhen, Wang, Guoxiang, Wang, Shun, Wang, Yan, Zhang, Xiaolin, Zhang, Chao, Chen, Weixing, Wang, Zhengyuan, Liu, Lihua, Fan, Jing, Tang, Yijun, Chen, Yongjie, Chen, Yangyang, Han, Changshun, Huang, Guojin, Liang, Jing, Shen, Jun, Wang, Qiuhong, Yang, Jungang, Zhen, Haidong, Zhou, Junping, Chen, Zhang, Chen, Xiaoyu, Li, Meng, Bo, Haiwang, Ye, Xiaoyan, Zhang, Yanbing, Bi, Jianqiao, Cao, Fengying, Guo, Hong, Lin, Yang, Liu, Meng, Lv, Pengcai, Shi, Xiumei, Song, Chuanyu, Sun, Yongtao, Sun, Yuelan, Wang, Shenhui, Wang, Min, Zhang, Rong, Chen, Jiabao, Hou, Yan, Leng, Qing-Tao, Meng, Qian, Li, Zi-Ying, Shen, Zhong-Yuan, Xia, Rui, Xue, Yuan, Zhang, Zhao, Bo, Xian-Jin, Zhou, Qiang, Chen, Huinan, Guo, Yongqing, Guo, Yuehong, Qi, Zhi, Wang, Jianfeng, Wei, Weiwei, Zhang, Lina, Zheng, Bao, Qi, Yaqiu, Chen, Yijiao, Chen, Yue, Fei, Nianqiang, Hu, Xuming, Hu, Min, Lei, Xiaoqin, Li, Xiaocui, Lv, Fangfang, Miao, Lingling, Ouyang, Qian, Lu, Conyu, Shen, Sun, Yu, Yuting, Wang, Dong, Wang, Chao, Wu, Liyuan, Xu, Jiaqi, Yuan, Lina, Zhang, Huan, Zhang, Yapping, Zhang, Jinning, Zhao, Chong, Zhao, Lei, Zhao, Tianzhao, Zheng, Dachun, Zhou, Haiyan, Zhou, Zhou, Ce, Kaizhi, Lu, Ting, Zhao, Changlin, He, Hong, Chen, Shasha, Chen, Baoli, Cheng, Jie, He, Lin, Jin, Caixia, Li, Hui, Li, Yuanming, Pan, Yugang, Shi, Xiao Hong Wen, Shuijing, Wu, Guohao, Xie, Kai, Zhang, Bing, Zhao, Xianfu, Lu, Feifei, Chen, Qisheng, Liang, Xuewu, Lin, Yunzhi, Ling, Gang, Liu, Jing, Tao, Yang, Lu, Jialong, Zhou, Fumei, Chen, Yunlin, Feng, Benchao, Hou, Jiamei, Lin, Mei, Liu, Foquan, Luo, Xiaoyun, Shi, Yingfen, Xiong, Lin, Xu, Shuangjia, Yang, Qin, Zhang, Huaigen, Zhang, Weihong, Zhao, Weilu, Zhao, Yun, Bai, Linbi, Chen, Sijia, Chen, Qinxue, Dai, Wujun, Geng, Kunyuan, Han, Xin, He, Luping, Huang, Binbin, Ji, Danyun, Jia, Shenhui, Jin, Qianjun, Li, Dongdong, Liang, Shan, Luo, Lulu, Lwang, Yunchang, Mo, Yuanyuan, Pan, Xinyu, Qi, Meizi, Qian, Jinling, Qin, Yelong, Ren, Yiyi, Shi, Junlu, Wang, Junkai, Wang, Leilei, Wang, Junjie, Xie, Yixiu, Yan, Yurui, Yao, Mingxiao, Zhang, Jiashi, Zhao, Xiuxiu, Zhuang, Yanqiu, Ai, Fang, Du, Long, He, Ledan, Huang, Zhisong, Li, Huijuan, Li, Yetong, Li, Liwei, Li, Meng, Su, Yazhuo, Yuan, Enman, Zhang, Jie, Zhang, Shuna, Zhao, Zhenrong, Ji, Ling, Pei, Wang, Li, Chen, Chen, Beibei, Dong, Jing, Li, Ziqiang, Miao, Hongying, Mu, Chao, Qin, Lin, Su, Zhiting, Wen, Keliang, Xie, Yonghao, Yu, Fang, Yuan, Xianwen, Hu, Zhang, Ye, Wangpin, Xiao, Zhipeng, Zhu, Qingqing, Dai, Kaiwen, Fu, Rong, Hu, Xiaolan, Hu, Song, Huang, Yaqi, Li, Yingping, Liang, Shuchun, Yu, Zheng, Guo, Yan, Jing, Tang, Na, Jie, Wu, Dajiang, Yuan, Ruilin, Zhang, Xiaoying, Zhao, Yuhong, Li, Hui-Ping, Bai, Chun-Xiao, Liu, Fei-Fei, Liu, Wei, Ren, Xiu-Li, Wang, Guan-Jie, Xu, Na, Hu, Bo, Li, Yangwen, Ou, Yongzhong, Tang, Shanglong, Yao, Shihai, Zhang, Cui-Cui, Kong, Bei, Liu, Tianlong, Wang, Wei, Xiao, Bo, Lu, Yanfei, Xia, Jiali, Zhou, Fang, Cai, Pushan, Chen, Shuangfei, Hu, Hongfa, Wang, Qiong, Xu, Liu, Hu, Liang, Jing, Bin, Li, Qiang, Liu, Yuejiang, Liu, Xinjian, Lu, Zhen Dan Peng, Xiaodong, Qiu, Quan, Ren, Youliang, Tong, Jin, Wang, Yazhou, Wen, Qiong, Wu, Jiangyan, Xia, Jue, Xie, Xiapei, Xiong, Shixia, Xu, Tianqin, Yang, Hui, Ye, Ning, Yin, Jing, Yuan, Qiuting, Zeng, Baoling, Zhang, Kang, Zheng, Jing, Cang, Shiyu, Chen, Fan, Yu, Shuying, Fu, Xiaodong, Ge, Baolei, Guo, Wenhui, Huang, Linghui, Jiang, Xinmei, Jiang, Liu, Yi, Yan, Pan, Yun, Ren, Shan, Qi, Jiaxing, Wang, Fei, Wang, Chi, Wu, Xiaoguang, Zhang, Ida Cecilie Christiansen, Simon Nørgaard Granum, Bodil Steen Rasmussen, Morten, Daugaard, Rajiv, Gambhir, Guðný Erla Steingrímsdóttir, Peter, Jensen-Gadegaard, Karsten Skovgaard Olsen, Hanna, Siegel, Katrine Zwicky Eskildsen, Mona Ring Gätke, Ida, Wibrandt, Simon Bisgaard Heintzelmann, Kai Henrik Wiborg Lange, Rune Sarauw Lundsgaard, Louise, Amstrup-Hansen, Claus, Hovendal, Michael, Larsen, Mette, Lenstrup, Tina, Kobborg, Jens Rolighed Larsen, Anette Barbre Pedersen, Søren Hübertz Smith, Rebecca Monett Oestervig, Arash, Afshari, Cheme, Andersen, Kim, Ekelund, Erik Lilja Secher, Birgitte, Brandsborg, Helene, Beloeil, Sigismond, Lasocki, Alexandre, Ouattara, Marlene, Sineus, Serge, Molliex, Marie Lim Legouge, Florent, Wallet, Antoine, Tesniere, Christophe, Gaudin, Paul, Lehur, Emma, Forsans, Stéphane de Rudnicki, Valerie Serra Maudet, Didier, Mutter, Ghassan, Sojod, Mehdi, Ouaissi, Jean-Marc, Regimbeau, Jacques, Desbordes, Nicolas, Comptaer, Diae El Manser, Sabine, Ethgen, Gilles, Lebuffe, Patrick, Auer, Christine, Härtl, Maria, Deja, Kirill, Legashov, Susanne, Sonnemann, Carola, Wiegand-Loehnert, Elke, Falk, Marit, Habicher, Stefan, Angermair, Beatrix, Laetsch, Katrin, Schmidt, Christian Von Heymann, Axel, Ramminger, Florian, Jelschen, Svenja, Pabel, Andreas, Weyland, Elke, Czeslick, Jochen, Gille, Michael, Malcharek, Armin, Sablotzki, Katharina, Lueke, Peter, Wetzel, Joerg, Weimann, Franz-Peter, Lenhart, Florian, Reichle, Frederike, Schirmer, Michael, Hüppe, Karl, Klotz, Carla, Nau, Julika, Schön, Thomas, Mencke, Christina, Wasmund, Carla, Bankewitz, Georg, Baumgarten, Andreas, Fleischer, Vera, Guttenthaler, Yvonne, Hack, Katharina, Kirchgaessner, Olja, Männer, Marlen, Schurig-Urbaniak, Rafael, Struck, Rebekka van Zyl, Maria, Wittmann, Ulrich, Goebel, Sarah, Harris, Siegfried, Veit, Evangelia, Andreadaki, Flora, Souri, Ioannis, Katsiadramis, Anthi, Skoufi, Maria, Vasileiou, Eleni, Aimoniotou-Georgiou, Anastasios, Katsourakis, Fotini, Veroniki, Glyceria, Vlachogianni, Konstantina, Petra, Dimitra, Chlorou, Eirini, Oloktsidou, Vasileios, Ourailoglou, Konstantinos, Papapostolou, Georgia, Tsaousi, Panagoula, Daikou, Georgia, Dedemadi, Ioannis, Kalaitzopoulos, Christos, Loumpias, Sotirios, Bristogiannis, Nikolaos, Dafnios, Georgios, Gkiokas, Elissaios, Kontis, Dimitra, Kozompoli, Aspasia, Papailia, Theodosios, Theodosopoulos, Christol, Bizios, Anastasia, Koutsikou, Aleaxandra, Moustaka, Ioannis, Plaitakis, Apostolos, Armaganidis, Theodora, Christodoulopoulou, Mihail, Lignos, Maria, Theodorakopoulou, Andreas, Asimakos, Eleni, Ischaki, Angeliki, Tsagkaraki, Spyros, Zakynthinos, Eleni, Antoniadou, Ioannis, Koutelidakis, Dimitrios, Lathyris, Irene, Pozidou, Nikolaos, Voloudakis, Maria, Dalamagka, Elena, Gkonezou, Christos, Chronis, Dimitra, Manolakaki, Dimitris, Mosxogiannidis, Tatiana, Slepova, Isaia-Sissy, Tsakiridou, Claire Lampiri Lampiri, Anastasia Vachlioti Vachlioti, Christos Panagiotakis Panagiotakis, Dimitrios Sfyras Sfyras, Fotios Tsimpoukas Tsimpoukas, Athanasia, Tsirogianni, Elena, Axioti, Andreas, Filippopoulos, Elli, Kalliafa, George, Kassavetis, Petros, Katralis, Ioannis, Komnos, Georgios, Pilichos, Ifigenia, Ravani, Antonis, Totis, Eymorfia, Apagaki, Andromachi, Efthymiadi, Nikolaos, Kampagiannis, Theoniki, Paraforou, Agoritsa, Tsioka, Georgios, Georgiou, Aristeidis, Vakalos, Aggeliki, Bairaktari, Efthimios, Charitos, George, Markou, Panagiota, Niforopoulou, Nikolaos, Papakonstantinou, Evdoxia, Tsigou, Archontoula, Xifara, Menelaos, Zoulamoglou, Panagiota, Gkioni, Stylianos, Karatzas, Aikaterini, Kyparissi, Efstratios, Mainas, Ioannis, Papapanagiotou, Theonymfi, Papavasilopoulou, George, Fragandreas, Eleni, Georgopoulou, Eleni, Katsika, Kyriakos, Psarras, Eirini, Synekidou, Maria, Verroiotou, Evangelia, Vetsiou, Donika, Zaimi, Athina, Anagnou, Konstantinos, Apostolou, Theodora, Melissopoulou, Theophilos, Rozenberg, Christos, Tsigris, Georgios, Boutsikos, Vasileios, Kalles, Nikolaos, Kotsalas, Christina, Lavdaiou, Fotini, Paikou, Georgia-Laura, Panagou, Anna, Spring, Ioannis, Botis, Maria, Drimala, Georgios, Georgakakis, Ellada, Kiourtzieva, Panagiota, Ntouma, Apostolos, Prionas, Kyriakos, Xouplidis, Eleftheria, Dalampini, Chrysavgi, Giannaki, Christina, Iasonidou, Orestis, Ioannidis, Athina, Lavrentieva, Athena, Lavrentieva, George, Papageorgiou, Maria, Kokkinoy, Maria, Stafylaraki, Stylianos, Gaitanakis, Periclis, Karydakis, Josef, Paltoglou, Panagiotis, Ponireas, Panagiotis, Chaloulis, Athanasios, Provatidis, Anisoglou, Sousana, Varvara Vanessa Gardikou, Maria, Konstantivelli, Olga, Lataniotou, Elisavet, Lisari, Maria, Margaroni, Konstantinos, Stamatiou, Edouardos, Nikolaidis, Ioannis, Pnevmatikos, Eleni, Sertaridou, Alexandros, Andreou, Eleni, Arkalaki, Elias, Athanasakis, Fotini, Chaniotaki, Aikaterini, Chatzimichali, Maria, Christofaki, Despina, Dermitzaki, Klara, Fiorentza, Georgios, Frantzeskos, Elisavet, Geromarkaki, Kalliopi, Kafkalaki, Marina, Kalogridaki, Konstyllia, Karydi, Sofia, Kokkini, Georgios, Kougentakis, Tatiana, Lefaki, Emmanouhl, Lilitsis, Aikaterini, Makatounaki, Polychronis, Malliotakis, Dimosthenis, Michelakis, Maria, Neonaki, Vasileia, Nyktari, Iliana, Palikyra, Eleftherios, Papadakis, Alexandra, Papaioannou, Konstantinos, Sfakianakis, Maria, Sgouraki, Xenia, Souvatzis, Anastasia, Spartinou, Nefeli, Stefanidou, Paulina, Syrogianni, Georgia, Tsagkaraki, Elena, Arnaoutoglou, Christina, Arnaoutoglou, Christina, Bali, Vasilios, Bouris, Rodamanthos, Doumos, Konstantia-Paraskevi, Gkini, Clio, Kapaktsi, Vasilios, Koulouras, Arian, Lena, Dimitra, Lepida, Evangelos, Michos, Dimitrios, Papadopoulos, Minas, Paschopoulos, Vaia Aliki Rompou, Ioanna, Siouti, Stavros, Tsampalas, Ourania, Ververidou, Georgios, Zilis, Alexandra, Charlalampidoy, Gregory, Christodoulidis, Andreas, Flossos, Konstantinos, Stamoulis, Man Shing Caleb Tsang, Man Shing Tsang, Man Ling Lai, Chi Pang Yip, Hey Man Heymans Chan, Bassanio, Law, Wing Sze Li, Hiu Man Chu, Emily Gar Yee Koo, Chi Cheong Joe Lam, Ka Ho Cheng, Tracy, Lam, Susanna, Chu, Wing Yan Lam, Kin Wai Kevin Wong, Dilys, Kwok, Ching Yue Janice Hung, Wai Kit Jacky Chan, Wing, Lamwong, Chun Kwong Eric Chung, Shu Kai Ma, Shuchi, Kaushik, Bhagyesh, Shah, Dhiren, Shah, Sanjay, Shah, Praburaj, Ar, Radhakrishnan, Muthuchellappan, Vandana, Agarwal, Jigeeshu, Divatia, Sanghamitra, Mishra, Ganesh, Nimje, Swati, Pande, Sukhada, Savarkar, Aditi, Shrivastava, Martin, Thomas, Shashikant, Yegnaram, Rahmat, Hidayatullah, Nasman, Puar, Sumara, Niman, Imai, Indra, Zulkarnain, Hamzah, Annika, Yuliana, Ucu Nurhadiat Abidin, Ade Nurkacan Dursin, Andri, Kurnia, Ade, Susanti, Dini, Handayani, Mahaalit Alit Aribawa, Aryabiantara, Arya, Tjokorda Gde Agung Senapathi, Utara Hartawan Utara, Widnyana Made Wid, Semarawima, Wima, Wiryana Made Wir, Brillyan, Jehosua, Jonathan, Kaunang, Eka Yudha Lantang, Rini, Najoan, Neil, Waworuntu, Hadi, Awad, Akram, Fuad, Burair, Geddoa, Abdel Razzaq Khalaf, Sabah Al Hussaini, Safauldeensalem, Albaj, Maithem, Kenber, Alessandra, Bettinelli, Savino, Spadaro, Carlo Alberto Volta, Luigi, Giancarlo, Vicari, Sottosanti, Lorenzo, Spagnesi, Ilaria, Toretti, Chiara, Alloj, Silvano, Cardellino, Livio, Carmino, Eleonora, Costanzo, Lucia Caterina Fanfani, Maria Teresa Novelli, Agostino, Roasio, Mattia, Bellandi, Luigi, Beretta, Elena, Bignami, Speranza, Bocchino, Luca, Cabrini, Daniele, Corti, Giovanni, Landoni, Roberta, Meroni, Elena, Moizo, Giacomo, Monti, Margherita, Pintaudi, Valentina Paola Plumari, Daiana, Taddeo, Valentina, Testa, Dario, Winterton, Alberto, Zangrillo, Luigi Maria Cloro, Chiara, Colangelo, Antonio, Colangelo, Giuseppe, Rotunno, Miguel Paludi Angel, Cloro Paolo Maria, Antonio, Pata, Vieri, Parrini, Alessandro, Gatta, Mauro, Nastasi, Carla, Tinti, Mario, Arrigo, Angelo, Benevento, Corrado, Bottini, Maurizio, Cannavo', Christian, Gastaldi, Alessandro, Marchesi, Angelantonio, Pascazio, Pata, Francesco, Emilio, Pozzi, Alberto, Premoli, Gaetano, Tessera, Luca, Boschi, Rocco, D'Andrea, Federico, Ghignone, Gilberto, Poggioli, Andrea, Sibilio, Mario, Taffurelli, Giampaolo, Ugolini, Mohd Azuan Ab Majid, Rusnah Ab Rahman, James, Joseph, Furquan, Pathan, Mohammad Hafizshah Sybil Shah, Huey Ling Yap, Seleen, Cheah, Im Im Chin, Ji Keon Looi, Siew Ching Tan, Sheshendrasurian, Visvalingam, Fan Yin Kwok, Chew Kiok Lee, Tse Siang Tan, Sze Meng Wong, Noor Hairiza Abdullah, Chiat Fong Liew, Lovenia, Luxuman, Nor Hafizah Mohd Zin, Muhamad Faiz Norddin, Raja Liza Raja Alias, Juan Yong Wong, Johnny, Yong, Mohd Tarmimi Bin Mustapha, Weng Ken Chan, Norizawati, Dzulkipli, Pei Xuan Kuan, Yew Ching Lee, Anita, Alias, Eng Ching Guok, Chiun Chen Jee, Brian Rhadamantyne Ramon, Cheng Wong Weng, Fara Nur Idayu Abd Ghafar, Faizal Zuhri Aziz, Nabilah, Hussain, Hooi Sean Lee, Ismawaty, Sukawi, Yuan Liang Woon, Husni Zaeem Abd Hadi, Ummi Azmira Ahmad Azam, Abdul Hafiz Alias, Saiful Aizar Kesut, Jun May Lee, Dar Vin Ooi, Hetty Ayuni Sulaiman, Tengku Alini Tengku Lih, Jeyaganesh, Veerakumaran, Eder, Rojas, Gerardo Esteban Alvarez Resendiz, Darcy Danitza Mari Zapata, Julio Cesar Jesús Aguilar López, Armando Adolfo Alvarez Flores, Juan Carlosc Bravo Amador, Erendira Jocelin Dominguez Avila, Laura Patricia González Aquino, Ricardo Lopez Rodriguez, Mariana Torres Landa, Emma, Urias, Markus, Hollmann, Abraham, Hulst, Osne, Kirzner, Benedikt, Preckel, Ankie Koopman-van Gemert, Marc, Buise, Noortje, Tolenaar, Eric, Weber, Jennifer de Fretes, Peter, Houweling, Patricia, Ormskerk, Jasper Van Bommel, Marcus, Lance, Valerie, Smit-Fun, Tom van Zundert, Peter, Baas, Hans Donald de Boer, Joost, Sprakel, Renske, Elferink-Vonk, Peter, Noordzij, Laura van Zeggeren, Bastiaan, Brand, Rob, Spanjersberg, Janneke Ten Bokkel-Andela, Janneke, Numan, Wilton van Klei, Bas van Zaane, Christa, Boer, Yoni van Duivenvoorde, Jens Peter Hering, Harry, Zonneveldt, Doug, Campbell, Siobhan, Hoare, Sahayam, Santa, Sara Jane Allen, Rachel, Bell, Hyun-Min David Choi, Matthew, Drake, Helen, Farrell, Kushlin, Higgie, Kerry, Holmes, Nicole, Jenkins, Chang Joon Kim, Steven, Kim, Kiew Chai Law, Davina, Mcallister, Karen, Park, Karen, Pedersen, Leesa, Pfeifer, Timothy, Salmond, Martin, Steynor, Michael, Tan, Ellen, Waymouth, Ahmad Sufian Ab Rahman, John, Armstrong, Rosie, Dudson, Nia, Jenkins, Jayashree, Nilakant, Seigne, Richard, Pardeep, Virdi, Liane, Dixon, Roana, Donohue, Mehreen, Farrow, Ross, Kennedy, Henderson, Marissa, Margie, Mckellow, Delany, Nicola, Rebecca, Pascoe, Stephen John Roberts, George, Rowell, Matthew, Sumner, Paul, Templer, Shardha, Chandrasekharan, Graham, Fulton, Jammer, Ib, Marlynn, Ali, Richard, More, Leona, Wilson, Yuan Hsuan Chang, Julia, Chang, Carolyn, Fowler, Jonathan, Panckhurst, Rachel, Sara, Francois, Stapelberg, Veronica, Cherrett, Donna Louise Ganter, Lloyd, Mccann, Julia, Foley, Fiona, Gilmour, Rachelle, Lumsden, Mark, Moores, Sue, Olliff, Elitza, Sardareva, Joyce, Tai, Matthew, Wikner, Christopher, Wong, Mark, Chaddock, Carolyn, Czepanski, Patrick, Mckendry, Daniel, Polakovic, Daniel, Polakovich, Axe, Robert, Margarita Tormo Belda, Tracy, Norton, Fadhel, Alherz, Lisa, Barneto, Alberto, Ramirez, Ahmed, Sayeed, Nicola, Smith, Cambell, Bennett, Shane, Mcquoid, Tracy-Lee, Jansen, Zin, Nico, John, Scott, David, Freschini, Angela, Freschini, Brian, Hopkins, Lara, Manson, Deon, Stoltz, Alexander, Bates, Simon, Davis, Victoria, Freeman, Lynette, Mcgaughran, Swarna Baskar Sharma, Tom, Burrows, Kelly, Byrne, Duane, English, Robert, Johnson, Brendon, Manikkam, Shaun, Naidoo, Margot, Rumball, Nicola, Whittle, Romilla, Franks, Hannah, Gibson-Lapsley, Ryan, Salter, Dean, Walsh, Richard, Cooper, Katherine, Perry, Amos, Obobolo, Umar Musa Sule, Abdurrahman, Ahmad, Mamuda, Atiku, Alhassan Datti Mohammed, Adamu Muhammad Sarki, Oyebola, Adekola, Olanrewaju, 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Bhavika, Daya, Leanne, Drummond, Ali, Elabib, Ehab Helmy Abdel Goad, Ismail, E Goga, Riaz, Goga, Harrichandparsad, R, Richard, E Hodgson, Jordaan, J, Nicky, Kalafatis, Christian, Kampik, T Landers, A, Emil, Loots, Rajhmum, Madansein, Anil, Madaree, Thandinkosi, E Madiba, Vukani, T Manzini, Mbali, Mbuyisa, Rajan, Moodley, Mduduzi, Msomi, Innocent, Mukama, Desigan, Naidoo, Rubeshan, Naidoo, Tesuven, K Naidu, Sindiswa, Ntloko, Eneshia, Padayachee, Lucelle, Padayachee, Martijn, Phaff, Bala, Pillay, Desigan, Pillay, Lutchmee, Pillay, Anupa, Ramnarain, Suren, R Ramphal, Paul, Ryan, Ahmed, Saloojee, Motshedisi, Sebitloane, Noluyolo, Sigcu, Jenna, L Taylor, Alexandra, Torborg, Linda, Visser, Philip, Anderson, Alae, Conradie, Mathew de Swardt, Martin de Villiers, Johan, Eikman, Riaan, Liebenberg, Johan, Mouton, Abbey, Paton, Louwrence van der Merwe, Candice, Wilscott-Davids, Wendy Joan Barrett, Marlet, Bester, Johan de Beer, Jacques, Geldenhuys, Hanni, Gouws, Jan-Hendrik, Potgieter, Magdel, Strydom, Edwin, Wilberforce-Turton, Rubendraj, R Chetty, Subash, Chirkut, Larissa, Cronje, Kim de Vasconcellos, Nokukhanya, Z Dube, N Sibusiso Gama, Garyth, M Green, Randolph, Green-Thompson, Suman Mewa Kinoo, Prenolin, Kistnasami, Kapil, Maharaj, Manogaran, S Moodley, Sibongile, J Mothae, Ruvashni, Naidoo, Aslam, M, Noorbhai, F, Vivesh, Rughubar, Jenendhiran, Reddy, Avesh, Singh, David, L Skinner, Murray, J Smith, Bhagwan, Singh, Ravi, Misra, Maheshwar, Naidoo, Pireshin, Ramdharee, Yvonne, Selibea, Selina, Sewpersad, Shailendra, Sham, Joseph, D Wessels, Cucu, Africander, Tarek, Bejia, Stephen, P Blakemore, Marisa, Botes, Bimalshakth, Bunwarie, Carlos, B Hernandez, Mohammud, A Jeeraz, Dagmara, A Legutko, Acela, G Lopez, Jenine, N De Meyer, Tanaka, Muzenda, Noel, Naidoo, Maryam, Patel, Rao, Pentela, Marina, Junge, Naj, Mansoor, Lana, Rademan, Pawel, Scislowski, Ismail, Seedat, Bianca van den Berg, Doreen van der Merwe, Steyn van Wyk, Komalan, Govender, Darshan, Naicker, Rajesh, Ramjee, 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Tsang, Man Shing, Lai, Man Ling, Yip, Chi Pang, Chan, Hey Man Heyman, Law, Bassanio, Li, Wing Sze, Chu, Hiu Man, Koo, Emily Gar Yee, Lam, Chi Cheong Joe, Cheng, Ka Ho, Lam, Tracy, Chu, Susanna, Lam, Wing Yan, Wong, Kin Wai Kevin, Kwok, Dily, Hung, Ching Yue Janice, Chan, Wai Kit Jacky, LamWong, Wing, Chung, Chun Kwong Eric, Ma, Shu Kai, Kaushik, Shuchi, Shah, Bhagyesh, Shah, Dhiren, Shah, Sanjay, Ar, Praburaj, Muthuchellappan, Radhakrishnan, Agarwal, Vandana, Divatia, Jigeeshu, Mishra, Sanghamitra, Nimje, Ganesh, Pande, Swati, Savarkar, Sukhada, Shrivastava, Aditi, Thomas, Martin, Yegnaram, Shashikant, Hidayatullah, Rahmat, Puar, Nasman, Niman, Sumara, Indra, Imai, Hamzah, Zulkarnain, Yuliana, Annika, Abidin, Ucu Nurhadiat, Dursin, Ade Nurkacan, Kurnia, Andri, Susanti, Ade, Handayani, Dini, Aribawa, Mahaalit Alit, Arya, Aryabiantara, Senapathi, Tjokorda Gde Agung, Utara, Utara Hartawan, Wid, Widnyana Made, Wima, Semarawima, Wir, Wiryana Made, Jehosua, Brillyan, Kaunang, Jonathan, Lantang, Eka Yudha, Najoan, Rini, Waworuntu, Neil, Awad, Hadi, Fuad, Akram, Geddoa, Burair, Khalaf, Abdel Razzaq, Al hussaini, Sabah, Albaj, Safauldeensalem, Kenber, Maithem, Bettinelli, Alessandra, Spadaro, Savino, Volta, Carlo Alberto, Giancarlo, Luigi, Sottosanti, Vicari, Spagnesi, Lorenzo, Toretti, Ilaria, Alloj, Chiara, Cardellino, Silvano, Carmino, Livio, Costanzo, Eleonora, Fanfani, Lucia Caterina, Novelli, Maria Teresa, Roasio, Agostino, Bellandi, Mattia, Beretta, Luigi, Bignami, Elena, Bocchino, Speranza, Cabrini, Luca, Corti, Daniele, Landoni, Giovanni, Meroni, Roberta, Moizo, Elena, Monti, Giacomo, Pintaudi, Margherita, Plumari, Valentina Paola, Taddeo, Daiana, Testa, Valentina, Winterton, Dario, Zangrillo, Alberto, Cloro, Luigi Maria, Colangelo, Chiara, Colangelo, Antonio, Rotunno, Giuseppe, Angel, Miguel Paludi, Maria, Cloro Paolo, Pata, Antonio, Parrini, Vieri, Gatta, Alessandro, Nastasi, Mauro, Tinti, Carla, Arrigo, Mario, Benevento, Angelo, Bottini, Corrado, Cannavo’, Maurizio, Gastaldi, Christian, Marchesi, Alessandro, Pascazio, Angelantonio, Pata, Francesco, Pozzi, Emilio, Premoli, Alberto, Tessera, Gaetano, Boschi, Luca, D’Andrea, Rocco, Ghignone, Federico, Poggioli, Gilberto, Sibilio, Andrea, Taffurelli, Mario, Ugolini, Giampaolo, Ab Majid, Mohd Azuan, Ab Rahman, Rusnah, Joseph, Jame, Pathan, Furquan, Shah, Mohammad Hafizshah Sybil, Yap, Huey Ling, Cheah, Seleen, Chin, Im Im, Looi, Ji Keon, Tan, Siew Ching, Visvalingam, Sheshendrasurian, Kwok, Fan Yin, Lee, Chew Kiok, Tan, Tse Siang, Wong, Sze Meng, Abdullah, Noor Hairiza, Liew, Chiat Fong, Luxuman, Lovenia, Mohd Zin, Nor Hafizah, Norddin, Muhamad Faiz, Alias, Raja Liza Raja, Wong, Juan Yong, Yong, Johnny, Bin Mustapha, Mohd Tarmimi, Chan, Weng Ken, Dzulkipli, Norizawati, Kuan, Pei Xuan, Lee, Yew Ching, Alias, Anita, Guok, Eng Ching, Jee, Chiun Chen, Ramon, Brian Rhadamantyne, Weng, Cheng Wong, Abd Ghafar, Fara Nur Idayu, Aziz, Faizal Zuhri, Hussain, Nabilah, Lee, Hooi Sean, Sukawi, Ismawaty, Woon, Yuan Liang, Abd Hadi, Husni Zaeem, Ahmad Azam, Ummi Azmira, Alias, Abdul Hafiz, Kesut, Saiful Aizar, Lee, Jun May, Ooi, Dar Vin, Sulaiman, Hetty Ayuni, Tengku Lih, Tengku Alini, Veerakumaran, Jeyaganesh, Rojas, Eder, Resendiz, Gerardo Esteban Alvarez, Zapata, Darcy Danitza Mari, Aguilar López, Julio Cesar Jesú, Flores, Armando Adolfo Alvarez, Amador, Juan Carlosc Bravo, Avila, Erendira Jocelin Dominguez, Aquino, Laura Patricia González, Rodriguez, Ricardo Lopez, Landa, Mariana Torre, Urias, Emma, Hollmann, Marku, Hulst, Abraham, Kirzner, Osne, Preckel, Benedikt, Koopman-van Gemert, Ankie, Buise, Marc, Tolenaar, Noortje, Weber, Eric, de Fretes, Jennifer, Houweling, Peter, Ormskerk, Patricia, Van Bommel, Jasper, Lance, Marcu, Smit-Fun, Valerie, van Zundert, Tom, Baas, Peter, de Boer, Hans Donald, Sprakel, Joost, Elferink-Vonk, Renske, Noordzij, Peter, van Zeggeren, Laura, Brand, Bastiaan, spanjersberg, Rob, ten Bokkel-Andela, Janneke, Numan, Janneke, van Klei, Wilton, van Zaane, 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Ganter, Donna Louise, McCann, Lloyd, Foley, Julia, Gilmour, Fiona, Lumsden, Rachelle, Moores, Mark, Olliff, Sue, Sardareva, Elitza, Tai, Joyce, Wikner, Matthew, Wong, Christopher, Chaddock, Mark, Czepanski, Carolyn, McKendry, Patrick, Polakovic, Daniel, Polakovich, Daniel, Robert, Axe, Tormo Belda, Margarita, Norton, Tracy, Alherz, Fadhel, Barneto, Lisa, Ramirez, Alberto, Sayeed, Ahmed, Smith, Nicola, Bennett, Cambell, McQuoid, Shane, Jansen, Tracy-Lee, Nico, Zin, Scott, John, Freschini, David, Freschini, Angela, Hopkins, Brian, Manson, Lara, Stoltz, Deon, Bates, Alexander, Davis, Simon, Freeman, Victoria, McGaughran, Lynette, Baskar Sharma, Swarna, Burrows, Tom, Byrne, Kelly, English, Duane, Johnson, Robert, Chai Law, Kiew, Manikkam, Brendon, Naidoo, Shaun, Rumball, Margot, Whittle, Nicola, Franks, Romilla, Gibson-Lapsley, Hannah, Salter, Ryan, Walsh, Dean, Cooper, Richard, Perry, Katherine, Obobolo, Amo, Sule, Umar Musa, Ahmad, Abdurrahman, Atiku, Mamuda, Mohammed, Alhassan Datti, Sarki, Adamu Muhammad, Adekola, Oyebola, Akanmu, Olanrewaju, Durodola, Akanmu, Olukoju, Olusegun, Raji, Victor, Olajumoke, Tokunbo, Oyebamiji, Emmanuel, Adenekan, Anthony, Adetoye, Adenekan, Faponle, Folayemi, Olateju, Simeon, Owojuyigbe, Afolabi, Talabi, Ademola, Adenike, Odewabi, Adewale, Badru, Collins, Nwokoro, Ezekiel, Emmanuel, Fatungase, Oluwabunmi Motunrayo, Grace, Anuforo, Sola, Sotannde, Stella, Ogunmuyiwa, Ademola, Adeyinka, Adeolu, Augustine A., Adigun, Tinuolac, Akinwale, Mukaila, Fasina, Oluyemi, Gbolahan, Olalere, Idowu, Olusola, Olonisakin, Rotimi Peter, Osinaike, Babatunde Babasola, Asudo, Felicia, Mshelia, Danladi, Abdur-Rahman, Lukman, Agodirin, Olayide, Bello, Jibril, Bolaji, Benjamin, Oyedepo, Olanrewaju Olubukola, Ezike, Humphrey, Iloabachie, Ikechukwu, Okonkwo, Ikemefuna, Onuora, Elia, Onyeka, Tonia, Ugwu, Innocent, Umeh, Friday, Alagbe-Briggs, Olubusola, Dodiyi-Manuel, Amabra, Echem, Richard, Obasuyi, Bright, Onajin-Obembe, Bisola, Bandeira, Maria Expedito, 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Kulikov, Alexander, Lubnin, Andrey, Grigoryev, Evgeny, Pugachev, Stanislav, Tolmasov, Alexander, Hussain, Ayyaz, Ilyina, Yana, Roshchina, Anna, Iurin, Aleksandr, Chazova, Elena, Dunay, Artem, Karelov, Alexey, Khvedelidze, Irina, Voldaeva, Olga, Belskiy, Vladislav, Dzhamullaev, Parvin, Grishkowez, Elena, Kretov, Vladimir, Levin, Valeriy, Molkov, Aleksandr, Puzanov, Sergey, Samoilenko, Aleksandr, Tchekulaev, Aleksandr, Tulupova, Valentina, Utkin, Ivan, Allorto, Nikki Leigh, Bishop, David Gray, Builu, Pierre Monji, Cairns, Carel, Dasrath, Ashish, de Wet, Jacque, den Hoedt, Marielle, Grey, Ben, Hayes, Morgan Philip, Küsel, Belinda Senta, Shangase, Nomcebo, Wise, Robert, Cacala, Sharon, Farina, Zane, Govindasamy, Vishendran, Kruse, Carl-Heinz, Lee, Carolyn, Marais, Leonard, Naidoo, Thinagrin Dhasarthun, Rajah, Chantal, Rodseth, Reitze Nil, Ryan, Lisa, von Rhaden, Richard, Adam, Suwayba, Alphonsus, Christella, Ameer, Yusuf, Anderson, Frank, Basanth, Sujith, Bechan, Sudha, Bhula, Chettan, 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Delgado García, David R., Zamudio, Diana, Garcia Del Valle, Santiago, Luz Serrano, M., Alonso, Eduardo, Anillo, Victor, Maseda, Emilio, Salgado, Patricia, Suarez, Lui, Suarez-de-la-Rica, Alejandro, Villagrán, María José, Alonso, José Ignacio, Cabezuelo, Estefania, Garcia-Saiz, Irene, Lopez del Moral, Olga, Martín, Silvia, Perez Gonzalez, Alba, Tovar Doncel, Sherezade, Vera, Martin Agüero, Ávila Sánchez, Francisco José, Castaño, Beatriz, Castaño Moreira, Beatriz, Flores Risco, Sahely, Paz Martín, Daniel, Pérez Martín, Fernando, Poza, Paloma, Ruiz, Adela, Serna Martínez, Wilson Fabio, Vicente, Bárbara Vázquez, Dominguez, Saul Velaz, Fernández, Salvador, Munoz-López, Alfonso, Bernat, Maria Jose, Mas, Arantxa, Planas, Kenneth, Jawad, Monir, Saeed, Yousif, Hedin, Annika, Levander, Helena, Holmström, Sandra, Lönn, David, Zoerner, Frank, Åkring, Irene, Widmark, Carl, Zettergren, Jan, Liljequist, Victor Aspelund, Nystrom, Lena, Odeberg-Wernerman, Suzanne, Oldner, Ander, Reje, Patrik, Lyckner, 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Amir, Shekar, Priya, Harden, Catherine, Hollands, Heidi, King, Angela, March, Linda, Minto, Gary, Patrick, Abigail, Waugh, Darren, Kumara, Paramesh, Simeson, Karen, Yarwood, Jamie, Browning, Julie, Hatton, Jonathan, Julian, Howe, Mitra, Atideb, Newton, Maria, Pernu, Pawan, Wilson, Alison, Commey, Thelma, Foot, Helen, Glover, Lyn, Gupta, Ajay, Lancaster, Nicola, Levin, Jill, Mackenzie, Felicity, Mestanza, Claire, Nofal, Emma, Pout, Lauren, Varden, Rosanna, Wild, Jonathan, Jones, Stephanie, Moreton, Sarah, Pulletz, Mark, Davies, Charlotte, Martin, Matthew, Thomas, Sian, Burns, Karen, McArthur, Carol, Patel, Panna, Lau, Gary, Rich, Natalie, Davis, Fiona, Lyons, Rachel, Port, Beth, Prout, Rachel, Smith, Christopher, Adelaja, Yemi, Bennett, Victoria, Bidd, Heena, Dumitrescu, Alexandra, Murphy, Jacqui Fox, Keen, Abigail, Mguni, Nhlanhla, Ong, Cheng, Adams, George, Boshier, Pier, Brown, Richard, Butryn, Izabella, Chatterjee, Jayanta, Freethy, Alexander, Lockwood, Geoffrey, Tsakok, Maria, Tsiligiannis, Sophia, Peat, William, Stephenson, Lorraine, Bradburn, Mike, Pick, Sara, Cunha, Pedro, Olagbaiye, Olufemi, Tayeh, Salim, Abernethy, Caroline, Balasubramaniam, Madhu, Bennett, Rachael, Bolton, David, Martinson, Victoria, Naylor, Charde, Bell, Stephanie, Heather, Blaylock, Kushakovsky, Vlad, Alcock, Liam, Alexander, Hazel, Anderson, Colette, Baker, Paul, Brookes, Morag, Cawthorn, Louise, Cirstea, Emanuel, Colling, Kerry, Coulter, Ian, Das, Suparna, Haigh, Kathryn, Hamdan, Alhafidz, Hugill, Keith, Kottam, Lucksy, Lisseter, Emily, Mawdsley, Matthew, McGivern, Julie, Padala, Krishnaveni, Phelps, Victoria, kumar, Vineshykaa Ramesh, Stewart, Kirsten, Towse, Kayley, Tregonning, Julie, Vahedi, Ali, Walker, Alycon, Baines, Duncan, Bilolikar, Anjali, Chande, Shiv, Copley, Edward, Dunk, Nigel, Kulkarni, Raghavendra, Kumar, Pawan, Metodiev, Yavor, Ncomanzi, Dumisani, Raithatha, Bhavesh, Raymode, Parizade, Szafranski, Jan, Twohey, Linda, Watt, Philip, Weatherall, Lucie, Weatherill, J., Whitman, Zoe, Wighton, Elinor, Abayasinghe, Chamika, Chan, Alexander, Darwish, Sharif, Gill, Jame, Glasgow, Emma, Hadfield, Daniel, Harris, Clair, Kochhar, Arun, Mellis, Clare, Pool, Andrew, Riozzi, Paul, Selman, Andrew, Smith, Emma-Jane, Vele, Liana, Gercek, Yuksel, Guy, Kramer, Holden, Dougla, Watson, Nichola, Whysall, Karen, Andreou, Prematie, Hales, Dawn, Thompson, Jonathan, Bowrey, Sarah, McDonald, Shara, Gilmore, Jemma, Hills, Vicky, Kelly, Chan, Kelly, Sinead, Lloyd, Geraint, Abbott, Tom, Gall, Lewi, Torrance, Hew, Vivian, Mark, Berntsen, Emer, Nolan, Tracey, Turner, Angu, Vohra, Akbar, Brown, Andrew, Clark, Richard, Coughlan, Elaine, Daniel, Conway, Patvardhan, Chinmay, Pearson, Rachel, Predeep, Sheba, Saad, Hesham, Shanmugam, Mohanakrishnan, Varley, Simon, Wylie, Katharine, Cooper, Lucy, Makowski, Arystarch, Misztal, Beata, Moldovan, Eliza, Pegg, Claire, Donovan, Andrew, Foot, Jayne, Large, Simon, Claxton, Andrew, Netke, Bhagyashree, Armstrong, Richard, Calderwood, Claire, Kwok, Andy, Mohr, Otto, Oyeniyi, Peter, Patnaik, Lisa, Post, Benjamin, Ali, Sarah, Arshad, Homa, Baker, Gerard, Brenner, Laura, Brincat, Maximilian, Brunswicker, Annemarie, Cox, Hannah, Cozar, Octavian Ionut, Durst, Alexander, Fengas, Lior, Flatt, Jim, Glister, Georgina, Narwani, Vishal, Photi, Evangelo, Rankin, Adeline, Rosbergen, Melissa, Tan, Mark, Beaton, Ceri, Horn, Rachel, Hunt, Jane, Rousseau, Guy, Stancombe, Lucia, Absar, Mohammed, Allsop, Joanne, Drinkwater, Zoe, Hodgkiss, Tracey, Smith, Kirsty, Brown, Jamie, Alexander-Sefre, Farhad, Campey, Lorraine, Dudgeon, Lucy, Hall, Kathryn, Hitchcock, Rachael, James, Lynne, Smith, Kate, Winstone, Ulrika, Ahmad, Norfaizan, Bauchmuller, Kri, Harrison, Jonathan, Jeffery, Holly, Miller, Duncan, Pinder, Angela, Pothuneedi, Sailaja, Rosser, Jonathan, Sanghera, Sumayer, Swift, Diane, Walker, Rachel, Bester, Delia, Cavanagh, Sarah, Cripps, Heather, Daniel, Harvey, Lynch, Julie, Paton, Alison, Pyke, Shirley, Scholefield, John, Whitworth, Helen, Bottrill, Fiona, Ramalingam, Ganesh, Webb, Stephen, Akerman, Nik, Antill, Philip, Bourner, Lynsey, Buckley, Sarah, Castle, Gail, Charles, Rob, Eggleston, Christopher, Foster, Rebecca, Gill, Satwant, Lindley, Kate, Lklouk, Mohamed, Lowery, Tracey, Martin, Oliver, Milne, David, O’Connor, Patrick, Ratcliffe, Andrew, Rose, Alastair, Smith, Annie, Varma, Sandeep, Ward, Jackie, Barcraft-Barnes, Helena, Camsooksai, Julie, Colvin, Carolyn, Reschreiter, Henrik, Tbaily, Lee, Venner, Nicola, Hamilton, Caroline, Kelly, Lewi, Toth-Tarsoly, Piroska, Dodsworth, Kerry, Foord, Denise, Gordon, Paul, Hawes, Elizabeth, Lamb, Nikki, Mouland, Johanna, Nightingale, Jeremy, Rose, Steve, Schrieber, Joe, Al ‘Amri, Khalid, Aladin, Hafiz, Arshad, Mohammed Asif, Barraclough, Jame, Bentley, Conor, Bergin, Colin, Carrera, Ronald, Clarkson, Aisling, Collins, Michelle, Cooper, Lauren, Denham, Samuel, Griffiths, Ewen, Ip, Peter, Jeyanthan, Somasundaram, Joory, Kavita, Kaur, Satwant, Marriott, Paul, Mitchell, Natalie, Nagaiah, Sukumar, Nilsson, Annette, Parekh, Nilesh, Pope, Martin, Seager, Joseph, Serag, Hosam, Tameem, Alifia, Thomas, Anna, Thunder, Joanne, Torrance, Andrew, Vohra, Ravinder, whitehouse, Arlo, Wong, Tony, Blunt, Mark, Wong, Kate, Giles, Julian, Reed, Isabelle, Weller, Debbie, Bell, Gillian, Birch, Julie, Damant, Rose, Maiden, Jane, Mewies, Clare, Prince, Claire, Radford, Jane, Balain, Birender, Banerjee, Robin, Barnett, Andrew, Burston, Ben, Davies, Kirsty, Edwards, Jayne, Evans, Chri, Ford, David, Gallacher, Pete, Hill, Simon, Jaffray, David, Karlakki, Sudheer, Kelly, Cormac, Kennedy, Julia, Kiely, Nigel, Lewthwaite, Simon, Marquis, Chri, Ockendon, Matthew, Phillips, Stephen, Pickard, Simon, Richardson, Jame, Roach, Richard, Smith, Tony, Spencer-Jones, Richard, Steele, Niall, Steen, Julie, Van Liefland, Marck, White, Steve, Faulds, Matthew, Harris, Meredyth, Kelly, Carrie, Nicol, Scott, Pearson, Sally Anne, Chukkambotla, Srikanth, Andrew, Alyson, Attrill, Elizabeth, Campbell, Graham, Datson, Amanda, Fouracres, Anna, Graterol, Juan, Graves, Lynne, Hong, Bosun, Ishimaru, Alexander, Karthikeyan, Arvind, King, Helen, Lawson, Tom, Lee, Gregory, Lyons, Saoirse, Macalister Hall, Andrew, Mathoulin, Sophie, Mcintyre, Eilidh, Mclaughlin, Danny, Mulcahy, Kathleen, Ratcliffe, Anna, Robbins, Jame, Sung, Weilin, Tayo, Adeoluwa, Trembath, Lisa, Venugopal, Suneetha, Walker, Robert, Wigmore, Geoffrey, Boereboom, Catherine, Downes, Charlotte, Humphries, Ryan, Melbourne, Susan, Smith, Coral, Tou, Samson, Ullah, Shafa, Batchelor, Nick, Boxall, Leigh, Broomby, Rupert, Deen, Tariq, Hellewell, Alistair, Helliwell, Laurence, Hutchings, Melanie, Hutchins, David, Keenan, Samantha, Mackie, Donna, Donna, Alison, Smith, France, Stone, Lucy, Thorpe, Kevin, Wassall, Richard, Woodgate, Andrew, Baillie, Shelley, Campbell, Tara, James, Sarah, King, Chri, Marques de Araujo, Daniela, Martin, Daniel, Morkane, Clare, Neely, Julia, Rajendram, Rajkumar, Burton, Megan, James, Kathryn, Keevil, Edward, Minik, Orsolya, Morgan, Jenna, Musgrave, Anna, Rajanna, Harish, Roberts, Tracey, Adamson, Michael, Jumbe, Sandra, Kendall, Jennie, Muthuswamy, Mohan Babu, Anderson, Charlotte, Cruikshanks, Andrew, Wrench, Ian, Zeidan, Lisa, Ardern, Diane, Harris, Benjamin, Hellstrom, Johanna, Martin, Jane, Thomas, Richard, Varsani, Nimu, Wrey Brown, Caroline, Docherty, Philip, Gillies, Michael, McGregor, Euan, Usher, Helen, Craig, Jayne, Smith, Andrew, Ahmad, Tahania, Bodger, Phoebe, Creary, Thai, Fowler, Alexander, Hewson, Ru, Ijuo, Eke, Jones, Timothy, Kantsedikas, Ilya, Lahiri, Sumitra, McLean, Aaron Lawson, Niebrzegowska, Edyta, Phull, Mandeep, Wang, Difei, Wickboldt, Nadine, Baldwin, Jacqueline, Doyle, Donna, Mcmullan, Sean, Oladapo, Michelle, Owen, Thoma, Williams, Alexandra, Daniel, Hull, Gregory, Peter, Husain, Tauqeer, Kirk-Bayley, Justin, Mathers, Edward, Montague, Laura, White, Stuart, Avis, Joanne, Cook, Tim, Dali-Kemmery, Lola, Kerslake, Ian, Lambourne, Victoria, Pearson, Annabel, Boyd, Christine, Callaghan, Mark, Lawson, Cathy, McCrossan, Roopa, Nesbitt, Vanessa, O’connor, Laura, Scott, Julia, Sinclair, Rhona, Farid, Nahla, Morgese, Ciro, Bhatia, Kailash, Karmarkar, Swati, Ahmed, Jamil, Branagan, Graham, Hutton, Monica, Swain, Andrew, Brookes, Jamie, Cornell, Jonathan, Dolan, Rachael, Hulme, Jonathan, Jansen van Vuuren, Amanda, Jowitt, Tom, Kalashetty, Gunasheela, Lloyd, Fran, Patel, Kiran, Sherwood, Nichola, Brown, Lynne, Chandler, Ben, Deighton, Kerry, Emma, Temlett, Haunch, Kirsty, Cheeseman, Michelle, Dent, Kathy, Garg, Sanjeev, Gray, Carol, Hood, Marion, Jones, Dawn, Juj, Joanne, Rao, Roshan, Walker, Tara, Al Anizi, Mashel, Cheah, Clarissa, Cheing, Yushio, Coutinho, Francisco, Gondo, Prisca, Hadebe, Bernard, Onie Hove, Mazvangu, khader, Ahamed, Krishnachetty, Bobby, Rhodes, Karen, Sokhi, Jagdish, Baker, Katie-Anne, Bertram, Wendy, Looseley, Alex, Mouton, Ronelle, Arnold, Glenn, Arya, Shobhit, Balfoussia, Danai, Baxter, Linden, Harris, Jame, Jones, Craig, Knaggs, Alison, Markar, Sheraz, Perera, Anisha, Scott, Alasdair, Shida, Asako, Sirha, Ravneet, Wright, Sally, Frost, Victoria, Gray, Catherine, MacGregor, Mark, Andrews, Emma, Arrandale, Lindsay, Barrett, Stephen, Cifra, Elna, Cooper, Mariese, Dragnea, Drago, Elna, Cifra, Maclean, Jennifer, Meier, Sonja, Milliken, Donald, Munns, Christopher, Ratanshi, Nadir, Salvana, Abegail, Watson, Anthony, Ali, Hani, Campbell, Gill, Critchley, Rebecca, Hicks, Catherine, Liddle, Alison, Pass, Marc, Ritchie, Charlotte, Thomas, Charlotte, Too, Lingxi, Welsh, Sarah, Gill, Talvinder, Johnson, Joanne, Reed, Joanne, Davis, Edward, Papadopoullos, Sam, Attwood, Clare, Biffen, Andrew, Boulton, Kerenza, Gray, Sophie, Hay, David, Mills, Sarah, Montgomery, Jane, Riddell, Rory, Simpson, Jame, Bhardwaj, Neeraj, Paul, Elaine, Uwubamwen, Nosakhare, Alexander, Maini, Arrich, Jame, Arumugam, Swarna, Blackwood, Dougla, Boggiano, Victoria, Brown, Robyn, Lam Chan, Yik, Chatterjee, Devnandan, Chhabra, Ashok, Christian, Rachel, Costelloe, Hannah, Coxwell Matthewman, Madeline, Dalton, Emma, Darko, Julia, Davari, Maria, Dave, Tejal, Deacon, Matthew, Deepak, Shantal, Edmond, Holly, Ellis, Jessica, El-Sayed, Ahmed, Eneje, Philip, English, Rose, Ewe, Renee, Foers, William, Franklin, John, Gallego, Laura, Garrett, Emily, Goldberg, Olivia, Goss, Harry, Greaves, Rosanna, Harris, Rudy, Hennings, Charle, Jones, Eleanor, Kamali, Nelson, Kokkinos, Naomi, Lewis, Cary, Lignos, Leda, Malgapo, Evaleen Victoria, Malik, Rizwana, Milne, Andrew, Mulligan, John-Patrick, Nicklin, Philippa, Palipane, Natasha, Parsons, Thoma, Piper, Rebecca, Prakash, Rohan, Ramesh, Byron, Rasip, Sarah, Reading, Jacob, Rela, Mariam, Reyes, Anna, Robert, Stephen, Rooms, Martin, Shah, Karishma, Simons, Henry, Solanki, Shalil, Spowart, Emma, Stevens, Amy, Thomas, Christopher, Waggett, Helena, Yassaee, Arrash, Kennedy, Anthony, Scott, Sara, Somanath, Sameer, Berg, Andrew, Hernandez, Miguel, Nanda, Rajesh, Tank, Ghanshyambhai, Wilson, Natalie, 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Subjects: Male, HSJ UCI, Critical Care and Intensive Care Medicine, law.invention, Perioperative Care/methods, 0302 clinical medicine, Surgical procedures, 030202 anesthesiology, law, Critical care/utilisation, Postoperative care/methods, Postoperative care/statistics and numerical data, Surgical procedures, operative/mortality, statistics and numerical data, Prospective Studies, Postoperative Period, Postoperative care/methods, education.field_of_study, Postoperative care/method, Elective Surgical Procedures/mortality, fluid output, Middle Aged, fluid administration, Intensive care unit, Hospitalization, Length of Stay/statistics & numerical data, operative/mortality, Intensive Care Units/statistics & numerical data, outcome, Female, Elective Surgical Procedure, Human, Adult, medicine.medical_specialty, Logistic Model, Postoperative care/statistics and numerical data, Critical care/utilisation, Population, Intensive Care Unit, Elective Surgical Procedures/statistics & numerical data, Hospitalization/statistics & numerical data, Humans, Logistic Models, Surgical procedures, operative/mortality, Postoperative care, methods, Perioperative Care, NO, 03 medical and health sciences, Anesthesiology, Intensive care, medicine, Elective surgery, Intensive care medicine, education, business.industry, 030208 emergency & critical care medicine, Perioperative, Length of Stay, Clinical trial, Prospective Studie, septic shock, business
Abstract: PURPOSE: As global initiatives increase patient access to surgical treatments, there is a need to define optimal levels of perioperative care. Our aim was to describe the relationship between the provision and use of critical care resources and postoperative mortality. METHODS: Planned analysis of data collected during an international 7-day cohort study of adults undergoing elective in-patient surgery. We used risk-adjusted mixed-effects logistic regression models to evaluate the association between admission to critical care immediately after surgery and in-hospital mortality. We evaluated hospital-level associations between mortality and critical care admission immediately after surgery, critical care admission to treat life-threatening complications, and hospital provision of critical care beds. We evaluated the effect of national income using interaction tests. RESULTS: 44,814 patients from 474 hospitals in 27 countries were available for analysis. Death was more frequent amongst patients admitted directly to critical care after surgery (critical care: 103/4317 patients [2%], standard ward: 99/39,566 patients [0.3%]; adjusted OR 3.01 [2.10-5.21]; p < 0.001). This association may differ with national income (high income countries OR 2.50 vs. low and middle income countries OR 4.68; p = 0.07). At hospital level, there was no association between mortality and critical care admission directly after surgery (p = 0.26), critical care admission to treat complications (p = 0.33), or provision of critical care beds (p = 0.70). Findings of the hospital-level analyses were not affected by national income status. A sensitivity analysis including only high-risk patients yielded similar findings. CONCLUSIONS: We did not identify any survival benefit from critical care admission following surgery. info:eu-repo/semantics/publishedVersion
Published: 2017
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15. The surgical safety checklist and patient outcomes after surgery

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Fleisher, Mike Grocott, James Haddow, Andreas Hoeft, Peter Holt, Rui Moreno, Naomi Pritchard, Andrew Rhodes, Duminda Wijeysundera, Matt Wilson, Tahania Ahmed, Kirsty Everingham, Russell Hewson, Marta Januszewska, Mandeep-Kaur Phull, Richard Halliwell, Mark Shulman, Paul Myles, Werner Schmid, Michael Hiesmayr, Patrick Wouters, Stefan de Hert, Suzana Lobo, Xiangming Fang, Lars Rasmussen, Emmanuel Futier, Matthieu Biais, Aurélien Venara, Karem Slim, Michael Sander, Despoina Koulenti, Kostoula Arvaniti, Mathew Chan, Atul Kulkarni, Susilo Chandra, Aida Tantri, Emad Geddoa, Muntadhar Abbas, Giorgio Della Rocca, Datin Sivasakthi, Marzida Mansor, Pastor Luna, Arthur Bouwman, Wolfgang Buhre, Vanessa Beavis, Douglas Campbell, Tim Short, Tunde Osinaike, Ricardo Matos, Ioana Grigoras, Mikhail Kirov, Denis Protsenko, Bruce Biccard, Cesar Aldecoa, Michelle Chew, Christoph Hofer, Martin Hubner, James Ditai, Tamas Szakmany, Lee Fleisher, Marissa Ferguson, Michael MacMahon, Ritchie Cherian, Helen Currow, Kathirgamanathan Kanathiban, David Gillespie, Edward Pathmanathan, Katherine Phillips, Jenifer Reynolds, Joanne Rowley, Jeanene Douglas, Ross Kerridge, Sameer Garg, Michael Bennett, Megha Jain, David Alcock, Nico Terblanche, Rochelle Cotter, Kate Leslie, Marcelle Stewart, Nicolette Zingerle, Antony Clyde, Oliver Hambidge, Adam Rehak, Sharon Cotterell, Wilson Binh Quan Huynh, Timothy McCulloch, Erez Ben-Menachem, Thomas Egan, Jennifer Cope, Paul Fellinger, Markus Haisjackl, Simone Haselberger, Caroline Holaubek, Paul Lichtenegger, Florian Scherz, Franz Hoffer, Veronika Cakova, Andreas Eichwalder, Norbert Fischbach, Reinhold Klug, Elisabeth Schneider, Martin Vesely, Reinhart Wickenhauser, Karl Gernot Grubmueller, Marion Leitgeb, Friedrich Lang, Nancy Toro, Marlene Bauer, Friedrich Laengle, Claudia Haberl, Thomas Mayrhofer, Christoph Trybus, Christian Buerkle, Karin Forstner, Reinhard Germann, Harald Rinoesl, Elke Schindler, Ernst Trampitsch, Gerhard Bogner, Daniel Dankl, Martin 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Wang, Fei Wang, Chi Wu, Xiaoguang Zhang, Ida Cecilie Christiansen, Simon Nørgaard Granum, Bodil Steen Rasmussen, Morten Daugaard, Rajiv Gambhir, Birgitte Brandsborg, Guðný Erla Steingrímsdóttir, Peter Jensen-Gadegaard, Karsten Skovgaard Olsen, Hanna Siegel, Katrine Zwicky Eskildsen, Mona Ring Gätke, Ida Wibrandt, Simon Bisgaard Heintzelmann, Kai Henrik Wiborg Lange, Rune Sarauw Lundsgaard, Louise Amstrup-Hansen, Claus Hovendal, Michael Larsen, Mette Lenstrup, Tina Kobborg, Jens Rolighed Larsen, Anette Barbre Pedersen, Søren Hübertz Smith, Rebecca Monett Oestervig, Arash Afshari, Cheme Andersen, Kim Ekelund, Erik Lilja Secher, Helene Beloeil, Sigismond Lasocki, Alexandre Ouattara, Marlene Sineus, Serge Molliex, Marie Lim Legouge, Florent Wallet, Antoine Tesniere, Christophe Gaudin, Paul Lehur, Emma Forsans, Stéphane de Rudnicki, Valerie Serra Maudet, Didier Mutter, Ghassan Sojod, Mehdi Ouaissi, Jean-Marc Regimbeau, Jacques Desbordes, Nicolas Comptaer, Diae el Manser, Sabine Ethgen, 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Visvalingam, Fan Yin Kwok, Chew Kiok Lee, Tse Siang Tan, Sze Meng Wong, Noor Hairiza Abdullah, Chiat Fong Liew, Lovenia Luxuman, Nor Hafizah Mohd Zin, Muhamad Faiz Norddin, Raja Liza Raja Alias, Juan Yong Wong, Johnny Yong, Mohd Tarmimi Bin Mustapha, Weng Ken Chan, Norizawati Dzulkipli, Pei Xuan Kuan, Yew Ching Lee, Anita Alias, Eng Ching Guok, Chiun Chen Jee, Brian Rhadamantyne Ramon, Cheng Weng Wong, Fara Nur Idayu Abd Ghafar, Faizal Zuhri Aziz, Nabilah Hussain, Hooi Sean Lee, Ismawaty Sukawi, Yuan Liang Woon, Husni Zaeem Abd Hadi, Ummi Azmira Ahmad Azam, Abdul Hafiz Alias, Saiful Aizar Kesut, Jun May Lee, Dar Vin Ooi, Hetty Ayuni Sulaiman, Tengku Alini Tengku Lih, Jeyaganesh Veerakumaran, Eder Rojas, Gerardo Esteban Alvarez Resendiz, Darcy Danitza Mari Zapata, Julio Cesar Jesús Aguilar López, Armando Adolfo Alvarez Flores, Juan Carlos Bravo Amador, Erendira Jocelin Dominguez Avila, Laura Patricia González Aquino, Ricardo Lopez Rodriguez, Mariana Torres Landa, Emma Urias, Markus Hollmann, Abraham Hulst, Osne Kirzner Benedikt Preckel, Ankie Koopman-van Gemert, Marc Buise, Noortje Tolenaar, Eric Weber, Jennifer de Fretes, Peter Houweling, Patricia Ormskerk, Jasper Van Bommel, Marcus Lance, Valerie Smit-Fun, Tom van Zundert, Peter Baas, Hans Donald de Boer, Joost Sprakel, Renske Elferink-Vonk, Peter Noordzij, Laura van Zeggeren, Bastiaan Brand, Rob Spanjersberg, Janneke ten Bokkel-Andela, Sandra Numan, Wilton van Klei, Bas van Zaane, Christa Boer, Yoni van Duivenvoorde, Jens Peter Hering, Sylvia van Rossum, Harry Zonneveldt, Doug Campbell, Siobhan Hoare, Sahayam Santa, Marlynn Ali, Sara Jane Allen, Rachel Bell, Hyun-min David Choi, Matthew Drake, Helen Farrell, Katia Hayes, Kushlin Higgie, Kerry Holmes, Nicole Jenkins, Chang Joon Kim, Steven Kim, Kiew Chai Law, Davina McAllister, Karen Park, Karen Pedersen, Leesa Pfeifer, Anna Pozaroszczyk, Timothy Salmond, Martin Steynor, Michael Tan, Ellen Waymouth, Ahmad Sufian Ab Rahman, John Armstrong, Rosie Dudson, Nia 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Biccard, Thuli Biyase, Ines Buccimazza, Jorge Cardosa, James Chen, Bhavika Daya, Leanne Drummond, Ali Elabib, Ehab Helmy Abdel Goad, Ismail E. Goga, Riaz Goga, R. Harrichandparsad, Richard E. Hodgson, J. Jordaan, Nicky Kalafatis, Christian Kampik, A.T. Landers, Emil Loots, Rajhmum Madansein, Anil Madaree, Thandinkosi E. Madiba, Vukani T. Manzini, Mbali Mbuyisa, Rajan Moodley, Mduduzi Msomi, Innocent Mukama, Desigan Naidoo, Rubeshan Naidoo, Tesuven K. Naidu, Sindiswa Ntloko, Eneshia Padayachee, Lucelle Padayachee, Martijn Phaff, Bala Pillay, Desigan Pillay, Lutchmee Pillay, Anupa Ramnarain, Suren R. Ramphal, Paul Ryan, Ahmed Saloojee, Motshedisi Sebitloane, Noluyolo Sigcu, Jenna L. 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Luz Serrano, Eduardo Alonso, Victor Anillo, Emilio Maseda, Patricia Salgado, Luis Suarez, Alejandro Suarez-de-la-Rica, María José Villagrán, José Ignacio Alonso, Estefania Cabezuelo, Irene Garcia-Saiz, Olga Lopez del Moral, Silvia Martín, Alba Perez Gonzalez, Ma Sherezade Tovar Doncel, Martin Agüero Vera, Francisco José Ávila Sánchez, Beatriz Castaño, Beatriz Castaño Moreira, Sahely Flores Risco, Daniel Paz Martín, Fernando Pérez Martín, Paloma Poza, Adela Ruiz, Wilson Fabio Serna Martínez, Bárbara Vázquez Vicente, Saul Velaz Dominguez, Salvador Fernández, Alfonso Munoz-López, Maria Jose Bernat, Arantxa Mas, Kenneth Planas, Monir Jawad, Yousif Saeed, Annika Hedin, Helena Levander, Sandra Holmström, David Lönn, Frank Zoerner, Irene Åkring, Carl Widmark, Jan Zettergren, Victor Aspelund Liljequist, Lena Nystrom, Suzanne Odeberg-Wernerman, Anders Oldner, Malin Jonsson Fagerlund, Patrik Reje, Sara Lyckner, Jesper Sperber, Anne Adolfsson, Bengt Klarin, Katrin Ögren, Jean-Pierre Barras, Thomas Bührer, Vasileios Despotidis, Naeder Helmy, Stephan Holliger, Dimitri Aristotle Raptis, Roger Schmid, Antoine Meyer, Yves Jaquet, Ulf Kessler, Mirza Muradbegovic, Solange R. Nahum, Teresa Rotunno, Boris Schiltz, François Voruz, Marc Worreth, Dimitri Christoforidis, Sotirios Georgios Popeskou, Markus Furrer, Gian Andrea Prevost, Andrea Stocker, Klaus Lang, Stefan Breitenstein, Michael T. Ganter, Martin Geisen, Christopher Soll, Michelle Korkmaz, Iris Lubach, Michael Schmitz, Moritz Meyer zu Schwabedissen, Meyer zu Schwabedissen Moritz, Urs Zingg, Thomas Hillermann, Stefan Wildi, Bernardo Bollen Pinto, Bernhard Walder, Giustina Mariotti, Ksenija Slankamenac, Mirioce Namuyuga, Edward Kyomugisha, Olivia Kituuka, Anne Wesonga Shikanda, Nasser Kakembo, Charles Otim Tom, Webombesa Antonina, Emmanuel Bua, Eden Michael Ssettabi, Joseph Epodoi, Fiona Kabagenyi, Fred Kirya, Ged Dempsey, Colette Seasman, Raja Basit Nawaz Khan, Claire Kurasz, Mark Macgregor, Burhan Shawki, Daren Francis, Vimal Hariharan, Simon Chau, Kate Ellis, Georgina Butt, Dennis-Wayne Chicken, Natasha Christmas, Samantha Allen, Gayatri Daniel Daniel, Angie Dempster, Juliette Kemp, Lewis Matthews, Philip Mcglone, Joanne Tambellini, Dawn Trodd, Katie Freitas, Atul Garg, Janesh Kumar Gupta, Shilpaja Karpate, Aditi Kulkarni, Chloe O'Hara, Jtroko Troko, Kirsty Angus, Jacqueline Bradley, Emma Brennan, Carolyn Brooks, Janette Brown, Gemma Brown, Amanda Finch, Karen Gratrix, Sue Hesketh, Gillian Hill, Carol Jeffs, Maureen Morgan, Chris Pemberton, Nicola Slawson, Helen Spickett, Gemma Swarbrick, Megan Thomas, Greta Van Duyvenvoorde, Andrew Brennan, Richard Briscoe, Sarah Cooper, Tom Lawton, Martin Northey, Rashmi Senaratne, Helen Stanworth, Lorna Burrows, Helen Cain, Rachael Craven, Keith Davies, Attila Jonas, Marcin Pachucki, Graham Walkden, Helen Davies, Mariethel Gudaca, Maria Hobrok, Dilshan Arawwawala, Lauren Fergey, Matthew Gardiner, Jacqueline Gunn, Lyndsay Johnson, Amanda Lofting, Amanda Lyle, Fiona Mc Neela, Susan Smolen, Joanne Topliffe, Sarah Williams, Martin Bland, Packianathaswamy Balaji, Vikas Kaura, Prasad Lanka, Neil Smith, Ahmed Ahmed, John Myatt, Ravikiran Shenoy, Wai Cheong Soon, Jessica Tan, Sunny Karadia, James Self, Emma Durant, Shiva Tripathi, Clare Bullock, Debbie Campbell, Alison Ghosh, Thomas Hughes, Lajos Zsisku, Sheshagiri Bengeri, Amanda Cowton, Mohammed Shazad Khalid, James Limb, Colin McAdam, Mandy Porritt, M. Amir Rafi, Priya Shekar, David Adams, Catherine Harden, Heidi Hollands, Angela King, Linda March, Gary Minto, Abigail Patrick, Rosalyn Squire, Darren Waugh, Paramesh Kumara, Karen Simeson, Jamie Yarwood, Julie Browning, Jonathan Hatton, Howes Julian, Atideb Mitra, Maria Newton, Pawan Kootelu Pernu, Alison Wilson, Thelma Commey, Helen Foot, Lyn Glover, Ajay Gupta, Nicola Lancaster, Jill Levin, Felicity Mackenzie, Claire Mestanza, Emma Nofal, Lauren Pout, Rosanna Varden, Jonathan Wild, Stephanie Jones, Sarah Moreton, Mark Pulletz, Charlotte Davies, Matthew Martin, Sian Thomas, Karen Burns, Carol McArthur, Panna Patel, Gary Lau, Natalie Rich, Fiona Davis, Rachel Lyons, Beth Port, Rachel Prout, Christopher Smith, Yemi Adelaja, Victoria Bennett, Heena Bidd, Alexandra Dumitrescu, Jacqui Fox Murphy, Abigail Keen, Nhlanhla Mguni, Cheng Ong, George Adams, Piers Boshier, Richard Brown, Izabella Butryn, Jayanta Chatterjee, Alexander Freethy, Geoffrey Lockwood, Maria Tsakok, Sophia Tsiligiannis, William Peat, Lorraine Stephenson, Mike Bradburn, Sara Pick, Pedro Cunha, Olufemi Olagbaiye, Salim Tayeh, Balaji Packianathaswamy, Caroline Abernethy, Madhu Balasubramaniam, Rachael Bennett, David Bolton, Victoria Martinson, Charde Naylor, Stephanie Bell, Blaylock Heather, Vlad Kushakovsky, Liam Alcock, Hazel Alexander, Colette Anderson, Paul Baker, Morag Brookes, Louise Cawthorn, Emanuel Cirstea, Rachel Clarkson, Kerry Colling, Ian Coulter, Suparna Das, Kathryn Haigh, Alhafidz Hamdan, Keith Hugill, Lucksy Kottam, Emily Lisseter, Matthew Mawdsley, Julie McGivern, Krishnaveni Padala, Victoria Phelps, Vineshykaa Ramesh kumar, Kirsten Stewart, Kayley Towse, Julie Tregonning, Ali Vahedi, Alycon Walker, Duncan Baines, Anjali Bilolikar, Shiv Chande, Edward Copley, Nigel Dunk, Raghavendra Kulkarni, Pawan Kumar, Yavor Metodiev, Dumisani Ncomanzi, Bhavesh Raithatha, Parizade Raymode, Jan Szafranski, Linda Twohey, Philip Watt, Lucie Weatherall, J. Weatherill, Zoe Whitman, Elinor Wighton, Chamika Abayasinghe, Alexander Chan, Sharif Darwish, James Gill, Emma Glasgow, Daniel Hadfield, Clair Harris, Phil Hopkins, Arun Kochhar, Gudrun Kunst, Clare Mellis, Andrew Pool, Paul Riozzi, Andrew Selman, Emma-Jane Smith, Liana Vele, Yuksel Gercek, Kramer Guy, Douglas Holden, Nicholas Watson, Karen Whysall, Prematie Andreou, Dawn Hales, Jonathan Thompson, Sarah Bowrey, Shara McDonald, Jemma Gilmore, Vicky Hills, Chan Kelly, Sinead Kelly, Geraint Lloyd, Tom Abbott, Lewis Gall, Hew Torrance, Mark Vivian, Emer Berntsen, Tracey Nolan, Angus Turner, Akbar Vohra, Andrew Brown, Richard Clark, Elaine Coughlan, Conway Daniel, Chinmay Patvardhan, Rachel Pearson, Sheba Predeep, Hesham Saad, Mohanakrishnan Shanmugam, Simon Varley, Katharine Wylie, Lucy Cooper, Arystarch Makowski, Beata Misztal, Eliza Moldovan, Claire Pegg, Andrew Donovan, Jayne Foot, Simon Large, Andrew Claxton, Bhagyashree Netke, Richard Armstrong, Claire Calderwood, Andy Kwok, Otto 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Craw N, Craw S, Pitt-Kerby T, Rowland-Axe R, Spurdle K, McDonald A, Simon D, Sinha V, Smith T, Banner-Goodspeed V, Boone M, Campbell K, Lu F, Scannell J, Sobol J, Balajonda N, Clemmons K, Conde C, Elgasim M, Funk B, Hall R, Hopkins T, Olaleye O, Omer O, Pender M, Porto A, Stevens A, Waweru P, Yeh E, Bodansky D, Evans A, Kleopoulos S, Maril R, Mathney E, Sanchez A, Tinuoye E, Bateman B, Eng K, Jiang N, Ladha K, Needleman J, Chen LL, Lane R, Robinowitz D, Ghushe N, Irshad M, O'Connor J, Patel S, Takemoto S, Wallace A, Mazzeffi M, Rock P, Wallace K, Zhu X, Chua P, Mattera M, Sharar R, Thilen S, Treggiari M, Morgan A, Sofjan I, Subramaniam K, Avidan M, Maybrier H, Muench M, Wildes T., Université de Lille, CHU Lille, Queen Mary University of London [QMUL], Graduate School, Medical Microbiology and Infection Prevention, Clinical Immunology and Rheumatology, 01 Internal and external specialisms, ACS - Heart failure & arrhythmias, AGEM - Endocrinology, metabolism and nutrition, APH - Quality of Care, ACS - Diabetes & metabolism, AII - Amsterdam institute for Infection and Immunity, ACS - Microcirculation, Pearse, R M, International Surgical Outcomes Study (ISO), Group, Zangrillo, A, Landoni, G, Beretta, L., International Surgical Outcomes Study (ISOS) group, Pearse, R.M., Beattie, S., Clavien, P.A., Demartines, N., Fleisher, L.A., Grocott, M., Haddow, J., Hoeft, A., Holt, P., Moreno, R., Pritchard, N., Rhodes, A., Wijeysundera, D., Wilson, M., Ahmed, T., Everingham, K., Hewson, R., Januszewska, M., Phull, M.K., Halliwell, R., Shulman, M., Myles, P., Schmid, W., Hiesmayr, M., Wouters, P., de Hert, S., Lobo, S., Fang, X., Rasmussen, L., Futier, E., Biais, M., Venara, A., Slim, K., Sander, M., Koulenti, D., Arvaniti, K., Chan, M., Kulkarni, A., Chandra, S., Tantri, A., Geddoa, E., Abbas, M., Della Rocca, G., Sivasakthi, D., Mansor, M., Luna, P., Bouwman, A., Buhre, W., Beavis, V., Campbell, D., Short, T., Osinaike, T., Matos, R., Grigoras, I., Kirov, M., Protsenko, D., 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Eskildsen, K.Z., Gätke, M.R., Wibrandt, I., Heintzelmann, S.B., Wiborg Lange, K.H., Lundsgaard, R.S., Amstrup-Hansen, L., Hovendal, C., Larsen, M., Lenstrup, M., Kobborg, T., Larsen, J.R., Pedersen, A.B., Smith, S.H., Oestervig, R.M., Afshari, A., Andersen, C., Ekelund, K., Secher, E.L., Beloeil, H., Lasocki, S., Ouattara, A., Sineus, M., Molliex, S., Legouge, M.L., Wallet, F., Tesniere, A., Gaudin, C., Lehur, P., Forsans, E., de Rudnicki, S., Maudet, V.S., Mutter, D., Sojod, G., Ouaissi, M., Regimbeau, J.M., Desbordes, J., Comptaer, N., Manser, D.E., Ethgen, S., Lebuffe, G., Auer, P., Härtl, C., Deja, M., Legashov, K., Sonnemann, S., Wiegand-Loehnert, C., Falk, E., Habicher, M., Angermair, S., Laetsch, B., Schmidt, K., Von Heymann, C., Ramminger, A., Jelschen, F., Pabel, S., Weyland, A., Czeslick, E., Gille, J., Malcharek, M., Sablotzki, A., Lueke, K., Wetzel, P., Weimann, J., Lenhart, F.P., Reichle, F., Schirmer, F., Hüppe, M., Klotz, K., Nau, C., Schön, J., Mencke, T., Wasmund, C., 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Stafylaraki, M., Gaitanakis, S., Karydakis, P., Paltoglou, J., Ponireas, P., Chaloulis, P., Provatidis, A., Sousana, A., Gardikou, V.V., Konstantivelli, M., Lataniotou, O., Lisari, E., Margaroni, M., Stamatiou, K., Nikolaidis, E., Pnevmatikos, I., Sertaridou, E., Andreou, A., Arkalaki, E., Athanasakis, E., Chaniotaki, F., Chatzimichali, C.A., Christofaki, M., Dermitzaki, D., Fiorentza, K., Frantzeskos, G., Geromarkaki, E., Kafkalaki, K., Kalogridaki, M., Karydi, K., Kokkini, S., Kougentakis, G., Lefaki, T., Lilitsis, E., Makatounaki, A., Malliotakis, P., Michelakis, D., Neonaki, M., Nyktari, V., Palikyra, I., Papadakis, E., Papaioannou, A., Sfakianakis, K., Sgouraki, M., Souvatzis, X., Spartinou, A., Stefanidou, N., Syrogianni, P., Tsagkaraki, G., Arnaoutoglou, E., Arnaoutoglou, C., Bali, C., Bouris, V., Doumos, R., Gkini, K.P., Kapaktsi, C., Koulouras, V., Lena, A., Lepida, D., Michos, E., Papadopoulos, D., Paschopoulos, M., Rompou, V.A., Siouti, I., Tsampalas, S., Ververidou, O., Zilis, G., Charlalampidoy, A., Christodoulidis, G., Flossos, A., Stamoulis, K., Tsang, MSC, Tsang, M.S., Lai, M.L., Yip, C.P., Heymans Chan, H.M., Law, B., Li, W.S., Chu, H.M., Koo, EGY, Lam, CCJ, Cheng, K.H., Lam, T., Chu, S., Lam, W.Y., Wong, KWK, Kwok, D., Hung, CYJ, Chan, WKJ, Wong, W.L., Chung, CKE, Ma, S.K., Kaushik, S., Shah, B., Shah, D., Shah, S., Ar, P., Muthuchellappan, R., Agarwal, V., Divatia, J., Mishra, S., Nimje, G., Pande, S., Savarkar, S., Shrivastava, A., Thomas, M., Yegnaram, S., Hidayatullah, R., Puar, N., Niman, S., Indra, I., Hamzah, Z., Yuliana, A., Abidin, U.N., Dursin, A.N., Kurnia, A., Susanti, A., Handayani, D., Alit, M.A., Arya, A., Senapathi, TGA, Utara, U.H., Wid, W.M., Wima, S., Wir, W.M., Jehosua, B., Kaunang, J., Lantang, E.Y., Najoan, R., Waworuntu, N., Awad, H., Fuad, A., Geddoa, B., Khalaf, A.R., Al Hussaini, S., Albaj, S., Kenber, M., Bettinelli, A., Spadaro, S., AlbertoVolta, C., Giancarlo, L., Sottosanti, V., Copetti, E., Spagnesi, L., Toretti, 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Swift, D., Walker, R., Bester, D., Cavanagh, S., Cripps, H., Daniel, H., Lynch, J., Pyke, S., Scholefield, J., Whitworth, H., Bottrill, F., Ramalingam, G., Webb, S., Akerman, N., Antill, P., Bourner, L., Buckley, S., Castle, G., Charles, R., Eggleston, C., Foster, R., Gill, S., Lindley, K., Lklouk, M., Lowery, T., Martin, O., Milne, D., O'Connor, P., Ratcliffe, A., Rose, A., Smith, A., Varma, S., Ward, J., Barcraft-Barnes, H., Camsooksai, J., Colvin, C., Reschreiter, H., Tbaily, L., Venner, N., Hamilton, C., Kelly, L., Toth-Tarsoly, P., Dodsworth, K., Foord, D., Gordon, P., Hawes, E., Lamb, N., Mouland, J., Nightingale, J., Rose, S., Schrieber, J., Al'Amri, K., Aladin, H., Arshad, M.A., Barraclough, J., Bentley, C., Bergin, C., Carrera, R., Clarkson, A., Collins, M., Denham, S., Griffiths, E., Ip, P., Jeyanthan, S., Joory, K., Kaur, S., Marriott, P., Mitchell, N., Nagaiah, S., Nilsson, A., Parekh, N., Pope, M., Seager, J., Serag, H., Tameem, A., Thomas, A., Thunder, J., Torrance, A., Vohra, R., Whitehouse, A., Wong, T., Blunt, M., Wong, K., Giles, J., Reed, I., Weller, D., Bell, G., Birch, J., Damant, R., Maiden, J., Mewies, C., Prince, C., Radford, J., Reynolds, T., Balain, B., Banerjee, R., Barnett, A., Burston, B., Edwards, J., Evans, C., Ford, D., Gallacher, P., Hill, S., Jaffray, D., Karlakki, S., Kennedy, J., Kiely, N., Lewthwaite, S., Marquis, C., Ockendon, M., Phillips, S., Pickard, S., Richardson, J., Roach, R., Smith, T., Spencer-Jones, R., Steele, N., Steen, J., Van Liefland, M., White, S., Faulds, M., Harris, M., Nicol, S., Pearson, S.A., Chukkambotla, S., Andrew, A., Attrill, E., Campbell, G., Datson, A., Fouracres, A., Graterol, J., Graves, L., Hong, B., Ishimaru, A., Karthikeyan, A., King, H., Lawson, T., Lee, G., Lyons, S., Hall, A.M., Mathoulin, S., Mcintyre, E., Mclaughlin, D., Mulcahy, K., Paddle, J., Robbins, J., Sung, W., Tayo, A., Trembath, L., Venugopal, S., Wigmore, G., Boereboom, C., Downes, C., Humphries, R., Melbourne, S., Tou, S., Ullah, S., Batchelor, N., Boxall, L., Broomby, R., Deen, T., Hellewell, A., Helliwell, L., Hutchings, M., Hutchins, D., Keenan, S., Mackie, D., Potter, A., Smith, F., Stone, L., Thorpe, K., Wassall, R., Woodgate, A., Baillie, S., Campbell, T., James, S., King, C., Marques de Araujo, D., Martin, D., Morkane, C., Neely, J., Rajendram, R., Burton, M., James, K., Keevil, E., Minik, O., Morgan, J., Musgrave, A., Rajanna, H., Roberts, T., Adamson, M., Jumbe, S., Kendall, J., Muthuswamy, M.B., Cruikshanks, A., Wrench, I., Zeidan, L., Ardern, D., Harris, B., Hellstrom, J., Martin, J., Thomas, R., Varsani, N., Brown, C.W., Docherty, P., Gillies, M., McGregor, E., Usher, H., Craig, J., Ahmad, T., Bodger, P., Creary, T., Fowler, A., Ijuo, E., Jones, T., Kantsedikas, I., Lahiri, S., McLean, A.L., Niebrzegowska, E., Phull, M., Wickboldt, N., Baldwin, J., Doyle, D., Mcmullan, S., Oladapo, M., Owen, T., Williams, A., Gregory, P., Husain, T., Kirk-Bayley, J., Mathers, E., Montague, L., Harper, M., Jack, J., Ridley, C., Avis, J., Cook, T., Dali-Kemmery, L., Kerslake, I., Lambourne, V., Pearson, A., Boyd, C., Callaghan, M., Lawson, C., McCrossan, R., Nesbitt, V., O'connor, L., Sinclair, R., Farid, N., Morgese, C., Bhatia, K., Karmarkar, S., Ahmed, J., Branagan, G., Hutton, M., Swain, A., Brookes, J., Cornell, J., Dolan, R., Hulme, J., Jansen van Vuuren, A., Jowitt, T., Kalashetty, G., Lloyd, F., Patel, K., Sherwood, N., Brown, L., Chandler, B., Deighton, K., Emma, T., Haunch, K., Cheeseman, M., Dent, K., Gray, C., Hood, M., Jones, D., Juj, J., Rao, R., Walker, T., Al Anizi, M., Cheah, C., Cheing, Y., Coutinho, F., Gondo, P., Hadebe, B., Hove, M.O., Khader, A., Krishnachetty, B., Rhodes, K., Sokhi, J., Baker, K.A., Bertram, W., Looseley, A., Mouton, R., Hanna, G., Arnold, G., Arya, S., Balfoussia, D., Baxter, L., Harris, J., Jones, C., Knaggs, A., Markar, S., Perera, A., Scott, A., Shida, A., Sirha, R., Wright, S., Frost, V., Andrews, E., Arrandale, L., Barrett, S., Cifra, E., Cooper, M., Dragnea, D., Elna, C., Maclean, J., Meier, S., Milliken, D., Munns, C., Ratanshi, N., Ramessur, S., Salvana, A., Watson, A., Ali, H., Critchley, R., Endersby, S., Hicks, C., Liddle, A., Pass, M., Ritchie, C., Thomas, C., Too, L., Welsh, S., Gill, T., Johnson, J., Reed, J., Davis, E., Papadopoullos, S., Attwood, C., Biffen, A., Boulton, K., Gray, S., Hay, D., Mills, S., Montgomery, J., Riddell, R., Simpson, J., Bhardwaj, N., Paul, E., Uwubamwen, N., Alexander, M., Arrich, J., Arumugam, S., Blackwood, D., Boggiano, V., Chan, Y.L., Chatterjee, D., Chhabra, A., Christian, R., Costelloe, H., Matthewman, M.C., Dalton, E., Darko, J., Davari, M., Dave, T., Deacon, M., Deepak, S., Edmond, H., Ellis, J., El-Sayed, A., Eneje, P., English, R., Ewe, R., Foers, W., Franklin, J., Gallego, L., Garrett, E., Goldberg, O., Goss, H., Greaves, R., Harris, R., Hennings, C., Jones, E., Kamali, N., Kokkinos, N., Lewis, C., Lignos, L., Malgapo, E.V., Malik, R., Milne, A., Mulligan, J.P., Nicklin, P., Palipane, N., Parsons, T., Piper, R., Prakash, R., Ramesh, B., Rasip, S., Reading, J., Rela, M., Reyes, A., Stephens, R., Rooms, M., Shah, K., Simons, H., Solanki, S., Spowart, E., Stevens, A., Waggett, H., Yassaee, A., Kennedy, A., Scott, S., Somanath, S., Berg, A., Hernandez, M., Nanda, R., Tank, G., Wilson, N., Wilson, D., Al-Soudaine, Y., Baldwin, M., Cornish, J., Davies, Z., Davies, L., Edwards, M., Frewer, N., Gallard, S., Glasbey, J., Harries, R., Hopkins, L., Kim, T., Koompirochana, V., Lawson, S., Lewis, M., Makzal, Z., Scourfield, S., Ahmad, Y., Bates, S., Blackwell, C., Bryant, H., Collins, H., Coulter, S., Cruickshank, R., Daniel, S., Daubeny, T., Golder, K., Hawkins, L., Helen, B., Hinxman, H., Levett, D., Salmon, K., Seaward, L., Skinner, B., Tyrell, B., Wadams, B., Walsgrove, J., Dickson, J., Constantin, K., Karen, M., O'Brien, P., O'Donohoe, L., Payne, H., Sundayi, S., Walker, E., Brooke, J., Cardy, J., Humphreys, S., Kessack, L., Kubitzek, C., Kumar, S., Cotterill, D., Hodzovic, E., Hosdurga, G., Miles, E., Saunders, G., Campbell, M., Chan, P., Jemmett, K., Raj, A., Naik, A., Oshowo, A., Ramamoorthy, R., Shah, N., Sylvan, A., Blyth, K., Burtenshaw, A., Freeman, D., Johnson, E., Lo, P., Martin, T., Plunkett, E., Wollaston, J., Allison, J., Carroll, C., Craw, N., Craw, S., Pitt-Kerby, T., Rowland-Axe, R., Spurdle, K., McDonald, A., Simon, D., Sinha, V., Banner-Goodspeed, V., Boone, M., Campbell, K., Lu, F., Scannell, J., Sobol, J., Balajonda, N., Clemmons, K., Conde, C., Elgasim, M., Funk, B., Hopkins, T., Olaleye, O., Omer, O., Pender, M., Porto, A., Waweru, P., Yeh, E., Bodansky, D., Evans, A., Kleopoulos, S., Maril, R., Mathney, E., Sanchez, A., Tinuoye, E., Bateman, B., Eng, K., Jiang, N., Ladha, K., Needleman, J., Chen, L.L., Lane, R., Robinowitz, D., Ghushe, N., Irshad, M., O'Connor, J., Patel, S., Takemoto, S., Wallace, A., Mazzeffi, M., Rock, P., Wallace, K., Chua, P., Mattera, M., Sharar, R., Thilen, S., Treggiari, M., Morgan, A., Sofjan, I., Subramaniam, K., Avidan, M., Maybrier, H., Muench, M., and Wildes, T.
Subjects: Male, Postoperative Complications/epidemiology, Hospital mortality, [SDV]Life Sciences [q-bio], surgery, Postoperative Complications, 0302 clinical medicine, cohort studies, 030202 anesthesiology, patient safety, 030212 general & internal medicine, Postoperative Period, Medicine(all), Middle Aged, Checklist, 3. Good health, Treatment Outcome, operative/mortality, Elective Surgical Procedures, Surgical Procedures, Operative, Meta-analysis, Cohort, Cohort studies, Female, Elective Surgical Procedure, postoperative care/methods, postoperative care/statistics and numerical data, surgical procedures, Anesthesiology and Pain Medicine, Cohort study, Adult, medicine.medical_specialty, Evidence-based medicine, NO, 03 medical and health sciences, Patient safety, medicine, postoperative care/method, Humans, Elective Surgical Procedures/standards, Aged, Cohort Studies, Evidence-Based Medicine, Hospital Mortality, Patient Safety, Postoperative Complications/mortality, Postoperative Complications/prevention & control, Surgical Procedures, Operative/methods, business.industry, Odds ratio, Surgery, Observational study, business, cohort studie
Abstract: BACKGROUND: The surgical safety checklist is widely used to improve the quality of perioperative care. However, clinicians continue to debate the clinical effectiveness of this tool.METHODS: Prospective analysis of data from the International Surgical Outcomes Study (ISOS), an international observational study of elective in-patient surgery, accompanied by a systematic review and meta-analysis of published literature. The exposure was surgical safety checklist use. The primary outcome was in-hospital mortality and the secondary outcome was postoperative complications. In the ISOS cohort, a multivariable multi-level generalized linear model was used to test associations. To further contextualise these findings, we included the results from the ISOS cohort in a meta-analysis. Results are reported as odds ratios (OR) with 95% confidence intervals.RESULTS: We included 44 814 patients from 497 hospitals in 27 countries in the ISOS analysis. There were 40 245 (89.8%) patients exposed to the checklist, whilst 7508 (16.8%) sustained ≥1 postoperative complications and 207 (0.5%) died before hospital discharge. Checklist exposure was associated with reduced mortality [odds ratio (OR) 0.49 (0.32-0.77); PCONCLUSIONS: Patients exposed to a surgical safety checklist experience better postoperative outcomes, but this could simply reflect wider quality of care in hospitals where checklist use is routine.
Published: 2018
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16. Systemic oxygen extraction during exercise at high altitude

Author: D.S. Martin, A. Cobb, P. Meale, K. Mitchell, M. Edsell, M.G. Mythen, M.P.W. Grocott, Tom Adams, Lindsay Biseker, Adam Booth, Oliver Burdall, Alexandra Cobb, Andrew Cumpstey, Steve Dauncey, Mark Edsell, James Farrant, Martin Feelisch, Bernadette Fernandez, Oliver Firth, Edward Gilbert, Daniel Grant, Michael Grocott, Phil Hennis, Laura Jackson, Will Jenner, Jildou van der Kaaij, Maryam Khosravi, Edith Kortekaas, Denny Levett, Zeyn Mahomed, Daniel Martin, Paula Meale, Jim Milledge, Kay Mitchell, Damian Mole, Oliver Moses, Michael Mythen, Fabio Rigat, Alasdair O'Doherty, Alex Salam, Matt Sanborn, Adam Sheperdigian, Fiona Shrubb, Jo Simpson, Nick Talbot, Liesel Wandrag, Savini Wijesingha, Wilby Williamson, Tom Woolley, and Heng Yow
Subjects: Adult, Male, Acclimatization, chemistry.chemical_element, Oxygen, Hypoxemia, Animal science, Oxygen Consumption, Translational Research, medicine, Humans, Peak exercise, exercise, business.industry, hypoxia, Altitude, Significant difference, Effects of high altitude on humans, Oxygen uptake, Anesthesiology and Pain Medicine, blood gas analysis, chemistry, Anesthesia, physiology, Female, medicine.symptom, business, Oxygen extraction
Abstract: Background Classic teaching suggests that diminished availability of oxygen leads to increased tissue oxygen extraction yet evidence to support this notion in the context of hypoxaemia, as opposed to anaemia or cardiac failure, is limited. Methods At 75 m above sea level, and after 7–8 days of acclimatization to 4559 m, systemic oxygen extraction [C(a−v)O2] was calculated in five participants at rest and at peak exercise. Absolute [C(a−v)O2] was calculated by subtracting central venous oxygen content (CcvO2) from arterial oxygen content ( C a O 2 ) in blood sampled from central venous and peripheral arterial catheters, respectively. Oxygen uptake ( V ˙ O 2 ) was determined from expired gas analysis during exercise. Results Ascent to altitude resulted in significant hypoxaemia; median (range) S p O 2 87.1 (82.5–90.7)% and P a O 2 6.6 (5.7–6.8) kPa. While absolute C(a−v)O2 was reduced at maximum exercise at 4559 m [83.9 (67.5–120.9) ml litre−1 vs 99.6 (88.0–151.3) ml litre−1 at 75 m, P=0.043], there was no change in oxygen extraction ratio (OER) [C(a−v)O2/CaO2] between the two altitudes [0.52 (0.48–0.71) at 4559 m and 0.53 (0.49–0.73) at 75 m, P=0.500]. Comparison of C(a−v)O2 at peak V ˙ O 2 at 4559 m and the equivalent V ˙ O 2 at sea level for each participant also revealed no significant difference [83.9 (67.5–120.9) ml litre1 vs 81.2 (73.0–120.7) ml litre−1, respectively, P=0.225]. Conclusion In acclimatized individuals at 4559 m, there was a decline in maximum absolute C(a−v)O2 during exercise but no alteration in OER calculated using central venous oxygen measurements. This suggests that oxygen extraction may have become limited after exposure to 7–8 days of hypoxaemia.
Published: 2014

17. Patient reported outcome of adult perioperative anaesthesia in the United Kingdom: a cross-sectional observational study

Author: Sujesh Bansal, Daniel Conway, David Saunders, Matt Oliver, VIKAS KAURA, Samantha Warnakulasuriya, Cherish Paul, Tom Lawton, Mamoon Yusaf, Lorelle Brownlee, Prakash Krishnan, Geoffrey Wigmore, James Sheehan, Johnny Kenth, Shaman Jhanji, Timothy Cook, Denny Levett, Robin Alston, Angus Royal, Ahmed Mesbah, Niamat Aldamluji, Matthew Creed, Suneetha Ramani Moonesinghe, Ciro Morgese, Akshay Shah, and Michael Grocott
Subjects: Adult, Male, Cross-sectional study, Anxiety, Intraoperative Awareness, Perioperative Care, 03 medical and health sciences, 0302 clinical medicine, Patient satisfaction, 030202 anesthesiology, Anesthesia, Conduction, Surveys and Questionnaires, Patient experience, Health care, Medicine, Humans, General anaesthesia, Anesthesia, 030212 general & internal medicine, Patient Reported Outcome Measures, Aged, business.industry, Perioperative, Middle Aged, United Kingdom, Anesthesiology and Pain Medicine, Cross-Sectional Studies, Patient Satisfaction, Observational study, Patient-reported outcome, Female, business
Abstract: Background Understanding the patient perspective on healthcare is central to the evaluation of quality. This study measured selected patient-reported outcomes after anaesthesia in order to identify targets for research and quality improvement. Methods This cross-sectional observational study in UK National Health Service hospitals, recruited adults undergoing non-obstetric surgery requiring anaesthesia care over a 48 h period. Within 24 h of surgery, patients completed the Bauer questionnaire (measuring postoperative discomfort and satisfaction with anaesthesia care), and a modified Brice questionnaire to elicit symptoms suggestive of accidental awareness during general anaesthesia (AAGA). Patient, procedural and pharmacological data were recorded to enable exploration of risk factors for these poor outcomes. Results 257 hospitals in 171 NHS Trusts participated (97% of eligible organisations). Baseline characteristics were collected on 16,222 patients; 15,040 (93%) completed postoperative questionnaires. Anxiety was most frequently cited as the worst aspect of the perioperative experience. Thirty-five per cent of patients reported severe discomfort in at least one domain: thirst (18.5%; 95% CI 17.8-19.1), surgical pain (11.0%; 10.5-11.5) and drowsiness (10.1%; 9.6-10.5) were most common. Despite this, only 5% reported dissatisfaction with any aspect of anaesthesia-related care. Regional anaesthesia was associated with a reduced burden of side-effects. The incidence of reported AAGA was one in 800 general anaesthetics (0.12%) Conclusions Anxiety and discomfort after surgery are common; despite this, satisfaction with anaesthesia care in the UK is high. The inconsistent relationship between patient-reported outcome, patient experience and patient satisfaction supports using all three of these domains to provide a comprehensive assessment of the quality of anaesthesia care.
Published: 2016

18. Changes in acute pulmonary vascular responsiveness to hypoxia during a progressive ascent to high altitude (5300 m)

Author: Andrew M, Luks, Denny, Levett, Daniel S, Martin, Christopher H, Goss, Kay, Mitchell, Bernadette O, Fernandez, Martin, Feelisch, Michael P, Grocott, and Erik R, Swenson
Subjects: Male, Pulmonary Circulation, Pulmonary Gas Exchange, Altitude, Interleukin-18, Blood Pressure, Altitude Sickness, Middle Aged, Pulmonary Artery, Nitric Oxide, Oxygen, Oxidative Stress, Humans, Female, Blood Gas Analysis, Hypoxia, Erythropoietin, Lung
Abstract: What is the central question of this study? Do the pulmonary vascular responses to hypoxia change during progressive exposure to high altitude and can alterations in these responses be related to changes in concentrations of circulating biomarkers that affect the pulmonary circulation? What is the main finding and its importance? In our field study with healthy volunteers, we demonstrate changes in pulmonary artery pressure suggestive of remodelling in the pulmonary circulation, but find no changes in the acute responsiveness of the pulmonary circulation to changes in oxygenation during 2 weeks of exposure to progressive hypoxia. Pulmonary artery pressure changes were associated with changes in erythropoietin, 8-isoprostane, nitrite and guanosine 3',5'-cyclic monophosphate. We sought to determine whether changes in pulmonary artery pressure responses to hypoxia suggestive of vascular remodelling occur during progressive exposure to high altitude and whether such alterations are related to changes in concentrations of circulating biomarkers with known or suspected actions on the pulmonary vasculature during ascent. We measured tricuspid valve transvalvular pressure gradients (TVPG) in healthy volunteers breathing air at sea level (London, UK) and in hypoxic conditions simulating the inspired O
Published: 2016

19. Proceedings of the American Society for Enhanced Recovery/Evidence Based Peri-Operative Medicine 2016 Annual Congress of Enhanced Recovery and Perioperative Medicine

Author: Charles R. Horres, Mohamed A. Adam, Zhifei Sun, Julie K. Thacker, Timothy J. Miller, Stuart A. Grant, Jeffrey Huang, Kirstie McPherson, Sanjiv Patel, Su Cheen Ng, Denise Veelo, Bart Geerts, Monty Mythen, Mark Foulger, Tim Collins, Michael Mythen, Mark Edwards, Denny Levett, Tristan Chapman, Imogen Fecher Jones, Julian Smith, John Knight, Michael Grocott, Thomas Sharp, Sandy Jack, Tom Armstrong, John Primrose, Adam B. King, Kye Higdon, Melissa Bellomy, Sandy An, Paul St. Jacques, Jon Wanderer, Matthew McEvoy, Anne C. Fabrizio, Michael C. Grant, Deborah Hobson, Jonathan Efron, Susan Gearhart, Bashar Safar, Sandy Fang, Christopher Wu, Elizabeth Wick, Leanne Darwin, John Moore, Aparna Rege, Jayanth Reddy, William Irish, Ahmad Zaaroura, Elizabeth Flores Vera, Deepak Vikraman, Todd Brennan, Debra Sudan, Kadiyala Ravindra, Deborah Watson, Manasee V. Shah, Brett A. Maiese, Michael T. Eaddy, Orsolya Lunacsek, An Pham, George J. Wan, Thomas Keen, Alexander B Stone, Christopher L. Wu, Elizabeth C. Wick, Rachel A. Anolik, Adam Glener, Thomas J. Hopkins, Scott T. Hollenbeck, Julie K. Marosky Thacker, Tracey Hong, Andrea Bisaillon, Peter Black, Alan So, Kelly Mayson, Rachel Forbes, Brad Koss, Tracy McGrane, Warren S. Sandberg, Jonathan Wanderer, Patrick Shanahan, John Rohan, Desirée Chappell, Carrie Chesher, Susan VanderBeek, Rebekah Kelly, Siamak Daneshmand, Soroush T. Bazargani, Hamed Ahmadi, Gus Miranda, Jie Cai, Anne K. Schuckman, Hooman Djaladat, Volz L., Milby J., Opeyemi Popoola, Tanisha Reid, Luciana Mullan, Mehrdad Rafizadeh, and Richard Pitera
Subjects: Gerontology, medicine.medical_specialty, Evidence-based practice, Perioperative medicine, business.industry, General surgery, Perioperative, Red cell transfusion, Hepatobiliary surgery, Enhanced recovery, medicine, business, Enhanced recovery after surgery, Surgical patients
Abstract: A1 Effects of enhanced recovery pathways on renal function Charles R. Horres, Mohamed A. Adam, Zhifei Sun, Julie K. Thacker, Timothy J. Miller, Stuart A. Grant A2 Economic outcomes of enhanced recovery after surgery (ERAS) Jeffrey Huang A3 What does eating, drinking and mobilizing after enhanced recovery surgery really mean? Kirstie McPherson, Sanjiv Patel, Su Cheen Ng, Denise Veelo, Bart Geerts, Monty Mythen A4 Intra-operative fluid monitoring practices Su Cheen Ng, Mark Foulger, Tim Collins, Kirstie McPherson, Michael Mythen A5 Development of an integrated perioperative medicine care pathway Mark Edwards, Denny Levett, Tristan Chapman, Imogen Fecher – Jones, Julian Smith, John Knight, Michael Grocott A6 Cardiopulmonary exercise testing for collaborative decision making prior to major hepatobiliary surgery Mark Edwards, Thomas Sharp, Sandy Jack, Tom Armstrong, John Primrose, Michael Grocott, Denny Levett A7 Effect of an enhanced recovery program on length of stay for microvascular breast reconstruction patients Adam B. King, Kye Higdon, Melissa Bellomy, Sandy An, Paul St. Jacques, Jon Wanderer, Matthew McEvoy A8 Addressing readmissions associated with an enhanced recovery pathway for colorectal surgery Anne C. Fabrizio, Michael C. Grant, Deborah Hobson, Jonathan Efron, Susan Gearhart, Bashar Safar, Sandy Fang, Christopher Wu, Elizabeth Wick A9 The Manchester surgical outcomes project: prevalence of pre operative anaemia and peri operative red cell transfusion rates Leanne Darwin, John Moore A10 Preliminary results from a pilot study utilizing ears protocol in living donor nephrectomy Aparna Rege, Jayanth Reddy, William Irish, Ahmad Zaaroura, Elizabeth Flores Vera, Deepak Vikraman, Todd Brennan, Debra Sudan, Kadiyala Ravindra A11 Enhanced recovery after surgery: the role of the pathway coordinator Deborah Watson A12 Hospitalization costs for patients undergoing orthopedic surgery treated with intravenous acetaminophen (IV-APAP) + IV opioids or IV opioids alone for postoperative pain Manasee V. Shah, Brett A. Maiese, Michael T. Eaddy, Orsolya Lunacsek, An Pham, George J. Wan A13 Development of an app for quality improvement in enhanced recovery Kirstie McPherson, Thomas Keen, Monty Mythen A14 A clinical rotation in enhanced recovery pathways and evidence based perioperative medicine for medical students Alexander B Stone, Christopher L. Wu, Elizabeth C. Wick A15 Enhanced recovery after surgery (ERAS) implementation in abdominal based free flap breast reconstruction Rachel A. Anolik, Adam Glener, Thomas J. Hopkins, Scott T. Hollenbeck, Julie K. Marosky Thacker A16 How the implementation of an enhanced recovery after surgery (ERAS) protocol can improve outcomes for patients undergoing cystectomy Tracey Hong, Andrea Bisaillon, Peter Black, Alan So, Associate Professor, Kelly Mayson A17 Use of an app to improve patient engagement with enhanced recovery pathways Kirstie McPherson, Thomas Keen, Monty Mythen A18 Effect of an enhanced recovery after surgery pathway for living donor nephrectomy patients Adam B. King, Rachel Forbes, Brad Koss, Tracy McGrane, Warren S. Sandberg, Jonathan Wanderer, Matthew McEvoy A19 Introduction and implementation of an enhanced recovery program to a general surgery practice in a community hospital Patrick Shanahan, John Rohan, Desiree Chappell, Carrie Chesher A20 “Get fit” for surgery: benefits of a prehabilitation clinic for an enhanced recovery program for colorectal surgical patients Susan VanderBeek, Rebekah Kelly A21 Evaluation of gastrointestinal complications following radical cystectomy using enhanced recovery protocol Siamak Daneshmand, Soroush T. Bazargani, Hamed Ahmadi, Gus Miranda, Jie Cai, Anne K. Schuckman, Hooman Djaladat A22 Impact of a novel diabetic management protocol for carbohydrate loaded patients within an orthopedic ERAS protocol Volz L, Milby J A23 Institution of a patient blood management program to decrease blood transfusions in elective knee and hip arthroplasty Opeyemi Popoola, Tanisha Reid, Luciana Mullan, Mehrdad Rafizadeh, Richard Pitera
Published: 2016
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20. Measurement of Exercise Tolerance before Surgery (METS) study: a protocol for an international multicentre prospective cohort study of cardiopulmonary exercise testing prior to major non-cardiac surgery

Author: Stephen Choi, Kevin Thorpe, Cyril David Mazer, Samantha Jean Bates, Kate Leslie, Gareth Lewis Ackland, John McNeil, Marcin Wasowicz, Rupert Pearse, Bruce Thompson, Usha Gurunathan, Harindra Wijeysundera, Daniel Martin, Philip Masel, Duminda Wijeysundera, Keyvan Karkouti, Tom Abbott, Thomas Painter, Paul Myles, Adrian Elliott, Paul Oh, Christopher STONELL, Denny Levett, Timothy Short, and Michael Grocott
Subjects: Research design, medicine.medical_specialty, 030204 cardiovascular system & hematology, Anaesthesia, 03 medical and health sciences, Postoperative complications, 0302 clinical medicine, 030202 anesthesiology, medicine, Protocol, Myocardial infarction, Natriuretic peptides, Risk factor, Prospective cohort study, business.industry, Preoperative assessment, General Medicine, medicine.disease, Risk prediction, 3. Good health, Surgery, Cardiopulmonary exercise testing, Heart failure, Physical therapy, Biomarker (medicine), Elective Surgical Procedure, business, Blood sampling
Abstract: Introduction: Preoperative functional capacity is considered an important risk factor for cardiovascular and other complications of major non-cardiac surgery. Nonetheless, the usual approach for estimating preoperative functional capacity, namely doctors’ subjective assessment, may not accurately predict postoperative morbidity or mortality. 3 possible alternatives are cardiopulmonary exercise testing; the Duke Activity Status Index, a standardised questionnaire for estimating functional capacity; and the serum concentration of N-terminal pro-B-type natriuretic peptide (NT pro-BNP), a biomarker for heart failure and cardiac ischaemia.Methods and analysis: The Measurement of Exercise Tolerance before Surgery (METS) Study is a multicentre prospective cohort study of patients undergoing major elective non-cardiac surgery at 25 participating study sites in Australia, Canada, New Zealand and the UK. We aim to recruit 1723 participants. Prior to surgery, participants undergo symptom-limited cardiopulmonary exercise testing on a cycle ergometer, complete the Duke Activity Status Index questionnaire, undergo blood sampling to measure serum NT pro-BNP concentration and have their functional capacity subjectively assessed by their responsible doctors. Participants are followed for 1?year after surgery to assess vital status, postoperative complications and general health utilities. The primary outcome is all-cause death or non-fatal myocardial infarction within 30?days after surgery, and the secondary outcome is all-cause death within 1?year after surgery. Both receiver-operating-characteristic curve methods and risk reclassification table methods will be used to compare the prognostic accuracy of preoperative subjective assessment, peak oxygen consumption during cardiopulmonary exercise testing, Duke Activity Status Index scores and serum NT pro-BNP concentration.Ethics and dissemination: The METS Study has received research ethics board approval at all sites. Participant recruitment began in March 2013, and 1-year follow-up is expected to finish in 2016. Publication of the results of the METS Study is anticipated to occur in 2017.
Published: 2016

21. Design and methodology of SNAP-1: a Sprint National Anaesthesia Project to measure patient reported outcome after anaesthesia

Author: Martin Tinker, Sujesh Bansal, Daniel Conway, David Saunders, Matt Oliver, VIKAS KAURA, Richard Pugh, Samantha Warnakulasuriya, Cherish Paul, Tom Lawton, Iain Moppett, Mamoon Yusaf, Lorelle Brownlee, Prakash Krishnan, Dominic Nielsen, Geoffrey Wigmore, Tim Peters, James Sheehan, Danielle Franklin, Johnny Kenth, Sally Humphreys, Shaman Jhanji, Denny Levett, Angus Royal, Ahmed Mesbah, Matthew Creed, Suneetha Ramani Moonesinghe, Agnieszka Skorko, Akshay Shah, and Michael Grocott
Subjects: Anesthesia awareness, business.industry, Epidemiology, Research, Patient satisfaction, Perioperative, Patient recruitment, Anesthesia, Cohort, Medicine, Patient-reported outcome, business, Cohort study, Case report form
Abstract: Background Patient satisfaction is an important metric of health-care quality. Accidental awareness under general anaesthesia (AAGA) is a serious complication of anaesthesia care which may go unrecognised in the immediate perioperative period but leads to long-term psychological harm for affected patients. The SNAP-1 study aimed to measure patient satisfaction with anaesthesia care and the incidence of AAGA, reported on direct questioning within 24 h of surgery, in a large multicentre cohort. A secondary aim of SNAP-1 was to test the effectiveness of a new network of Quality Audit and Research Coordinators in NHS anaesthetic departments, to achieve widespread study participation and high patient recruitment rates. This manuscript describes the study methodology. Methods SNAP-1 was a prospective observational cohort study. The study protocol was approved by the National Research Ethics Service. All UK NHS hospitals with anaesthetic departments were invited to participate. Adult patients undergoing any type of non-obstetric surgery were recruited in participating hospitals on 13th and 14th May 2014. Demographic data were collected by anaesthetists providing perioperative care. Patients were then approached within 24 h of surgery to complete two questionnaires—the Bauer patient satisfaction questionnaire (to measure patient reported outcome) and the modified Brice questionnaire (to detect possible accidental awareness). Completion of postoperative questionnaires was taken as evidence of implied consent. Results were recorded on a standard patient case report form, and local investigators entered anonymised data into an electronic database for later analysis by the core research team. Results Preliminary analyses indicate that over 15,000 patients were recruited across the UK, making SNAP-1 the largest NIHR portfolio-adopted study in anaesthesia to date. Both descriptive and analytic epidemiological analyses will be used to answer specific questions about the patient perception of anaesthesia care overall and in surgical sub-specialties and to determine the incidence of AAGA. Conclusions The SNAP-1 study recruited a large number of UK hospitals and thousands of perioperative patients using newly established networks in the UK anaesthetic profession. The results will provide benchmarking information to aid interpretation of patient satisfaction data and also determine the incidence of AAGA reported on a single postoperative visit. Electronic supplementary material The online version of this article (doi:10.1186/s13741-015-0011-2) contains supplementary material, which is available to authorized users.
Published: 2015

22. Abnormal Cardiac High Energy Phosphate Metabolism and Impaired Diastolic Function after Mt Everest: A Reversible Model of Early Heart Failure?

Author: Holloway, Cameron J., Murray, Andrew J., Cochlin, Lowri, Emmanuel, Yaso, Denny Levett, Rider, Oliver J., Tyler, Damian J., Robson, Matthew, Francis, Jane M., Knight, Nicholas S., Neubauer, Stefan, Montgomery, Hugh E., Grocott, Michael P., and Clarke, Kieran
Published: 2008

23. ACCLIMATISATION TO HIGH ALTITUDE HYPOXIA IN HUMAN SKELETAL MUSCLE IS DRIVEN BY CO-ORDINATED CHANGES IN MITOCHONDRIAL ENERGETICS AND FATTY ACID METABOLISM

Author: Denny Levett, Menassa, David, Montgomery, Hugh, Martin, Daniel, Grocott, Michael, Murray, Andrew, and Caudwell Xtreme Everest Res Grp

24. Resting and exercising cardiorespiratory variables and acute mountain sickness

Author: Hooper, T. J., Denny Levett, Mellor, A. J., and Grocott, M. P.

25. Evaluation of a perioperative Fit 4 Surgery School

Author: Fecher-Jones, I., Grocott, M., Denny Levett, Edwards, M., Jack, S., and Forrester, J.

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25 results on '"Denny Levett"'

1. Dietary Nitrate Supplementation Does Not Alter Exercise Efficiency at High Altitude – Further Results From the Xtreme Alps Study

2. Sustained vasomotor control of skin microcirculation in Sherpas versus altitude‐naive lowlanders: Experimental evidence from Xtreme Everest 2

3. Exercise Training Induces a Shift in Extracellular Redox Status with Alterations in the Pulmonary and Systemic Redox Landscape in Asthma

4. Caudwell Xtreme Everest: A prospective study of the effects of environmental hypoxia on cognitive functioning.

5. Design and conduct of Xtreme Everest 2: An observational cohort study of Sherpa and lowlander responses to graduated hypobaric hypoxia [v1; ref status: indexed, http://f1000r.es/57m]

6. The effect of high-altitude on human skeletal muscle energetics: P-MRS results from the Caudwell Xtreme Everest expedition.

7. A capaciflector provides continuous and accurate respiratory rate monitoring for patients at rest and during exercise

8. Design and conduct of Xtreme Everest 2: An observational cohort study of Sherpa and lowlander responses to graduated hypobaric hypoxia [version 1; referees: 2 approved]

9. Perioperative Quality Initiative consensus statement on intraoperative blood pressure, risk and outcomes for elective surgery

10. Perioperative Quality Initiative consensus statement on the physiology of arterial blood pressure control in perioperative medicine

11. Perioperative Quality Initiative consensus statement on preoperative blood pressure, risk and outcomes for elective surgery

12. Elective surgery cancellations due to the COVID-19 pandemic: global predictive modelling to inform surgical recovery plans

13. Perioperative Quality Initiative consensus statement on postoperative blood pressure, risk and outcomes for elective surgery

14. Critical care admission following elective surgery was not associated with survival benefit

15. The surgical safety checklist and patient outcomes after surgery

16. Systemic oxygen extraction during exercise at high altitude

17. Patient reported outcome of adult perioperative anaesthesia in the United Kingdom: a cross-sectional observational study

18. Changes in acute pulmonary vascular responsiveness to hypoxia during a progressive ascent to high altitude (5300 m)

19. Proceedings of the American Society for Enhanced Recovery/Evidence Based Peri-Operative Medicine 2016 Annual Congress of Enhanced Recovery and Perioperative Medicine

20. Measurement of Exercise Tolerance before Surgery (METS) study: a protocol for an international multicentre prospective cohort study of cardiopulmonary exercise testing prior to major non-cardiac surgery

21. Design and methodology of SNAP-1: a Sprint National Anaesthesia Project to measure patient reported outcome after anaesthesia

22. Abnormal Cardiac High Energy Phosphate Metabolism and Impaired Diastolic Function after Mt Everest: A Reversible Model of Early Heart Failure?

23. ACCLIMATISATION TO HIGH ALTITUDE HYPOXIA IN HUMAN SKELETAL MUSCLE IS DRIVEN BY CO-ORDINATED CHANGES IN MITOCHONDRIAL ENERGETICS AND FATTY ACID METABOLISM

24. Resting and exercising cardiorespiratory variables and acute mountain sickness

25. Evaluation of a perioperative Fit 4 Surgery School

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