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Herbert GL, Robinson DBT, Powell AG, Abdelrahman T, Khalid U, Lewis WG. Economic cost-utility analysis of stage-directed oesophageal cancer treatment. BJS Open 2024; 8:zrad159. [PMID: 38557866 DOI: 10.1093/bjsopen/zrad159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 11/14/2023] [Accepted: 12/01/2023] [Indexed: 04/04/2024] Open
Affiliation(s)
- Geraint L Herbert
- Health Education and Improvement Wales, Tŷ Dysgu, Cefn Coed, Nantgarw, UK
- Department of Surgery, University Hospital of Wales, Heath Park Way, Cardiff, UK
- School of Medicine, Cardiff University, Cardiff, UK
- Department of Surgery, Aneurin Bevan University Health Board, Grange University Hospital, Caerleon Road, Llanfrechfa, Cwmbran, UK
| | - David B T Robinson
- Health Education and Improvement Wales, Tŷ Dysgu, Cefn Coed, Nantgarw, UK
- Department of Surgery, University Hospital of Wales, Heath Park Way, Cardiff, UK
| | - Arfon G Powell
- Greater Manchester Oesophagogastric Surgery Unit, Salford Royal Hospital, Stott Lane, Salford, UK
| | - Tarig Abdelrahman
- Department of Surgery, University Hospital of Wales, Heath Park Way, Cardiff, UK
| | - Usman Khalid
- Health Education and Improvement Wales, Tŷ Dysgu, Cefn Coed, Nantgarw, UK
- Department of Surgery, University Hospital of Wales, Heath Park Way, Cardiff, UK
- School of Medicine, Cardiff University, Cardiff, UK
- Wales Kidney Research Unit, Division of Infection and Immunity, Cardiff University School of Medicine, Cardiff, UK
| | - Wyn G Lewis
- Health Education and Improvement Wales, Tŷ Dysgu, Cefn Coed, Nantgarw, UK
- Department of Surgery, University Hospital of Wales, Heath Park Way, Cardiff, UK
- School of Medicine, Cardiff University, Cardiff, UK
- Department of Surgery, Aneurin Bevan University Health Board, Grange University Hospital, Caerleon Road, Llanfrechfa, Cwmbran, UK
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Hajibandeh S, Hajibandeh S, Brown C, Harper ER, Saji AP, Hughes I, Mitra K, Rashwany H, Clayton A, Patel N, Abdelrahman T, Foliaki A, Kumar N. Sarcopenia versus clinical frailty scale in predicting the risk of postoperative mortality after emergency laparotomy: a retrospective cohort study. Langenbecks Arch Surg 2024; 409:59. [PMID: 38351404 DOI: 10.1007/s00423-024-03252-9] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 02/04/2024] [Indexed: 02/16/2024]
Abstract
OBJECTIVES To compare predictive significance of sarcopenia and clinical frailty scale (CFS) in terms of postoperative mortality in patients undergoing emergency laparotomy METHODS: In compliance with STROCSS statement standards, a retrospective cohort study with prospective data collection approach was conducted. The study period was between January 2017 and January 2022. All adult patients with non-traumatic acute abdominal pathology who underwent emergency laparotomy in our centre were included. The primary outcome was 30-day mortality and secondary outcomes were in-hospital mortality and 90-day mortality. The predictive value of sarcopenia and CFS were compared using the receiver operating characteristic (ROC) curve analysis and multivariable binary logistic regression analysis. RESULTS A total of 1043 eligible patients were included. The risk of 30-day mortality, in-hospital mortality, and 90-day mortality were 8%, 10%, and 11%, respectively. ROC curve analysis suggested that sarcopenia is a significantly stronger predictor of 30-day mortality (AUC: 0.87 vs. 0.70, P<0.0001), in-hospital mortality (AUC: 0.79 vs. 0.67, P=0.0011), and 90-day mortality (AUC: 0.79 vs. 0.67, P=0.0009) compared with CFS. Moreover, multivariable binary logistic regression analysis identified sarcopenia as an independent predictor of mortality [coefficient: 4.333, OR: 76.16 (95% CI 37.06-156.52), P<0.0001] but not the CFS [coefficient: 0.096, OR: 1.10 (95% CI 0.88-1.38), P=0.4047]. CONCLUSIONS Sarcopenia is a stronger predictor of postoperative mortality compared with CFS in patients undergoing emergency laparotomy. It cancels out the predictive value of clinical frailty scale in multivariable analyses; hence among the two variables, sarcopenia deserves to be included in preoperative predictive tools.
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Affiliation(s)
- Shahab Hajibandeh
- Department of General Surgery, University Hospital of Wales, Cardiff, CF14 4XW, UK.
| | - Shahin Hajibandeh
- Department of General Surgery, Royal Stoke University Hospital, Stoke-on-Trent, UK
| | - Christopher Brown
- Department of General Surgery, University Hospital of Wales, Cardiff, CF14 4XW, UK
| | | | | | - Ioan Hughes
- Department of General Surgery, University Hospital of Wales, Cardiff, CF14 4XW, UK
| | - Kalyan Mitra
- Department of General Surgery, University Hospital of Wales, Cardiff, CF14 4XW, UK
| | - Hind Rashwany
- Department of General Surgery, University Hospital of Wales, Cardiff, CF14 4XW, UK
| | - Amy Clayton
- Department of Radiology, University Hospital of Wales, Cardiff, UK
| | - Neil Patel
- Department of General Surgery, University Hospital of Wales, Cardiff, CF14 4XW, UK
| | - Tarig Abdelrahman
- Department of General Surgery, University Hospital of Wales, Cardiff, CF14 4XW, UK
| | - Antonio Foliaki
- Department of General Surgery, University Hospital of Wales, Cardiff, CF14 4XW, UK
| | - Nagappan Kumar
- Department of General Surgery, University Hospital of Wales, Cardiff, CF14 4XW, UK
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Hajibandeh S, Hajibandeh S, McKenna M, Jones W, Healy P, Witherspoon J, Blackshaw G, Lewis W, Foliaki A, Abdelrahman T. Effect of intraoperative botulinum toxin injection on delayed gastric emptying and need for endoscopic pyloric intervention following esophagectomy: a systematic review, meta-analysis, and meta-regression analysis. Dis Esophagus 2023; 36:doad053. [PMID: 37539558 DOI: 10.1093/dote/doad053] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 05/31/2023] [Indexed: 08/05/2023]
Abstract
The aim of this study was to evaluate the effect of intraoperative botulinum toxin (BT) injection on delayed gastric emptying (DGE) and need for endoscopic pyloric intervention (NEPI) following esophagectomy. In compliance with Preferred Reporting Items for Systematic reviews and Meta-Analyses statement standards, a systematic review of studies reporting the outcomes of intraoperative BT injection in patients undergoing esophagectomy for esophageal cancer was conducted. Proportion meta-analysis model was constructed to quantify the risk of the outcomes and direct comparison meta-analysis model was constructed to compare the outcomes between BT injection and no BT injection or surgical pyloroplasty. Meta-regression was modeled to evaluate the effect of variations in different covariates among the individual studies on overall summary proportions. Nine studies enrolling 1070 patients were included. Pooled analyses showed that the risks of DGE and NEPI following intraoperative BT injection were 13.3% (95% confidence interval [CI]: 7.9-18.6%) and 15.2% (95% CI: 7.9-22.5%), respectively. There was no difference between BT injection and no BT injection in terms of DGE (odds ratio [OR]: 0.57, 95% CI: 0.20-1.61, P = 0.29) and NEPI (OR: 1.73, 95% CI: 0.42-7.12, P = 0.45). Moreover, BT injection was comparable to pyloroplasty in terms of DGE (OR: 0.85, 95% CI: 0.35-2.08, P = 0.73) and NEPI (OR: 8.20, 95% CI: 0.63-105.90, P = 0.11). Meta-regression suggested that male gender was negatively associated with the risk of DGE (coefficient: -0.007, P = 0.003). In conclusion, level 2 evidence suggests that intraoperative BT injection may not improve the risk of DGE and NEPI in patients undergoing esophagectomy. The risk of DGE seems to be higher in females and in early postoperative period. High quality randomized controlled trials with robust statistical power are required for definite conclusions. The results of the current study can be used for hypothesis synthesis and power analysis in future prospective trials.
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Affiliation(s)
- Shahab Hajibandeh
- Department of General Surgery, University Hospital of Wales, Cardiff, UK
| | - Shahin Hajibandeh
- Department of General Surgery, Royal Stoke University Hospital, Stoke-on-Trent, UK
| | - Matthew McKenna
- Department of General Surgery, University Hospital of Wales, Cardiff, UK
| | - William Jones
- Department of General Surgery, University Hospital of Wales, Cardiff, UK
| | - Paul Healy
- Department of General Surgery, University Hospital of Wales, Cardiff, UK
| | - Jolene Witherspoon
- Department of General Surgery, University Hospital of Wales, Cardiff, UK
| | - Guy Blackshaw
- Department of General Surgery, University Hospital of Wales, Cardiff, UK
| | - Wyn Lewis
- Department of General Surgery, University Hospital of Wales, Cardiff, UK
| | - Antonio Foliaki
- Department of General Surgery, University Hospital of Wales, Cardiff, UK
| | - Tarig Abdelrahman
- Department of General Surgery, University Hospital of Wales, Cardiff, UK
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4
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Minto T, Abdelrahman T, Jones L, Wheat J, Key T, Shivakumar N, Ansell J, Seddon O, Cronin A, Tomkinson A, Theron A, Trickett RW, Sagua N, Sultana S, Clark A, McKay E, Johnson A, Behera K, Towler J, Kynaston H. Safety of maintaining elective and emergency surgery during the COVID-19 pandemic with the introduction of a Protected Elective Surgical Unit (PESU): A cross-specialty evaluation of 30-day outcomes in 9,925 patients undergoing surgery in a University Health Board. Surg Open Sci 2022; 10:168-173. [PMID: 36211629 PMCID: PMC9531361 DOI: 10.1016/j.sopen.2022.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 08/29/2022] [Accepted: 09/12/2022] [Indexed: 11/06/2022] Open
Abstract
Background The COVID-19 pandemic has caused unprecedented health care challenges mandating surgical service reconfiguration. Within our hospital, emergency and elective streams were separated and self-contained Protected Elective Surgical Units were developed to mitigate against infection-related morbidity. Aims of this study were to determine the risk of COVID-19 transmission and mortality and whether the development of Protected Elective Surgical Units can result in significant reduction in risk. Methods A retrospective observational study of consecutive patients from 18 specialties undergoing elective or emergency surgery under general, spinal, or epidural anaesthetic over a 12-month study period was undertaken. Primary outcome measures were 30-day postoperative COVID-19 transmission rate and mortality. Secondary adjusted analyses were performed to ascertain hospital and Protected Elective Surgical Unit transmission rates. Results Between 15 March 2020 and 14 March 2021, 9,925 patients underwent surgery: 6,464 (65.1%) elective, 5,116 (51.5%) female, and median age 57 (39–70). A total of 69.5% of all procedures were performed in Protected Elective Surgical Units. Overall, 30-day postoperative COVID-19 transmission was 2.8% (3.4% emergency vs 1.2% elective P < .001). Protected Elective Surgical Unit postoperative transmission was significantly lower than non–Protected Elective Surgical Unit (0.42% vs 3.2% P < .001), with an adjusted likely in-hospital Protected Elective Surgical Unit transmission of 0.04%. The 30-day all-cause mortality was 1.7% and was 14.6% in COVID-19–positive patients. COVID-19 infection, age > 70, male sex, American Society of Anesthesiologists grade > 2, and emergency surgery were all independently associated with mortality. Conclusion This study has demonstrated that Protected Elective Surgical Units can facilitate high-volume elective surgical services throughout peaks of the COVID-19 pandemic while minimising viral transmission and mortality. However, mortality risk associated with perioperative COVID-19 infection remains high.
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Affiliation(s)
- T Minto
- University Hospital of Wales, Heath Park, Cardiff, United Kingdom CF14 4XW
| | - T Abdelrahman
- University Hospital of Wales, Heath Park, Cardiff, United Kingdom CF14 4XW
| | - L Jones
- University Hospital of Wales, Heath Park, Cardiff, United Kingdom CF14 4XW
| | - J Wheat
- University Hospital of Wales, Heath Park, Cardiff, United Kingdom CF14 4XW
| | - T Key
- University Hospital of Wales, Heath Park, Cardiff, United Kingdom CF14 4XW
| | - N Shivakumar
- University Hospital of Wales, Heath Park, Cardiff, United Kingdom CF14 4XW
| | - J Ansell
- University Hospital of Wales, Heath Park, Cardiff, United Kingdom CF14 4XW
| | - O Seddon
- University Hospital of Wales, Heath Park, Cardiff, United Kingdom CF14 4XW
| | - A Cronin
- University Hospital of Wales, Heath Park, Cardiff, United Kingdom CF14 4XW
| | - A Tomkinson
- University Hospital of Wales, Heath Park, Cardiff, United Kingdom CF14 4XW
| | - A Theron
- University Hospital of Wales, Heath Park, Cardiff, United Kingdom CF14 4XW
| | - RW Trickett
- University Hospital of Wales, Heath Park, Cardiff, United Kingdom CF14 4XW
| | - N Sagua
- School of Medicine, Cardiff University, University Hospital of Wales Main Bldg, Heath Park, Cardiff, United Kingdom CF14 4XN
| | - S Sultana
- School of Medicine, Cardiff University, University Hospital of Wales Main Bldg, Heath Park, Cardiff, United Kingdom CF14 4XN
| | - A Clark
- School of Medicine, Cardiff University, University Hospital of Wales Main Bldg, Heath Park, Cardiff, United Kingdom CF14 4XN
| | - E McKay
- School of Medicine, Cardiff University, University Hospital of Wales Main Bldg, Heath Park, Cardiff, United Kingdom CF14 4XN
| | - A Johnson
- School of Medicine, Cardiff University, University Hospital of Wales Main Bldg, Heath Park, Cardiff, United Kingdom CF14 4XN
| | - Karishma Behera
- School of Medicine, Cardiff University, University Hospital of Wales Main Bldg, Heath Park, Cardiff, United Kingdom CF14 4XN
| | - J Towler
- School of Medicine, Cardiff University, University Hospital of Wales Main Bldg, Heath Park, Cardiff, United Kingdom CF14 4XN
| | - H Kynaston
- University Hospital of Wales, Heath Park, Cardiff, United Kingdom CF14 4XW,School of Medicine, Cardiff University, University Hospital of Wales Main Bldg, Heath Park, Cardiff, United Kingdom CF14 4XN,Corresponding author at: School of Medicine, Cardiff University, Cardiff, United Kingdom CF14 4XN.
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5
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Minto T, Abdelrahman T, Jones L, Shivakumar N, Wheat J, Ansell J, Seddon O, Cronin A, Tomkinson A, Theron A, Trickett R, Kynaston H, Sagua N, Sultana S, Clark A, McKay E, Johnson A, Behera K, Towler J. 276 Safety of Maintaining Elective and Emergency Surgery During the COVID-19 Pandemic with the Introduction of an Innovative Protected Elective Surgical Unit (PESU): A Cross-Specialty Evaluation of 30-Day Outcomes in 9925 Patients Undergoing Surgery in a University Health Board. Br J Surg 2022. [DOI: 10.1093/bjs/znac040.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Aim
High quality mobile health applications (mhealth apps) have the potential to enhance the prevention, diagnosis, and treatment of burns. The primary aim of this study was to evaluate whether the quality of mhealth apps for burns care is being adequately assessed. The secondary aim was to determine whether these apps meet UK regulatory standards.
Method
We searched AMED, BNI, CINAHL, Cochrane library, Embase, Emcare, Medline and PsychInfo to identify studies assessing mhealth app quality for burns. The PRISMA reporting guideline was adhered to. Two independent reviewers screened s to identify relevant studies. We analysed whether seven established domains of mhealth app quality were assessed: design, information/content, usability, functionality, ethical issues, security/privacy, and user-perceived value.
Results
Of the 28 included studies, none assessed all seven domains of quality. Design was assessed in 4/28 studies; information/content in 26/28 studies; usability in 12/28 studies; functionality in 10/28 studies; ethical issues were never assessed in any studies; security/privacy was not assessed; subjective assessment was made in 9/28 studies. 17/28 studies included apps that met the definition of ‘medical device’ according to MHRA guidance, yet only one app was appropriately certified with the UK Conformity Assessed (UKCA) mark.
Conclusions
The quality of mHealth apps for burns are not being adequately assessed. The majority of apps should be considered medical devices according to UK standards, but only one was appropriately certified. Regulatory bodies should support mhealth app developers, so as to improve quality control whilst simultaneously fostering innovation.
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Affiliation(s)
- T. Minto
- University Hospital Wales, Cardiff, United Kingdom
| | | | - L. Jones
- University Hospital Wales, Cardiff, United Kingdom
| | | | - J. Wheat
- University Hospital Wales, Cardiff, United Kingdom
| | - J. Ansell
- University Hospital Wales, Cardiff, United Kingdom
| | - O. Seddon
- University Hospital Wales, Cardiff, United Kingdom
| | - A. Cronin
- University Hospital Wales, Cardiff, United Kingdom
| | - A. Tomkinson
- University Hospital Wales, Cardiff, United Kingdom
| | - A. Theron
- University Hospital Wales, Cardiff, United Kingdom
| | - R. Trickett
- University Hospital Wales, Cardiff, United Kingdom
| | - H. Kynaston
- University Hospital Wales, Cardiff, United Kingdom
| | - N. Sagua
- Cardiff Medical School, Cardiff, United Kingdom
| | - S. Sultana
- Cardiff Medical School, Cardiff, United Kingdom
| | - A. Clark
- Cardiff Medical School, Cardiff, United Kingdom
| | - E. McKay
- Cardiff Medical School, Cardiff, United Kingdom
| | - A. Johnson
- Cardiff Medical School, Cardiff, United Kingdom
| | - K. Behera
- Cardiff Medical School, Cardiff, United Kingdom
| | - J. Towler
- Cardiff Medical School, Cardiff, United Kingdom
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Robinson DBT, James OP, Hopkins L, Brown C, Powell A, Abdelrahman T, Egan RJ, Lewis W. Trainee burnout: when does the fire start? Postgrad Med J 2020; 98:124-130. [PMID: 33148781 DOI: 10.1136/postgradmedj-2020-137839] [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] [Received: 04/09/2020] [Revised: 09/01/2020] [Accepted: 10/11/2020] [Indexed: 11/03/2022]
Abstract
PURPOSE OF THE STUDY Burnout is an increasingly recognised phenomenon in acute healthcare specialities and associated with depersonalisation, ill health and training programme attrition. This study aimed to quantify contributory physiological variables that may indicate stress in newly qualified doctors. STUDY DESIGN Post Graduate Year 1 doctors (n=13, 7 f, 6 m) were fitted with a VivaLNK wellness device during four prior induction days, followed by their first 14 days work as qualified doctors. Minute-by-minute Heart Rate (HR), Respiratory Rate (RR), and Stress Index (SI) data were correlated with Maslach Burnout Inventories, Short Grit Scales (SGS) and clinical rota duties: Induction vs Normal Working-Day (NWD) versus On-call shift. RESULTS In a total 125 recorded shift episodes, on comparing Induction versus NWD versus On-call shift work, no variation was observed in HR above baseline (25.47 vs 27.14 vs 24.34, p=0.240), RR above baseline (2.21 vs 1.86 vs 1.54, p=0.126) or SI (32.98 vs 38.02 vs 35.47, p=0.449). However, analysis of participant-specific temporal SIs correlated with shift-related clinical duties; that is, study participants who were most stressed during a NWD, were also more stressed during Induction (R2 0.442, p=0.026), and also during On-call shifts (R2 0.564, p=0.012). Higher SGS scores were inversely related to lower SIs (coefficient -32.52, 95% CI -45.881 to 19.154, p=0.001). CONCLUSION Stress and burnout stimulus appear to start on day one of induction for susceptible PGY1 doctors, and continues into front-line clinical work irrespective of shift pattern. Short Grit Scale questionnaires appear an effective tool to facilitate targeted stress countermeasures.
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Affiliation(s)
- David Bryan Thomas Robinson
- School of Surgery, NHS Wales Health Education and Improvement Wales, Nantgarw, UK .,General Surgery, Prince Charles Hospital, Merthyr Tydfil, UK
| | - Osian Penri James
- School of Surgery, NHS Wales Health Education and Improvement Wales, Nantgarw, UK.,General Surgery, Royal Gwent Hospital, Newport, UK
| | - Luke Hopkins
- School of Surgery, NHS Wales Health Education and Improvement Wales, Nantgarw, UK.,General Surgery, Morriston Hospital, Swansea, UK
| | - Chris Brown
- School of Surgery, NHS Wales Health Education and Improvement Wales, Nantgarw, UK
| | - Arfon Powell
- School of Surgery, NHS Wales Health Education and Improvement Wales, Nantgarw, UK.,Division of Cancer and Genetics, Cardiff University School of Medicine, Cardiff, UK
| | - Tarig Abdelrahman
- School of Surgery, NHS Wales Health Education and Improvement Wales, Nantgarw, UK
| | - Richard John Egan
- School of Surgery, NHS Wales Health Education and Improvement Wales, Nantgarw, UK.,General Surgery, Morriston Hospital, Swansea, UK
| | - Wyn Lewis
- School of Surgery, NHS Wales Health Education and Improvement Wales, Nantgarw, UK
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Al-Ardah M, Barnett RE, Morris S, Abdelrahman T, Nutt M, Boyce T, Rasheed A. Lessons learnt from the first 200 unselected consecutive cases of laparoscopic exploration of common bile duct stones at a district general hospital. Surg Endosc 2020; 35:6268-6277. [PMID: 33140155 DOI: 10.1007/s00464-020-08127-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 10/21/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND The management of choledocholithiasis evolves with diagnostic imaging and therapeutic technology, facilitating a laparoscopic approach. We review our first 200 cases of laparoscopic exploration of the common bile duct, highlighting challenges and lessons learnt. METHODS We retrospectively studied the first 200 cases of laparoscopic cholecystectomy with common bile duct exploration between 2006 and 2019. The database contains demographics, clinicopathological characteristics, diagnostic modalities, operative techniques, duration and outcomes. RESULTS We compared two approaches: transcystic vs. transcholedochal in our 200 cases. Choledocholithiasis was suspected preoperatively in 163 patients. 21 cases found no stones. Of the remainder, 111/179 cases were completed via the transcystic route and the remaining were completed transcholedochally (68/179); 25% of the transcholedochal cases were converted from a transcystic approach. CBD diameter for transcystic route was 8.2 vs. 11.0 mm for transcholedochal. Total clearance rate was 84%. Retained or recurrent stones were noted in 7 patients. Length of stay was 5.8 days, 3.5 days in the transcystic route vs. 9.4 days after transcholedochal clearance. Eight patients required re-operation for bleeding or bile leak. No mortalities were recorded in this cohort, but 2 cases (1%) developed a subsequent CBD stricture. CONCLUSION Concomitant laparoscopic common bile duct clearance with cholecystectomy is feasible, safe and effective in a district general hospital, despite constraints of time and resources. The transcystic route has a lower complication rate and shorter hospital stay, and hence our preference of this route for all cases. Advancements in stone management technology will allow wider adoption of this technique, benefitting more patients.
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Affiliation(s)
- Mahmoud Al-Ardah
- Gwent Centre for Digestive Diseases, Royal Gwent Hospital, Newport, NP20 2UB, UK.
| | - Rebecca E Barnett
- Department of General Surgery, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK
| | - Simon Morris
- Gwent Centre for Digestive Diseases, Royal Gwent Hospital, Newport, NP20 2UB, UK
| | - Tarig Abdelrahman
- Department of General Surgery, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK
| | - Michael Nutt
- Gwent Centre for Digestive Diseases, Royal Gwent Hospital, Newport, NP20 2UB, UK
| | - Tamsin Boyce
- Gwent Centre for Digestive Diseases, Royal Gwent Hospital, Newport, NP20 2UB, UK
| | - Ashraf Rasheed
- Gwent Centre for Digestive Diseases, Royal Gwent Hospital, Newport, NP20 2UB, UK
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8
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Powell AGMT, Eley C, Abdelrahman T, Coxon AH, Chin C, Appadurai I, Davies R, Bailey DM, Lewis WG. Physiological performance and inflammatory markers as indicators of complications after oesophageal cancer surgery. BJS Open 2020; 4:840-846. [PMID: 32749071 PMCID: PMC7528531 DOI: 10.1002/bjs5.50328] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 06/24/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The extent to which physiological factors influence outcome following oesophageal cancer surgery is poorly understood. This study aimed to evaluate the extent to which cardiorespiratory fitness and selected metabolic factors predicted complications after surgery for carcinoma. METHODS Two hundred and twenty-five consecutive patients underwent preoperative cardiopulmonary exercise testing to determine peak oxygen uptake ( V ˙ o2peak ), anaerobic threshold and the ventilatory equivalent for carbon dioxide ( V ˙ e/ V ˙ co2 ). Cephalic venous blood was assayed for serum C-reactive protein (CRP) and albumin levels, and a full blood count was done. The primary outcome measure was the Morbidity Severity Score (MSS). RESULTS One hundred and ninety-eight patients had anatomical resection. A high MSS (Clavien-Dindo grade III or above) was found in 48 patients (24·2 per cent) and was related to an increased CRP concentration (area under the receiver operating characteristic (ROC) curve (AUC) 0·62, P = 0·001) and lower V ˙ o2peak (AUC 0·36, P = 0·003). Dichotomization of CRP levels (above 10 mg/l) and V ˙ o2peak (below 18·6 ml per kg per min) yielded adjusted odds ratios (ORs) for a high MSS of 2·86 (P = 0·025) and 2·92 (P = 0·002) respectively. Compared with a cohort with a low Combined Inflammatory and Physiology Score (CIPS), the OR was 1·70 (95 per cent c.i. 0·85 to 3·39) for intermediate and 27·47 (3·12 to 241·69) for high CIPS (P < 0·001). CONCLUSION CRP and V ˙ o2peak were independently associated with major complications after potentially curative oesophagectomy for cancer. A composite risk score identified a group of patients with a high risk of developing complications.
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Affiliation(s)
- A G M T Powell
- Division of Cancer and Genetics, Cardiff University, Cardiff, UK.,Departments of Surgery, Cardiff, UK
| | - C Eley
- Departments of Surgery, Cardiff, UK
| | | | | | - C Chin
- Departments of Surgery, Cardiff, UK
| | - I Appadurai
- Anaesthesia, University Hospital of Wales, Cardiff, UK
| | - R Davies
- Anaesthesia, University Hospital of Wales, Cardiff, UK
| | - D M Bailey
- Neurovascular Research Laboratory, Faculty of Life Sciences and Education, University of South Wales, Pontypridd, UK
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9
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Robinson DBT, Hopkins L, James OP, Brown C, Powell AGMT, Hemington-Gorse S, Abdelrahman T, Lewis WG, Egan RJ. Surgical training rotation design: effects of hospital type, rotation theme and duration. BJS Open 2020; 4:970-976. [PMID: 32706526 PMCID: PMC7528516 DOI: 10.1002/bjs5.50326] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 06/17/2020] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Entrants into UK surgical specialty training undertake a 2-year programme of core surgical training, rotating through specialties for varying lengths of time, at different hospitals, to gain breadth of experience. This study aimed to assess whether these variables influenced core surgical trainee (CST) work productivity. METHODS Intercollegiate Surgical Curriculum Programme portfolios of consecutive CSTs between 2016 and 2019 were examined. Primary outcome measures were workplace-based assessment (WBA) completion, operative experience and academic outputs (presentations to learned societies, publications and audits). RESULTS A total of 344 rotations by 111 CSTs were included. Incremental increases in attainment were observed related to the duration of core surgical training rotation. The median number of consultant-validated WBAs completed during core surgical training were 48 (range 0-189), 54 (10-120) and 75 (6-94) during rotations consisting of 4-, 6- and 12-month posts respectively (P < 0·001). Corresponding median operative caseloads (as primary surgeon) were 84 (range 3-357), 110 (44-394) and 134 (56-366) (P < 0·001) and presentations to learned societies 0 (0-12), 0 (0-14) and 1 (0-5) (P = 0·012) respectively. Hospital type and specialty training theme were unrelated to workplace productivity. Multivariable analysis identified length of hospital rotation as the only factor independently associated with total WBA count (P = 0·001), completion of audit (P = 0·015) and delivery of presentation (P = 0·001) targets. CONCLUSION Longer rotations with a single educational supervisor, in one training centre, are associated with better workplace productivity. Consideration should be given to this when reconfiguring training programmes within the arena of workforce planning.
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Affiliation(s)
- D B T Robinson
- Wales Postgraduate Medical and Dental Education School of Surgery, Health Education and Improvement Wales, Nantgarw, UK
| | - L Hopkins
- Wales Postgraduate Medical and Dental Education School of Surgery, Health Education and Improvement Wales, Nantgarw, UK.,Department of Surgery, Morriston Hospital, Swansea, UK
| | - O P James
- Wales Postgraduate Medical and Dental Education School of Surgery, Health Education and Improvement Wales, Nantgarw, UK
| | - C Brown
- Wales Postgraduate Medical and Dental Education School of Surgery, Health Education and Improvement Wales, Nantgarw, UK
| | - A G M T Powell
- Division of Cancer and Genetics, Cardiff University, Heath Park, Cardiff, UK
| | - S Hemington-Gorse
- Wales Postgraduate Medical and Dental Education School of Surgery, Health Education and Improvement Wales, Nantgarw, UK
| | - T Abdelrahman
- Wales Postgraduate Medical and Dental Education School of Surgery, Health Education and Improvement Wales, Nantgarw, UK
| | - W G Lewis
- Wales Postgraduate Medical and Dental Education School of Surgery, Health Education and Improvement Wales, Nantgarw, UK
| | - R J Egan
- Department of Surgery, Morriston Hospital, Swansea, UK.,Swansea Medical School, Swansea University, Swansea, UK
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Robinson DBT, Powell AGMT, Hopkins L, James OP, Abdelrahman T, Egan R, Lewis WG. Proof of surgical publication prowess: prospective observational study of factors associated with surrogate markers of academic reach. BJS Open 2020; 4:724-729. [PMID: 32490575 PMCID: PMC7397360 DOI: 10.1002/bjs5.50307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 05/05/2020] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND In the UK, general surgery higher surgical trainees (HSTs) must publish at least three peer-reviewed scientific articles (as first, second or corresponding author) to qualify for certification of completion of training (CCT). This study aimed to identify the factors associated with success in this arena. METHODS Deanery rosters supplemented with data from the Intercollegiate Surgical Curriculum Programme, PubMed and ResearchGate were used to identify the profiles of consecutive HSTs. Primary outcomes were publication numbers at defined points in higher training (speciality training year (ST) 3-8); secondary outcomes were the Hirsch index and ResearchGate scores. RESULTS Fifty-nine consecutive HSTs (24 women, 35 men) were studied. The median publication number was 3 (range 0-30). At least three published articles were obtained by 30 HSTs (51 per cent), with 19 (38 per cent) of 50 HSTs achieving this by ST4 (of whom 15 (79 per cent) had undertaken out of programme for research (OOPR) time) and 24 (80 per cent) by ST6. Thirteen HSTs (22 per cent) (ST3, 6; ST4, 4; ST5, 2; ST8, 1) had yet to publish at the time of writing. OOPR was associated with achieving three publications (24 of 35 (69 per cent) versus 6 of 24 (25 per cent) with no formal research time; P = 0·001), higher overall number of publications (median 6 versus 1 respectively; P < 0·001), higher ResearchGate score (median 23·37 versus 5·27; P < 0·001) and higher Hirsch index (median 3 versus 1; P < 0·001). In multivariable analysis, training grade (odds ratio (OR) 1·89, 95 per cent c.i. 0·01 to 3·52; P = 0·045) and OOPR (OR 6·55, 2·04 to 21·04; P = 0·002) were associated with achieving three publications. CONCLUSION If CCT credentials are to include publication profiles, HST programmes should incorporate research training in workforce planning.
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Affiliation(s)
- D B T Robinson
- Health Education and Improvement Wales School of Surgery, Nantgarw, UK
| | - A G M T Powell
- Division of Cancer and Genetics, Cardiff University, Cardiff, UK
| | - L Hopkins
- Health Education and Improvement Wales School of Surgery, Nantgarw, UK
| | - O P James
- Health Education and Improvement Wales School of Surgery, Nantgarw, UK
| | - T Abdelrahman
- Health Education and Improvement Wales School of Surgery, Nantgarw, UK
| | - R Egan
- Department of Surgery, Morriston Hospital, Swansea, UK
| | - W G Lewis
- Health Education and Improvement Wales School of Surgery, Nantgarw, UK
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Robinson DBT, Hopkins L, James OP, Brown C, Powell AGMT, Abdelrahman T, Hemington-Gorse S, Walsh L, Egan RJ, Lewis W. Egalitarianism in surgical training: let equity prevail. Postgrad Med J 2020; 96:650-654. [DOI: 10.1136/postgradmedj-2020-137563] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 04/02/2020] [Accepted: 04/08/2020] [Indexed: 11/04/2022]
Abstract
This study aimed to quantify core surgical trainee (CST) differential attainment (DA) related to three cohorts; white UK graduate (White UKG) versus black and minority ethnic UKG (BME UKG) versus international medical graduates (IMGs). The primary outcome measures were annual review of competence progression (ARCP) outcome, intercollegiate Membership of the Royal College of Surgeons (iMRCS) examination pass and national training number (NTN) selection. Intercollegiate Surgical Curriculum Programme (ISCP) portfolios of 264 consecutive CSTs (2010–2017, 168 white UKG, 66 BME UKG, 30 IMG) from a single UK regional post graduate medical region (Wales) were examined. Data collected prospectively over an 8-year time period was analysed retrospectively. ARCP outcomes were similar irrespective of ethnicity or nationality (ARCP outcome 1, white UKG 60.7% vs BME UKG 62.1% vs IMG 53.3%, p=0.395). iMRCS pass rates for white UKG vs BME UKG vs IMG were 71.4% vs 71.2% vs 50.0% (p=0.042), respectively. NTN success rates for white UKG vs BME UKG vs IMG were 36.9% vs 36.4% vs 6.7% (p=0.023), respectively. On multivariable analysis, operative experience (OR 1.002, 95% CI 1.001 to 1.004, p=0.004), bootcamp attendance (OR 2.615, 95% CI 1.403 to 4.871, p=0.002), and UKG (OR 7.081, 95% CI 1.556 to 32.230, p=0.011), were associated with NTN appointment. Although outcomes related to BME DA were equitable, important DA variation was apparent among IMGs, with iMRCS pass 21.4% lower and NTN success sixfold less likely than UKG. Targeted counter measures are required to let equity prevail in UK CST programmes.
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Robinson DBT, James OP, Hopkins L, Brown C, Bowman C, Abdelrahman T, Pollitt MJ, Egan RJ, Bailey DM, Lewis WG. Stress and Burnout in Training; Requiem for the Surgical Dream. J Surg Educ 2020; 77:e1-e8. [PMID: 31375465 DOI: 10.1016/j.jsurg.2019.07.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 05/22/2019] [Accepted: 07/03/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE Burnout among trainee doctors is common with as many as two-thirds reporting poor health. This study aimed to assess burnout in a cohort of UK core and higher general surgical trainees. DESIGN The Maslach Burnout Inventory for Medical Personnel was distributed to 158 surgical trainees to evaluate emotional exhaustion (EE), depersonalization (DP), and personal accomplishment (PA). High EE (≥27) and DP (≥10), low PA (≤33) scores were taken to indicate burnout. SETTING A single UK (Wales) Deanery. PARTICIPANTS One hundred responses were received; 65 core surgical trainees, 31 Higher Surgical Trainees (HST), and 4 not specified. RESULTS Median EE, DP, and PA scores were 22.0 (range 2-50), 7.5 (0-25), and 36.0 (19-47), respectively. High burnout by domain was: EE (n = 33), DP (n = 39), PA (n = 34), with 59% of trainees demonstrating burnout in ≥1 one domain, with strong interdomain correlation (EE:DP r = 0.351, p < 0.001; EE:PA r = -0.455, p < 0.001; DP:PA r = -0.446, p < 0.001). Female gender (p = 0.020), core surgical training grade (p = 0.012), and being childless (p = 0.033) were independently associated with higher levels of EE; whereas HST grade (p = 0.007), age >30 years (p = 0.010), married/partner status (p = 0.001), and parenthood (p = 0.015), were associated with lower levels of burnout with regard to DP. Binary logistic regression revealed lower burnout in all domains to be associated with HST status (hazard ratio 0.116, 95% confidence interval 0.014-0.980, p = 0.048) and male gender (hazard ratio 4.365, (1.246-15.293), p = 0.021). CONCLUSIONS Burnout among surgical trainees was common in at least 1 Maslach Burnout Inventory domain. Urgent counter measures are required to protect the health and wellbeing of trainees at risk, which ought to be associated with commensurate improvement in patient safety.
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Affiliation(s)
- David B T Robinson
- Wales PGMDE School of Surgery, Health Education and Improvement Wales, Nantgarw, United Kingdom.
| | - Osian P James
- Wales PGMDE School of Surgery, Health Education and Improvement Wales, Nantgarw, United Kingdom
| | - Luke Hopkins
- Wales PGMDE School of Surgery, Health Education and Improvement Wales, Nantgarw, United Kingdom
| | - Chris Brown
- Wales PGMDE School of Surgery, Health Education and Improvement Wales, Nantgarw, United Kingdom
| | - Chris Bowman
- Wales PGMDE School of Surgery, Health Education and Improvement Wales, Nantgarw, United Kingdom
| | - Tarig Abdelrahman
- Wales PGMDE School of Surgery, Health Education and Improvement Wales, Nantgarw, United Kingdom
| | - Michael J Pollitt
- Department of Surgery, Prince Charles Hospital, Merthyr Tydfil, United Kingdom
| | - Richard J Egan
- Department of Surgery, Morriston Hospital, Swansea, United Kingdom
| | - Damian M Bailey
- Neurovascular Research Laboratory, Faculty of Life Sciences and Education, University of South Wales, Pontypridd, United Kingdom
| | - Wyn G Lewis
- Wales PGMDE School of Surgery, Health Education and Improvement Wales, Nantgarw, United Kingdom
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Hopkins L, Robinson DB, Brown C, Abdelrahman T, Powell AG, Pollitt MJ, Hemington-Gorse S, Lewis WG, Egan RJ. Summative Supervisor Reporting: A Quality Performance Perspective. J Surg Educ 2020; 77:88-95. [PMID: 31481311 DOI: 10.1016/j.jsurg.2019.08.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 07/26/2019] [Accepted: 08/19/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE This study aimed to quality assure Assigned Educational Supervisor (AES) reports, using UK Joint Committee on Surgical Training objective criteria, to evaluate contribution to Annual Review of Competence Progression. DESIGN Consecutive 145 AES reports from 75 trainers regarding 68 Core Surgical Trainees were assessed from 9 hospitals (2 Tertiary centers [77 reports], 7 District General Hospitals [68 reports]). Reports were assessed by independent assessors based on free text related to performance mapped to curricular objectives, operative logbooks, and Clinical Supervisor reports, and overall summary grades assigned ranging from development required, adequate, good to excellent. SETTING A core surgical training program serving a single UK (Wales) deanery. PARTICIPANTS Sixty-eight consecutively appointed core surgical trainees and 75 consultant surgeon trainers. RESULTS Summary grades of adequate or above were achieved in 101 of 145 (69.7%) reports. Trainees' objective setting meetings were completed within 6 weeks of starting placements in 124 of 145 (85.5%). The proportions of AES reports containing free text commentary on curricular objectives, portfolio objectives, and operative logbook development were 128 of 145, 123 of 145, and 55 of 145, respectively. AES report quality was not associated with hospital status, subspecialty, or trainee grade. Female trainers were significantly more likely to provide reports graded as Good or Excellent compared with their male colleagues (7 of 12 vs. 27 of 133, χ2 (2) = 9.389, p = 0.009). AES reports for male trainees were significantly more likely to be rated as further development required (40 of 85, 47.1%) when compared with female trainees (4 of 32, 12.5%, p = 0.007). CONCLUSIONS Three in ten AES reports were insufficient to contribute to objective Annual Review of Competence Progression outcomes and a gender gap was apparent related to engagement. AES trainers should provide more focus if this summative tool is to be an effective career progression metric.
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Affiliation(s)
- Luke Hopkins
- Wales Deanery PGMDE School of Surgery, Health Education and Improvement Wales, Cardiff, Wales; Swansea University Medical School, Sketty, Wales.
| | - David Bt Robinson
- Wales Deanery PGMDE School of Surgery, Health Education and Improvement Wales, Cardiff, Wales
| | - Christopher Brown
- Wales Deanery PGMDE School of Surgery, Health Education and Improvement Wales, Cardiff, Wales
| | - Tarig Abdelrahman
- Wales Deanery PGMDE School of Surgery, Health Education and Improvement Wales, Cardiff, Wales
| | - Arfon Gmt Powell
- Wales Deanery PGMDE School of Surgery, Health Education and Improvement Wales, Cardiff, Wales; Division of Cancer and Genetics, School of Medicine, Cardiff University, Cardiff, Wales
| | - M John Pollitt
- Wales Deanery PGMDE School of Surgery, Health Education and Improvement Wales, Cardiff, Wales
| | - Sarah Hemington-Gorse
- Wales Deanery PGMDE School of Surgery, Health Education and Improvement Wales, Cardiff, Wales
| | - Wyn G Lewis
- Wales Deanery PGMDE School of Surgery, Health Education and Improvement Wales, Cardiff, Wales
| | - Richard J Egan
- Swansea University Medical School, Sketty, Wales; Department of Surgery, Morriston Hospital, Swansea, Wales
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Brown C, Abdelrahman T, Lewis W, Pollitt J, Egan, R. To bed or not to bed: the sleep question? Postgrad Med J 2019; 96:520-524. [DOI: 10.1136/postgradmedj-2018-135795] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 08/12/2019] [Accepted: 11/26/2019] [Indexed: 11/03/2022]
Abstract
BackgroundSleep deprivation and fatigue from long-shift work impacts doctors’ personal safety, inhibits cognitive performance and risks clinical error. The aim of this study was to assess the sleep quality of surgical trainees participating in European Working Time Directive-compliant training rotations within a UK deanery.MethodsA trainee cohort numbering 38 (21 core, 17 higher surgical trainees, 29 men and 9 women, median age 31 (25–44 years)) completed a sleep diary over 30 days using the Sleep Time (Azumio) smartphone application and triangulated with on-call rosters to identify shift patterns. The primary outcome measure was sleep quality related to rostered clinical duties.ResultsConsecutive 1152 individual sleep episodes were recorded. The median time asleep (hours:min) was 6:29 (5:27–7:19); the median sleep efficiency was 86% (80%–93%); the median light sleep (hours:min) was 2:50 (1:50–3:49); and the median rapid eye movement (REM) sleep (hours:min) was 3:20 (2:37–4:07). Significant adverse sleep profiles were observed in trainees undertaking emergency on-call duty when compared with elective (non-on-call) duty; the median time asleep (hours:min) 5:49 vs 6:43 (p<0.001); the median sleep efficiency was 85% vs 87% (p<0.001); the median light sleep (hours:min) was 2:16 vs 2:58 (p<0.001); and REM sleep (hours:min) was 2:57 vs 3:27 (p<0.001). Recovery of sleep duration, efficiency and quality necessitated five full days of time.ConclusionSurgical emergency on-call duty adversely influences sleep quality. Proper consideration of fail-safe rota design, prioritising sleep hygiene, recovery and well-being, allied to robust patient safety and quality of care should be made a priority.
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Brown C, Robinson D, Abdelrahman T, Egan R, Goddard S, Pollitt J, Warren N, Lewis W. Novel simulation model for emergency laparotomy. BMJ STEL 2019; 5:248. [DOI: 10.1136/bmjstel-2018-000421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/15/2018] [Indexed: 11/04/2022]
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Brown C, Robinson D, Egan RJ, Hopkins L, Abdelrahman T, Powell A, Pollitt MJ, Lewis WG. Prospective Cohort Study of Haptic Virtual Reality Laparoscopic Appendicectomy Learning Curve Trajectory. J Am Coll Surg 2019. [DOI: 10.1016/j.jamcollsurg.2019.08.1255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Wood S, James OP, Hopkins L, Harries R, Robinson DBT, Brown CM, Abdelrahman T, Egan RJ, Lewis WG. Variations in competencies needed to complete surgical training. BJS Open 2019; 3:852-856. [PMID: 31832592 PMCID: PMC6887895 DOI: 10.1002/bjs5.50200] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 05/22/2019] [Indexed: 11/07/2022] Open
Abstract
Background This study aimed to analyse the degree of relative variation in specialty-specific competencies required for certification of completion of training (CCT) by the UK Joint Committee on Surgical Training. Methods Regulatory body guidance relating to operative and non-operative surgical skill competencies required for CCT were analysed and compared. Results Wide interspecialty variation was demonstrated in the required minimum number of logbook cases (median 1201 (range 60-2100)), indexed operations (13 (5-55)), procedure-based assessments (18 (7-60)), publications (2 (0-4)), communications to learned associations (0 (0-6)) and audits (4 (1-6)). Mandatory courses across multiple specialties included: Training the Trainers (10 of 10 specialties), Advanced Trauma Life Support (6 of 10), Good Clinical Practice (9 of 10) and Research Methodologies (8 of 10), although no common accord was evident. Discussion Certification guidelines for completion of surgical training were inconsistent, with metrics related to minimum operative caseload and academic reach having wide variation.
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Affiliation(s)
- S Wood
- Wales Deanery PGMDE School of Surgery Health Education and Improvement Wales, Cefn Coed Nantgarw UK
| | - O P James
- Wales Deanery PGMDE School of Surgery Health Education and Improvement Wales, Cefn Coed Nantgarw UK
| | - L Hopkins
- Wales Deanery PGMDE School of Surgery Health Education and Improvement Wales, Cefn Coed Nantgarw UK
| | - R Harries
- Wales Deanery PGMDE School of Surgery Health Education and Improvement Wales, Cefn Coed Nantgarw UK
| | - D B T Robinson
- Wales Deanery PGMDE School of Surgery Health Education and Improvement Wales, Cefn Coed Nantgarw UK
| | - C M Brown
- Wales Deanery PGMDE School of Surgery Health Education and Improvement Wales, Cefn Coed Nantgarw UK
| | - T Abdelrahman
- Wales Deanery PGMDE School of Surgery Health Education and Improvement Wales, Cefn Coed Nantgarw UK
| | - R J Egan
- Wales Deanery PGMDE School of Surgery Health Education and Improvement Wales, Cefn Coed Nantgarw UK.,Department of Surgery Morriston Hospital, Heol Maes Eglwys Swansea UK
| | - W G Lewis
- Wales Deanery PGMDE School of Surgery Health Education and Improvement Wales, Cefn Coed Nantgarw UK
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Brown C, Robinson D, Egan R, Hopkins L, Abdelrahman T, Powell A, Pollitt MJ, Lewis WG. Prospective Cohort Study of Haptic Virtual Reality Laparoscopic Appendicectomy Learning Curve Trajectory. J Laparoendosc Adv Surg Tech A 2019; 29:1128-1134. [PMID: 31361560 DOI: 10.1089/lap.2019.0332] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 11/12/2022] Open
Abstract
Background: Simulation training is strongly advocated by 24/7 risk-rich professions because swift learning curve inflection point attainment delivers earlier competence; the left-shift effect. The aim of this study was to determine the value of haptic laparoscopic virtual reality simulation, by iterative benchmark exercise (n = 8), before simulated laparoscopic appendicectomy (SLA); the hypothesis was that favorable benchmark learning curve trajectories would be associated with improved SLA competence when compared with consultant expert performance. Methods: A 28-trainee cohort completed 1349 Laparoscopic Haptic Virtual Reality Skills (LHVRS) tasks, during which 19 ergonomic variables were assessed by virtual interface, including force feedback (Surgicalscience.com), before 153 SLAs. Primary outcome measure was SLA composite competence score related to six consultant trainer experts. Results: Of the eight LHVRS tasks, the three with the steepest learning curve trajectories correlated with better median overall SLA competence scores, namely tissue grasping/lifting (rho = 0.362, P = .049), fine dissection (rho = 0.388, P = .028), and camera navigation (rho = 0.518, P = .007); fine dissection was the only haptic laparoscopic virtual reality simulation task that predicted a SLA score within a Youden index defined, 70% of the consultant expert level (area under curve [AUC] = 0.803, P = .028). A significant SLA learning curve emerged, with a learning curve trajectory inflection point at the fourth SLA attempt (first SLA 30.5% versus fourth SLA score 76.0%, gradient 76°, P = .010). Conclusion: Learning curve trajectory can be measured, influenced, and accelerated significantly; a pronounced left-shift effect, with translational potential for enhanced shorter training time and improved patient safety.
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Affiliation(s)
- Chris Brown
- Department of Surgery, University Hospital of Wales, Cardiff, United Kingdom
| | - David Robinson
- Department of Surgery, University Hospital of Wales, Cardiff, United Kingdom
| | - Richard Egan
- Department of Surgery, Morriston Hospital, Swansea, United Kingdom
| | - Luke Hopkins
- Department of Surgery, University Hospital of Wales, Cardiff, United Kingdom
| | - Tarig Abdelrahman
- Department of Surgery, University Hospital of Wales, Cardiff, United Kingdom
| | - Arfon Powell
- Division of Cancer and Genetics, Cardiff University School of Medicine, Cardiff, United Kingdom
| | - M John Pollitt
- Department of Surgery, Prince Charles Hospital, Merthyr Tydfil, United Kingdom
| | - Wyn G Lewis
- Department of Surgery, University Hospital of Wales, Cardiff, United Kingdom
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Latif A, Hopkins L, Robinson D, Brown C, Abdelrahman T, Egan R, Iorwerth A, Pollitt J, Lewis WG. Influence of Trainer Role, Subspecialty and Hospital Status on Consultant Workplace-based Assessment Completion. J Surg Educ 2019; 76:1068-1075. [PMID: 30745232 DOI: 10.1016/j.jsurg.2019.01.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 12/17/2018] [Accepted: 01/20/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE Performance assessment is challenging to administer and validate, yet remains central to patient safety and quality of care. The aim of this study was to evaluate Consultant Surgeon trainer performance with respect to Workplace Based Assessment (WBA) completion. DESIGN All WBAs for 60 Core Surgical Trainees (n = 2932) recorded in one academic year were analyzed using the Intercollegiate Surgical Curriculum Progamme. Primary outcome measures were numbers of WBAs performed related to trainer role (Assigned Educational Supervisor vs. Clinical Supervisor vs. No Training Role), gender, surgical subspecialty, hospital status (teaching vs. district general), and trainer RCSEng. TrACE course accreditation. SETTING A core surgical training program serving a single UK (Wales) deanery. PARTICIPANTS Sixty consecutively appointed core surgical trainees. RESULTS Median WBA number performed irrespective of trainer role was 6 (range 0-51), consisting of CBD 2 (0-18), mini-CEX 2 (0-22), DOPS 2 (0-32), and PBA 0 (0-10). Assigned Educational Supervisor trainers were more likely to complete the full range of WBAs compared with Clinical Supervisor and No Training Role assessors; WBA 17 vs. 6 vs. 3; CBD 5 vs. 2 vs. 1; mini-CEX 5 vs. 2 vs. 1; DOPS 4 vs. 2 vs. 1; and PBA 0 vs. 0 vs. 0 (p < 0.001). WBAs completed varied by subspecialty; first quartile performance: ENT, Plastic Surgery, (median 12, interquartile range 13), compared with fourth quartile: OMFS, Urology, T&O, and Cardiothoracic Surgery (median 5, interquartile range 11, p = 0.016). Hospital status, gender, and TrACE accreditation were not associated with WBA performance. CONCLUSIONS Important variations in trainer WBA completion were apparent; training programme directors and trainees alike should be aware of this when agreeing educational contracts.
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Affiliation(s)
- Ahmed Latif
- Wales Deanery PGMDE School of Surgery, Health Education and Improvement Wales, Nantgarw, Cardiff, United Kingdom
| | - Luke Hopkins
- Wales Deanery PGMDE School of Surgery, Health Education and Improvement Wales, Nantgarw, Cardiff, United Kingdom
| | - David Robinson
- Wales Deanery PGMDE School of Surgery, Health Education and Improvement Wales, Nantgarw, Cardiff, United Kingdom
| | - Christopher Brown
- Wales Deanery PGMDE School of Surgery, Health Education and Improvement Wales, Nantgarw, Cardiff, United Kingdom
| | - Tarig Abdelrahman
- Wales Deanery PGMDE School of Surgery, Health Education and Improvement Wales, Nantgarw, Cardiff, United Kingdom
| | - Richard Egan
- Department of Surgery, Morriston Hospital, Swansea, Wales, United Kingdom
| | - Awen Iorwerth
- Wales Deanery PGMDE School of Surgery, Health Education and Improvement Wales, Nantgarw, Cardiff, United Kingdom
| | - John Pollitt
- Wales Deanery PGMDE School of Surgery, Health Education and Improvement Wales, Nantgarw, Cardiff, United Kingdom
| | - Wyn G Lewis
- Wales Deanery PGMDE School of Surgery, Health Education and Improvement Wales, Nantgarw, Cardiff, United Kingdom.
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Robinson DBT, Hopkins L, Brown C, Abdelrahman T, Powell AG, Egan RJ, Lewis WG. Relative Value of Adapted Novel Bibliometrics in Evaluating Surgical Academic Impact and Reach. World J Surg 2018; 43:967-972. [DOI: 10.1007/s00268-018-04893-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Dewi F, Egan RJ, Abdelrahman T, Morris C, Stechman MJ, Lewis WG. Prognostic Significance of Acute Kidney Injury Following Emergency Laparotomy: A Prospective Observational Cohort Study. World J Surg 2018; 42:3575-3580. [PMID: 30097705 DOI: 10.1007/s00268-018-4744-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
AIMS Post-operative acute kidney injury (AKI) is a common and independent mortality risk factor carrying high clinical and economic cost. This study aimed to establish the incidence of AKI in patients undergoing emergency laparotomy (EL), to determine patients' risk profile and consequent mortality. METHODS Consecutive 239 patients of median age 68 (IQR 51-76) years, undergoing EL in a UK tertiary hospital, were studied. Primary outcome measure was AKI and in-hospital operative mortality. RESULTS Ninety-five patients (39.7%) developed AKI, which was associated with in-hospital mortality in 32 patients (33.7%) compared with 7 patients (4.9%) without AKI. AKI occurred in 81.1% of all mortalities, but none occurred when AKI resolved within 48 h of EL. AKI was associated with chronic kidney disease, age, serum lactate, white cell count, pre-EL systolic blood pressure and tachycardia (p < 0.010). Median length of hospital stay in AKI survivors was 15 days compared with 11 days in the absence of AKI (p < 0.001). On multivariable analysis, only AKI at 48 h post-EL was significantly and independently associated with mortality [HR 10.895, 95% CI 3.152-37.659, p < 0.001]. CONCLUSION Peri-operative AKI after EL was common and associated with a more than sixfold significant greater mortality. Pre-operative risk profile assessment and prompt protocol-driven intervention should minimise AKI and reduce EL mortality.
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Affiliation(s)
- F Dewi
- Wales Postgraduate Medical and Dental Education Deanery, Cardiff, UK
| | - R J Egan
- Wales Postgraduate Medical and Dental Education Deanery, Cardiff, UK
| | - T Abdelrahman
- Wales Postgraduate Medical and Dental Education Deanery, Cardiff, UK
| | - C Morris
- Department of Surgery, University Hospital of Wales, Cardiff, CF14 4XW, UK
| | - M J Stechman
- Department of Surgery, University Hospital of Wales, Cardiff, CF14 4XW, UK
| | - W G Lewis
- Department of Surgery, University Hospital of Wales, Cardiff, CF14 4XW, UK.
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Brown C, Harries RL, Abdelrahman T, Thomas C, Pollitt MJ, Lewis WG. Surgical gender gap: a curriculum concordance and career vector perspective. Postgrad Med J 2018; 94:483-488. [PMID: 30355590 DOI: 10.1136/postgradmedj-2017-135437] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 05/11/2018] [Accepted: 07/31/2018] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Women's participation in medicine has increased dramatically during the last 50 years, yet Office for National Statistics data (2016) regarding annual pay continue to show an unequivocal 34% deficit in female doctors' remuneration compared with their male counterparts. This study aimed to identify whether there are measurable differences in the training, career vectors and profiles of higher general surgical trainees (HSTs), related to gender. METHOD The Deanery roster supplemented with Intercollegiate Surgical Curriculum Programme and Scopus data was used to identify the profiles of 101 consecutive HSTs (38 women, 63 men, single UK deanery). Primary outcome measures were training programme attrition rate, time to completion of training and achievement of third level 4 competence (3L4C) in indicative operations. Secondary outcomes were publication number, citations and Hirsch Indices (HIs). RESULTS Attrition rates were similar irrespective of gender (female n=3 (7.9%) vs male n=6 (9.5%), p=0.871). Training duration was on average 16 months longer in women (94 (72-134) months) than men (78 (72-112), p=0.002). Operative learning curve trajectories were similar; median operations required to achieve 3L4C was 380 (f) versus 410 (m, p=1.00). Academic profiles of men were stronger than women, specifically higher degrees; men (n=31, 83.8%), women (n=6, 16.2%, p=0.001); median (range) publication number 8 (0-57) versus 3 (0-38, p=0.003), citations 43 (0-1600) versus 9 (0-774, p=0.001), and HI 3 (0-26) versus 2 (0-12, p=0.002). CONCLUSION A complex variable gender gap was apparent related to time in training and academic profile, but not training attrition or operative learning curve trajectory.
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Affiliation(s)
- Chris Brown
- Wales Post Graduate Medical and Dental Education Deanery School of Surgery, Cardiff University, Cardiff, UK
| | - Rhiannon L Harries
- Wales Post Graduate Medical and Dental Education Deanery School of Surgery, Cardiff University, Cardiff, UK
| | - Tarig Abdelrahman
- Wales Post Graduate Medical and Dental Education Deanery School of Surgery, Cardiff University, Cardiff, UK
| | - Charlotte Thomas
- Wales Post Graduate Medical and Dental Education Deanery School of Surgery, Cardiff University, Cardiff, UK
| | - M John Pollitt
- Wales Post Graduate Medical and Dental Education Deanery School of Surgery, Cardiff University, Cardiff, UK
| | - Wyn G Lewis
- Wales Post Graduate Medical and Dental Education Deanery School of Surgery, Cardiff University, Cardiff, UK
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Brown C, Abdelrahman T, Powell AG, Pollitt MJ, Lewis WG, Egan RJ. To Bed or Not to Bed: The Sleep Question. J Am Coll Surg 2018. [DOI: 10.1016/j.jamcollsurg.2018.07.509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Abdelrahman T, Latif A, Chan D, Jones H, Farag M, Lewis W, Havard T, Escofet X. Outcomes after laparoscopic anti-reflux surgery related to obesity: A systematic review and meta-analysis. Int J Surg 2018; 51:76-82. [DOI: 10.1016/j.ijsu.2018.01.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 01/03/2018] [Indexed: 02/07/2023]
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Brown C, Abdelrahman T, Patel N, Iorwerth A, Pollitt J, Holt M, Lewis WG. Rural Rotations at Core: Rarefied Exposure or Real Experience? J Surg Educ 2018; 75:43-48. [PMID: 28711646 DOI: 10.1016/j.jsurg.2017.06.019] [Citation(s) in RCA: 4] [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] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 05/20/2017] [Accepted: 06/17/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE Surgical rotations involving rural General Hospitals (rGH) are frequently associated with recruitment challenges, partly because of adverse perceptions regarding distances from social support networks and training opportunities. The aim of this study was to determine the outcomes of core surgical training rotations involving rGHs when compared with urban hospitals in a single UK Deanery. DESIGN Online Intercollegiate Surgical Curriculum Programme portfolios from 163 core surgical trainees (CST) were examined related to postlocation, operative experience, workplace-based assessments, and academic achievement. Of the 163 CSTs, 27 had completed at least 50% of their 2-year training posts at rGHs and were compared with 136 control CSTs completing rotations in urban general and teaching hospitals (uGH). The primary outcome measures were MRCS pass rate and success at national ST3 selection. SETTING A core surgical training program serving a single UK Deanery. PARTICIPANTS Consecutive 177 CSTs appointed to a single UK Deanery between 2010 and 2016. RESULTS Success at MRCS and national ST3 selection were similar for CSTs from rGH vs uGH rotations-MRCS success: 70.4 vs 72.8% (p = 0.816), and ST3 success: 22.2% vs 27.0% (p = 0.811). Median rGH vs uGH curriculum-based outcomes were operative case load: 378 vs 422 (p = 0.300); workplace-based assessments completed: 79 vs 94 (p = 0.499); audits performed: 4 vs 4 (p = 0.966); learned society communications: 1 vs 2 (p = 0.020); and scientific publications: 0 vs 0 (p = 0.478). CONCLUSION CST rotations including rGHs produced a different spectrum of training experience compared with uGH rotations but overall primary outcomes were similar.
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Affiliation(s)
- Christopher Brown
- Department of Surgery, Wales Post Graduate Medical and Dental Education Deanery School of Surgery, Cardiff University, Cardiff, United Kingdom.
| | - Tarig Abdelrahman
- Department of Surgery, Wales Post Graduate Medical and Dental Education Deanery School of Surgery, Cardiff University, Cardiff, United Kingdom
| | - Neil Patel
- Department of Surgery, Wales Post Graduate Medical and Dental Education Deanery School of Surgery, Cardiff University, Cardiff, United Kingdom
| | - Awen Iorwerth
- Department of Surgery, Wales Post Graduate Medical and Dental Education Deanery School of Surgery, Cardiff University, Cardiff, United Kingdom
| | - John Pollitt
- Department of Surgery, Wales Post Graduate Medical and Dental Education Deanery School of Surgery, Cardiff University, Cardiff, United Kingdom
| | - Mark Holt
- Department of Surgery, Wales Post Graduate Medical and Dental Education Deanery School of Surgery, Cardiff University, Cardiff, United Kingdom
| | - Wyn G Lewis
- Department of Surgery, Wales Post Graduate Medical and Dental Education Deanery School of Surgery, Cardiff University, Cardiff, United Kingdom
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Brown C, Abdelrahman T, Thomas C, Pollitt J, Lewis WG. Surgical academic reach: the higher degree effect quantified. Postgrad Med J 2017; 94:151-154. [PMID: 29187522 DOI: 10.1136/postgradmedj-2017-135350] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 11/07/2017] [Accepted: 11/19/2017] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Proof of professional specific academic attainment is embedded within the Joint Committee on Surgical Training 2013 general surgery curriculum, mandating that all higher general surgical trainees (HST) obtain three peer-reviewed publications to qualify for Certification of Completion of Training. Yet, Modernising Medical Careers (MMC) has been associated with a trend away from the gold standard postgraduate credentials of higher degrees by research. This study aimed to evaluate the academic achievements of a post-MMC UK Deanery HST cohort to determine what additional benefits higher degree study might confer. METHOD The Scopus bibliographic database (Elsevier, RELX Group) was used to characterise the academic profiles of 101 consecutive HSTs and supplemented with Intercollegiate Surgical Programme Curriculum data. Primary outcome measures were numbers of publications, citations and Hirsch indices (HI). RESULTS Thirty-seven HSTs (36.6%) had been awarded higher degrees (29 Doctor of Medicine, 8 Doctor of Philosophy). Academic profiles of HSTs with higher degrees were stronger than those of HSTs without, specifically: median (range) publication numbers 16 (2-57) vs 2 (0-11, P<0.001), citations 93 (0-1600) vs 6 (0-132, P<0.001), first author publications 6 (0-33) vs 3 (0-106, P<0.001), communications to learnt societies 30 (5-79) vs 8 (2-35, P<0.001) and HI 6 (1-26) vs 1 (0-6, P<0.001). CONCLUSION Proof of academic reach by higher degree was associated with important enhanced professional credentials, strengthening HIs sixfold. Trainers and trainees alike should be aware of the relative magnitude of such benefits when planning educational programmes.
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Affiliation(s)
- Chris Brown
- Wales Post Graduate Medical and Dental Education Deanery School of Surgery, Cardiff University, Cardiff, UK
| | - Tarig Abdelrahman
- Wales Post Graduate Medical and Dental Education Deanery School of Surgery, Cardiff University, Cardiff, UK
| | - Charlotte Thomas
- Wales Post Graduate Medical and Dental Education Deanery School of Surgery, Cardiff University, Cardiff, UK
| | - John Pollitt
- Wales Post Graduate Medical and Dental Education Deanery School of Surgery, Cardiff University, Cardiff, UK
| | - Wyn G Lewis
- Wales Post Graduate Medical and Dental Education Deanery School of Surgery, Cardiff University, Cardiff, UK
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Brown C, Abdelrahman T, Pollitt J, Holt M, Lewis WG. FRCS first pass variance: deanery and specialty contrariety. Postgrad Med J 2017; 94:48-52. [PMID: 28790151 DOI: 10.1136/postgradmedj-2017-135045] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 07/05/2017] [Accepted: 07/16/2017] [Indexed: 11/03/2022]
Abstract
BACKGROUND FRCS exit examination success may be interpreted as a surrogate marker for UK Deanery-related training quality. The aim of this study was to evaluate relative FRCS examination pass rates related to Deanery and Surgical Specialty. METHODS Joint Committee on Surgical Training-published examination first attempt pass rates were scrutinised for type I higher surgical trainees and outcomes compared related to Deanery and Surgical Specialty. RESULTS Of 9363 FRCS first attempts, 3974 were successful (42.4%). Median and mean pass rates related to Deanery were 42.1% and 30.7%, respectively, and ranged from 26.7% to 45.6%. Median (range) pass rates by specialty were urology 76.3% (60%-100%), trauma and orthopaedic surgery 74.7% (58.2%-100%), general surgery 70.0% (63.1%-86%), ENT 62.5% (50%-100%), cardiothoracic surgery 50.0% (25%-100%), oral and maxillofacial surgery 50% (40.0%-100%), neurosurgery 50% (22.7%-100%), plastic surgery 47.6% (30.0%-100%) and paediatric surgery 25% (16.7%-100%). Significant variance was observed across all specialties and deaneries (p=0.001). CONCLUSION As much as threefold variance exists related to FRCS examination first attempt success, trainees should be aware of this spectrum when preferencing deaneries during national selection.
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Affiliation(s)
- Chris Brown
- Wales Post Graduate Medical and Dental Education Deanery, School of Surgery, Cardiff, UK
| | - Tarig Abdelrahman
- Wales Post Graduate Medical and Dental Education Deanery, School of Surgery, Cardiff, UK
| | - John Pollitt
- Wales Post Graduate Medical and Dental Education Deanery, School of Surgery, Cardiff, UK
| | - Mark Holt
- Wales Post Graduate Medical and Dental Education Deanery, School of Surgery, Cardiff, UK
| | - Wyn G Lewis
- Wales Post Graduate Medical and Dental Education Deanery, School of Surgery, Cardiff, UK.,Upper GI Surgery, University Hospital of Wales, Cardiff, UK
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Brown C, Abdelrahman T, Patel N, Thomas C, Pollitt MJ, Lewis WG. Operative learning curve trajectory in a cohort of surgical trainees. Br J Surg 2017; 104:1405-1411. [DOI: 10.1002/bjs.10584] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 02/20/2017] [Accepted: 04/04/2017] [Indexed: 11/10/2022]
Abstract
Abstract
Background
Certification of completion of training in general surgery in the UK requires demonstration of competence in index operations by means of three level 4 competence consultant-validated procedure-based assessments (PBAs). The aim of this study was to evaluate the trajectory of operative learning curves related to PBA performance levels for curriculum-defined indicative operations with respect to numbers performed and training time.
Methods
Logbook data from consecutive higher general surgical trainees were compared with PBA evaluations to determine the relationship between PBA performance level, operative experience, training time and indicative numbers. Learning curve gradients were calculated using the inverse trigonometric function of tan related to operative experience and training time.
Results
Eighty-four surgical trainees participated. Median caseload to achieve three level 4 competence assessments was 64 (range 18–110) for inguinal hernia, 83 (15–177) for emergency laparotomy, 87 (23–192) for laparoscopic cholecystectomy, 95 (22–209) for appendicectomy, 45 (17–111) for segmental colectomy and 16 (6–28) for Hartmann's procedure. Median learning curve gradients to achieve level 4 competence for emergency laparotomy were 15·3° and 33·7° by caseload and training time respectively, compared with 73·3° and 59·9° for Hartmann's procedure. Significant variance was observed in the gradients of all learning curves related to both the caseload between the first level 3 and the first level 4 PBA (P = 0·001), and between the first and third level 4 PBAs (P < 0·001).
Conclusion
Significant learning curve gradient variance was observed, with discrepancies between expected indicative operative numbers and the point at which competence was judged to have been achieved. Numbers of index operations to achieve certification of completion of training warrant further examination.
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Affiliation(s)
- C Brown
- Wales Post Graduate Medical and Dental Education Deanery School of Surgery, Cardiff University, Cardiff CF14 4XW, UK
| | - T Abdelrahman
- Wales Post Graduate Medical and Dental Education Deanery School of Surgery, Cardiff University, Cardiff CF14 4XW, UK
| | - N Patel
- Wales Post Graduate Medical and Dental Education Deanery School of Surgery, Cardiff University, Cardiff CF14 4XW, UK
| | - C Thomas
- Wales Post Graduate Medical and Dental Education Deanery School of Surgery, Cardiff University, Cardiff CF14 4XW, UK
| | - M J Pollitt
- Wales Post Graduate Medical and Dental Education Deanery School of Surgery, Cardiff University, Cardiff CF14 4XW, UK
| | - W G Lewis
- Wales Post Graduate Medical and Dental Education Deanery School of Surgery, Cardiff University, Cardiff CF14 4XW, UK
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Ellul T, Bullock N, Abdelrahman T, Powell AGMT, Witherspoon J, Lewis WG. The 100 most cited manuscripts in emergency abdominal surgery: A bibliometric analysis. Int J Surg 2016; 37:29-35. [PMID: 27923680 DOI: 10.1016/j.ijsu.2016.12.006] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Revised: 11/30/2016] [Accepted: 12/01/2016] [Indexed: 12/01/2022]
Abstract
BACKGROUND The number of citations a scientific article receives provides a good indication of its impact within any given field. This bibliometric analysis aimed to identify the 100 most cited articles in Emergency Abdominal Surgery (EAS), to highlight key areas of interest and identify those that have most significantly shaped contemporary clinical practice in this newly evolving surgical specialty. This is of increasing relevance as concerns grow regarding the variable and suboptimal outcomes in Emergency General Surgery. MATERIALS AND METHODS The Thomson Reuters Web of Science database was used to search using the terms [Emergency AND Abdom* AND Surg*] to identify all English language, full manuscripts. Results were ranked according to citation number. The top 100 articles were further analysed by subject, author, journal, year of publication, institution, and country of origin. RESULTS The median (range) citation number of the top 100 out of 7433 eligible papers was 131 (1569-97). The most cited paper (by Goldman et al., Massachusetts General Hospital, New England Journal of Medicine; 1569 citations) focused on cardiac risk stratification in non-cardiac surgery. The Journal of Trauma, Injury, Infection and Critical Care published the most papers and received most citations (n = 19; 2954 citations. The majority of papers were published by centres in the USA (n = 52; 9422 citations), followed by the UK (n = 13; 1816 citations). The most common topics of publication concerned abdominal aneurysm management (n = 26) and emergency gastrointestinal surgery (n = 26). CONCLUSION Vascular surgery, risk assessment and gastrointestinal surgery were the areas of focus for 59% of the contemporary most cited emergency abdominal surgery manuscripts. By providing the most influential references this work serves as a guide to what makes a citable emergency surgery paper.
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Affiliation(s)
- Thomas Ellul
- Department of Surgery, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK; Cardiff University School of Medicine, University Hospital of Wales, Health Park, Cardiff, CF14 4XN, UK.
| | - Nicholas Bullock
- Department of Surgery, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK.
| | - Tarig Abdelrahman
- Department of Surgery, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK.
| | - Arfon G M T Powell
- Department of Surgery, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK; Cardiff University School of Medicine, University Hospital of Wales, Health Park, Cardiff, CF14 4XN, UK.
| | - Jolene Witherspoon
- Department of Surgery, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK.
| | - Wyn G Lewis
- Department of Surgery, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK; Cardiff University School of Medicine, University Hospital of Wales, Health Park, Cardiff, CF14 4XN, UK.
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Egan RJ, Abdelrahman T, Tate S, Ansell J, Harries R, Davies L, Clark G, Lewis WG. Modular emergency general surgery training: A pilot study of a novel programme. Ann R Coll Surg Engl 2016; 98:475-8. [PMID: 27269241 PMCID: PMC5210010 DOI: 10.1308/rcsann.2016.0187] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2016] [Indexed: 11/22/2022] Open
Abstract
Introduction Pan-speciality consensus guidance advocates mandatory emergency general surgery (EGS) training modules for specialist registrars (StRs). This pilot study evaluated the impact of EGS modules aimed at StRs over 1 year. Methods Eleven StRs were allocated a focused 4-week EGS module, in addition to the standard 1:12 on-call duty rota, in a tertiary surgical centre. Primary outcome measures included the number of indicative emergency operations and validated Procedure Based Assessments (PBAs) performed, both during the EGS module and over the training year. Results StRs performed a median of 11 (range 5-15) laparotomies during the EGS module versus 31 (range 9-49) over the whole training year. StRs attended 43.7% of available laparotomies during the module (range 24.1-63.7%). EGS modules provided more than one-third of the total emergency laparotomy experience, and a quarter of the emergency colectomy, appendicectomy and Hartmann's procedure experience. There were no differences in EGS module-related outcomes between junior and senior StRs. Significantly more PBAs related to laparotomy and segmental colectomy were completed during EGS modules than the on-call duty rota, at 32% versus 14% (p<0.001) and 48% versus 22% (p=0.019), respectively. Performance levels were maintained following module completion. Conclusions These findings provide an important baseline when considering future modular EGS training.
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Affiliation(s)
- R J Egan
- Wales Deanery, Neuadd Meirionnydd , Cardiff , UK
| | | | - S Tate
- Wales Deanery, Neuadd Meirionnydd , Cardiff , UK
| | - J Ansell
- Wales Deanery, Neuadd Meirionnydd , Cardiff , UK
| | | | - L Davies
- University Hospital of Wales , Cardiff , UK
| | - Gwb Clark
- University Hospital of Wales , Cardiff , UK
| | - W G Lewis
- University Hospital of Wales , Cardiff , UK
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Matthews AH, Abdelrahman T, Powell AGMT, Lewis WG. Surgical Education's 100 Most Cited Articles: A Bibliometric Analysis. J Surg Educ 2016; 73:919-929. [PMID: 27344302 DOI: 10.1016/j.jsurg.2016.05.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Revised: 05/03/2016] [Accepted: 05/14/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Bibliometric analysis highlights the key topics and publications, which have shaped surgical education. Here, the 100 most cited articles in the arena of surgical education were analyzed. METHODS Thomson Reuters Web of Science was interrogated using the keyword search terms "surgery" and ("learning" or "skills" or "competence" or "assessment" or "training" or "procedure-based assessments" or "performance" or "technical skills" or "curriculum" or "education" or "mentoring"] to identify all English language full articles, and the 100 most cited articles were analyzed by topic, journal, author, year, institution, and country of origin. RESULTS A total of 403,733 eligible articles were returned and the median citation number was 164 (range: 107-1018). The most cited article (by Seymour, Yale University School of Medicine, Annals of Surgery, 1018 citations) focused on the use of virtual reality surgical simulation training. Annals of Surgery published the highest number of articles and received the most citations (n = 16, 3715 citations). The countries with the greatest number of publications were the USA (n = 45), Canada (n = 19), and the UK (n = 18). The commonest topics included simulation (n = 45) and assessment of clinical competence (n = 40). CONCLUSION Surgical skill acquisition and assessment was the area of focus of 85% of the most cited contemporary articles, and this study provides the most cited references, serving as a guide as to what makes a citable published work in the field of surgical education.
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Affiliation(s)
| | - Tarig Abdelrahman
- Department of Surgery, University Hospital of Wales, Cardiff, United Kingdom
| | | | - Wyn G Lewis
- Department of Surgery, University Hospital of Wales, Cardiff, United Kingdom.
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Abdelrahman T, Long J, Egan R, Lewis WG. Operative Experience vs. Competence: A Curriculum Concordance and Learning Curve Analysis. J Surg Educ 2016; 73:694-698. [PMID: 26966081 DOI: 10.1016/j.jsurg.2016.01.011] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Revised: 12/16/2015] [Accepted: 01/20/2016] [Indexed: 06/05/2023]
Abstract
OBJECTIVE Certification of completion of training in general surgery requires proof of competence of index operations by means of 3, level-4 consultant-validated procedural-based assessments. The aim of this study was to examine the relationship between index operative experience and competence. DESIGN Higher surgical trainee procedural-based assessments were compared with e-logbooks to determine the relationship between index operative experience and achievement of a third level 4 competence (L4C) related to the indicative procedures of emergency laparotomy (EL, target 100), Hartmann procedure (5), appendicectomy (80), segmental colectomy (20), laparoscopic cholecystectomy (50), and inguinal hernia (80). SETTING All trainees are from a single UK Deanery. PARTICIPANTS Consecutive 69 national training number higher surgical trainees were appointed to a single UK Deanery between 2007 and 2014. RESULTS EL L4C was achieved at a median of 76 (15-136) cases, Hartmann procedure L4C at 17 (7-27) cases (p = 0.009 vs. EL), appendicectomy L4C at 107 (20-206) cases, segmental colectomy L4C at 52 (15-131) cases, laparoscopic cholecystectomy L4C at 72 (40-197) cases, and inguinal hernia L4C at 64 (17-132) cases. CONCLUSIONS The learning curve and caseload required to demonstrate L4C related to specific procedure varied over 4-fold, from 0.76 to 3.4 times the national indicative target number guidance. Certification of completion of training operative logbook number targets should be reconsidered to better reflect the competencies demanded by the curriculum.
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Affiliation(s)
- Tarig Abdelrahman
- Department of General Surgery, University Hospital of Wales, Cardiff, Wales.
| | - Jennifer Long
- Department of General Surgery, University Hospital of Wales, Cardiff, Wales
| | - Richard Egan
- Department of General Surgery, University Hospital of Wales, Cardiff, Wales
| | - Wyn G Lewis
- Department of General Surgery, University Hospital of Wales, Cardiff, Wales
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Perry H, Foley KG, Witherspoon J, Powell-Chandler A, Abdelrahman T, Roberts A, Lewis WG. Relative accuracy of emergency CT in adults with non-traumatic abdominal pain. Br J Radiol 2016; 89:20150416. [PMID: 26790835 DOI: 10.1259/bjr.20150416] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE CT examination prior to emergency laparotomy has become ubiquitous in contemporary clinical practice, but the relative accuracy of CT in this context has not been widely reported. The aim of this study was to determine the accuracy and strength of agreement between the perceived pre-operative CT diagnosis and operative findings. METHODS Data from patients undergoing pre-operative CT prior to emergency laparotomy from January 2013 to June 2014 in a large teaching hospital were analysed. The CT diagnosis was compared with operative findings using the χ(2) test and weighted kappa statistic (Kw). Results were further analysed related to the time of day the CT was reported, anatomical location and grade of the reporting radiologist. RESULTS 361 patients [median age 67 years (18-98 years); 180 males] underwent CT prior to emergency laparotomy. CT reports were deemed accurate in 318 (88.1%) cases and inaccurate in 43 (11.9%) cases, which resulted in 5 negative laparotomies in this latter cohort (11.6%, χ(2) 37.50, df 1; p < 0.0001). Accuracy and strength of agreement varied with anatomical location of the pathology; upper gastrointestinal (UGI) 75.5%, Kw 0.673 (0.531-0.815; p < 0.001); small bowel 89.9%, Kw 0.781 (0.687-0.875, p < 0.001); lower gastrointestinal (LGI) 90.4%, Kw 0.821 (0.749-0.893; p < 0.001). CT examinations reported within normal working hours had higher strength of agreement [Kw 0.832 (0.768-0.896), p < 0.001] than CTs reported out of hours [Kw 0.789 (0.721-0.857), p < 0.001], but there was no significant difference in overall accuracy (89.9 vs 86.0%; χ(2) 1.306, df 1, p = 0.253). Reporter seniority was not associated with improved diagnostic accuracy (χ(2) 1.825, df 1; p = 0.177). CONCLUSION CT agreement with emergency operative pathology was good to excellent, but the strength of agreement varied in relation to anatomical location of pathology. ADVANCES IN KNOWLEDGE Overall accuracy was 88.1% with good to excellent agreement between pre-operative CT and emergency laparotomy findings in adult patients with non-traumatic abdominal pain in the acute setting. Diagnostic accuracy of CT reporting varies with anatomical location of pathology.
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Affiliation(s)
- Helen Perry
- 1 Department of General Surgery, University Hospital of Wales, Cardiff, UK
| | | | - Jolene Witherspoon
- 1 Department of General Surgery, University Hospital of Wales, Cardiff, UK
| | | | - Tarig Abdelrahman
- 1 Department of General Surgery, University Hospital of Wales, Cardiff, UK
| | - Ashley Roberts
- 2 Department of Radiology, University Hospital of Wales, Cardiff, UK
| | - Wyn G Lewis
- 1 Department of General Surgery, University Hospital of Wales, Cardiff, UK
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Abdelrahman T, Brown J, Wheat J, Thomas C, Lewis W. Hirsch Index Value and Variability Related to General Surgery in a UK Deanery. J Surg Educ 2016; 73:111-115. [PMID: 26481425 DOI: 10.1016/j.jsurg.2015.07.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 07/30/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVES The Hirsch Index (h-index) is often used to assess research impact, and on average a social science senior lecturer will have an h-index of 2.29, yet its validity within the context of UK General Surgery (GS) is unknown. The aim of this study was to calculate the h-indices of a cohort of GS consultants in a UK Deanery to assess its relative validity. DESIGN Individual h-indices and total publication (TP) counts were obtained for GS consultants via the Scopus and Web of Science (WoS) Internet search engines. Assessment of construct validity and reliability of these 2 measures of the h-index was undertaken. SETTING All hospitals in a single UK National Health Service Deanery were included (14 general hospitals). PARTICIPANTS All 136 GS consultants from the Deanery were included. RESULTS Median h-index (Scopus) was 5 (0-52) and TP 15 (0-369), and strong correlation was found between h-index and TP (ρ = 0.932, p < 0.001), with the intraclass correlation between Scopus and WoS h-index also significant (intraclass correlation coefficient = 0.973 [95% CI: 0.962-0.981], p < 0.001). Academic GS consultants had higher h-indices than nonacademic University Hospital and District General Hospital consultants (Scopus 12 vs 7 vs 4 [p < 0.001] and WoS 10.5 vs 7 vs 4 [p < 0.001]). h-Index was >2.29 in 57.4% of consultants. No subspecialty differences were apparent in median h-indices (p = 0.792) and TP (p = 0.903). CONCLUSIONS h-Index is a valid GS research productivity metric with over half of consultants performing at levels equivalent to social science Senior Lecturers.
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Affiliation(s)
- Tarig Abdelrahman
- Department of General Surgery, University Hospital of Wales, Cardiff, Wales, United Kingdom.
| | - Josephine Brown
- Department of General Surgery, University Hospital of Wales, Cardiff, Wales, United Kingdom
| | - Jenny Wheat
- Department of General Surgery, University Hospital of Wales, Cardiff, Wales, United Kingdom
| | - Charlotte Thomas
- Department of General Surgery, University Hospital of Wales, Cardiff, Wales, United Kingdom
| | - Wyn Lewis
- Department of General Surgery, University Hospital of Wales, Cardiff, Wales, United Kingdom
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Bosanquet D, Ansell J, Abdelrahman T, Cornish J, Harries R, Stimpson A, Davies L, Glasbey J, Frewer K, Frewer N, Russell D, Russell I, Torkington J. Systematic review and meta regression of factors affecting midline incisional hernia rates: An analysis of 14,618 patients. Int J Surg 2015. [DOI: 10.1016/j.ijsu.2015.07.307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Bosanquet DC, Ansell J, Abdelrahman T, Cornish J, Harries R, Stimpson A, Davies L, Glasbey JCD, Frewer KA, Frewer NC, Russell D, Russell I, Torkington J. Systematic Review and Meta-Regression of Factors Affecting Midline Incisional Hernia Rates: Analysis of 14,618 Patients. PLoS One 2015; 10:e0138745. [PMID: 26389785 PMCID: PMC4577082 DOI: 10.1371/journal.pone.0138745] [Citation(s) in RCA: 210] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 09/03/2015] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The incidence of incisional hernias (IHs) following midline abdominal incisions is difficult to estimate. Furthermore recent analyses have reported inconsistent findings on the superiority of absorbable versus non-absorbable sutures. OBJECTIVE To estimate the mean IH rate following midline laparotomy from the published literature, to identify variables that predict IH rates and to analyse whether the type of suture (absorbable versus non-absorbable) affects IH rates. METHODS We undertook a systematic review according to PRISMA guidelines. We sought randomised trials and observational studies including patients undergoing midline incisions with standard suture closure. Papers describing two or more arms suitable for inclusion had data abstracted independently for each arm. RESULTS Fifty-six papers, describing 83 separate groups comprising 14,618 patients, met the inclusion criteria. The prevalence of IHs after midline incision was 12.8% (range: 0 to 35.6%) at a weighted mean of 23.7 months. The estimated risk of undergoing IH repair after midline laparotomy was 5.2%. Two meta-regression analyses (A and B) each identified seven characteristics associated with increased IH rate: one patient variable (higher age), two surgical variables (surgery for AAA and either surgery for obesity surgery (model A) or using an upper midline incision (model B)), two inclusion criteria (including patients with previous laparotomies and those with previous IHs), and two circumstantial variables (later year of publication and specifying an exact significance level). There was no significant difference in IH rate between absorbable and non-absorbable sutures either alone or in conjunction with either regression analysis. CONCLUSIONS The IH rate estimated by pooling the published literature is 12.8% after about two years. Seven factors account for the large variation in IH rates across groups. However there is no evidence that suture type has an intrinsic effect on IH rates.
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Affiliation(s)
| | - James Ansell
- University Hospital of Wales, Cardiff, CF14 4XW, United Kingdom
| | | | - Julie Cornish
- University Hospital of Wales, Cardiff, CF14 4XW, United Kingdom
| | - Rhiannon Harries
- Morriston Hospital, Heol Maes Eglwys, Swansea, SA6 6NL, United Kingdom
| | - Amy Stimpson
- Glan Clwyd Hospital, Rhyl, LL18 5UJ, United Kingdom
| | - Llion Davies
- University Hospital of Wales, Cardiff, CF14 4XW, United Kingdom
| | - James C D Glasbey
- Cardiff University School of Medicine, Cardiff, CF14 4XN, United Kingdom
| | - Kathryn A Frewer
- Cardiff University School of Medicine, Cardiff, CF14 4XN, United Kingdom
| | - Natasha C Frewer
- Cardiff University School of Medicine, Cardiff, CF14 4XN, United Kingdom
| | - Daphne Russell
- Swansea University College of Medicine, Swansea, SA2 8AA, United Kingdom
| | - Ian Russell
- Swansea University College of Medicine, Swansea, SA2 8AA, United Kingdom
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Abdelrahman T, Witkowska W, Al-Otaibi S, Vattipally S, Thomson E. Baseline majority and minority resistance mutations in HIV-infected MSM with acute HCV. J Clin Virol 2015. [DOI: 10.1016/j.jcv.2015.07.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Abdelrahman T, Young P, Kozyar O, Davies E, Dojcinov S, Mansel RE. Giant pseudoangiomatous stromal hyperplasia presenting in the breast of a prepubertal child. BMJ Case Rep 2015; 2015:bcr-2014-206797. [PMID: 26002664 DOI: 10.1136/bcr-2014-206797] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Large benign lesions of the breasts are rare in children. We present a case of a 35 cm mass, weighing 2.7 kg in a 13-year-old girl with small developing breasts. Despite the enormity of the lesion, the patient managed to keep it concealed from her parents for 8 months. While initially suspicious of sarcoma a diagnosis of pseudoangiomatous stromal hyperplasia was suggested radiologically and confirmed histologically. Excision with reduction mammoplasty was performed, care taken not to disrupt the remaining breast tissue to facilitate future breast development. 18 months on, the cosmetic appearance of the breasts is good, with healthy underlying breast tissue developing. To the best of our knowledge this case is the largest documented breast tumour of this type in a patient of this age and illustrates the challenge of treating such tumours in the developing breast.
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Affiliation(s)
- Tarig Abdelrahman
- Department of General Surgery, Abertawe Bro Morgannwg University Health Board, Bridgend, UK
| | - Philippa Young
- Department of Radiology, University Hospital Llandough, Cardiff, UK
| | - Olexandra Kozyar
- Department of Pathology, University Hospital of Wales, Cardiff, UK
| | - Eleri Davies
- Department of Breast Surgery, University Hospital Llandough, Cardiff, UK
| | - Stefan Dojcinov
- Department of Pathology, University Hospital of Wales, Cardiff, UK
| | - Robert E Mansel
- Department of Breast Surgery, University Hospital Llandough, Cardiff, UK
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Thomas C, Griffiths G, Abdelrahman T, Santos C, Lewis W. Does UK surgical training provide enough experience to meet today’s training requirements? BMJ 2015. [DOI: 10.1136/bmj.h2503] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Abdelrahman T, Longworth T, Locker A. Appropriateness of vascular referrals to secondary care – An audit of current practice. Int J Surg 2013. [DOI: 10.1016/j.ijsu.2013.06.826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Coulman KD, Abdelrahman T, Owen-Smith A, Andrews RC, Welbourn R, Blazeby JM. Patient-reported outcomes in bariatric surgery: a systematic review of standards of reporting. Obes Rev 2013; 14:707-20. [PMID: 23639053 DOI: 10.1111/obr.12041] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2013] [Revised: 03/20/2013] [Accepted: 04/01/2013] [Indexed: 12/01/2022]
Abstract
Bariatric surgery is increasingly being used to treat severe obesity, but little is known about its impact on patient-reported outcomes (PROs). For PRO data to influence practice, well-designed and reported studies are required. A systematic review identified prospective bariatric surgery studies that used validated PRO measures. Risk of bias in randomized controlled trials (RCTs) was assessed, and papers were examined for reporting of (i) who completed PRO measures; (ii) missing PRO data and (iii) clinical interpretation of PRO data. Studies meeting all criteria were classified as robust. Eighty-six studies were identified. Of the eight RCTs, risk of bias was high in one and unclear in seven. Sixty-eight different PRO measures were identified, with the Short Form (SF)-36 questionnaire most commonly used. Forty-one (48%) studies explicitly stated measures were completed by patients, 63 (73%) documented missing PRO data and 50 (58%) interpreted PRO data clinically. Twenty-six (30%) met all criteria. Although many bariatric surgery studies assess PROs, study design and reporting is often poor, limiting data interpretation and synthesis. Well-designed studies that include agreed PRO measures are needed with reporting to include integration with clinical outcomes to inform practice.
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Affiliation(s)
- K D Coulman
- Centre for Surgical Research, School of Social and Community Medicine, University of Bristol, Bristol, UK; Department of Bariatric and Upper GI Surgery, Musgrove Park Hospital, Taunton and Somerset NHS Foundation Trust, Taunton, Somerset, UK
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Abdelrahman T, Griffiths A, Davies L, Furtado S, Henwood M. Can RCSEng standards for the management of high risk general surgical patients be achieved in UK hospitals? Int J Surg 2012. [DOI: 10.1016/j.ijsu.2012.06.463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Reddy VM, Abdelrahman T, Lau A, Anyanwu K, Whinney DJ. Using keywords to predict the need for an audiogram: an analysis of referral letters using logistic regression. Inform Prim Care 2011; 18:171-5. [PMID: 21396240 DOI: 10.14236/jhi.v18i3.769] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Otolaryngology clinics are often booked without considering the distribution of work for doctors and audiologists. This causes inefficiencies of time and human resources. This may be due to clinics being booked before referrals have been triaged to identify whether a hearing test, known as a pure tone audiogram (PTA), is indicated. A model that can predict the need for PTA without clinician-led triage could be useful to address these booking issues. OBJECTIVE To establish if it is possible to predict whether a referred patient requires a PTA based on occurrences of words in the referral letter. METHOD Binary logistic regression analysis of 500 letters of referral for otolaryngology outpatients. The derived model was then tested on 50 referral letters. All the referral letters were reviewed by clinicians and classified according to whether or not a PTA would be required. RESULTS The regression model correctly predicted requirement for a PTA in 42 of 50 referral letters (84%), with a sensitivity of 91% and specificity of 82%. CONCLUSION The model is able to predict requirement for a PTA from referral letters with a high degree of accuracy. This method may have a role in assisting administrative/clerical staff or non-specialist clinicians to book appropriate ear, nose and throat (ENT) clinic appointments, with or without a PTA. As a result, workload would be distributed more evenly, through the clinic for both otolaryngologists and audiologists, increasing efficiency.
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Affiliation(s)
- Venkat M Reddy
- ENT Department, Royal Cornwall Hospital, Truro, Cornwall, UK.
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Holt RIG, Abdelrahman T, Hirsch M, Dhesi Z, George T, Blincoe T, Peveler RC. The prevalence of undiagnosed metabolic abnormalities in people with serious mental illness. J Psychopharmacol 2010; 24:867-73. [PMID: 19304868 DOI: 10.1177/0269881109102788] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The prevalence of metabolic syndrome is increased 2-3-fold in people with serious mental illness (SMI). Monitoring of physical health in these individuals is poor, despite clear guidance from the National Institute of Health and Clinical Excellence. The aim of this study was to assess the proportion of people with SMI who had been screened for metabolic abnormalities within the previous year and in a further study to assess the prevalence of undiagnosed metabolic abnormalities in people who had not been screened. The notes and computer records of 100 patients with SMI from community and in-patient settings were evaluated. In a subsequent study, the prevalence of metabolic syndrome was assessed in 71 previously unscreened patients. The study was carried out at the psychiatric in-patient and out-patient units in Southampton and Winchester. The frequency of screening and prevalence of the metabolic syndrome as defined by the International Diabetes Federation (IDF) were assessed. There was documented evidence that the following cardiovascular risk factors had been measured in the previous year: blood pressure (32%), glucose (16%), lipids (9%) and weight (2%). In the metabolic abnormalities study, 41 of 71 (58%) patients were found to fulfil the IDF criteria for the metabolic syndrome. Two had previously undiagnosed diabetes. Twelve percent of patients had a greater than 20% risk of a cardiovascular event within the next 10 years. Despite clear guidance and a high prevalence of undiagnosed metabolic syndrome, screening rates for metabolic abnormalities in people with SMI remain low. Improved screening of metabolic complications should lead to better identification and treatment of this clinical problem.
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Affiliation(s)
- R I G Holt
- Endocrinology & Metabolism Sub-division, Developmental Origins of Adult Disease Division, University of Southampton, Southampton, UK.
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Reddy VM, Lau A, Abdelrahman T, Carswell AJ. Is There an Association Between Radon Exposure and the Incidence of Thyroid Cancer? Int J Surg 2010. [DOI: 10.1016/j.ijsu.2010.07.077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Elghouzzi MH, Senegas A, Steinmetz T, Guntz P, Barlet V, Assal A, Gallian P, Volle P, Chuteau C, Beolet M, Berrebi S, Filisetti D, Doderer C, Abdelrahman T, Candolfi E. Multicentric evaluation of the DiaMed enzyme-linked immunosorbent assay malaria antibody test for screening of blood donors for malaria. Vox Sang 2007; 94:33-40. [PMID: 18021184 DOI: 10.1111/j.1423-0410.2007.00998.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND The risk of malaria transmission by blood transfusion is critical due to extensive travel from endemic areas to non-endemic areas. An enzyme-linked immunosorbent assay (ELISA) malaria antibody test has been developed that is claimed to perform better than the immunofluorescence assay test (IFAT). The assay contains antigens to both Plasmodium falciparum and Plasmodium vivax. A multicentre study was performed to evaluate the appropriateness of replacing the IFAT by the new ELISA test. MATERIAL AND METHODS Nine French blood banks participated in this multicentre study. Two panels of samples were evaluated. The first included 4163 samples from healthy donors and was used to calculate clinical specificity of the assay. The second involved 10,995 samples, either collected retrospectively or prospectively from malaria-risk donors , was used to assess the comparative performance of the ELISA and IFAT. Discordant samples were further tested using an in-house IFAT and also tested for presence of Plasmodium DNA by polymerase chain reaction. RESULTS The ELISA showed a clinical specificity of 99.02%. In the malaria-risk blood donors groups, the retrospective group showed a concordance rate of 92.6% (k = 0.90), while the prospective group showed a concordance rate of 97% (k = 0.46). After confirming the discordant sample results by an in-house IFAT, the k index increased to 0.81. None of the discordant samples was shown to contain Plasmodium DNA. CONCLUSION The performance of the ELISA test in this study has confirmed its potential as a new screening test for use in blood banks, as an alternative to the IFAT in prevention of transfusion-transmitted malaria in non-endemic countries.
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Affiliation(s)
- M-H Elghouzzi
- Etablissement Français du Sang Ile de France, 94150 Rungis, France
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Abdelrahman T, Letscher Bru V, Waller J, Noacco G, Candolfi E. Dermatomycosis: comparison of the performance of calcofluor and potassium hydroxide 30% for the direct examination of skin scrapings and nails. J Mycol Med 2006. [DOI: 10.1016/j.mycmed.2006.03.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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