Search

Aims The Open-Fracture Patient Evaluation Nationwide (OPEN) study was performed to provide clarity in open fracture management previously skewed by small, specialist centre studies and large, unfocused registry investigations. We report the current management metrics of open fractures across the UK. Method Patients admitted to hospital with an open fracture (excluding phalanges or isolated hand injuries) between 1 June 2021 and 30 September 2021 were included. Institutional information governance approval was obtained at the lead site and all data entered using Research Electronic Data Capture software. All domains of the British Orthopaedic Association Standard for Open Fracture Management were recorded. Results Across 51 centres, 1,175 patients were analyzed. Antibiotics were given to 754 (69.0%) in the emergency department, 240 (22.0%) pre-hospital, and 99 (9.1%) as inpatients. Wounds were photographed in 848 (72.7%) cases. Median time to first surgery was 16 hrs 14 mins (interquartile range (IQR) 8 hrs 29 mins to 23 hrs 19 mins). Complex injuries were operated on sooner (median 12 hrs 51 mins (IQR 4 hrs 36 mins to 21 hrs 14 mins)). Of initial procedures, 1,053 (90.3%) occurred between 8am and 8pm. A consultant orthopaedic surgeon was present at 1,039 (89.2%) first procedures. In orthoplastic centres, a consultant plastic surgeon was present at 465 (45.1%) first procedures. Overall, 706 (60.8%) patients required a single operation. At primary debridement, 798 (65.0%) fractures were definitively fixed, while 734 (59.8%) fractures had fixation and coverage in one operation through direct closure or soft-tissue coverage. Negative pressure wound therapy was used in 235 (67.7%) staged procedures. Following wound closure or soft-tissue cover, 509 (47.0%) patients received antibiotics for a median of three days (IQR 1 to 7). Conclusion OPEN provides an insight into care across the UK and different levels of hospital for open fractures. Patients are predominantly operated on promptly, in working hours, and at specialist centres. Areas for improvement include combined patient review and follow-up, scheduled operating, earlier definitive soft-tissue cover, and more robust antibiotic husbandry. Cite this article: Bone Joint J 2022;104-B(9):1073–1080.

Aims The purpose of this study was to determine the weightbearing practice of operatively managed fragility fractures in the setting of publically funded health services in the UK and Ireland. Methods The Fragility Fracture Postoperative Mobilisation (FFPOM) multicentre audit included all patients aged 60 years and older undergoing surgery for a fragility fracture of the lower limb between 1 January 2019 and 30 June 2019, and 1 February 2021 and 14 March 2021. Fractures arising from high-energy transfer trauma, patients with multiple injuries, and those associated with metastatic deposits or infection were excluded. We analyzed this patient cohort to determine adherence to the British Orthopaedic Association Standard, “all surgery in the frail patient should be performed to allow full weight-bearing for activities required for daily living ”. Results A total of 19,557 patients (mean age 82 years (SD 9), 16,241 having a hip fracture) were included. Overall, 16,614 patients (85.0%) were instructed to perform weightbearing where required for daily living immediately postoperatively (15,543 (95.7%) hip fracture and 1,071 (32.3%) non-hip fracture patients). The median length of stay was 12.2 days (interquartile range (IQR) 7.9 to 20.0) (12.6 days (IQR 8.2 to 20.4) for hip fracture and 10.3 days (IQR 5.5 to 18.7) for non-hip fracture patients). Conclusion Non-hip fracture patients experienced more postoperative weightbearing restrictions, although they had a shorter hospital stay. Patients sustaining fractures of the shaft and distal femur had a longer median length of stay than demographically similar patients who received hip fracture surgery. We have shown a significant disparity in weightbearing restrictions placed on patients with fragility fractures, despite the publication of a national guideline. Surgeons intentionally restrict postoperative weightbearing in the majority of non-hip fractures, yet are content with unrestricted weightbearing following operations for hip fractures. Cite this article: Bone Joint J 2022;104-B(8):972–979.

IntroductionThe aim of the protocol is to present the methodology of a scoping review that aims to synthesise up-to-date evidence on the management and outcomes of facial nerve palsy in low-income and middle-income countries (LMICs).Methods and analysisThe scoping review will be conducted per the Arksey and O’Malley’s framework and the Joanna Briggs Institute Reviewers’ Manual. The scoping review question, eligibility criteria and search strategy will be developed in accordance to the Population, Concept, and Context strategy. The search will be conducted in electronic bibliographic databases (Medline (OVID), Embase, WHO Global Index Medicus, Cochrane Library, Global Health, African Journals Online). The review will synthesise and report the findings with descriptive statistics and a narrative description of both quantitative and qualitative evidence.Ethics and disseminationThis scoping review does not require ethical approval. This protocol will describe the proposed scoping review that will map the evidence on the management and outcomes of facial nerve palsies in LMICs. The proposed review aims to collate and summarise published literature to inform policy-makers and healthcare organisations and governments and to identify knowledge gaps that will translate into future research priorities in LMICs.

Over the last decade, many advancements have been made in the management of low-grade gliomas (LGGs). Overall survival outcomes are correlated with factors such as postoperative residual volumes and specific tumor biomolecular profiles such as IDH mutation status. It is unclear whether these advancements have benefited LGG patients in Africa. This scoping review protocol outlines how the authors will evaluate the epidemiology, presentations, management and outcomes of LGGs in Africa.MEDLINE, Embase and African Journals Online will be searched from database inception to date in order to identify the relevant studies. Patients of all ages with histologically and/or radiologically confirmed LGGs that were managed in an African country will be included. Surgical and chemoradiation management of LGG tumours will be considered. Original research, reviews, commentaries, editorials and case reports will be included.Primary outcomes of the review will include LGG management, morbidity and mortality. Secondary outcomes include epidemiology and recurrence of LGGs.This scoping review will be the first to evaluate the current landscape of LGG management and outcomes in Africa, highlighting pertinent themes that may be used to guide further research as well as health system strengthening efforts by policymakers and stakeholders.The protocol has been registered on the Open Science Framework (OSF; registration link:LGGs account for 17% to 22% of total brain tumours and have a median survival time between 5.6 and 13.3 years.Despite many recent advancements in the management of LGGs, there is a paucity in the data within the African landscape.This scoping review will be the first to evaluate the current landscape of LGG management and outcomes in Africa, highlighting pertinent themes that may be used to guide further research and policymaking efforts.

Aims Understanding of open fracture management is skewed due to reliance on small-number lower limb, specialist unit reports and large, unfocused registry data collections. To address this, we carried out the Open Fracture Patient Evaluation Nationwide (OPEN) study, and report the demographic details and the initial steps of care for patients admitted with open fractures in the UK. Methods Any patient admitted to hospital with an open fracture between 1 June 2021 and 30 September 2021 was included, excluding phalanges and isolated hand injuries. Institutional information governance approval was obtained at the lead site and all data entered using Research Electronic Data Capture. Demographic details, injury, fracture classification, and patient dispersal were detailed. Results In total, 1,175 patients (median age 47 years (interquartile range (IQR) 29 to 65), 61.0% male (n = 717)) were admitted across 51 sites. A total of 546 patients (47.1%) were employed, 5.4% (n = 63) were diabetic, and 28.8% (n = 335) were smokers. In total, 29.0% of patients (n = 341) had more than one injury and 4.8% (n = 56) had two or more open fractures, while 51.3% of fractures (n = 637) occurred in the lower leg. Fractures sustained in vehicle incidents and collisions are common (38.8%; n = 455) and typically seen in younger patients. A simple fall (35.0%; n = 410) is common in older people. Overall, 69.8% (n = 786) of patients were admitted directly to an orthoplastic centre, 23.0% (n = 259) were transferred to an orthoplastic centre after initial management elsewhere, and 7.2% were managed outwith specialist units (n = 81). Conclusion This study describes the epidemiology of open fractures in the UK. For a decade, orthopaedic surgeons have been practicing in a guideline-driven, network system without understanding the patient features, injury characteristics, or dispersal processes of the wider population. This work will inform care pathways as the UK looks to the future of trauma networks and guidelines, and how to optimize care for patients with open fractures. Cite this article: Bone Jt Open 2022;3(10):746–752.

Background Africa bears >15% of the global burden of neurosurgical disease. Yet to date, Africa still has the lowest neurosurgical workforce density globally, and efforts to fill this gap by 2030 need to be multiplied. Although the past decade has seen an increase in neurosurgery residency programs in the continent, it is unclear how these residency programs are similar or viable. This study aims to highlight the current status of neurosurgical training in Africa as well as the differences within departments, countries or African regions. Methods A literature search using keywords related to ‘neurosurgery’, ‘training’, and ‘Africa’ and relevant names of African countries will be performed on PubMed and Google Scholar. If unavailable online, the authors will contact local neurosurgeons at identified training programmes for their curricula. The residency curricula collected will be analysed against a standardized and validated medical education curriculum viability tool. Results The primary aim will be the description of African neurosurgical curricula. In addition, the authors will perform a comparative analysis of the identified African neurosurgical curricula using a standardized and validated medical education curriculum viability tool. Discussion This study will be the first to evaluate the current landscape of neurosurgery training in Africa and will highlight pertinent themes that may be used to guide further research. The findings will inform health system strengthening efforts by local training programme directors, governments, policymakers and stakeholders.

Sellar, suprasellar or parasellar masses refer to space-occupying lesions that arise from the area surrounding the pituitary gland and many other vital structures, which can impact quality of life if damaged. Therefore, optimal management by a multidisciplinary team, which includes neurosurgeons, would be required to ensure that patients receive timely intervention to prevent long-term co-morbidities. The landscape of management of these masses in high-income countries are well described in the literature, however, there is a lack of clarity in the counterpart low- and middle-income countries, thus necessitating an evaluation of the literature. This protocol outlines how we will conduct our scoping review on the topic of interest. MEDLINE, Embase, Global Index Medicus and African Journals Online will be searched from year 2000 to date in order to identify the relevant studies. Patients with a sellar, suprasellar or parasellar masses managed in an LMIC will be included. Surgical, medical and conservative management of the relevant masses will be considered. Articles in English and French will be included. Primary outcome will describe the management of sellar, suprasellar, or parasellar masses in LMICs. Secondary outcomes will include describing the epidemiology, presentation and outcomes of patients with sellar, suprasellar or parasellar masses. This scoping review will be the first to evaluate the current landscape of the management and outcomes of sellar, suprasellar and parasellar masses in LMICs, highlighting important themes that may be used to guide further research as well as health system strengthening efforts by policymakers, governments and stakeholders.

Introduction Africa has the second-highest neurosurgical workforce deficit globally, and many medical students in Africa lack exposure to the field. This study aims to assess the impact of a neurosurgical rotation during medical school in shaping the perception and interest of students towards a career in neurosurgery. Method This is a continental, multi-centre, cross-sectional study. A Google form e-survey was disseminated to African clinical medical students between February 21st and March 20th, 2021. Data was analysed using descriptive statistics and adjusted logistic regression modelling. Results Data was received from 539 students in 30 African countries (n=30/54, 55.6%). The majority of participants were male (n=289/539, 53.6%) and were from Kenya (n=83/539, 15.4%). Most students had undertaken a clinical neurosurgery rotation (n=278/539, 51.6%); the majority reported a rotation length of four weeks or less (n=181/278, 65.1%). Students with clinical experience were less likely to pursue the specialty (p=0.02) and had a stronger perception that it is more difficult for women to pursue neurosurgery (p=0.0001) when compared to those without clinical experience. However, after adjusting for other factors, students with greater than four weeks of neurosurgical exposure were more likely to express a career interest in neurosurgery (odds ratio [OR]=1.75, p Conclusions Our findings support standardised, continent-wide, curriculum development, and advocacy supporting improved gender inclusivity in education and policymaking to improve the quality of neurosurgical exposure during medical school and help tackle the neurosurgical workforce deficit across Africa.

Introduction Traumatic spinal cord injury (TSCI) is a subset of neurotrauma, which is a significant contributor to global trauma mortality and morbidity in children. The management and outcomes of paediatric TSCI in low- and middle-income countries (LMICs) is unknown. We conducted a scoping review to characterise the methods of management and outcomes of TSCI in LMICs. Method MEDLINE, EMBASE, and Global Index Medicus were searched from database inception to February 15, 2021. Studies reporting management or outcomes of paediatric TSCI in LMICs were included. Pooled statistics were calculated using measures of central tendency and spread. Results A total of 1171 studies were identified, of which, five were included. A total of 212 patients were included in our review with age of participants ranging from 2.5 to 18 years old (mean = 15.4 years). Most patients were male (n=162/212, 76.4%, 95% confidence interval [CI] = 70.7–82.1%). The commonest cited cause of injury was falls (n=104/212, 49.1%, 95% CI = 42.3–55.8%). The most common level of injury was cervical (n=83/212, 39.2%, 95 CI% = 32.6–45.7%). The majority of patients underwent surgery (n=134/212, 63.2%, 95 CI% = 56.7–69.7%). The extent of injury was quantified and classified using the ASIA chart in only one paper. Long-term management data was not present in any of the included studies. Conclusions There is a scarcity of published studies reporting the management and outcome of paediatric TSCI in LMICs. There is insufficient data to be compared and to draw a strong conclusion. This hinders the development of guidelines to inform best practice.

Introduction\ud Africa bears more than 15% of the global burden of neurosurgical disease; however, it has the lowest neurosurgical workforce density worldwide. The past decade has seen an increase in neurosurgery residency programs on the continent. It is unclear how these residency programs are similar or viable. This study highlights the current status, interdepartmental and regional differences, with the main objective of offering a template for improving the provision of neurosurgical education on the continent.\ud \ud Method\ud PubMed and Google Scholar were searched using keywords related to “neurosurgery,” “training,” and “Africa” from database inception to 10/13/2021. The residency curricula were analyzed using a standardized and validated medical education curriculum viability tool.\ud \ud Results\ud Curricula from 14 African countries were identified. The curricula differed in resident recruitment, evaluation mode and frequency, curriculum content, and length of training. The length of training varied from four to eight years with a mean of six years. The Eastern African region had the highest number of examinations, with a mean of 8.5. Few curricula had correlates of viability - ensuring that the instructors are competent (64.3%), prioritization of faculty development (64.3%), faculty participation in decision making (64.3%), prioritization of resident support services (50%), creating a conducive environment for quality education (42.9%), and addressing student complaints (28.6%).\ud \ud Conclusion\ud There are significant differences in the African postgraduate neurosurgical education curriculum warranting standardization. This study has identified areas of improvement for neurosurgical education in Africa.

Introduction Complications following mandibular fractures occur in 9–23% of patients. Identifying those at risk is key to prevention. Previous studies highlighted smoking, age and time from injury to presentation as risk factors but rarely recorded other possible confounders. In this paper, we use a collaborative snapshot audit to document novel risk factors and confirm established risks for complications following the treatment of mandibular fractures. Methods The audit was carried out by 122 OMFS trainees across the UK and Ireland (49 centres) over 6 months, coordinated by the Maxillofacial Surgery Trainees Research Collaborative. Variables recorded included basic demography, medical and social history, injury mechanism and type, management and 30-day outcome. Results Nine hundred and forty-seven (947) patients with fractured mandibles were recorded. Surgical management was carried out in 76.3%. Complications at 30 days occurred 65 (9%) of those who were managed surgically. Risk factors for complications included male sex, increasing age, any medical history, increasing number of cigarettes smoked per week, increasing alcohol use per week, worse oral hygiene and increased time from injury to presentation. Discussion We have used a large prospective snapshot audit to confirm established risk factors and identify novel risk factors. We demonstrate that time from injury to presentation is confounded by other indicators of poor health behaviour. These results are important in designing trial protocols for management of mandibular fractures and in targeting health interventions to patients at highest risk of complications.

Introduction Africa has the second highest neurosurgical workforce deficit globally. Despite the many recent advancements in increasing neurosurgical access in Africa, published reports have shown that the vast majority of undergraduate students have little or no exposure to neurosurgery. The lack of exposure may pose a challenge in reducing the neurosurgical workforce deficit, which is one of the long-term strategies of tackling the unmet burden of disease. Students may also miss the opportunity to appreciate the specialty and its demands as well as nurture their interest in the field. This study aims to assess the impact of a neurosurgical rotation during medical school in shaping the perception and interest of students towards a career in neurosurgery. Methods The cross-sectional study will be conducted through the dissemination of a self-administered e-survey hosted on Google Forms from 21st February 2021 to 20th March 2021. The survey will contain five-point Likert scale, multiple-choice and free-text questions. The structured questionnaire will have four sections with 27 items: (i) socio-demographic background, (ii) neurosurgical experience, (iii) perception towards a neurosurgical career and (iv) interest in a neurosurgical career. All consenting medical students in African medical schools who are in their clinical years (defined as fourth to sixth years or higher years of study) will be eligible. Odds ratios and their 95% confidence intervals, Wilcoxon rank-sum test, Welch t-test and adjusted logistic regression models will be used to test for associations between independent and dependent variables. Statistical significance will be accepted at P

IntroductionThe protocol presents the methodology of a scoping review that aims to synthesise contemporary evidence on the management and outcomes of intracranial fungal infections in Africa.Methods and analysisThe scoping review will be conducted in accordance with the Arksey and O’Malley’s framework. The research question, inclusion and exclusion criteria and search strategy were developed based on the Population, Intervention, Comparator, Outcome framework. A search will be conducted in electronic bibliographic databases (Medline (OVID), Embase, African Journals Online, Cochrane Library and African Index Medicus). No restrictions on language or date of publication will be made. Quantitative and qualitative data extracted from included articles will be presented through descriptive statistics and a narrative description.Ethics and disseminationThis study protocol does not require ethical approval. Findings will be reported in a peer-reviewed medical journal and presented at local, regional, national and international conferences.

INTRODUCTION: To explore our experience of hosting the 10th Annual Neurology and Neurosurgery Interest Group-Society of British Neurological Surgeons (NANSIG-SBNS) Neurosurgery Careers Day, held virtually for the first time. METHODS: Reflective feedback and review of an international, virtual neurosurgery careers day. The authors reflect on the logistics of organizing the event, and the pre- and post-event feedback provided by delegates. Recommendations have been made on how to successfully host a virtual event. The key themes that permeated the event have been outlined and discussed in the context of the feedback received. RESULTS: The event was attended by 231 delegates from 20 countries worldwide. Knowledge of neurosurgery as a career and the application process increased after attending the careers day (4.27/5 to 4.51/5, p=0.003 and 3.12/5 to 4.31/5, p

Aim: To evaluate whole body, forearm, hand and surgical tool movements during various stitching tasks in experienced surgeons and final year medical students. Objectives: To determine the time required to complete each surgical task. To analyse the body centre of mass, neck, elbow, forearm and hand kinematics, the distance travelled by the surgical tool to determine the reliability, repeatability and compare differences of the aforementioned objective measures within and between surgeons and students. Method: A Cross-sectional 3D motion analysis pilot study designed. Five volunteer surgeons and five medical students were included. Retro-reflective markers were affixed to each participant’s skin on specific palpated anatomical landmarks and on a silicon suturing pad and surgical tools. Result: Experienced surgeons required significantly less time to complete each task. Their body centre of mass as well as their neck ROM were significantly smaller. The surgical tool also travelled less distance when used by surgeons (p[less than]0.05). Repeatability was higher in surgeons (ICC>0.70) compared to students (ICC>0.55). Conclusion: It is feasible to evaluate the surgical competences of junior surgeons from the very earliest years of their training. Optical Motion Capture System is a promising tool in Surgical Skills Teaching & Training.

Background Recently published literature has shed light on the lack of representation and exposure to Black, Asian and Minority Ethnic (BAME) skin types in dermatology education and training. This may lead to diagnostic uncertainty and impact the overall quality of care delivered. Thus, this paper discusses the design and development of an e-learning resource as an innovative solution to address this educational need during the pandemic. Methods A focus group was conducted to assess the learning needs of trainees on cutaneous manifestations of BAME patients. An e-learning resource was created using instructional design, educational and multimedia principles such as the ADDIE (Analysis, Design, Development, Implementation, Evaluation) model and Gagne’s nine steps. The e-learning was disseminated to trainees across a one-month period. Feedback on the content and relevance of the e-learning was collected on the completion of the module. Results Overall, 84% (n=42) of trainees reported that the module improved their confidence and knowledge acquisition of common skin conditions in BAME skin types (p

Background The principles of global surgery should be taught as a part of the core curriculum in medical schools. The need for medical students to be familiar with the topic is increasing in acceptance. There is, however, a paucity of data on how medical students are exposed to global surgery. This study aims to evaluate exposure of medical students to global surgery, awareness of the key messages of the Lancet Commission on Global Surgery, global surgery career aspirations and barriers to said aspirations. Methods ISOMERS was a multi-centre, online, cross-sectional survey of final year medical students globally. The questionnaire utilised a combination of Likert-scale, multiple-choice, and free text questions. Results In this study, 1593 final year medical students from 144 medical schools in 20 countries participated. The majority (n = 869/1496, 58.1%) believed global surgery to be relevant, despite 17.7% (n = 271/1535) having any exposure to global surgery. Most participants (n = 1187/1476, 80.4%) wanted additional resources on global surgery. Difficulty in providing appropriate care for patients living abroad (n = 854/1242, 68.8%) was the most common perceived barrier to a career in global surgery. Conclusions Participants believed global surgery was a relevant topic for medical students and wanted additional resources that they could access on global surgery. It is critical for medical students to become aware that global surgery is a field that aims to address inequity in surgical care not just internationally, but nationally and locally as well.

Background:Worldwide, neurological disorders are the leading cause of disability-adjusted life years lost and the second leading cause of death. Despite global health capacity-building efforts, each year, 22.6 million individuals worldwide require neurosurgeon's care due to diseases such as traumatic brain injury and hydrocephalus, and 13.8 million of these individuals require surgery. It is clear that neurosurgical care is indispensable in both national and international public health discussions. This study highlights the role neurosurgeons can play in supporting the global health agenda, national surgical plans, and health strengthening systems (HSS) interventions.Methods:Guided by a literature review, the authors discuss key topics such as the global burden of neurosurgical diseases, the current state of neurosurgical care around the world and the inherent benefits of strong neurosurgical capability for health systems.Results:Neurosurgical diseases make up an important part of the global burden of diseases. Many neurosurgeons possess the sustained passion, resilience, and leadership needed to advocate for improved neurosurgical care worldwide. Neurosurgical care has been linked to 14 of the 17 Sustainable Development Goals (SDGs), thus highlighting the tremendous impact neurosurgeons can have upon HSS initiatives.Conclusion:We recommend policymakers and global health actors to: (i) increase the involvement of neurosurgeons within the global health dialogue; (ii) involve neurosurgeons in the national surgical system strengthening process; (iii) integrate neurosurgical care within the global surgery movement; and (iv) promote the training and education of neurosurgeons, especially those residing in Low-and middle-income countries, in the field of global public health.

Aim Traditionally, the UK has been highly regarded as a place for doctors to pursue undergraduate medical training and postgraduate training. However, recent reports show that more than 40% of UK-graduate doctors leave the country to pursue specialty training elsewhere. This paper aims to identify and evaluate the motivating factors for UK graduates to leave the NHS. Method An anonymised questionnaire was disseminated at a webinar series regarding the application process to pursue residency overseas. The data was independently analysed by two reviewers. A one-way ANOVA (with Tukey’s Post Hoc test) was utilised to compare the difference between motivating factors. Results were considered statistically significant for p-values Results 1,118 responses from the UK medical students and doctors were collected; of which, 1,001 (89.5%) were medical students, and 88 (7.9%) were junior doctors. There was a higher preference for leaving after the Foundation Programme compared to the other periods (p Conclusions Future work on the quality of life for doctors in the UK, especially for prospective surgical trainees, should be explored. Policymakers should focus on assessing the difference in working hours, on-call hours or wages that may differ among the healthcare systems.

Aim Research has shown exposure to specialities as a medical student can have a great influence in choice of career. Exposure to potential mentors during this time also has an additive effect on career shaping of medical students. It is important to encourage interest in trauma and orthopaedics (T&O) to ensure the best candidates are selected. Our aim was to establish the compulsory duration of T&O teaching provided by all (non-new) medical schools. This study also aims to identify which other specialities were taught alongside T&O. Method Surveys were distributed to medical students in all 33 (non-new) medical schools, through surgical societies and colleagues met through courses, between June 2019- February 2020. The survey asked the total length of compulsory teaching of T&O in days, and how this was divided into pre-clinical or clinical teaching. Results Data for all 33 UK medical schools were collected. Only 7 medical schools taught T&O as a standalone subject. The other 26 medical schools combined T&O with other specialities, most commonly with Rheumatology (n = 16). The average total length of days of T&O teaching across medical school was 17 days (range 3-60). Majority of this teaching was given in the clinical years of medical school (n = 30). Conclusions Research has shown medical students require enough exposure to increase their interest in pursuing a particular speciality. Currently there is a huge variance on the number of compulsory teaching days for T&O.

Background: The COVID-19 pandemic has caused a surge in research activity while restricting data collection methods, leading to a rise in survey-based studies. Anecdotal evidence suggests this increase in neurosurgical survey dissemination has led to a phenomenon of survey fatigue, characterized by decreased response rates and reducing the quality of data. This paper aims to analyze the effect of COVID-19 on neurosurgery surveys and their response rates, and suggest strategies for improving survey data collection.Methods: A search was conducted on March 20, 2021, on Medline and EMBASE. This included the terms “neurosurgery,” “cranial surgery,” “spine surgery,” and “survey” and identified surveys written in English, on a neurosurgical topic, distributed to neurosurgeons, trainees, and medical students. Results were screened by two authors according to these inclusion criteria, and included articles were used for data extraction, univariable, and bivariable analysis with Fisher's exact-test, Wilcoxon rank-sum test, and Spearman's correlation.Results: We included 255 articles in our analysis, 32.3% of which were published during the COVID-19 pandemic. Surveys had an average of 25.6 (95% CI = 22.5–28.8) questions and were mostly multiple choice (78.8%). They were disseminated primarily by email (75.3%, 95% CI = 70.0–80.6%) and there was a significant increase in dissemination via social media during the pandemic (OR = 3.50, 95% CI = 1.30–12.0). COVID-19 surveys were distributed to more geographical regions than pre-pandemic surveys (2.1 vs. 1.5, P = 0.01) and had higher total responses (247.0 vs. 206.4, P = 0.01), but lower response rates (34.5 vs. 51.0%, P < 0.001) than pre-COVID-19 surveys.Conclusion: The rise in neurosurgical survey distribution during the COVID-19 pandemic has led to survey fatigue, reduced response rates, and data collection quality. We advocate for population targeting to avoid over-researching, collaboration between research teams to minimize duplicate surveys, and communication with respondents to convey study importance, and we suggest further strategies to improve response rates in neurosurgery survey data collection.

Background Recent reports show that about 10% of UK-graduate doctors leave the country to pursue specialty training elsewhere. Our article aims to evaluate the motivating factors for UK graduates to leave the National Health Service (NHS), especially during the COVID-19 pandemic and Brexit. Study design Cross-sectional study. Method A novel 22-item questionnaire was disseminated at a webinar series regarding the application process to pursue residency training in six different countries/regions from 2 August 2020 to 13 September 2020. The data was analysed using Kruskal-Wallis rank-sum with post-hoc Wilcoxon test to compare the difference in significance among the motivating factors. Results 1118 responses from the UK medical students and doctors were collected; of which, 1001 (89.5%) were medical students, and 88 (7.9%) were junior doctors. There was a higher propensity for leaving after the Foundation Programme compared with other periods (p Conclusion Future work on the quality of life for doctors in the UK should be explored, especially among those considering leaving the NHS. Policymakers should focus on assessing the difference in working hours, on-call hours and wages that may differ among healthcare systems.

Background\ud Traumatic spinal cord injury (TSCI) is a subset of neurotrauma, which is a significant contributor to global trauma mortality and morbidity in children. The management and outcomes of paediatric TSCI in low-and-middle income countries (LMICs) is unknown. We conducted a scoping review to characterise the methods of management and outcomes of TSCI in LMICs.\ud \ud Methods\ud MEDLINE, EMBASE, and Global Index Medicus were searched from database inception to February 15, 2021. Studies reporting management or outcomes of paediatric TSCI in LMICs were included. Pooled statistics were calculated using measures of central tendency and spread.\ud \ud Results\ud A total of 1171 studies were identified, of which, 5 were included. A total of 212 patients were included in our review with age of participants ranging from 2.5 to 18 years old (mean = 15.4 years). Most patients were male (n=162, 76.4%). The commonest cited cause of injury were falls (n=104/212, 49.1%). The most common level of injury was cervical (n=83, 39.2%). The majority of patients underwent surgery (n=134/212, 63.2%). The extent of injury was quantified and classified using the ASIA chart in only one paper. Long-term management data was not present in any of the included studies.\ud \ud Conclusion\ud There is a scarcity of published studies reporting the management and outcome of paediatric TSCI in LMICs. The paucity of studies in this domain provides insufficient data to be compared, reducing the ability to draw a strong conclusion. This hinders the development of guidelines to inform best practice.

Aim To identify the most relevant clinical factors in the National Bowel Cancer Audit (NBOCA) that contribute to the variation in the quality of care provided in different hospitals for colorectal cancer patients undergoing surgery. Method Data from 36,116 patients with colorectal cancer who had undergone surgery were retrospectively collected from the NBOCA and analysed from 145 and 146 hospitals over two years. A validated multiple linear regression was performed to compare the identified clinical factors with various quality outcomes. The quality outcomes defined in this study were the length of hospitalisation, 2-year mortality, readmission rate, 90-day mortality, and 18-month stoma rate. Results Four clinical factors (laparoscopy rate, abdominal-perineal-resection-of-rectum (APER), pre-operative radiotherapy and patients with distant metastases) were shown to have a significant (p Conclusions Hospitals should monitor the four clinical factors for patients with colorectal cancer during perioperative care. Clinicians should consider these factors along with the individual patients’ history when formulating a management plan for patients with colorectal cancer.

Introduction:Intracranial suppurations account for a significant proportion of intracranial masses in low- and middle-income countries (LMICs), particularly among children. The development of better imaging equipment, antibiotics, and surgical techniques has enabled significant progress in detecting and treating intracranial abscesses. However, it is unclear whether these advances are accessible and utilised by LMICs. In this review, we aimed to describe the landscape of paediatric intracranial suppurations in LMICs.Methods:This scoping review was conducted using the Arksey and O'Malley framework. MEDLINE, EMBASE, WHO Global Index Medicus, AJOL and Google scholar were searched for relevant articles from database inception to January 18th, 2021. Publications in English and French were included.Results:Of the 1,011 records identified, 75 were included. The studies, on average, included 18.8 (95% CI = 8.4–29.1) children (mean age: 8.2 years). Most children were male (62.2%, 95% CI = 28.7–95.7%). Intracranial suppurations were most commonly (46.5%) located in the supratentorial brain parenchyma. The most prevalent causative mechanism was otitis (37.4%) with streptococcus species being the most common causative organism (19.4%). CT scan (71.2%) was most commonly used as a diagnostic tool and antibiotics were given to all patients. Symptoms resolved in 23.7% and improved in 15.3% of patients. The morbidity rate was 6.9%, 18.8% of patients were readmitted, and the mortality rate was 11.0%.Conclusion:Most intracranial suppurations were complications of preventable infections and despite MRI being the gold standard for detecting intracranial suppurations, CT scans were mostly used in LMICs. These differences are likely a consequence of inequities in healthcare and have resulted in a high mortality rate in LMICs.

International medical students have often been termed ‘‘cash cows’’ due to the hefty amount of fees paid each year.1 It has been reported that only 7.5% of international students are permitted at UK medical schools1; however, multiple medical schools are currently exceeding this cap in order to earn a larger sum of fees. This amount can range from £20 000 to £40 000 for preclinical students and £35 000–£70 000 for clinical students per academic year.1 Furthermore, international medical students’ fees are also subjected to an annual inflation of 1%–2% as per the Retail Price Index.1 Since August 2016, additional training costs were implemented for international students under an Additional Cost of Teaching (ACT) levy in Scotland.2 This levy was intended to finance clinical skills and placements for international students delivered by medical health professionals. It required all international medical students applying to Scotland to pay a national levy of an additional £10 000 per academic year.2 Likewise, Belfast has implemented a similar system for all European Union (EU) and international students, from the 2021/2022 intake onwards, in order to allow access to clinical placements in the Northern Ireland Health and Social Care system.3 However, the full £10 000 only has to be paid in years 3, 4 and; in year 1, no levy has to be paid and …

Medical schools are responsible for training medical students to recognise and commence management for a broad spectrum of diseases, including clinical neuroscience conditions. To guide medical schools on topics that should be taught, speciality bodies have produced speciality-based core curricula. It is unknown to what extent these guidelines are used in designing each medical school's curriculum. This survey aimed at assessing the use of these guidelines in designing clinical neuroscience curricula.This is a national survey. A 21-item questionnaire was sent to faculty members involved in the development of the clinical neuroscience curriculum in each medical school in the UK. Data collection occurred from1st September 2020-31 st August 2021. The Association of British Neurologists (ABN) and the Royal College of Surgeons England (RCSEng) guidelines were used as a benchmark. Descriptive statistics are reported.Data was collected from 91.9% of eligible UK medical schools. 61.8% respondents were aware of ABN guidelines and 35.3% were aware of RCSEng guidelines. 17/28 (60.7%) topics recommended by the guidelines were taught in the neuroscience curricula of over 90% of the medical schools. Neurologists were involved in the design of the clinical neuroscience curriculum in 94.1% (n = 32/34) of medical schools, and neurosurgeons in 61.8%. Tutorials/seminars were used by all medical schools to teach clinical neuroscience content. Neurologists were involved in teaching at all schools and neurosurgeons in 70.6%. Objective Structured Clinical Examination (OSCE)/oral examinations and single best answer (SBA)/multiple-choice question (MCQ) tests were used in all medical schools as methods of assessment.There is variation between medical schools on what clinical neuroscience topics are taught and by whom. Multi-modality educational delivery was evident. Some medical schools did not currently use, advertise, or recommend external clinical neuroscience educational resources; but there was support for future use of external resources including guidelines.

This cohort study assesses the association between day of the week and process measure adherence in patients undergoing colorectal surgery and identifies hospital-level factors associated with weekend adherence.