Aims A significant proportion of patients never fully recover baseline activity levels following ... more Aims A significant proportion of patients never fully recover baseline activity levels following major abdominal surgery. Postoperative muscle atrophy may be a major contributing factor to this, but is often overlooked. This study aimed to quantify the degree of muscle loss in patients undergoing routine recovery following major abdominal surgery and in patients admitted to critical care. Methods Fifteen patients undergoing major open colorectal resection were recruited. Cross surface area (CSA) and muscle thickness (MT) of a quadriceps muscle, Vastus Lateralis (VL) were measured pre-operatively and on post-operative day (POD) 5 using ultrasound. Knee extension strength was also measured pre-operatively and on POD5 using a handheld dynamometer. A systematic literature review was performed to identify studies reporting muscle loss in patients admitted to an intensive treatment unit (ITU), with pooled means of changes in quadriceps muscle CSA calculated. Results By POD 5 VL CSA had de...
Aims Significant loss of muscle mass and function occurs after major abdominal surgery. Neuromusc... more Aims Significant loss of muscle mass and function occurs after major abdominal surgery. Neuromuscular electrical stimulation (NMES) has been shown to reduce muscle atrophy in some patient groups, but evidence in postoperative patients is limited. This study assesses the efficacy of NMES in attenuating muscle atrophy following major abdominal surgery. Methods Fifteen patients undergoing open colorectal resection were recruited to a split body randomised control trial and their lower limbs randomised to control (CON) or NMES (STIM). The STIM limb underwent 15 minutes of quadriceps NMES twice daily on postoperative day (POD) 1 to 4. Ultrasound measurement of Vastus Lateralis (VL) cross sectional area (CSA) and muscle thickness (MT) was made preoperatively and on POD 5, as was dynamometer measurement of knee extensor strength (KES). All outcomes were analysed using linear mixed model techniques. The study was approved by NHS research ethics committee (ref 20/EM/069). Results NMES signif...
Background COVID-19 has had a global impact on all aspects of healthcare including surgical train... more Background COVID-19 has had a global impact on all aspects of healthcare including surgical training. This study aimed to quantify the impact of COVID-19 on operative case numbers recorded by surgeons in training, and annual review of competency progression (ARCP) outcomes in the UK. Methods Anonymized operative logbook numbers were collated from electronic logbook and ARCP outcome data from the Intercollegiate Surgical Curriculum Programme database for trainees in the 10 surgical specialty training specialties. Operative logbook numbers and awarded ARCP outcomes were compared between predefined dates. Effect sizes are reported as incident rate ratios (IRR) with 95 per cent confidence intervals. Results Some 5599 surgical trainees in 2019, and 5310 in surgical specialty training in 2020 were included. The IRR was reduced across all specialties as a result of the COVID-19 pandemic (0.62; 95 per cent c.i. 0.60 to 0.64). Elective surgery (0.53; 95 per cent c.i. 0.50 to 0.56) was affect...
Proceedings of the National Academy of Sciences of the United States of America, Sep 21, 2017
The human genome contains ∼30,000 CpG islands (CGIs). While CGIs associated with promoters nearly... more The human genome contains ∼30,000 CpG islands (CGIs). While CGIs associated with promoters nearly always remain unmethylated, many of the ∼9,000 CGIs lying within gene bodies become methylated during development and differentiation. Both promoter and intragenic CGIs may also become abnormally methylated as a result of genome rearrangements and in malignancy. The epigenetic mechanisms by which some CGIs become methylated but others, in the same cell, remain unmethylated in these situations are poorly understood. Analyzing specific loci and using a genome-wide analysis, we show that transcription running across CGIs, associated with specific chromatin modifications, is required for DNA methyltransferase 3B (DNMT3B)-mediated DNA methylation of many naturally occurring intragenic CGIs. Importantly, we also show that a subgroup of intragenic CGIs is not sensitive to this process of transcription-mediated methylation and that this correlates with their individual intrinsic capacity to ini...
International journal of surgery (London, England), Mar 3, 2017
Traditionally few students have had the opportunity to contribute to high-quality clinical resear... more Traditionally few students have had the opportunity to contribute to high-quality clinical research. Over the last five years, collaborative networks have empowered students and trainees to participate in high-impact multicentre studies that have potential to change clinical practice and improve patient care. The UK Foundation Programme Application System (FPAS) should recognise the significant contributions of students participating in collaborative studies when ranking final year medical students applying for the Foundation Programme, encouraging a culture of positive engagement with audit and research. Postgraduate research collaboratives are regional and national networks of trainees who work together to run prospective multicentre research which identify and address areas of practice where there is a need for research for patient benefit [1]. For example, the National Sepsis Audit investigated the care of emergency general surgery patients, finding that whilst sepsis is a common presentation, adherence to severe sepsis guidelines is incomplete in the majority of patients [2]. Similarly, the National Appendicectomy Audit found wide variation in the care and outcomes of patients undergoing appendicectomy, challenging surgeons to evaluate their outcomes more closely [3]. Trainee collaboratives have also run randomised controlled trials, such as Reinforcement of Closure of Stoma Site, a trial testing a novel surgical intervention; prophylactic biological mesh to prevent incisional hernia following stoma closure [4]. Inspired by the well-established postgraduate trainee research collaborative model, Student Audit and Research in Surgery (STARSurg; www.starsurg.org) is a student-driven, national research network across the UK and Ireland. Founded in 2013, it aims to engage students in multicentre research studies early in their career, embedding clinical research as a fundamental part of their future evidence-based medical practice.
There is an increasing drive in medical education to utilize technology to augment teaching and l... more There is an increasing drive in medical education to utilize technology to augment teaching and learning. Portable media players facilitate the accessibility of materials and allow e-learning whilst away from desk-based computers. Audio and video podcasts are becoming more popular as bandwidth increases, allowing for larger files such as videos to be used. Teaching videos are not novel, but the availability of portable media players allows ubiquitous consumption. Studies have previously demonstrated the effectiveness of audio podcasts as a teaching medium (Atreja et al. 2008; Shantikumar 2009). An anonymous questionnaire was designed to probe the knowledge and use of podcasting among medical students. The uptake of podcasting was high with 98% having used audio podcasts and 53% video podcasts (100 responses). 94% of students have a media player capable of playing audio files and 60% video files. Students were very interested in using podcasts on portable players with 46% rating it 10/10 (mean 8.27/10). When asked if podcasting could replace teaching sessions, the mean score was 2.59/10. The mean score increased to 9.11/10 in response to being asked whether podcasts should augment existing teaching (p 0.0001, Students t-test). A key advantage of podcasting is that it allows students to take their revision with them on the move. Media players allow students to utilize both audio (94%) and video (60%) podcasts at home or in the hospital. E-learning provides a suitable medium for those unable to attend didactic lectures. Students on the whole were keen to see podcasts being utilized as a part of their curriculum; however the idea of podcasting replacing teaching sessions was rejected. Those involved in the teaching of medical students should be aware of the current high uptake of podcasts by students. Teachers considering making available their own content should be encouraged as it will be well received and widely utilized.
Introduction: A rectus sheath haematoma is a rare condition that arises from the accumulation of ... more Introduction: A rectus sheath haematoma is a rare condition that arises from the accumulation of blood within the rectus sheath from either muscular tear or rupture of the epigastric vessels. It is a known complication of either blunt abdominal trauma, anticoagulation therapy or the repetitive contraction of the rectus muscle such as paroxysms of coughing. It remains an uncommon and elusive entity and is often clinically misdiagnosed. Case presentation: An 80-year-old British man with a known aortic aneurysm was admitted with sudden onset of right iliac fossa pain. The patient was hemodynamically stable and underwent a computed tomography scan which revealed an intact aorta and an acute rectus sheath hematoma. Conclusion: To the best of our knowledge, no case has previously been reported involving the diagnostic challenge of a rectus sheath hematoma in a patient with a known aortic aneurysm. Here we discuss the symptoms and signs of a rectus sheath hematoma, as well as the radiological modalities that could be utilized to reach the diagnosis. Case presentation An 80-year-old British Caucasian man with a known abdominal aortic aneurysm was brought to the Accident
The aim of surgical training across the 10 surgical specialties is to produce competent day 1 con... more The aim of surgical training across the 10 surgical specialties is to produce competent day 1 consultants. Progression through training in the UK is assessed by the Annual Review of Competency Progression (ARCP).ObjectiveThis study aimed to examine variation in ARCP outcomes within surgical training and identify differences in outcomes between specialties.DesignA national cohort study using data from the UK Medical Education Database was performed. ARCP outcome was the primary outcome measure. Multilevel ordinal regression analyses were performed, with ARCP outcomes nested within trainees.ParticipantsHigher surgical trainees (ST3–ST8) from nine UK surgical specialties were included (vascular surgery was excluded due to insufficient data). All surgical trainees across the UK with an ARCP outcome between 2010 and 2017 were included.ResultsEight thousand two hundred and twenty trainees with an ARCP outcome awarded between 2010 and 2017 were included, comprising 31 788 ARCP outcomes. Th...
Aims COVID-19 has had a global impact on all aspects of healthcare including surgical teaching an... more Aims COVID-19 has had a global impact on all aspects of healthcare including surgical teaching and training. This study aimed to quantify the impact of COVID-19 on operative case numbers recorded by surgeons in training, and annual review of competency progression (ARCP) outcomes in the United Kingdom. Methods Anonymised operative logbook numbers were collated from e-logbook and ARCP outcome data were collated from the Intercollegiate Surgical Curriculum Programme (ISCP) database for trainees across core and the ten higher surgical specialities. Operative logbook numbers and ARCP outcomes were compared between pre-COVID dates. Effect sizes are reported as incident rate ratios (IRR) with 95% confidence intervals (CI). Results 5599 surgical trainees in 2019 and 5310 in 2020 in surgical specialty training were included. The IRR was reduced across all subspecialties because of the COVID-19 pandemic (0.55; 95% CI 0.53-0.57). Elective surgery (0.60; 95% CI 0.59-0.61) was affected more tha...
The PITSTOP study is a multi centre UK observational study looking at the treatment outcomes for ... more The PITSTOP study is a multi centre UK observational study looking at the treatment outcomes for pilonidal sinus disease. To identify healing rates, recurrence and re-intervention, we will recruit consecutive, consenting adults with pilonidal sinus, considered suitable for surgery in NHS trusts with large pilonidal practices. Classification will be by anatomy/pathology of pit and tracks. We will record method of excision (minimal, major, curettage) and closure (none, midline, lateral, flap, glue, phenol injection). A survey of current practice will be conducted with current consultants in the UK also to assess current treatment practices for pilonidal sinus disease. To get an overview of patient views and experiences as well as assess which interventions patients would rather avoid and which outcomes are they most value, we will conduct brief semi-structured interviews. This is to assess which interventions patients would rather avoid and which outcomes they most value. A Discrete C...
After wide consultation with trainees, trainers, employers and other stakeholders, the new Genera... more After wide consultation with trainees, trainers, employers and other stakeholders, the new General Surgical Curriculum was approved earlier this year and will be implemented from 4 August 2021. It will be outcome based and will be the biggest change in surgical training since 2007. Trainees can progress at their own rate and complete when they have acquired the capabilities of a Day-1 consultant in general surgery with a special interest. The Multiple Consultant Report (MCR) is new and has been developed as the main assessment tool for this outcomes-based curriculum. Assessment in the MCR will be on progress from the ability to only observe at the start of training, to performance at the level of Day-1 consultant in the complex, integrated skills needed for the day-to-day performance of the role in each of the areas of the job (the Capabilities in Practice). The MCR and trainee self assessment will improve feedback and allow specific and bespoke agreed learning objectives to be more...
Delay to closure of ileostomy following anterior resection for rectal cancer may impair postopera... more Delay to closure of ileostomy following anterior resection for rectal cancer may impair postoperative bowel function and quality of life. We analysed time to ileostomy closure across the UK and investigated factors delaying closure.
Background Attrition within surgical training is a challenge. In the USA, attrition rates are as ... more Background Attrition within surgical training is a challenge. In the USA, attrition rates are as high as 20–26%. The factors predicting attrition are not well known. The aim of this systematic review is to identify factors that influence attrition or performance during surgical training. Method The review was performed in line with PRISMA guidelines and registered with the Open Science Framework (OSF). Medline, EMBASE, PubMed and the Cochrane Central Register of Controlled Trials were searched for articles. Risk of bias was assessed using the Newcastle–Ottawa scale. Pooled estimates were calculated using random effects meta-analyses in STATA version 15 (Stata Corp Ltd). A sensitivity analysis was performed including only multi-institutional studies. Results The searches identified 3486 articles, of which 31 were included, comprising 17,407 residents. Fifteen studies were based on multi-institutional data and 16 on single-institutional data. Twenty-nine of the studies are based on US...
Surgical site infection (SSI) is one of the most common infections associated with health care, b... more Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with e...
Introduction Several surgical options exist for the treatment of haemorrhoids, with rubber band l... more Introduction Several surgical options exist for the treatment of haemorrhoids, with rubber band ligation (RBL) being the commonest. Long term outcome data for RBL is sparse. We investigate the effectiveness of RBL haemorrhoids in the outpatient setting. Method Data for consecutive patients undergoing RBL of haemorrhoids between January 2013–January 2014 was collected retrospectively. Patients were followed up for a minimum of one year with specific data collected for previous treatments, proctoscopic appearances, and outcomes after RBL. Results Two hundred and sixty four patients [145 males, median age 52 years (range 19–94)] underwent RBL. In 177 this episode of RBL was their first intervention for haemorrhoids, with the remaining patients having previously had several different treatments including RBL (31%, n = 81), surgery (3%, n = 7) and sclerotherapy (<1%, n = 1). Median time between previous treatments and RBL was 1 year (range 1 month- 30 years). The number of haemorrhoids was noted in 65% of patients (n = 177; solitary haemorrhoid 23% n = 40, multiple haemorrhoids 77% n = 137). Grade was recorded in 94/264: 1% Grade I (n = 11), 26% Grade II (n = 46), 19% Grade III (n = 33), 2% Grade IV (n = 4). Post RBL 88% (n = 231) of patients were offered 10 week open outpatient appointment as per local protocol, 11 patients (4%) were discharged and 22 (8%) were given specific dates for follow up (median 10 months (range 4–20 months)). 17% required further investigation: endoscopy in 16% (n = 44, where 37/44 were patients over the age of 50 years which follows local protocol for rectal bleed), defecating proctography in 2 patients and CT pneumocolon in 2 patients. At 1-year post RBL 72% (n = 192) of patients had not returned, but the remaining 72 were re-referred (mean time 8 months, standard deviation 154 days) with recurrent symptoms. Further treatment was with repeat RBL (n = 30) and surgery (n = 33), 1 patient referred to dermatology, one patient was referred to gastroenterology with proctitis. Seven patients returning to clinic either declined further banding or data was unavailable. Conclusion Patients presenting with haemorrhoids can be treated with RBL and then discharged (notwithstanding local protocols for exclusion of malignancy in patients over a certain age with PR bleeding). Three quarters will not return with further symptoms and the remainder will not represent for a year, so making planned follow up unnecessary. Disclosure of interest None Declared.
Aims A significant proportion of patients never fully recover baseline activity levels following ... more Aims A significant proportion of patients never fully recover baseline activity levels following major abdominal surgery. Postoperative muscle atrophy may be a major contributing factor to this, but is often overlooked. This study aimed to quantify the degree of muscle loss in patients undergoing routine recovery following major abdominal surgery and in patients admitted to critical care. Methods Fifteen patients undergoing major open colorectal resection were recruited. Cross surface area (CSA) and muscle thickness (MT) of a quadriceps muscle, Vastus Lateralis (VL) were measured pre-operatively and on post-operative day (POD) 5 using ultrasound. Knee extension strength was also measured pre-operatively and on POD5 using a handheld dynamometer. A systematic literature review was performed to identify studies reporting muscle loss in patients admitted to an intensive treatment unit (ITU), with pooled means of changes in quadriceps muscle CSA calculated. Results By POD 5 VL CSA had de...
Aims Significant loss of muscle mass and function occurs after major abdominal surgery. Neuromusc... more Aims Significant loss of muscle mass and function occurs after major abdominal surgery. Neuromuscular electrical stimulation (NMES) has been shown to reduce muscle atrophy in some patient groups, but evidence in postoperative patients is limited. This study assesses the efficacy of NMES in attenuating muscle atrophy following major abdominal surgery. Methods Fifteen patients undergoing open colorectal resection were recruited to a split body randomised control trial and their lower limbs randomised to control (CON) or NMES (STIM). The STIM limb underwent 15 minutes of quadriceps NMES twice daily on postoperative day (POD) 1 to 4. Ultrasound measurement of Vastus Lateralis (VL) cross sectional area (CSA) and muscle thickness (MT) was made preoperatively and on POD 5, as was dynamometer measurement of knee extensor strength (KES). All outcomes were analysed using linear mixed model techniques. The study was approved by NHS research ethics committee (ref 20/EM/069). Results NMES signif...
Background COVID-19 has had a global impact on all aspects of healthcare including surgical train... more Background COVID-19 has had a global impact on all aspects of healthcare including surgical training. This study aimed to quantify the impact of COVID-19 on operative case numbers recorded by surgeons in training, and annual review of competency progression (ARCP) outcomes in the UK. Methods Anonymized operative logbook numbers were collated from electronic logbook and ARCP outcome data from the Intercollegiate Surgical Curriculum Programme database for trainees in the 10 surgical specialty training specialties. Operative logbook numbers and awarded ARCP outcomes were compared between predefined dates. Effect sizes are reported as incident rate ratios (IRR) with 95 per cent confidence intervals. Results Some 5599 surgical trainees in 2019, and 5310 in surgical specialty training in 2020 were included. The IRR was reduced across all specialties as a result of the COVID-19 pandemic (0.62; 95 per cent c.i. 0.60 to 0.64). Elective surgery (0.53; 95 per cent c.i. 0.50 to 0.56) was affect...
Proceedings of the National Academy of Sciences of the United States of America, Sep 21, 2017
The human genome contains ∼30,000 CpG islands (CGIs). While CGIs associated with promoters nearly... more The human genome contains ∼30,000 CpG islands (CGIs). While CGIs associated with promoters nearly always remain unmethylated, many of the ∼9,000 CGIs lying within gene bodies become methylated during development and differentiation. Both promoter and intragenic CGIs may also become abnormally methylated as a result of genome rearrangements and in malignancy. The epigenetic mechanisms by which some CGIs become methylated but others, in the same cell, remain unmethylated in these situations are poorly understood. Analyzing specific loci and using a genome-wide analysis, we show that transcription running across CGIs, associated with specific chromatin modifications, is required for DNA methyltransferase 3B (DNMT3B)-mediated DNA methylation of many naturally occurring intragenic CGIs. Importantly, we also show that a subgroup of intragenic CGIs is not sensitive to this process of transcription-mediated methylation and that this correlates with their individual intrinsic capacity to ini...
International journal of surgery (London, England), Mar 3, 2017
Traditionally few students have had the opportunity to contribute to high-quality clinical resear... more Traditionally few students have had the opportunity to contribute to high-quality clinical research. Over the last five years, collaborative networks have empowered students and trainees to participate in high-impact multicentre studies that have potential to change clinical practice and improve patient care. The UK Foundation Programme Application System (FPAS) should recognise the significant contributions of students participating in collaborative studies when ranking final year medical students applying for the Foundation Programme, encouraging a culture of positive engagement with audit and research. Postgraduate research collaboratives are regional and national networks of trainees who work together to run prospective multicentre research which identify and address areas of practice where there is a need for research for patient benefit [1]. For example, the National Sepsis Audit investigated the care of emergency general surgery patients, finding that whilst sepsis is a common presentation, adherence to severe sepsis guidelines is incomplete in the majority of patients [2]. Similarly, the National Appendicectomy Audit found wide variation in the care and outcomes of patients undergoing appendicectomy, challenging surgeons to evaluate their outcomes more closely [3]. Trainee collaboratives have also run randomised controlled trials, such as Reinforcement of Closure of Stoma Site, a trial testing a novel surgical intervention; prophylactic biological mesh to prevent incisional hernia following stoma closure [4]. Inspired by the well-established postgraduate trainee research collaborative model, Student Audit and Research in Surgery (STARSurg; www.starsurg.org) is a student-driven, national research network across the UK and Ireland. Founded in 2013, it aims to engage students in multicentre research studies early in their career, embedding clinical research as a fundamental part of their future evidence-based medical practice.
There is an increasing drive in medical education to utilize technology to augment teaching and l... more There is an increasing drive in medical education to utilize technology to augment teaching and learning. Portable media players facilitate the accessibility of materials and allow e-learning whilst away from desk-based computers. Audio and video podcasts are becoming more popular as bandwidth increases, allowing for larger files such as videos to be used. Teaching videos are not novel, but the availability of portable media players allows ubiquitous consumption. Studies have previously demonstrated the effectiveness of audio podcasts as a teaching medium (Atreja et al. 2008; Shantikumar 2009). An anonymous questionnaire was designed to probe the knowledge and use of podcasting among medical students. The uptake of podcasting was high with 98% having used audio podcasts and 53% video podcasts (100 responses). 94% of students have a media player capable of playing audio files and 60% video files. Students were very interested in using podcasts on portable players with 46% rating it 10/10 (mean 8.27/10). When asked if podcasting could replace teaching sessions, the mean score was 2.59/10. The mean score increased to 9.11/10 in response to being asked whether podcasts should augment existing teaching (p 0.0001, Students t-test). A key advantage of podcasting is that it allows students to take their revision with them on the move. Media players allow students to utilize both audio (94%) and video (60%) podcasts at home or in the hospital. E-learning provides a suitable medium for those unable to attend didactic lectures. Students on the whole were keen to see podcasts being utilized as a part of their curriculum; however the idea of podcasting replacing teaching sessions was rejected. Those involved in the teaching of medical students should be aware of the current high uptake of podcasts by students. Teachers considering making available their own content should be encouraged as it will be well received and widely utilized.
Introduction: A rectus sheath haematoma is a rare condition that arises from the accumulation of ... more Introduction: A rectus sheath haematoma is a rare condition that arises from the accumulation of blood within the rectus sheath from either muscular tear or rupture of the epigastric vessels. It is a known complication of either blunt abdominal trauma, anticoagulation therapy or the repetitive contraction of the rectus muscle such as paroxysms of coughing. It remains an uncommon and elusive entity and is often clinically misdiagnosed. Case presentation: An 80-year-old British man with a known aortic aneurysm was admitted with sudden onset of right iliac fossa pain. The patient was hemodynamically stable and underwent a computed tomography scan which revealed an intact aorta and an acute rectus sheath hematoma. Conclusion: To the best of our knowledge, no case has previously been reported involving the diagnostic challenge of a rectus sheath hematoma in a patient with a known aortic aneurysm. Here we discuss the symptoms and signs of a rectus sheath hematoma, as well as the radiological modalities that could be utilized to reach the diagnosis. Case presentation An 80-year-old British Caucasian man with a known abdominal aortic aneurysm was brought to the Accident
The aim of surgical training across the 10 surgical specialties is to produce competent day 1 con... more The aim of surgical training across the 10 surgical specialties is to produce competent day 1 consultants. Progression through training in the UK is assessed by the Annual Review of Competency Progression (ARCP).ObjectiveThis study aimed to examine variation in ARCP outcomes within surgical training and identify differences in outcomes between specialties.DesignA national cohort study using data from the UK Medical Education Database was performed. ARCP outcome was the primary outcome measure. Multilevel ordinal regression analyses were performed, with ARCP outcomes nested within trainees.ParticipantsHigher surgical trainees (ST3–ST8) from nine UK surgical specialties were included (vascular surgery was excluded due to insufficient data). All surgical trainees across the UK with an ARCP outcome between 2010 and 2017 were included.ResultsEight thousand two hundred and twenty trainees with an ARCP outcome awarded between 2010 and 2017 were included, comprising 31 788 ARCP outcomes. Th...
Aims COVID-19 has had a global impact on all aspects of healthcare including surgical teaching an... more Aims COVID-19 has had a global impact on all aspects of healthcare including surgical teaching and training. This study aimed to quantify the impact of COVID-19 on operative case numbers recorded by surgeons in training, and annual review of competency progression (ARCP) outcomes in the United Kingdom. Methods Anonymised operative logbook numbers were collated from e-logbook and ARCP outcome data were collated from the Intercollegiate Surgical Curriculum Programme (ISCP) database for trainees across core and the ten higher surgical specialities. Operative logbook numbers and ARCP outcomes were compared between pre-COVID dates. Effect sizes are reported as incident rate ratios (IRR) with 95% confidence intervals (CI). Results 5599 surgical trainees in 2019 and 5310 in 2020 in surgical specialty training were included. The IRR was reduced across all subspecialties because of the COVID-19 pandemic (0.55; 95% CI 0.53-0.57). Elective surgery (0.60; 95% CI 0.59-0.61) was affected more tha...
The PITSTOP study is a multi centre UK observational study looking at the treatment outcomes for ... more The PITSTOP study is a multi centre UK observational study looking at the treatment outcomes for pilonidal sinus disease. To identify healing rates, recurrence and re-intervention, we will recruit consecutive, consenting adults with pilonidal sinus, considered suitable for surgery in NHS trusts with large pilonidal practices. Classification will be by anatomy/pathology of pit and tracks. We will record method of excision (minimal, major, curettage) and closure (none, midline, lateral, flap, glue, phenol injection). A survey of current practice will be conducted with current consultants in the UK also to assess current treatment practices for pilonidal sinus disease. To get an overview of patient views and experiences as well as assess which interventions patients would rather avoid and which outcomes are they most value, we will conduct brief semi-structured interviews. This is to assess which interventions patients would rather avoid and which outcomes they most value. A Discrete C...
After wide consultation with trainees, trainers, employers and other stakeholders, the new Genera... more After wide consultation with trainees, trainers, employers and other stakeholders, the new General Surgical Curriculum was approved earlier this year and will be implemented from 4 August 2021. It will be outcome based and will be the biggest change in surgical training since 2007. Trainees can progress at their own rate and complete when they have acquired the capabilities of a Day-1 consultant in general surgery with a special interest. The Multiple Consultant Report (MCR) is new and has been developed as the main assessment tool for this outcomes-based curriculum. Assessment in the MCR will be on progress from the ability to only observe at the start of training, to performance at the level of Day-1 consultant in the complex, integrated skills needed for the day-to-day performance of the role in each of the areas of the job (the Capabilities in Practice). The MCR and trainee self assessment will improve feedback and allow specific and bespoke agreed learning objectives to be more...
Delay to closure of ileostomy following anterior resection for rectal cancer may impair postopera... more Delay to closure of ileostomy following anterior resection for rectal cancer may impair postoperative bowel function and quality of life. We analysed time to ileostomy closure across the UK and investigated factors delaying closure.
Background Attrition within surgical training is a challenge. In the USA, attrition rates are as ... more Background Attrition within surgical training is a challenge. In the USA, attrition rates are as high as 20–26%. The factors predicting attrition are not well known. The aim of this systematic review is to identify factors that influence attrition or performance during surgical training. Method The review was performed in line with PRISMA guidelines and registered with the Open Science Framework (OSF). Medline, EMBASE, PubMed and the Cochrane Central Register of Controlled Trials were searched for articles. Risk of bias was assessed using the Newcastle–Ottawa scale. Pooled estimates were calculated using random effects meta-analyses in STATA version 15 (Stata Corp Ltd). A sensitivity analysis was performed including only multi-institutional studies. Results The searches identified 3486 articles, of which 31 were included, comprising 17,407 residents. Fifteen studies were based on multi-institutional data and 16 on single-institutional data. Twenty-nine of the studies are based on US...
Surgical site infection (SSI) is one of the most common infections associated with health care, b... more Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with e...
Introduction Several surgical options exist for the treatment of haemorrhoids, with rubber band l... more Introduction Several surgical options exist for the treatment of haemorrhoids, with rubber band ligation (RBL) being the commonest. Long term outcome data for RBL is sparse. We investigate the effectiveness of RBL haemorrhoids in the outpatient setting. Method Data for consecutive patients undergoing RBL of haemorrhoids between January 2013–January 2014 was collected retrospectively. Patients were followed up for a minimum of one year with specific data collected for previous treatments, proctoscopic appearances, and outcomes after RBL. Results Two hundred and sixty four patients [145 males, median age 52 years (range 19–94)] underwent RBL. In 177 this episode of RBL was their first intervention for haemorrhoids, with the remaining patients having previously had several different treatments including RBL (31%, n = 81), surgery (3%, n = 7) and sclerotherapy (<1%, n = 1). Median time between previous treatments and RBL was 1 year (range 1 month- 30 years). The number of haemorrhoids was noted in 65% of patients (n = 177; solitary haemorrhoid 23% n = 40, multiple haemorrhoids 77% n = 137). Grade was recorded in 94/264: 1% Grade I (n = 11), 26% Grade II (n = 46), 19% Grade III (n = 33), 2% Grade IV (n = 4). Post RBL 88% (n = 231) of patients were offered 10 week open outpatient appointment as per local protocol, 11 patients (4%) were discharged and 22 (8%) were given specific dates for follow up (median 10 months (range 4–20 months)). 17% required further investigation: endoscopy in 16% (n = 44, where 37/44 were patients over the age of 50 years which follows local protocol for rectal bleed), defecating proctography in 2 patients and CT pneumocolon in 2 patients. At 1-year post RBL 72% (n = 192) of patients had not returned, but the remaining 72 were re-referred (mean time 8 months, standard deviation 154 days) with recurrent symptoms. Further treatment was with repeat RBL (n = 30) and surgery (n = 33), 1 patient referred to dermatology, one patient was referred to gastroenterology with proctitis. Seven patients returning to clinic either declined further banding or data was unavailable. Conclusion Patients presenting with haemorrhoids can be treated with RBL and then discharged (notwithstanding local protocols for exclusion of malignancy in patients over a certain age with PR bleeding). Three quarters will not return with further symptoms and the remainder will not represent for a year, so making planned follow up unnecessary. Disclosure of interest None Declared.
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Papers by Jon Lund