Search

Three surgical trainees talk to us about juggling their careers with other roles and what they want to achieve in the future.

To reassess the trends in upper urinary tract (UUT) stone disease burden and management in the UK during the last 5 years.The present paper is our third quinquennial analysis of trends in the management of renal stones in England. Data were collected using the Hospital Episode Statistics database for the years 2015-2020 inclusive. These were then analysed, summarized and presented.The number of UUT stone episodes increased by 2.2% from 86 742 in 2014-2015 to 88 632 in 2019-2020 but annual prevalence remained static at 0.14%. The number of UUT stone episodes in those of working age has remained static but increased by 9% for patients aged 60 years (from 27 329 to 29 842). The number of shockwave lithotripsy (SWL) treatments decreased by 6.8%. There was a further increase in the use of ureteroscopy (URS) between 2015 and 2020 of 18.9%. Within this subgroup, flexible URS had the most rapid increase in use, with a rise of 20.4% from 7108 to 8558 recorded cases. Over the 20-year period from 2000 to 2020 there was a remarkable 257% increase in URS cases. There was a further decline in open surgery for UUT stone disease by 40%. Stone surgery day-case numbers have increased by 14.7% (from 31 014 to 35 566), with a corresponding decline in the number of bed days of 14.3%. Emergency cases increased by 40%, while elective cases saw a slight increase of 1.9%.The present study shows a plateauing in the prevalence of UUT stone disease in England in the last 5 years, with a move towards day-case procedures and an increase in the proportion of emergency work. For the first time in England, URS has overtaken SWL as the most common procedure for treating UUT stone disease, which might reflect patients' or physicians' preference for a more effective definitive treatment.

Background: Early onset of anxiety disorders in adolescences have been found to greatly impact both individual and social wellbeing in a long run. Therefore, much effort has been devoted into investigating the risk factors related to the anxiety disorder (Blanco et al., 2014; Fullana et al., 2020). One of the most studied risk factors was personality. The robust associations between the Big Five Personality traits and anxiety disorders have been well studied in the past decades (Bienvenu et al., 2003; Kotov et al. 2010). Cross-sectional studies have suggested that neuroticism, conscientiousness and extraversion are particularly relevant to internalizing disorders in youth and adults (Kotov et al. 2010). Not only that elevated neuroticism predicts the onset of anxiety and depressive disorders, but also predicts their subsequent episodes and symptom (Newton-Howes et al. 2015; Jeronimus et al. 2016). Whereas reduced conscientiousness and extraversion have been found to be associated with the symptom severity (Goldstein et al., 2018; Lyon et al., 2021). Several studies suggested there might be mediating effects of conscientiousness and extraversion on depression and anxiety, in addition to the effect of neuroticism (Naragon-Gainey et al., 2017). Yet, little findings have considered the role of openness and agreeableness. Past literature has been focusing on the predictive power of the Big Five traits. But these traits are rather general, resulting in unexplained variance in predicting symptoms and behaviours in anxiety disorders (Paunonen & Ashton, 2001). While these general traits could be parsed into narrow facets, little has been known whether the facets could predict the psychopathology of anxiety over and above the effects of their corresponding general traits. We will mainly examine whether the Big Five Personality traits and facets of neuroticism, conscientiousness, and extraversion predict the first onset of anxiety disorders in a community sample of adolescent females. Objective(s) of the study: Given the knowledge gap in current literatures, the present study would further explore the relationship between specific personality facets and the course of anxiety disorders in adolescent female participants. The aim of this study is to examine personality that uniquely predict the first onset of anxiety disorders, at both trait- and facet-level. The specific objectives include: 1. To prospectively examine the personality traits and facets, and risk factors associated with first onset of anxiety disorders in adolescence. 2. To advance our understanding in the relationship between specific personality facets and psychopathology of anxiety disorders. 3. To provide insights and direction for early intervention targeting at adolescent with anxiety problems, in order to promote better mental health in the long run.

Aim To gather the opinions of orthopaedic trainees on the use of virtual reality (VR) simulators in their training. Method Twelve entry level orthopaedic trainees trialled a tibial nailing surgery on a VR simulator. Each participant completed a pre- and post-intervention questionnaire containing twelve 10-point Likert scale questions assessing their opinions on VR simulator use in their training. Paired data sets were analysed using the Wilcoxon signed-rank test. Results Only 25% of participants had previously experienced a VR simulator, yet participants felt strongly that VR simulators had a place in orthopaedic training (M = 8.750 ± 1.288) and that if they had access, they would use a VR simulator to practice surgical skills (M = 9.000 ± 1.044). After trying the VR simulator, participants felt more strongly that VR simulators should be a mandatory part of orthopaedic training (M = 6.750 ± 1.658 to M = 7.500 ± 1.567, P = 0.048); VR simulators are an engaging learning tool (M = 8.583 ± 1.379 to M = 9.417 ± 0.793, P = 0.029); access to a VR simulator would improve their training (M = 8.250 ± 1.545 to M = 9.250 ± 0.866, P = 0.036) and VR simulators will form the basis of orthopaedic training in the future (M = 5.250 ± 2.734 to M = 6.667 ± 2.498, P = 0.032). Conclusions Orthopaedic trainees want VR simulators in their training and will use them if given access. A positive reception from trainees is vital in order to effectively implement VR simulators into orthopaedic training.

Over the past 50 years the capability of technology to improve surgical care has been realised and while surgical trainees and trainers strive to deliver care and train; the technological ‘solutions’ market continues to expand. However, there remains no coordinated process to assess these technologies. The FOS:TEST Report aimed to (1) define the current, unmet needs in surgical training, (2) assess the current evidence-base of technologies that may be beneficial to training and map these onto both the patient and trainee pathway and (3) make recommendations on the development, assessment, and adoption of novel surgical technologies. The FOS:TEST Commission was formed by the Association of Surgeons in Training (ASiT), The Royal College of Surgeons of England (RCS England) Robotics and Digital Surgery Group and representatives from all trainee specialty associations. Two national datasets provided by Health Education England were used to identify unmet surgical training needs through qualitative analysis against pre-defined coding frameworks. These unmet needs were prioritised at two virtual consensus hackathons and mapped to the patient and trainee pathway and the capabilities in practice (CiPs) framework. The commission received more than 120 evidence submissions from surgeons in training, consultant surgeons and training leaders. Following peer review, 32 were selected that covered a range of innovations. Contributors also highlighted several important key considerations, including the changing pedagogy of surgical training, the ethics and challenges of big data and machine learning, sustainability, and health economics. This summates to 7 Key Recommendations and 51 concluding statements. The FOS:TEST Commission was borne out of what is a pivotal point in the digital transformation of surgical training. Academic expertise and collaboration will be required to evaluate efficacy of any novel training solution. However, this must be coupled with pragmatic assessments of feasibility and cost to ensure that any intervention is scalable for national implementation. Currently, there is no replacement for hands-on operating. However, for future UK and ROI surgeons to stay relevant in a global market, our training methods must adapt. The Future of Surgery: Technology Enhanced Surgical Training Report provides a blueprint for how this can be achieved.

To establish whether computerised tomography abdomen and pelvis (CTAP) with contrast is a necessary tool in the diagnosis of acute appendicitis in those aged 40 years or older compared to clinical assessment alone. The study was performed in a district general hospital in England. A retrospective analysis included 314 patients aged 40 years or older who presented between 3rd October 2020 and 31st October 2021 and received a CTAP with contrast where the request queried appendicitis. An Alvarado score was calculated for each patient as a measure of clinical likelihood of appendicitis based on documentation from their initial assessment by a General Surgeon. CTAP demonstrated evidence of acute appendicitis in 46.1% of patients. CTAP diagnosed alternative pathologies in 41.1% of patients. These included diverticulitis (10.5%), gynaecological pathology (4.5%), urological pathology (3.2%), malignancy (2.9%) and others (19.4%). 11.8% demonstrated no cause for symptoms. Furthermore, those with an Alvarado score of 9 or more, 94.9% had a CTAP reporting appendicitis. With scores of 3–8, only 49.4% had a CT finding of appendicitis and this dropped to 5.0% with scores of 0–2. This study supports using CTAP to aid in diagnosing appendicitis in patients aged 40 years or older with Alvarado scores of 8 or less. However, patients scoring 9 or more had a 94.4% positive finding of acute appendicitis on CTAP, thus potentially negating the need for a CTAP scan pre-operatively. Alvarado scores of 2 or less suggest an alternative diagnosis is more likely, however CTAP may still be a valid investigation.

To establish an on-call escape room as a novel educational tool for Foundation Year 1 (FY1) doctors’ induction at Epsom and St Helier University Hospitals Trust. The escape room simulates common on-call scenarios for newly qualified doctors, with a view to facilitating communication and teamwork with unfamiliar peers and establishing a safe environment to develop practical skills. Ultimately aiming to reduce anxiety and improve confidence amongst our FY1 cohort. A pilot escape room, as a simulated on-call shift with nine clinical scenarios, was designed for groups of 4–5 doctors. Following feedback, a 70-minute escape room with 17 clinical scenarios was established. Sequential completion of tasks would ‘unlock’ the door to handover with a senior colleague, thereby finishing the ‘shift’. Questionnaires utilised a 10-point Likert scale to assess confidence and anxiety levels with regards to on–call shifts. Statistical analysis was performed using the Student’s t-test. Pilot: Nineteen participants trialled the pilot escape room. Perceived levels of confidence increased from a mean of 5.0 to 7.1 (p < 0.05). Final: Forty-one participants underwent the final version of the escape room with perceived levels of on-call confidence increasing from a mean of 4.2 to 6.5 (p < 0.05), prescribing confidence from 5.3 to 6.6 (p < 0.05), using apps from 6.3 to 7.5 (p < 0.05), consulting trust guidelines from 5.0 to 7.0 (p < 0.05) and handing over from 5.8 to 6.8 (p < 0.05). Anxiety levels also decreased from 7.2 to 6.3 (p < 0.05) with an overall mean score of 9/10 for ‘enjoyability’ of the session. Incorporating an on-call escape room scenario into induction has demonstrably increased confidence levels and reduced anxiety levels amongst new FY1 doctors. This novel teaching method maximises participant engagement with the view to an enhanced learning experience.

Our guest Technologist reviews the highly anticipated FOS:TEST report.

What are the new findings? ►► The COVID-19 pandemic prevented physical innovation formats and virtual innovation strategies such as the virtual hackathon proposed in this article may address this challenge ►► Virtual interdisciplinary collaboration between students and early career professionals can ead to rapid innovations to address urgent unmet clinical needs in times of global emergencies How might it impact on healthcare in the future? ►► Innovation pathways should be augmented with virtual innovation strategies to break down barriers to engagement in healthcare innovation, improve global interdisciplinary collaboration and enhance rapid innovation adoption moving into the future ►► Particular healthcare technologies likely to be positively impacted by this include those in digital health, global health and medical device sectors © 2021 Georg Thieme Verlag All rights reserved

Background: The incidence of acute kidney injury (AKI) as a complication of acute upper gastrointestinal bleeding (AUGIB) is not known. Recently, RIFLE criteria were used widely in the medical research to identify patients with different degrees of renal insufficiency. Objectives: Our purpose is to determine the incidence, clinical presentations, endoscopic findings and outcomes of AKI in the elderly presenting with AUGIB using RIFLE criteria. The study was conducted in a community hospital in Washington State. This was a retrospective pilot study of elderly patients (≥60 years old) presenting with AUGIB. Categorical variables were analyzed using the Chi-square test. The Student t-test was used to compare continuous variables. A total of 113 patients were included (52 males and 61 females) in the study. The patients were classified into those with AKI based on RIFLE criteria and those without. The two groups were compared in regard to clinical presentations, laboratory and endoscopic findings, complications, length and cost of hospitalization. Results: Fifty five patients (48.7%) met RIFLE criteria for AKI, while 58 patients did not develop any renal dysfunction. Patients with AUGIB complicated with AKI tend to be residents at nursing homes (38% vs. 14%, P < 0.004), present with weakness (49% vs 29%., P < 0.04) and altered mental status (25% vs. 55%, P < 0.003), have higher serum creatinine at presentation (1.8 mg/dL vs. 1.2 mg/dL, P < 0.002), have less incidence of gastritis/gastric ulcers (67% vs. 42%, P < 0.007), have nondiagnostic upper endoscopic examination (29% vs. 14%, P < 0.05), higher incidences of cardiac complications including myocardial infarction (9% and 0%, P < 0.02), longer lengths of stay (5.0 days vs. 2.37 days, P < 0.005) and higher hospitalization costs ($20,230 vs. $11,779, P < 0.02). Conclusion: The incidence of developing AKI as a consequence of AUGIB in the elderly is very common. Those with AKI tend to have a more complicated clinical course in the hospital.