Should the NHS be privatized? Annual varsity medical debate - London, 22nd January 2010

RIGHTS : This article is licensed under the BioMed Central licence at http://www.biomedcentral.com/about/license which is similar to the 'Creative Commons Attribution Licence'. In brief you may : copy, distribute, and display the work; make derivative works; or make commercial use of the work - under the following conditions: the original author must be given credit; for any reuse or distribution, it must be made clear to others what the license terms of this work are.Abstract The Varsity Medical Debate, between Oxford and Cambridge Universities, brings together practitioners and the public, professors, pupils and members of the polis, to facilitate discussion about ethics and policy within healthcare. The motion on privatizing the National Health Service (NHS) was specifically chosen to reflect the growing sentiment in the UK where further discourse upon models of healthcare was required. Time and again, the outcome of British elections pivots upon the topic of financial sustainability of the NHS. Having recently celebrated its sixtieth anniversary, the NHS has become heavily politicized in recent months, especially in the aftermath of the devastating global recession.Published versio

Training safer orthopedic surgeons Construct validation of a virtual-reality simulator for hip fracture surgery

BACKGROUND AND PURPOSE: Virtual-reality (VR) simulation in orthopedic training is still in its infancy, and much of the work has been focused on arthroscopy. We evaluated the construct validity of a new VR trauma simulator for performing dynamic hip screw (DHS) fixation of a trochanteric femoral fracture. PATIENTS AND METHODS: 30 volunteers were divided into 3 groups according to the number of postgraduate (PG) years and the amount of clinical experience: novice (1–4 PG years; less than 10 DHS procedures); intermediate (5–12 PG years; 10–100 procedures); expert (> 12 PG years; > 100 procedures). Each participant performed a DHS procedure and objective performance metrics were recorded. These data were analyzed with each performance metric taken as the dependent variable in 3 regression models. RESULTS: There were statistically significant differences in performance between groups for (1) number of attempts at guide-wire insertion, (2) total fluoroscopy time, (3) tip-apex distance, (4) probability of screw cutout, and (5) overall simulator score. The intermediate group performed the procedure most quickly, with the lowest fluoroscopy time, the lowest tip-apex distance, the lowest probability of cutout, and the highest simulator score, which correlated with their frequency of exposure to running the trauma lists for hip fracture surgery. INTERPRETATION: This study demonstrates the construct validity of a haptic VR trauma simulator with surgeons undertaking the procedure most frequently performing best on the simulator. VR simulation may be a means of addressing restrictions on working hours and allows trainees to practice technical tasks without putting patients at risk. The VR DHS simulator evaluated in this study may provide valid assessment of technical skill

Policy and practice review consensus statements and clinical guidelines on managing pediatric trauma and orthopedics during the COVID-19 pandemic: a systematic review on the global response for future pandemics and public health crises

IntroductionThe COVID-19 pandemic has been recognized as an unprecedented global health crisis. Over 7 million mortalities have been documented with many paediatric fatalities. Trauma and orthopaedic care, much like other specialities, were marginalized due to resource allocation during the pandemic which affected paediatric care. This is the first systematic review to centralise and compile the recommended published guidelines from professional bodies in principally English speaking countries on managing paediatric trauma and orthopaedic care. These guidelines will be required to be implemented sooner and more effectively in case of future pandemics with similar impact.MethodsA search was conducted on PubMed/MedLine, Cochrane Library and Embase using terms including p(a)ediatric or child* and/or COVID* or coronavirus or SARS-CoV-2 and/or trauma and/or orthop(a)edic* with a simplified MeSH heading [mh] in order to make the search as comprehensive as possible. General terminology was utilized to make the search as exhaustive as possible for this systematic review. Another search was conducted on resources available in the public domain from professional bodies publishing on consensus statements and clinical practice guidelines in countries where English is the principal language managing pediatric trauma and orthopedics. The review adhered to PRISMA guidance.ResultsThe search revealed a total of 62 results from both databases and professional bodies. Duplicates were removed. This was then reviewed to identify a total of 21 results which fit the inclusion criteria and included within the main analysis. The guidelines from professional bodies were outlined and categorized into aspects of clinical care.DiscussionThe impact of COVID-19 pandemic has compelled for changes in clinical practice and pediatric management. The systematic review highlights the relevant guidelines on service provision for pediatric patients including indications for urgent referrals, surgical prioritization, reasons for follow-up and trauma guidelines. The rationale for care during the unpredictable evolution of the COVID-19 pandemic may have the potential to be translated and replicated in future pandemics of similar significance

The first South American free online virtual morphology laboratory: creating history

Fil: Ávila, Rodolfo Esteban . Universidad Nacional de Córdoba. Facultad de Odontología; Argentina.Fil: Samar, María Elena. Universidad Nacional de Córdoba. Facultad de Odontología; Argentina.Fil: Metcalfe, David. University Hospital Coventry & Warwickshire. Warwick Medical School; United Kingdoom.Fil: Evans, Jessica. Kingston Hospital. Department of Surgery. Kingston upon Thames; United Kingdoom.Fil: Abrahams, Peter H. University Hospital Coventry & Warwickshire. Warwick Medical School; United Kingdoom.Fil: Sugand, Kapil. Imperial College. MSk Lab; United Kingdoom.Biomedical teaching has been revolutionized through multimedia and global collaboration. In a joint effort between Argentina and the UK, a Virtual Laboratory has been created for teaching mor- phological topics interactively pertaining to cell biology, histology and embryology intended for Health Science students at the National University of Cordoba, Argentina. Aim: To observe whether the online resource has changed the attitudes of student-users and offers a suitable replacement to traditional labora- tory work. Methods: Through a central website that has evolved for almost a decade and most likely the first of its kind on the continent, the virtual laboratory program was launched and students were recruited to participate in a basic survey on the significance of the virtual laboratory program to their learning needs, attitudes to using electronic media and whether they agreed that classroom teaching should be obsolete altogether. Results: 291 student-users were recruited in the academic year of 2010. 267, of whom 92% used the virtual laboratory as a principal tool for learning. The online virtual practical work-guide de- signed by faculty was the most commonly used supplementary resource. A minority of students still pre- ferred to supplement their learning by traditional methods such as books and classroom notes as well as external online resources. Conclusion: Our interactive virtual program was unanimously preferred as the principle learning tool for morphological sciences. The Virtual Laboratory, using popular electronic mul- timedia and inter-continental partnership, will enhance all aspects of biomedical education as a unique teaching resource in South America.http://www.scirp.org/journal/PaperInformation.aspx?PaperID=36717info:eu-repo/semantics/publishedVersionFil: Ávila, Rodolfo Esteban . Universidad Nacional de Córdoba. Facultad de Odontología; Argentina.Fil: Samar, María Elena. Universidad Nacional de Córdoba. Facultad de Odontología; Argentina.Fil: Metcalfe, David. University Hospital Coventry & Warwickshire. Warwick Medical School; United Kingdoom.Fil: Evans, Jessica. Kingston Hospital. Department of Surgery. Kingston upon Thames; United Kingdoom.Fil: Abrahams, Peter H. University Hospital Coventry & Warwickshire. Warwick Medical School; United Kingdoom.Fil: Sugand, Kapil. Imperial College. MSk Lab; United Kingdoom.Otras Ciencias de la Salu

Do patients accurately represent their experiences after hip and knee replacements?

Background To investigate discrepancies, if any, between the complications that patients report on the patient-reported outcome measures (PROMs) questionnaire and what is formally recorded in their medical records. Methodology A retrospective analysis of PROMs-reported complications was performed at a single elective center for all patients who had an elective primary total knee or hip replacement between April 2016 and March 2017. Corresponding patient medical records were then analyzed to correlate the PROMs with any documentation of postoperative complications, which similar to the PROMs data were categorized into wound complications, urinary complications, readmission, and further operative procedures. Results A set of 54 complete patient records were compared to the corresponding PROMs data. The combined overall positive predictive value was 0.47 while the overall negative predictive value was 0.91. Concordance between patients and the medical records was 70.4% for wound complication, 66.7% for urinary complications, 83.3% for readmission, and 96.3% for reoperation. Conclusion PROMs data are becoming increasingly important in auditing and planning healthcare provision. This study highlights a significant level of discrepancy between the PROMs-reported complication rates and those documented in the medical records. There is a visible disparity between patient perception and the medical definition of postoperative complications. Further patient education and empowerment are required in preparation for arthroplasty

IMPACT-Global Hip Fracture Audit: Nosocomial infection, risk prediction and prognostication, minimum reporting standards and global collaborative audit. Lessons from an international multicentre study of 7,090 patients conducted in 14 nations during the COVID-19 pandemic

AIMS: This international study aimed to assess: 1) the prevalence of preoperative and postoperative COVID-19 among patients with hip fracture, 2) the effect on 30-day mortality, and 3) clinical factors associated with the infection and with mortality in COVID-19-positive patients. METHODS: A multicentre collaboration among 112 centres in 14 countries collected data on all patients presenting with a hip fracture between 1(st) March-31(st) May 2020. Demographics, residence, place of injury, presentation blood tests, Nottingham Hip Fracture Score, time to surgery, management, ASA grade, length of stay, COVID-19 and 30-day mortality status were recorded. RESULTS: A total of 7090 patients were included, with a mean age of 82.2 (range 50-104) years and 4959 (70%) being female. Of 651 (9.2%) patients diagnosed with COVID-19, 225 (34.6%) were positive at presentation and 426 (65.4%) became positive postoperatively. Positive COVID-19 status was independently associated with male sex (odds ratio (OR) 1.38, p=0.001), residential care (OR 2.15, p<0.001), inpatient fall (OR 2.23, p=0.003), cancer (OR 0.63, p=0.009), ASA grade 4-5 (OR 1.59, p=0.008; OR 8.28, p<0.001), and longer admission (OR 1.06 for each increasing day, p<0.001). Patients with COVID-19 at any time had a significantly lower chance of 30-day survival versus those without COVID-19 (72.7% versus 92.6%, p<0.001). COVID-19 was independently associated with an increased 30-day mortality risk (hazard ratio (HR) 2.83, p<0.001). Increasing age (HR 1.03, p=0.028), male sex (HR 2.35, p<0.001), renal disease (HR 1.53, p=0.017), and pulmonary disease (HR 1.45, p=0.039) were independently associated with a higher 30-day mortality risk in patients with COVID-19 when adjusting for confounders. CONCLUSION: The prevalence of COVID-19 in hip fracture patients during the first wave of the pandemic was 9%, and was independently associated with a three-fold increased 30-day mortality risk. Among COVID-19-positive patients, those who were older, male, with renal or pulmonary disease had a significantly higher mortality risk

Correction to: Two years later: Is the SARS-CoV-2 pandemic still having an impact on emergency surgery? An international cross-sectional survey among WSES members

Background: The SARS-CoV-2 pandemic is still ongoing and a major challenge for health care services worldwide. In the first WSES COVID-19 emergency surgery survey, a strong negative impact on emergency surgery (ES) had been described already early in the pandemic situation. However, the knowledge is limited about current effects of the pandemic on patient flow through emergency rooms, daily routine and decision making in ES as well as their changes over time during the last two pandemic years. This second WSES COVID-19 emergency surgery survey investigates the impact of the SARS-CoV-2 pandemic on ES during the course of the pandemic. Methods: A web survey had been distributed to medical specialists in ES during a four-week period from January 2022, investigating the impact of the pandemic on patients and septic diseases both requiring ES, structural problems due to the pandemic and time-to-intervention in ES routine. Results: 367 collaborators from 59 countries responded to the survey. The majority indicated that the pandemic still significantly impacts on treatment and outcome of surgical emergency patients (83.1% and 78.5%, respectively). As reasons, the collaborators reported decreased case load in ES (44.7%), but patients presenting with more prolonged and severe diseases, especially concerning perforated appendicitis (62.1%) and diverticulitis (57.5%). Otherwise, approximately 50% of the participants still observe a delay in time-to-intervention in ES compared with the situation before the pandemic. Relevant causes leading to enlarged time-to-intervention in ES during the pandemic are persistent problems with in-hospital logistics, lacks in medical staff as well as operating room and intensive care capacities during the pandemic. This leads not only to the need for triage or transferring of ES patients to other hospitals, reported by 64.0% and 48.8% of the collaborators, respectively, but also to paradigm shifts in treatment modalities to non-operative approaches reported by 67.3% of the participants, especially in uncomplicated appendicitis, cholecystitis and multiple-recurrent diverticulitis. Conclusions: The SARS-CoV-2 pandemic still significantly impacts on care and outcome of patients in ES. Well-known problems with in-hospital logistics are not sufficiently resolved by now; however, medical staff shortages and reduced capacities have been dramatically aggravated over last two pandemic years

Training safer trauma & orthopaedic surgeons through simulation: multidisciplinary, multimodal, and multimedia methodologies

The aim of this thesis was to observe for educational technology through various platforms that could enhance, rather than replace, current training methods in Trauma and Orthopaedic surgery. 9 studies, spanning over 6 years, focussed on validating contemporary simulation methods that consisted of multimodal, multimedia and multi-disciplinary approaches to challenge orthodox pedagogy. Balance between fidelity, interaction and immersion was justified for each simulation scenario after being trialled and tested on cohorts of students, trainees and consultant surgeons. New content was created for the purpose of this thesis as well as being the first to validate commercial virtual reality simulators. Validation consisted of construct, face and content validity as well as training effect and acceptability. Initially, the opinions of the international undergraduate medical student body on the importance of surgical simulation and patient perception on the use of simulated models during Orthopaedic consultations were researched. 5 studies compromised of randomised controlled trials to reach a high level of evidence. Out of those, 3 training effect studies demonstrated that repeated practice improved the psychomotor skills as well as decision-making abilities in cognitive task analysis. With more options available as a result of this thesis, the hope is to formally implement more simulation into the curriculum. The simulation scenarios in this body of work were conducted in a safe and controlled environment to minimise the learning curve when it came to familiarising with new knowledge, thus upholding patient safety as a core pillar of clinical governance. A blended approach attempted to develop and hone both technical and non-technical skills to potentially reduce risk of iatrogenic errors and litigation for future generations of surgeons. Overall, the intention of the modern simulation modalities was to bring Trauma and Orthopaedic surgical training out of its infancy into the 21st century using quantitative and qualitative evidence.Open Acces