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Sheffield, United Kingdom

Dodd P.D.F.,Sheffield Vascular Institute
Cell and Tissue Banking | Year: 2010

Vascular allografts have been used by surgeons with varying levels of enthusiasm over the last 100 years, to treat a wide variety of vascular conditions. This article reviews the history of vascular allografts, the current indications for use, and the background to current retrieval, processing and cryopreservation techniques. © 2009 Springer Science+Business Media B.V. Source

Beard J.D.,Sheffield Vascular Institute | Marriott J.,University of Sheffield | Purdie H.,Clinical Research Facility | Crossley J.,University of Sheffield
Health Technology Assessment | Year: 2011

Objectives: To compare user satisfaction and acceptability, reliability and validity of three different methods of assessing the surgical skills of trainees by direct observation in the operating theatre across a range of different surgical specialties and index procedures. Design and setting: A 2-year prospective, observational study in the operating theatres of three teaching hospitals in Sheffield. Methods: The assessment methods were procedure-based assessment (PBA), Objective Structured Assessment of Technical Skills (OSATS) and Non-technical Skills for Surgeons (NOTSS). The specialties were obstetrics and gynaecology (O&G) and upper gastrointestinal, colorectal, cardiac, vascular and orthopaedic surgery. Two to four typical index procedures were selected from each specialty. Surgical trainees were directly observed performing typical index procedures and assessed using a combination of two of the three methods (OSATS or PBA and NOTSS for O&G, PBA and NOTSS for the other specialties) by the consultant clinical supervisor for the case and the anaesthetist and/or scrub nurse, as well as one or more independent assessors from the research team. Outcome measures: Information on user satisfaction and acceptability of each assessment method from both assessor and trainee perspectives was obtained from structured questionnaires. The reliability of each method was measured using generalisability theory. Aspects of validity included the internal structure of each tool and correlation between tools, construct validity, predictive validity, interprocedural differences, the effect of assessor designation and the effect of assessment on performance. Results: Of the 558 patients who were consented, a total of 437 (78%) cases were included in the study: 51 consultant clinical supervisors, 56 anaesthetists, 39 nurses, 2 surgical care practitioners and 4 independent assessors provided 1635 assessments on 85 trainees undertaking the 437 cases. A total of 749 PBAs, 695 NOTSS and 191 OSATSs were performed. Non-O&G clinical supervisors and trainees provided mixed, but predominantly positive, responses about a range of applications of PBA. Most felt that PBA was important in surgical education, and would use it again in the future and did not feel that it added time to the operating list. The overall satisfaction of O&G clinical supervisors and trainees with OSATS was not as high, and a majority of those who used both preferred PBA. A majority of anaesthetists and nurses felt that NOTSS allowed them to rate interpersonal skills (communication, teamwork and leadership) more easily than cognitive skills (situation awareness and decision-making), that it had formative value and that it was a valuable adjunct to the assessment of technical skills. PBA demonstrated high reliability (G > 0.8 for only three assessor judgements on the same index procedure). OSATS had lower reliability (G > 0.8 for five assessor judgements on the same index procedure). Both were less reliable on a mix of procedures because of strong procedure-specific factors. A direct comparison of PBA between O&G and non-O&G cases showed a striking difference in reliability. Within O&G, a good level of reliability (G > 0.8) could not be obtained using a feasible number of assessments. Conversely, the reliability within non-O&G cases was exceptionally high, with only two assessor judgements being required. The reasons for this difference probably include the more summative purpose of assessment in O&G and the much higher proportion of O&G trainees in this study with training concerns (42% vs 4%). The reliability of NOTSS was lower than that for PBA. Reliability for the same procedure (G > 0.8) required six assessor judgements. However, as procedure-specific factors exerted a lesser influence on NOTSS, reliability on a mix of procedures could be achieved using only eight assessor judgements. NOTSS also demonstrated a valid internal structure. The strongest correlations between NOTSS and PBA or OSATS were in the 'decision-making' domain. PBA and NOTSS showed better construct validity than OSATS, the year of training and the number of recent index procedures performed being significant independent predictors of performance. There was little variation in scoring between different procedures or different designations of assessor. Conclusions: The results suggest that PBA is a reliable and acceptable method of assessing surgical skills, with good construct validity. Specialties that use OSATS may wish to consider changing the design or switching to PBA. Whatever workplace-based assessment method is used, the purpose, timing and frequency of assessment require detailed guidance. NOTSS is a promising tool for the assessment of non-technical skills, and surgical specialties may wish to consider its inclusion in their assessment framework. Further research is required into the use of health-care professionals other than consultant surgeons to assess trainees, the relationship between performance and experience, the educational impact of assessment and the additional value of video recording. Funding: The National Institute for Health Research Health Technology Assessment programme. © Queen's Printer and Controller of HMSO 2011. Source

Palfreyman S.,Sheffield Vascular Institute
Nursing older people | Year: 2011

Patient-reported outcome measures (PROMs) are increasingly being used in the NHS to inform clinical treatments and even the funding of individual healthcare providers. This article examines the background to their increasing use. It aims to provide nurses with information and advice about resources to increase their knowledge of PROMs. It outlines the importance of patient-centred outcomes, describes the different types of PROMs and their use in clinical practice. Source

Tew G.A.,Sheffield Hallam University | Klonizakis M.,Sheffield Vascular Institute | Saxton J.M.,Sheffield Hallam University
European Journal of Applied Physiology | Year: 2010

The impact of cardiopulmonaryfitness (V̇O2max) on the age-related decline in skin-microvessel vasodilator function has not been fully established and the inter-relationships among different measures of microvascular vasodilator function are unknown. We used laser Doppler flowmetry to assess relative changes in forearm skin blood flow to various stimuli in three groups of adults: young (n = 15; 27 ± 2 years), older sedentary (n = 14; 65 ± 6 years) and older fit (n = 15; 61 ± 5 years). Local-heating induced and post-occlusive hyperaemia responses were higher inthe young and olderfit groups compared tothe older sedentary group (P < 0.05) and were moderately correlated with V̇O2max in the pooled cohort of older adults (r = 0.49-0.58; P < 0.05). Peak hyperaemia responses to acetylcholine and sodium nitroprusside were higher in young compared to older sedentary adults (P < 0.05) and were not associated with V̇O 2max in older adults (P > 0.05). Associations among different measures of microvascular vasodilator function were generally moderate at best. In summary, the local heating and reactive hyperaemia data indicate that the age-related decline in skin-microvessel vasodilator function can be ameliorated through regular aerobic exercise training. As this is not supported by the iontophoresis data, we recommend that, when assessing microvascular function, the use of a single physiological or pharmacological stimulation coupledtolaser Doppler flowmetry shouldbeavoided. Finally, the moderate correlations between outcomes probably reflect the distinct mediators that are responsible for the vasodilator response to each test. © Springer-Verlag 2010. Source

Marriott J.,University of Sheffield | Purdie H.,Clinical Research Facility | Crossley J.,University of Sheffield | Beard J.D.,Sheffield Vascular Institute
British Journal of Surgery | Year: 2011

Background: Procedure-based assessment (PBA) is used within most UK surgical training programmes for assessing trainees procedural skills in the operating theatre. All postgraduate assessment methods require evidence to support their implementation. The aims were to evaluate the validity, reliability and acceptability of PBA. Methods: Eighty-one trainees in six surgical specialties were assessed performing common procedures; 749 PBAs were provided across 348 operations by 57 clinical supervisors and four independent assessors. Results: Construct validity was demonstrated by correlation of PBA scores with measures of surgical training and experience. Reliability (G exceeding 0·8) of the adjusted total item score and global summary score for a given procedure was achieved using four and three assessor judgements respectively; assessing a mix of procedures required more cases/assessors because performance is procedure specific. The acceptability of PBA for assessment and feedback within surgical training was predominantly positive among clinical supervisors and trainees. Conclusion: PBA demonstrated good overall validity and acceptability, and exceptionally high reliability. Trainees should be assessed adequately for each given procedure. Copyright © 2010 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. Source

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