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Booth J, Fowler AJ, Pearse R, Dias P, Wan YI, Witton R, Abbott TEF. Dental Surgical Activity in Hospitals during COVID-19: A Nationwide Observational Cohort Study. JDR Clin Trans Res 2024:23800844231216356. [PMID: 38166457 DOI: 10.1177/23800844231216356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2024] Open
Abstract
INTRODUCTION The number of surgical extractions performed in hospitals in England remains unclear. This study reports the volume of surgical extractions conducted in hospitals and change in activity during the COVID-19 pandemic. METHODS We conducted a nationwide observational cohort study using Hospital Episode Statistics (HES) in England for patients undergoing surgical removal of a tooth (defined using OPSC-4 code F09) between April 1, 2015, and December 31, 2020. Procedures were stratified by age, gender, and urgency (elective or nonelective), reported using descriptive statistics, number, and percentage. We conducted post hoc modeling to predict surgical activity to December 2023. In addition, we contrasted this with aggregate national data on simple dental extraction procedures and drainage of dental abscesses in hospital as well as dental activity in general practice. RESULTS We identified a total of 569,938 episodes for the surgical removal of a tooth (females 57%). Of these, 493,056/569,938 (87%) were for adults and 76,882/569,938 (13%) children ≤18 years. Surgical extractions were most frequent in adult females. Elective cases accounted for 96% (n = 548,805/569,938) of procedures. The median number of procedures carried out per quarter was 27,256, dropping to 12,003 during the COVID-19 pandemic, representing a 56% reduction in activity. This amounted to around 61,058 cancelled procedures. Modeling predicts that this activity has not returned to prepandemic levels. CONCLUSIONS The number of surgical extractions taking place in hospitals during the pandemic fell by 56%. The true impact of this reduction is unknown, but delayed treatment increases the risk of complications, including life-threatening infections. KNOWLEDGE TRANSFER STATEMENT The result of this study provides an evidence-based overview of the trends relating to surgical extractions of teeth in England taking place in hospitals. This information can be used to inform service and workforce planning to meet the needs of patients requiring surgical extractions. The data also provide an insight into the oral health needs of the population in England.
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Affiliation(s)
- J Booth
- Dental Public Health and Primary Care, Barts & The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- Peninsula Dental School, University of Plymouth, Drake Circus, Plymouth, UK
| | - A J Fowler
- Critical Care and Perioperative Medicine Research Group, William Harvey Research Institute, Queen Mary University of London, London, UK
| | - R Pearse
- Critical Care and Perioperative Medicine Research Group, William Harvey Research Institute, Queen Mary University of London, London, UK
| | - P Dias
- Critical Care and Perioperative Medicine Research Group, William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Y I Wan
- Critical Care and Perioperative Medicine Research Group, William Harvey Research Institute, Queen Mary University of London, London, UK
| | - R Witton
- Peninsula Dental School, University of Plymouth, Drake Circus, Plymouth, UK
| | - T E F Abbott
- Critical Care and Perioperative Medicine Research Group, William Harvey Research Institute, Queen Mary University of London, London, UK
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Shah SA, Mulholland RH, Wilkinson S, Katikireddi SV, Pan J, Shi T, Kerr S, Agrawal U, Rudan I, Simpson CR, Stock SJ, Macleod J, Murray JLK, McCowan C, Ritchie L, Woolhouse M, Sheikh A. Impact on emergency and elective hospital-based care in Scotland over the first 12 months of the pandemic: interrupted time-series analysis of national lockdowns. J R Soc Med 2022; 115:429-438. [PMID: 35502909 PMCID: PMC9723811 DOI: 10.1177/01410768221095239] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 04/07/2022] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES COVID-19 has resulted in the greatest disruption to National Health Service (NHS) care in its over 70-year history. Building on our previous work, we assessed the ongoing impact of pandemic-related disruption on provision of emergency and elective hospital-based care across Scotland over the first year of the pandemic. DESIGN We undertook interrupted time-series analyses to evaluate the impact of ongoing pandemic-related disruption on hospital NHS care provision at national level and across demographics and clinical specialties spanning the period 29 March 2020-28 March 2021. SETTING Scotland, UK. PARTICIPANTS Patients receiving hospital care from NHS Scotland. MAIN OUTCOME MEASURES We used the percentage change of accident and emergency attendances, and emergency and planned hospital admissions during the pandemic compared to the average admission rate for equivalent weeks in 2018-2019. RESULTS As restrictions were gradually lifted in Scotland after the first lockdown, hospital-based admissions increased approaching pre-pandemic levels. Subsequent tightening of restrictions in September 2020 were associated with a change in slope of relative weekly admissions rate: -1.98% (-2.38, -1.58) in accident and emergency attendance, -1.36% (-1.68, -1.04) in emergency admissions and -2.31% (-2.95, -1.66) in planned admissions. A similar pattern was seen across sex, socioeconomic status and most age groups, except children (0-14 years) where accident and emergency attendance, and emergency admissions were persistently low over the study period. CONCLUSIONS We found substantial disruption to urgent and planned inpatient healthcare provision in hospitals across NHS Scotland. There is the need for urgent policy responses to address continuing unmet health needs and to ensure resilience in the context of future pandemics.
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Affiliation(s)
- Syed Ahmar Shah
- Usher Institute, Edinburgh Medical School, University of
Edinburgh, Edinburgh, EH16 4UX UK
| | - Rachel H Mulholland
- Usher Institute, Edinburgh Medical School, University of
Edinburgh, Edinburgh, EH16 4UX UK
| | - Samantha Wilkinson
- Usher Institute, Edinburgh Medical School, University of
Edinburgh, Edinburgh, EH16 4UX UK
| | | | - Jiafeng Pan
- Department of Mathematics and Statistics, University of
Strathclyde, Glasgow, G1 1XH UK
| | - Ting Shi
- Usher Institute, Edinburgh Medical School, University of
Edinburgh, Edinburgh, EH16 4UX UK
| | - Steven Kerr
- Usher Institute, Edinburgh Medical School, University of
Edinburgh, Edinburgh, EH16 4UX UK
| | - Uktarsh Agrawal
- School of Medicine, University of St. Andrews, St Andrews, KY16
9TF UK
| | - Igor Rudan
- Usher Institute, Edinburgh Medical School, University of
Edinburgh, Edinburgh, EH16 4UX UK
| | - Colin R Simpson
- Usher Institute, Edinburgh Medical School, University of
Edinburgh, Edinburgh, EH16 4UX UK
- School of Health, Wellington Faculty of Health, Victoria
University of Wellington, PO Box 600,Wellington 6140 New Zealand
| | - Sarah J Stock
- Usher Institute, Edinburgh Medical School, University of
Edinburgh, Edinburgh, EH16 4UX UK
| | - John Macleod
- The National Institute for Health Research Applied Research
Collaboration West (NIHR ARC West) at University Hospitals Bristol and Weston
NHS Foundation Trust, Bristol, BS1 2NT, UK
| | | | - Colin McCowan
- School of Medicine, University of St. Andrews, St Andrews, KY16
9TF UK
| | - Lewis Ritchie
- Academic Primary Care, University of Aberdeen School of Medicine
and Dentistry, Aberdeen, AB24 3FX UK
| | - Mark Woolhouse
- Usher Institute, Edinburgh Medical School, University of
Edinburgh, Edinburgh, EH16 4UX UK
| | - Aziz Sheikh
- Usher Institute, Edinburgh Medical School, University of
Edinburgh, Edinburgh, EH16 4UX UK
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Gomez F, Reimer P, Pereira PL, Bent C, Cazzato RL, Das M, Diamantopoulos A, Zeka B, Kaufmann N, Makris G. The Impact of COVID-19 on Interventional Radiology Practice Worldwide: Results from a Global Survey. Cardiovasc Intervent Radiol. [PMID: 35277726 PMCID: PMC8916069 DOI: 10.1007/s00270-022-03090-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 02/04/2022] [Indexed: 02/08/2023]
Abstract
Background The COVID-19 pandemic had an unprecedented impact on clinical practice and healthcare professionals. We aimed to assess how interventional radiology services (IR services) were impacted by the pandemic and describe adaptations to services and working patterns across the first two waves. Methods An anonymous six-part survey created using an online service was distributed as a single-use web link to 7125 members of the Cardiovascular and Interventional Radiological Society of Europe via email. Out of 450 respondents, 327 who completed the survey at least partially including 278 who completed the full survey were included into the analysis. Results Interventional radiologists (IRs) reported that the overall workload decreased a lot (18%) or mildly (36%) or remained stable (29%), and research activities were often delayed (30% in most/all projects, 33% in some projects). Extreme concerns about the health of families, patients and general public were reported by 43%, 34% and 40%, respectively, and 29% reported having experienced significant stress (25% quite a bit; 23% somewhat). Compared to the first wave, significant differences were seen regarding changes to working patterns, effect on emergency work, outpatient and day-case services in the second wave. A total of 59% of respondents felt that their organisation was better prepared for a third wave. A total of 19% and 39% reported that the changes implemented would be continued or potentially continued on a long-term basis. Conclusion While the COVID-19 pandemic has negatively affected IR services in terms of workload, research activity and emotional burden, IRs seem to have improved the own perception of adaptation and preparation for further waves of the pandemic. Supplementary Information The online version contains supplementary material available at 10.1007/s00270-022-03090-6.
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Glasbey JC, Dobbs TD, Abbott TEF. Can patients with asymptomatic SARS-CoV-2 infection safely undergo elective surgery? Br J Anaesth 2022; 128:909-911. [PMID: 35369990 PMCID: PMC8907026 DOI: 10.1016/j.bja.2022.03.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 03/01/2022] [Accepted: 03/01/2022] [Indexed: 11/10/2022] Open
Abstract
Current or recent infection with SARS-CoV-2 increases the risk of perioperative morbidity and mortality. Consensus guidelines recommend delaying elective major surgery after acute SARS-CoV-2 infection for 7 or 8 weeks. However, because of the growing backlog of untreated surgical disease and the potential risks of delaying surgery, surgical services may be under pressure to reduce this period. Here, we discuss the risks and benefits of delaying surgery for patients with current or recent SARS-CoV-2 infection in the context of the evolving COVID-19 pandemic, the limited evidence supporting delays to surgery, and the need for more research in this area.
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Subramaniam J, Durrant F, Edwardson S, El‐Ghazali S, Holt C, McCrossan R, Pramanik I, Wong DJN. Recruitment to higher specialty training in anaesthesia in the UK during the COVID‐19 pandemic: a national survey. Anaesthesia 2022; 77:538-546. [DOI: 10.1111/anae.15660] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2021] [Indexed: 12/18/2022]
Affiliation(s)
- J. Subramaniam
- Department of Anaesthesia Guy's and St Thomas' NHS Foundation Trust London UK
| | - F. Durrant
- Department of Anaesthesia Guy's and St Thomas' NHS Foundation Trust London UK
| | - S. Edwardson
- Departments of Anaesthesia and Critical Care Royal Infirmary of Edinburgh Edinburgh UK
| | - S. El‐Ghazali
- Department of Anaesthesia Guy's and St Thomas' NHS Foundation Trust London UK
| | - C. Holt
- Department of Anaesthesia Guy's and St Thomas' NHS Foundation Trust London UK
| | - R. McCrossan
- Department of Anaesthesia James Cook University Hospital South Tees Hospitals NHS Foundation Trust Middlesbrough UK
| | - I. Pramanik
- Department of Anaesthesia Guy's and St Thomas' NHS Foundation Trust London UK
| | - D. J. N. Wong
- Department of Anaesthesia Guy's and St Thomas' NHS Foundation Trust London UK
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Leeuwen EHV, Taris T, van Rensen ELJ, Knies E, Lammers JW. Positive impact of the COVID-19 pandemic? A longitudinal study on the impact of the COVID-19 pandemic on physicians' work experiences and employability. BMJ Open 2021; 11:e050962. [PMID: 34862285 PMCID: PMC8646962 DOI: 10.1136/bmjopen-2021-050962] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE The COVID-19 pandemic places an enormous demand on physicians around the world. The aim of this study was to examine the impact of the COVID-19 pandemic on physicians' work experiences and their ability and willingness to continue working in their profession until retirement (ie, their employability). DESIGN A longitudinal comparative design was used. Survey data were collected on three moments: before (May 2019), in the early phase (May 2020) and in a later phase (November 2020) of the COVID-19 pandemic. Time effects were tested using repeated-measures analyses of variance and one-way analyses of variance. SETTING This study took place among physicians of two hospitals in a large city in the Netherlands. PARTICIPANTS 165 hospital physicians with surgical, medical and other specialties participated in this study. RESULTS Physicians' employability significantly increased from the time prior to the COVID-19 pandemic, compared with the period during this pandemic. Employability differs among physicians with surgical, medical and other specialties. Furthermore, physicians experienced a lower emotional, physical and quantitative workload during the first peak of the COVID-19 pandemic, compared with before the pandemic. Moreover, physicians experienced the most stress from the impact of COVID-19 on their work in general and from combining work and private life. CONCLUSIONS This study shows that physicians' employability and work experiences are affected by the COVID-19 pandemic. Work experiences vary for physicians with different specialties. These varieties stress the importance of attention for physicians' individual needs and challenges regarding working during the COVID-19 pandemic and the possibility of continuing work in the aftermath of this crisis. Based on this, physicians can be offered tailor-made solutions. This is important to maintain a healthy and employable workforce, which is essential for a sustainable healthcare system.
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Affiliation(s)
- Evelien H van Leeuwen
- Department of Quality and Patient Safety, UMC Utrecht, Utrecht, The Netherlands
- Department of Strategic Human Resource Management, Utrecht University School of Governance, Utrecht, The Netherlands
| | - Toon Taris
- Department of Social, Health and Organizational Psychology, Utrecht University, Utrecht, The Netherlands
| | | | - Eva Knies
- Department of Strategic Human Resource Management, Utrecht University School of Governance, Utrecht, The Netherlands
| | - Jan-Willem Lammers
- Department of Respiratory Medicine, UMC Utrecht, Utrecht, The Netherlands
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Abbott TEF, Fowler AJ, Dobbs TD, Gibson J, Shahid T, Dias P, Akbari A, Whitaker IS, Pearse RM. Mortality after surgery with SARS-CoV-2 infection in England: a population-wide epidemiological study. Br J Anaesth 2021; 127:205-214. [PMID: 34148733 PMCID: PMC8192173 DOI: 10.1016/j.bja.2021.05.018] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 05/14/2021] [Accepted: 05/20/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic has heavily impacted elective and emergency surgery around the world. We aimed to confirm the incidence of perioperative severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and associated mortality after surgery. METHODS Analysis of routine electronic health record data from NHS hospitals in England. We extracted data from Hospital Episode Statistics in England describing adult patients undergoing surgery between January 1, 2020 and February 28, 2021. The exposure was SARS-CoV-2 infection defined by International Classification of Diseases (ICD)-10 codes. The primary outcome measure was 90 day in-hospital mortality. Data were analysed using multivariable logistic regression adjusted for age, sex, Charlson Comorbidity Index, Index of Multiple Deprivation, presence of cancer, surgical procedure type and admission acuity. Results are presented as n (%) and odds ratios (OR) with 95% confidence intervals (CI). RESULTS We identified 2 666 978 patients undergoing surgery of whom 28 777 (1.1%) had SARS-CoV-2 infection. In total, 26 364 (1.0%) patients died in hospital. SARS-CoV-2 infection was associated with a much greater risk of death (SARS-CoV-2: 6153/28 777 [21.4%] vs no SARS-CoV-2: 20 211/2 638 201 [0.8%]; OR=5.7 [95% CI, 5.5-5.9]; P<0.001). Amongst patients undergoing elective surgery, 2412/1 857 586 (0.1%) had SARS-CoV-2, of whom 172/2412 (7.1%) died, compared with 1414/1 857 586 (0.1%) patients without SARS-CoV-2 (OR=25.8 [95% CI, 21.7-30.9]; P<0.001). Amongst patients undergoing emergency surgery, 22 918/582 292 (3.9%) patients had SARS-CoV-2, of whom 5752/22 918 (25.1%) died, compared with 18 060/559 374 (3.4%) patients without SARS-CoV-2 (OR=5.5 [95% CI, 5.3-5.7]; P<0.001). CONCLUSIONS The low incidence of SARS-CoV-2 infection in NHS surgical pathways suggests current infection prevention and control policies are highly effective. However, the high mortality amongst patients with SARS-CoV-2 suggests these precautions cannot be safely relaxed.
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Affiliation(s)
- T E F Abbott
- William Harvey Research Institute, Queen Mary University of London, London, UK.
| | - A J Fowler
- William Harvey Research Institute, Queen Mary University of London, London, UK
| | - T D Dobbs
- Reconstructive and Regenerative Medicine Group (ReconRegen), Institute of Life Sciences, Swansea University Medical School, Swansea, UK; Welsh Centre for Burns and Plastics, Morriston Hospital, Swansea, UK
| | - J Gibson
- Reconstructive and Regenerative Medicine Group (ReconRegen), Institute of Life Sciences, Swansea University Medical School, Swansea, UK; Welsh Centre for Burns and Plastics, Morriston Hospital, Swansea, UK
| | - T Shahid
- William Harvey Research Institute, Queen Mary University of London, London, UK
| | - P Dias
- William Harvey Research Institute, Queen Mary University of London, London, UK
| | - A Akbari
- Health Data Research UK, Swansea University Medical School, Swansea, UK
| | - I S Whitaker
- Reconstructive and Regenerative Medicine Group (ReconRegen), Institute of Life Sciences, Swansea University Medical School, Swansea, UK; Welsh Centre for Burns and Plastics, Morriston Hospital, Swansea, UK
| | - R M Pearse
- William Harvey Research Institute, Queen Mary University of London, London, UK
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Dobbs TD, Gibson JAG, Fowler AJ, Abbott TE, Shahid T, Torabi F, Griffiths R, Lyons RA, Pearse RM, Whitaker IS. Surgical activity in England and Wales during the COVID-19 pandemic: a nationwide observational cohort study. Br J Anaesth 2021; 127:196-204. [PMID: 34148732 PMCID: PMC8277602 DOI: 10.1016/j.bja.2021.05.001] [Citation(s) in RCA: 56] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 04/29/2021] [Accepted: 05/04/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND A significant proportion of healthcare resource has been diverted to the care of those with COVID-19. This study reports the volume of surgical activity and the number of cancelled surgical procedures during the COVID-19 pandemic. METHODS We used hospital episode statistics for all adult patients undergoing surgery between January 1, 2020 and December 31, 2020 in England and Wales. We identified surgical procedures using a previously published list of procedure codes. Procedures were stratified by urgency of surgery as defined by NHS England. We calculated the deficit of surgical activity by comparing the expected number of procedures from 2016 to 2019 with the actual number of procedures in 2020. Using a linear regression model, we calculated the expected cumulative number of cancelled procedures by December 31, 2021. RESULTS The total number of surgical procedures carried out in England and Wales in 2020 was 3 102 674 compared with the predicted number of 4 671 338 (95% confidence interval [CI]: 4 218 740-5 123 932). This represents a 33.6% reduction in the national volume of surgical activity. There were 763 730 emergency surgical procedures (13.4% reduction) compared with 2 338 944 elective surgical procedures (38.6% reduction). The cumulative number of cancelled or postponed procedures was 1 568 664 (95% CI: 1 116 066-2 021 258). We estimate that this will increase to 2 358 420 (95% CI: 1 667 587-3 100 808) up to December 31, 2021. CONCLUSIONS The volume of surgical activity in England and Wales was reduced by 33.6% in 2020, resulting in more than 1.5 million cancelled operations. This deficit will continue to grow in 2021.
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Affiliation(s)
- Thomas D Dobbs
- Reconstructive Surgery & Regenerative Medicine Research Centre, Institute of Life Sciences, Swansea University Medical School, Swansea, UK; Welsh Centre for Burns and Plastics, Morriston Hospital, Swansea, UK.
| | - John A G Gibson
- Reconstructive Surgery & Regenerative Medicine Research Centre, Institute of Life Sciences, Swansea University Medical School, Swansea, UK
| | - Alex J Fowler
- William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Tom E Abbott
- William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Tasnin Shahid
- William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Fatemeh Torabi
- Population Data Science, Swansea University Medical School, Swansea, UK
| | - Rowena Griffiths
- Population Data Science, Swansea University Medical School, Swansea, UK
| | - Ronan A Lyons
- Population Data Science, Swansea University Medical School, Swansea, UK
| | - Rupert M Pearse
- William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Iain S Whitaker
- Reconstructive Surgery & Regenerative Medicine Research Centre, Institute of Life Sciences, Swansea University Medical School, Swansea, UK; Welsh Centre for Burns and Plastics, Morriston Hospital, Swansea, UK
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