982 Higher General Surgical Trainee preferences for Annual Review of Competency Progression during COVID-19 Pandemic

Aim

The COVID-19 pandemic has caused significant disruption in surgical training. We aim to explore the preferences of higher general surgical trainees for Annual Review of Competency Progression (ARCP) also compare the responses across different training grades.

Method

All higher general surgical trainee in a single deanery were invited to participate in an online voluntary anonymous survey. The respondents were divided in two groups: junior (ST3-ST5) and senior higher surgical trainees (ST6-ST8) and responses compared.

Results

Sixty-four of 88 trainees responded. Thirty-three (51.6%) were ST3–ST5, 24 (37.5%) were ST6–ST8 and 7 (10.9%) were out-of-training. More trainees in ST3–ST5 group preferred to defer the next rotation for 12 months (18.2% vs 0%, p = 0.034), repeat current sub-specialty (33.3% vs 4.2%, p = 0.009), or add 12 months to training and delay predicted CCT date by 12 months (18.2% vs 0%, p = 0.034). Most trainees in both groups preferred the option of prolonging training should be offered to all trainees with an option to decline extension if ARCP competencies met (66.7% vs 50.0%, p = 0.276).

Conclusions

The preference for ARCP and length of training was different between two training groups, hence the need of trainees should be considered by training committees when addressing the impact of COVID-19.

930 Impact of the COVID-19 Pandemic on Higher General Surgical Training – A West of Scotland Experience

Introduction

COVID-19 pandemic has caused significant disruption in all aspects of training. Our aim was to explore the degree of impact caused by the pandemic on higher general surgical trainees.

Method

All higher general surgical trainees in a single UK deanery were invited to participate in an online, voluntary, anonymous survey via SurveyMonkey.

Results

64 (72.7%) of the trainees responded. 39.1% were ST3/4, 29.7% were ST5/6, 20.3% were ST7/8 and 10.9% were out of training (maternity & research). Thirty-five (55.6%) worked in district general hospitals. Forty (68.9%) trainees felt that they had fewer opportunities to be primary surgeon. Forty-two (67.7%) trainees did not have access to laparoscopic simulation trainers. Fifty-two (88.1%) trainees had their courses and 2 (3.4%) had their FRCS part 2 exam postponed. 16 (27.1%) trainees reported they had been off-sick, with a median of 7 days off (range 3-35 days). Thirty-three (55.9%) trainees felt more stressed due to the pandemic and 35 (59.4%) had symptoms of burnout.

Conclusions

The COVID-19 pandemic has had an unprecedented impact on all aspects of higher surgical training. The most noticeable impact has been on the reduction in the confidence in laparoscopic and endoscopic skills.

Oxidative Stress and Cardiovascular Risk in Type 1 Diabetes Mellitus: Insights From the DCCT/EDIC Study

Background

Hyperglycemia leading to increased oxidative stress is implicated in the increased risk for the development of macrovascular and microvascular complications in patients with type 1 diabetes mellitus.

Methods and Results

A random subcohort of 349 participants was selected from the DCCT / EDIC (Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications) cohort. This included 320 controls and 29 cardiovascular disease cases that were augmented with 98 additional known cases to yield a case cohort of 447 participants (320 controls, 127 cases). Biosamples from DCCT baseline, year 1, and closeout of DCCT , and 1 to 2 years post‐ DCCT ( EDIC years 1 and 2) were measured for markers of oxidative stress, including plasma myeloperoxidase, paraoxonase activity, urinary F 2α isoprostanes, and its metabolite, 2,3 dinor‐8 iso prostaglandin F 2α . Following adjustment for glycated hemoblobin and weighting the observations inversely proportional to the sampling selection probabilities, higher paraoxonase activity, reflective of antioxidant activity, and 2,3 dinor‐8 iso prostaglandin F 2α , an oxidative marker, were significantly associated with lower risk of cardiovascular disease (−4.5% risk for 10% higher paraoxonase, P <0.003; −5.3% risk for 10% higher 2,3 dinor‐8 iso prostaglandin F 2α , P =0.0092). In contrast, the oxidative markers myeloperoxidase and F 2α isoprostanes were not significantly associated with cardiovascular disease after adjustment for glycated hemoblobin. There were no significant differences between DCCT intensive and conventional treatment groups in the change in all biomarkers across time segments.

Conclusions

Heightened antioxidant activity (rather than diminished oxidative stress markers) is associated with lower cardiovascular disease risk in type 1 diabetes mellitus, but these biomarkers did not change over time with intensification of glycemic control.

Clinical Trial Registration

URL : https://www.clinicaltrials.gov . Unique identifiers: NCT 00360815 and NCT 00360893.

The management of acute seizures in Naval Service personnel

Seizures are a relatively common Emergency Department (ED) presentation among young adult populations, considered for the purpose of this report as being aged 15-59. Due to the varied aetiologies involved, understanding of the potential causes and their presentation is key to managing these patients. Although seizure incidence within the United Kingdom (UK) Armed Forces population is generally low, it is not negligible. Therefore, awareness of the initial management is required by all those involved in patient care from the Medical Assistant (MA) at the Role 1 facility, through to the senior doctors at Role 3 establishments. All management should be in line with the Clinical Guidelines for Operations (CGOs) and Advanced Life Support (ALS) principles, with resuscitation, seizure control and patient stabilisation taking precedence initially. Ultimately, the use of laboratory testing and imaging at a Role 3 setting will be required to accurately confirm a diagnosis. Information obtained during these assessments may serve to assist the Naval Service Medical Board of Survey (NSMBOS) in determining suitability for continued Service retention and employment.

Estrogen and xenoestrogens upregulate the brain aromatase isoform (P450aromB) and perturb markers of early development in zebrafish (Danio rerio)

Estrogen synthesized in the brain itself by the action of cytochrome P450 aromatase (P450arom) is known to have permanent organizing effects on the developing CNS. In fish, estrogen upregulates the predominant brain isoform (P450aromB), implying that xenoestrogens (XE) could act as neurodevelopmental toxicants by altering P450aromB. To test this hypothesis, zebrafish embryos were exposed to 17beta-estradiol (E(2)), diethylstilbestrol (DES, a potent agonist), and bisphenol A (BPA, a weak agonist). RT-PCR/Southern transfer analysis showed that E(2) (0.01-10 microM) upregulated P450aromB in a dose-response manner. The effect of DES (0.01 microM) was similar to 1 microM E(2) (three- to four-fold higher than control), but BPA was less effective (<threefold increase at 10 microM). mRNA levels of the predominant ovarian isoform (P450aromA) were unchanged by estrogen. Treatment with E(2) (0.1-10 microM) between 2 and 72 hpf had dose-response effects on mortality and hatching and induced a 'curved tail down' phenotype characteristic of mutants with defects of early CNS development. The critical period of estrogen sensitivity for effects on mortality and curved tails was 2-24 hpf, whereas hatching effects were both stage- and duration-dependent. Developmental effects of DES and BPA were similar to E(2) but testosterone, and 5alpha-dihydrotestosterone were ineffective. 17alpha-Estradiol showed a small but significant effect on curved tails. We conclude that P450aromB mRNA is a sensitive marker of XE effect during embryogenesis, but further studies are required to determine whether changes in neural aromatase expression and estrogen biosynthesis have consequences for CNS development.

Effect of scavenging on the psychomotor and cognitive function of subjects sedated with nitrous oxide and oxygen inhalation

Maximizing scavenger effectiveness using a 45 L/min evacuation rate as recommended by the National Institute of Occupational Safety and Health (NIOSH) may alter the sedation level of the dental patient. The purpose of this pilot study was to determine if scavenging at the recommended NIOSH evacuation rate reduced psychomotor and cognitive impairment as a result of inhaling nitrous oxide. Computer-administered neurobehavioral tests of human psychomotor and cognitive function previously established in controlled trials to be sensitive to nitrous oxide inhalation were employed in this blind, randomized, crossover study of 30 healthy adult subjects. The results indicated that scavenging produced statistically significant improvement in finger-tapping speed, symbol/digit coding speed, and recall accuracy. Hand/eye coordination was not improved significantly by scavenging. Enhancement of psychomotor skills and cognitive functioning was interpreted as an undesirable side effect of scavenging that could potentially influence dental patient anxiety management when using nitrous oxide inhalation. The results of this pilot study suggested that scavenger operation under the conditions tested could reduce the level of psychosedation achieved with nitrous oxide inhalation.

Cryopreservation and the maintenance of cell lines

Techniques for cell-line preservation which enable reliable and reproducible recovery of material with unchanged, defined characteristics are essential in many biotechnology industries. Cryopreservation is one such technique, and in this review we explore some of its problems, successes and potential future applications.

Observations on the use of music in rehabilitation of stroke patients

A preliminary investigation was initiated to explore the use of music as a means of improving general mobility, social interaction, and emotional stability in patients who have suffered a stroke. A literature search had revealed very little information on the use of music in the rehabilitation of such patients. The investigators videotaped a series of sessions involving group movement-to-music, group music-making, and individual movement-to-music. An individual case study in music-making was carried out as well. All videotapes were reviewed and we observed that an increase in the range and ease of movement of the patients occurred during weight-shifting activities, when appropriate music with a tempo of 58 to 63 beats per minute was used. Our observations supported the findings of recent research concerning preferred tempi for certain activities and reinforcement of movement by appropriate tempi. Other factors in our study, such as size of group, placement, cueing, and the opportunity to touch, appeared to affect the responses obtained in group situations. As the result of our observations, we have concluded that music enhances the general mobility and social interaction of patients who have sustained a cerebrovascular accident and that it may also improve a patient's emotional stability.