Effects of cooperation on information disclosure in mock‐witness interviews

Purpose: Forensic interviewers often face witnesses who are unwilling to cooperate with the investigation. In this experimental study, we examined the extent to which cooperativeness instructions affect information disclosure in a witness investigative interview. Methods: One hundred and thirty-six participants watched a recorded mock-crime and were interviewed twice as mock-witnesses. They were randomly assigned to one of four conditions instructing different levels of cooperativeness: Control (no instructions), Cooperation, No Cooperation, and No Cooperation plus Cooperation. The cooperativeness instructions aimed to influence how participants’ perceived the costs and benefits of cooperation. We predicted that Cooperation and No Cooperation instructions would increase and decrease information disclosure and accuracy, respectively. Results: We found decreased information disclosure and, to a lesser extent, accuracy in the No Cooperation and No Cooperation plus Cooperation conditions. In a second interview, the shift of instructions from No Cooperation to Cooperation led to a limited increase of information disclosure at no cost of accuracy. Cooperativeness instructions partially influenced the communication strategies participants used to disclose or withhold information. Conclusions: Our results demonstrate the detrimental effects of uncooperativeness on information disclosure and, to a lesser extent, the accuracy of witness statements. We discuss the implications of a lack of witness cooperation and the importance of gaining witness cooperation to facilitate information disclosure in investigative interviews

Groin wound infection after vascular exposure ( GIVE ) multicentre cohort study

Surgical site infections (SSIs) of groin wounds are a common and potentially preventable cause of morbidity, mortality, and healthcare costs in vascular surgery. Our aim was to define the contemporaneous rate of groin SSIs, determine clinical sequelae, and identify risk factors for SSI. An international multicentre prospective observational cohort study of consecutive patients undergoing groin incision for femoral vessel access in vascular surgery was undertaken over 3 months, follow‐up was 90 days. The primary outcome was the incidence of groin wound SSI. 1337 groin incisions (1039 patients) from 37 centres were included. 115 groin incisions (8.6%) developed SSI, of which 62 (4.6%) were superficial. Patients who developed an SSI had a significantly longer length of hospital stay (6 versus 5 days, P = .005), a significantly higher rate of post‐operative acute kidney injury (19.6% versus 11.7%, P = .018), with no significant difference in 90‐day mortality. Female sex, Body mass index≥30 kg/m2, ischaemic heart disease, aqueous betadine skin preparation, bypass/patch use (vein, xenograft, or prosthetic), and increased operative time were independent predictors of SSI. Groin infections, which are clinically apparent to the treating vascular unit, are frequent and their development carries significant clinical sequelae. Risk factors include modifiable and non‐modifiable variables

Evaluation of prognostic risk models for postoperative pulmonary complications in adult patients undergoing major abdominal surgery: a systematic review and international external validation cohort study

Background Stratifying risk of postoperative pulmonary complications after major abdominal surgery allows clinicians to modify risk through targeted interventions and enhanced monitoring. In this study, we aimed to identify and validate prognostic models against a new consensus definition of postoperative pulmonary complications. Methods We did a systematic review and international external validation cohort study. The systematic review was done in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched MEDLINE and Embase on March 1, 2020, for articles published in English that reported on risk prediction models for postoperative pulmonary complications following abdominal surgery. External validation of existing models was done within a prospective international cohort study of adult patients (≥18 years) undergoing major abdominal surgery. Data were collected between Jan 1, 2019, and April 30, 2019, in the UK, Ireland, and Australia. Discriminative ability and prognostic accuracy summary statistics were compared between models for the 30-day postoperative pulmonary complication rate as defined by the Standardised Endpoints in Perioperative Medicine Core Outcome Measures in Perioperative and Anaesthetic Care (StEP-COMPAC). Model performance was compared using the area under the receiver operating characteristic curve (AUROCC). Findings In total, we identified 2903 records from our literature search; of which, 2514 (86·6%) unique records were screened, 121 (4·8%) of 2514 full texts were assessed for eligibility, and 29 unique prognostic models were identified. Nine (31·0%) of 29 models had score development reported only, 19 (65·5%) had undergone internal validation, and only four (13·8%) had been externally validated. Data to validate six eligible models were collected in the international external validation cohort study. Data from 11 591 patients were available, with an overall postoperative pulmonary complication rate of 7·8% (n=903). None of the six models showed good discrimination (defined as AUROCC ≥0·70) for identifying postoperative pulmonary complications, with the Assess Respiratory Risk in Surgical Patients in Catalonia score showing the best discrimination (AUROCC 0·700 [95% CI 0·683–0·717]). Interpretation In the pre-COVID-19 pandemic data, variability in the risk of pulmonary complications (StEP-COMPAC definition) following major abdominal surgery was poorly described by existing prognostication tools. To improve surgical safety during the COVID-19 pandemic recovery and beyond, novel risk stratification tools are required. Funding British Journal of Surgery Society

Use of a Heli-FX System Guide steerable sheath for internal iliac artery bridging stent re-intervention following iliac branch procedure via a contralateral femoral approach

Endovascular aneurysm repair (EVAR) offers lower early morbidity and mortality at the expense of increased long-term re-intervention. Dilatation of distal landing zones is increasingly managed with iliac branch procedures. Re-intervention for endoleak from the internal iliac artery (IIA) bridging stent component is usually approached from arm access due to concerns regarding inducement of displacement of the EVAR caused by traversing the neobifurcation of the stentgraft from contralateral groin access. We present a novel case of successful re-intervention for IIA endoleak in the setting of previous fenestrated repair using the Heli-FX System Guide steerable sheath.</jats:p

Worldwide CAS Practice in 2011

Stroke prevention is a major public health priority; best medical therapy for patients who are at risk of atherosclerosis reduces their risk of stroke. In patients with tight carotid artery stenosis, the risk of subsequent stroke is significantly reduced by removing the atherosclerotic plaque. Carotid endarterectomy (CEA) has been available for more than 50 years and has, to date, been the standard treatment for significant carotid stenosis in symptomatic and asymptomatic patients. Carotid artery stenting (CAS) is a new and effective treatment that avoids the pain and morbidity associated with surgery. A number of trials have compared CAS with CEA, and although both procedures have a real risk of perioperative stroke, recent randomized trials have highlighted an increased risk of minor stroke with CAS and an increased risk of perioperative myocardial infarction with CEA. Cranial nerve injury and access site hematoma requiring return to the operating room or an unexpected increase in the level of care are significantly greater after CEA, while contrast related issues are a consideration for CAS. Clinical trials have not yet provided clear evidence of superiority of either treatment for “standard operative risk” patients and have been criticized for their design, patient selection, and very variable physician training and credentialing. This article describes the main messages of current guidelines for CAS from the European Society for Vascular Surgery (ESVS) (2009), the American Heart Association (AHA) (2011), and the UK National Institute for Clinical Excellence (NICE) (2011). The ESVS and the AHA guideline documents are large consensus documents covering a wide range of topics related to the management of carotid disease, whereas NICE guidelines are specific to CAS. The extracts in this article summarize the messages from these guidelines.</p

Should we train the trainers? Results of a randomized trial.

BACKGROUND: The development of efficient training methods in surgery is increasingly important. The effectiveness of training trainers is unclear. This study was designed to determine the effect on their trainees' performance of instructing trainers in a specific cognitive training method. STUDY DESIGN: Ten trainers from a university teaching hospital were randomized to train novices on a one-to-one basis in a simulated procedure using either a four-step cognitive method or their own unspecified method. Thirty trainees were randomly assigned to either a cognitive or standard trainer. After training, trainees were assessed on performing the procedure using a task-specific checklist, a global rating scale, and time taken to complete the procedure. RESULTS: Trainees who were trained using the specific cognitive method completed the procedure in a faster time (mean 331 seconds [SD 37 seconds] versus 426 seconds [SD 66 seconds]) and with higher global rating scores (mean 23.25 seconds [SD 3.7 seconds] versus 20.5 seconds [SD 4.5 seconds]) compared with those taught by a standard method. CONCLUSIONS: Instructing trainers in a cognitive training method results in a significant improvement in training outcomes

Worldwide CAS Practice in 2011

Stroke prevention is a major public health priority; best medical therapy for patients who are at risk of atherosclerosis reduces their risk of stroke. In patients with tight carotid artery stenosis, the risk of subsequent stroke is significantly reduced by removing the atherosclerotic plaque. Carotid endarterectomy (CEA) has been available for more than 50 years and has, to date, been the standard treatment for significant carotid stenosis in symptomatic and asymptomatic patients. Carotid artery stenting (CAS) is a new and effective treatment that avoids the pain and morbidity associated with surgery. A number of trials have compared CAS with CEA, and although both procedures have a real risk of perioperative stroke, recent randomized trials have highlighted an increased risk of minor stroke with CAS and an increased risk of perioperative myocardial infarction with CEA. Cranial nerve injury and access site hematoma requiring return to the operating room or an unexpected increase in the level of care are significantly greater after CEA, while contrast related issues are a consideration for CAS. Clinical trials have not yet provided clear evidence of superiority of either treatment for “standard operative risk” patients and have been criticized for their design, patient selection, and very variable physician training and credentialing. This article describes the main messages of current guidelines for CAS from the European Society for Vascular Surgery (ESVS) (2009), the American Heart Association (AHA) (2011), and the UK National Institute for Clinical Excellence (NICE) (2011). The ESVS and the AHA guideline documents are large consensus documents covering a wide range of topics related to the management of carotid disease, whereas NICE guidelines are specific to CAS. The extracts in this article summarize the messages from these guidelines.</p