Surgical training rotation design: effects of hospital type, rotation theme and duration

Background Entrants into UK surgical specialty training undertake a 2‐year programme of core surgical training, rotating through specialties for varying lengths of time, at different hospitals, to gain breadth of experience. This study aimed to assess whether these variables influenced core surgical trainee (CST) work productivity. Methods Intercollegiate Surgical Curriculum Programme portfolios of consecutive CSTs between 2016 and 2019 were examined. Primary outcome measures were workplace‐based assessment (WBA) completion, operative experience and academic outputs (presentations to learned societies, publications and audits). Results A total of 344 rotations by 111 CSTs were included. Incremental increases in attainment were observed related to the duration of core surgical training rotation. The median number of consultant‐validated WBAs completed during core surgical training were 48 (range 0–189), 54 (10–120) and 75 (6–94) during rotations consisting of 4‐, 6‐ and 12‐month posts respectively (P  < 0·001). Corresponding median operative caseloads (as primary surgeon) were 84 (range 3–357), 110 (44–394) and 134 (56–366) (P  < 0·001) and presentations to learned societies 0 (0–12), 0 (0–14) and 1 (0–5) (P = 0·012) respectively. Hospital type and specialty training theme were unrelated to workplace productivity. Multivariable analysis identified length of hospital rotation as the only factor independently associated with total WBA count (P = 0·001), completion of audit (P = 0·015) and delivery of presentation (P = 0·001) targets. Conclusion Longer rotations with a single educational supervisor, in one training centre, are associated with better workplace productivity. Consideration should be given to this when reconfiguring training programmes within the arena of workforce planning

Using ordinal logistic regression to evaluate the performance of laser-Doppler predictions of burn-healing time

Background Laser-Doppler imaging (LDI) of cutaneous blood flow is beginning to be used by burn surgeons to predict the healing time of burn wounds; predicted healing time is used to determine wound treatment as either dressings or surgery. In this paper, we do a statistical analysis of the performance of the technique. Methods We used data from a study carried out by five burn centers: LDI was done once between days 2 to 5 post burn, and healing was assessed at both 14 days and 21 days post burn. Random-effects ordinal logistic regression and other models such as the continuation ratio model were used to model healing-time as a function of the LDI data, and of demographic and wound history variables. Statistical methods were also used to study the false-color palette, which enables the laser-Doppler imager to be used by clinicians as a decision-support tool. Results Overall performance is that diagnoses are over 90% correct. Related questions addressed were what was the best blood flow summary statistic and whether, given the blood flow measurements, demographic and observational variables had any additional predictive power (age, sex, race, % total body surface area burned (%TBSA), site and cause of burn, day of LDI scan, burn center). It was found that mean laser-Doppler flux over a wound area was the best statistic, and that, given the same mean flux, women recover slightly more slowly than men. Further, the likely degradation in predictive performance on moving to a patient group with larger %TBSA than those in the data sample was studied, and shown to be small. Conclusion Modeling healing time is a complex statistical problem, with random effects due to multiple burn areas per individual, and censoring caused by patients missing hospital visits and undergoing surgery. This analysis applies state-of-the art statistical methods such as the bootstrap and permutation tests to a medical problem of topical interest. New medical findings are that age and %TBSA are not important predictors of healing time when the LDI results are known, whereas gender does influence recovery time, even when blood flow is controlled for. The conclusion regarding the palette is that an optimum three-color palette can be chosen 'automatically', but the optimum choice of a 5-color palette cannot be made solely by optimizing the percentage of correct diagnoses

Cost-effectiveness of interventions for increasing the possession of functioning smoke alarms in households with pre-school children: a modelling study

Background The UK has one of the highest rates for deaths from fire and flames in children aged 0-14 years compared to other high income countries. Evidence shows that smoke alarms can reduce the risk of fire-related injury but little exists on their cost-effectiveness. We aimed to compare the cost effectiveness of different interventions for the uptake of 'functioning' smoke alarms and consequently for the prevention of fire-related injuries in children in the UK. Methods We carried out a decision model-based probabilistic cost-effectiveness analysis. We used a hypothetical population of newborns and evaluated the impact of living in a household with or without a functioning smoke alarm during the first 5 years of their life on overall lifetime costs and quality of life from a public health perspective. We compared seven interventions, ranging from usual care to more complex interventions comprising of education, free/low cost equipment giveaway, equipment fitting and/or home safety inspection. Results Education and free/low cost equipment was the most cost-effective intervention with an estimated incremental cost-effectiveness ratio of [pound sign]34,200 per QALY gained compared to usual care. This was reduced to approximately £4,500 per QALY gained when 1.8 children under the age of 5 were assumed per household. Conclusions Assessing cost-effectiveness, as well as effectiveness, is important in a public sector system operating under a fixed budget restraint. As highlighted in this study, the more effective interventions (in this case the more complex interventions) may not necessarily be the ones considered the most cost-effective

Design and preliminarily validation of a tool to assess the impact of chronic non‐cancer pain on people’s daily life in Spanish‐language: PAIN_Integral Scale ©

Aim: To build and preliminarily validate a Spanish-language instrument to assess the impact that CNCP has on the daily lives of people who suffer from it. Background: The experience of pain is multifactorial and a correct assessment of it helps to control the intensity of pain. Although there are instruments that evaluate areas on which Chronic Non-Cancer Pain impacts, it would be necessary to include other aspects that scientific literature identifies as relevant. Design: Instrument and construct cross-sectional study for psychometric validation. Methods: A total of 157 items based on items from validated questionnaires were evaluated by a group of 21 chronic pain experts using Delphi methodology in three evaluation rounds. A final questionnaire of 55 items with a 5-point Likert-type scale was formed. This questionnaire was piloted on a total of 30 patients to assess their understanding of the items and the psychometric validation process was carried out (January to March 2020) on a subsequent sample of 395 people, all of whom attended Pain Units and Primary Care Centres of the Public Health System in Spain. Results: The PAIN_Integral Scale© showed acceptable internal consistency scores measured by Cronbach's alpha. Exploratory Factor Analysis indicated a structure of nine factors that explain 71.02% of the total variance, from 157 to a final total of 36 items. Confirmatory Factor Analysis showing adequate values confirmed this structure. The effect size was used to calculate the cut-off points for the overall scale, setting them at scores of 130 and 135. Conclusion: This instrument would allow to assess other constructs and dimensions not included in the instruments previously available such as treatment compliance, proactivity, resilience, hopelessness due to pain and pain catastrophizing. However, despite the fact that the preliminary analysis shows good results, it is necessary to continue with its validation process in subsequent studies