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Lathan R, Hitchman L, Walshaw J, Ravindhran B, Carradice D, Smith G, Chetter I, Yiasemidou M. Telemedicine for sustainable postoperative follow-up: a prospective pilot study evaluating the hybrid life-cycle assessment approach to carbon footprint analysis. Front Surg 2024; 11:1300625. [PMID: 38562585 PMCID: PMC10982357 DOI: 10.3389/fsurg.2024.1300625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 02/28/2024] [Indexed: 04/04/2024] Open
Abstract
Introduction Surgical site infections (SSI) are the most common healthcare-associated infections; however, access to healthcare services, lack of patient awareness of signs, and inadequate wound surveillance can limit timely diagnosis. Telemedicine as a method for remote postoperative follow-up has been shown to improve healthcare efficiency without compromising clinical outcomes. Furthermore, telemedicine would reduce the carbon footprint of the National Health Service (NHS) through minimising patient travel, a significant contributor of carbon dioxide equivalent (CO2e) emissions. Adopting innovative approaches, such as telemedicine, could aid in the NHS Net-Zero target by 2045. This study aimed to provide a comprehensive analysis of the feasibility and sustainability of telemedicine postoperative follow-up for remote diagnosis of SSI. Methods Patients who underwent a lower limb vascular procedure were reviewed remotely at 30 days following the surgery, with a combined outcome measure (photographs and Bluebelle Wound Healing Questionnaire). A hybrid life-cycle assessment approach to carbon footprint analysis was used. The kilograms of carbon dioxide equivalent (kgCO2e) associated with remote methods were mapped prospectively. A simple outpatient clinic review, i.e., no further investigations or management required, was modelled for comparison. The Department of Environment, Food, and Rural Affairs (DEFRA) conversion factors plus healthcare specific sources were used to ascertain kgCO2e. Patient postcodes were applied to conversion factors based upon mode of travel to calculate kgCO2e for patient travel. Total and median (interquartile range) carbon emissions saved were presented for both patients with and without SSI. Results Altogether 31 patients (M:F 2.4, ±11.7 years) were included. The median return distance for patient travel was 42.5 (7.2-58.7) km. Median reduction in emissions using remote follow-up was 41.2 (24.5-80.3) kgCO2e per patient (P < 0.001). The carbon offsetting value of remote follow-up is planting one tree for every 6.9 patients. Total carbon footprint of face-to-face follow-up was 2,895.3 kgCO2e, compared with 1,301.3 kgCO2e when using a remote-first approach (P < 0.001). Carbon emissions due to participants without SSI were 700.2 kgCO2e by the clinical method and 28.8 kgCO2e from the remote follow-up. Discussion This model shows that the hybrid life-cycle assessment approach is achievable and reproducible. Implementation of an asynchronous digital follow-up model is effective in substantially reducing the carbon footprint of a tertiary vascular surgical centre. Further work is needed to corroborate these findings on a larger scale, quantify the impact of telemedicine on patient's quality of life, and incorporate kgCO2e into the cost analysis of potential SSI monitoring strategies.
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Affiliation(s)
- Ross Lathan
- Academic Vascular Surgical Unit, Hull University Teaching Hospital NHS Trust, Hull, United Kingdom
- Centre for Clinical Sciences, Hull York Medical School, Hull, United Kingdom
- Department of Health Sciences, University of York, York, United Kingdom
| | - Louise Hitchman
- Academic Vascular Surgical Unit, Hull University Teaching Hospital NHS Trust, Hull, United Kingdom
- Centre for Clinical Sciences, Hull York Medical School, Hull, United Kingdom
| | - Josephine Walshaw
- Academic Vascular Surgical Unit, Hull University Teaching Hospital NHS Trust, Hull, United Kingdom
- Centre for Clinical Sciences, Hull York Medical School, Hull, United Kingdom
| | - Bharadhwaj Ravindhran
- Academic Vascular Surgical Unit, Hull University Teaching Hospital NHS Trust, Hull, United Kingdom
- Centre for Clinical Sciences, Hull York Medical School, Hull, United Kingdom
| | - Daniel Carradice
- Academic Vascular Surgical Unit, Hull University Teaching Hospital NHS Trust, Hull, United Kingdom
- Centre for Clinical Sciences, Hull York Medical School, Hull, United Kingdom
| | - George Smith
- Academic Vascular Surgical Unit, Hull University Teaching Hospital NHS Trust, Hull, United Kingdom
- Centre for Clinical Sciences, Hull York Medical School, Hull, United Kingdom
| | - Ian Chetter
- Academic Vascular Surgical Unit, Hull University Teaching Hospital NHS Trust, Hull, United Kingdom
- Centre for Clinical Sciences, Hull York Medical School, Hull, United Kingdom
| | - Marina Yiasemidou
- Centre for Clinical Sciences, Hull York Medical School, Hull, United Kingdom
- The Royal London, Barts Health NHS Trust, London, United Kingdom
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Dexter E, Walshaw J, Wynn H, Dimashki S, Leo A, Lindsey I, Yiasemidou M. Faecal incontinence-a comprehensive review. Front Surg 2024; 11:1340720. [PMID: 38362459 PMCID: PMC10867159 DOI: 10.3389/fsurg.2024.1340720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Accepted: 01/18/2024] [Indexed: 02/17/2024] Open
Abstract
Introduction Faecal incontinence (FI) is a distressing and often stigmatizing condition characterised as the recurrent involuntary passage of liquid or solid faeces. The reported prevalence of FI exhibits considerable variation, ranging from 7 to 15% in the general population, with higher rates reported among older adults and women. This review explores the pathophysiology mechanisms, the diagnostic modalities and the efficiency of treatment options up to date. Methods A review of the literature was conducted to identify the pathophysiological pathways, investigation and treatment modalities. Result and discussion This review provides an in-depth exploration of the intricate physiological processes that maintain continence in humans. It then guides the reader through a detailed examination of diagnostic procedures and a thorough analysis of the available treatment choices, including their associated success rates. This review is an ideal resource for individuals with a general medical background and colorectal surgeons who lack specialized knowledge in pelvic floor disorders, as it offers a comprehensive understanding of the mechanisms, diagnosis, and treatment of faecal incontinence (FI).
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Affiliation(s)
- Eloise Dexter
- Colorectal Surgery, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
| | - Josephine Walshaw
- Leeds Institute of Medical Research, St James’ University Hospital, University of Leeds, Leeds, United Kingdom
- Department of Health Research, University of York, York, United Kingdom
| | - Hannah Wynn
- Upper Gastrointestinal Surgery, York and Scarborough Teaching Hospitals NHS Foundation Trust, York, United Kingdom
| | - Safaa Dimashki
- Plastic Surgery, Mid Yorkshire Teaching NHS Trust, Wakefield, United Kingdom
| | - Alex Leo
- Colorectal Surgery, The Royal London Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Ian Lindsey
- Colorectal Surgery, Oxford University Hospitals, Oxford, United Kingdom
| | - Marina Yiasemidou
- Colorectal Surgery, The Royal London Hospital, Barts Health NHS Trust, London, United Kingdom
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Westwood E, Walshaw J, Boag K, Chua W, Dimashki S, Khalid H, Lathan R, Wellington J, Lockwood S, Yiasemidou M. Time for change: compliance with RCS green theatre checklist-facilitators and barriers on the journey to net zero. Front Surg 2023; 10:1260301. [PMID: 37942001 PMCID: PMC10628494 DOI: 10.3389/fsurg.2023.1260301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 09/27/2023] [Indexed: 11/10/2023] Open
Abstract
Background Climate change is an era-defining health concern, with healthcare related emissions paradoxically compounding negative impacts. The NHS produces 5% of the UK's carbon footprint, with operating theatres a recognised carbon hotspot. NHS England aims to become Net Zero by 2045. Consequently, UK Royal Colleges of Surgery have published guidance to foster an evidence-based sustainable transformation in surgical practice. Methods A single-centre quality improvement project was undertaken, aiming to provide an overview of sustainable practice locally. The Intercollegiate "Green Theatre Checklist" was taken as an audit standard, focusing on "preparing for surgery" and "intraoperative equipment" subsections. Any general surgical procedure was eligible for inclusion. Usage of reusable textiles, non-sterile gloves, catheters, antibiotics, alcohol vs. water-based scrub techniques, skin sterilisation choices, and skin closure materials were recorded. Baseline data collection occurred over a 3 week period, followed by dissemination of results locally via clinical governance meetings and poster displays. A re-audit of practice was conducted using the same methodology and duration. Results Datasets 1 (n = 23) and 2 (n = 23) included open (n = 22), laparoscopic (n = 24), elective (n = 22) and non-elective (n = 24) cases. Good practice was demonstrated in reusable textiles (trolley covers 96%, 78%, drapes 100%, 92%) however procurement issues reduced otherwise good reusable gown use in Dataset 2 in (90%, 46%). No unnecessary catheter use was identified, and loose skin preparations were used unanimously. Uptake of alcohol-based scrubbing techniques was low (15%, 17%) and unnecessary non-sterile glove use was observed in >30% of procedures. All laparoscopic ports and scissors were single use. Carbon footprints were 128.27 kgCO2e and 117.71 kgCO2e in datasets 1 and 2 respectively. Conclusion This project evidences good practice alongside future local focus areas for improved sustainability. Adoption of hybrid laparoscopic instruments, avoiding unnecessary equipment opening, and standardising reusable materials could reduce carbon and environmental impact considerably. Successful implementation requires considered procurement practices, improved awareness and education, clear leadership, and a sustained cultural shift within the healthcare community. Collaboration among professional institutions and access to supporting evidence is crucial in driving engagement and empowering clinicians to make locally relevant changes a reality.
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Affiliation(s)
- Elizabeth Westwood
- General Surgery, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, United Kingdom
| | - Josephine Walshaw
- Department of Health Research, University of York, York, United Kingdom
- General Surgery, Hull University Teaching Hospitals NHS Trust, Hull, United Kingdom
- Clinical Sciences Centre, Hull York Medical School, Hull, United Kingdom
| | - Katie Boag
- General Surgery, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, United Kingdom
- Leeds Institute of Medical Research, St. James's University Hospital, University of Leeds, Leeds, United Kingdom
| | - WeiYing Chua
- School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Safaa Dimashki
- General Surgery, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, United Kingdom
| | - Hammaad Khalid
- General Surgery, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, United Kingdom
| | - Ross Lathan
- Clinical Sciences Centre, Hull York Medical School, Hull, United Kingdom
- Academic Unit of Vascular Surgery, Hull University Teaching Hospitals NHS Trust, Hull, United Kingdom
| | - Jack Wellington
- School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Sonia Lockwood
- General Surgery, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, United Kingdom
| | - Marina Yiasemidou
- Clinical Sciences Centre, Hull York Medical School, Hull, United Kingdom
- Colorectal Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
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Dexter E, Walshaw J, Brown A, Nadeem T, Yiasemidou M, Lo T. Improving weekend handover in a teaching hospital elective general surgery department. Front Surg 2023; 10:1263502. [PMID: 37869422 PMCID: PMC10587553 DOI: 10.3389/fsurg.2023.1263502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 09/11/2023] [Indexed: 10/24/2023] Open
Abstract
Background Effective documentation and transfer of clinical information are vital for the continuity of care, patient safety, and maintaining medico-legal records, as outlined by the Royal College of Surgeons "Safe Handover: Guidance from the Working Time Directive working party". Our elective surgery weekend team cross-covers both Colorectal and Upper Gastrointestinal surgical specialties across multiple wards, which poses a significant challenge. The aim of this study was to improve the documentation of patients' weekend plans through the introduction of a weekend handover proforma. Method We reviewed the weekend plans of 199 patients overall. 41 records were initially reviewed over a 2-week period. The surgical multidisciplinary team was then surveyed to establish the need for an improved weekend handover. Following this, a weekend handover proforma was introduced as part of the Friday ward round and education on the expectations were provided at a local Surgery Clinical Governance meeting. The documentation of the weekend plan was reviewed for 158 patients over a 6-week period and a post-intervention survey was disseminated. Results The preliminary survey highlighted concerns for delayed discharges and patient safety over the weekend, with 88.2% of respondents agreeing a weekend handover proforma would be beneficial. The initial data confirmed inadequate documentation of diagnosis (19.5%), operation/procedure (28.1%), and weekend plans for blood tests (19.5%), discharge planning (2.4%), diet (46.3%), antibiotics (19.5%), intravenous (IV) fluids (22.0%), mobility (19.5%) and drain/wound care (37.5%). After education and implementing a weekend handover proforma, these results increased for documentation of diagnosis (61.2%), operation/procedure (83.2%), blood tests (59.7%), and discharge planning (85.8%). However, there was little improvement in diet (53.0%) and no improvement in the weekend plans for antibiotics (14.2%), IV fluids (17.2%), mobility (14.9%) and drain/wound care (20.2%). The post-intervention survey showed an improvement across all areas, notably continuity of care and patient safety, with 95.5% of individuals finding the weekend handover proforma aided in patient care over the weekend. Conclusion Education of the ward team and implementation of a weekend handover proforma resulted in a marked improvement in the documentation of patients' weekend plans, which is essential to ensure the continuation of safe and effective patient care.
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Affiliation(s)
- Eloise Dexter
- Department of General Surgery, Hull University Teaching Hospitals NHS Trust, Hull, United Kingdom
| | - Josephine Walshaw
- Department of General Surgery, Hull University Teaching Hospitals NHS Trust, Hull, United Kingdom
- Department of Health Sciences, Faculty of Sciences, University of York, York, United Kingdom
| | - Ayla Brown
- Department of General Surgery, Hull University Teaching Hospitals NHS Trust, Hull, United Kingdom
| | - Tehmina Nadeem
- Department of General Surgery, Hull University Teaching Hospitals NHS Trust, Hull, United Kingdom
| | - Marina Yiasemidou
- Department of General Surgery, The Royal London Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Terence Lo
- Department of General Surgery, Hull University Teaching Hospitals NHS Trust, Hull, United Kingdom
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Yiasemidou M, Yates C, Cooper E, Goldacre R, Lindsey I. External rectal prolapse: more than meets the eye. Tech Coloproctol 2023; 27:783-785. [PMID: 37278904 DOI: 10.1007/s10151-023-02829-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 05/29/2023] [Indexed: 06/07/2023]
Affiliation(s)
- M Yiasemidou
- Pelvic Floor Unit, Department of Colorectal Surgery, Oxford University Hospitals NHS Trust, Oxford, England
| | - C Yates
- Pelvic Floor Unit, Department of Colorectal Surgery, Oxford University Hospitals NHS Trust, Oxford, England
| | - E Cooper
- Pelvic Floor Unit, Department of Colorectal Surgery, Oxford University Hospitals NHS Trust, Oxford, England
| | - R Goldacre
- Nuffield Department of Population Health, Big Data Institute, Oxford University, Oxford, England
| | - I Lindsey
- Pelvic Floor Unit, Department of Colorectal Surgery, Oxford University Hospitals NHS Trust, Oxford, England.
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6
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Heinz J, Walshaw J, Kwan JY, Long J, Carradice D, Totty J, Kontouli KM, Lainas P, Hitchman L, Smith G, Huo B, Guadalajara H, Garcia-Olmo D, Sharma D, Biyani CS, Tomlinson J, Loubani M, Galli R, Lathan R, Chetter I, Yiasemidou M. PRESS survey: PREvention of surgical site infection-a global pan-specialty survey of practice protocol. Front Surg 2023; 10:1251444. [PMID: 37818209 PMCID: PMC10560728 DOI: 10.3389/fsurg.2023.1251444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 08/15/2023] [Indexed: 10/12/2023] Open
Abstract
Background Surgical site infections (SSI) complicate up to 40% of surgical procedures, leading to increased patient morbidity and mortality. Previous research identified disparities in SSI prevention guidelines and clinical practices across different institutions. The study aims to identify variations in SSI prevention practices within and between specialties and financial systems and provide a representation of existing SSI preventative measures to help improve the standardization of SSI prevention practices. Methods This collaborative cross-sectional survey will be aimed at pan-surgical specialties internationally. The study has been designed and will be reported in line with the CROSS and CHERRIES standards. An international study steering committee will design and internally validate the survey in multiple consensus-based rounds. This will be based on SSI prevention measures outlined in the CDC (2017), WHO (2018), NICE (2019), Wounds UK (2020) and the International Surgical Wound Complications Advisory Panel (ISWCAP) guidelines. The questionnaire will include demographics, SSI surveillance, preoperative, peri-operative and postoperative SSI prevention. Data will be collected on participants' surgical specialty, operative grade, of practice and financial healthcare system of practice. The online survey will be designed and disseminated using QualtricsXM Platform™ through national and international surgical colleges and societies, in addition to social media and snowballing. Data collection will be open for 3 months with reminders, and raking will be used to ascertain the sample. Responses will be analyzed, and the chi-square test used to evaluate the impact of SSI prevention variables on responses. Discussion Current SSI prevention practice in UK Vascular surgery varies considerably, with little consensus on many measures. Given the inconsistency in guidelines on how to prevent SSIs, there is a need for standardization. This survey will investigate the disparity in SSI preventative measures between different surgical fields and countries.
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Affiliation(s)
- J Heinz
- Clinical Sciences Centre, Hull York Medical School, Hull, United Kingdom
- Academic Vascular Surgical Unit, Hull University Teaching Hospitals NHS Trust, Hull, United Kingdom
| | - J Walshaw
- Clinical Sciences Centre, Hull York Medical School, Hull, United Kingdom
- Academic Vascular Surgical Unit, Hull University Teaching Hospitals NHS Trust, Hull, United Kingdom
- Department of Health Sciences, University of York, York, United Kingdom
| | - J Y Kwan
- Leeds Vascular Institute, Leeds Teachings Hospitals NHS Trust, Leeds, United Kingdom
| | - J Long
- Clinical Sciences Centre, Hull York Medical School, Hull, United Kingdom
- Academic Vascular Surgical Unit, Hull University Teaching Hospitals NHS Trust, Hull, United Kingdom
| | - D Carradice
- Clinical Sciences Centre, Hull York Medical School, Hull, United Kingdom
- Academic Vascular Surgical Unit, Hull University Teaching Hospitals NHS Trust, Hull, United Kingdom
| | - J Totty
- Clinical Sciences Centre, Hull York Medical School, Hull, United Kingdom
- Department of Plastic and Reconstructive Surgery, Hull University Teaching Hospitals NHS Trust, Hull, United Kingdom
| | - K M Kontouli
- Department of Mathematics, University of Ioannina, Ioannina, Greece
| | - P Lainas
- Department of Digestive Surgery, Metropolitan Hospital, HEAL Academy, Athens, Greece
- Department of Minimally Invasive Digestive Surgery, Antoine-Béclère Hospital, Partis-Saclay University, Clamart, France
| | - L Hitchman
- Clinical Sciences Centre, Hull York Medical School, Hull, United Kingdom
- Academic Vascular Surgical Unit, Hull University Teaching Hospitals NHS Trust, Hull, United Kingdom
| | - G Smith
- Clinical Sciences Centre, Hull York Medical School, Hull, United Kingdom
- Academic Vascular Surgical Unit, Hull University Teaching Hospitals NHS Trust, Hull, United Kingdom
| | - B Huo
- Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - H Guadalajara
- Department of Surgery, Hospital Universitario Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Madrid, Spain
| | - D Garcia-Olmo
- Department of Surgery, Hospital Universitario Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Madrid, Spain
| | - D Sharma
- Department of Surgery, Government NSCB Medical College, Jabalpur, India
| | - C S Biyani
- Department of Urology, St James University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - J Tomlinson
- Trauma and Orthopedics, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - M Loubani
- Department of Cardiothoracic Surgery, Hull University Teaching Hospitals NHS Trust, Hull, United Kingdom
| | - R Galli
- Department of Surgery, Cantonal Hospital Baselland, Liestal, Switzerland
| | - R Lathan
- Clinical Sciences Centre, Hull York Medical School, Hull, United Kingdom
- Academic Vascular Surgical Unit, Hull University Teaching Hospitals NHS Trust, Hull, United Kingdom
- Department of Health Sciences, University of York, York, United Kingdom
| | - I Chetter
- Clinical Sciences Centre, Hull York Medical School, Hull, United Kingdom
- Academic Vascular Surgical Unit, Hull University Teaching Hospitals NHS Trust, Hull, United Kingdom
| | - M Yiasemidou
- Clinical Sciences Centre, Hull York Medical School, Hull, United Kingdom
- Department of General Surgery, Bradford Teaching Hospitals NHS Trust, Bradford, United Kingdom
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McClean A, Huo B, Kwan JY, Long J, Walshaw J, Mesri M, Francis N, Arulampalam TH, Chetter I, Yiasemidou M. The impact of the European Association of Endoscopic Surgery research grant scheme-a mixed qualitative quantitative methodology study protocol. Front Surg 2023; 10:1197103. [PMID: 37405059 PMCID: PMC10315820 DOI: 10.3389/fsurg.2023.1197103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 05/31/2023] [Indexed: 07/06/2023] Open
Abstract
Background The European Association of Endoscopic Surgery (EAES) is a surgical society who promotes the development and expansion of minimally invasive surgery to surgeons and surgical trainees. It does so through its activities in education, training, and research. The EAES research committee aims to promote the highest quality clinical research in endoscopic and minimally invasive surgery. They have provided grant funding since 2009 in education, surgery, and basic science. Despite the success and longevity of the scheme, the academic and non-academic impact of the research funding scheme has not been evaluated. Aims The primary aim of this project is to assess the short, long term academic and real world impact of the EAES funding scheme. The secondary aims are to identify barriers and facilitators for achieving good impact. Methods This will be a mixed qualitative and quantitative study. Semi-structured interviews will be performed with previous grant recipients. The questions for the interviews will be selected after a consensus is achieved amongst the members of the steering committee of this project. The responses will be transcribed and thematic analysis will be applied. The results of the thematic analysis will be used to populate a questionnaire which will be disseminated to grant recipients. This study is kindly funded by the EAES. Discussion The first question this project is expected to answer is whether the EAES research funding scheme had a significant positive impact on research output, career progression but also non-academic output such as change in clinical guidelines, healthcare quality and cost-effectiveness improvement. This project however is also expected to identify facilitators and barriers to successful completion of projects and to achieving high impact. This will inform EAES and the rest of the surgical and academic communities as to how clinicians would like to be supported when conducting research. There should also be a positive and decisive change towards removing factors that hinder the timely and successful completion of projects.
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Affiliation(s)
- Adam McClean
- Clinical Fellow General Surgery, Bradford Teaching Hospitals, Bradford, United Kingdom
| | - Bright Huo
- Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Jing Yi Kwan
- NIHR Academic Clinical Fellow, Vascular Surgery, Leeds Teaching Hospitals, Leeds, United Kingdom
| | - Judith Long
- Research Manager, Academic Vascular Surgical Unit, Hull University Teaching Hospitals NHS Trust, Hull, United Kingdom
| | - Josephine Walshaw
- Department of Health Research, University of York, York, United kingdom
| | - Mina Mesri
- Department of Medicine, Hull York MedicalSchool, York, United kingdom
| | - Nader Francis
- Consultant Colorectal Surgeon, Department of Surgery, Yeovil District Hospital NHS Foundation Trust, Honorary Professor of Surgery UCL, Yeovil, United Kingdom
| | - Tan H. Arulampalam
- Consultant Colorectal Surgeon, ICENI Centre, Colchester Hospital University NHS Foundation Trust, Colchester, Essex, United Kingdom
| | - Ian Chetter
- Professor of Surgery, Hull University Teaching Hospital, Hull, United Kingdom
| | - Marina Yiasemidou
- Department of Medicine, NIHR Academic Clinical Lecturer in General Surgery, Hull York Medical School, Hull, United Kingdom
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Kwan JY, Lainas P, Banks P, Jimenez De Veciana A, Said H, Mehrem A, Debbarma M, Matthews M, Etim G, Biyani CS, Rajpal S, Phillipson M, Palit V, Renwick P, Yiasemidou M. Five-Year results of a multi-specialty induction course for surgical training. Front Surg 2023; 10:1198696. [PMID: 37405057 PMCID: PMC10315573 DOI: 10.3389/fsurg.2023.1198696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 05/30/2023] [Indexed: 07/06/2023] Open
Abstract
Background The Essential Surgical Skills Course (ESSC) is a multi-specialty induction "boot camp" style course that has been run successfully for five years. The aim of the current paper is to create an accurate guide for the replication of the course by other teams and assess the course's fitness for purpose, through the survey feedback provided by trainees. Methods The course's fitness for purpose was assessed through cumulative five-year survey feedback from trainees. This observational study describes the design and process of content adjustment according to feedback. Results The course its five-year span offered twelve different procedural skills in four different specialties. Feedback for each session was persistently >8/10. Key themes identified as beneficial include teacher-to-trainee ratio (often 1:1), teaching style, course structure and responsiveness. Conclusions The ESSC was found to be fit for purpose for the induction of trainees into surgical training. The key factors contributing to the success of the course include the structured method of curriculum design, outstanding teaching delivery methods, teacher-to-trainee ratio, the availability of appropriate faculty and infrastructure and the willingness to learn from trainee feedback and adjust the content of the course accordingly. It acts as a paradigm for courses aimed to prepare surgical trainees for a "step-up" in their careers.
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Affiliation(s)
- Jing Yi Kwan
- Department of Vascular Surgery, Leeds Teaching Hospitals, Leeds, United Kingdom
| | - Panagiotis Lainas
- Department of Digestive Surgery, Metropolitan Hospital, HEAL Academic, Athens, Greece
- Department of Minimally Invasive Digestive Surgery, Antoine-Beclere Hospital, Paris-Saclay University, Clamart, France
| | - Philippa Banks
- Department of General Surgery, Bradford Teaching Hospitals, Bradford, United Kingdom
| | | | - Hagar Said
- School of Medicine, University of York, York, United Kingdom
| | - Anna Mehrem
- Department of General Surgery, Bradford Teaching Hospitals, Bradford, United Kingdom
| | - Manash Debbarma
- Department of Urology, Mid Yorkshire Hospitals NHS Trust, Wakefield, United Kingdom
| | - Melissa Matthews
- School of Medicine, Hull York Medical School, Hull, United Kingdom
| | - Gloria Etim
- School of Medicine, Hull York Medical School, Hull, United Kingdom
| | | | - Sanjay Rajpal
- Department of Urology, Airedale General Hospital, Airedale, United Kingdom
| | - Mark Phillipson
- Department of Orthopaedics, Leeds Teaching Hospitals, Leeds, United Kingdom
| | - Victor Palit
- Department of Urology, Leeds Teaching Hospitals, Leeds, United Kingdom
| | - Paul Renwick
- Department of Vascular Surgery, Hull University Teaching Hospitals, Hull, United Kingdom
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9
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Walshaw J, Huo B, McClean A, Gajos S, Kwan JY, Tomlinson J, Biyani CS, Dimashki S, Chetter I, Yiasemidou M. Innovation in gastrointestinal surgery: the evolution of minimally invasive surgery-a narrative review. Front Surg 2023; 10:1193486. [PMID: 37288133 PMCID: PMC10242011 DOI: 10.3389/fsurg.2023.1193486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 05/04/2023] [Indexed: 06/09/2023] Open
Abstract
Background Minimally invasive (MI) surgery has revolutionised surgery, becoming the standard of care in many countries around the globe. Observed benefits over traditional open surgery include reduced pain, shorter hospital stay, and decreased recovery time. Gastrointestinal surgery in particular was an early adaptor to both laparoscopic and robotic surgery. Within this review, we provide a comprehensive overview of the evolution of minimally invasive gastrointestinal surgery and a critical outlook on the evidence surrounding its effectiveness and safety. Methods A literature review was conducted to identify relevant articles for the topic of this review. The literature search was performed using Medical Subject Heading terms on PubMed. The methodology for evidence synthesis was in line with the four steps for narrative reviews outlined in current literature. The key words used were minimally invasive, robotic, laparoscopic colorectal, colon, rectal surgery. Conclusion The introduction of minimally surgery has revolutionised patient care. Despite the evidence supporting this technique in gastrointestinal surgery, several controversies remain. Here we discuss some of them; the lack of high level evidence regarding the oncological outcomes of TaTME and lack of supporting evidence for robotic colorectalrectal surgery and upper GI surgery. These controversies open pathways for future research opportunities with RCTs focusing on comparing robotic to laparoscopic with different primary outcomes including ergonomics and surgeon comfort.
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Affiliation(s)
- Josephine Walshaw
- Academic Vascular Surgical Unit, Hull University Teaching Hospitals NHS Trust, Hull, United Kingdom
| | - Bright Huo
- Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Adam McClean
- Department of General Surgery, Bradford Teaching Hospitals NHS Trust, Bradford, United Kingdom
| | - Samantha Gajos
- Emergency Medicine Department, York and Scarborough Teaching Hospitals NHS Foundation Trust, York, United Kingdom
| | - Jing Yi Kwan
- Department of General Surgery, Bradford Teaching Hospitals NHS Trust, Bradford, United Kingdom
- Department of Vascular Surgery, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - James Tomlinson
- Department of Spinal Surgery, SheffieldTeaching Hospitals, Sheffield, United Kingdom
| | - Chandra Shekhar Biyani
- Department of Vascular Surgery, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Safaa Dimashki
- Department of General Surgery, Bradford Teaching Hospitals NHS Trust, Bradford, United Kingdom
| | - Ian Chetter
- Academic Vascular Surgical Unit, Hull University Teaching Hospitals NHS Trust, Hull, United Kingdom
| | - Marina Yiasemidou
- NIHR Academic Clinical Lecturer General Surgery, University of Hull, Hull, United Kingdom
- Hull York Medical School, University of York, York, United Kingdom
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Al-Ghunaim T, Johnson J, Biyani CS, Yiasemidou M, O'Connor DB. Burnout and patient safety perceptions among surgeons in the United Kingdom during the early phases of the coronavirus disease 2019 pandemic: A two-wave survey. Scott Med J 2023; 68:41-48. [PMID: 36946068 PMCID: PMC10067362 DOI: 10.1177/00369330231163378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
BACKGROUND Surgeons in the UK report high burnout levels. Burnout has been found to be associated with adverse patient outcomes but there are few studies that have examined this association in surgeons and even fewer which have examined this relationship over time. PURPOSE The main aim was to examine the relationships between surgeon burnout and surgeons' perceptions of patient safety cross-sectionally and longitudinally. The secondary aim was to test whether surgeons' burnout levels varied over the first six months of the coronavirus disease 2019 pandemic. METHODS This paper reports data from a two-wave survey (first wave from 5 May and 30 June 2020, the second wave 5 January to 30 February 2021). The dataset was divided into a longitudinal group (for surgeons who responded at both the time points) and two cross-sectional groups (for surgeons who responded at a one-time point, but not the other). RESULTS The first key finding was that burnout was associated with patient safety outcomes measured at the same time point (Group 1 = 108, r = 0.309, p < 0.05 and Group 2 = 84, r = 0.238, p < 0.05). Second, burnout predicted poor patients' safety perceptions over time, and poor patient safety predicted burnout over time (Group 3 = 39, p < 0.05). Third, burnout increased between the first and second surveys (t = -4.034, p < 0.05). CONCLUSION Burnout in surgeons may have serious implications for patient safety. Interventions to support surgeons should be prioritised, and healthcare organisations, surgeons and psychological specialists should collaborate on their development.
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Affiliation(s)
| | - Judith Johnson
- School of Psychology University of Leeds, Leeds, UK
- Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford, UK
- School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
| | - Chandra S Biyani
- Department of Urology, St James's University Hospital, Beckett Street, Leeds, West Yorkshire, UK
| | - Marina Yiasemidou
- NIHR Academic Clinical Lecturer General Surgery, University of Hull, Hull, UK
- ST8 Colorectal Surgery, Bradford Teaching Hospitals, Bradford, UK
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Yiasemidou M, Howitt A, Long J, Sedman P, Garcia-Olmo D, Guadalajara H, Van Cleynenbreugel B, Sharma D, Biyani SC, Patel B, Lam W, Harikrishnan A, Gómez Rivas J, Robinson J, Manuel Ribeiro de Oliveira T, Escalona Vivas G, Sanchez-Salas R, Tourinho-Barbosa R, Chetter I. An international consensus for mitigation of the detrimental effects of the COVID-19 pandemic on laparoscopic training. PLoS One 2022; 17:e0272446. [PMID: 36137091 PMCID: PMC9499280 DOI: 10.1371/journal.pone.0272446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 07/20/2022] [Indexed: 11/19/2022] Open
Abstract
Aim Achieve an international consensus on how to recover lost training opportunities. The results of this study will help inform future EAES guidelines about the recovery of surgical training before and after the pandemic. Background A global survey conducted by our team demonstrated significant disruption in surgical training during the COVID-19 pandemic. This was wide-spread and affected all healthcare systems (whether insurance based or funded by public funds) in all participating countries. Thematic analysis revealed the factors perceived by trainees as barriers to training and gave birth to four-point framework of recovery. These are recommendations that can be easily achieved in any country, with minimal resources. Their implementation, however, relies heavily on the active participation and leadership by trainers. Based on the results of the global trainee survey, the authors would like to conduct a Delphi-style survey, addressed to trainers on this occasion, to establish a pragmatic step-by-step approach to improve training during and after the pandemic. Methods This will be a mixed qualitative and quantitative study. Semi-structured interviews will be performed with laparoscopic trainers. These will be transcribed and thematic analysis will be applied. A questionnaire will then be proposed; this will be based on both the results of the semi structured interviews and of the global trainee survey. The questionnaire will then be validated by the steering committee of this group (achieve consensus of >80%). After validation, the questionnaire will be disseminated to trainers across the globe. Participants will be asked to consent to participate in further cycles of the Delphi process until more than 80% agreement is achieved. Results This study will result in a pragmatic framework for continuation of surgical training during and after the pandemic (with special focus on minimally invasive surgery training).
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Affiliation(s)
- Marina Yiasemidou
- NIHR Academic Clinical Lecturer, University of Hull, Hull, United Kingdom
- ST8 Colorectal Surgery, Bradford Teaching Hospitals, Bradford, United Kingdom
- * E-mail:
| | - Annabel Howitt
- General Surgery, Bradford Teaching Hospitals, Bradford, United Kingdom
| | - Judith Long
- Hull University Teaching Hospitals, Hull, United Kingdom
| | - Peter Sedman
- Hull University Teaching Hospitals, Hull, United Kingdom
| | - Damian Garcia-Olmo
- Chief of Surgery Department at Fundacion Jimenez Díaz University Hospital (Universidad Autonoma de Madrid), Madrid, Spain
| | - Hector Guadalajara
- University Hospital Fundación Jimenez Díaz and Associate Professor at “Universidad Autonoma de Madrid”, Madrid, Spain
| | - Ben Van Cleynenbreugel
- University Hospitals of Leuven and a Guest Lecturer at the Catholic University of Leuven, Leuven, Belgium
| | | | - Shekhar Chandra Biyani
- Leeds Teaching Hospitals and Honorary Senior Clinical Lecturer, University of Leeds, Leeds, United Kingdom
| | - Bijendra Patel
- Barts Health NHS Trust and University College London Hospitals NHS Foundation Trust and Professor of Surgery, University of London, London, United Kingdom
| | - Wayne Lam
- Department of Surgery, Faculty of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, China
| | | | | | | | | | - Gabriel Escalona Vivas
- Hospital Sótero del Río and researcher at the Simulation and Experimental Surgery Center at the Pontificia Universidad Católica in Santiago, Santiago, Chile
| | - Rafael Sanchez-Salas
- Department of Urology L’Institut Mutualiste Montsouris Université, Paris Descartes, Paris, France
| | - Rafael Tourinho-Barbosa
- Department of Urology Hospital Cardio Pulmonar–Oncologia D’Or and Núcleo de Oncologia da Bahia, Faculdade de Medicina do ABC, Salvador, Bahia, Brazil
| | - Ian Chetter
- Hull University Teaching Hospitals, Hull, United Kingdom
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Guadalajara H, Yiasemidou M, Muñoz de Nova JL, Sedman P, Fernandez Gonzalez S, Maslekar S, Recarte Rico M, Egan R, Juez LD, Riyad K, García Septiem J, Lockwood S, Galindo Jara P, Giorga A, García Virosta M, Hance J, Lobo Martínez E, Martín-Pérez E, Howitt A, Jayne D, Chetter I, García-Olmo D, Fernández-Cebrián JM, Jover JM, Acín-Gándara D, Perea-del-Pozo E, Dios-Barbeito S, Aparicio-Sánchez D, Durán-Muñoz-Cruzado VM, Pareja-Ciuró F, Martin-Antona E, Cano-Valderrama O, Torres-Garcia AJ, Zarain-Obrador L, Durán-Poveda M, Peinado-Iribar B, Fernandez-Luengas D, Pascual-Migueláñez I, Garcia-Chiloeches A, Puerta A, Martín-Pérez E, García-del-Álamo-Hernández Y, Maqueda-González R, Gutiérrez-Samaniego M, Colao-García L, Núñez-O’Sullivan S, Vaquero MA, Picardo-Nieto A, Blazquez-Martin A, Vera-Mansilla C, Soto-Schüte S, Gutiérrez-Calvo A, Mínguez-García J, Sanchez-Argüeso A, Hernández-Villafranca S, Qian-Zhang S, Gortazar-de-las-Casas S, Dominguez-Prieto V, Lopez-Fernandez O, Casalduero-García L, Iparraguirre MÁ, Florez-Gamarra M, Argüello-de-Andrés JM, Tallón-Iglesias B, Pereira-Perez F, García-Ureña MÁ, Paeriro G, Fuenmayor-Valera ML, Pardo R, Pellen M, Basheer M, Harries R, Parkins K, Spencer N, Li Z, Burridge J, Wynn H, Mesri M. The international PIACO study: pattern of surgical approaches for acute surgical pathologies in Spain versus UK. Was conservative treatment and open surgery during COVID-19 the way to go? BJS Open 2022; 6:6658292. [PMID: 35939374 PMCID: PMC9359448 DOI: 10.1093/bjsopen/zrac089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 06/03/2022] [Accepted: 06/14/2022] [Indexed: 11/18/2022] Open
Affiliation(s)
- Hector Guadalajara
- Department of General and Digestive Surgery, Fundación Jimenez Díaz University Hospital , Madrid , Spain
| | | | - José Luis Muñoz de Nova
- Department of General and Digestive Surgery, La Princesa University Hospital, Instituto de Investigación Sanitaria Princesa (IIS-IP) , Madrid , Spain
| | - Peter Sedman
- Upper Gi Surgery, Hull University Teaching Hospitals , Hull , UK
| | - Saul Fernandez Gonzalez
- Department of General and Digestive Surgery, Fundación Jimenez Díaz University Hospital , Madrid , Spain
| | | | - María Recarte Rico
- Department of General and Digestive Surgery, Tajo University Hospital , Madrid , Spain
| | - Richard Egan
- Department of General Surgery, Swansea Bay UHB, Swansea University , Swansea, Wales , UK
| | - Luz Divina Juez
- Department of General and Digestive Surgery, Ramon y Cajal University Hospital , Madrid , Spain
| | | | - Javier García Septiem
- Department of General and Digestive Surgery, La Princesa University Hospital, Instituto de Investigación Sanitaria Princesa (IIS-IP) , Madrid , Spain
| | - Sonia Lockwood
- Colorectal Surgery, Bradford Teaching Hospitals , Bradford , UK
| | - Pablo Galindo Jara
- Department of General and Digestive Surgery, Torrejon University Hospital , Madrid , Spain
| | - Andrea Giorga
- Colorectal Surgery, Leeds Teaching Hospitals , Leeds , UK
| | - Mariana García Virosta
- Department of General and Digestive Surgery, Infanta Sofia University Hospital , Madrid , Spain
| | - Julian Hance
- Colorectal Surgery, Leeds Teaching Hospitals , Leeds , UK
| | - Eduardo Lobo Martínez
- Department of General and Digestive Surgery, Ramon y Cajal University Hospital , Madrid , Spain
| | - Elena Martín-Pérez
- Department of General and Digestive Surgery, La Princesa University Hospital, Instituto de Investigación Sanitaria Princesa (IIS-IP) , Madrid , Spain
| | - Annabel Howitt
- Department of Colorectal Surgery, Bradford Teaching Hospitals , Bradford , UK
| | - David Jayne
- Leeds Institute of Biomedical Sciences, University of Leeds , Leeds , UK
| | - Ian Chetter
- Academic Vascular Surgery, University of Hull , Hull , UK
| | - Damian García-Olmo
- Department of General and Digestive Surgery, Fundación Jimenez Díaz University Hospital , Madrid , Spain
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Yiasemidou M, Tomlinson J, Chetter I, Biyani CS, Collaborative REINS. SP4.1.1 The impact of the SARS-CoV-2 (COVID-19) crisis on surgical training: a global survey and a proposed framework for recovery. Br J Surg 2021. [PMCID: PMC8574427 DOI: 10.1093/bjs/znab361.081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background The SARS-Cov-2 pandemic had a profound impact on surgical services, potentially causing a detrimental impact on training opportunities. The aim of this global survey was to assess the impact of the COVID-19 crisis on surgical training and develop a framework for recovery. Methods A cross-sectional, web-based survey was conducted. This was designed by a steering committee of medical educationalists and validated by a group of trainees prior to dissemination. Results 608 responses were obtained from 34 countries and 15 specialties. The results demonstrated major disruptions in all aspects of training. The impact was highest for conferences (525/608) and hands-on courses (517/608), but less for in-patient care related training (268/608). European trainees were significantly more likely to experience direct training disruption than trainees in Asia (O.R 0.148, 95% C.I -2.443, -1.378) or Australia (O.R 0.097, -2.981, -1.678) (c2= 87.162 p < 0.001). Alternative training resources (webinars: 359/608, educational videos: 234/608) have emerged, although trainees expressed some dissatisfaction with them. The collective responses generated a five-pillar framework for training recovery: that involved; prioritisation of trainee and public safety; guidance from training stakeholders with the involvement of trainees; prioritisation of training especially the roles of senior surgeons/trainers; provision of access to alternative/new teaching methods and measures to address trainee anxiety. Conclusions Training has been greatly affected. The introduction of new teaching methods and focus on training after the pandemic are imperative.
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Affiliation(s)
- Marina Yiasemidou
- NIHR Academic Clinical Lecturer, Hull York Medical School
- Bradford Teaching Hospitals
| | | | - Ian Chetter
- Hull York Medical School
- Hull University Teaching Hospitals
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Yiasemidou M, Guadalajara H, Lockwood S, Maslekar S, Olmo DG, Chetter I. EP.FRI.451 Laparotomy rates and factors influencing treatment modality for diverticulitis during the COVID-19 lockdown. Br J Surg 2021. [PMCID: PMC8574428 DOI: 10.1093/bjs/znab312.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background Infection control measures during the COVID-19 crisis modified diverticulitis treatment. Here we present the treatment applied in three large UK centres compared to the same timeframe in 2019. Methods This was a multicentre, comparative study, whereby diverticulitis cases from March 23rdto May 11th2019 acted as historical controls for cases during lockdown. Severity at presentation (SD), comorbidities, treatment modality, Length of Stay (LOS), complications and COVID-19 status (CS) were recorded. Chi-squared, ANOVA, Mann-Whitney test and linear regression were used for analyses. Results 59 patients presented with diverticulitis in 2020 compared to 130 in 2019 (M:F 27/32, 56/74 and 64vs.62 y.o.). Laparotomy was performed in 6/59 and 12/130 respectively. Comparing 2019 to 2020, there was no statistical difference for severity (p = 0.643), treatment modality (0.946), comorbidities (0.313), LOS (0.602). Linear regression demonstrated statistically significant association between treatment employed (p < 0.001) and SD, while there was no association with age, comorbidities or CS. LOS was associated with severity only (p < 0.001), whilst CS, treatment, age and comorbidities yielded no statistical difference. Conclusion Diverticulitis cases during 2020 lockdown reduced noticeably (59vs.130). There was no difference in severity, treatment, comorbidities or LOS between 2019 and 2020. Laparotomy was performed in 6/59 and 12/130 respectively. Decision about treatment and LOS in 2020 was associated with severity of disease only. There was no association with COVID status. These findings should be interpreted with caution due to small COVID positive numbers and not including ambulatory units, however, they are consistent with findings from our sister Spanish group.
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15
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Wareing J, Sandhar H, Howitt A, Yiasemidou M, Craske D. 829 Perioperative Surgical Patients and The Availability and Utilisation Of ECGs Machines Pre- And Post-Pandemic. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Introduction
ECGs are a NICE recommended pre-operative investigation and an integral part of post-operative monitoring. Delay in recognition of cardiac pathology can be catastrophic. Therefore, ECG machines should be readily available. Here, we report the results of an audit assessing the availability of ECG machines in surgical wards.
Method
In 2018 and then 2020, a bespoke, nine-item audit proforma was disseminated to all foundation doctors.
Results
In 2018, 17/32 wards had a ward based, readily available machine, 6/32 shared with another ward and 15/32 did not have a ward-based machine. The same was noted in 2020. In 2018 and 2020, the average time to obtain an ECG machine was 27 and 23 respectively. When no ECG was available, a doctor would obtain the machine 24% in 2018 compare to 52% in 2020. The diagnoses of the patients who had ECGs in 2018 were: normal sinus rhythm, atrial fibrillation, bradycardia, supraventricular tachycardia, sinus tachycardia and STEMI. In 2020 were: normal sinus rhythm, atrial fibrillation, supraventricular tachycardia, sinus tachycardia, atrial flutter, bradycardia, prolonged QTc, hyperkalaemia, STEMI and NSTEMI. The average time for NSTEMI patients to have an ECG was 35mins while for STEMI patients was 11.6mins.
Conclusions
Whilst our audit has highlighted the importance of ECG machine availability, the time to obtain one remained static between the two cycles. A study investigating the impact on patient outcomes may highlight the necessity for available ECG machines further.
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Affiliation(s)
- J Wareing
- Bradford Teaching Hospital Foundation Trust, Bradford, United Kingdom
| | - H Sandhar
- Bradford Teaching Hospital Foundation Trust, Bradford, United Kingdom
| | - A Howitt
- Bradford Teaching Hospital Foundation Trust, Bradford, United Kingdom
| | - M Yiasemidou
- Bradford Teaching Hospital Foundation Trust, Bradford, United Kingdom
- University of Hull, Hull, United Kingdom
| | - D Craske
- Bradford Teaching Hospital Foundation Trust, Bradford, United Kingdom
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Pears M, Biyani CS, Joyce AD, Spearpoint K, Yiasemidou M, Cleynenbreugel BV, Patterson J, Mushtaq F. Capturing the non-technical skills of a technical skills trainer (NTS-TeST) during simulation. Scott Med J 2021; 66:124-133. [PMID: 33847552 DOI: 10.1177/00369330211008594] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To develop an assessment instrument that can be used as a comprehensive feedback record to convey to a trainer the non-technical aspects of skill acquisition and training. METHODS The instrument was developed across three rounds. In Round 1, 6 endourological consultants undertook a modified Delphi process. Round 2 included 10 trainers who assessed each question's relevance and practicability. Round 3 involved a pilot study with fifteen urology residents who participated in a technical skills simulation session with the incorporation of the instrument. We report the content, face, and construct validity, and the internal consistency of an NTS instrument for trainers. RESULTS The instrument had a consistent and a high positive average for each of the 4 sections of the instrument, regardless of the type of user. Positive Spearman's correlation coefficients (0.02 to .64) for content validity and Cronbach's alpha (a = 0.70) indicated good validity and moderate reliability of the instrument. CONCLUSION We propose a novel NTS instrument for trainers during a simulation. This instrument can be used for benchmarking the quality of technical skills simulation training.
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Affiliation(s)
- Matthew Pears
- Applied Cognition and Healthcare Researcher, School of Psychology, University of Leeds, UK
| | | | | | - Ken Spearpoint
- Honorary Consultant Urologist, St James University Hospital, UK
| | - Marina Yiasemidou
- Principal Lecturer, Programme Lead, MSc Health & Medical Simulation University of Hertfordshire, Hatfield, UK
| | - Ben Van Cleynenbreugel
- NIHR Academic Clinical Lecturer in General Surgery, Academic Surgery, Hull York Medical School, ST6 Colorectal Surgery, Bradford Teaching Hospitals, UK
| | | | - Faisal Mushtaq
- Consultant Urologist, Royal Hallamshire Hospital, Sheffield, UK
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Yiasemidou M, Tomlinson J, Chetter I, Biyani CS. Impact of the SARS-CoV-2 (COVID-19) crisis on surgical training: global survey and a proposed framework for recovery. BJS Open 2021; 5:6226009. [PMID: 33855364 PMCID: PMC8047098 DOI: 10.1093/bjsopen/zraa051] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 11/17/2020] [Indexed: 11/30/2022] Open
Abstract
Background The SARS-CoV-2 pandemic had a profound impact on surgical services, potentially having a detrimental impact on training opportunities. The aim of this global survey was to assess the impact of the COVID-19 crisis on surgical training and to develop a framework for recovery. Methods A cross-sectional, web-based survey was conducted. This was designed by a steering committee of medical educationalists and validated by a group of trainees before dissemination. Results A total of 608 responses were obtained from 34 countries and 15 specialties. The results demonstrated major disruption in all aspects of training. The impact was greatest for conferences (525 of 608) and hands-on courses (517 of 608), but less for inpatient care-related training (268 of 608). European trainees were significantly more likely to experience direct training disruption than trainees in Asia (odds ratio 0.15) or Australia (OR 0.10) (χ2 = 87.162, P < 0.001). Alternative training resources (webinars, 359 of 608; educational videos, 234 of 608) have emerged, although trainees expressed some dissatisfaction with them. The collective responses generated a four-pillar framework for training recovery that involved: guidance from training stakeholders with the involvement of trainees; prioritization of training, especially the roles of senior surgeons/trainers; provision of access to alternative/new teaching methods; and measures to address trainee anxiety. Conclusion Training has been greatly affected by the COVID-19 pandemic. The introduction of new teaching methods and a focus on training after the pandemic are imperative.
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Affiliation(s)
| | - M Yiasemidou
- Leeds Teaching Hospitals, Leeds, UK; University of Hull, Hull, UK; Hull University Teaching Hospitals NHS Trust, Hull, UK
| | | | - I Chetter
- University of Hull, Hull, UK; Hull University Teaching Hospitals NHS Trust, Hull, UK
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Guadalajara H, Muñoz de Nova JL, Fernandez Gonzalez S, Yiasemidou M, Recarte Rico M, Juez LD, García Septiem J, Galindo Jara P, García Virosta M, Lobo Martínez E, Martín-Pérez E, García-Olmo D. Author response to: Comment on: Patterns of acute surgical inflammatory processes presentation of in the COVID-19 outbreak (PIACO Study): surgery may be the best treatment option. Br J Surg 2021; 108:e42-e43. [PMID: 33640951 PMCID: PMC7929292 DOI: 10.1093/bjs/znaa022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 09/19/2020] [Indexed: 11/14/2022]
Affiliation(s)
- H Guadalajara
- Department of General and Digestive Surgery, Fundación Jimenez Díaz University Hospital, Madrid, Spain
| | - J L Muñoz de Nova
- Department of General and Digestive Surgery, La Princesa University Hospital, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain
| | - S Fernandez Gonzalez
- Department of General and Digestive Surgery, Fundación Jimenez Díaz University Hospital, Madrid, Spain
| | - M Yiasemidou
- ST6 Colorectal Surgery, Leeds Teaching Hospitals, University of Hull, Hull, UK
| | - M Recarte Rico
- Department of General and Digestive Surgery, Tajo University Hospital, Madrid, Spain
| | - L D Juez
- Department of General and Digestive Surgery, Ramon y Cajal University Hospital, Madrid, Spain
| | - J García Septiem
- Department of General and Digestive Surgery, La Princesa University Hospital, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain
| | - P Galindo Jara
- Department of General and Digestive Surgery, Torrejon University Hospital, Madrid, Spain
| | - M García Virosta
- Department of General and Digestive Surgery, Infanta Sofia University Hospital, Madrid, Spain
| | - E Lobo Martínez
- Department of General and Digestive Surgery, Ramon y Cajal University Hospital, Madrid, Spain
| | - E Martín-Pérez
- Department of General and Digestive Surgery, La Princesa University Hospital, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain
| | - D García-Olmo
- Department of General and Digestive Surgery, Fundación Jimenez Díaz University Hospital, Madrid, Spain
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Yiasemidou M, Mushtaq F, Basheer M, Galli R, Panagiotou D, Stock S, Preston N, Mon-Williams M, Jayne DG, Miskovic D. Patient-specific mental rehearsal with three-dimensional models before low anterior resection: randomized clinical trial. BJS Open 2020. [PMCID: PMC7944490 DOI: 10.1093/bjsopen/zraa004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Background It was hypothesized that preparing for a surgical procedure, taking into account individual patient characteristics, may facilitate the procedure and improve surgical quality. The aim of this study was to compare different case-specific, preoperative mental rehearsal methods before minimally invasive rectal cancer surgery. Methods In this RCT, patients were allocated in a 1 : 1 : 1 : 1 ratio to four groups: systematic mental rehearsal (SMR) using MRI scans; SMR and three-dimensional (3D) virtual models; SMR and synthetic 3D printed models; and routine practice (control group). Surgeons operating on all but the control group underwent mental rehearsal with the visual aids, including axial MRI scans of the pelvis, interactive 3D virtual models reconstructed from axial MRIs, and synthetic models, manufactured by 3D printing. Operations were video-recorded and assessed by two experts blinded to allocation using two validated scores, the Competency Assessment Tool (CAT) and Objective Clinical Human Reliability Analysis (OCHRA). The primary outcome of the study was surgical performance, measured by the CAT. Results Forty-nine patients were randomized and allocated to the four groups. There were 12 participants in each of the control, MRI and SMR, and virtual and SMR groups, whereas the SMR using physical models and simulation group included 13. No difference was observed between groups in median CAT scores (control 30.50, MRI 34.25, virtual 31.75, physical 34.00; P = 0.748, partial η2 <0.001, where pη2 is indicative of effect size) or OCHRA scores (anterior, posterior, right and left lateral planes, transection P>0.200, pη2 =0.052–0.088). Time spent not performing dissection was significantly shorter for the SMR with MRI group than for the control (57.5 versus 42 respectively; P < 0.001, pη2 =0.212). Conclusion Mental rehearsal did not affect CAT and OCHRA scores of consultant surgeons. Reference number: ISRCTN 75603704 (https://www.isrctn.com).
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Affiliation(s)
- M Yiasemidou
- Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, St James’s University Hospital, Leeds, UK
- Academic Surgery, University of Hull, Hull, UK
| | - F Mushtaq
- School of Psychology, University of Leeds, Leeds, UK
| | - M Basheer
- Department of Colorectal Surgery, Pinderfields Hospital, Mid Yorkshire Hospitals NHS Trust, Wakefield, UK
| | - R Galli
- Department of Colorectal Surgery, St James’s University Hospital, Leeds Teaching Hospitals, Leeds, UK
| | - D Panagiotou
- General Surgery, York Teaching Hospital, York, UK
| | - S Stock
- General and Trauma Surgery, World Mate Emergency Hospital, Battambang, Cambodia
| | - N Preston
- School of Psychology, University of Leeds, Leeds, UK
| | | | - D G Jayne
- Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, St James’s University Hospital, Leeds, UK
- Department of Colorectal Surgery, St James’s University Hospital, Leeds Teaching Hospitals, Leeds, UK
| | - D Miskovic
- Department of Colorectal Surgery, St Mark’s Hospital, Harrow, London, UK
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20
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Thomas O, Ramsay A, Yiasemidou M, Hardie C, Ashmore D, Macklin C, Bandyopadhyay D, Bijendra Patel, Burke JR, Jayne D. The surgical management of cutaneous abscesses: A UK cross-sectional survey. Ann Med Surg (Lond) 2020; 60:654-659. [PMID: 33304582 PMCID: PMC7718210 DOI: 10.1016/j.amsu.2020.11.068] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 11/24/2020] [Indexed: 12/20/2022] Open
Abstract
Aim Cutaneous abscesses are one of the most common acute general surgery presentations. This study aimed to understand the current practice in the management of cutaneous abscesses in the United Kingdom (UK), once the decision has been made that acute surgical incision and drainage (I&D) is required. Method General surgeons from across the UK were surveyed on their opinions on the optimum management of cutaneous abscesses. Outcomes measured included anaesthesia, incision technique, antibiotic administration, departmental abscess pathways, and post-drainage management. A combination of Likert scales, multiple-choice questions, and short answer questions were used. Comparisons were made of Likert scales between regions using a two-sample independent t-test. The survey was peer reviewed and distributed through the Association of Coloproctology of Great Britain and Ireland (ACPGBI) network between April and June 2018. Results Sixty-one responses were collected from surgeons throughout the UK. Of these respondents, 69% indicated that cutaneous abscesses would always or usually require a General Anaesthetic (GA) for treatment, and 82% indicated that abscesses were at least sometimes not treated until the next day due to a lack of resources. While 79% of surgeons stated that pus swabs are always or are usually taken, 44% of respondents never or rarely chased the results. The main indications for giving antibiotics were sepsis/systemically unwell patients, and cellulitis. 31% of responding centres had an abscess management protocol, and 82% of respondents confirmed that they would always pack the abscess wound post-operatively. Conclusion ‘Incision and drainage’ is currently the most widely used technique for the surgical management of cutaneous abscess. However, this study demonstrates the significant variability in the use of anaesthesia, antibiotics, packing and the use of protocols to guide and streamline patient management. There are no current NICE guidelines specifically covering cutaneous abscess management. There is significant practice variation in the management of cutaneous abscesses across the UK. Wound packing is still commonplace, despite guidelines recommending that there is evidence that it should be avoided. New recommendations on the use of antibiotics whilst treating cutaneous abscesses are yet to be taken up by most surgeons. Surgically managed cutaneous abscesses in the UK are preferably managed under a general anaesthetic.
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Affiliation(s)
- Owen Thomas
- Leeds Institute of Biomedical & Clinical Sciences, Clinical Sciences Building, St James's University Hospital, Leeds, LS9 7TF, UK
| | - Alistair Ramsay
- The John Golligher Colorectal Surgery Unit, St. James's University Hospital, Leeds Teaching Hospital Trust, Beckett Street, Leeds, LS9 7TF, UK
| | - Marina Yiasemidou
- Leeds Institute of Biomedical & Clinical Sciences, Clinical Sciences Building, St James's University Hospital, Leeds, LS9 7TF, UK
| | - Claire Hardie
- Leeds Institute of Biomedical & Clinical Sciences, Clinical Sciences Building, St James's University Hospital, Leeds, LS9 7TF, UK
| | - Daniel Ashmore
- Leeds Institute of Biomedical & Clinical Sciences, Clinical Sciences Building, St James's University Hospital, Leeds, LS9 7TF, UK
| | | | | | - Bijendra Patel
- Barts Health NHS Trust, Whitechapel Rd, London, E1 1FR, UK
| | - Joshua R Burke
- The John Golligher Colorectal Surgery Unit, St. James's University Hospital, Leeds Teaching Hospital Trust, Beckett Street, Leeds, LS9 7TF, UK.,Leeds Institute of Biomedical & Clinical Sciences, Clinical Sciences Building, St James's University Hospital, Leeds, LS9 7TF, UK
| | - David Jayne
- The John Golligher Colorectal Surgery Unit, St. James's University Hospital, Leeds Teaching Hospital Trust, Beckett Street, Leeds, LS9 7TF, UK.,Leeds Institute of Biomedical & Clinical Sciences, Clinical Sciences Building, St James's University Hospital, Leeds, LS9 7TF, UK
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21
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Laloo R, Giorga A, Williams A, Biyani CS, Yiasemidou M. Virtual surgical education for core surgical trainees in the Yorkshire deanery during the COVID-19 pandemic. Scott Med J 2020; 65:138-143. [PMID: 32878576 PMCID: PMC7472191 DOI: 10.1177/0036933020951927] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Aims An online teaching programme for Core Surgical Trainees (CSTs) was designed and delivered during the COVID-19 pandemic. The aim of this study is to assess the feasibility and the reception of a fully online teaching programme. Methods Twenty teaching sessions were delivered either via Zoom™ or were pre-recorded and uploaded onto a Google Classroom™ and YouTube™ website. Online feedback, delivered via Google Forms™, were completed by CSTs following each teaching session. YouTube Studio™ analytics were used to understand patterns in viewing content. Results 89.9% of trainees were satisfied with the teaching series. Trainees preferred short, weekly sessions (79%), delivered by senior surgeons, in the form of both didactical and interactive teaching. YouTube analytics revealed that the highest peak in views was documented on the weekend before the deadline for evidence upload on the Intercollegiate Surgical Collegiate Programme (ISCP) portfolio. Conclusion An entirely online teaching programme is feasible and well-received by CSTs. Trainees preferred live, interactive, procedure-based, consultant-led sessions lasting approximately thirty minutes to one hour and covering a myriad of surgical specialties. This feedback can be used to improve future online surgical teaching regionally and nationally in order to gain training opportunities lost during the pandemic.
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Affiliation(s)
- Ryan Laloo
- Academic Clinical Fellow in Vascular Surgery, Leeds Teaching Hospitals Trust, UK
| | - Andrea Giorga
- Academic Clinical Fellow in Vascular Surgery, Leeds Teaching Hospitals Trust, UK
| | | | | | - Marina Yiasemidou
- General Surgery registrar, Leeds Teaching Hospitals Trust, UK *Ryan Laloo and Andrea Giorga were both first co-authors
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22
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Pears M, Yiasemidou M, Ismail MA, Veneziano D, Biyani CS. Role of immersive technologies in healthcare education during the COVID-19 epidemic. Scott Med J 2020; 65:112-119. [DOI: 10.1177/0036933020956317] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The unparalleled epidemic of the novel coronavirus (COVID-19), during early December 2019 in Wuhan, China, has rapidly evolved into a global pandemic, became a matter of grave concern. The pandemic presented a unique challenge to government agencies worldwide. The paucity of resources and lack of knowledges to manage the pandemic, coupled with the fear of future consequences has established the need for adoption of emerging and future technologies to address the upcoming challenges. With introduction of measures to control the pandemic, trainees will see a dramatic decline in their in-person exposure to all aspects of their education, with no clear endpoint. This presents an extreme challenge for educators and, given the rapidly evolving situation, there have not yet been training authorities recommendations. We propose several innovative solutions to deliver medical education while maintaining the safety of residents and educators.
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Affiliation(s)
- Matthew Pears
- Applied Cognition and Healthcare Researcher, School of Psychology, University of Leeds, UK
| | - Marina Yiasemidou
- NIHR Academic Clinical Lecturer in General Surgery, Hull York Medical School, ST6 Colorectal Surgery, Bradford Teaching Hospitals, Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, UK
| | | | - Domenico Veneziano
- Consultant Urologist, Department of Urology and Kidney Transplant, G.O.M. Reggio Calabria, Italy
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23
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Guadalajara H, Muñoz de Nova JL, Fernandez Gonzalez S, Yiasemidou M, Recarte Rico M, Juez LD, García Septiem J, Galindo Jara P, García Virosta M, Lobo Martínez E, Martín-Pérez E, García-Olmo D. Patterns of acute surgical inflammatory processes presentation of in the COVID-19 outbreak (PIACO Study): Surgery may be the best treatment option. Br J Surg 2020; 107:e494-e495. [PMID: 32820826 PMCID: PMC7461068 DOI: 10.1002/bjs.11950] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 07/02/2020] [Indexed: 11/16/2022]
Affiliation(s)
- H Guadalajara
- Department of General and Digestive Surgery, Fundación Jimenez Díaz University Hospital, Madrid, Spain
| | - J L Muñoz de Nova
- Department of General and Digestive Surgery, La Princesa University Hospital, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain
| | - S Fernandez Gonzalez
- Department of General and Digestive Surgery, Fundación Jimenez Díaz University Hospital, Madrid, Spain
| | - M Yiasemidou
- ST6 colorectal surgery, Leeds Teaching Hospitals, Clinical lecturer, University of Hull, Madrid, Spain
| | - M Recarte Rico
- Department of General and Digestive Surgery, Tajo University Hospital, Madrid, Spain
| | - L D Juez
- Department of General and Digestive Surgery, Ramon y Cajal University Hospital, Madrid, Spain
| | - J García Septiem
- Department of General and Digestive Surgery, La Princesa University Hospital, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain
| | - P Galindo Jara
- Department of General and Digestive Surgery, Torrejon University Hospital, Madrid, Spain
| | - M García Virosta
- Department of General and Digestive Surgery, Infanta Sofia University Hospital, Madrid, Spain
| | - E Lobo Martínez
- Department of General and Digestive Surgery, Ramon y Cajal University Hospital, Madrid, Spain
| | - E Martín-Pérez
- Department of General and Digestive Surgery, La Princesa University Hospital, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain
| | - D García-Olmo
- Department of General and Digestive Surgery, Fundación Jimenez Díaz University Hospital, Madrid, Spain
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24
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Yiasemidou M, Glassman D, Khan K, Downing J, Sivakumar R, Fawole A, Biyani CS. Validation of a cost-effective appendicectomy model for surgical training. Scott Med J 2020; 65:46-51. [PMID: 31959075 DOI: 10.1177/0036933019900340] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Appendicitis is a commonly occurring condition worldwide. The gold standard treatment is appendicectomy. Although training models are commercially available for this procedure, they are often associated with high cost. Here we present a cost-effective model. AIM To establish construct validity of a cost-effective laparoscopic appendicectomy simulation model. METHODS Three groups of surgeons were recruited; novices (n = 31), of intermediate expertise (n = 13) and experts (n = 5) and asked to perform a simulated laparoscopic appendicectomy using the new model. Their performance was assessed by a faculty member and compared between the three groups using a validated scoring system (Global Operative Assessment of Laparoscopic Skills [GOALS] score). RESULTS One-way ANOVA test showed a significant difference in task performance between groups (p < 0.0001). Post-hoc comparisons after the application of Bonferroni correction (statistically significant p value <0.017) demonstrate a significant difference in performance between all groups for all GOALS categories as well as the total score. Effect size calculations showed that experience level had moderate (Eta-squared >0.5 and <0.8) and significant (>0.8) impact on the performance of the simulated procedure. CONCLUSION The model described in this study is cost-effective, valid and can adequately simulate appendicectomy. The authors recommend inclusion of this model to postgraduate surgical training.
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Affiliation(s)
- Marina Yiasemidou
- Honorary Research Fellow, Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, St. James University Hospital, Leeds, UK.,Specialty Registrar Colorectal Surgery, Mid Yorkshire NHS Trust, West Yorkshire, UK
| | - Daniel Glassman
- TIG Oncoplastic Fellow Breast Surgery, York Teaching Hospital, York, UK
| | - Khalid Khan
- Registrar Colorectal Surgery, Hull and East Riding NHS Trust, Hull, UK
| | - Justine Downing
- Specialty Registrar Breast Surgery, Barnsley District General Hospital, Barnsley, UK
| | | | - Adeshina Fawole
- Consultant Colorectal Surgeon, Mid Yorkshire NHS Trust, West Yorkshire, UK
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25
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Yiasemidou M, Glassman D, Jayne D, Miskovic D. Is patient-specific pre-operative preparation feasible in a clinical environment? A systematic review and meta-analysis. Comput Assist Surg (Abingdon) 2019; 23:57-68. [PMID: 30497290 DOI: 10.1080/24699322.2018.1495266] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Technical difficulty of an operation is associated with patient and disease characteristics, indicating the necessity for surgeons to exercise patient-specific preparation. Such methods have been shown to be effective in the simulation suite, however, application in a real clinical environment has been sporadic. This systematic review attempts to answer if patient-specific preparation in challenging surgical procedures is feasible. A systematic review of OvidMedline, Embase and all Evidence Based Medicine review databases, was conducted in search of studies who described surgical rehearsals in all specialties. Following the application of defined inclusion and exclusion criteria relevant data were extracted and summarised. Descriptive synthesis was performed for all included studies and meta-analysis of data was applied when possible. Of fourty-nine studies included, thirty-seven were case-series, ten were non-randomised comparative trials and two randomised controlled trials. Accuracy of applied methods ranged from 66.7 to 100% and a good outcome was seen in 60-100% of operations. Meta-analysis of studies comparing rehearsals to real procedures (same patients) showed that simulated procedures were significantly faster than real ones (SMD = -1.56 [-2.19, -0.93] p < 0.00001) but were similar in other outcomes (fluoroscopy time: SMD = -0.1 [-0.63, 0.42] p = 0.7, fluoroscopy volume: SMD = -0.43[-0.97, 0.11], p = 0.12). Meta-analysis of studies comparing pre-operative rehearsals to standard treatment (two distinct groups of patients), demonstrated that real procedures were performed quicker if pre-operative rehearsal took place (SMD = -0.47 [-0.79, -0.16], P = 0.003) but the immediate clinical outcome was similar for practiced and not practiced operations (SMD =0.03[-0.23, 0.29], p = 0.82). Current evidence suggests that patient-specific pre-operative preparation is feasible and safe and decreases operational time.
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Affiliation(s)
- Marina Yiasemidou
- a Leeds Institute of Biomedical and Clinical Sciences , University of Leeds , Leeds , UK
| | | | - David Jayne
- a Leeds Institute of Biomedical and Clinical Sciences , University of Leeds , Leeds , UK
| | - Danilo Miskovic
- a Leeds Institute of Biomedical and Clinical Sciences , University of Leeds , Leeds , UK
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26
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Hanchanale V, Kailavasan M, Rajpal S, Koenig P, Yiasemidou M, Palit V, Rogawski K, Eardley I, Terry T, Jain S, Myatt A, Biyani CS. Impact of urology simulation boot camp in improving endoscopic instrument knowledge. BMJ STEL 2018; 5:151-154. [DOI: 10.1136/bmjstel-2018-000313] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/21/2018] [Indexed: 01/13/2023]
Abstract
ObjectiveEducation and training of surgeons has traditionally focused on the development of individual knowledge, technical skills and decision making. Knowledge about endoscopic instruments is one of the core elements of urological training. We assessed the precourse knowledge of newly appointed urology trainees and the impact of boot camp in improving their knowledge.MethodsNewly appointed specialty trainees in urology took part in a pilot 5-day urology simulation boot camp (USBC). The aim of the USBC was to improve their confidence, procedural performance and non-technical skills, with one of the modules looking at the trainees’ knowledge about common endoscopic instruments in urology. Delegates were first asked to identify and assemble the instruments, followed by one-to-one teaching about the instruments. An Objective Structured Assessment Tool was used to assess their knowledge in the identification and assembly of the cystoscope, resectoscope and optical urethrotome, before and at the end of the course.ResultsData of two successive boot camps were collected to assess knowledge of instruments of newly appointed urology trainees. Majority of the trainees had good precourse knowledge of the cystoscopy kit, with 84% able to correctly identify the parts. Seventy-six per cent of candidates were able to identify the resectoscope equipment, but only approximately a third of trainees were able to correctly identify the urethrotome kit. The assembly of cystoscope, resectoscope and urethrotome was performed correctly in 74%, 42% and 32% at baseline and 94%, 90% and 77% postcourse, respectively. Overall performance improved significantly in the postcourse assessment (<0.001).ConclusionThis urology boot camp has addressed gaps in trainees’ core equipment knowledge and guided them to improve their knowledge with respect to identification and assembly of cystoscope, resectoscope and urethrotome.
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27
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Abstract
BACKGROUND Traditional surgical training, largely based on the Halstedian model "see one, do one, teach one" is not as effective in the era of working time restrictions and elaborate shift-patterns. As a result, contemporary surgeons turned to educational methods outside the operating theatre such as simulation. Cadavers are high fidelity models but their use has ethical and cost implications and their availability may be limited. In this review, we explore the role of cadaveric simulation in modern surgical education. METHODS All the Evidence-Based Medicine databases were searched for relevant reviews. The resulting studies were assessed for inclusion to this review, according to pre-determined criteria. Data extraction was performed using a custom-made spreadsheet, and the quality of included reviews was assessed using a validated scoring system (AMSTAR). RESULTS The literature review yielded 33 systematic reviews; five of which matched the inclusion criteria and were included in this review of reviews. Cadaveric simulation was found to have good face (subjective assessment of usefulness) and content validity (whether a specific element adds or retracts to the educational value) while trainees improved their surgical skills after practicing on cadavers. However, concerns have been raised about ethical issues, high cost and availability. CONCLUSION Cadavers are an effective medium for surgical teaching, and it may be appropriate for them to be used whenever surrounding conditions such cost and availability allow. Further research is required to provide evidence on whether there is equivalence between cadavers and other educational media which may not bear the same shortcomings.
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Affiliation(s)
- M Yiasemidou
- Leeds Institute of Biomedical and Clinical Sciences, Leeds, LS9 7TF, UK. .,St. James' University Hospital, 7.26 Clinical Sciences Building, Leeds, West Yorkshire, LS9 7TF, UK.
| | | | | | - C S Biyani
- Urology Department, Leeds Teaching Hospitals, Leeds, UK
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28
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Yiasemidou M, Galli R, Glassman D, Tang M, Aziz R, Jayne D, Miskovic D. Patient-specific mental rehearsal with interactive visual aids: a path worth exploring? Surg Endosc 2017; 32:1165-1173. [PMID: 28840324 PMCID: PMC5807505 DOI: 10.1007/s00464-017-5788-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 07/28/2017] [Indexed: 11/06/2022]
Abstract
Background Surgeons of today are faced with unprecedented challenges; necessitating a novel approach to pre-operative preparation which takes into account the specific tests each case poses. In this study, we examine patient-specific mental rehearsal for pre-surgical practice and assess whether this method has an additional effect when compared to generic mental rehearsal. Methods Sixteen medical students were trained how to perform a simulated laparoscopic cholecystectomy (SLC). After baseline assessments, they were randomised to two equal groups and asked to complete three SLCs involving different anatomical variants. Prior to each procedure, Group A practiced mental rehearsal with the use of a pre-prepared checklist and Group B mental rehearsal with the checklist combined with virtual models matching the anatomical variations of the SLCs. The performance of the two groups was compared using simulator provided metrics and competency assessment tool (CAT) scoring by two blinded assessors. Results The participants performed equally well when presented with a “straight-forward” anatomy [Group A vs. Group B—time sec: 445.5 vs. 496 p = 0.64—NOM: 437 vs. 413 p = 0.88—PL cm: 1317 vs. 1059 p = 0.32—per: 0.5 vs. 0 p = 0.22—NCB: 0 vs. 0 p = 0.71—DVS: 0 vs. 0 p = 0.2]; however, Group B performed significantly better [Group A vs. B Total CAT score—Short Cystic Duct (SCD): 20.5 vs. 26.31 p = 0.02 η2 = 0.32—Double cystic Artery (DA): 24.75 vs. 30.5 p = 0.03 η2 = 0.28] and committed less errors (Damage to Vital Structures—DVS, SCD: 4 vs. 0 p = 0.03 η2=0.34, DA: 0 vs. 1 p = 0.02 η2 = 0.22). in the cases with more challenging anatomies. Conclusion These results suggest that patient-specific preparation with the combination of anatomical models and mental rehearsal may increase operative quality of complex procedures.
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Affiliation(s)
- Marina Yiasemidou
- Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK.
| | - Raffaele Galli
- John Goligher Surgery Unit, St. James University Hospital, Leeds, UK
| | | | | | - Rahoz Aziz
- Medical School, University of Leeds, Leeds, UK
| | - David Jayne
- Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK
| | - Danilo Miskovic
- Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK
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Abstract
Necrotising fasciitis is a rare, serious infection of the deep fascia leading to subcutaneous tissue necrosis. It is extremely important for this condition to be identified and treated promptly as it bears significant mortality. We describe a case of necrotising fasciitis after laparoscopic rectal cancer surgery. To our knowledge, this is the first case reported after the specific procedure. This case report aims to encourage surgeons to have a low threshold in recognising necrotising fasciitis postoperatively, especially for patients with possible risk factors.
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Affiliation(s)
| | | | - M Basheer
- Mid Yorkshire Hospitals NHS Trust , UK
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30
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Yiasemidou M, Glassman D, Mushtaq F, Athanasiou C, Williams MM, Jayne D, Miskovic D. Mental practice with interactive 3D visual aids enhances surgical performance. Surg Endosc 2017; 31:4111-4117. [PMID: 28283764 PMCID: PMC5636856 DOI: 10.1007/s00464-017-5459-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 02/03/2017] [Indexed: 10/24/2022]
Abstract
BACKGROUND Evidence suggests that Mental Practice (MP) could be used to finesse surgical skills. However, MP is cognitively demanding and may be dependent on the ability of individuals to produce mental images. In this study, we hypothesised that the provision of interactive 3D visual aids during MP could facilitate surgical skill performance. METHODS 20 surgical trainees were case-matched to one of three different preparation methods prior to performing a simulated Laparoscopic Cholecystectomy (LC). Two intervention groups underwent a 25-minute MP session; one with interactive 3D visual aids depicting the relevant surgical anatomy (3D-MP group, n = 5) and one without (MP-Only, n = 5). A control group (n = 10) watched a didactic video of a real LC. Scores relating to technical performance and safety were recorded by a surgical simulator. RESULTS The Control group took longer to complete the procedure relative to the 3D&MP condition (p = .002). The number of movements was also statistically different across groups (p = .001), with the 3D&MP group making fewer movements relative to controls (p = .001). Likewise, the control group moved further in comparison to the 3D&MP condition and the MP-Only condition (p = .004). No reliable differences were observed for safety metrics. CONCLUSION These data provide evidence for the potential value of MP in improving performance. Furthermore, they suggest that 3D interactive visual aids during MP could potentially enhance performance, beyond the benefits of MP alone. These findings pave the way for future RCTs on surgical preparation and performance.
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Affiliation(s)
- Marina Yiasemidou
- Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, St James University Hospital, Clinical Science Building, Beckett street, Leeds, LS9 7TF, UK.
| | - Daniel Glassman
- School of Surgery, Health Education Yorkshire and the Humber, University of Leeds, Willow Terrace Road, Leeds, LS2 9JT, UK
| | - Faisal Mushtaq
- School of Psychology, Faculty of Medicine & Health, University of Leeds, Leeds, LS2 9JT, UK
| | - Christos Athanasiou
- Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, St James University Hospital, Clinical Science Building, Beckett street, Leeds, LS9 7TF, UK
| | - Mark-Mon Williams
- School of Psychology, Faculty of Medicine & Health, University of Leeds, Leeds, LS2 9JT, UK
| | - David Jayne
- Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, St James University Hospital, Clinical Science Building, Beckett street, Leeds, LS9 7TF, UK
| | - Danilo Miskovic
- Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, St James University Hospital, Clinical Science Building, Beckett street, Leeds, LS9 7TF, UK
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31
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Yiasemidou M, de Siqueira J, Tomlinson J, Glassman D, Stock S, Gough M. "Take-home" box trainers are an effective alternative to virtual reality simulators. J Surg Res 2017; 213:69-74. [PMID: 28601335 DOI: 10.1016/j.jss.2017.02.038] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 01/17/2017] [Accepted: 02/21/2017] [Indexed: 01/08/2023]
Abstract
BACKGROUND Practice on virtual reality simulators (VRSs) has been shown to improve surgical performance. However, VRSs are expensive and usually housed in surgical skills centers that may be inaccessible at times convenient for surgical trainees to practice. Conversely, box trainers (BT) are inexpensive and can be used anywhere at anytime. This study assesses "take-home" BTs as an alternative to VRS. METHODS After baseline assessments (two simulated laparoscopic cholecystectomies, one on a VRS and one on a BT), 25 surgical trainees were randomized to two groups. Trainees were asked to practice three basic laparoscopic tasks for 6 wk (BT group using a "take-home" box trainer; VR group using VRS in clinical skills centers). After the practice period, all performed two laparoscopic cholecystectomy, one on a VRS and one on a BT; (i.e., posttraining assessment). VRS provided metrics (total time [TT], number of movements instrument tip path length), and expert video assessment of cholecystectomy in a BT (Global Operative Assessment of Laparoscopic Skills [GOALS] score) were recorded. Performance during pretraining and posttraining assessment was compared. RESULTS The BT group showed a significant improvement for all VRS metrics (P = 0.008) and the efficiency category of GOALS score (P = 0.03). Only TT improved in the VRS group, and none of the GOALS categories demonstrated a statistically significant improvement after training. Finally, the improvement in VRS metrics in the BT group was significantly greater than in the VR group (TT P = 0.005, number of movements P = 0.042, path length P = 0.031), although there were no differences in the GOALS scores between the groups. CONCLUSIONS This study suggests that a basic "take-home" BT is a suitable alternative to VRS.
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Affiliation(s)
- Marina Yiasemidou
- School of Surgery, Health Education Yorkshire and the Humber, Leeds, UK; Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK.
| | | | - James Tomlinson
- School of Surgery, Health Education Yorkshire and the Humber, Leeds, UK
| | - Daniel Glassman
- School of Surgery, Health Education Yorkshire and the Humber, Leeds, UK
| | - Simon Stock
- World Mate Emergency Hospital, Battambang, Cambodia
| | - Michael Gough
- School of Surgery, Health Education Yorkshire and the Humber, Leeds, UK
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Yiasemidou M, Glassman D, Tomlinson J, Song D, Gough MJ. Perceptions About the Present and Future of Surgical Simulation: A National Study of Mixed Qualitative and Quantitative Methodology. J Surg Educ 2017; 74:108-116. [PMID: 27617919 DOI: 10.1016/j.jsurg.2016.07.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Revised: 06/17/2016] [Accepted: 07/23/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES Assess expert opinion on the current and future role of simulation in surgical education. DESIGN Expert opinion was sought through an externally validated questionnaire that was disseminated electronically. PARTICIPANTS Heads of Schools of Surgery (HoS) (and deputies) and Training Program Directors (TPD) (and deputies). RESULTS Simulation was considered a good training tool (HoS: 15/15, TPD: 21/21). The concept that simulation is useful mostly to novices and for basic skills acquisition was rejected (HoS: 15/15, TPDs: 21/21; HoS: 13/15, TPDs: 18/21). Further, simulation is considered suitable for teaching nontechnical skills (HoS: 13/15, TPDs: 20/21) and re-enacting stressful situations (HoS: 14/15, TPDs: 15/21). Most respondents also felt that education centers should be formally accredited (HoS: 12/15, TPDs: 16/21) and that consultant mentors should be appointed by every trust (HoS: 12/15, TPDs: 19/21). In contrast, there were mixed views on its use for trainee assessment (HoS: 6/15, TPDs: 14/21) and whether it should be compulsory (HoS: 8/15, TPDs: 11/21). CONCLUSION The use of simulation for the acquirement of both technical and nontechnical skills is strongly supported while views on other applications (e.g., assessment) are conflicting. Further, the need for center accreditation and supervised, consultant-led teaching is highlighted.
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Affiliation(s)
- Marina Yiasemidou
- School of Surgery, Health Education Yorkshire and Humber, Leeds Institute of Biomedical and Clinical Sciences, Leeds, West Yorkshire, United Kingdom.
| | - Daniel Glassman
- Leeds Teaching Hospitals, Leeds, West Yorkshire, United Kingdom
| | - James Tomlinson
- School of Surgery, Health Education Yorkshire and the Humber, Leeds Teaching Hospitals, Leeds, West Yorkshire, United Kingdom
| | - David Song
- Medical School, University of Leeds, Leeds, West Yorkshire, United Kingdom
| | - Michael J Gough
- School of Surgery, Health Education Yorkshire and the Humber, Leeds, West Yorkshire, United Kingdom
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Tomlinson JE, Yiasemidou M, Watts AL, Roberts DJH, Timothy J. Cadaveric Spinal Surgery Simulation: A Comparison of Cadaver Types. Global Spine J 2016; 6:357-61. [PMID: 27190738 PMCID: PMC4868577 DOI: 10.1055/s-0035-1563724] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Accepted: 07/23/2015] [Indexed: 12/21/2022] Open
Abstract
Study Design Single-blinded study. Objective To assess the suitability of three types of cadaver for simulating pedicle screw insertion and establish if there is an ideal. Methods Three types of cadaver-Thiel-embalmed, Crosado-embalmed, and formaldehyde-embalmed-were draped and the spines exposed. Experienced surgeons were asked to place pedicle screws in each cadaver and give written questionnaire feedback using a modified Likert scale. Soft tissue and bony properties were assessed, along with the role of simulation in spinal surgery training. Results The Thiel cadaver rated highest for soft tissue feel and appearance with a median score of 6 for both (range 2 to 7). The Crosado cadaver rated highest for bony feel, with a median score of 6 (range 2 to 7). The formaldehyde cadaver rated lowest for all categories with median scores of 2, 2.5, and 3.5, respectively. All surgeons felt pedicle screw insertion should be learned in a simulated setting using human cadavers. Conclusion Thiel and Crosado cadavers both offered lifelike simulation of pedicle screw insertion, with each having advantages depending on whether the focus is on soft tissue approach or technical aspects of bony screw insertion. Both cadaver types offer the advantage of long life span, unlike fresh frozen tissue, which means cadavers can be used multiple times, thus reducing the costs.
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Affiliation(s)
- James E. Tomlinson
- Leadership Fellow, Health Education Yorkshire and the Humber, University of Leeds, Leeds, United Kingdom,Address for correspondence James E. Tomlinson, MA, MB, BChir, FRCS (T&O) Leadership Fellow, Health Education Yorkshire and the Humber, University of LeedsLeeds LS2 9JTUnited Kingdom
| | - Marina Yiasemidou
- Leadership Fellow, Health Education Yorkshire and the Humber, University of Leeds, Leeds, United Kingdom
| | - Anna L. Watts
- Orthopaedic Department, Northern General Hospital, Sheffield, United Kingdom
| | | | - Jake Timothy
- Department of Neurosurgery, Leeds Teaching Hospitals, Leeds, United Kingdom
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Glassman D, Yiasemidou M, Venkateswaran B, Sivakumar R, Majumder S, Biyani CS. A multi-specialty surgical course for residents transitioning from early to intermediate training. Int J Med Educ 2016; 7:130-131. [PMID: 27132256 PMCID: PMC4860289 DOI: 10.5116/ijme.5708.e9ea] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Accepted: 04/09/2016] [Indexed: 06/05/2023]
MESH Headings
- Curriculum
- Education, Medical, Graduate/methods
- Education, Medical, Graduate/trends
- Education, Medical, Undergraduate/methods
- Education, Medical, Undergraduate/trends
- Humans
- Internship and Residency/methods
- Internship and Residency/organization & administration
- Internship and Residency/trends
- Specialties, Surgical/education
- Specialties, Surgical/trends
- Surgeons/education
- Teaching/trends
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Affiliation(s)
- Daniel Glassman
- School of Surgery, Health Education Yorkshire and the Humber, Leeds, UK
| | - Marina Yiasemidou
- School of Surgery, Health Education Yorkshire and the Humber, Leeds, UK
| | | | | | - Sanjib Majumder
- Mid Yorkshire Hospitals NHS Trust, Wakefield, West Yorkshire, UK
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Abstract
Osteoarthritis is the most common form of arthritis in the Western world, causing disabling symptoms in 10% of people older than 55 years. Hyaluronic acid injections can reduce osteoarthritic pain but require three to five doses administered weekly. This preliminary study aims to assess the efficacy of a more flexible viscosupplementation regimen. Patients were given three sodium hyaluronate isotonic solution injections (Ostenil; TRB Chemedica SA, Vouvry, Switzerland), biweekly. They were then asked to record their pain before and after administration of the injections, on a visual analog score. A total of 91 knees were injected. Analysis of the data showed that the viscosupplementation injections significantly reduced the baseline pain within the first 24 to 48 hours post first injection (before injection, 68.8mm; 2 days postinjection, 48.9 mm; p < 0.001); these effects were maintained up to 6 months. No adverse effects were reported. The proposed regimen appears safe and efficient in reducing osteoarthritic pain of the knee joint. A randomized controlled study is needed to confirm these results.
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Affiliation(s)
- Marina Yiasemidou
- Academic Surgical Unit, St. James University Hospital, Leeds, West Yorkshire, United Kingdom
| | - Usama Munir
- Department of Trauma and Orthopaedics, Whiston Hospital, Prescot, Merseyside, United Kingdom
| | - Daniel Glassman
- General Surgery Department, Pinderfields Hospital, Wakefield, West Yorkshire, United Kingdom
| | - David Teanby
- Department of Trauma and Orthopaedics, Whiston Hospital, Prescot, Merseyside, United Kingdom
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Glassman D, Yiasemidou M, Ishii H, Somani BK, Ahmed K, Biyani CS. Effect of Playing Video Games on Laparoscopic Skills Performance: A Systematic Review. J Endourol 2015; 30:146-52. [PMID: 26414043 DOI: 10.1089/end.2015.0425] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND AND PURPOSE The advances in both video games and minimally invasive surgery have allowed many to consider the potential positive relationship between the two. This review aims to evaluate outcomes of studies that investigated the correlation between video game skills and performance in laparoscopic surgery. METHODS A systematic search was conducted on PubMed/Medline and EMBASE databases for the MeSH terms and keywords including "video games and laparoscopy," "computer games and laparoscopy," "Xbox and laparoscopy," "Nintendo Wii and laparoscopy," and "PlayStation and laparoscopy." Cohort, case reports, letters, editorials, bulletins, and reviews were excluded. Studies in English, with task performance as primary outcome, were included. The search period for this review was 1950 to December 2014. RESULTS There were 57 abstracts identified: 4 of these were found to be duplicates; 32 were found to be nonrelevant to the research question. Overall, 21 full texts were assessed; 15 were excluded according to the Medical Education Research Study Quality Instrument quality assessment criteria. The five studies included in this review were randomized controlled trials. Playing video games was found to reduce error in two studies (P 0.002 and P 0.045). For the same studies, however, several other metrics assessed were not significantly different between the control and intervention group. One study showed a decrease in the time for the group that played video games (P 0.037) for one of two laparoscopic tasks performed. In the same study, however, when the groups were reversed (initial control group became intervention and vice versa), a difference was not demonstrated (P for peg transfer 1 - 0.465, P for cobra robe - 0.185). Finally, two further studies found no statistical difference between the game playing group and the control group's performance. CONCLUSION There is a very limited amount of evidence to support that the use of video games enhances surgical simulation performance.
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Affiliation(s)
| | - Marina Yiasemidou
- 2 Healthcare Education Yorkshire and The Humber, School of Surgery , Leeds, United Kingdom
| | - Hiro Ishii
- 3 University Hospital Southampton NHS Foundation Trust , Southampton, United Kingdom
| | - Bhaskar Kumar Somani
- 3 University Hospital Southampton NHS Foundation Trust , Southampton, United Kingdom
| | - Kamran Ahmed
- 4 NIHR (TUF) Academic Clinical Lecturer, Guy's Hospital , London, United Kingdom
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Tomlinson J, Yiasemidou M. Teaching future surgeons: a step towards better training? Clin Teach 2015; 12:143. [PMID: 25789908 DOI: 10.1111/tct.12338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- James Tomlinson
- School of Surgery, Health Education Yorkshire and the Humber, Leeds, Yorkshire, UK
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Glassman D, Yiasemidou M, Napier J, Bhattacharyya M. Infrarenal aortic aneurysm: an incidental radiological finding. J Emerg Med 2012; 43:e205-e206. [PMID: 21549547 DOI: 10.1016/j.jemermed.2011.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2010] [Revised: 08/21/2010] [Accepted: 03/16/2011] [Indexed: 05/30/2023]
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Karamanolis G, Theofanidou I, Yiasemidou M, Giannoulis E, Triantafyllou K, Ladas SD. A glass of water immediately increases gastric pH in healthy subjects. Dig Dis Sci 2008; 53:3128-32. [PMID: 18473176 DOI: 10.1007/s10620-008-0301-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2008] [Accepted: 04/10/2008] [Indexed: 12/09/2022]
Abstract
UNLABELLED Onset of action of antisecretory agents is of pivotal importance for patients with gastroesophageal reflux disease (GERD) treated "on-demand." AIM To study the acute effect of acid-inhibiting drugs and water administration on gastric pH. METHOD A cross-over study was performed in 12 H. pylori (-), healthy subjects (6 men; mean age: 26 years). A single oral dose of the following agents was received with a wash-out period between each study: a glass of water (200 ml), antacid, ranitidine, omeprazole, esomeprazole, and rabeprazole. Gastric pH was recorded for 6 h after drug intake. RESULTS Water increased gastric pH >4 in 10/12 subjects after 1 min. The time (median) needed to pH >4 was for: antacid 2 min, ranitidine 50 min, omeprazole 171 min, esomeprazole 151 min, and rabeprazole 175 min. Gastric pH >4 lasted for 3 min after water and for 12 min after antacids; it remained >4 until the end of recording in: 4/12 subjects with ranitidine, 11/12 with rabeprazole, and all with omeprazole and esomeprazole. CONCLUSION Water and antacid immediately increased gastric pH, while PPIs showed a delayed but prolonged effect compared to ranitidine.
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Affiliation(s)
- George Karamanolis
- Hepatogastroenteroly Unit, 2nd Department of Internal Medicine-Propaedeutic, "Attikon" University General Hospital, Athens University, Athens, Greece
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