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Background and aims The ileoanal pouch (IPAA) provides patients with ulcerative colitis (UC) that have not responded to medical therapy an option to retain bowel continuity and defecate without the need for a long-term stoma. Despite good functional outcomes, some pouches fail, requiring permanent diversion, pouchectomy, or a redo pouch. The incidence of pouch failure ranges between 2 and 15% in the literature. We conducted a systematic review and meta-analysis aiming to define the prevalence of pouch failure in patients with UC who have undergone IPAA using population-based studies. Methods We searched Embase, Embase classic and PubMed from 1978 to 31st of May 2021 to identify cross-sectional studies that reported the prevalence of pouch failure in adults (≥ 18 years of age) who underwent IPAA for UC. Results Twenty-six studies comprising 23,389 patients were analysed. With Conclusions The overall prevalence of pouch failure in patients over the age of 18 who have undergone restorative proctocolectomy in UC is 6%. These data are important for counselling patients considering this operation. Importantly, for those patients with UC being considered for a pouch, their disease course has often resulted in both physical and psychological morbidity and hence providing accurate expectations for these patients is vital.

Background: Significant efforts have been made to improve medical students' exposure to interventional radiology (IR). Foundation doctors in the UK, however, are a neglected group, with little being done engage these doctors who are at a crucial juncture in their training. Objectives: The objective of the study is to assess Foundation Year 1 (FY1) doctors' understanding of and exposure to IR. Methods: FY1s from two teaching hospitals in the UK at the end of their first year of Foundation training were invited to take part in an 18-question survey, including 14 single-best-answer (SBA) questions. The questions examined knowledge of IR and other specialties. The SBAs were scored out 14 and the Student's t-test was used to compare IR and non-IR scores. Results: Questionnaires were given to 72 FY1 doctors and 52 (72.2%) were completed. The median score was 9/14 (64.3%) [4.5/14–12/14]. Questions relating to coronary intervention and neurosurgery scored best (96.2% and 94.3%, respectively). The mean score for IR-related questions was significantly lower than that for non-IR questions (51.5% vs. 81.1%, respectively, P < 0.0001). Participants who referred patients to IR at least once per month scored higher than those who rarely referred (60.5% vs. 47.2%, respectively, P < 0.0084). Nearly 83.0% of participants expressed a desire to gain more exposure to IR. Conclusion: Although Foundation doctors have some understanding of IR, reflecting some exposure to the specialty, this remains deficient when compared with their knowledge of other specialties. This may be improved by the introduction of IR specific teaching during the Foundation program.

Background The Ileoanal pouch (IPAA) provides patients with ulcerative colitis (UC) that has not responded to medical therapy an option to retain bowel continuity and defecate without the need for a long-term stoma. Despite good functional outcomes, some pouches fail, requiring permanent diversion, pouchectomy or a redo pouch. The incidence of pouch failure ranges between 1% -15% in the literature. Understanding the incidence of pouch failure is vital in counselling patients considering this operation. Therefore, we conducted a systematic review and meta-analysis aiming to define the prevalence of pouch failure in patients with UC who have undergone IPAA using population-based studies. Methods We searched Embase, Embase classic and PubMed from 1978- 31st of May 2021 to identify cross-sectional studies that reported the prevalence of pouch failure in adults (≥18 years of age) who underwent IPAA for UC. We hand-searched the references from eligible studies and the proceedings from Inflammatory bowel disease conferences. We combined the proportion of patients with pouch failure in each study to give a pooled prevalence for each study. We performed a random-effects model in order to pool the data to provide an estimate of the prevalence of pouch failure. Heterogeneity was assessed using the I2 statistic. Results Thirty-three studies comprising 29,153 patients were analysed. After a five-year follow-up period, the prevalence of pouch failure was 4% (95%CI 2%-6%) (IDDF2021-ABS-0105 Figure 1). Between 5-10 years of follow-up, the prevalence was 4% (95%CI 3%-7%) (IDDF2021-ABS-0105 Figure 2). This increased to 11% (95%CI 7%-16%) with over 10 years of follow-up (IDDF2021-ABS-0105 Figure 3). The overall prevalence of pouch failure was 5% (95%CI 4%-6%) (IDDF2021-ABS-0105 Figure 4). Conclusions The prevalence of pouch failure in patients over the age of 18 who have undergone restorative proctocolectomy in UC is 11% after a 10-year follow-up. These data are important for counselling patients considering this operation. Importantly, for those patients with UC being considered for a pouch, their disease course has often resulted in both physical and psychological morbidity and hence providing accurate expectations for these patients is vital.

The COVID-19 pandemic has affected 20 million people worldwide with over 732,000 deaths and trillions of dollars of lost economic productivity. It has put many countries into lockdown to contain the virus and save lives. As COVID-19 cases in some countries start to plateau and societies work hard to ‘flatten the curve’, leaders are being asked to formulate plans for safe and staged ‘exit strategies’ to reopen society. Each country will decide on their own exit strategy but many plans are considering similar vital healthcare principles including the maintenance of social distancing to prevent ongoing community transmission, testing capacity, protection of the healthcare systems and the health of their care workers. This review aims to provide an overview of essential factors that plans for exit strategy should consider and their effect on the societies' social and healthcare life., Highlights • Exit strategies following COVID-19 are being formulated with guidelines to ensure society returns to ‘normality’ safely. • Exit strategies are taken a phased approach to end lockdown following COVID-19. • Exit strategies should consider ongoing community transmission, testing capacity and protection of the healthcare systems.

The COVID-19 pandemic has resulted in over 4.3 million confirmed cases and over 290,000 deaths globally. It has also sparked fears of an impending economic crisis and recession. Social distancing, self-isolation and travel restrictions have lead to a reduced workforce across all economic sectors and caused many jobs to be lost. Schools have closed down, and the need for commodities and manufactured products has decreased. In contrast, the need for medical supplies has significantly increased. The food sector is also facing increased demand due to panic-buying and stockpiling of food products. In response to this global outbreak, we summarise the socio-economic effects of COVID-19 on individual aspects of the world economy.

The Coronavirus (COVID-19) pandemic has resulted in over 2.3 million confirmed cases and over 160,000 deaths. The impact of COVID-19 on surgical practice is widespread ranging from workforce and staffing issues, procedural prioritisation, viral transmission risk intraoperatively, changes to perioperative practice and ways of working alongside the impact on surgical education and training. Whilst there has been a growing literature base describing the early clinical course of COVID-19 and on aspects of critical care related to treating these patients, there has been a dearth of evidence on how this pandemic will affect surgical practice. This paper seeks to review the current evidence and offers recommendations for changes to surgical practice to minimise the effect of the COVID-19 pandemic., Highlights • COVID-19 has a wide-ranging impact on surgical practice including changes to case prioritization, changes in operative technique and workforce planning. • Telemedicine virtual clinics are to be encouraged where possible. • Elective and non-urgent surgeries must be postponed. • Consider safe non-surgical management of patients.

An unprecedented outbreak of pneumonia of unknown aetiology in Wuhan City, Hubei province in China emerged in December 2019. A novel coronavirus was identified as the causative agent and was subsequently termed COVID-19 by the World Health Organization (WHO). Considered a relative of severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS), COVID-19 is caused by a betacoronavirus named SARS-CoV-2 that affects the lower respiratory tract and manifests as pneumonia in humans. Despite rigorous global containment and quarantine efforts, the incidence of COVID-19 continues to rise, with 90,870 laboratory-confirmed cases and over 3,000 deaths worldwide. In response to this global outbreak, we summarise the current state of knowledge surrounding COVID-19.

Highlights • Analysing the benefits of Wide-Awake Local Anaesthetic, No Tourniquet in upper limb surgery. • Over 40 WALANT papers published since the last systematic review. • Systematic review compliant with the PRISMA guidelines., Introduction Wide Awake Local Anaesthetic No Tourniquet (WALANT) technique has been developed to eliminate tourniquet pain during upper limb and hand surgery whilst also improving utilisation of operating theatre time and inpatient stay, however inconclusive data still limits the techniques uptake. Here presents a protocol for a systematic review to collate findings to produce conclusive data on efficacy of WALANT. Methods This systematic review will be registered a priori. All study designs defined by the Oxford Centre for Evidence-Based Medicine will be included in the search. “WALANT” in “upper limb” and “hand” surgery will be investigated as per the devised search strategy. 18 electronic databases will be searched, including PubMed, Medline and Embase in addition to a Grey literature search. Two independent teams of 3 researchers will screen all relevant titles, abstracts and subsequent full texts for suitability. Data will be extrapolated and entered into a preformatted database for analysis. Ethics and dissemination This systematic review will be published in a peer-reviewed journal and presented at both national and international conferences within the field of plastic and orthopaedic surgery. This review aims to inform surgical practice and policy.

Aim To investigate the effect of playing computer games and manual dexterity on catheter–wire manipulation in a mechanical aortic model. Material and methods Medical student volunteers filled in a preprocedure questionnaire assessing their exposure to computer games. Their manual dexterity was measured using a smartphone game. They were then shown a video clip demonstrating renal artery cannulation and were asked to reproduce this. All attempts were timed. Two-tailed Student's t -test was used to compare continuous data, while Fisher's exact test was used for categorical data. Results Fifty students aged 18–22 years took part in the study. Forty-six completed the task at an average of 168 seconds (range 103–301 seconds). There was no significant difference in the dexterity score or time to cannulate the renal artery between male and female students. Students who played computer games for >10 hours per week had better dexterity scores than those who did not play computer games: 9.1 versus 10.2 seconds ( p =0.0237). Four of 19 students who did not play computer games failed to complete the task, while all of those who played computer games regularly completed the task ( p =0.0168). Conclusion Playing computer games is associated with better manual dexterity and ability to complete a basic interventional radiology task for novices.

Interventional radiology (IR) is traditionally underrepresented in undergraduate medical curricula. Final-year medical students ought to be familiar with some common IR procedures in order to make adequate referrals and work-up patients appropriately. We evaluated the knowledge of final-year medical students on common IR procedures and compared it with their knowledge of other specialties. A fourteen-question, single-best-answer questionnaire assessing the knowledge of IR procedures and other minimally invasive non-IR procedures was administered to a group of final-year medical students. Paired two-tailed student’s t test was used to compare knowledge across specialties. Fifty-one questionnaires were administered and returned. No student answered all questions correctly. The median score was 5/11. The best-answered question was on coronary intervention followed by neurosurgical procedures. The average score for IR procedures was 38% versus 57% for non-IR procedures (P

Background.Contrast-induced nephropathy (CIN) is a recognised complication of intravascular administration of iodinated contrast media (ICM). Previous studies suggest a higher incidence in the elderly, but no large study has assessed this to date. We set out to assess changes in creatinine in elderly inpatients following computed tomography (CT) examination and compare those who received intravenous contrast to those who did not.Methods.Using the Radiology Information System in two teaching hospitals, inpatients over the age of seventy who had a CT examination and a baseline creatinine were identified and their follow-up creatinine levels were analysed. Elderly inpatients who underwent a noncontrast CT over the same period were used as controls.Results.677 elderly inpatients who received ICM were compared with 487 controls. 9.2% of patients who received ICM developed acute kidney injury (AKI) compared to 3.5% of inpatient controls (P<0.0001). Patients with higher baseline eGFR had a higher incidence of post-CT AKI.Conclusions.The incidence of post-CT AKI is higher in patients who received IV ICM compared to those who did not; the difference may be partly attributable to contrast-induced nephropathy. This suggests that the incidence of CIN in the elderly may not be as high as previously thought.