Author: Jason Curtis

Evaluating the perceptions of workplace-based assessments in surgical training: a systematic review (2022)

Posted on by

Type of publication:
Systematic Review

Author(s):
Mughal Z.; *Patel S.; Gupta K.K.; Metcalfe C.; Beech T.; Jennings C.

Citation:
Annals of the Royal College of Surgeons of England. (no pagination), 2022. Date of Publication: 14 Nov 2022. [epub ahead of print]

Abstract:
INTRODUCTION: Workplace-based assessments (WBAs) are intended to maximise learning opportunities in surgical training. There is speculation as to whether mandatory assessments in this form contribute to a tick-box culture. The objective of this review was to investigate surgical trainees' attitudes towards WBAs. METHOD(S): This systematic review of qualitative studies was performed in accordance with the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) statement. The literature was searched on the Medline, Embase, PubMed and Web of Science databases on 22 March 2022. RESULT(S): Sixteen studies were included in the review, mostly carried out on users of the Intercollegiate Surgical Curriculum Programme portfolio in the UK. Trainees felt that WBAs were educationally useful, providing opportunity for feedback, but this was overshadowed by a pressure to reach a set annual quota for WBAs and achieve high scores. Other themes included inaccurate recording of WBAs, the role of WBAs as formative or summative assessments, engagement and accessibility of trainers, and lack of time to complete WBAs. CONCLUSION(S): Negative perceptions about WBAs were widespread among surgical trainees despite a recognition of their capacity to facilitate learning. This review supports the recent removal of the annual quota for WBAs in UK surgical training programmes.

Link to full-text [NHS OpenAthens account required]

Resection and primary anastomosis is safe in selected patients with perforated diverticulitis: A cohort study (2022)

Posted on by

Type of publication:
Conference abstract

Author(s):
*Dowdeswell M.; *Chang J.; *Rajalingam V.; *Wolos M.; *McCloud J.; *Cheetham M.

Citation:
British Journal of Surgery. Conference: Association of Surgeons of Great Britain and Ireland Annual Congress, ASGBI 2022. Liverpool United Kingdom. 109(Supplement 5) (pp v30-v31), 2022. Date of Publication: 2022.

Abstract:
Aims: Historically, the preferred procedure for perforated diverticular disease is Hartmann's procedure (Hp). Although reliably achieving source control, it's associated with a high rate of post-operative complications and a stoma which of ten becomes permanent. We reviewed our experience of patients undergoing Hp vs primary anastomosis (PA) for perforated diverticulitis. Method(s): All patients undergoing emergency resectional surgery for perforated diverticulitis between March 2015 and Jan 2021 were identified from The Hospital Episode Statistics (HES) data. Demographics were collected and The patient groups were case matched for age and Charleson Comorbidity Index (CCI), Computed Tomography (CT) appearance and intraoperative contamination data. Post-operative morbidity/mortality data was compared. Result(s): 105 patients were included. 15 patients had PA (without diversion) and 90 Hp. In The PA cohort were10 males, median age 52 (range 27-76). There were no anastomotic leaks. 30-day morbidities were superficial wound dehiscence (1) and early incisional hernia (1). Median post-operative stay was 9 days (range 5-25). Hp control group (age below 76, Charlson score 10and below, Hinchey 1-3 intraoperatively). Included 58 patients, 26 males, median age 60.5 (range 30-76). Median post-operative stay was 10.5 days (range 5-227). 2 patients required re-operation. 5 patients developed wound infections. At the time of the study 18 patients have undergone reversal, 6 are On active waiting-list for reversal. There was a single 30-day mortality (post-discharge). Conclusion(s):We have shown that PA is safe in selected cohort of patients and have identified that over 50% of patients undergoing Hp could have been considered for PA.

The potential for day case total parathyroidectomy in patients with secondary hyperparathyroidism (2022)

Posted on by

Type of publication:
Conference abstract

Author(s):
*McDonald S.; *Al-Saadi N.; *Chang J.; *Neophytou C.; *Houghton A.

Citation:
British Journal of Surgery. Conference: Association of Surgeons of Great Britain and Ireland Annual Congress, ASGBI 2022. Liverpool United Kingdom. 109(Supplement 5) (pp v106), 2022. Date of Publication: 2022.

Abstract:
Aims: Hypocalcaemia is a common complication after parathyroidectomy for secondary hyperparathyroidism (SHpT) and is of ten The cause of a prolonged hospital stay post operatively. Although there is no current guidance on targets for total parathyroidectomy for SHpT, current guidance recommends a day-case rate of 90% for patients undergoing Surgery for primary hyperparathyroidism. Our centre has developed a safe protocol which allows us to perform total parathyroidectomies as a day-case procedure in patients with SHpT. This protocol, developed in conjunction with The renal physicians, involves giving The patients alpha calcidol pre-operatively for 5 days, to minimise The incidence of hypocalcaemia, and close monitoring of The calcium levels post operatively, to permit safe discharge. Method(s): We carried out a single centre retrospective study on all patients who underwent a total parathyroidectomy for SHpT between February 2005 and May 2021. All The patients received The alpha calcidol regimen pre-operatively. Data on patient baseline characteristics, peri-operative calcium, potassium and PTH levels, length of hospital stay, operative procedure details, hospital readmission and 30-day morbidity were collected. Result(s): 49 patients underwent a total parathyroidectomy during The study period. 67% of patients were discharged on day 0 or on day 1 post-operatively. Reasons for prolonged hospital stay in The remaining patients included refractory hyperkalaemia requiring dialysis, complications secondary to anaesthesia, as well as hypocalcaemia in a few cases. No patients required readmission during The 30-day post-operative period. Conclusion(s): Day-case Surgery for SHpT can be achieved safely with a pre-operative regimen of alpha calcidol and close monitoring of calcium levels post-operatively.

Link to full-text [no password required]

Safety of in-hospital delay to appendicectomy in acute appendicitis: A retrospective study (2022)

Posted on by

Type of publication:
Conference abstract

Author(s):
Claydon O.; Down B.; *Kumar S.

Citation:
British Journal of Surgery. Conference: Association of Surgeons of Great Britain and Ireland Annual Congress, ASGBI 2022. Liverpool United Kingdom. 109(Supplement 5) (pp v72), 2022. Date of Publication: 2022.

Abstract:
Aims: In many hospitals the availability of operating theatres and access to senior surgical and anaesthetic support diminishes during night hours. Therefore urgent surgery is sometimes postponed until the following morning rather than performed overnight, if judged to be safe. We aim to determine if a delay to laparoscopic appendicectomy in cases of acute appendicitis of over 12 hours, analogous to an overnight delay, is correlated to worse patient outcomes. Our primary outcome was delayed discharge from hospital. Our secondary outcomes were appendicitis severity, conversion, and post-operative complications. Method(s): We undertook a retrospective review of The medical records of patients who underwent laparoscopic appendicectomy at a UK district General hospital between 01/01/2018 and 30/08/2019. For each patient clinical and demographic information; and times of hospital admission, surgery, and discharge; were collected. Delayed discharged was defined as 'time to discharge' >24 hours. Result(s): 506 patients were included. In 144 patients (28.5%) 'time to surgery' was under 12 hours; in 362 patients (71.5%) 'time to surgery' was over 12 hours. 362 patients (71.5%) had a delayed discharge. 303 patients (59.9%) had Simple appendicitis; 143 patients had severe appendicitis (28.3%); 60 patients had a macroscopically normal appendix (11.9%). No statistically significant association between 'time to surgery' and delayed discharge, appendicitis severity, conversion or 30 day re-presentations was observed. Conclusion(s): Time from admission to start of appendicectomy did not affect patient outcomes. Short in-hospital delays to appendicectomy, for example an overnight delay, may be safe in certain patients, taking account of clinical judgement.

Stent diameter and stent-related symptoms, does size matter? A systematic review and meta-analysis (2022)

Posted on by

Type of publication:
Systematic Review

Author(s):
Ehsanullah S.A.; Bruce A.; Juman C.; *Krishan A.; Higginbottom J.; Khashaba S.; Alnaib Z.

Citation:
Urology Annals. 14(4) (pp 295-302), 2022. Date of Publication: October 2022.

Abstract:
The ureteral insertion of a silicone tube was first performed in 1967. A validated ureteral stent symptom questionnaire (USSQ) is used for an objective assessment of patient-reported stent-related symptoms. As the impact of stent diameter on the incidence of stent-related symptoms is unclear, we aimed to perform a systematic review and meta-analysis comparing USSQ reported outcomes when using a 6 Fr diameter ureteric stent, versus smaller diameter stents (4.7-5 Fr) when inserted for ureteric stones. All randomized control trials and comparative studies of 6 Fr versus 4.7-5 Fr ureteric stents were reviewed. The USSQ outcomes were considered as the primary outcome measures while stent migration was considered as a secondary outcome measure. A total of 61 articles were identified of which four studies met the eligibility criteria. There was a statistically significant association between the use of wider (6 Fr) diameter stents and the incidence of urinary symptoms as measured by the urinary index score. Larger stent diameters were associated with a statistically significant increase in the pain index score. There was no statistically significant difference in the scores between the compared stent diameters with regard to work performance score, general health index score, additional problems index score, and stent migration. There were insufficient reported outcomes to perform a meta-analysis of sexual matters index score. Our meta-analysis shows that using smaller diameter ureteric stents is associated with reduced urinary symptoms and patient-reported pain. Other USSQ parameter outcomes are statistically similar in the 6 Fr ureteric stent cohort versus the 4.7-5 Fr ureteric stent cohort. Our meta-analysis was limited due to the limited number of studies and gross heterogeneity of reporting parameters in various studies. We hope a large-scale homogeneous randomized control trial will further shed more insight into the stent symptoms response to stent diameter

Link to full-text [open access, no password required]

Patient experiences of weight loss and eating after bariatric surgery: A Systematic Review and Qualitative Synthesis (2023)

Posted on by

Type of publication:Journal article

Author(s):*Ansari M; Serjeant S

Citation:Journal of Human Nutrition & Dietetics. 36(4):1438-1450, 2023 Aug.

Abstract:Background: An estimated 26% of men and 29% of women in the UK are living with obesity according to recent statistics. Bariatric Surgery (BS) can induce significant weight loss and improve co-morbidity status. However previous studies highlight challenges in maintaining dietary changes and weight loss. This systematic review aimed to investigate patient experiences of weight loss and eating in the first two years following surgery, to provide clinical recommendations to support this group.Methods: Ethical approval was granted by the University. A systematic search was conducted in four databases. Studies were selected according to the predefined eligibility criteria and methodological quality, assessed via the CASP tool. Data were extracted and analysed using a thematic synthesis method. Rigour was enhanced via use of a data extraction tool, a validated method for data synthesis, peer-review and transparent reporting.Results: In total, 507 records were screened; nine studies met the inclusion criteria. The thematic synthesis yielded four, interlinked analytical themes based on 154 patients' experiences: relationship with food, relationship with oneself, relationship with others and unfinished journey. Positive experiences were reported including development of healthy eating behaviours and significant weight loss, improving physical and psychosocial wellbeing. On the other hand, challenges in adjusting to life after surgery were also reported.Conclusions: This study highlighted the need for personalised dietary advice, addressing the psychological aspects of eating. Support should be extended to the family. Ongoing psychological support must be incorporated in the post-surgery care pathway to help patients deal with the negative outcomes of surgery such as excess skin.

Link to full-text [open access - no password required]

Altmetrics:

The influence of the Covid pandemic on the epidemiology of Achilles tendon ruptures in east Shropshire, United Kingdom (2023)

Posted on by

Type of publication:Journal article

Author(s):*Carmont MR; *Morgan F; *Fakoya K; Heaver C; Brorsson A; Nilsson-Helander K

Citation:Journal of ISAKOS : joint disorders & orthopaedic sports medicine, Journal of Isakos. 8(2):94-100, 2023

Abstract:Objectives: Management strategies of the Covid pandemic included isolation to prevent transmission. This study aimed to determine if the pandemic of 2020 influenced the epidemiology of Achilles Tendon Rupture (ATR).Methods: The demographics of presentations from the local population to xxx hospital, Shropshire, United Kingdom with an ATR were analysed and compared together with the season, month, and year of the injury.Results: From 2009 to 2019 there was no significant change in the incidence of ATR over time with mean (SD) incidence of 13.3 per 100,000. In 2020, there was a decrease in injuries with an incidence of 8.4 per 100,000, with an increase in 2021 to 22.4 per 100,000. In 2021, there was an increase in injuries from March with numbers maintained until October. The most common activity of ATR was Team sport (36.2%), followed by Activities of Daily Living (28.9%), Other physical activities (21.0%) and Racket sports (13.9%). In 2020 there was the lowest number of injuries sustained in Team and Racket sports, however in 2021 they accounted for over half of Injuries.Conclusions: There were significantly more patients sustaining ATR in 2021, the year after the covid pandemic and mandatory isolation. This was considered to be related to altered activity and Team and Racket sports during 2020.Levels of Evidence: IV Case series.

A quantitative cross-sectional study assessing the surgical trainee perception of the operating room educational environment (2022)

Posted on by

Type of publication:Journal article

Author(s):Rupani N; Evans A; *Iqbal M

Citation:BMC Medical Education, 2022 Nov 08; Vol. 22 (1), pp. 764

Abstract:Background: Limited hours and service provision are diminishing training opportunities, whilst increasing standards of surgical proficiency is being sought. It is imperative to maximise the value of each educational event. An objective measure of higher surgical trainee perception of the operating room environment in England has not been performed before and this can steer future change in optimising educational events in theatre. The Operating Room Educational Environment Measure (OREEM) evaluates each component of the learning environment to enable optimisation of these educational events. However, the OREEM has not yet been assessed for reliability in higher surgical trainees in England. The aim of the current study was to explore areas of strength and weakness in the educational environment in the operating room as perceived by surgical trainees' in one English region. The secondary aim was to assess the reliability of the OREEM.Methods: Using a quantitative approach, data was collected over one month from surgical trainees in England using the OREEM.Results: Fifty-four surgical trainees completed the questionnaire. The OREEM had good internal consistency (α = 0.906, variables = 40). The mean OREEM score was 79.16%. Areas for improvement included better learning opportunities (average subscale score = 72.9%) and conducting pre- and post-operative teaching (average score = 70.4%). Trainees were most satisfied with the level of supervision and workload (average subscale score = 82.87%). The learning environment favoured senior trainees (p = 0.017). There was a strong correlation between OREEM and the global satisfaction score (p < 0.001).Conclusions: The OREEM was shown to be a reliable measure of the educational environment. It can be used to identify areas of improvement and as an audit tool. The current perception of the education environment is satisfactory, however, areas of improvement include reducing service provision, empowering trainees to plan lists, improving teamwork and using tools to optimise the educational value of each operation. There is a favourable attitude regarding the use of improvement tools, especially for dissatisfied trainees.

Link to full-text [NHS OpenAthens account required]

Induction of labour for predicted macrosomia: study protocol for the 'Big Baby' randomised controlled trial (2022)

Posted on by

Type of publication:Journal article

Author(s):Ewington LJ; Gardosi J; Lall R; Underwood M; Fisher JD; Wood S; Griffin R; Harris K; Bick D; Booth K; Brown J; Butler E; Fowler K; Williams M; *Deshpande S; *Gornall A; Dewdney J; Hillyer K; Gates S; Jones C; Mistry H; Petrou S; Slowther AM; Willis A; Quenby S

Citation:BMJ Open, 2022 Nov 11; Vol. 12 (11), pp. e058176. Date of Electronic Publication: 2022 Nov 11.

Abstract:Introduction: Large-for-gestational age (LGA) fetuses have an increased risk of shoulder dystocia. This can lead to adverse neonatal outcomes and death. Early induction of labour in women with a fetus suspected to be macrosomic may mitigate the risk of shoulder dystocia. The Big Baby Trial aims to find if induction of labour at 38+0-38+4 weeks' gestation, in pregnancies with suspected LGA fetuses, reduces the incidence of shoulder dystocia.Methods and Analysis: The Big Baby Trial is a multicentre, prospective, individually randomised controlled trial of induction of labour at 38+0 to 38+4 weeks' gestation vs standard care as per each hospital trust (median gestation of delivery 39+4) among women whose fetuses have an estimated fetal weight >90th customised centile according to ultrasound scan at 35+0 to 38+0 weeks' gestation. There is a parallel cohort study for women who decline randomisation because they opt for induction, expectant management or caesarean section. Up to 4000 women will be recruited and randomised to induction of labour or to standard care. The primary outcome is the incidence of shoulder dystocia; assessed by an independent expert group, blind to treatment allocation, from delivery records. Secondary outcomes include birth trauma, fractures, haemorrhage, caesarean section rate and length of inpatient stay. The main trial is ongoing, following an internal pilot study. A qualitative reporting, health economic evaluation and parallel process evaluation are included.

Link to full-text [open access - no password required]