The Australasian Students' Surgical Association: organizational growth amidst the challenges of the COVID-19 pandemic

[Extract] Student surgical societies play an important role in complementing university medical curricula in the delivery of surgical education, fostering interest in surgery and facilitating networking and career opportunities.1 The Australasian Students' Surgical Association (ASSA) was established in 2015 as a not-for-profit student-run organization aiming to unite the 26 student surgical societies across Australia and New Zealand.2 Through in-person conferences, Sydney-based leadership seminars and surgical workshops, the ASSA has successfully achieved its vision to support surgical education, foster student interest in surgery, and create a culture of collaboration amongst surgical societies. As the COVID-19 pandemic presented a variety of unforeseen challenges to the medical profession, student organizations across the world were required to adapt to the content and delivery of activities.3 The pandemic posed significant challenges for the ASSA to continue promoting a pre-vocational interest in surgery for Australian and New Zealand medical students and required innovative strategies to continue delivering educational opportunities. This need to adopt alternative approaches provided an opportunity for innovation and embracing technology to overcome COVID-19 related restrictions to continue achieving the goals for ASSA

Female and low- and middle-income authorship trends in high-impact ENT journals (2011-2020)

INTRODUCTION: Despite a recent drive to increase diversity, the global academic workforce is skewed in favor of authors from high-income countries, and women are under-represented in the published medical literature. OBJECTIVES: To explore the trends in authorship of three high-impact otolaryngology journals over a ten-year period (2011-2020). METHODS: Journals selected: JAMA Otolaryngology-Head and Neck Surgery, The Laryngoscope and Rhinology. Articles were reviewed from four issues per journal per year, and data was collected on: time of publication; subspeciality; number of authors; sex of first and last authors; country of practice of first author and country where each study was conducted. Trends were examined though univariate and multivariate logistic regression models. RESULTS: 2998 articles were included. 93.9% of first authors and 94.2% of studies were from high-income countries.Women were first authors in 31.5% (n = 912) and senior authors in 18.4% (n = 524) of articles. Female first authorship significantly increased between 2011 and 2020 however female senior authorship remained the same. There have been no significant changes in the proportion of published articles from low-and middle-income countries (LMIC) over time (p = .65). Amongst the LMIC articles, 72% came from Brazil, Turkey or China and there were no published papers from countries with a low-income economy (gross national income per capita of $1085 or less). CONCLUSIONS: Although female first authorship has increased in the last decade, there has been minimal other demographic change in authorship over this time. High-impact otolaryngology journals poorly represent academia in low-and-middle income countries. There is a need for increased advocacy promoting gender and geographical research equity in academic medicine. LEVEL OF EVIDENCE: III

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Supportive care of patients diagnosed with high grade glioma and their carers in Australia

Purpose This study aimed to: determine the supportive care available for Australian patients with High Grade Glioma (HGG) and their carers; identify service gaps; and inform changes needed to implement guidelines and Optimal Care Pathways. Methods This cross-sectional online survey recruited multidisciplinary health professionals (HPs) who were members of the Cooperative Trials Group for Neuro-Oncology involved in management of patients diagnosed with HGG in Australian hospitals. Descriptive statistics were calculated. Fisher\u27s exact test was used to explore differences between groups. Results 42 complete responses were received. A majority of MDT meetings were attended by a: neurosurgeon, radiation oncologist, medical oncologist, radiologist, and care coordinator. Less than 10% reported attendance by a palliative care nurse; physiotherapist; neuropsychologist; or speech therapist. Most could access referral pathways to a cancer care coordinator (76%), neuropsychologist (78%), radiation oncology nurse (77%), or psycho-oncologist (73%), palliative care (93–100%) and mental health professionals (60–85%). However, few routinely referred to an exercise physiologist (10%), rehabilitation physician (22%), dietitian (22%) or speech therapist (28%). Similarly, routine referrals to specialist mental health services were not standard practice. Nearly all HPs (94%) reported HGG patients were advised to present to their GP for pre-existing conditions/comorbidities; however, most HPs took responsibility (≤ 36% referred to GP) for social issues, mental health, symptoms, cancer complications, and treatment side-effects. Conclusions While certain services are accessible to HGG patients nationally, improvements are needed. Psychosocial support, specialist allied health, and primary care providers are not yet routinely integrated into the care of HGG patients and their carers despite these services being considered essential in clinical practice guidelines and optimal care pathways