ABSTRACT
Introduction COVID-19 has resulted in many new challenges for healthcare services. Colonoscopy, which is the gold standard investigation for diagnosis of colorectal cancer (CRC), has been significantly impacted with cessation of services during peak corona virus outbreaks with significant backlog. Several strategies have been proposed to address this. One of the main approaches is to risk stratify patients using a quantitative faecal immunochemical test (qFIT) alone or in combination with CT scan. Our study assessed the adherence of Bedford Hospital NHS Foundation Trust in performing both qFIT and CTAP with Iv contrast prior to colonoscopy referral. This study also evaluated the sensitivity of qFIT and CTAP both individually and in combination of missing a cancer when used as a triage service for prioritisation of colonoscopy. Methodology Data was collected retrospectively from all colonoscopies performed in Bedford hospital, from June to August 2020, totalling 470 patients. Results Average patient age was 59.9 years, with an age range of 19 to 90 years old. 55% were males and 45% were females. 45% (210) patients had a FIT performed pre colonoscopy. 129 patients had positive FIT. Overall, 35% (164) of patients underwent CTAP prior to colonoscopy. 125 patients underwent both FIT and CTAP prior to colonoscopy. Individually, FIT had a positive predictive value (PPV) and negative predictive value (NPV) of 6.2% and 98.7% with respect to diagnosing CRC. CTAP had a PPV and NPV of 42.9% and 100%. Performing FIT and CTAP in combination had a PPV and NPV of 28.6% and 100% respectively. Conclusion Sensitivity of single qFIT is low and can miss cancers if used alone. Therefore, it should not be utilised as a single test for triage in community for prioritising colonoscopy in symptomatic patients. The risk of missing a cancer can be reduced by CTAP with Iv contrast as an add on test with negative predictive value of 100%.
ABSTRACT
BACKGROUND: The COVID-19 pandemic has compounded existing training issues for plastic surgeons. The issues that exist result from a complex interplay of system, generational and individual factors, and can be hard to tease out by quantitative means. This pilot study aimed to investigate the perceptions of trainees and trainers of plastic surgical training in the UK. METHODS: Ten semi-structured interviews were performed using purposive sampling in a central London plastic surgical unit. These were coded into and discussed in four themes: Medical directives and service demands; Sociocultural norms within plastic surgical training; Equity and access; and Plastic surgery training methods. RESULTS: This study showed that current plastic surgery training is not optimised for learning or well-being, and that inequities are fostered, to the detriment of the specialty. Investment and planning are required to support our trainers and protect the diversity of our trainee group, with efficient and monitored learning essential to maintain our breadth and competence of practice. CONCLUSION: Expanding this work through a broader study could provide valuable information to contribute to the development of future training schemes and curricula within British plastic surgery.
ABSTRACT
Background and objective The coronavirus disease 2019 (COVID-19) pandemic has led to many challenges in face-to-face teaching and training in plastic surgery. However, it has also proved to be an incubator for many technological solutions. Augmented reality (AR) platforms may offer a safe, equitable, and efficient means to provide training in plastic surgery. This study aimed to explore the user's experience of AR as an educational intervention during the COVID-19 pandemic in the United Kingdom (UK). Materials and methods The Proximie® AR platform (Proximie Limited, London, UK) has been in use in a UK plastic surgical department for facilitating webinars, visual libraries, and streamed procedures. The experience of a range of trainers and trainees was qualitatively explored through 10 individual interviews. Data-emergent theme analysis was also performed. Results AR was well-received in the context of COVID-19 and training in general as a means to enable theatre access, and visual revision, remotely. The potential for its use in remote coaching and telementoring was also discussed. Recommendations were made by the users to optimise the experience both from the trainer and learner perspectives. Data were presented pertaining to the following themes: surgical AR as a substitute for hands-on learning; surgical AR and theoretical learning; considerations specific to streamed procedures using Proximie®; considerations in the use of technology in general. Conclusion Harnessing novel technologies in surgical education offers an exciting opportunity, fast-tracked by COVID-19, but applicable beyond it. Though this study includes a small sample size, its findings suggest that AR platforms may offer a uniquely interactive remote educational experience in surgical training. Strategies and suggestions for its use are discussed, as well as broader considerations in using technology in surgical education.