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Davidson M, Brennan E, Garg M, Oeppen RS, Brennan PA. Briefings in surgical teams: a pilot study of experiences and attitudes. Br J Oral Maxillofac Surg 2024; 62:197-202. [PMID: 38320922 DOI: 10.1016/j.bjoms.2023.12.004] [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: 11/29/2023] [Accepted: 12/05/2023] [Indexed: 02/08/2024]
Abstract
While healthcare should not be compared to other high reliability organisations (HROs), many lessons, attitudes, and transferable practices can be applied and adapted from them to improve patient safety and team morale. Despite briefings improving both patient safety and effective team working, some in healthcare have not valued or actively engaged with them, deeming them to be irrelevant. In this pilot study we explored the experiences of, and attitudes to, briefings using a 10-question Survey Monkey. This was promoted during a human factors session at the 2023 Association of Surgeons in Training Conference (ASiT) and at a large NHS trust. Questions were asked about the number of briefings per day, attitudes, engagement, and respondents' attitudes to them. In total, 109 responses were received. A total of 85% reported at least one briefing on a normal operating day, 65% felt them to be interactive, 67% reported that briefings were led by the most senior surgical team member, and 58% lasted four minutes or more. Eighteen per cent of respondents felt they were of little benefit, and 56% did not routinely de-brief at the end of the day. This study has highlighted variable attitudes to team briefings, with some colleagues still seeing them as a 'tick box' exercise. While culture has changed following the introduction of the WHO checklist, the importance of active engagement and education to improve the delivery and value of effective briefings cannot be overestimated. It is also an opportunity to create a 'safe space' for team members and to confirm zero tolerance for any inappropriate behaviour, including sexual misconduct.
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Affiliation(s)
- M Davidson
- BALPA, 1 Heathrow Boulevard, 278 Bath Road, West Drayton UB7 0DQ, UK
| | - E Brennan
- University of Bristol Medical School, Bristol, BS8 1UD, UK
| | - M Garg
- Maxillofacial Unit, Oxford University NHS Trust, Oxford, OX3 9DU, UK
| | - R S Oeppen
- University Hospitals Southampton, SO16 6YD, UK
| | - P A Brennan
- Maxillofacial Unit, Queen Alexandra Hospital, Portsmouth PO6 3LY, UK.
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2
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Higgs N, Morton L, Alam P, Brennan PA. Reducing aerosol risk in flexible nasendoscopy using a protective facial visor. Br J Oral Maxillofac Surg 2024; 62:205-206. [PMID: 38185580 DOI: 10.1016/j.bjoms.2023.10.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 07/18/2023] [Accepted: 10/17/2023] [Indexed: 01/09/2024]
Affiliation(s)
- N Higgs
- Queen Alexandra Hospital, Portsmouth PO6 3LY, UK.
| | - L Morton
- Queen Alexandra Hospital, Portsmouth PO6 3LY, UK
| | - P Alam
- St Richards Hospital, Chichester PO19 6SE, UK
| | - P A Brennan
- Queen Alexandra Hospital, Portsmouth PO6 3LY, UK
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3
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Brennan P, Jarvis S. Fallibility, performance, patient safety and teamwork: embedding human factors in surgery. Ann R Coll Surg Engl 2024; 106:102-105. [PMID: 38295841 PMCID: PMC10830336 DOI: 10.1308/rcsann.2024.0007] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024] Open
Affiliation(s)
- P Brennan
- Consultant Maxillofacial Surgeon, Portsmouth Hospitals University NHS Trust, UK
| | - S Jarvis
- Specialist in Aviation Human Factors and Director of Jarvis Bagshaw Ltd, UK
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Parry D, Odedra A, Fagbohun M, Oeppen RS, Davidson M, Brennan PA. Abbreviation use decreases effective clinical communication and can compromise patient safety. Br J Oral Maxillofac Surg 2023; 61:509-513. [PMID: 37563053 DOI: 10.1016/j.bjoms.2023.07.004] [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: 07/04/2023] [Accepted: 07/16/2023] [Indexed: 08/12/2023]
Abstract
Clear communication is paramount for achieving the safest and best patient outcomes, for maximising time efficiency, and lowering clinician workload. Multiple factors contribute to communication efficacy, including knowledge of topics between those communicating, interpersonal familiarity, and available time. Information exchange is growing faster and more frequent due to evolving communication technology, and communication is expanding as a response to increasing workloads. The number of referrals between specialties and the general practitioner (GP) is rising. The use of abbreviations has expanded in clinical communications and is likely to lead to misunderstanding, increased workload, and worse patient outcomes. In this article, we explore the use of abbreviations in the clinical setting.
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Affiliation(s)
- D Parry
- King's College London, Hodgkin Building, London SE1 1UL, United Kingdom.
| | - A Odedra
- Colchester General Hospital, Colchester CO4 5JL, United Kingdom.
| | - M Fagbohun
- The Park Practice, 17 Oakfield Road, London SE20 8QA, United Kingdom.
| | - R S Oeppen
- University Hospitals, Southampton SO16 6YD, United Kingdom.
| | | | - P A Brennan
- Queen Alexandra Hospital, Porstmouth PO6 3LY, United Kingdom.
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Nutor C, Dunlop A, Sadler O, Brennan PA. Prenatal Cannabis Use and Offspring Autism-Related Behaviors: Examining Maternal Stress as a Moderator in a Black American Cohort. J Autism Dev Disord 2023:10.1007/s10803-023-05982-z. [PMID: 37097527 PMCID: PMC10127191 DOI: 10.1007/s10803-023-05982-z] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2023] [Indexed: 04/26/2023]
Abstract
Prenatal cannabis use and maternal stress have been proposed as risk factors for autism spectrum disorder (ASD). Black mothers and mothers of lower socioeconomic status (SES) may be especially likely to experience high levels of stress. This study examined the impact of prenatal cannabis use and maternal stress (i.e., prenatal distress, racial discrimination, and lower SES) on child ASD-related behaviors in a sample of 172 Black mother-child pairs. We found that prenatal stress was significantly associated with ASD-related behaviors. Prenatal cannabis use did not predict ASD-related behaviors and did not interact with maternal stress to predict ASD-related behaviors. These findings replicate previous work on prenatal stress-ASD associations and add to the limited literature on prenatal cannabis-ASD associations in Black samples.
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Affiliation(s)
- C Nutor
- Department of Psychology, Emory University, 36 Eagle Row, Atlanta, GA, 30322, USA.
| | - A Dunlop
- Department of Gynecology and Obstetrics, Emory University, 1365 E Clifton Rd NE, Atlanta, GA, 30322, USA
| | - O Sadler
- Department of Psychology, Emory University, 36 Eagle Row, Atlanta, GA, 30322, USA
| | - P A Brennan
- Department of Psychology, Emory University, 36 Eagle Row, Atlanta, GA, 30322, USA
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Parry D, Iqbal S, Harrap I, Oeppen RS, Brennan PA. Caffeine: benefits and drawbacks for technical performance. Br J Oral Maxillofac Surg 2023; 61:198-201. [PMID: 36914458 DOI: 10.1016/j.bjoms.2023.01.007] [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: 01/11/2023] [Accepted: 01/18/2023] [Indexed: 02/18/2023]
Abstract
Surgical and minimally-invasive procedures, including cardiac and radiological, have high-stake patient outcomes. Working pressures, altering shift rotas, and ever-increasing demands have led to worsening sleep patterns for surgeons and allied professionals. Sleep deprivation alone has harmful consequences in relation to clinical outcomes and the physical and mental health of the surgeon, and to offset fatigue, some surgeons use legal stimulants such as caffeine and energy drinks. This stimulant use, however, may come at the cost of negative effects on cognitive and physical function. We aimed to explore evidence behind the use of caffeine, and its consequences on technical performance and clinical outcomes.
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Affiliation(s)
- D Parry
- Department of Anatomy, King's College London, Hodgkin Building, London SE1 1UI, UK.
| | - S Iqbal
- Darent Valley Hospital, Dartford DA2 8DA, UK.
| | - I Harrap
- Leeds University Teaching Hospitals, Leeds LS9 7TF, UK.
| | - R S Oeppen
- University Hospitals Southampton NHS Foundation Trust, Southampton, SO16 6YD, UK.
| | - P A Brennan
- Queen Alexandra Hospital, Porstmouth, PO6 3LY, UK.
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Yammine SG, Huybrechts I, Biessy C, Dossus L, Panico S, Sánchez MJ, Benetou V, Turzanski-Fortner R, Katzke V, Idahl A, Skeie G, Olsen KS, Tjønneland A, Halkjaer J, Colorado-Yohar S, Heath AK, Sonestedt E, Sartor H, Schulze MB, Palli D, Crous-Bou M, Dorronsoro A, Overvad K, Gurrea AB, Severi G, Vermeulen RCH, Sandanger TM, Travis RC, Key T, Amiano P, Van Guelpen B, Johansson M, Sund M, Tumino R, Wareham N, Sacerdote C, Krogh V, Brennan P, Riboli E, Weiderpass E, Gunter MJ, Chajès V. Dietary fatty acids and endometrial cancer risk within the European Prospective Investigation into Cancer and Nutrition. BMC Cancer 2023; 23:159. [PMID: 36797668 PMCID: PMC9936701 DOI: 10.1186/s12885-023-10611-0] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 02/06/2023] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND Diet may impact important risk factors for endometrial cancer such as obesity and inflammation. However, evidence on the role of specific dietary factors is limited. We investigated associations between dietary fatty acids and endometrial cancer risk in the European Prospective Investigation into Cancer and Nutrition (EPIC). METHODS This analysis includes 1,886 incident endometrial cancer cases and 297,432 non-cases. All participants were followed up for a mean of 8.8 years. Multivariable Cox proportional hazard models were used to estimate hazard ratios (HR) and 95% confidence intervals (CI) of endometrial cancer across quintiles of individual fatty acids estimated from various food sources quantified through food frequency questionnaires in the entire EPIC cohort. The false discovery rate (q-values) was computed to control for multiple comparisons. RESULTS Consumption of n-6 γ-linolenic acid was inversely associated with endometrial cancer risk (HR comparing 5th with 1st quintileQ5-Q1=0.77, 95% CI = 0.64; 0.92, ptrend=0.01, q-value = 0.15). This association was mainly driven by γ-linolenic acid derived from plant sources (HRper unit increment=0.94, 95%CI= (0.90;0.98), p = 0.01) but not from animal sources (HRper unit increment= 1.00, 95%CI = (0.92; 1.07), p = 0.92). In addition, an inverse association was found between consumption of n-3 α-linolenic acid from vegetable sources and endometrial cancer risk (HRper unit increment= 0.93, 95%CI = (0.87; 0.99), p = 0.04). No significant association was found between any other fatty acids (individual or grouped) and endometrial cancer risk. CONCLUSION Our results suggest that higher consumption of γ-linolenic acid and α-linoleic acid from plant sources may be associated with lower risk of endometrial cancer.
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Affiliation(s)
- S G Yammine
- Université Sorbonne Paris Nord and Université Paris Cité, INSERM, INRAE, CNAM, Center of Research in Epidemiology and StatisticS (CRESS) , Nutritional Epidemiology Research Team (EREN), F-93017, Bobigny, France.
| | - I Huybrechts
- International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - C Biessy
- International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - L Dossus
- International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - S Panico
- Dipartimento di medicina clinica e chirurgia, Federico II University, Naples, Italy
| | - M J Sánchez
- Escuela Andaluza de Salud Pública (EASP), Granada, Spain
- Instituto de Investigación Biosanitaria ibs. GRANADA, Granada, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain
| | - V Benetou
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens, Grèce
| | | | - V Katzke
- The German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - A Idahl
- Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, Umeå, Sweden
| | - G Skeie
- Faculty of Health Sciences, Department of Community Medicine, UiT The Arctic University of Norway, N - 9037, Tromsø, Norway
| | - K Standahl Olsen
- Faculty of Health Sciences, Department of Community Medicine, UiT The Arctic University of Norway, N - 9037, Tromsø, Norway
| | - A Tjønneland
- Danish Cancer Society Research Center, Copenhagen, Denmark
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - J Halkjaer
- Danish Cancer Society Research Center, Copenhagen, Denmark
| | - S Colorado-Yohar
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Murcia, Spain
- Research Group on Demography and Health, National Faculty of Public Health, University of Antioquia, Medellín, Colombia
| | - A K Heath
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College, London, United Kingdom
| | - E Sonestedt
- Department of Clinical Sciences Malmö, Lund University, Sweden
| | - H Sartor
- Department of Clinical Sciences Malmö, Lund University, Sweden
| | - M B Schulze
- Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam- Rehbruecke, Nuthetal, Germany
- Institute of Nutritional Science, University of Potsdam, Potsdam, Germany
| | - D Palli
- Cancer Risk Factors and Life-Style Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy
| | - M Crous-Bou
- Unit of Nutrition and Cancer, Cancer Epidemiology Research Program, Catalan Institute of Oncology (ICO) - Bellvitge Biomedical Research Institute (IDIBELL). L'Hospitalet de Llobregat, 08908, Barcelona, Spain
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, 02115, Boston, MA, USA
| | - A Dorronsoro
- Ministry of Health of the Basque Government, Sub-Directorate for Public Health and Addictions of Gipuzkoa, San Sebastian, Spain
| | - K Overvad
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - A Barricarte Gurrea
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Navarra Public Health Institute, Pamplona, Spain
- Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - G Severi
- Cancer Epidemiology Centre, Cancer Council Victoria, Melbourne, VIC, Australia
- Centre for Research in Epidemiology and Population Health, INSERM U1018, Université Paris-Saclay, Villejuif, France
- Human Genetics Foundation, Turin, Italy
| | - R C H Vermeulen
- Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
- Institute for Risk Assessment Sciences (IRAS), Department of Population Health Sciences, Utrecht University, Utrecht, The Netherlands
| | - T M Sandanger
- Faculty of Health Sciences, Department of Community Medicine, UiT The Arctic University of Norway, N - 9037, Tromsø, Norway
| | - R C Travis
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - T Key
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - P Amiano
- Ministry of Health of the Basque Government, Sub-Directorate for Public Health and Addictions of Gipuzkoa, San Sebastian, Spain
| | - B Van Guelpen
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
- Wallenberg Centre for Molecular Medicine, Umeå University, Umeå, Sweden
| | - M Johansson
- International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - M Sund
- Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
| | - R Tumino
- Cancer Registry and Histopathology Department, Provincial Health Authority (ASP 7), Ragusa, Italy
| | - N Wareham
- MRC Epidemiology Unit, University of Cambridge, Cambridge, England, U.K
| | - C Sacerdote
- Unit of Cancer Epidemiology, Città della Salute e della Scienza University-Hospital, Via Santena 7, 10126, Turin, Italy
| | - V Krogh
- Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale Dei Tumori Di, Milano, Italy
| | - P Brennan
- International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - E Riboli
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College, London, United Kingdom
| | - E Weiderpass
- International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - M J Gunter
- International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - V Chajès
- International Agency for Research on Cancer, World Health Organization, Lyon, France
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Zienius K, Hewins W, Summers D, McKinlay L, Brennan P, Porteous L, Grant R. P01.21.A Testing Semantic Verbal Fluency (SVFT) in patients with headache suspicious of cancer helps predict those with tumour on imaging. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac174.093] [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: 11/13/2022] Open
Abstract
Abstract
Background
Differentiating secondary headache from primary headache on history alone can sometimes be difficult. Headache “plus” other subtle cognitive features improves prediction. Patients and relatives may attribute subtle cognitive or behavioural changes to other causes (e.g. anxiety, low mood). Sematic verbal fluency - “how many animals can you think of in a minute” is commonly impaired on admission in patients with headache harbouring a tumour. We were interested whether SVFT at point of referral for scan would help predict a tumour and requested GPs report the SVFT on electronic referral for direct access scanning in cases with a history of headache suspicious of cancer. The aim of the pilot study was to establish if the SVFT was a “red flag” for secondary causes of headache. We report the results of a 20-month audit of cases.
Material and Methods
An electronic Protocol Based Referral (PBR) was developed for Headache Suspicious of Cancer to expedite scanning. The PBR sat alongside the routine e-DACI system that had been in use for some years. The GP was asked to complete the SVFT at the time of referral for scanning. Other data were gathered: PMH cancer; other symptoms/signs; co-morbid conditions and medications.
Results
GPs submitted requests for ePBR scanning in 669 cases over 20 months (62% females; Mean age 53: 60% <60 years). SVFT was completed on the request form in 381 (57%) cases. In these cases median SVFT was 17 animals. 11/381 cases were found to have cancer on scanning (2.9%): 10/188 cases with intracranial tumours had a SVFT <17 (5.32%) compared with one with a SVFT >=17. The median SVFT in cases with cancer was 10 animals. Other possible causes of SVFT <17 were - 53 psychiatric or chronic pain conditions on multiple drugs;12 were not native English speakers; 19 had co-existing dementia; 5 had small vessel disease; 4 cysts; 4 Giant Cell Arteritis ; 2 Chiari 1 malformation; PMH - encephalitis (1).
Conclusion
A SVFT result <17, at the point of referral for brain imaging, in patients with headache suspicious of cancer was associated with intracranial cancer in more than 1:20 cases, whereas a SVFT of >=17 was associated with cancer in 1:200 cases. SVFT may be an additional useful “red flag”. The most appropriate SVFT cut-off requires more research in a larger study. Low SVFT in headache patients may inform Cancer Referral Guidelines, improve the identification of secondary headache and help expedite cases.
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Affiliation(s)
- K Zienius
- University of Edinburgh , Edinburgh , United Kingdom
| | - W Hewins
- University of Edinburgh , Edinburgh , United Kingdom
| | - D Summers
- Department of Clinical Neurosciences, Royal Edinburgh Infirmary , Edinburgh , United Kingdom
| | - L McKinlay
- Department of Clinical Neurosciences , Edinburgh , United Kingdom
| | - P Brennan
- University of Edinburgh , Edinburgh , United Kingdom
| | - L Porteous
- Lead for Cancer, NHS Lothian , Edinburgh , United Kingdom
| | - R Grant
- University of Edinburgh, Edinburgh Centre for Neuro-Oncology , Edinburgh , United Kingdom
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Feng X, Wu WY, Onwuka J, Alcala K, Smith-Byrne K, Zahed H, Guida F, Yuan JM, Wang R, Milne R, Bassett J, Langhammer A, Hveem K, Stevens V, Wang Y, Brennan P, Melin B, Johansson M, Robbins H, Johansson M. P1.01-01 Comparison between Protein and Autoantibody Biomarkers for the Early Detection of Lung Cancer. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.162] [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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10
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Hardie JA, Green G, Bor R, Brennan PA. Response to Roche letter to editor Re. Cutting edge selection: learning from high reliability organisations for virtual recruitment in surgery during the COVID-19 pandemic. Ann R Coll Surg Engl 2022; 104:636-637. [PMID: 35686749 PMCID: PMC9433171 DOI: 10.1308/rcsann.2022.0070] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- JA Hardie
- Trauma & Orthopaedic Department, Luton & Dunstable Hospital, Lewsey Road, Luton, LU4 0DZ, UK
| | - G Green
- Centre for Aviation Psychology, Ground Floor Suite 62 Rosslyn Hill Street, Hampstead, London, United Kingdom, NW3 1ND
| | - R Bor
- Centre for Aviation Psychology, Ground Floor Suite 62 Rosslyn Hill Street, Hampstead, London, United Kingdom, NW3 1ND
| | - PA Brennan
- Maxillofacial Unit, Queen Alexandra Hospital, Portsmouth PO6 3LY, UK
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11
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Guy IA, Kerstein RL, Brennan PA. How to WHO: lessons from aviation in checklists and debriefs. Ann R Coll Surg Engl 2022; 104:510-516. [PMID: 34846195 PMCID: PMC9246552 DOI: 10.1308/rcsann.2021.0234] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The World Health Organization (WHO) surgical safety checklist (SSC) has had an overall positive impact; however, it has not completely prevented adverse events and compliance with the checklist varies. The aviation industry is considered to have better engagement with their safety checklists, reporting not only safety improvements, but also a cultural shift in their checklist philosophy over recent years. METHODS We explored the personal attitudes of pilots working in the aviation industry to identify principles of an effective checklist philosophy that could be transposed to the healthcare setting to empower more effective, consistent and ultimately successful implementation of the WHO SSC. A questionnaire was developed by the authors. Three airline pilots were interviewed via telephone, and asked questions regarding the logistics of and attitudes to checklists in the aviation industry. RESULTS Several key factors for successful checklist implementation were identified. These include regular training and education on human factors and the checklist's purpose, and institution of an atmosphere that is receptive, engaged and welcoming. Much can be learned from the aviation industry, where not only has the incidence of adverse events decreased, but the attitudes of people working in the industry have also transformed. CONCLUSION The WHO SSC is an invaluable tool used in healthcare settings worldwide. However, it is not a standalone commodity. To be effective, it necessitates steadfast engagement from the team members involved in its implementation. Human and checklist must work in partnership, using each other's strengths and fallibilities, to optimise outcomes and prevent risks to patient safety.
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Affiliation(s)
- IA Guy
- University Hospitals Birmingham NHS Foundation Trust, UK
| | - RL Kerstein
- Oxford University Hospitals NHS Foundation Trust, UK
| | - PA Brennan
- Portsmouth Hospitals University NHS Trust, UK
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12
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Hardie JA, Hunn D, Mitchell TE, Brennan PA. Patient, Procedure, People (PPP): recognising and responding to intraoperative critical events. Ann R Coll Surg Engl 2022; 104:409-413. [PMID: 34939840 PMCID: PMC9157965 DOI: 10.1308/rcsann.2021.0193] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Intraoperative critical events are rarely experienced by individual surgeons but are commonly experienced at a workforce level. Finding unfamiliar or unexpected pathology, anatomy, haemorrhage or an iatrogenic organ or structure injury cannot be completely eliminated in the complex surgical environment. It is vital that an appropriate, safe response to these infrequent events takes place to prevent possible further harm to patients. This paper introduces 'Patient, Procedure, People', a tool adapted from aviation threat and error management (TEM) training. It allows surgical teams to improve situational awareness (SA), communicate effectively, flatten team hierarchy gradients and improve decision-making before responding to critical events. We review factors contributing to poor decision-making, with resulting errors. These include loss of SA (tunnel vision), acute stress reactions (fight-flight or freeze-hide) and limbic hijacking (surprise and startle events). Events may cause workload to increase beyond cognitive capacity, further exacerbating the situation. After completing initial actions to achieve a temporary 'place of safety', surgical teams may use the tool to effectively manage threat or mitigate error. Aviation is a high-reliability organisation that has pioneered human factors research and training. Airline pilots undergo regular simulated emergencies assessment, including mandatory human factors assessment. Although the complexities of the operating theatre do not currently lend themselves to high-fidelity simulation as in aviation, valuable transferrable lessons can be learnt from aviation's approach to TEM.
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Affiliation(s)
- JA Hardie
- Frimley Health NHS Foundation Trust, UK
| | | | | | - PA Brennan
- Portsmouth Hospitals University NHS Trust, UK
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Ruperti Repilado FJ, Greutmann M, Bouchardy J, Brennan P, Campens L, Gallego P, Garcia-Orta R, Jensen AS, Ladouceur M, Miranda-Barrio B, Morissens M, Rueda Soriano J, Van Den Bosch AE, Tobler D, Schwerzmann M. The coronavirus disease 2019 pandemic among adult congenital heart disease patients: findings of a one-year multicentric, international study. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1878] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
One year after the beginning of the Coronavirus Disease 2019 (COVID-19) pandemic, the evidence on outcomes among adults with congenital heart disease (ACHD) is still limited.
Purpose
We aimed to compare patient characteristics and outcomes between the first and the subsequent COVID-19 waves and to identify overall predictors for complicated disease course among ACHD patients.
Methods
We collected reported COVID-19 cases among ACHD patients followed at 26 tertiary care centers in 10 European countries between March 27, 2020 and March 25, 2021. Patient characteristics, heart defect complexity and residual problems, medical history, date of diagnosis and course and outcome of COVID-19 were recorded. Cases were stratified into first vs. subsequent COVID-19 waves (cut-off date July 15, 2020). A complicated disease course was defined as hospitalization for COVID-19 requiring ventilation and/or inotropic support, extracorporeal membrane oxygenation or death. Data were reported as median (interquartile range) and counts (percentage).
Results
Overall, 548 cases were included (first wave: n=161; subsequent waves: n=387). Median age 33 (26–44) years, 52% female. Thirty-three patients (6%) had a complicated disease course. Between waves (first vs. subsequent), there were no statistically significant differences related to gender (women 57% vs. 49%, p=0.09), body mass index (BMI) category (p=0.7), heart defect complexity (p=0.08) and residual heart defect-related problems (p=0.6). Patients in the first wave were older, had more often ≥2 comorbidities and a complicated disease course (37 vs 33 years, p=0,001; 17% vs. 7%, p=0.0003; and 9% vs. 5%, p=0.04, respectively). The proportion of deaths did not significantly differed between waves (4% vs 2%, p=0.2). A detailed comparison of the above-reported characteristics is depicted in table 1. From multivariable models, adjusted odds ratios (OR) (95% confidence interval) for the prediction of complicated COVID-19 course are depicted in table 2. Main independent predictors for a complicated disease course were: cyanotic heart disease, including unrepaired cyanotic defects or severe pulmonary hypertension with Eisenmenger syndrome (OR 8.49 [3.14–22.94], p<0.001), BMI >25 kg/m2 (OR 3.91 [1.62–9.43], p=0.002), having ≥2 comorbidities (OR 2.63 [1.05–6.62], p=0.04) and age per five years (OR 1.21 [1.05–1.42], p=0.01).
Conclusion
Complicated COVID-19 course among ACHD patients is rare. Outcomes in the first wave were worse when compared to subsequent waves, mainly because patients of the first wave were older and had more comorbidities. Age, cyanotic heart disease (including unrepaired cyanotic defects or severe pulmonary hypertension with Eisenmenger syndrome), having ≥2 comorbidities and a BMI >25 kg/m2 were the main predictors for a complicated disease course.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
| | - M Greutmann
- University Hospital Zurich, Cardiology, Zurich, Switzerland
| | - J Bouchardy
- University Hospital Centre Vaudois (CHUV), Cardiology, Lausanne, Switzerland
| | - P Brennan
- Belfast Health and Social Care Trust, Cardiology, Belfast, United Kingdom
| | - L Campens
- Ghent University Hospital, Cardiology, Ghent, Belgium
| | - P Gallego
- University Hospital Virgen del Rocio, Cardiology, Seville, Spain
| | - R Garcia-Orta
- University Hospital Virgen de las Nieves, Cardiology, Granada, Spain
| | - A S Jensen
- Rigshospitalet - Copenhagen University Hospital, Cardiology, Copenhagen, Denmark
| | - M Ladouceur
- Hopital Europeen Georges Pompidou- University Paris Descartes, Cardiology, Paris, France
| | | | - M Morissens
- Brugmann University Hospital, Cardiology, Brussels, Belgium
| | - J Rueda Soriano
- Hospital Universitario y Politecnico La Fe, Cardiology, Valencia, Spain
| | - A E Van Den Bosch
- Erasmus University Medical Centre, Cardiology, Rotterdam, Netherlands (The)
| | - D Tobler
- University Hospital Basel, Cardiology, Basel, Switzerland
| | - M Schwerzmann
- Bern University Hospital, Inselspital, Bern, Switzerland
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14
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Ellis R, Scrimgeour D, Cleland J, Lee A, Brennan P. 50 A Cross-Sectional Study Examining the Association Between MRCS Performance and Surgeons Receiving Fitness to Practice Sanctions. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.839] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Aim
Fitness to practice (FtP) investigations by the General Medical Council (GMC) can be one of the most stressful experiences in a surgeon’s career. Demographic factors are known to alter the likelihood of GMC investigation. Despite this there are no studies assessing risk factors in surgeons for FtP sanctions. Thus, we used the newly created Intercollegiate Membership of Royal College of Surgeons (MRCS) examination database to identify risk factors for and the prevalence of GMC sanctions in early-career surgeons.
Method
FtP sanction data contained in the GMC list of registered medical practitioners (LRMP) database was linked at person-level to all UK graduates who had attempted MRCS Part A or Part B between September 2007 and January 2020. Data were anonymised by the Royal College of Surgeons of England prior to analysis.
Results
f 11,660 candidates who had attempted the MRCS within the study period only 31 (0.3%) candidates had GMC FtP sanctions within the last two years. Of these, 12 had active conditions on their registration, 7 had active undertakings and 14 had warnings. Candidate demographics were similar between cohorts and there were no significant differences between MRCS performance identified.
Conclusions
In this, the largest study of MRCS candidates to date, the prevalence of active FtP sanctions in early-career surgeons was 0.3%, significantly lower than the prevalence of sanctions across more experienced UK surgeons (0.9%). These data highlight early-career surgeons as a low-risk group for disciplinary action and should reassure patients and medical professionals of the rarity of FtP sanctions.
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Affiliation(s)
- R Ellis
- Urology Department, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
- Intercollegiate Committee for Basic Surgical Examinations, London, United Kingdom
| | - D Scrimgeour
- Department of Colorectal Surgery, Aberdeen Royal Infirmary, Aberdeen, United Kingdom
- Intercollegiate Committee for Basic Surgical Examinations, London, United Kingdom
| | - J Cleland
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, United Kingdom
| | - A Lee
- Department of Medical Statistics, University of Aberdeen, Aberdeen, United Kingdom
| | - P Brennan
- Intercollegiate Committee for Basic Surgical Examinations, London, United Kingdom
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15
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Ellis R, Scrimgeour D, Cleland J, Lee A, Brennan P. 238 MRCS Performance Predicts Surgical Career Outcomes. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.846] [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
Successful completion of the MRCS examination is mandatory for progression into higher surgical (registrar) training in the UK. National selection for training programmes is a highly competitive process. Despite this, the ranking of applicants does not currently include MRCS performance scores. This offers a unique opportunity to compare two independent assessments of surgical trainees to establish whether MRCS performance can predict future surgical career outcomes and competitiveness in training.
Method
All UK candidates who attempted MRCS between 2007-2020 were matched to career outcome data using the GMC list of registered medical practitioners and anonymised (n = 2910). Chi-squared tests determined associations with first attempt MRCS pass/fail outcomes. Multinomial regression models were developed to establish the predictive power of success at MRCS in determining surgical specialty and training deanery choices.
Results
There was statistically significant variability in MRCS Part A pass rates, ranging from 55.1%-76.7% between surgical specialties (P=0.001) but no significant variability in Part B pass rates (P=0.655). There was significant variability in Part A and Part B pass rates between training deaneries (P=0.010 and P=0.036 respectively). Pass rates ranged from 59.9%-77.7% for Part A and 70.1%-85.0% for Part B between training deaneries. Those in more competitive specialties and training deaneries performed better in MRCS in terms of first attempt pass rate, scores and number of attempts taken to pass.
Conclusions
MRCS performance is an early predictor of surgical career choice and competitiveness. Trainees who perform well at MRCS are more likely to enter competitive surgical specialties and training deaneries.
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Affiliation(s)
- R Ellis
- Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
- Intercollegiate Committee for Basic Surgical Examinations, London, United Kingdom
| | - D Scrimgeour
- Department of Colorectal Surgery, Aberdeen Royal Infirmary, Aberdeen, Aberdeen, United Kingdom
| | - J Cleland
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - A Lee
- Department of Medical Statistics, University of Aberdeen., Aberdeen, United Kingdom
| | - P Brennan
- Intercollegiate Committee for Basic Surgical Examinations, London, United Kingdom
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16
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Ellis R, Scrimgeour D, Cleland J, Lee A, Brennan P. 51 The Impact of Disability on Performance in the Intercollegiate Membership of the Royal College of Surgeons examination (MRCS). Br J Surg 2021. [DOI: 10.1093/bjs/znab258.041] [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: 11/13/2022]
Abstract
Abstract
Aim
The number of clinicians with disabilities is increasing, however there is no data on the performance of doctors with registered disabilities in the postgraduate environment. If we are to ensure diversity and equality within the workforce, we must first identify whether attainment differences exist in markers of performance. To address this, we assessed the impact of disabilities on performance in the MRCS.
Method
All UK medical graduates who had attempted MRCS Part A (n = 9,597) and Part B (n = 4,562) between 2007-2017 with linked disability data in the UK Medical Education Database (https://www.ukmed.ac.uk) were included. Univariate analysis identified associations with MRCS performance and logistic regression models identified independent predictors of success.
Results
Candidates with registered disabilities (n = 635) had lower MRCS Part A pass rates (46.3% vs 59.8% (p < 0.001)) but similar Part B pass rates (68.2% vs 70.9% (p = 0.339)). They were nearly twice as likely to fail Part A (odds ratio 0.55 [95% Confidence Interval 0.46-0.64]). When prior academic attainment (A-Levels and medical school performance) was accounted for, there was no statistically significant difference in the likelihood of MRCS success (p>0.05). Pass rates were similar for candidates with specific learning difficulties and those with other registered disabilities (p>0.05).
Conclusions
This is the first study to assess the impact of disability status and type on performance at a postgraduate medical examination. It appears that candidates with registered disabilities performed less well in formal, written examinations generally. Although our data indicate that current MRCS testing accommodations are fair, enabling performance unrestricted by disability.
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Affiliation(s)
- R Ellis
- Urology Department, Nottingham University Hospitals, Nottingham, United Kingdom
- Intercollegiate Committee for Basic Surgical Examinations, London, United Kingdom
| | - D Scrimgeour
- Department of Colorectal Surgery, Aberdeen Royal Infirmary, Aberdeen, United Kingdom
- Intercollegiate Committee for Basic Surgical Examinations, London, United Kingdom
| | - J Cleland
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - A Lee
- Department of Medical Statistics, University of Aberdeen, Aberdeen, United Kingdom
| | - P Brennan
- Intercollegiate Committee for Basic Surgical Examinations, London, United Kingdom
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17
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Ellis R, Cleland J, Scrimgeour D, Lee AJ, Brennan PA. The impact of disability on performance in a high-stakes postgraduate surgical examination: a retrospective cohort study. J R Soc Med 2021; 115:58-68. [PMID: 34269623 DOI: 10.1177/01410768211032573] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Despite rising numbers of doctors in the workforce with disabilities, little is known about the impact of disabilities on postgraduate performance. To ensure all groups are treated fairly in surgical training, it is essential to know whether any attainment differences exist in markers of surgical performance. To address this gap, we assessed the impact of disabilities on performance on the Intercollegiate Membership of the Royal College of Surgeons examination (MRCS). DESIGN Retrospective cohort study. SETTING Secondary care. PARTICIPANTS All UK MRCS candidates attempting Part A (n = 9600) and Part B (n = 4560) between 2007 and 2017 with linked disability data in the UK Medical Education Database (https://www.ukmed.ac.uk) were included. MAIN OUTCOME MEASURES Chi-square tests and correlation coefficients established univariate associations with MRCS performance, while multiple logistic regressions identified independent predictors of success. RESULTS Though MRCS Part B pass rates were similar (p = 0.339), candidates with registered disabilities had significantly lower first-attempt Part A pass rates (46.3% vs. 59.8%, p < 0.001). Candidates with disabilities also performed less well in examinations taken throughout school and medical school, and after adjusting for prior academic performance and sociodemographic predictors of success, logistic regression found that candidates with disabilities were no less likely to pass MRCS than their peers (odds ratio 1.04, 95% confidence interval 0.66 to 1.62). No significant variation was found in MRCS performance between type of disability or degree of limitations caused by disability (p > 0.05). CONCLUSION Although candidates with registered disabilities performed less well in formal, written examinations, our data indicate that they are as likely to pass MRCS at first attempt as their peers who achieved similar grades at high school and medical school. In order to enable equity in career progression, further work is needed to investigate the causes of attainment differences in early career assessments.
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Affiliation(s)
- R Ellis
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen AB25 2ZD, UK.,Urology Department, Nottingham University Hospitals NHS Trust, Nottingham NG5 1PB, UK
| | - J Cleland
- 371018Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232, Singapore
| | - Dsg Scrimgeour
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen AB25 2ZD, UK.,Department of Colorectal Surgery, Aberdeen Royal Infirmary, Aberdeen AB25 2ZN, UK
| | - A J Lee
- Department of Medical Statistics, Institute of Applied Health Sciences, University of Aberdeen, AB25 2ZD, UK
| | - P A Brennan
- Department of Maxillo-Facial Surgery, 112006Queen Alexandra Hospital, Portsmouth, PO6 3LY, UK
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18
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Brennan PA, Shakib K. Wrong-site tooth extraction removed from the list of NHS never events - implications for OMFS. Br J Oral Maxillofac Surg 2021; 59:840-842. [PMID: 34253399 DOI: 10.1016/j.bjoms.2021.02.021] [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: 02/26/2021] [Accepted: 02/26/2021] [Indexed: 11/18/2022]
Abstract
Never events that are relevant to OMFS include wrong-site procedures (including tooth extraction), and retained instruments and swabs. In February 2021, the list of never events was updated to exclude wrong tooth extraction, as the systemic barriers to prevent these incidents were not considered 'strong enough.' We discuss the matter, and provide some recommendations to minimise the risk of wrong tooth extraction, which to date has been the commonest never event in the NHS.
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Affiliation(s)
- P A Brennan
- Maxillofacial Unit, Queen Alexandra Hospital, Portsmouth PO6 3LY, UK.
| | - K Shakib
- University of Buckingham Medical & Dental Schools, Foscote Hospital, Banbury OX16 9XP, UK.
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19
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O'Cearbhaill RM, Alderson J, Power S, Herlihy DB, Brennan P, O'Hare A, Thornton J. Improving endovascular access to the target vessel for thrombus aspiration -Use of the wedge device to overcome anatomic hurdles. Interv Neuroradiol 2021; 28:213-218. [PMID: 34121488 DOI: 10.1177/15910199211024794] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND AND PURPOSE Aspiration is a successful technique used in thrombectomy for acute stroke. It is contingent upon the appropriate position of the aspiration catheter, so that it is in contact with the thrombus. However, navigating the craniocervical vasculature is challenging is some patients. The wedge microcatheter (MicroVention®) is designed to reduce the gap between the microcatheter and the SofiaPlus 6F catheter for ease of advancement. The purpose of this study is to describe our initial experience with the wedge microcatheter. MATERIALS AND METHODS A retrospective review of 38 consecutive patients in whom the wedge microcatheter was used during thrombectomy was performed to determine whether the wedge microcatheter was successful in delivering the Sofia catheter to the desired location. RESULTS We have found this device to be successful in delivering the aspiration catheter to the correct position in 97% (N = 37) of cases. It was used predominantly to pass the origin of branching vessels and also to navigate the tortuous cavernous and petrous segments of the ICA. CONCLUSION The wedge microcatheter is a successful tool in delivering the aspiration catheter to the desired vessel for revascularisation.
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Affiliation(s)
| | - J Alderson
- Department of Radiology, Beaumont Hospital, Dublin, Ireland
| | - S Power
- Department of Radiology, Beaumont Hospital, Dublin, Ireland
| | - D B Herlihy
- Department of Radiology, Beaumont Hospital, Dublin, Ireland
| | - P Brennan
- Department of Radiology, Beaumont Hospital, Dublin, Ireland
| | - A O'Hare
- Department of Radiology, Beaumont Hospital, Dublin, Ireland
| | - J Thornton
- Department of Radiology, Beaumont Hospital, Dublin, Ireland
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20
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Ellis R, Cleland J, Scrimgeour DSG, Lee AJ, Brennan PA. A cross-sectional study examining the association between MRCS performance and surgeons receiving sanctions against their medical registration. Surgeon 2021; 20:211-215. [PMID: 34030984 DOI: 10.1016/j.surge.2021.04.003] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 03/20/2021] [Accepted: 04/06/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Fitness to practice (FtP) investigations by the General Medical Council (GMC) safeguard patients and maintain the integrity of the medical profession. The likelihood of FtP sanctions is influenced by specialty and socio-demographic factors and can be predicted by performance at postgraduate examinations. This is the first study to characterise the prevalence of FtP sanctions in early-career surgeons and to examine the association with performance at the Membership of the Royal College of Surgeons (MRCS) examination. METHODS All UK graduates who attempted MRCS between September 2007-January 2020 were matched to the GMC list of registered medical practitioners. Clinicians who had active FtP sanctions between 28th August 2018 and 28th August 2020 were identified. Data were anonymised by RCS England prior to analysis. RESULTS Of 11,660 candidates who attempted MRCS within the study period, only 31 (0.3%) had FtP sanctions between 2018 and 2020. Of these, 12 had active conditions on registration, seven had undertakings and 14 had warnings. There was no statistically significant difference in MRCS performance in either Parts A or B of the examination for those with and those free from FtP sanctions (P > 0.05). CONCLUSIONS In this, the largest study of MRCS candidates to date, the prevalence of active FtP sanctions in early-career surgeons was 0.3%, significantly lower than the prevalence of sanctions across more experienced UK surgeons (0.9%). These data highlight early-career surgeons as a low-risk group for disciplinary action and should reassure patients and medical professionals of the rarity of FtP sanctions.
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Affiliation(s)
- R Ellis
- Institute of Applied Health Sciences, University of Aberdeen, AB25 2ZD, United Kingdom; Urology Department, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom.
| | - J Cleland
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - D S G Scrimgeour
- Institute of Applied Health Sciences, University of Aberdeen, AB25 2ZD, United Kingdom; Department of Colorectal Surgery, Aberdeen Royal Infirmary, Aberdeen, AB25 2ZN, United Kingdom
| | - A J Lee
- Department of Medical Statistics, Institute of Applied Health Sciences, University of Aberdeen, AB25 2ZD, United Kingdom
| | - P A Brennan
- Department of Maxillo-Facial Surgery, Queen Alexandra Hospital, Portsmouth, PO6 3LY, United Kingdom
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21
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Kelly FE, Bailey CR, Aldridge P, Brennan PA, Hardy RP, Henrys P, Hussain A, Jenkins M, Lang A, McGuire N, McNarry A, Osborn M, Pittilla L, Ralph M, Sarkar S, Taft D. Fire safety and emergency evacuation guidelines for intensive care units and operating theatres: for use in the event of fire, flood, power cut, oxygen supply failure, noxious gas, structural collapse or other critical incidents: Guidelines from the Association of Anaesthetists and the Intensive Care Society. Anaesthesia 2021; 76:1377-1391. [PMID: 33984872 DOI: 10.1111/anae.15511] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2021] [Indexed: 12/21/2022]
Abstract
The need to evacuate an ICU or operating theatre complex during a fire or other emergency is a rare event but one potentially fraught with difficulty: Not only is there a risk that patients may come to harm but also that staff may be injured and unable to work. Designing newly-built or refurbished ICUs and operating theatre suites is an opportunity to incorporate mandatory fire safety features and improve the management and outcomes of such emergencies: These include well-marked manual fire call points and oxygen shut off valves (area valve service units); the ability to isolate individual zones; multiple clear exit routes; small bays or side rooms; preference for ground floor ICU location and interconnecting routes with operating theatres; separate clinical and non-clinical areas. ICUs and operating theatre suites should have a bespoke emergency evacuation plan and route map that is readily available. Staff should receive practical fire and evacuation training in their clinical area of work on induction and annually as part of mandatory training, including 'walk-through practice' or simulation training and location of manual fire call points and fire extinguishers, evacuation routes and location and operation of area valve service units. The staff member in charge of each shift should be able to select and operate fire extinguishers and lead an evacuation. Following an emergency evacuation, a network-wide response should be activated, including retrieval and transport of patients to other ICUs if needed. A full investigation should take place and ongoing support and follow-up of staff provided.
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Affiliation(s)
- F E Kelly
- Department of Anaesthesia and Intensive Care Medicine, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - C R Bailey
- Department of Anaesthesia, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - P Aldridge
- Fire, Security and Corporate Affairs, Leeds Teaching Hospitals NHS Trust and General Secretary, National Association of Healthcare Fire Officers, UK
| | - P A Brennan
- Portsmouth Hospitals University Trust, Portsmouth, UK
| | - R P Hardy
- Department of Anaesthesia and Intensive Care Medicine, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - P Henrys
- BOC Ltd, British Compressed Gas Association Medical Gas Committee
| | - A Hussain
- AH Fire Ltd, Member of the National Association of Healthcare Fire Officers, UK
| | - M Jenkins
- Intensive Care Unit, Royal United Hospitals NHS Foundation Trust, Bath, UK
| | - A Lang
- Human Factors Research Group, Faculty of Engineering, University of Nottingham, Nottingham, UK
| | - N McGuire
- Devices, Medicines and Healthcare products Regulatory Agency
| | - A McNarry
- Department of Anaesthesia, Western General Hospital, Edinburgh, UK
| | - M Osborn
- Department of Oncology, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - L Pittilla
- North of England Paediatric Critical Care Network and Paediatric Critical Care Society
| | - M Ralph
- NHS Improvement (Department of Health) and Chair, Medical Gas Association
| | - S Sarkar
- Department of Anaesthesia and Intensive Care Medicine, Sherwood Forest Hospitals NHS Foundation Trust, Nottinghamshire, UK
| | - D Taft
- Health and Safety Executive
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22
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Hardie JA, Green G, Bor R, Brennan PA. Cutting edge selection: learning from high reliability organisations for virtual recruitment in surgery during the COVID-19 pandemic. Ann R Coll Surg Engl 2021; 103:385-389. [PMID: 33955275 DOI: 10.1308/rcsann.2021.0034] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION National selection for higher surgical training (ST3+) recruitment in the UK is competitive. The process must prioritise patient safety while being credible, impartial and fair. During the COVID-19 pandemic, all face-to-face interviews were cancelled. Selection was based on a controversial isolated self-assessment score with no evidence checking taking place. From 2021, selection will take place entirely online. Although this has cost and time advantages, new challenges emerge. METHODS We review surgical selection as it transitions to an online format and suggest validated methods that could be adapted from High Reliability Organisations (HRO). FINDINGS Virtual selection methods include video interviewing, online examinations and aptitude testing. These tools have been used in business for many years, but their predictive value in surgery is largely unknown. In healthcare, the established online Multi-Specialty Recruitment Assessment (MSRA) examines generic professional capabilities. Its scope, however, is too limited to be used in isolation. Candidates and interviewers alike may have concerns about the technical aspects of virtual recruitment. The significance of human factors must not be overlooked in the online environment. Surgery can learn from HROs, such as aviation. Pilot and air traffic control selection is integral to ensuring safety. These organisations have already established digital selection methods for psychological aptitude, professional capabilities and manual dexterity. CONCLUSION National selection for higher surgical training (ST3+) can learn from HROs, using validated methods to prioritise patient safety while being acceptable to candidates, trainers and health service recruiters.
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Affiliation(s)
| | - G Green
- Centre for Aviation Psychology, UK
| | - R Bor
- Centre for Aviation Psychology, UK.,Royal Free Hospital NHS Foundation Trust, UK
| | - P A Brennan
- Portsmouth Hospitals University NHS Trust, UK
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23
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Brennan P, Holroyd D. 485 Optimisation of The Evening Surgical Handover Process in A Large Tertiary Surgical Department - A Quality Improvement Project. Br J Surg 2021. [DOI: 10.1093/bjs/znab134.433] [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
Introduction
The aim of the project was to improve the quality and effectiveness of the evening surgical handover in a large tertiary surgical department, incorporating up to 150 patients.
Method
Audit standards were derived from GMC and RCSEng guidelines. An initial audit of the evening handover was conducted over a period of two weeks. Following this, a standard operating protocol (SOP) was introduced, with re-audit 4-weeks following implementation.
Results
The initial audit identified an inconsistent format and significant variability. Few handovers commenced with all team members present (11%) and were uninterrupted (33%). A laminated handover SOP checklist was produced and a new proforma was introduced to document tasks or reviews required overnight. A mandatory evening surgical HDU round was invoked and a “watchers” system was introduced to identify patients at highest risk of deterioration.
Re-audit demonstrated significant improvements in all domains to > 85%. ICU referrals overnight decreased from 6% to 2%. Further improvements measures were implemented in the form of a dynamic virtual handover document.
Conclusions
A structured SOP improved the consistency of the handover process. A night review of all HDU patients reduced the rate of ICU referrals. Implementation of virtual handover processes may be required in the COVID-era.
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Affiliation(s)
- P Brennan
- Glasgow Royal Infirmary, Glasgow, United Kingdom
| | - D Holroyd
- Glasgow Royal Infirmary, Glasgow, United Kingdom
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24
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Ellis R, Brennan P, Cleland J, A. Lee, D. Scrimgeour. 221 UK Medical School Selection Criteria Predicts Success in Part A of The Intercollegiate Membership of The Royal College of Surgeons (MRCS) Examination. Br J Surg 2021. [DOI: 10.1093/bjs/znab134.539] [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: 11/13/2022]
Abstract
Abstract
Background
Selection into UK medical school typically involves a combination of three measures: prior academic attainment, selection tests (e.g., the University Clinical Aptitude Test (UCAT), Biomedical Admissions Test (BMAT), Graduate Medical School Admissions Test (GAMSAT)), and an interview. We investigated whether prior attainment and selection test scores can predict MRCS success.
Method
We used the UKMED database to analyse selection data for all UK graduates who attempted MRCS Part A (n = 9729) and Part B (n = 4644) between 2007-2017. Univariate analysis and Pearson correlation coefficients were used to examine the relationship between selection scores and first attempt MRCS success.
Results
Successful MRCS Part A candidates had better A-Levels and higher scores in UCAT, BMAT and GAMSAT examinations (p < 0.001) than their unsuccessful peers. No statistically significant difference was observed for MRCS Part B. A moderate positive correlation was found between Part A, BMAT (r = 0.315, p < 0.001) and GAMSAT scores (r = 0.346, p < 0.001). A weak positive correlation was found between Part A, A-Level (r = 0.144, p < 0.001) and UCAT scores (r = 0.246, p < 0.001).
Conclusions
A-level results and medical school selection tests predict success in the knowledge-based (Part A) MRCS examination.
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Affiliation(s)
- R Ellis
- Centre for Healthcare Education Research and Innovation, University of Aberdeen, Aberdeen, United Kingdom
- Urology Department, Nottingham University Hospitals, Nottingham, United Kingdom
- Intercollegiate Committee for Basic Surgical Examinations, RCS, United Kingdom
| | - P Brennan
- Intercollegiate Committee for Basic Surgical Examinations, RCS, United Kingdom
| | - J Cleland
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - A. Lee
- Department of Medical Statistics, University of Aberdeen, Aberdeen, United Kingdom
| | - D. Scrimgeour
- Department of Colorectal Surgery, Aberdeen Royal Infirmary, Aberdeen, United Kingdom
- Intercollegiate Committee for Basic Surgical Examinations, RCS, United Kingdom
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Shivank K, Ilin R, Walker K, Brennan P. 525 Automated Continuous Instrument Tracking in Laparoscopic Box Trainers Predicts Performance at Assessment: A Prospective Cohort Study in Core Surgical Trainees. Br J Surg 2021. [DOI: 10.1093/bjs/znab135.007] [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
Introduction
Box-trainers enable deliberate practice of laparoscopic skills and can be equipped with instrument tracking metrics to provide feedback. However, the relationship between metrics, assessment outcomes and practice are unclear.
Method
Core surgical trainees were provided take-home box trainers with SurgTrac™ instrument tracking metrics for practice (eoSurgical Ltd., Scotland, UK). Practice was incentivised by certification and video assessment of a basic task, peg capping. Assessment was by consultant general surgeons, using objective structured assessment of technical skills (OSATS). The following metrics were analysed: task duration, distance moved by instruments, average instrument speed, average instrument acceleration, left- or right-handedness and instrument smoothness. Metrics were correlated to OSATS scores using regression analysis. Threshold for significance was p = 0.05.
Results
During the study period, there were 1639 peg capping performances by 85 trainees; 103 video recordings were submitted for assessment. All metrics were significantly associated with OSATS score, except instrument acceleration. The multiple linear regression model was highly correlated with actual scores (Pearson correlation 0.658; p < 0.001). Practice was positively correlated with regression model predicted OSATS score (regression analysis; ANOVA p < 0.001).
Conclusions
Instrument tracking metrics reliably predict OSATS performance and practice improves predicted score. Trainees can use metrics in unsupervised practice and gauge whether they are improving as expected.
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Affiliation(s)
- K Shivank
- Edinburgh Medical School, Edinburgh, United Kingdom
| | - R Ilin
- eoSurgical Ltd., Edinburgh, United Kingdom
| | - K Walker
- Scottish Surgical Simulation Collaborative, Royal College of Surgeons of Edinburgh and Royal College of Physicians and Surgeons of Glasgow, United Kingdom
- NHS Education for Scotland, Edinburgh, United Kingdom
- Raigmore Hospital and Centre for Health Sciences, Inverness, United Kingdom
| | - P Brennan
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, United Kingdom
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Ellis R, Scrimgeour D, Brennan P, Lee A, Cleland J. 191 Performance at Medical School and Foundation Programme Selection Can Predict Success in The MRCS Examination. Br J Surg 2021. [DOI: 10.1093/bjs/znab135.006] [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: 11/15/2022]
Abstract
Abstract
Background
Identifying factors that predict success in the Membership of the Royal College of Surgeons (MRCS) examination can aid trainees’ exam preparation and help deaneries identify candidates likely to require additional support. We assessed whether performance at Medical School and UK Foundation Programme selection (Educational Performance Measurement (EPM) and Situational Judgement Test (SJT)) predicted MRCS success.
Method
We analysed data from the UKMED Database for UK graduates who had attempted MRCS Part A (n = 1,975) and Part B (n = 630) between 2013-2017. Univariate analysis examined the relationship between performance and the likelihood of passing MRCS at first attempt. Logistic regression identified independent predictors of MRCS success.
Results
Each additional EPM decile increased the chances of passing MRCS by 52% for Part A (odds ratio 1.52 [95% confidence interval 1.46-1.60]) and 27% for Part B (1.27 [1.18-1.38]). Each EPM point awarded for degrees increased the likelihood of passing Part A by 29% (1.29 [1.12-1.48]). SJT score was not a statistically significant independent predictor of MRCS success (P>0.05).
Conclusions
This is the first study to investigate the relationship between UK medical school performance and postgraduate surgical exam success. Higher ranked students are more likely to succeed in the MRCS compared to their lower ranked peers.
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Affiliation(s)
- R Ellis
- Centre for Healthcare Education Research and Innovation, University of Aberdeen, Aberdeen, United Kingdom
- Urology Department, Nottingham University Hospitals, Nottingham, United Kingdom
- Intercollegiate Committee for Basic Surgical Examinations, Royal Colleges of Surgeons, United Kingdom
| | - D Scrimgeour
- Intercollegiate Committee for Basic Surgical Examinations, Royal Colleges of Surgeons, United Kingdom
- Department of Colorectal Surgery, Aberdeen Royal Infirmary, Aberdeen, United Kingdom
| | - P Brennan
- Intercollegiate Committee for Basic Surgical Examinations, Royal Colleges of Surgeons, United Kingdom
| | - A Lee
- Department of Medical Statistics, University of Aberdeen, Aberdeen, United Kingdom
| | - J Cleland
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
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27
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Ellis R, Scrimgeour D, Cleland J, Lee A, Brennan P. 220 Choice of UK Medical School Predicts Success in The Intercollegiate Membership of The Royal College of Surgeons (MRCS) Examination. Br J Surg 2021. [DOI: 10.1093/bjs/znab134.538] [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
Background
UK medical schools vary in terms of factors such as mission, specific curricula and pedagogy. As relatively little is understood about the impact of these differences at a post-graduate level, we examined the relationship between medical school and MRCS success.
Method
Using the UKMED database we analysed data on UK medical graduates who attempted MRCS Part A (n = 9729) and MRCS Part B (n = 4644) between 2007-2017. Univariate analysis characterised the relationship between medical school and first attempt MRCS success. Logistic regression modelling identified independent predictors of MRCS success.
Results
MRCS pass rates differed significantly between medical schools (P < 0.001). Trainees from standard-entry 5-year programmes were more likely to pass MRCS at first attempt compared to those from extended (Gateway) courses ((Part A (Odds Ratio (OR) 3.72 [95% Confidence Interval (CI) 2.69-5.15]); Part B (OR 1.67 [1.02-2.76])). Non-graduates were more likely to pass Part A (OR 1.40 [1.19-1.64]) and Part B (OR 1.66 [1.24-2.24]). Russell Group graduates were more likely to pass MRCS Part A (OR 1.79 [1.56-2.05]) and Part B (OR 1.24 [1.03-1.49])).
Conclusions
Medical programme and medical school are associated with MRCS success. Further research is needed to tease out the relationship between individual factors, medical school and MRCS performance.
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Affiliation(s)
- R Ellis
- Centre for Healthcare Education Research and Innovation, University of Aberdeen, Aberdeen, United Kingdom
- Urology Department, Nottingham University Hospitals, Nottingham, United Kingdom
- Intercollegiate Committee for Basic Surgical Examinations, RCS, United Kingdom
| | - D Scrimgeour
- Intercollegiate Committee for Basic Surgical Examinations, RCS, United Kingdom
- Department of Colorectal Surgery, Aberdeen Royal Infirmary, Aberdeen, United Kingdom
| | - J Cleland
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - A Lee
- Department of Medical Statistics, University of Aberdeen, Aberdeen, United Kingdom
| | - P Brennan
- Intercollegiate Committee for Basic Surgical Examinations, RCS, United Kingdom
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Brennan PA, Dalal A, Knighton J, Jones R, Oeppen RS. Pilot study to evaluate safety culture perception in the operating theatres of an acute NHS Trust using the National Air Traffic Services (NATS) App. Br J Oral Maxillofac Surg 2021; 59:1085-1089. [PMID: 34281735 DOI: 10.1016/j.bjoms.2021.04.013] [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: 04/13/2021] [Accepted: 04/15/2021] [Indexed: 11/19/2022]
Abstract
An area critical to safety in an organisation is the perceived and actual culture. National Air Traffic Services (NATS) work closely with large safety-critical industries including various aviation companies to enable them to identify strengths and vulnerabilities with the aim of improving safe practice. NATS have developed a simple free downloadable self-assessment App that individuals can use to assess their own culture perception in their organisation. The App has 16 questions arranged in four domains but to our knowledge it has not been used to date in healthcare. As part of the initiatives to improve staff culture, we evaluated operating theatre colleagues' safety perception in our large acute NHS Trust in a pilot study using the NATS safety App. Staff downloaded the App to their smart device before completing it. Responses were sent anonymously through the App and collated by NATS. A total of 146 colleagues downloaded and completed the questionnaire. One hundred and seventeen staff (80%) felt encouraged to report safety concerns, but 86% (n=126) confirmed a lack of available support from healthcare managers. Only 43% of respondents (n=63) would find it easy to challenge colleagues if they observed unsafe behaviour. This pilot study has identified positive indicators of an evolving NHS safety culture, and some concerns about speaking up, support, and challenging colleagues without fear. These issues are known to occur across healthcare. Further work is needed in the NHS to provide a supportive environment to improve patient safety, and lower hierarchy in surgical teams.
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Affiliation(s)
- P A Brennan
- Maxillofacial Unit, Queen Alexandra Hospital, Portsmouth PO6 3LY, UK.
| | - A Dalal
- Poole Hospital, Longfleet Road, Poole BH15 2JB, UK
| | - J Knighton
- Queen Alexandra Hospital, Portsmouth PO6 3LY, UK
| | - R Jones
- Queen Alexandra Hospital, Portsmouth PO6 3LY, UK
| | - R S Oeppen
- Southampton University Hospitals Trust, Tremona Road, Southampton SO16 6YD, UK
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29
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Mitchell OR, Couzins M, Dave R, Bekker J, Brennan PA. COVID-19 vaccination and low cervical lymphadenopathy in the two week neck lump clinic - a follow up audit. Br J Oral Maxillofac Surg 2021; 59:720-721. [PMID: 33947605 PMCID: PMC8057932 DOI: 10.1016/j.bjoms.2021.04.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 04/13/2021] [Indexed: 11/22/2022]
Abstract
The UK COVID vaccination programme has progressed at an astonishing rate since the first patients received their doses in December 2020. It is well known that other vaccines including influenza and human papilloma virus (HPV) can result in reactive lymphadenopathy in the axilla and/or neck. Patients are now presenting via the two week wait neck lump clinic with supraclavicular fossa and low neck lymphadenopathy related to COVID vaccination, and to similar one stop breast clinics with axillary lymph nodes. In an audit of 80 patients seen over a period of one month, we found COVID vaccine-related low neck lymphadenopathy in four cases (5%), with an additional rectal cancer patient thought to have metastatic disease who presented with a Virchow type node. COVID vaccine-related lymphadenopathy should be considered in the differential diagnosis of low-neck nodes if they occurred shortly after vaccination, but it is important to exclude sinister disease using ultrasound and other investigations as necessary.
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Affiliation(s)
- O R Mitchell
- Departments of Oral and Maxillofacial Surgery, Queen Alexandra Hospital, Portsmouth, PO6 3LY, UK
| | - M Couzins
- Departments of Clinical Radiology, Queen Alexandra Hospital, Portsmouth, PO6 3LY, UK
| | - R Dave
- Departments of Clinical Radiology, Queen Alexandra Hospital, Portsmouth, PO6 3LY, UK
| | - J Bekker
- Departments of Clinical Radiology, Queen Alexandra Hospital, Portsmouth, PO6 3LY, UK
| | - P A Brennan
- Departments of Oral and Maxillofacial Surgery, Queen Alexandra Hospital, Portsmouth, PO6 3LY, UK.
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Couzins M, Ali R, Mitchell O, Brennan PA, Bekker J. Computed tomography-guided transfacial buccal space core biopsy of deep head and neck space lesions: our experience. Br J Oral Maxillofac Surg 2021; 59:1238-1242. [PMID: 34284885 DOI: 10.1016/j.bjoms.2021.04.009] [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: 04/11/2021] [Accepted: 04/13/2021] [Indexed: 11/18/2022]
Abstract
Deep head and neck space lesions can present a number of diagnostic challenges due to their deep anatomical position and difficult access for diagnostic tissue sampling. We describe a series of percutaneous 'transfacial' buccal space computed tomography (CT)-guided core biopsies of these lesions and subsequent histological findings. Six patients underwent CT-guided core biopsy of deep parotid, parapharyngeal, or masticator space lesions over a 30-month period. We describe our biopsy technique and correlate our histological findings with subsequent surgical resection where performed. Five of six of CT-guided biopsies obtained sufficient tissue for histological interpretation with varying findings, including salivary gland tumours and squamous cell carcinoma confirmed on subsequent resection. One patient was treated palliatively following core biopsy. No biopsy-related complications were observed. In our small series, percutaneous CT-guided transfacial biopsy via the buccal space has proved an excellent option for the minimally invasive tissue acquisition of deep head and neck space lesions.
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Affiliation(s)
- M Couzins
- Departments of Clinical Radiology, Queen Alexandra Hospital, Portsmouth, UK.
| | - R Ali
- Departments of Clinical Radiology, Queen Alexandra Hospital, Portsmouth, UK
| | - O Mitchell
- Oral and Maxillofacial Surgery, Queen Alexandra Hospital, Portsmouth, UK
| | - P A Brennan
- Oral and Maxillofacial Surgery, Queen Alexandra Hospital, Portsmouth, UK
| | - J Bekker
- Departments of Clinical Radiology, Queen Alexandra Hospital, Portsmouth, UK
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31
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Robbins H, Alcala K, Swerdlow A, Schoemaker M, Wareham N, Key T, Travis R, Brennan P, Crosbie P, Callister M, Baldwin D, Landy R, Johansson M. P42.07 Comparative Performance of Lung Cancer Risk Models to Define Lung Screening Eligibility in the United Kingdom. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.831] [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: 11/28/2022]
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Abstract
The COVID-19 pandemic resulted in an unprecedented reduction in the delivery of surgical services worldwide, especially in non-urgent, non-cancer procedures. A prolonged period without operating (or ‘layoff period’) can result in surgeons experiencing skill fade (both technical and non-technical) and a loss of confidence. While senior surgeons in the UK may be General Medical Council (GMC) validated and capable of performing a procedure, a loss of ‘currency’ may increase the risk of error and intraoperative patient harm, particularly if unexpected or adverse events are encountered. Dual surgeon operating may mitigate risks to patient safety as surgeons regain currency while returning to non-urgent operating and may also be beneficial after the greatly reduced activity observed during the COVID-19 pandemic for low-volume complex operations. In addition, it could be a useful tool for annual appraisal, sharing updated surgical techniques and helping team cohesion. This paper explores lessons from aviation, a leading industry in human factors principles, for regaining surgical skills currency. We discuss real and perceived barriers to dual surgeon operating including finance, training, substantial patient waiting lists, and intraoperative power dynamics.
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Affiliation(s)
- R Ellis
- Intercollegiate Committee for Basic Surgical Examinations, United Kingdom; Urology Department, Nottingham University Hospitals, Nottingham, United Kingdom.
| | - J A Hardie
- Trauma & Orthopaedic Department, Frimley Park Hospital, Camberley GU16 7UJ, United Kingdom
| | - D J Summerton
- Department of Urology, University Hospitals of Leicester NHS Trust, Leicester LE5 4PW, United Kingdom
| | - P A Brennan
- Intercollegiate Committee for Basic Surgical Examinations, United Kingdom; Maxillofacial Unit, Queen Alexandra Hospital, Portsmouth PO6 3LY, United Kingdom
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34
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Mitchell OR, Dave R, Bekker J, Brennan PA. Supraclavicular lymphadenopathy following COVID-19 vaccination: an increasing presentation to the two-week wait neck lump clinic? Br J Oral Maxillofac Surg 2021; 59:384-385. [PMID: 33685772 PMCID: PMC7883701 DOI: 10.1016/j.bjoms.2021.02.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 02/04/2021] [Indexed: 11/05/2022]
Abstract
The first COVID-19 vaccination was given in December 2020 and there is an effort to vaccinate the international population on a massive scale. Common side effects from the vaccine include headache and tiredness. Regional lymphadenopathy has been described in relation to other vaccines. We describe two cases of supraclavicular reactive lymphadenopathy presenting in patients who had the COVID vaccination in the ipsilateral arm. Awareness of this diagnosis is important for patients presenting to the neck lump clinic.
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Affiliation(s)
| | - R Dave
- Queen Alexandra Hospital, Portsmouth.
| | - J Bekker
- Queen Alexandra Hospital, Portsmouth.
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35
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Ellis R, Oeppen RS, Brennan PA. Virtual postgraduate exams and assessments: the challenges of online delivery and optimising performance. Br J Oral Maxillofac Surg 2021; 59:233-237. [PMID: 33446398 DOI: 10.1016/j.bjoms.2020.12.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 12/11/2020] [Indexed: 11/18/2022]
Abstract
The COVID-19 pandemic has catalysed the computerisation and online delivery of postgraduate examinations. Social distancing regulations and lockdown measures resulted in many written and clinical examinations being cancelled during the initial surge of the virus. In an effort to reinstate the assessment of trainees and enable career progression, the UK medical regulator, the General Medical Council (GMC) has approved unprecedented changes to clinical examinations, including virtual assessment. We outline the changes made and the advantages and disadvantages of these new examination formats. We discuss ways for candidates and examiners to optimise their virtual environment and develop skills that can improve performance.
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Affiliation(s)
- R Ellis
- Nottingham University Hospitals NHS Trust, Nottingham NG5 1PB.
| | - R S Oeppen
- University Hospitals Southampton, Tremona Road, Southampton SO16 6YD.
| | - P A Brennan
- Maxillofacial Unit, Queen Alexandra Hospital, Portsmouth PO6 3LY.
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36
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Fonseka T, Ellis R, Salem H, Brennan PA, Terry T. The effects of COVID-19 on training within urology: Lessons learned in virtual learning, human factors, non-technical skills and reflective practice. J Clin Urol 2021; 14:29-35. [PMID: 38603044 PMCID: PMC7435206 DOI: 10.1177/2051415820950109] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 07/21/2020] [Indexed: 11/16/2022]
Abstract
The COVID-19 pandemic has changed training and recruitment in urology in unprecedented ways. As efforts are made to ensure trainees can continue to progress, lessons can be learned to improve training and urological practice even after the acute phase of the pandemic is over. Novel methods of education through virtual learning have burgeoned amidst the social distancing the pandemic has brought. The importance of training in human factors and non-technical skills has also been brought to the fore while operating under the constraints of personal protective equipment and working in new teams and unfamiliar environments. This paper critically appraises the available evidence of how urological training has been affected by COVID-19 and the lessons we have learned and continue to learn going forward. Level of Evidence Not Applicable.
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Affiliation(s)
- T Fonseka
- Urology Department, Royal Derby
Hospital, University Hospitals of Derby and Burton, UK
| | - R Ellis
- Urology Department, Royal Derby
Hospital, University Hospitals of Derby and Burton, UK
| | - H Salem
- Urology Department, Royal Derby
Hospital, University Hospitals of Derby and Burton, UK
| | - PA Brennan
- Maxillofacial Unit, Queen Alexandra
Hospital, UK
| | - T Terry
- Urology Department, Nottingham
University Hospitals, UK
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37
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Blackhall KK, Downie IP, Walsh S, Burhan R, Ramchandani P, Kusanale A, Srinivasan B, Brennan PA, Singh RP. Comparison of provision of maxillofacial emergency service during the two COVID-19 national lockdowns in the United Kingdom. Br J Oral Maxillofac Surg 2020; 59:716-719. [PMID: 33975765 PMCID: PMC7832651 DOI: 10.1016/j.bjoms.2020.12.016] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 12/19/2020] [Indexed: 11/16/2022]
Abstract
We previously published a study on the provision of emergency maxillofacial services during the first UK COVID-19 pandemic national lockdown. We repeated the study during the second lockdown and now present our findings that highlight the main differences and learning issues as the services have evolved.
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Affiliation(s)
- K K Blackhall
- Dept. Oral and Maxillofacial Surgery, Salisbury District Hospital, Salisbury, Wiltshire, SP2 8BJ
| | - I P Downie
- Dept. Oral and Maxillofacial Surgery, Salisbury District Hospital, Salisbury, Wiltshire, SP2 8BJ
| | - S Walsh
- Dept. Oral and Maxillofacial Surgery, St Richard's Hospital, Spitalfield Ln, Chichester, PO19 6SE
| | - R Burhan
- Dept. Oral and Maxillofacial Surgery, Southampton University Hospital, Tremona Rd, Southampton, SO16 6YD
| | - P Ramchandani
- Dept. Oral and Maxillofacial Surgery, Poole Hospital, Longfleet Rd, Poole, BH15 2JB
| | - A Kusanale
- Dept. Oral and Maxillofacial Surgery, Poole Hospital, Longfleet Rd, Poole, BH15 2JB
| | - B Srinivasan
- Dept. Oral and Maxillofacial Surgery, Queen Alexandra Hospital, Cosham, Portsmouth, PO6 3LY
| | - P A Brennan
- Dept. Oral and Maxillofacial Surgery, Queen Alexandra Hospital, Cosham, Portsmouth, PO6 3LY
| | - R P Singh
- Dept. Oral and Maxillofacial Surgery, Southampton University Hospital, Tremona Rd, Southampton, SO16 6YD.
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38
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Hardie JA, Brennan PA. The personal limitations checklist: human factors insights from air accidents to reduce intraoperative harm. Br J Oral Maxillofac Surg 2020; 59:853-857. [PMID: 34274172 DOI: 10.1016/j.bjoms.2020.12.007] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 12/10/2020] [Indexed: 11/27/2022]
Abstract
High Reliability Organisations (HRO), including healthcare and aviation, have a common focus on risk management. The human element is a 'weak link' which may result in accidents or adverse events taking place. Surgeons and other healthcare professionals can learn from aviation's rigorous approach to the role of human factors (HF) in such events, and how we can minimise them. Air Accident Investigation Branch (AAIB) reports show that fatal accidents are frequently caused by pilots flying outside their own personal limits, those of the aircraft or environment. Similarly, patient morbidity or mortality may occur if surgeons work outside personal their capability, with poor procedure selection and patient optimisation, or with a team or theatre environment not suited to the procedure. We introduce the personal limitations checklist - a tool adapted from aviation that allows surgeons to define their limits in advance of any decision to operate, and develop critical self-reflection. It also allows management of patient expectations, shared decision making, and flattening of team hierarchy. The minimum skills, patient characteristics, team and theatre resources for any given procedure to proceed are defined. If the surgeon is 'out of limits', redressing these factors, seeking additional assistance, or thorough patient consenting may be required for the safe conduct of the procedure. We explore external pressures that could cause a surgeon to exceed both personal and organisational limits.
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Affiliation(s)
- J A Hardie
- Trauma & Orthopaedic Department, Frimley Park Hospital, Camberley GU16 7UJ, UK.
| | - P A Brennan
- Maxillofacial Unit, Queen Alexandra Hospital, Portsmouth PO6 3LY, UK.
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39
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Magennis P, Begley A, McLean A, Rapaport B, Dhariwal DK, Brennan PA, Hutchison I. The UK Mentoring and Support Programme (MSP) for those considering a career in Oral and Maxillofacial Surgery (OMFS). A review of a 'Register Interest in OMFS' website and the MSP as two key resources created by the British Association of Oral and Maxillofacial Surgeons to promote recruitment and retention (2008-2020). Br J Oral Maxillofac Surg 2020; 59:935-940. [PMID: 34400024 DOI: 10.1016/j.bjoms.2020.12.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 10/21/2020] [Accepted: 12/01/2020] [Indexed: 11/17/2022]
Abstract
In 2008, to create a rapid route for information transfer in relation training and recruitment for OMFS trainees, the British Association of Oral and Maxillofacial Surgeons (BAOMS) created a website to "Register Your Interest in OMFS" (RYIO). From 2011 a Mentoring and Support Programme (MSP) was created to provide focussed guidance for trainees aiming for specialty training. This paper reviews the effectiveness and cost of these programmes. Between 2008 and 2020, 1744 individuals used RYIO on 2715 occasions. Of these registrations, 1772 were by dentists, 193 dental students, 589 doctors and 161 medical students. 2354 were from UK and Ireland and 351 from the rest of the world. 188 registrants subsequently became UK OMFS trainees or specialists. All registrants valued the information provided. In response to RYIO trainee feedback the new 'Taste of OMFS 2020' programme was created. The MSP was originally called the Junior Trainee Programme (JTP). The MSP scheme provides a layer of mentorship/support which runs parallel to the medical/dental training post or period of study. Of 180 members of MSP, 72 have obtained specialty training posts in OMFS. There are 88 current members. Full information is available on the BAOMS website www.baoms.org.uk. Reviewing both programmes, participant feedback is excellent with tangible results whilst cost effectiveness is high.
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Affiliation(s)
- P Magennis
- Liverpool University Hospitals NHS Foundation Trust, United Kingdom.
| | - A Begley
- Liverpool University Hospitals NHS Foundation Trust, United Kingdom.
| | - A McLean
- University of Liverpool, United Kingdom.
| | - B Rapaport
- University of Liverpool, United Kingdom.
| | - D K Dhariwal
- John Radcliffe Hospital, Oxford, United Kingdom.
| | | | - I Hutchison
- Institute of Dentistry, Barts and The London, United Kingdom.
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Brennan PA, Shaw G, Davies RJ, Oeppen RS. Erratum to 'Personal black box' thinking to improve our communication, behaviour and interaction with others' [Br. J. Oral and Maxillofac. Surg. 58 (2020) 882-884]. Br J Oral Maxillofac Surg 2020; 59:143. [PMID: 33272703 DOI: 10.1016/j.bjoms.2020.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- P A Brennan
- Queen Alexandra Hospital, Portsmouth, PO6 3LY, UK.
| | - G Shaw
- Critical Factors Ltd, 2, Melrose Avenue, Borehamwood, WB6 2BJ, UK
| | - R J Davies
- Addenbrookes Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, CB2 0QQ UK
| | - R S Oeppen
- University Hospitals Southampton, Tremona Road, Southampton, SO16 6YD UK
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Ellis R, Scrimgeour DSG, Brennan PA. Surgical training during the COVID-19 pandemic: preparing for future uncertainty. Br J Oral Maxillofac Surg 2020; 60:42-45. [PMID: 34256956 PMCID: PMC7709721 DOI: 10.1016/j.bjoms.2020.11.017] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 11/24/2020] [Indexed: 11/26/2022]
Abstract
The COVID-19 pandemic has brought unprecedented changes in healthcare and surgical training, with elective operating reduced or stopped, conferences rearranged and examinations cancelled. Trainees and trainers have adapted, creating innovative and resourceful ways to continue learning, enabling progression through surgical training. With rising COVID-19 cases across the world and further waves of infections likely, we reflect on recent changes to surgical training and discuss how best to support the next generation of surgeons during this period of uncertainty.
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Affiliation(s)
- R Ellis
- Intercollegiate Committee for Basic Surgical Examinations, United Kingdom; Urology Department, Nottingham University Hospitals, Nottingham NG5 1PB, United Kingdom.
| | - D S G Scrimgeour
- Intercollegiate Committee for Basic Surgical Examinations, United Kingdom; Department of Colorectal Surgery, Aberdeen Royal Infirmary, Aberdeen AB25 2ZN, United Kingdom.
| | - P A Brennan
- Intercollegiate Committee for Basic Surgical Examinations, United Kingdom; Maxillofacial Unit, Queen Alexandra Hospital, Portsmouth PO6 3LY, United Kingdom.
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Houlihan LM, Halloran PJO, Lynch J, Widdess-Walsh P, Brennan P, Javadpour M. Reversible cerebral vasoconstrictive syndrome preceded by minor head trauma. Br J Neurosurg 2020; 34:647-649. [DOI: 10.1080/02688697.2019.1672858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- L. M. Houlihan
- Departments of Neurosurgery, Neurology and Neuroradiology, Beaumont Hospital, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - P. J. O' Halloran
- Departments of Neurosurgery, Neurology and Neuroradiology, Beaumont Hospital, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - J. Lynch
- Departments of Neurosurgery, Neurology and Neuroradiology, Beaumont Hospital, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - P. Widdess-Walsh
- Departments of Neurosurgery, Neurology and Neuroradiology, Beaumont Hospital, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - P. Brennan
- Departments of Neurosurgery, Neurology and Neuroradiology, Beaumont Hospital, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - M. Javadpour
- Departments of Neurosurgery, Neurology and Neuroradiology, Beaumont Hospital, Royal College of Surgeons in Ireland, Dublin, Ireland
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Oeppen RS, Rutherford E, Sadler P, Isaac R, Brennan PA. Virtual ARCP assessment and trainee feedback meetings: facilitating the best experience and practice. Br J Oral Maxillofac Surg 2020; 58:1240-1244. [PMID: 33127166 PMCID: PMC7556257 DOI: 10.1016/j.bjoms.2020.09.037] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Accepted: 09/15/2020] [Indexed: 11/16/2022]
Abstract
As a result of COVID-19, there has been an exponential increase in the use of remote technology for many local, regional and national meetings that would previously have been held on a face-to-face basis. Remote meetings have ensured that essential clinical, educational and strategic work can continue but it is not ‘business as usual’, although colleagues accept this form of communication as the new norm. In medical education and assessment, the Annual Review of Competence Progression (ARCP) meetings and other formative educational meetings are being conducted remotely. This form of communication has some advantages but may also present possible barriers for feedback and development particularly for ‘trainees in difficulty’ when there are concerns about progression, and when an unsatisfactory outcome has been awarded. It is also worth remembering that there may be generational differences with the ease of use of virtual meeting platforms. We present some of the important factors for optimising the panel of virtual ARCPs and discuss methods to improve feedback given remotely for trainees.
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Affiliation(s)
- R S Oeppen
- University Hospitals Southampton, Southampton, SO16 6YD, UK
| | - E Rutherford
- University Hospitals Southampton, Southampton, SO16 6YD, UK
| | - P Sadler
- HEE Wessex, Southern House, Otterbourne, SO21 2RU, UK
| | - R Isaac
- Queen Alexandra Hospital, Portsmouth, PO6 3LY, UK
| | - P A Brennan
- Queen Alexandra Hospital, Portsmouth, PO6 3LY, UK.
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Herron JBT, Dennis J, Brennan PA. Coronavirus antibody positive tests and continued use of personal protective equipment throughout the pandemic. Br J Oral Maxillofac Surg 2020; 58:1014-1016. [PMID: 32660877 PMCID: PMC7305874 DOI: 10.1016/j.bjoms.2020.06.021] [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] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 06/11/2020] [Indexed: 01/01/2023]
Abstract
The COVID-19 pandemic has thrust not only a novel virus onto the world, but new challenges resulting in novel approaches. Governments have reduced regulation in order to facilitate timely advances to combat the disease. Antibody testing has rapidly been deployed but it is creating challenges for staff and patients. Mask use has come to the forefront and human factor (HF) strategies must be examined to reduce risk associated with lack of engagement from both healthcare staff and patients. In this we explore these issues and suggest some solutions.
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Affiliation(s)
- J B T Herron
- Faculty of Health Sciences and Wellbeing Sunderland University, Chester Road, Sunderland SR1 3SD, UK.
| | - J Dennis
- Academic Foundation Year Two, Faculty of Medicine, Department of Metabolism, Digestion and Reproduction, Imperial College, London SW7 2AZ, UK
| | - P A Brennan
- Maxillofacial Unit, Queen Alexandra Hospital, Portsmouth PO6 3LY, UK
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Magennis P, Begley A, Hölzle F, Ulrich HP, Brennan PA, Hutchison I. United Kingdom immigration and emigration of oral and maxillofacial Surgery (OMFS) specialists 2000-2020: how might Brexit impact on OMFS? Br J Oral Maxillofac Surg 2020; 58:1304-1309. [PMID: 33280947 DOI: 10.1016/j.bjoms.2020.09.030] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 09/11/2020] [Accepted: 09/15/2020] [Indexed: 11/26/2022]
Abstract
The United Kingdom left the European Union (EU) in January 2020. As it is unclear how many of the rights of OMFS surgeons to travel and work will remain after the transition period, we have reviewed how these rights have been used in the past. The OMFS specialist list from the GMC was compared with a database of current OMFS colleagues. Data were analysed using WinStat® (R. Fitch Software). Of 494 active surgeons on the OMFS specialist list, 23 (5%) completed their OMFS training outside the UK. Of these, 22 were specialists from Europe of whom 12 were substantive NHS consultants with others working as Fellows or visiting the UK occasionally. Two per cent of UK OMFS consultants are -specialists from Europe, the majority from Greece. Of the OMFS specialists who completed training in the UK since 1995, 24 are currently working outside the UK, and of them, 16 left the UK to return to their nation of origin (all 11 of those working in the European Economic Area [EEA] were born there). Of the seven UK-born specialists working overseas, none was working in the EEA. Twenty per cent of UK trainees whose primary degree was known (n = 117) received their primary qualification outside the UK, 38 in from the EU, and 79 from further afield. The majority of these UK trained specialists with non-UK first degrees (n = 101) stayed in the UK to work after training. The most significant impact of Brexit on OMFS could be a restriction on the opportunity for non-UK doctors and dentists to come to the UK to train and stay to work.
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Affiliation(s)
- P Magennis
- Liverpool University Hospitals NHS Foundation Trust.
| | - A Begley
- Liverpool University Hospitals NHS Foundation Trust.
| | - F Hölzle
- Department of OMFS, RWTH Aachen University Hospital, Aachen, Germany.
| | | | | | - I Hutchison
- Barts and The London Institute of Dentistry.
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Abstract
Lipomas are common benign tumours that can occur in most parts of the body. Lipomas arising from the deep temporal fat pad, found between the two layers of the deep temporal fascia, are rare, however; there has been only one documented case report to our knowledge. We describe a second case arising from the temporal fat pad in a patient treated at our unit, having previously reported the first one, and discuss the relevant anatomy and management.
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Affiliation(s)
- J Davies
- Portsmouth Hospitals NHS Trust, UK
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Brennan PA, Shakib K, Parmar S, Dhariwal D, Oeppen RS. Equality, diversity, culture and ethnicity - we cannot stay silent. Br J Oral Maxillofac Surg 2020; 58:735-737. [PMID: 32674914 DOI: 10.1016/j.bjoms.2020.07.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 07/02/2020] [Indexed: 12/26/2022]
Affiliation(s)
- P A Brennan
- Maxillofacial Unit, Queen Alexandra Hospital, Portsmouth PO6 3LY, UK.
| | - K Shakib
- UCL Division of Surgery & Interventional Science, Royal Free London NHS Hospital Trust, London NW3 2PF, UK
| | - S Parmar
- Queen Elizabeth Hospital, University Hospitals Birmingham NHS Trust, B15 2TH, UK
| | - D Dhariwal
- Oxford University Hospitals NHS Foundation Trust, Oxford OX3 9DU, UK
| | - R S Oeppen
- University Hospitals Southampton, Tremona Road, Southampton SO16 6YD, UK
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Blackhall KK, Downie IP, Ramchandani P, Kusanale A, Walsh S, Srinivasan B, Shields H, Brennan PA, Singh RP. Provision of Emergency Maxillofacial Service During the COVID-19 Pandemic : A Collaborative Five Centre UK Study. Br J Oral Maxillofac Surg 2020; 58:698-703. [PMID: 32482348 PMCID: PMC7247479 DOI: 10.1016/j.bjoms.2020.05.020] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 05/15/2020] [Indexed: 12/13/2022]
Abstract
The global pandemic of Coronavirus disease (COVID-19) represents one of the greatest challenges to healthcare systems, and has forced medical specialties to rapidly adapt their approaches to patient care. Oral and Maxillofacial Surgery is considered particularly at risk of disease transmission due to aerosol generation during surgical interventions, patient proximity and operating environment. On day 2 (26th March, 2020) of when severe restrictions in population movement were instigated in the United Kingdom, we began a study to prospectively monitor the presentation and management of maxillofacial emergencies at five hospital trusts. Data was collected onto an online live database fed through a smartphone application. Of the total 529 patients over six weeks, 395 attended for face-to-face consultations and 134 patients received remote consultations via telephone or video link. There were 255 trauma related cases, 221 infection and 48 cases of postoperative complications. Most trauma cases were minor soft tissue injury related to slip, trip or fall at home. There were 44 cases of facial fractures with a tendency for conservative treatment. 19 cases were related to domestic violence or self-harm. Of the 216 dental related emergencies, 68% could have been managed in the primary care setting. A quarter of all emergency patients were satisfactorily managed by remote consultations. There was a significant change in the provision of emergency maxillofacial service during the pandemic lockdown. We discuss the study findings as well as the potential implications in relation to planning for possible further COVID- 19 spikes and future pandemics.
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Affiliation(s)
- K K Blackhall
- Dept. Oral and Maxillofacial Surgery, Salisbury District Hospital, Salisbury, Wiltshire, SP2 8BJ
| | - I P Downie
- Dept. Oral and Maxillofacial Surgery, Salisbury District Hospital, Salisbury, Wiltshire, SP2 8BJ
| | - P Ramchandani
- Dept. Oral and Maxillofacial Surgery, Poole Hospital, Longfleet Rd, Poole, BH15 2JB
| | - A Kusanale
- Dept. Oral and Maxillofacial Surgery, Poole Hospital, Longfleet Rd, Poole, BH15 2JB
| | - S Walsh
- Dept. Oral and Maxillofacial Surgery, St Richard's Hospital, Spitalfield Ln, Chichester, PO19 6SE
| | - B Srinivasan
- Dept. Oral and Maxillofacial Surgery, Queen Alexandra Hospital, Cosham, Portsmouth, PO6 3LY
| | - H Shields
- Dept. Oral and Maxillofacial Surgery, Southampton University Hospital, Tremona Rd, Southampton, SO16 6YD
| | - P A Brennan
- Dept. Oral and Maxillofacial Surgery, Queen Alexandra Hospital, Cosham, Portsmouth, PO6 3LY
| | - R P Singh
- Dept. Oral and Maxillofacial Surgery, Southampton University Hospital, Tremona Rd, Southampton, SO16 6YD.
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Ghadiri SJ, Brennan P, Calonje E, Carmichael AJ, Rajan N. Coinheritance of naevoid basal cell carcinoma syndrome and neurofibromatosis type 1 associated with an exceptional spectrum of tumours. Br J Dermatol 2020; 183:1108-1110. [PMID: 32562549 DOI: 10.1111/bjd.19324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 06/10/2020] [Accepted: 06/10/2020] [Indexed: 11/29/2022]
Affiliation(s)
- S J Ghadiri
- Department of Dermatology, James Cook University Hospital, Middlesbrough, TS4 3BW, UK
| | - P Brennan
- Clinical Genetics, James Cook University Hospital, Middlesbrough, TS4 3BW, UK
| | - E Calonje
- Department of Dermatopathology, St John's Institute of Dermatology, St Thomas' Hospital, London, SE1 7EH, UK
| | - A J Carmichael
- Department of Dermatology, James Cook University Hospital, Middlesbrough, TS4 3BW, UK
| | - N Rajan
- Department of Dermatology, Royal Victoria Infirmary, Newcastle upon Tyne, NE1 4LP, UK.,Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, NE1 3BZ, UK
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Hardie JA, Brennan PA. Are you surgically current? Lessons from aviation for returning to non-urgent surgery following COVID-19. Br J Oral Maxillofac Surg 2020; 58:843-847. [PMID: 32576468 PMCID: PMC7303632 DOI: 10.1016/j.bjoms.2020.06.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 06/08/2020] [Indexed: 12/27/2022]
Abstract
The COVID-19 crisis has caused many issues across healthcare. In surgery, many operations have been cancelled with some surgeons losing their regular operating lists. During this time, technical expertise and decision making can deteriorate. In aviation after a prolonged period of absence from flying, this deficit in keeping skills and thinking up to date is known as being “out of currency” or “not current”. Although aviation and healthcare cannot be compared, numerous human factors concepts are applicable to both. In this article, we explore the likely impact of potentially prolonged absences in operating on surgical skills and psyche, and introduce the concept of a Surgical Skills Currency Barometer. We also discuss a “task-o-meter” thought experiment, and suggest practices which could be adopted to help protect surgeon workload from exceeding surgical capability when returning to operating following a period of prolonged absence.
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Affiliation(s)
- J A Hardie
- Trauma & Orthopaedic Department, Frimley Park Hospital, Camberley GU16 7UJ, UK.
| | - P A Brennan
- Maxillofacial Unit, Queen Alexandra Hospital, Portsmouth PO6 3LY, UK.
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