Semi-structured interviews enable the exploration of a participant's views and experiences, and can reveal in-depth insights into a problem. Interviews usually consist of a dialogue between the researcher and the study participant.1 Dyadic interviewing2 is a form of qualitative research in which two participants interact and respond to open-ended questions posed by the researcher, recognizing and utilizing the interdependent relationship between individuals. This can be a useful approach for some research settings. Researchers may study the relationship between interviewees in addition to the data generated by their interaction, offering a joint perspective on shared problems such as management of chronic illness.3 The data from dyadic interviewing can be explored through considering the dyad as a single unit of analysis, or alternatively as two separate perspectives. Individual interviewing involves a single perspective but might enable that participant to speak more openly; there is a risk with dyadic interviewing that a disclosure from one interviewee could cause harm to the other, or one person may dominate the interview.3 Therefore, sensitive subjects may be better discussed in individual interviews. Sometimes, researchers encounter family members of study participants who wish to join a one-to-one interview; this may create a dilemma. We have recently completed a qualitative study exploring the psychological impact of recovery following surgery for pancreatic cancer,4 which had patient involvement from its inception.5 'My husband always comes with me to the appointments and I said to him yesterday "where are you going to sit?" because I thought I'm not, I can't speak openly about things because I don't want to upset him.' Our research protocol stipulated that participants would be interviewed alone, and it was therefore crucial that we abided by the protocol that had been approved by the ethics committee. Our patient advisory group had suggested that the interview should be conducted with the person who had had surgery for cancer on their own, to enable them to discuss their concerns without fear of worrying relatives. The interview topic guide focused specifically on the perspectives of the patient, and did not include questions directly exploring family members' perspectives. In designing our study, we felt that although there were possible benefits to conducting dyadic interviews, there was a risk that the presence of a family member could prevent the participant from disclosing difficult feelings and emotions.3 This was borne out by several comments from our participants stating that although they had received support from family and friends, they often had not spoken openly to them about their fears or concerns; it was likely therefore that they would not have disclosed these feelings in a research interview with a family member present. It is important, however, to recognize that a cancer diagnosis is likely to have a significant psychological impact on family members as well as the individual patient, and there may be a therapeutic value for relatives in engaging in the research process. We have reflected, throughout our work, that it is possible to balance the needs of the participant with the needs of the family, while also meeting the demands of the research. We were able to achieve this by inviting family members to participate in an informal discussion with the researcher following the interview if they wished. This enabled them to express their own perspectives on the treatment journey of their loved one, as well as allowing them to reflect on their own feelings about their relative's illness, treatment and recovery. Similarly to the principles of dyadic research, the participant and family member were encouraged to reflect together on their experiences. Although we made it clear to our participants and family members that this discussion would not be used as data for the research (and thus we were still working within the remit of our protocol), we were able to utilize it as part of our field notes to provide context for each interview. 'The day she was diagnosed with cancer was undoubtedly the second worst day of my life, the worst being the day of her surgery. Once discharged, rightly so it was her that got all the attention, but it's very tough coping with your own trauma while supporting and looking after someone going through theirs, having to stay strong while sometimes despairing to almost breaking point. And it's a long journey through chemo and follow-up, and there isn't any support for people like me. Support organizations were unable to help because they had no capacity. Eventually I had to pay privately for therapy. This helped enormously, and I am on antidepressants for anxiety. It can't be right that because I had the means to seek help privately I could. Being involved in the study has been for us the opportunity to let people know how hard it can be for the patient as well as their family. It's been very useful and rewarding to know that this research may help focus people's minds and ensure that others in our situation in the future may benefit from our experiences.' Recognizing the depth of impact on family members of people with pancreatic cancer was a by-product of our study and should be pursued further. We would be interested in the views of other researchers conducting interviews exploring sensitive subjects, around the inclusion of family members in such interviews. We are grateful to the participants and family members of our study. The authors declare they have no conflicts of interest. A Patient Advisory Group offered input into the main study design, analysis and dissemination. Steven Armitage is the husband of one of our study participants and offered to co-produce this paper. Data sharing is not applicable to this article as no new data were created or analysed.
Ten per cent of patients diagnosed with pancreatic cancer undergo pancreaticoduodenectomy. It is known that these patients have unmet psychological support needs, and GPs are key in enabling effective coordination of care for people living with life-shortening conditions.To explore patients' perspectives on the role of primary care in their management, and their sources of support.Inductive qualitative study of patients who had undergone pancreaticoduodenectomy between 6 months and 6 years previously for pancreatic or distal biliary duct cancers. Participants were recruited by clinical nurse specialists (CNSs) from a single NHS trust in Northwest England.Semi-structured interviews, either face-to-face or via video link, were conducted with 20 participants. Interviews were audio-recorded, transcribed, and anonymised. Thematic analysis utilised principles of constant comparison.Participants described immense treatment burden and uncertainty around the role of the GP in their ongoing care. They recognised that GPs may have little experience of patients who have undergone pancreaticoduodenectomy, but felt that GPs can play a vital role in offering support. Participants wished for emotional support postoperatively, and valued support networks including family and friends. However, they found expressing their deepest fears difficult. Participants felt they would value greater recognition by primary care of both physical and psychological sequelae of major pancreatic surgery, and the impact on their families.Patients may feel themselves to be a 'burden' to both healthcare professionals and their own support networks following pancreaticoduodenectomy. Primary care is in a key position to proactively offer psychological support.
Abstract Background The optimal timing of cholecystectomy for patients admitted with acute gallbladder pathology is unclear. Some studies have shown that emergency cholecystectomy during the index admission can reduce length of hospital stay with similar rates of conversion to open surgery, complications and mortality compared with a ‘delayed’ operation following discharge. Others have reported that cholecystectomy during the index acute admission results in higher morbidity, extended length of stay and increased costs. This study examined the cost-effectiveness of emergency versus delayed cholecystectomy for acute benign gallbladder disease. Methods Using data from a prospective population-based cohort study examining the outcomes of cholecystectomy in the UK and Ireland, a model-based cost–utility analysis was conducted from the perspective of the UK National Health Service, with a 1-year time horizon for costs and outcomes. Probabilistic sensitivity analysis was used to investigate the impact of parameter uncertainty on the results obtained from the model. Results Emergency cholecystectomy was found to be less costly (£4570 versus £4720; €5484 versus €5664) and more effective (0·8868 versus 0·8662 QALYs) than delayed cholecystectomy. Probabilistic sensitivity analysis showed that the emergency strategy is more than 60 per cent likely to be cost-effective across willingness-to-pay values for the QALY from £0 to £100 000 (€0–120 000). Conclusion Emergency cholecystectomy is less costly and more effective than delayed cholecystectomy. This approach is likely to be beneficial to patients in terms of improved health outcomes and to the healthcare provider owing to the reduced costs.
Abstract Introduction The 2020 ST3 recruitment year for Higher Surgical Training (HST) did not have a face-to-face interview due to COVID-19. Candidates were solely scored on portfolio self-assessment alone. We have assessed the impact on Core Surgical Trainee progression into ST3 by comparing the 2020 recruitment year with 2019. Method Total numbers of applicants to ST3 for all 7 surgical sub-specialties that recruit at ST3 level were obtained via Freedom of Information requests from Health Education England (HEE). These were sorted by those who were in CST, had completed CST or had an alternative equivalence certificate. Results Overall applicant numbers were up in 2020, mainly from an increase in applicants with a Certificate of Readiness to Enter Higher Surgical Training. Overall ST3 positions appointed to were down. CST progression rate was down slightly, with an increase in appointees >10 years since graduation. Conclusions The 2020 recruitment year for ST3 HST had a higher number of applicants and lower places available than 2019. The majority of the extra applicants were trainees who have not completed CST in the UK. CST progression rate to HST was down slightly. The lack of face-to-face interview may benefit some candidates graduating >10 years ago.
Introduction: Mentorship is essential to achieve excellence in HPB surgery. Main obstacles to success include limited access to high-quality training, research opportunities and mentoring by surgical leaders. As E-AHPBA we aimed to build a pilot Mentorship Program (MP) with 10 mentors and mentees and monitor mid-and long-term results in terms of achieving prefixed goals. Methods: Mentors with known personal and professional qualities were invited from among EAHPBA members, call for mentees was launched through official website. A questionnaire was sent to investigate personal/professional attitudes and expectations.Matching was done by stage of career, surgical field, research expertise and specific keywords. Formal training was provided to mentors and mentees, and bi-monthly online meeting were expected along the 24 months of duration. Results: The MP was launched in January 2023 and received 107 applications of whom 47 (44%) were eligible for matching.Guidance, networking and research were most cited key words in mentees' applications. All selected mentors agreed to participate. Training was attended by 100% and rated 4/5 and 5/5 by mentors and mentees respectively. Median age was 44 (39-51) and 36 (28-40) yrs. Four mentors were female, and a same sex matching was favorite when appropriate. People from 14 different Countries were included. At the time of first meeting,sharing experience with other mentees,having a personal guidance free from prejudice and a structured approach to plan a career were the most valued aspects. Conclusions: MP is needed among young HPB surgeons. This pilot project seems to fill a gap in the usual training system providing personalized mentoring that may translate into career progression. Mid-and long-term results will be investigated by specific interviews.
The British Society of Gastroenterology (BSG) guidelines state that “Urgent therapeutic ERCP should be performed in patients with acute pancreatitis of suspected or proven gall stone aetiology who satisfy the criteria for predicted or actual severe pancreatitis”. The Cochrane review in 2012 suggested that ERCP does not affect morbidity and mortality and some patients with gallstones in the CBD will pass spontaneously.
Aim
The aim of this study was to assess predictive factors of mortality and the need for ERCP in severe gallstone pancreatitis.
Method
Data for patients who presented with acute severe biliary pancreatitis between January 2012 and April 2014 was collected. Data collected included predicted severity (Modified Glasgow score), liver function tests, white cell count, USS, ERCP and MRCP reports. Overall 90 day mortality was also recorded.
Results
123 patients had predicted severe pancreatitis. On US 21 patients had a dilated CBD and 16 had CBD stone. 51% of patients (n = 63) had MRCP of which 22 patients had CBD stones. 60 patients had ERCP. In 17% (n = 21) no stone was found. 2 patients (3%) developed post ERCP pancreatitis.11% (n = 14)of the patients admitted with predicted severe acute pancreatitis died. On univariate analysis albumin (p = 0.003), alanine transaminase (ALT) (p= <0.05) but not ERCP was significant in predicting mortality. High white cell count demonstrated a trend towards predicting mortality (p = 0.08) but did not reach statistical significance. On multivariate analysis albumin (p = 0.41) and ALT (p = 0.005) retained statistical significance.
Conclusion
Low serum albumin and ALT predicts mortality in severe GSP but ERCP does not and may precipitate further attacks of pancreatitis. Patients who have severe gallstone pancreatitis without deteriorating LFTs or cholangitis should have an MRCP to confirm stones in the CBD prior to ERCP.
Abstract Background The aim was to describe the management of benign gallbladder disease and identify characteristics associated with all-cause 30-day readmissions and complications in a prospective population-based cohort. Methods Data were collected on consecutive patients undergoing cholecystectomy in acute UK and Irish hospitals between 1 March and 1 May 2014. Potential explanatory variables influencing all-cause 30-day readmissions and complications were analysed by means of multilevel, multivariable logistic regression modelling using a two-level hierarchical structure with patients (level 1) nested within hospitals (level 2). Results Data were collected on 8909 patients undergoing cholecystectomy from 167 hospitals. Some 1451 cholecystectomies (16·3 per cent) were performed as an emergency, 4165 (46·8 per cent) as elective operations, and 3293 patients (37·0 per cent) had had at least one previous emergency admission, but had surgery on a delayed basis. The readmission and complication rates at 30 days were 7·1 per cent (633 of 8909) and 10·8 per cent (962 of 8909) respectively. Both readmissions and complications were independently associated with increasing ASA fitness grade, duration of surgery, and increasing numbers of emergency admissions with gallbladder disease before cholecystectomy. No identifiable hospital characteristics were linked to readmissions and complications. Conclusion Readmissions and complications following cholecystectomy are common and associated with patient and disease characteristics.
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