ABSTRACT
Introduction: COVID-19 has negatively impacted on all aspects of surgical training, compounding longstanding issues with surgical trainees achieving required endoscopy training standards. Innovative approaches are required to ensure trainees progress appropriately. Aim(s): We aim to present an ideal immersive training pathway for endoscopy training for General Surgery trainees. Result(s): JAG certification has strict criteria which are achievable during a six month "immersive" training period with six, half day, sessions per week. JAG basic skills courses should be booked in advance and ideally complete in The 2nd to 3rd month of training. Weeks 1-2: Supervised simulator training to introduce basic scope handling and manipulation. Observation of "upper" and "lower" lists to grasp understanding of patient journey. Weeks 3-4: Attend at lEast 3 dedicated training sessions per week with DopS discussion and completion. ongoing simulator practice (1-2 sessions per week). Attendance at service lists with recognised trainers (1-2 sessions per week);likely to be opportunities for trainees to participate on ad Hoc basis. Weeks 4-20: As per weeks 3-4 with an increased attendance of ad Hoc lists and reduction of simulation to one session per week. Weeks 20-24: Consolidation of learning, endoscopies undertaken with minimal assistance from trainer. Weeks 24-26: Reduced capacity lists with trainer in The Department but out-with scope room in preparation of independent lists after JAG certification. Conclusion(s): We have described The ideal immersive endoscopy training pathway. Consideration should be given to incorporating this into The General surgical curriculum around on-call commitments, elective operating and clinics.
ABSTRACT
Aims: Achieving endoscopic targets for CCT is problematic for General Surgery trainees. COVID-19 has negatively impacted all aspects of surgical training. Nationally, only 19% of Colorectal trainees report completing 300 colonoscopies by CCT. We report on an immersive endoscopy training programme to achieve CCT targets. Method(s): Toconfirm reduced access to endoscopy, local General Surgery trainees (n=95) were invited to complete our survey assessing their endoscopic experience during their training to date. We compared The results to outcomes from a new 6-month immersive endoscopy programme. 2 out-of-programme (Oop) trainees;one had no endoscopy experience (completed core training;Oop 1);one had attempted 70 colonoscopies and 130 UGI endoscopies (ST4;Oop2). Result(s): 42 trainees completed The survey (44% response rate), ranging from ST2-ST8 (74% ST2-ST6, 14% ST7/ST8, 12% Oop). UGI endoscopies attempted by all trainees: mean 119 (range 10-306). 55% had attended or secured a place on The JAG UGI endoscopy course. Colonoscopies attempted by all trainees: mean 67 (range 2-233). 45% having attended or secured a place on The JAG colonoscopy course. 29% of trainees anticipated not reaching target CCT endoscopy numbers. In Comparison, in 6 months;Oop1 attempted 49 OGD, 199 colonoscopies with a place secured on colonoscopy course. Oop2 attempted 109 OGD and 216 colonoscopies with both courses completed. Conclusion(s): Shortcomings in endoscopic training and courses, particularly for colonoscopy, have been confirmed. Implementation of immersion endoscopy training can achieve CCT target numbers and competency within a short time, irrespective of previous experience.
ABSTRACT
Substance abuse disorder is a public health issue which causes significant biological, psychological, social and financial harm in families both in Malta and around the world. Although traditional interventions are well established and backed by significant amounts of literature, the relapse rate, particularly in young people, remains high. As such, technology has often been touted as an alternative to traditional therapy as well as a tool in the prevention and reduction of substance use. This paper analyses the literature surrounding some of the more frequently described examples of technology-based interventions to determine their roles and limitations in the prevention, reduction and treatment of substance abuse disorders whilst also briefly analysing COVID-19’s effect on technology use in addiction treatment. As our ability to harness technology and novel forms of media in medicine increases, so too will the options for substance abuse treatment increase. Some examples of technology-based interventions discussed in this paper include online recovery groups, online forums, educational interventions, self-guided webbased therapeutic interventions, m-health and virtual reality software.
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INTRODUCTION/HYPOTHESIS: 2020 was marked by social and political events that substantially disrupted healthcare. The COVID-19 pandemic, lockdown, public health measures, as well as civic and political unrest over racial tensions during an election year could plausibly impact injury care. We hypothesized that increased injuries related to high-risk activities during 2020 was temporally related to sociopolitical unrest and pandemic public health measures. METHODS: Retrospective data from two Level 1 urban, adult trauma centers in different US states (City A population:1.6M, City B:0.21M) were assessed (1/1/2020- 12/31/2020). Calendar months were divided into quartiles and compared to analogous quartiles in years 2016 -2019. Variables studied (demographics, injury mechanisms and outcomes) were compared between years, and across 2020 quartiles, against a backdrop of key sociopolitical events. RESULTS: More patients presented for injury in 2020 (A: n=1057, B: n= 1053) than in prior years (p< 0.05). Compared to 2016-2019, 2020, patients were more often black (A:63.1% vs. 69.8% p< 0.001;B:31.0% vs. 34.3%, p=0.02). Institution A patients were more likely to be male (p=0.002) & younger (p< 0.001) in 2020 vs. 2016-2019. Both institutions noted a steep rise in gunshot wound (GSW) and motor vehicle collision (MVC) injuries following state lockdowns (Fig A, B) with a persistent rise in GSWs until late fall (Fig C). CONCLUSIONS: 2020 was a unique year of sociopolitical unrest interwoven with a pandemic. Most affected populations were young, black males in two different urban centers and primarily involved GSWs and MVCs. Future disaster response planning should consider the drivers of these trends to mitigate their impact, especially in vulnerable populations.
ABSTRACT
Introduction & Objectives: COVID-19 pandemic has significantly affected urological activity worldwide. The enhancement of hygienic measures including distancing, restricted access to the ward, reduction in the number of hospitalized patients and use of PPE has potentially reduced the risk of COVID-19 infections. These strategies could simultaneously reduce the risk of nosocomial infections during hospitalization. The aim of our study is to evaluate the effectiveness of prevention measures against COVID-19 in reducing the incidence of infectious complications during hospitalization. Materials & Methods: In a retrospective observational study, we collecteddata of all patients admitted to two Urological centers: “Santa Croce and Carle” in Cuneo and “Policlinico Paolo Giaccone” in Palermo. We compared the period from February to May 2019 to the corresponding months of 2020. After collecting patients clinical characteristics (age, comorbidities, etc.), we evaluated the days of hospitalization, the number and type of surgical interventions (major, endoscopic - divided into upper and lower tract - and others), the onset of fever or new COVID-19 cases during hospitalization, the number of blood and urine cultures performed and the type of pathogen identified. Data were compared with media-standard deviation (SD) and with unpaired T-test. A value of p <0.05 was considered significant. Discrete data were analysed with contingency analysis. A Chi2 <0.05 was considered significant. Results: A total of 985 patients were included. Comparing 2019 with 2020, there was a statistically significant reduction in the incidence of postoperative fever considering all hospitalized patients (p<0.001). There was a statistically significant reduction in post-operative fever incidence after major surgery(p<0.04) and lower tract endoscopic procedures (p<0.02). There were no statistically significant differences in uppertract endoscopic procedures (p<0.99), neither in other minor surgical procedures (p<0.6). The rate of patients with positive blood culture compared to 2019 has decreased significantly (p<0.007), and although statistical significance was not reached, the same trend is observed in the number of patients with positive urine culture (p<0.08). Conclusions: The strong prevention measures implemented during COVID-19 pandemic have led to a general significant decrease in infectious complications acquired during hospitalization. This is more evident in patients undergoing major surgical procedures that require longer hospital stay. The use of some of widely used preventive measures against COVID-19 should therefore be maintained in the hospital environment even at the end of the pandemic situation(e.g. frequent hand washing,reduced access to hospital wards anddistancing between patients in hospital rooms and common spaces).