Publications by authors named "Madelaine Gimzewska"

3 Publications

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Beyond HOSPEX: what is the additional training value of military hospital exercises (HOSPEX)?

BMJ Mil Health 2020 May 14. Epub 2020 May 14.

256 (City of London) Field Hospital, London, UK.

Background: The use of simulation in clinical environments is a frequently used adjunct to training individuals and teams. The military uses clinical simulation to train large numbers of personnel, standardise patient pathways and sustain specific skills to ensure medical personnel are prepared to deploy in their clinical roles.

Methods: As part of a North Atlantic Treaty Organization (NATO) exercise, 256 Field Hospital (Reserves) deployed a team of clinicians to simulate a role 2 basic field hospital. This hospital exercise (HOSPEX) involved training, and a 4-day real-time exercise with casualty simulation. A retrospective survey of all clinical personnel was conducted to analyse the utility of the exercise on their understanding of their job role, the workings of the field hospital and their confidence in deploying on operations.

Results: 39 personnel were surveyed, with questions graded on a modified Likert scale. 41% had previous operational experience in their current job role. A significantly higher proportion of respondents graded their understanding of their job role, and the field hospital overall, as good or excellent having completed the exercise (p<0.01), and 90% felt more confident in fulfilling their operational role postexercise. 90% of respondents had previous experience of simulation, and 94% of these rated the military simulation as being more beneficial than civilian equivalents.

Discussion: With a shift towards simulation in medical training, opportunities have arisen within HOSPEX to develop additional skills for teams and individuals. Simulation is especially important in personnel who have not had previous operational experience, who may deploy on first time operations in senior clinical and leadership roles.

Conclusion: HOSPEXs are perceived as being extremely useful by clinical personnel preparing for future operational deployment. HOSPEX simulation has prepared the military for varied operations since its inception, and the paradigm has potential for extension into civilian training for high intensity medical responses.
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May 2020

Deep venous stenting in trauma - What is the role?

Phlebology 2020 04 9;35(3):150-152. Epub 2019 Aug 9.

Imperial College London, London, UK.

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April 2020

Totally percutaneous versus surgical cut-down femoral artery access for elective bifurcated abdominal endovascular aneurysm repair.

Cochrane Database Syst Rev 2017 02 21;2:CD010185. Epub 2017 Feb 21.

Northern Vascular Centre, Freeman Hospital, Freeman Road, Newcastle upon Tyne, UK, NE7 7DN.

Background: Abdominal aortic aneurysms (AAAs) are a vascular condition with significant risk attached, particularly if they rupture. It is, therefore, critical to identify and repair these as an elective procedure before they rupture and require emergency surgery. Repair has traditionally been an open surgical technique that required a large incision across the abdomen. Endovascular abdominal aortic aneurysm repairs (EVARs) are now a common alternative. In this procedure, the common femoral artery is exposed via a cut-down approach and a graft introduced to the aneurysm in this way. This review examines a totally percutaneous approach to EVAR. This technique gives a minimally invasive approach to femoral artery access that may reduce groin wound complication rates and improve recovery time. The technique may, however, be less applicable in people with, for example, groin scarring or arterial calcification. This is an update of the review first published in 2014.

Objectives: This review aims to compare the clinical outcomes of percutaneous access with surgical cut-down femoral artery access in elective bifurcated abdominal endovascular aneurysm repair (EVAR).

Search Methods: For this update the Cochrane Vascular Information Specialist (CIS) searched their Specialised Register (last searched October 2016) and CENTRAL (2016, Issue 9). We also searched clinical trials registries and checked the reference lists of relevant retrieved articles.

Selection Criteria: We considered only randomised controlled trials. The primary intervention was a totally percutaneous endovascular repair. We considered all device types. We compared this against surgical cut-down femoral artery access endovascular repair. We only considered studies investigating elective repairs. We excluded studies reporting emergency surgery for a ruptured abdominal aortic aneurysm and those reporting aorto-uni-iliac repairs.

Data Collection And Analysis: Two review authors independently collected all data. Owing to the small number of trials identified we did not conduct any formal sensitivity analysis. Heterogeneity was not significant for any outcome.

Main Results: Two studies with a total of 181 participants met the inclusion criteria, 116 undergoing the percutaneous technique and 65 treated by cut-down femoral artery access. One study had a small sample size and did not adequately report method of randomisation, allocation concealment or pre-selected outcomes. The second study was a larger study with few sources of bias and good methodology.We observed no significant difference in mortality between groups, with only one mortality occurring overall, in the totally percutaneous group (risk ratio (RR) 1.50; 95% confidence interval (CI) 0.06 to 36.18; 181 participants; moderate-quality evidence). Only one study reported aneurysm exclusion. In this study we observed only one failure of aneurysm exclusion in the surgical cut-down femoral artery access group (RR 0.17, 95% CI 0.01 to 4.02; 151 participants; moderate-quality evidence). No wound infections occurred in the cut-down femoral artery access group or the percutaneous group across either study (moderate-quality evidence).There was no difference in major complication rate between cut-down femoral artery access and percutaneous groups (RR 0.91, 95% CI 0.20 to 1.68; 181 participants; moderate-quality evidence); or in bleeding complications and haematoma (RR 0.94, 95% CI 0.31 to 2.82; 181 participants; high-quality evidence).Only one study reported long-term complication rates at six months, with no differences between the percutaneous and cut-down femoral artery access group (RR 1.03, 95% CI 0.34 to 3.15; 134 participants; moderate-quality evidence).We detected differences in surgery time, with percutaneous approach being significantly faster than cut-down femoral artery access (mean difference (MD) -31.46 minutes; 95% CI -47.51 minutes to -15.42 minutes; 181 participants; moderate-quality evidence). Only one study reported duration of ITU (intensive treatment unit) and hospital stay, with no difference found between groups.

Authors' Conclusions: This review shows moderate-quality evidence of no difference between the percutaneous approach compared with cut-down femoral artery access group for short-term mortality, aneurysm exclusion, major complications, wound infection and long-term (six month) complications, and high-quality evidence for no difference in bleeding complications and haematoma. There was a difference in operating time, with moderate-quality evidence showing that the percutaneous approach was faster than the cut-down femoral artery access technique. We downgraded the quality of the evidence to moderate as a result of the limited number of studies, low event numbers and imprecision. As the number of included studies were limited, further research into this technique would be beneficial. The search identified one ongoing study, which may provide an improved evidence base in the future.
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February 2017