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Background Differential attainment has been widely observed in United Kingdom (UK) medical training, with minority ethnicity being associated with reduced success in recruitment and progression through training. Specialty training in Public Health in the UK recruits candidates with medical as well as non-medical backgrounds. At the request of the UK Faculty of Public Health and Health Education England, we sought to examine whether differential attainment may or may not be occurring in the multi-stage recruitment process. Methods We analysed three-years of national recruitment data into Public Health specialty training to identify whether demographic characteristics including age, sex, ethnicity and professional background were associated with successful recruitment. Results In total 2252 applications between 2018 and 2020 were analysed. Candidates who were older, Asian, black, or from backgrounds other than medicine were significantly less likely to progress from the psychometric testing stage than the white British group. Fewer statistically significant differences were observed at the final stage of recruitment involving interviews, group work and a written task. Conclusions The findings suggest that older candidates, those from some ethnic minority backgrounds and those from backgrounds other than medicine are disadvantaged by the current recruitment process, with differential attainment associated with the psychometric testing stage.

Introduction Surgical site infection (SSI) is the most common and costly complication of surgery. International guidelines recommend topical alcoholic chlorhexidine (CHX) before surgery. However, upper limb surgeons continue to use other antiseptics, citing a lack of applicable evidence, and concerns related to open wounds and tourniquets. This study aimed to evaluate the safety and effectiveness of different topical antiseptics before upper limb surgery. Methods This international multicentre prospective cohort study recruited consecutive adults and children who underwent surgery distal to the shoulder joint. The intervention was use of CHX or povidone–iodine (PVI) antiseptics in either aqueous or alcoholic form. The primary outcome was SSI within 90 days. Mixed-effects time-to-event models were used to estimate the risk (hazard ratio (HR)) of SSI for patients undergoing elective and emergency upper limb surgery. Results A total of 2454 patients were included. The overall risk of SSI was 3.5 per cent. For elective upper limb surgery (1018 patients), alcoholic CHX appeared to be the most effective antiseptic, reducing the risk of SSI by 70 per cent (adjusted HR 0.30, 95 per cent c.i. 0.11 to 0.84), when compared with aqueous PVI. Concerning emergency upper limb surgery (1436 patients), aqueous PVI appeared to be the least effective antiseptic for preventing SSI; however, there was uncertainty in the estimates. No adverse events were reported. Conclusion The findings align with the global evidence base and international guidance, suggesting that alcoholic CHX should be used for skin antisepsis before clean (elective upper limb) surgery. For emergency (contaminated or dirty) upper limb surgery, the findings of this study were unclear and contradict the available evidence, concluding that further research is necessary., This international study recruited 2454 children and adults undergoing surgery on their upper limb (arm or hand), from 42 hospitals worldwide. The overall risk of infection after surgery was 3.5 per cent. Before planned (elective) surgery, if surgeons cleaned the skin with alcoholic chlorhexidine, then the risk of infection was reduced by 70 per cent.

Study Design: Retrospective review of prospectively collected spinal surgery and transfusion databases. Objectives: To evaluate the efficacy of a care pathway developed at our institution since 2003 with a focus on reducing the need for blood transfusions in children undergoing scoliosis correction surgery. The care pathway includes nurse-led clinics facilitating preoperative hemoglobin optimization, intraoperative cell salvage, the use of tranexamic acid, and a transfusion criteria awareness program. Methods: Retrospective review of our institution’s prospectively recorded spinal surgery and transfusion databases including all cases of scoliosis surgery in patients 18 years and younger between 2001 and 2015. Results: A total of 1039 procedures were included in the analysis. Overall, 24.4% of patients received a transfusion. The proportion of patients transfused was 89.2% in 2001-2003, 39.6% in 2004-2006, 16.5% in 2007-2009, 15.6% in 2010-2012, and 20.1% in 2013-2015. The volume of blood products transfused in those undergoing transfusion was 9.1 units in 2001-2003, 4.8 units in 2004-2006, 5.0 units in 2007-2009, 2.3 units in 2010-2012, and 2.1 units in 2013-2015. A multivariate logistic regression demonstrated adjusted odds ratios for the probability of receiving any transfusion of 5.45 (95% confidence interval 3.62-8.11) for patients with neuromuscular diagnoses and 11.17 (5.02-24.86) for those undergoing combined anterior and posterior surgical approach. Conclusions: We have demonstrated over a 15-year period that the introduction of a multifaceted, multidisciplinary pathway can dramatically and sustainably reduce the need for blood transfusions and their attendant risks in pediatric scoliosis surgery. This data lends weight to the adoption of such a care pathway in pediatric scoliosis surgery.

Background Nail bed injuries are the most common hand injury in children. Surgical dogma is to replace the nail plate after repairing the nail bed. Recent evidence suggests this might increase infection rates and returns to clinic. The aim of this pilot randomised control trial was to inform the design and conduct of a definitive trial comparing replacing or discarding the nail plate after nail bed repair. Methods This study recruited participants from four hand units in the United Kingdom from April to July 2015. Participants were children under the age of 16 years with a nail bed injury requiring surgery. They were randomised to either having the nail plate replaced or discarded after nail bed repair. Additionally, follow-up method was also randomly allocated (postal versus clinic). We collected information on complications at two weeks and 30 days, and on nail plate appearance at four months using the Zook classification. Two possible approaches to follow-up were also piloted and compared. Results During the recruitment period there were 156 potentially eligible children. Sixty were randomised using remote web-based allocation in just over 3 months. By two weeks, there were two infections, both in children with replaced nail plates. The nail replaced group also experienced more complications. There was no evidence of a difference in return rates between postal and clinic follow-up. Conclusions This is the first pilot randomised control trial delivered using the Reconstructive Surgery Trials Network. Recruitment was rapid and nail bed repair appeared to have low complication and infection rates. The study findings have led to revision of the definitive trial protocol including the mode and timing of follow-up and modification of the Zook classification.