Strategies to secure surgical research funding: fellowships and grants.

Innovation and advances in surgery are entirely dependent on research. Fellowships and grants are the principal means by which surgical research projects are funded. However, these are scarce and highly competitive. This article offers guidance through the application process for the aspiring academic surgeon. Approaching the application in a timely and structured manner, seeking advice from current and previous award-holders and members of review panels, and obtaining preliminary data are key ingredients to success

Perspectives on procedure based assessments: a thematic analysis of semi-structured interviews with ten UK surgical trainees

Objectives: The introduction of competency-based training has necessitated development and implementation of accompanying mechanisms for assessment. Procedure based assessments (PBAs) are an example of workplace-based assessments that are used to examine focal competencies in the workplace. The primary objective was to understand surgical trainees’ perspective on the value of PBA. Design: Semi-structured interviews with 10 surgical trainees individually interviewed to explore their views. Interviews were audio-recorded and transcribed, following this they were open and axial coded. Thematic analysis was then performed. Results: Semi-structured interviews yielded several topical and recurring themes. In trainees’ experience the use of PBAs as a summative tool limits their educational value. Trainees reported a lack of support from seniors and variation in the usefulness of the tool based on stage of training. Concerns related to the validity of PBAs for evaluating trainees’ performance with reports of ‘gaming’ the system and trainees completing their own assessments. Trainees’ did identify the significant value of PBAs when used correctly. Benefits included the identification of additional learning opportunities, standardisation of assessment and their role in providing a measure of progress. Conclusions: The UK surgical trainees interviewed identified both limitations and benefits to PBAs, however we would argue based on their responses and our experience that their use as a summative tool limits their formative use as an educational opportunity. PBAs should either be used exclusively to support learning or solely used as a summative tool, if so further work is needed to audit, validate and standardise them for this purpose

Mentoring during surgical training: Consensus recommendations for mentoring programmes from the Association of Surgeons in Training

AbstractMentoring has been present within surgical training for many years, albeit in different forms. There is evidence that formal mentoring can improve patient outcomes and facilitate learning and personal growth in the mentee. The Association of Surgeons in Training (ASiT) is an independent educational charity working to promote excellence in surgical training. This document recommends the introduction of a structured mentoring programme, which is readily accessible to all surgical trainees.A review of the available evidence – including an ASiT-led survey of its membership – highlights the desire of surgical trainees to have a mentor, whilst the majority do not have access to one. There is also limited training for those in mentoring roles. In response, ASiT have implemented a pilot mentoring scheme, with surgical trainees acting both as mentors and mentees. Based on the existing literature, survey data and pilot experience, ASiT formalises in this document consensus recommendations for mentoring in surgical training

Trends in lower limb amputation incidence in European Union 15+ Countries 1990-2017

Objective: Lower extremity amputation (LEA) carries significant mortality, morbidity and health economic burden. In the Westernworld,it most commonly results from complications of peripheral arterial occlusive disease (PAOD) or diabetic foot disease. Incidence of PAOD has declined in Europe,the United States and parts of Australasia.We aimed to assess trends in LEA incidence in European Union (EU15+) countries for the years 1990 to 2017. Design: Observational study using data obtained from the 2017 Global Burden of Disease (GBD) study. Materials: GBD Results Tool: http://ghdx.healthdata.org/gbd-results-too. Methods: Age-standardised incidence rates (ASIRs) for LEA (stratified into toe amputation,and LEA proximal to toes) were extracted from the GBD Results Tool for EU15+ countries foreach ofthe years 1990-2017.Trends were analysed using Join point regression analysis. Results: Between 1990 and 2017, variable trends in the incidence of LEA were observedin EU15+ countries. For LEAs proximal to toes, increasing trends were observed in 6 of 19 countries anddecreasing trends in 9 of 19 countries, with 4 countries showing varying trendsbetween sexes. For toe amputation, increasing trends were observed in 8 of 19 countries and decreasing trends in 8 of 19 countries for both sexes, with 3 countries showing varying trendsbetween sexes. Australia hadthe highest ASIRs for both sexes in all LEAs at all time 6 points, with steadily increasing trends. The USA observed the greatest reduction all LEAsin both sexes over the time periodanalysed (LEAs proximal to toes: females -22.93%, males -29.76%; toe amputation: females -29.93%, males -32.67%). The greatest overall increase in incidence was observed in Australia. Conclusions: Variable trends in LEA incidence were observed across EU15+ countries. These trends do not reflect previously observed reductions in incidence of PAO Dover the same time period

Paradoxical impact of socioeconomic factors on outcome of atrial fibrillation in Europe: trends in incidence and mortality from atrial fibrillation

Aims: To understand the changing trends in Atrial Fibrillation (AF) incidence and mortality across Europe from 1990 to 2017, and how socioeconomic factors and sex differences play a role. Methods and Results: We performed a temporal analysis of data from the 2017 Global Burden of Disease Database for 20 countries across Europe using Joinpoint regression analysis. Age-adjusted incidence, mortality and mortality to incidence ratios (MIRs) to approximate case fatality rate are presented. Incidence and mortality trends were heterogenous throughout Europe, with Austria, Denmark and Sweden experiencing peaks in incidence in the middle of the study period. Mortality rates were higher in wealthier countries with the highest being Sweden for both men and women (8.83 and 8.88 per 100,000, respectively) in 2017. MIRs were higher in women in all countries studied, with the disparity increasing the most over time in Germany (43.6% higher in women versus men in 1990 to 74.5% higher in women in 2017). Conclusion: AF incidence and mortality across Europe did not show a general trend, but unique patterns for some nations were observed. Higher mortality rates were observed in wealthier countries, potentially secondary to a survivor effect where patients survive long enough to suffer from AF and its complications. Outcomes for women with AF were worse than men, represented by higher MIRs. This suggests there is widespread healthcare inequality between the sexes across Europe, or that there are biological differences between them in terms of their risk of adverse outcomes from A

Interstitial lung disease incidence and mortality in the United Kingdom and the European Union: an observational study, 2001-2017

Objective: To compare the trends in age-standardised incidence and mortality from interstitial lung diseases (ILD) in the United Kingdom (UK) and the European Union (EU). Design: Observational study using data obtained from the Global Burden of Disease Study. Setting and Participants: Residents of the UK and of the twenty-seven EU countries. Main outcome measures: ILD age-standardised incidence rates per 100 000 (ASIR), age-standardised death rates per 100 000 (ASDR), and mortality-to-incidence ratio (MIRs) are presented for males and females separately for each country, for the years 2001–2017. Trends were analysed using Joinpoint regression analysis. Results: For men, in 2017, the median incidence of ILD was 7.22 (IQR 5.57–8.96) per 100 000 population. For women, in 2017, the median incidence of ILD was 4.34 (IQR 3.36–6.29) per 100 000 population. For men, in 2017, the median ASDR attributed to ILD was 2.04 (IQR 1.13–2.71) per 100 000 population. For women, the median ASDR in 2017 for ILD was 1.02 (0.68–1.37) per 100 000 population. There was an overall increase in ASDR during the observation period with a median change of +20.42% (IQR 5.44–31.40) for men and an increase of +15.44% (IQR −1.01–31.52) for women. Despite increases in mortality over the entire observation period, there were decreasing mortality trends in the majority of countries at the end of the observation period (75% for men and 86% for women). Conclusion: Over the past two decades, there have been increases in the incidence and mortality of interstitial lung diseases in Europe. The most recent trends, however, demonstrate decreases in mortality from ILD in the majority of European countries for both men and women. These data support the ongoing improvements in the diagnosis and management of ILD

Systematic review of exercise therapy in the management of post-thrombotic syndrome

Objectives Exercise improves haemodynamic parameters in patients with chronic venous disease. There is a paucity of evidence on its effect in post-thrombotic syndrome (PTS). The aim of this systematic review is to assess the impact of exercise in PTS. Methods Adhering to PRISMA guidelines and following PROSPERO registration (CRD42021220924), MEDLINE, Cochrane Library, EMBASE database, and trial registries were searched on 19th May 2022. Results One article met the inclusion criteria and a narrative synthesis was carried out. The included randomised controlled trial reported a between-group mean difference of 4.6 points (p = .027) in the VEINES-QOL score and −2.0 points (p = .14) in the Villalta score, in favour of exercise therapy. The statistical significance threshold was not reached. Conclusion Data on exercise in PTS remains sparse but exercise appears to be a safe intervention. In the context of this literature, a potential future trial and outcome reporting measures are suggested