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SARS-CoV-2 infection and venous thromboembolism after surgery (2022)

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Type of publication:
Journal article

Author(s):
COVIDSurg Collaborative; GlobalSurg Collaborative. (COVIDSurg Collaborative involves *Yen Nee Jenny Bo, *Mohammad Iqbal, *Aarti Lakhiani, *Guleed Mohamed, *William Parry-Smith, and *Banchhita Sahu of Shrewsbury and Telford Hospitals NHS Trust)

Citation:
Anaesthesia, Jan 2022, Volume77, Issue1, Pages 28-39

Abstract:
SARS-CoV-2 has been associated with an increased rate of venous thromboembolism in critically ill patients. Since surgical patients are already at higher risk of venous thromboembolism than general populations, this study aimed to determine if patients with peri-operative or prior SARS-CoV-2 were at further increased risk of venous thromboembolism. We conducted a planned sub-study and analysis from an international, multicentre, prospective cohort study of elective and emergency patients undergoing surgery during October 2020. Patients from all surgical specialties were included. The primary outcome measure was venous thromboembolism (pulmonary embolism or deep vein thrombosis) within 30 days of surgery. SARS-CoV-2 diagnosis was defined as peri-operative (7 days before to 30 days after surgery); recent (1–6 weeks before surgery); previous (≥7 weeks before surgery); or none. Information on prophylaxis regimens or pre-operative anti-coagulation for baseline comorbidities was not available. Postoperative venous thromboembolism rate was 0.5% (666/123,591) in patients without SARS-CoV-2; 2.2% (50/2317) in patients with peri-operative SARS-CoV-2; 1.6% (15/953) in patients with recent SARS-CoV-2; and 1.0% (11/1148) in patients with previous SARS-CoV-2. After adjustment for confounding factors, patients with peri-operative (adjusted odds ratio 1.5 (95%CI 1.1–2.0)) and recent SARS-CoV-2 (1.9 (95%CI 1.2–3.3)) remained at higher risk of venous thromboembolism, with a borderline finding in previous SARS-CoV-2 (1.7 (95%CI 0.9–3.0)). Overall, venous thromboembolism was independently associated with 30-day mortality (5.4 (95%CI 4.3–6.7)). In patients with SARS-CoV-2, mortality without venous thromboembolism was 7.4% (319/4342) and with venous thromboembolism was 40.8% (31/76). Patients undergoing surgery with peri-operative or recent SARS-CoV-2 appear to be at increased risk of postoperative venous thromboembolism compared with patients with no history of SARS-CoV-2 infection. Optimal venous thromboembolism prophylaxis and treatment are unknown in this cohort of patients, and these data should be interpreted accordingly.

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The effect of the measures taken during the coronavirus pandemic on specialty trainees in obstetrics and gynaecology in the United Kingdom: an online questionnaire survey in one region (2022)

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Type of publication:
Journal article

Author(s):
Elghobashy M; Stout A; Hatti A; *Smotra G; El-Ghobashy A

Citation:
Journal of Obstetrics and Gynaecology. 42(5) (pp 1455-1460), 2022. Date of Publication: 2022.

Abstract:
The coronavirus pandemic (COVID-19) has had unprecedented effects on healthcare delivery. A 34-question online survey was sent to obstetrics and gynaecology trainees within the West Midlands to assess the impact of the pandemic on training, working practices and well-being. 101 responses were received from obstetrics and gynaecology trainees. Trainees reported a significant reduction in both elective and emergency surgeries as well as outpatient clinics. Over one third of respondents felt additional training time may be required following reduction of clinical opportunities. 44% of trainees felt their workload increased significantly. 55% of trainees felt the pandemic had a significant negative impact on their physical and mental well-being. Obstetrics and gynaecology trainees in the West Midlands have adapted to the challenges of the COVID-19 pandemic despite significant impact on their training, working practices and wellbeing. It is important to tailor training to improve trainees' education and combat lost training time during the pandemic. This should be considered for long-term shaping of the obstetrics and gynaecology training pathway. IMPACT STATEMENT What is already known on this subject? Little research is available about the impact of the COVID-19 pandemic on obstetrics and gynaecology trainees. This is the first study of its kind to assess the effect of the pandemic on obstetrics ang gynaecology trainees in the United Kingdom. What do the results of this study add? The results of this study have shown that obstetrics and gynaecology training has been heavily affected during the COVID-19 pandemic. There have been significant impacts on their training, working patterns and physical and mental wellbeing. What are the implications of these findings for clinical practice and/or further research? These findings can be used to mould the obstetrics and gynaecology training pathway based on the feedback given by the trainees during the pandemic. The survey questions can also be utilised as a framework for similar research projects across the United Kingdom Deaneries, among other specialties and around the world.

Appropriately timed COVID-19 PCR testing for hospital inpatients (2021)

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Type of publication:
Conference abstract

Author(s):
*Zaheer Raffeeq, *Nawaid Ahmad, *Emma Crawford, *Devapriya Dev, *Annabel Makan, *Koottalai Srinivasan, *Harmesh Moudgil

Citation:
European Respiratory Journal 2021 58 Suppl 65, PA448

Abstract:
Background: Nosocomial spread of Coronavirus has been an issue for hospitals across the UK, with a recent report by Public Health England (PHE) and the London School of Hygiene and Tropical Medicine (LSHTM) stating that the effective reproduction rate of SARS-CoV-2 in hospitals has been projected to have been as high as 14 during the first wave of the pandemic [1]. In order to stifle this spread hospital Infection and Prevention Control (IPC) set out regular guidelines concerning when patients should be tested for COVID-19.
Aims and objectives: We attempted to assess how well our trust followed the IPC guidance for testing patients for COVID-19, specifically with regard to swab timing following admission to hospital.
Methods: We analysed all admissions to the hospital during the week of 1st October 2020 to the 7th October 2020. We looked at how many patients were appropriately swabbed on day 1, and day 5, as was required according to IPC guidance at the time.
Results: We found that of the 266 patients admitted in the said week, 4 patients (1.5%) had a swab greater than 24 hours after admission, and 17 (6.39%) patients did not have a PCR swab at all. 148 patients stayed in hospital 5 days or greater, with 19 patients (17.27%) receiving their second swab correctly on day 5 of admission and 91 patients (82.73%) either not having their swab on the correct day or not having a follow up swab at all.
Conclusion: While testing on entry was generally done in a timely manner, follow-up swabs are not performed according to the guidelines set out by IPC, and therefore not following evidence-based practice.

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Direct to surgery treatment of suspected lung cancer – results from a UK lung cancer multidisciplinary team (MDT) (2021)

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Type of publication:
Conference abstract

Author(s):
*Manoj Marathe, *Tinaye Mandishona, *Harmesh Moudgil, *Nawaid Ahmad, *Emma Crawford, *Annabel Makan, *Koottalai Srinivasan

Citation:
European Respiratory Journal 2021 58 Suppl 65, OA2640

Abstract:
Introduction: The selective resection of suspicious nodules and masses without pre-operative tissue diagnosis is an established treatment that can shorten time to curative lung cancer treatment. We evaluated the outcomes of this practice in our local MDT.
Methods: We performed a retrospective review of 84 patients with curatively resectable single lung lesions who underwent surgical resection from January 2017 to December 2018 without histological diagnosis.
Results: Malignancy was confirmed in 68/84 (81%) patients. 57/68 patients were diagnosed with a primary lung malignancy and 11/68 with metastatic disease. Figures 1 and 2 show significant and non significant differentiators determined by the chi squared test.
Conclusion: These results support the use of spiculated and / or irregular lesion appearance along with SUV uptake >=2.5 as significant pre-histology differentiators of malignant and benign lesions. Neither past history of cancer nor size of lesion in isolation were predictive of malignancy. Our study gives further evidence that a direct-to-surgery approach is a suitable treatment option for appropriate suspicious nodules.

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Paediatric Injuries Pre And During COVID-19 Requiring an Operative Intervention: The District General Hospital Experience (2021)

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Type of publication:Conference abstract

Author(s):*Howard E.; *Arshad S.; *Kabariti R.; *Roach R.

Citation:British Journal of Surgery; Sep 2021; vol. 108, Supplement 6

Abstract:Aim: To assess the effect of lockdown and the following summer period on paediatric trauma patients who required an operative intervention in a district general hospital. Method(s): A single centre retrospective audit was performed on all paediatric patients <16 years requiring an operative intervention. Two study periods were assessed-pre-COVID (22/03/2019-30/09/2019) and during the COVID-19 pandemic and subsequent summer period (26/03/ 2020-26/09/2020). Data were collected on patient demographics, type of injury sustained, and intervention performed. Result(s): During the COVID-19 pandemic 119 operations were performed, compared to 238 operations performed before the pandemic. Distal radius fractures were the most common injury both during and before the pandemic. However, during the pandemic there was a higher incidence of both hand injuries and lower limb lacerations. The most common type of operation both before and during the pandemic was manipulation under anaesthetic, but there was an increased incidence of washouts performed during the pandemic. Conclusion(s): Despite extensive restructuring of services due to COVID-19, 119 operations were performed during the pandemic. However, this is 119 fewer operations than the same period of the previous year. The reduced rate of operations could be a consequence of increased parental supervision, and less outdoor activity during the pandemic period, but further research is necessary.

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Organising a surgical conference during the COVID-19 pandemic-is it 'virtually' the same? (2021)

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Type of publication:Conference abstract

Author(s):Hashmi Y.; Sahu M.A.; Hatt K.; Osman S.; Bhuiyan Z.A.; *Ahmed U.

Citation:British Journal of Surgery; Sep 2021; vol. 108, Supplement 6

Abstract:Introduction: Surgical conferences are invaluable events for healthcare professionals; they provide opportunities to engage with upcoming scientific discoveries, network professionally with peers as well as expand learning through lectures and workshops. For medical students, conferences provide an opportunity to expand understanding beyond the undergraduate curriculum in an interactive manner. COVID-19 has caused disruption to the organisation and attendance of in-person conferences (IPCs). Virtual conferences (VCs) offer a viable solution, allowing delegates to attend from the comfort of their own homes. Method(s): The aim of our study was to evaluate an organised VC and explore the perceived benefits and limitations of VCs compared to IPCs. A virtual one-day trauma & orthopaedics (T&O) conference was organised involving lectures, workshops, poster, and oral presentations. Anonymous questionnaire forms were distributed to delegates following the conference to assess the aims of our paper. Result(s): From 106 responses, 96.2% rated the conference as 'Excellent' or 'Good' with 92.5% stating that it increased their passion for T&O surgery. Based on a five-point Likert scale (5= strongly agree, 1= strongly disagree), mean score of agreement for preferring VCs to IPCs was 3.30(+/- 1.24). Key advantages of the VC were a lower cost (70.8%) and not having to travel (77.4%), whereas the main limitation was the inability to participate in hands-on workshops (84.9%). Conclusion(s): Despite the success of our VC, delegate feedback indicates a mixed response comparing VCs to IPCs. We share our findings to encourage similar events to be organised and for other specialties.

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Emotional Resilience and Bariatric Surgical Teams: a Priority in the Pandemic (2021)

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Type of publication:Conference abstract

Author(s):Graham Y.; Mahawar K.; Omar I.; *Riera M.; Bhasker A.; Wilson M.

Citation:British Journal of Surgery; Oct 2021; vol. 108, Supplement 7

Abstract:The infection control measures implemented as a result of COVID-19 led to a postponement of bariatric surgical procedures across many countries worldwide. Many bariatric surgical teams were in essence left without a profession, with many redeployed to other areas of clinical care and were not able to provide the levels of patient support given before COVID-19. As the pandemic continues, some restrictions have been lifted, with staff adjusting to new ways of working, incorporating challenging working conditions and dealing with continuing levels of stress. This article explores the concept of emotional labour, defined as 'inducing or suppressing feelings in order to perform one's work', and its application to multidisciplinary teams working within bariatric surgery, to offer insight into the mental health issues that may be affecting healthcare professionals working in this discipline.

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23-hour stay following total parathyroidectomy in renal patients (2021)

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Type of publication:Conference abstract

Author(s):*Neophytou C.; *Chang J.; *Howard E.; *Houghton A.

Citation:British Journal of Surgery; Oct 2021; vol. 108, Supplement 7

Abstract:Aim: Total parathyroidectomy in end-stage renal failure (ESRF), is an effective way to improve or stabilise calcium and parathormone levels and thus improve renal osteodystrophy. Previous BAEST guidelines were not in favour of true day-case neck surgery due to the risk of airway compromise from bleeding. Additionally, ESRF patients are at risk of profound hypocalcaemia after total parathyroidectomy. Patients undergoing total parathyroidectomy are prescribed Alfacalcidol 4mcg daily for 5 days prior to surgery. Following surgery under GA on a morning list, the potassium and calcium levels are checked in the afternoon. Calcium levels are then monitored daily for 3 days and subsequently when required. Oral Alfacalcidol is continued at the same dose until the nephrologists advise otherwise. Method(s): All ESRF patients undergoing total parathyroidectomy for secondary hyperparathyroidism were identified between 01/01/2005 and 31/12/2019 from a prospectively maintained electronic database. Demographics, biochemistry, length of stay (LoS) and outcomes were analysed. Result(s): There were 43 (30 male) total parathyroidectomies. The median age was 53 (range 14 – 78), and median LoS 1 day (range 0 -13). 26 patients (60%) were discharged within 23 hours (26% were day-case). Prolonged stay was due to calcium replacement (n=8) or dialysis (n=4) requirements. Pre- and post-operative calcium values over 2.49mmol/L were significantly related to 23-hour stay (p=0.010482 and p=0.000263 respectively). No 30-day re-admissions were observed Conclusion(s): Careful patient selection and adherence to a perioperative management protocol in total parathyroidectomy may enable early discharge within 23 hours. Preoperative calcium levels help predict this outcome.

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Fascial defect closure in laparoscopic incisional/ventral hernia: A systematic review and meta-analysis of published randomized, controlled trials (2021)

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Type of publication:Conference abstract

Author(s):Rehman S.; *Akhtar M.S.; Khan M.; Sains P.; Sajid M.S.

Citation:British Journal of Surgery; Oct 2021; vol. 108, Supplement 7

Abstract:Aims: Closure of fascial defect (CFD) during laparoscopic incisional/ ventral hernia repair (LIVHR) remains a controversial issue which requires further investigations to reach a solid conclusion. The objective of this study is to present a systematic review comparing the outcomes of randomized controlled trials evaluating the defect closure versus no-defect closure in patients undergoing LIVHR. Method(s): A systematic review of randomized, controlled trials reporting the fascial defect closure in patients undergoing LIVHR until January 2021 published in Embase, Medline, PubMed, PubMed Central and Cochrane databases was performed using the principles of metaanalysis. Result(s): A total of four RCTs involving 443 patients were included. In the random effects model analysis, using the statistical software Review Manager, defect closure during LIVHR showed no difference in hernia recurrence (risk ratio (RR), 0.89; 95% CI, 0.31, 2.57; z=0.21; P=0.84). In addition, the post-operative complications (RR, 0.69; 95% CI, 0.41, 1.16; z=1.41; P=0.16), duration of operation (Standardized mean difference (SMD), -0.04; 95% CI, -0.52, 0.43; z=0.18; P=0.86) and hospital stay (SMD, 0.27; 95% CI, -0.02, 0.56; z=1.80; P=0.07) were also statistically similar in both groups. CFD was associated with an increased post-operative pain score (SMD, 1.82; 95% CI, 0.61, 3.03; z=2.95; P=0.003). Conclusion(s): Fascial defect closure in patients undergoing LIVHR does not demonstrate any superiority over no-defect closure in terms of recurrence, post-operative morbidity, post-operative pain duration of operation and length of hospital stay.

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The post graduate virtual learning environment: An effective platform for the delivery of a surgical teaching programme in the West Midlands (2021)

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Type of publication:Conference abstract

Author(s):El-Sayed C.; *Ahmed U.; *Farquharson A.

Citation:British Journal of Surgery; Oct 2021; vol. 108, Supplement 7

Abstract:Aim: The Postgraduate Virtual Learning Environment (PGVLE) is a digital platform developed by HEEWM in response to the COVID-19 pandemic to deliver a virtual teaching programme to surgical trainees. The programme is delivered through the BigBlueButton; an integrated virtual classroom. All teaching sessions are recorded and archived to allow trainees to review content at their convenience. We performed a contemporaneous study to review the effectiveness and quality of the platform in delivering teaching and suggest its future role in the surgical curriculum. Method(s): Anonymised feedback was gathered of trainee's perspective of the platform experience, the quality of teaching and the archived content. All trainees were General Surgery higher trainees (HST) (ST3- ST8). The data from sequential teaching days was analysed. Result(s): Of 90 HST, on average 40 attended each monthly training day (consistent with pre-COVID attendance). 122 trainee responses were completed. 68% of respondents were between ST3-ST5. 91% rated the administration and delivery of the teaching sessions as excellent or very good. 16% of trainees watched the archived sessions after the teaching day of which 46% felt it met their educational expectations. Conclusion(s): The PGVLE is an effective platform for the delivery of a virtual surgical teaching programme. It met with high levels of trainee satisfaction in the context of the pandemic. The archived content provides advantages to consolidation of learning. It is thought that the PGVLE platform will become a key feature of the surgical training programme in a hybrid learning model, related to relevant curricula, in the future.

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