Castle Hill Hospital is an NHS hospital to the west of Cottingham, East Riding of Yorkshire, England, and is run by Hull University Teaching Hospitals NHS Trust.
Since robotic-assisted cardiac surgery was established, the adoption rate was slow despite proven its efficacy and safety. Limited knowledge about the learning curve (LC) has led to lacking recognised training programme which in turn jeopardises patient safety and reduces the uptake rate. This study aims to review current literature, identify any knowledge gaps and quantify the LC. In addition, the study focuses on the application of LC knowledge on the curriculum development which has not been covered in the literature before. This systematic narrative review was conducted according to PRISMA-20 guideline. Ovid MEDLINE, PubMed, EMBASE and SCOPUS were searched from database inception to the 5th of February 2024. Eligible articles were those assessing LC in robotic-assisted cardiac surgery and reported in English. Among 24 studies which met the eligibility criteria (Table 1), 12 studies are for robotic-assisted coronary artery bypass, 9 for robotic-assisted mitral valve repair and 3 for robotic-assisted atrial septal defect repair. All studies were observational. Reporting LC exhibited substantial heterogeneity in terms of outcome variables and statistical analysis. None of the studies have quantified the surgeons’ previous experience. Finally, having structured training programme is the most recommended method to mitigate the steep LC while creating standardised reporting system has been advised to decrease heterogeneity in the future studies. Current literature shows high heterogeneity in defining LC which creates challenges in developing safe curriculum. Nonetheless, adopting structured programme with good exposure to simulation sessions are deemed effective approach to reduce LC and improve patient safety.
Evidence suggests that physical activity and exercise interventions can mitigate cancer treatment side effects. However, an improved understanding of how physical activity/exercise can be embedded within cancer care pathways is needed. We examined what is known about the barriers and facilitators to implementing physical activity/exercise interventions in the adjuvant cancer treatment pathway from a patient and healthcare professional perspective. The protocol was registered a priori with PROSPERO in March 2023. Electronic databases (CINAHL Plus, MEDLINE, PsycINFO and Cochrane) were searched for quantitative, qualitative, and mixed methods evidence from 2004 to 2025. Quality appraisal was undertaken using the appropriate Critical Appraisal Skills Programme tools. Barriers and facilitators were inductively coded into themes and then mapped to the Capability-Opportunity-Motivation-Behaviour (COM-B) model and Theoretical Domains Framework (TDF). Thematic meta-synthesis was applied to the data. Fifteen qualitative, twelve quantitative and two mixed methods studies met the inclusion criteria. Three core themes emerged that influenced implementation: exercise intervention, organisational setting and impact of cancer. The barriers and facilitators identified by patient and healthcare professional participants were relevant to all the COM-B constructs, with the most prevalent TDF domains being skills, knowledge, environmental context and resources, social influences and optimism. Findings emphasise knowledge and education, previous experience with exercise, resources, motivation, gender, age, social factors, positive promotion, individualised programming throughout treatment and access to credible practitioners as nuanced perspectives between patients and healthcare professionals. These converging perspectives are influential determinants to help identify potential solutions for embedding exercise within cancer treatment pathways.
Surgeries that require one-lung ventilation have high rates of postoperative cardiopulmonary complications with associated morbidity and mortality. Statins may limit inflammation involved in the development of these complications. We tested the hypothesis that perioperative simvastatin use reduces postoperative cardiopulmonary complications, compared with placebo, in surgery requiring one-lung ventilation. Randomised, double-blind, multicentre trial of simvastatin versus placebo in patients undergoing elective oesophagectomy, lobectomy or pneumonectomy at 15 sites throughout the UK. Planned sample size is 452 patients. Participants were randomised to either simvastatin 80 mg or placebo for 4 days preoperatively and up to 7 days postoperatively. The primary outcome measure was a composite endpoint of the incidence of acute respiratory distress syndrome, postoperative pulmonary complications, myocardial infarction and/or myocardial ischaemia during the first 7 days postoperatively or until hospital discharge. A modified intention-to-treat analysis excluded patients who did not receive the intervention preoperatively or proceed with the planned surgery. 251 patients were randomised, 126 assigned to simvastatin and 125 to placebo, with 208 included in the modified intention-to-treat population. The trial was stopped early because of futility following recommendations from the data monitoring and ethics committee. The primary outcome occurred in 45/106 patients (42.5%) in the simvastatin group and 39/102 patients (38.2%) in the placebo group (OR 1.19 (95% CI 0.68 to 2.08); p=0.54). Secondary and safety outcomes were similar between the groups. In patients undergoing one-lung ventilation, simvastatin did not reduce the incidence of postoperative cardiopulmonary complications. isrctn.org identifier, ISRCTN48095567.
