scholarly journals EP.TU.356Can day case elective operating lists provide efficient training opportunities for general surgical trainees?

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Rachael Coulson ◽  
Catherine Gilmore ◽  
Catherine Sheridan ◽  
Anna Murray ◽  
Scott McCain ◽  
...  
Keyword(s):  
Time Frame ◽  
Day Surgery ◽  
Day Case ◽  
Surgical Trainees ◽  
Significant Difference ◽  
Centre Of Excellence ◽  
Hands On Learning ◽  
Short Time ◽  
The Impact ◽  
Training Opportunities

Abstract Introduction During the COVID-19 pandemic there has been a reduction in trainee hands-on learning opportunities due to curtailment of elective workload. Our study aims to assess the impact of non-consultant led operating on theatre list efficiency. Methods Prospective data collection over an eight week period of consecutive elective day case hernia lists at a newly established regional centre of excellence for day surgery. Specifically recording of key time points in surgical cases including time ready, knife to skin, last suture and exit theatre. This was achieved using the Theatre Management System (TMS). Results 46 patients underwent open unilateral elective inguinal hernia repair. 54% (N = 25) of cases were trainee led. Median trainee time was 53 minutes, vs 51 minutes for consultant led procedures; no significant difference (p > 0.05). Conclusion Day case elective hernia lists can be efficient training opportunities for general surgical trainees. Our results demonstrate that trainee-led operating in this setting have not resulted in significantly increased surgical time or operative theatre inefficiency. It is widely acknowledged there is benefit to training in performing the same technical skill within a short time frame.

The Impact of ISTCS – A Clinician's Perspective (Questionnaire Study)

2010 ◽  
Vol 92 (9) ◽  
pp. 1-3
Author(s):  
D Mendis ◽  
A Hawrani
Keyword(s):  
Healthcare Delivery ◽  
Postal Questionnaire ◽  
Questionnaire Study ◽  
Case Mix ◽  
Day Case ◽  
General Attitude ◽  
Inpatient Services ◽  
The Impact ◽  
Training Opportunities ◽  
Controversial Aspect

Independent sector treatment centres and their effect on the NHS remain a controversial aspect of healthcare delivery. This postal questionnaire study aims to identify the general attitude among surgical consultants about their effects, specifically on NHS workload, departmental/trust finances, training opportunities and case mix. NHS hospitals within five miles of an ISTC offering day case/inpatient services were targeted.

scholarly journals TP8.2.10 Impact of COVID-19 on General Surgery Training in a University Hospital with Ring Fenced Elective Centre

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Tanzeela Gala ◽  
Quratul Ain ◽  
Chekwas Obasi ◽  
Hajar Rashid ◽  
Sarkhell Radha ◽  
...  
Keyword(s):  
General Surgery ◽  
Normal Activity ◽  
University Hospital ◽  
Surgical Trainees ◽  
Higher Surgical Training ◽  
Theatre Utilisation ◽  
The Impact ◽  
Second Wave ◽  
Training Opportunities ◽  
General Surgery Training

Abstract Aim Higher Surgical training was decimated by the COVID-19 pandemic with cessation of elective care. Trainees raised concerns that the elective restart and need for higher theatre activity to clear backlogs would impact on training opportunities. This study evaluated the resumption of training associated with a ring-fenced elective centre (EC). Methods The EC was established in July 2020 and three time periods were determined: pre-COVID (10/19-2/20), 1st wave of COVID (3/20-7/20) and post EC go-live (8/20-12/20). Data was collated from the E-Logbooks of General Surgery Registrars. Results The normal all-speciality pre COVID theatre-activity averaged 1052 cases/month. During the first wave elective activity decreased to 254 cases/month (24% of normal activity). Within 5 weeks of establishment of the EC, theatre activity was near normal despite a reduced number of theatres (with higher theatre utilisation). Pre COVID, trainees accessed 22.9 cases per month which then dropped to 7.7 cases during the first wave of COVID. Post the go live of the EC, trainees were able to operate on 20 cases per month almost back to normal training levels. Prior to the impact of the second wave, each trainee had developed a deficit of 90 cases during the 5 months pause. Conclusion The ring-fenced elective centre has protected training opportunities for higher surgical trainees. However, the pause in training requires a targeted training recovery plan to overcome the deficit secondary to the first and subsequent waves of COVID to ensure that the JCST target of 1200 cases can be met for CCT.

scholarly journals Feather Corticosterone Measurements of Greater Flamingos Living under Different Forms of Flight Restraint

Animals ◽  
2020 ◽  
Vol 10 (4) ◽  
pp. 605 ◽  
Author(s):  
Lukas Reese ◽  
Katrin Baumgartner ◽  
Lorenzo von Fersen ◽  
Roswitha Merle ◽  
Mechthild Ladwig-Wiegard ◽  
...  
Keyword(s):  
Animal Welfare ◽  
Time Frame ◽  
High Variability ◽  
Housing Conditions ◽  
Measurable Effect ◽  
Behavioral Observations ◽  
Significant Difference ◽  
The Impact ◽  
Greater Flamingos ◽  
Feather Corticosterone

Deflighting zoo birds is a practice that receives increasing criticism due to its presumed incompatibility with animal welfare. To our knowledge, this is the first approach to address this problem in a scientific way. To do this, we compared feather corticosterone (CORTf) from Greater Flamingos (Phoenicopterus roseus, n = 151) of different flight status (i.e., pinioned, feather clipped, airworthy) from twelve different zoological institutions. To complement the hormone measurements, behavioral observations (scan samplings) were conducted prior to feather sampling within the presumed time frame of feather growth. We hypothesized that CORTf of the deflighted flamingos would differ from CORTf of their airworthy conspecifics. No significant difference in CORTf was found between the three groups, and our hypothesis was rejected. However, the impact of the institution itself (i.e., the housing conditions) proved to be the most dominant variable (variance between the institutions = 53.82%). Due to high variability, the behavioral observations were evaluated descriptively but did not give rise to doubt the findings in CORTf. Therefore, we assume that the method of flight restraint of Greater Flamingos does not have a measurable effect on CORTf. We consider this model for evaluating animal welfare of zoo birds a useful tool and provide ideas for further adjustments for consecutive studies.

Day-case tonsillectomy for children in Glasgow: the impact of changing indications and deprivation

2013 ◽  
Vol 127 (4) ◽  
pp. 392-398 ◽  
Author(s):  
W A Clement
Keyword(s):  
Obstructive Sleep Apnoea ◽  
Day Surgery ◽  
Sleep Apnoea ◽  
Day Case ◽  
Sleep Related Breathing Disorders ◽  
Number Of Children ◽  
Breathing Disorders ◽  
Obstructive Sleep ◽  
Same Day Discharge ◽  
The Impact

AbstractObjective:To determine the number of children undergoing tonsillectomy that could have this performed as a day surgery procedure.Methods:This paper reports a prospective cohort study, which entailed a comparison of children's eligibility for day-case surgery between 2001 and 2011 and an assessment of the Scottish Index of Multiple Deprivation scores.Results:In total, 148 children were enrolled. In 2011, 60 children (42 per cent) were eligible for surgery with same day discharge compared with 27 per cent in 2001. The percentage of children undergoing tonsillectomy for sleep-related breathing disorders or obstructive sleep apnoea hypopnoea syndrome increased from 26 per cent to 55 per cent.Conclusion:Eligibility for tonsillectomy with same day discharge has increased. This appears to be related to an increase in the number of children who are able to fulfil the social criteria for same day discharge. The results indicate an association between deprivation and tonsillectomy, particularly surgery carried out for the symptoms of sleep-related breathing disorders or obstructive sleep apnoea hypopnoea syndrome. There has been a significant increase in the percentage of children undergoing tonsillectomy for the indication of sleep-related breathing disorders or obstructive sleep apnoea hypopnoea syndrome.

scholarly journals Keratinocyte Skin Cancers in General Surgery: The Impact of Anaesthesia, Trainee Supervision, and Choice of Reconstruction

2021 ◽  
Vol 2021 ◽  
pp. 1-3
Author(s):  
William McSweeney ◽  
Matthew Leaning ◽  
Darius Dastouri
Keyword(s):  
Cell Carcinoma ◽  
Health Expenditure ◽  
Day Surgery ◽  
Cross Sectional Study ◽  
General Anesthetic ◽  
Complete Excision ◽  
Cross Sectional ◽  
Surgical Trainees ◽  
Skin Cancers ◽  
The Impact

Background. Keratinocyte skin cancers are common in Australia, incurring disproportionately high health expenditure in comparison with mortality. General surgeons often excise these lesions as day-surgery. Balancing individual complexities of these cancers with trainee supervision and health expenditure is key to deliver efficacious care and maintain day-surgery volume for patients during a pandemic. Methods. A retrospective, cross-sectional study was performed, examining 414 procedures from January 2019 to December 2020. Pathology was reviewed, and benign lesions excluded. Complete excision was based on 5 mm margins for squamous cell carcinoma (SCC), 0.5 mm microscopic margins for low-risk basal cell carcinoma (BCC) subtypes, and 3 mm for high-risk. Results of trainee-performed local anesthetic (LA) excision and general anesthetic (GA) excision (consultant scrubbed) were compared. Results. 288 excisions were reviewed for completeness, location, and reconstruction modality. 69% were BCC (199), and 31% were SCC (89). These were excised under GA (72.5%) and LA (27.5%). 25.6% of BCC excisions were “close,” and 22.6% were “positive” under GA, whilst 31% were “close” and 15.5% were “positive” under LA. 52.8% of SCC excisions were “close,” and 7.8% were “positive” under GA, compared with 42.8% “close” and 9.5% “positive” under LA. Complex reconstruction (skin graft, flap) was more common under GA (38% SCC and 36.1% BCC), but occurred at a modest rate under LA (22% BCC and 28.5% SCC). Conclusions. The results confirm that comparable margins and reconstruction options are achievable when excising keratinocyte cancers under LA by surgical trainees. This is fundamental in cost and timesaving, as well as reducing risk of aerosolisation of virus during GA, in a pandemic.

scholarly journals 1358 Does A COVID Protected Hospital Within A COVID Hospital Enable Elective Care and Training Opportunities?

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
H Rashid ◽  
T Gala ◽  
Q Ain ◽  
H Ashraf ◽  
S Vesamia ◽  
...  
Keyword(s):  
Critical Care ◽  
Training Environment ◽  
Informatics System ◽  
Surgical Trainees ◽  
Business Informatics ◽  
The Uk ◽  
The Impact ◽  
Second Wave ◽  
Training Opportunities ◽  
And Training

Abstract Introduction Elective care in the UK came to a standstill with the advent of the COVID-19 pandemic. A restart could only be enabled with ‘green site’ separation and a ‘covid protected’ zone. A ‘hospital within the hospital’ concept was developed including 9 elective theatres, 28 ring fenced elective beds, a surgical enhanced care unit, a canteen, and a separated entrance. This model was underpinned with PPE, enhanced infection control and guidance for staff. The study documented the ability to recover elective activity and therefore provide a training environment for surgical trainees. Method Data was collected weekly (7/20 to 1/21) through the business informatics system with regard to theatres cases completed compared to the activity achieved in the 11-theatre elective estate pre COVID-19. Results Pre COVID-19, an average of 263 cases were completed per week. In the first week of operation, 31% of theatre capacity was achieved. By week 7, 106% of pre COVID was recorded and 130% by week 11. This was maintained until the impact of the second wave where activity has reduced to 50% but is not anticipated to reduce further as local anaesthetic and blocks maybe utilised. Conclusions This ‘hospital within the hospital’ has enabled elective care to return to above normal levels, with increased efficiencies. This has enabled a rapid return to a training environment for trainees disheartened with deployment to critical care in the first wave.

Effects of formalin preservation on invertebrate stable isotope values over decadal time scales

2012 ◽  
Vol 90 (11) ◽  
pp. 1320-1327 ◽  
Author(s):  
Michael D. Rennie ◽  
Ted Ozersky ◽  
David O. Evans
Keyword(s):  
Stable Isotope ◽  
Marine Invertebrate ◽  
Time Frame ◽  
Freshwater Invertebrates ◽  
Significant Difference ◽  
Formalin Preservation ◽  
Ecosystem Changes ◽  
Short Time ◽  
Control Samples

Stable isotope values derived from chemically preserved organisms are a valuable resource for documenting long-term ecosystem changes. However, isotopic correction factors of preservation effects applied to samples stored for decades are frequently based on studies lasting only months, assuming that the effects of preservation stabilize within a short time frame. Very few studies test this critical assumption. We validated this assumption for formalin-preserved invertebrate tissues, finding no significant difference between mean isotopic δ13C and δ15N values of material stored 1–15 years across taxa. Preservation effects were evaluated for Amphipoda, Chironomidae, Dreissenidae, Ephemeroptera, Gastropoda, Isopoda, Sphaeridae, Oligochaeta, and Trichoptera. On average, freshwater benthos δ13C was lower by approximately 2‰ after formalin fixation, whereas δ15N values were not different from control samples. Fixation effects were similar among taxa, but were more pronounced in Gastropoda and Sphaeridae for δ13C and in Trichoptera for δ15N. We reviewed the literature to show that preserved freshwater zooplankton δ13C were slightly but significantly lower relative to control samples (–0.2‰) and higher in δ15N (+0.25‰). The mean decline among marine invertebrate δ13C was greater than for freshwater invertebrates after 1+ years of formalin preservation, but effects on δ15N were not different between marine and freshwater invertebrates.

scholarly journals P095: Do resident as teacher programs increase emergency medicine residents comfort level with teaching junior learners?

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S90-S90
Author(s):  
M. R. Lipkus ◽  
A. Meiwald ◽  
K. Van Aarsen
Keyword(s):  
Emergency Medicine ◽  
Time Frame ◽  
Comfort Level ◽  
Group Discussions ◽  
Formal Curriculum ◽  
Comfort Levels ◽  
Academic Hospitals ◽  
Educational Concept ◽  
Short Time ◽  
The Impact

Introduction: At academic hospitals, it is a residents responsibility to teach junior learners. Residents endorse that there is limited education on how to effectively teach junior learners, and suggest a more formal curriculum on how to teach would be beneficial. Emergency Medicine (EM) residencies in North America may have a resident as teacher (RAT) curriculum, however, no Canadian EM study has characterized the impact of a RAT curriculum on residents. Our educational concept was to implement a formalized RAT workshop for residents in an EM residency. We assessed residents attitudes and comfort levels towards teaching in response to the curriculum. Methods: A formal RAT curriculum, provided at a single center in a 6-hour session, was provided for both Royal College and College of Family Physician EM residents. Residents completed a survey evaluating attitudes and behaviours regarding their ability to teach and give feedback as part of their roles as teachers, consistent with Kirkpatricks second level of program evaluation. The surveys were administered pre-workshop, immediately post-workshop, and at 3 and 6 months following the RAT workshop. Results: Residents were surveyed in terms of their attitudes towards teaching on a 5-point likert scale. Our educational concept was delivered through a 6-hour workshop with emphasis on practical teaching skills that residents could incorporate into their practice. Lecture topics included orientation of the learner, giving effective feedback, teaching within a short time frame, as well as an introduction to theory of learning. Lectures were geared to be interactive, and included breakout sessions and group discussions. 21 residents participated in the workshop. Of 18 pre-survey respondents, 89.8% (n=16) had no previous formal training in how to teach, yet 72.21% (n=13) ‘sometimes’ or ‘often’ have a learner on shift with them. There were 15 post survey respondents. 53.33% (n=8) respondents somewhat agreed or agreed they were more likely to teach in response to the workshop, and 56.25% (n=8) responded that they somewhat agreed or agreed they were more comfortable with teaching while in the Emergency Department in an immediate post workshop survey. Conclusion: After a formal RAT curriculum, residents reported that they had increased comfort and were more likely to teach junior learners. Although small and single-centered, our study will help provide a basis for larger RAT studies, evaluating the effect on both residents and junior learners.

scholarly journals The Impact of Hurricane Irma on the Metabolism of St. Martin’s Island

2020 ◽  
Vol 12 (17) ◽  
pp. 6731 ◽  
Author(s):  
Roxana Popescu ◽  
Hélène Beraud ◽  
Bruno Barroca
Keyword(s):  
Waste Management ◽  
Spatial Structure ◽  
Future Development ◽  
Time Frame ◽  
Small Islands ◽  
Total Destruction ◽  
Saint Martin ◽  
Short Time ◽  
The Impact ◽  
Hurricane Irma

Due to their sometimes devastating and, at the same time, transformative effects, the impacts of major hurricanes on small islands leave their mark both on the way territories operate and on their future development. This was the case during the passage of hurricane Irma over the island of Saint Martin in 2017. By analyzing the stocks and circulation of hurricane waste flows, our aim was to see whether the inherent evolution of Saint Martin’s metabolism as a result of the island’s total destruction tended toward a lasting transformation of its waste management system and, therefore, toward the territory’s sustainability. This evolution was analyzed in a diachronic approach and over a short time frame. It was based on three structuring territorial metabolism dimensions: the intensity of waste flows, the spatial structure of the metabolism and the actors and techniques that explain it. Results show that while the intensity of the waste flows changed durably after Irma, the lasting transformation of the spatial structure and the actor system was less obvious and depended on the waste stream. Results also reveal the importance of reflecting on the development of recycling and reuse methods as a solution for improving post-hurricane waste planning on islands.

scholarly journals General paediatric surgery for patients aged under 5 years: a 5-year experience at a district general hospital

2016 ◽  
Vol 98 (7) ◽  
pp. 479-482 ◽  
Author(s):  
C-S Kwok ◽  
AC Gordon
Keyword(s):  
District General Hospital ◽  
Complication Rates ◽  
Paediatric Surgery ◽  
Day Case ◽  
Day Case Surgery ◽  
Surgical Trainees ◽  
Case Surgery ◽  
The Uk ◽  
Training Opportunities ◽  
Electronic Hospital

Introduction The gradual shift of general paediatric surgery (GPS) provision from district general hospitals (DGH) to specialised units is well recognised in the UK. The consequences of centralisation include a reduction in exposure to GPS for current surgical trainees. The GPS practice of a DGH is examined here. Methods All operations performed on children aged under 5 years over a 5-year period were identified using the local electronic operation database. Electronic hospital records and clinic letters were accessed to collect data on demographics, operations performed and outcome measures. Results 472 GPS operations were performed on children between the age of 22 days and 5 years between 2009 and 2014, of which 43 were on an emergency basis and 105 were performed on patients aged less than 1 year. Three patients were admitted following day case surgery. Six patients were readmitted within 30 days. Complication rates for all procedures and the four most common procedures were similar to those found in published literature. Conclusions GPS for patients aged less than 5 years is comparatively safe in the DGH setting. The training opportunities available at DGHs are invaluable to surgical trainees and vital for sustaining the future provision of GPS by such hospitals.

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