COVID19, the war in Ukraine, the economic crisis, the energy crisis, climate change

Each month brings new fears and new reasons to worry about the future. In a world marked by permanent change, by the occurrence of the unthinkable generating a continuous feeling of insecurity, having confidence has become increasingly difficult: confidence in the future, confidence in our environments, in our organisations, confidence in our contemporaries, confidence in our collaborators and confidence in our ability to face a difficult tomorrow. Confidence and fear are inseparable and they are like the opposite sides of the same coin. Unable to look at both sides of a coin at the same time, we must constantly fight our fears with confidence. Therefore, more than ever, trust is an essential element to obtain team security and it only takes one person feeling insecure for the overall confidence of the team to be eroded. This feeling of low self-confidence is particularly true for the younger generation of veterinary surgeons and specialized veterinary assistants. This can result in difficulties that are often unexpressed and can lead professionals to abandon these vocations of "passion" since they do not feel up to the expectations of clients and managers alike. Building the self-confidence of the people concerned has become a professional priority. The origin of the feeling of lack of self-confidence is collective. Therefore, its treatment is collective. Since each member has the capacity to fight against their fears, he or she can play their part and increase security in the team.

Transformation of an independent sector treatment centre to a regional trauma centre during COVID pandemic

ContextOn the 11th March 2020, the WHO declared SARS-CoV-2 (COVID) outbreak a global pandemic. Healthcare facilities in the UK faced an unprecedented challenge of managing the outbreak, whilst maintaining basic healthcare services such as cancer and trauma. The NHS and independent sector partnership allowed a safe work stream, a relationship that continues now to support the elective recovery coming out of the pandemic.Issue/ChallengeReorganisation of healthcare provision led to the transformation of Practice Plus Group (PPG) hospital, Ilford to a green site for Barking Havering and Redbridge NHS University Trust (BHRUT) trauma service from 30/03/2020 to 10/06/2020. PPG Hospital had to rise to the challenge mobilising quickly from an elective service to a trauma unit serving a local population of over 1 million. The hospital transformed over one weekend, mobilising staff and equipment to deliver a trauma service. Their service went on to exemplify gold standard treatment of the very sick. The unit responded, adapted and developed outpatient clinics, plaster room, trauma ward and theatres to manage COVID-negative trauma cases that BHRUT received.Assessment of issue and analysis of its causesClinical staff had to upskill to take on the very sick (ASA 4) who may require end organ support, to carry out trauma surgery and procedures that were never performed before at the unit. Surgeons and surgical trainees from the trust became part of the multidisciplinary collaboration whilst the senior leaders developed a strong relationship to ensure good governance throughout the period. All of PPG staff had to get involved in ward care. Staff were trained with regards to personal protective equipment (PPE), Aerosol generating procedures (AGPs), pressure area care and applying traction to realign bones as some of the examples. The staff involved came from the following groups: theatre staff, outpatient staff, the anaesthetic consultants, ward staff, endoscopy, pharmacy, physio, housekeeping, infection control and portering.ImpactConsultant anaesthetists had a steep learning curve to both update their trauma knowledge and sharpen their skills. The guidelines of fracture hips were reviewed. The weekly teaching meetings’ topics were all about anaesthesia for emergency surgery, trauma and COVID. Anaesthetic work rota modified to provide a suitable recovery time following long days in theatres. The necessity of rest periods improves immunity.InterventionThere were some logistic hurdles, including the lack of availability of a suitable meeting facility that can accommodate a large number of attendees. There was a need to have a combined meeting with the BHRUT team in the red zone. On the first day, the meeting was carried out on the ‘ZOOM’ platform on smart phones. Within a couple of days. The trauma meeting was held in the capacious theatre reception, using a wall-mounted big screen for audio-visual display. This allowed better communication with all clinical teams including orthopaedic surgery, anaesthesia, nursing and coordinators.Involvement of stakeholders, such as patients, carers or family members:The PPG team implemented the pillars of clinical governance to improve the quality of care. The virtual monthly morbidity meeting included clinicians from all disciplines. A brief update of previous monthly data was reviewed. An initial internal audit showed that the average anaesthetic start time was 09:39. 19 lists (out of 23, 83%) started even after 09:15. The identified causes for this delay included late sending time, and the patient not being ready at the ward due to longer pre-operative checks and staff shortage. A ‘Golden Patient' was not always identified. A collaborative multi-disciplinary approach aimed to streamline the admission processes to ensure availability of both the surgical team and the patient to ensure a prompt theatre start. A repeat audit confirmed that the average anaesthetic start time has become 09:03. Only four out of 24 lists had an anaesthetic start time of 09:15 or later (17%). Th t is an Improvement of 69%.Key MessagesAs COVID created so much pressure on BHRUT, we quickly formed a positive can do working relationship both clinically and managerially to set up the Trauma service in just a few days. The 30 day mortality rate of patients with fracture neck of femur was less than the national average. This positive approach has enabled us to continue working together to help ease pressure off the lengthy patient waiting lists in Orthopaedics and General Surgery.Lessons learntPPG was proud to receive many compliments from patients and BHR staff. A patient wrote ‘I am so humbled and impressed by the amazing team-work and skill of the staff here that I want to congratulate you on what is an outstanding success amongst all the many stories coming out of the corona pandemic. Watching the way in which staff from so many different departments and skills bases are coming to this ward and learning nursing techniques with humility and patience as well as bonding in an upbeat, joyful team is something I will always remember. A surgical trainee mentioned The Independent Sector Treatment Centre (ISTC) team has been absolutely excellent so far. They have made us feel welcome and have worked hard to optimize the service'. This COVID cooperation paved the way for the ongoing cooperation between BHR and PPG, Ilford.Measurement of improvementThe outcome data shows that the service was able to successfully manage fractured neck of femur with better outcomes against national KPI. During the period from 30/03/20 to 10/06/2020, 85 patients had surgery for an emergency fracture neck of femur (Table 1). At PPG, the 30 days mortality rate was 3.5%. The national mortality rate for patients with fracture neck of Femur was 6.1%.75 patients with fracture neck of femur had surgical fixation within 36 hours.Strategy for improvementCollaborative cooperation between NHS and PPG led to set up of new pathways, governance and processes that enable patients to be transferred directly to us as well as creating capacity for BHRUT surgeons to operate in our hospital, supported by our theatre and ward teams.

Impact of personal protective equipment on the clarity of vision among trachoma survey graders and trichiasis surgeons in the context of COVID-19

Background/aimsThe COVID-19 pandemic necessitated the use of personal protective equipment for those involved in trachoma survey grading and trichiasis surgery. We sought to determine which configuration of a face shield would be less likely to impact grading accuracy and ability to conduct trichiasis surgery. The research also included assessment of comfort, ease of cleaning and robustness.MethodsThere were three research phases. In phase 1, assessment of four potential face shield configurations was undertaken with principal trachoma graders and trichiasis surgeon trainers to decide which two options should undergo further testing. In phase 2, clarity of vision and comfort (in a classroom environment) of the two configurations were assessed compared with no face shield (control), while grading trachomatous inflammation—follicular (TF). The second phase also included the assessment of impact of the configurations while performing trichiasis surgery using a training model. In phase 3, face shield ease of use was evaluated during routine surgical programmes.ResultsIn phase 2, 124 trachoma graders and 28 trichiasis surgeons evaluated the 2 face shield configurations selected in phase 1. TF agreement was high (kappa=0.83 and 0.82) for both configurations compared with not wearing a face shield. Comfort was reported as good by 51% and 32% of graders using the two configurations. Trichiasis skill scores were similar for both configurations.ConclusionThe face shield configuration that includes a cut-out for mounting the 2.5× magnifying loupes does not appear to impact the ability or comfort of trachoma graders or trichiasis surgeons to carry out their work.

Anesthesia for penetrating injury of the oropharynx in a child: a case report

BackgroundPenetrating injury of the oropharynx occurs frequently in children, however, anesthetic management is seldom described in such cases.Case presentationA 2-year old child came to the emergency room with a toothbrush impacted in the gingivobuccal sulcus making airway management difficult. We used a simple yet unique approach to secure the airway safely given the lack of pediatric size fibreoptic and videolaryngoscopes in our emergency operation theatre. The patient was kept in Pediatric ICU and watched for any complications and discharged on the 4th postoperative day.ConclusionsThus, ingenious non-invasive techniques to secure the airway can prevent the patient from undergoing surgical tracheostomy.

One stop vein clinic

Team involved are:Vascular surgery department in collaboration with the radiology department.Kent and Canterbury hospitalEast Kent University Foundation TrustIn the current practice under the vascular clinic, a patient with venous disease must pass through a journey of 3 steps.An outpatient appointment initially for clinical examination and evaluation of stage of his venous disease,Referral to radiographer for a duplex ultrasound scan (to rule out thrombosis and clarify the level of the disease)Further appointment with surgeon for receiving their final diagnosis and being listed for treatment.This unfortunately, has cause an unacceptable considerable delay in providing our service and treating those patients. The delay between referral to diagnosis exceeded more than 8 months. The main reasons were:Shortage of radiographersCOVID backlogTime consumed between these 3 appointmentsAssessment of issue and analysis of its causesWe analysed the factors of the cause of the delay in management of patients with venous diseases and it showed that the main reason for delay is delay in ultrasound scan, (the second step in the patient journey to gain the diagnosis).-We faced a period when our only radiographer resigned and we stayed without radiographers in the department for several months until the management were able to recruit a new radiographer. This of course has created a huge impact on our service.Of course the covid has impacted badly on our service. As we cancelled all the patient appointments with venous diseases and concentrated in life or limb threatening conditions only.-The inherited pathway has an element in delay as well as the time consumed between these 3 appointments may exceed several months.ImpactThe project is to merge all the three appointments in only one appointment where the patient will be examined and have the ultrasound in same setting. Thus, the patient will be able to have the outcome immediately in the same session without delay.The main problem , is that there's no enough radiographers to join the vascular surgeons in their clinic to carry on the scan simultaneously. Hence, the idea came to light, that the scan should be done by the vascular surgeons themselves.InterventionThis project helped me to act as a leader and express the ideas without fear and come out of my comfort zone.-We have been taught by the eclips team, To be a good leader , you have to start with your self.Thus, when I started this project, I had to learn the ultrasound skills and collaborate with the radiology department to ease the steps for the rest of the vascular team who would like to follow my steps and gain the ultrasound skill.Involvement of stakeholders, such as patients, carers or family members:The stakeholders areThe patientsFor the patient benefit, being assessed in one clinic, is believed to reduce the stress of awaiting diagnosis for such problem, in addition to some other merits like less time off work for patients, and less transportation cost.The vascular surgeons.The ultrasound is a cornerstone in the modern vascular era, and learning the skills for this tool will in fact benefit the surgeons in their daily work as they can scan the patient themselves particularly in case of emergency.The radiographers and radiology department.It is believed that scanning the patient by the vascular surgeons for the venous diseases will reduce the pressure on the radiology department for a huge list of patients awaiting scan .The management–Saving administration resources, by reducing the clinic cost and reducing the number of clinics.–Reduce the need for hiring locum radiographers or out of hours shifts to reduce the number of patients awaiting their venous scan.–To achieve the 18 months NHS timeframe between referral to diagnosis.–Cost effective measure to use the resources which is already present (portable ultrasounds) without need to buy a new machine or use another room for the scanning.Key MessagesThe main message is that there's a lot of brilliant ideas to improve the service in NHS. Giving us the chance to express these ideas is amazing. All appreciation to eclips team who helped us to start such projects.When I started describing my idea to my line manager, I was astonished that he was completing my words as if he was reading my mind. His support was outstanding and he eased the project steps to me.I hope my project will come to light and to be implemented in other sites as in my opinion, it will help plenty of patients who are struggling to manage their venous disease because of unaccepted delay , unfortunately a lot of them have no choice but to go the private sector which is extremely expensive.Lessons learntMy retrospective audit is still ongoing.There are 2 elements in my project.The first one is subjective, as I had to start with my self.I had a very limited ultrasound experience. So, I have done some search until I found a good centre for ultrasound course for vascular diseases. I applied and had my basic ultrasound skills.The challenge is how to apply this knowledge to the patients where I'm not yet confident to give a report. So, the collaboration with the radiology department was started and they were extremely helpful and supportive as they were kindly supported us with one of the best radiologist consultant to supervise me until I feel confident to do the scan independently. This step took around 2 months until is has been successful.-The second element is objective. As collecting the data during the working hours with busy rota is challenging.Measurement of improvementTo measure the effect of our improvement.We looked at the numbers of patients awaiting venous scan before starting the project (February 2022),. the number was around 230 patients.I managed to share my experience to my colleagues and one of them was interested and joined me. we as 2 speciality vascular surgeon in a half day once weekly clinic , were able to complete a venous scan of 105 patients (almost 50% of the number) in just 6 months.-Currently , we are running an audit to assess the time difference before and after the implementation of the project and hopefully, the data will come to light soon.Strategy for improvementThe timeline for the project is 6 month, which have been completed successfully as myself and the other vascular surgeon are able to perform the venous scan independently.The data is analysed at the moment and will soon be published.

Comparison of Survivorship and Failure Modes Between Anatomic and Reverse Total Shoulder Arthroplasty Across Multiple Government Joint Registries for a Single Platform Shoulder System

[...]recent years have seen a dramatic shift in utilization of rTSA in which rTSA is increasingly used to treat OA in patients with an intact rotator cuff, with a corresponding decline in use of aTSA.1-5 The reasons for this shift in usage are multi-factorial but may be due to the perceived lower risk of revision surgery with rTSA relative to aTSA, as the quality of the rotator cuff muscles and tendon are not necessary for a functional rTSA but are pre-requisite for a functional aTSA. Furthermore, these registries have high rates of government-mandated compliance such that all patients are enrolled and very few patients are lost to follow-up, thus minimizing the potential for selection bias that is inherently present in nearly all nongovernment registry clinical outcome studies. [...]to better understand the relative differences in primary aTSA and primary rTSA usage and performance, we analyzed two different government joint registries for survivorship and for reasons for revision associated with one platform shoulder system and compared trends in usage of aTSA and rTSA over a period of over 10 years to elucidate reasons for any market trends. Additionally, reasons for revision and the cumulative revision rate were assessed across the government joint registries to quantify and compare the performance of this platform shoulder prosthesis for primary aTSA and primary rTSA in each country over the study period. Over the period of analysis, use of primary aTSA and primary rTSA with the particular platform system has increased year to year in both Australia and the UK, with the exception of a decline in 2020 and 2021 due to COVID-19.

How pediatricians can help mitigate the mental health crisis

Just as traumatic or stressful events and experiences can increase the risk, strong and supportive relationships and institutions can offset or mitigate that risk. [...]if mental health conditions do develop, early and ongoing recognition and treatment can decrease associated morbidity.2 4 The 2019-2020 National Survey of Children's Health showed that 23% of children aged 3 to 17 years have a reported mental, emotional, developmental, or behavioral (MEDB) problem, with prevalence unevenly distributed by geographic area and social determinants of health: Beginning in April 2020, the proportion of mental health-related visits in pediatric emergency departments increased significantly for both children and adolescents.8 A 2021 report from the Child Mind Institute, "The Impact of the COVID-19 Pandemic on Children's Mental Health: What We Know So Far," highlights the disproportionate negative impact on vulnerable children: those with preexisting mental health problems, especially those with limited access to treatment, racial minorities experiencing racism in the health care system and beyond, LGBTQ+ children, and families living with economic uncertainty or food insecurity.4 Skill-building resources To mitigate the level of need that has created the current crisis, it is particularly important that emerging mental health symptoms be recognized and addressed early within the pediatric medical home before they escalate to the level of crisis. [...]the AAP has developed a mental health toolkit for pediatricians that includes materials, real- world cases, tools for screening, video examples of skills, and an algorithm serving as a cognitive map for how to approach mental health concerns in an outpatient office setting.9 Another resource, The REACH Institute, offers live and online evidence-based training courses for pediatricians on identification and treatment of mental health issues, including screening, medication management, cognitive behavioral therapy, and a host of other topics, all patient-centered and designed to be feasible in an outpatient office setting.10 (For more on The REACH Institute and pediatrician training, see "Guiding principles in managing pediatric mental health issues," page 18.) Address the economic and social barriers that contribute to poor mental health foryoung people,families, and caregivers. 6 Increase timely data collection and research to identify and respond to youth mental health needs more rapidly.

Outcome Of Non-Elective Covid Positive Orthopaedic Injury Procedures In Two Tertiary Care Hospitals

Objective: To evaluate the outcome of COVID-positive orthopaedic injury patients operated as emergency cases regarding overall disease progression, laboratory parameters and fracture healing. Study Design: Prospective longitudinal study. Place and Duration of Study: Pak Emirates Military Hospital Rawalpindi and Combined Military Hospital Malir Karachi Pakistan, from Apr to Nov 2020. Methodology: All the orthopaedic injury patients with no other injuries who tested positive for COVID-19 were included in the study. The demographic data, time of injury and surgery, co-morbidities and values of inflammatory markers such as Creactive protein (CRP), Total Leukocyte Count (TLC), Serum Ferritin and Neutrophil percentage were noted pre-op and on the fifth-day post-operation. The bone fracture, its severity, and the type of orthopaedic intervention were also noted. Results: A total of 17 patients were included in the study, out of which 12 were males (70.6%), and 5 were females (29.4%), with a mean age of 49.06±18.78 years. There were 9(52.9%) cases of mild COVID-19, 3(17.6%) cases of moderate and 5(29.2%) cases of severe disease among orthopaedic injury cases. The most common fracture was of the femur in 12(70.6%) patients, followed by tibia/fibula in 3(17.6%) and 2(11.8%) cases of radius and ulna. In addition, there were 2(11.8%) cases of non-union and 5(29.4%) delayed union. Only 2(5.2%) health professionals developed mild COVID. Conclusion: Orthopedic emergency operations of COVID-19-positive patients can be performed safely following strict COVID-19 protocols.

Enhance-Net: An Approach to Boost the Performance of Deep Learning Model Based on Real-Time Medical Images

Real-time medical image classification is a complex problem in the world. Using IoT technology in medical applications assures that the healthcare sectors improve the quality of treatment while lowering costs via automation and resource optimization. Deep learning is critical in categorizing medical images, which is accomplished by artificial intelligence. Deep learning algorithms allow radiologists and orthopaedic surgeons to make their life easier by providing them with quicker and more accurate findings in real time. Despite this, the classic deep learning technique has hit its performance limits. For these reasons, in this research, we examine alternative enhancement strategies to raise the performance of deep neural networks to provide an optimal solution known as Enhance-Net. It is possible to classify the experiment into six distinct stages. Champion-Net was chosen as a deep learning model from a pool of benchmark deep learning models (EfficientNet: B0, MobileNet, ResNet-18, and VGG-19). This stage helps choose the optimal model. In the second step, Champion-Net was tested with various resolutions. This stage helps conclude dataset resolution and improves Champion-Net performance. The next stage extracts green channel data. In the fourth step, Champion-Net combines with image enhancement algorithms CLAHE, HEF, and UM. This phase serves to improve Enhance-performance. The next stage compares the Enhance-Net findings to the lightness order error (LoE). In Enhance-Net models, the current study combines image enhancement and green channel with Champion-Net. In the final step, radiologists and orthopaedic surgeons use the trained model for real-time medical image prediction. The study effort uses the musculoskeletal radiograph-bone classification (MURA-BC) dataset. Classification accuracy of Enhance-Net was determined for the train and test datasets. These models obtained 98.02 percent, 94.79 percent, and 94.61 percent accuracy, respectively. The 96.74% accuracy was achieved during real-time testing with the unseen dataset.

Burnout in Surgical Trainees: a Narrative Review of Trends, Contributors, Consequences and Possible Interventions.

Surgical disciplines are popular and training places are competitive to obtain, but trainees report higher levels of burnout than either their non-surgical peers or attending or consultant surgeons. In this review, we critically summarise evidence on trends and changes in burnout over the past decade, contributors to surgical trainee burnout, the personal and professional consequences of burnout and consider the evidence for interventions. There is no evidence for a linear increase in burnout levels in surgeons over the past decade but the impact of the COVID-19 pandemic has yet to be established and is likely to be significant. Working long hours and experiencing stressful interpersonal interactions at work are associated with higher burnout in trainees but feeling more supported by training programmes and receiving workplace supervision are associated with reduced burnout. Burnout is associated with poorer overall mental and physical well-being in surgical trainees and has also been linked with the delivery of less safe patient care in this group. Useful interventions could include mentorship and improving work conditions, but there is a need for more and higher quality studies.

Supervision of redeployed surgical trainees during the COVID-19 pandemic: what have we learnt and how can we improve?

OBJECTIVE: When cases of patients presenting with Coronavirus Disease 2019 (COVID-19) overwhelmed existing services in the United Kingdom (UK), surgical trainees were redeployed to assist frontline efforts. This project characterises the effects of redeployment on the supervision of these trainees. The resulting generation of practical recommendations could be implemented for future crises. DESIGN: A qualitative approach was utilised, comprised of seven phenomenological interviews with surgical and intensive care consultants, as well as redeployed surgical trainees. Interview recordings were transcribed and subsequently analysed using Thematic Analysis. SETTING: The project utilised participants currently in surgical training within the London deanery across a variety of surgical specialties representing several UK National Health Service (NHS) Trusts. PARTICIPANTS: Three types of participants were interviewed. Four interviews were conducted with redeployed surgical trainees, across all stages of training, in full time employment who were redeployed for two weeks or more. One interview was conducted with an educational supervisor of multiple redeployed trainees. The third group comprised two consultant intensivists who supervised redeployed trainees within their respective departments. RESULTS: Four themes were developed: 'Responding to an unforeseen crisis', 'Maintaining surgical identity and culture; A fish out of water?', 'Trainee supervision and support' and 'Preparation and sequelae'. Participants described a sense of obligation to the pandemic effort. Many described a significant interruption to training, however communication of this to surgical supervisors was suboptimal with minimal mitigation. Supervisors on the frontline were challenged by the assessment of trainee competence and acceptance into a new community of practice. Both trainees and supervisors described the management of uncertainty, advocating for the use of reflective practice to ensure preparation for the future. CONCLUSION: This project presents an insight into several potentially long-lasting effects on surgical training. The recommendations generated may be applicable to trainees returning to work from time out of training, increasing the utility of this work.

Professional practices at the heart of the crisis in emergency management: The example of the COVID-19 crisis

Our organisations have been severely shaken by the COVID-19 pandemic and the world of work has not been spared. Only essential activities continued in order to maintain a minimum level of functioning, just like in hospitals or in local authorities. During the first five months of the crisis in 2020 (from March to July), 34 interviews were conducted in these two public service entities in order to examine the management of urgent matters in the light of ``activity'' and at the heart of the crisis. The results show that while the emergency is mainly managed by an improvisation activity based on the intuition of the actors in the field, the crisis is managed by governance in a rational manner leading to the drafting of procedures after the event. This crisis situation pushed organisations to reconfigure themselves in an emergency, allowing the development of new professional practices. The strategies of damage control and proceduralization will be discussed. Perspectives are opened on the questions of training for these crisis situations against a background of developing presumption of ignorance. (c) 2022 AIPTLF. Published by Elsevier Masson SAS. All rights reserved.

COVID Stressed, but Not due to the Virus.

INTRODUCTION: Acute care surgeons can experience posttraumatic stress disorder (PTSD) due to the cumulative stress of practice. This study sought to document the potential impact of the COVID-19 pandemic on PTSD in acute care surgeons and to identify potential contributing factors. METHODS: The six-item brief version of the PTSD Checklist-Civilian Version (PCL-6), a validated instrument capturing PTSD symptomology, was used to screen Eastern Association for the Surgery of Trauma members. Added questions gauged pandemic effects on professional and hospital systems-level factors. Regression modeling used responses from attending surgeons that fully completed the PCL-6. RESULTS: Complete responses from 334 of 360 attending surgeons were obtained, with 58 of 334 (17%) screening positive for PTSD symptoms. Factors significantly contributing to both higher PCL-6 scores and meeting criteria for PTSD symptomology included decreasing age, increased administrative duties, reduced research productivity, nonurban practice setting, and loss of annual bonuses. Increasing PCL-6 score was also affected by perceived illness risk and higher odds of PTSD symptomology with elective case cancellation. For most respondents, fear of death and concerns of illness from COVID-19 were not associated with increased odds of PTSD symptomology. CONCLUSIONS: The prevalence of PTSD symptomology in this sample was similar to previous reports using surgeon samples (15%-22%). In the face of the COVID-19 pandemic, stress was not directly related to infectious concerns but rather to the collateral challenges caused by the pandemic and unrelated demographic factors. Understanding factors increasing stress in acute care surgeons is critical as part of pandemic planning and management to reduce burnout and maintain a healthy workforce.

How COVID has changed veterinary medicine

The COVID 19 pandemic has caused an increase in the number of owned cats and dogs and the resulting increased demand for veterinarians and veterinary services. This has also caused increased work stress and performance issues by veterinarians. This paper describes how veterinarians can minimize work stress by modifying their schedule of medical activities in order to still maintain an ideal work life balance.

Acceptability and feasibility of telehealth outpatient video-link consultations: A national cross-sectional survey of surgeons prior to the COVID-19 pandemic.

OBJECTIVE: This study explored use and perceived barriers to the use of post-operative video-link telehealth among a sample of Australian surgeons shortly before the COVID-19 pandemic. METHODS: During 2019-2020, a survey was mailed to RACS or RANZCOG Fellows. DESIGN: Cross-sectional survey. SETTING AND PARTICIPANTS: A total of 907 surgeons practising in Australia completed the survey. MAIN OUTCOME MEASURES: The study-specific survey assessed telehealth use in the last 3 months and the perceived barriers and enablers to the use of post-operative teleconsultations, across the domains: quality of care; convenience and efficiency; legal/regulatory issues; financial issues and technological issues. RESULTS: Twenty-five percent of eligible surgeons returned the survey, with n = 763 pre-pandemic responses included in analyses. Approximately one-quarter (26%) of surgeons had used telehealth post-operatively with patients in the last 3 months. The most frequently endorsed barriers to use related to quality of care: 'I cannot undertake a patient examination' and 'I cannot provide the same level of care as during an in-person consultation'; and convenience and efficiency: 'Teleconsultations are more difficult to arrange'. Surgeons who had recently used telehealth were less likely to endorse most barriers. Younger age, awareness of Medicare telehealth reimbursement and working in neurosurgery, urology, paediatric surgery and plastic and reconstructive surgery (compared to general surgery) were associated with recent telehealth use by surgeons. CONCLUSIONS: Some surgeons' perceived barriers to telehealth pre-COVID may be overcome by COVID-19-related telehealth uptake and familiarisation. However, many barriers will need to be addressed to ensure that telehealth adoption is sustained beyond the pandemic.

Effectiveness of 6 surgical approaches for minimally invasive lumbar interbody fusion: 1-year follow-up results from a global multicentre study

Background: Minimally invasive lumbar interbody fusion (MI-LIF) procedures are an effective treatment for patients with degenerative lumbar disease (DLD). However, consensus does not exist among surgeons for selecting 1 approach over another. The objectives were to collect patientreported, surgical and fusion outcome data at 1 year after surgery for patients receiving either anterior lumbar interbody fusion (ALIF), direct lateral interbody fusion (DLIF), oblique lumbar interbody fusion (OLIF), posterior lumbar interbody fusion (PLIF), transforaminal lumbar interbody fusion (TLIF) or midline lumbar interbody fusion (MIDLF) for DLD. Methods: A total of 340 patients with DLD were consecutively enrolled in a prospective, global, multicentre cohort study (MASTERS-D2;NCT02617563). Patients were treated according to the surgeon's choice with 1 of 6 MI-LIF procedures. Outcome data for disability (Oswestry Disability Index), back and leg pain (Visual Analogue Scale), quality of life (EQ-5D) were collected at baseline, 4 weeks, 3 months and 12 months. Demographic, surgical and safety data were also recorded. Fusion status was assessed by using computed tomography or x-rays at 1 year (plus or minus 6 mo) after surgery. Paired sample t tests were used to test for improvement from baseline. Results: One year after surgery, patients attained clinically significant improvements on all patient-reported outcome measures regardless of approach used. Patients who were selected to receive an ALIF comprised the highest proportion of smokers, were the youngest and had the longest operating time, but low fluoroscopy exposure. Anterolateral (ALIF, DLIF, OLIF) compared with posterior (MIDLF, PLIF, TLIF) approaches had the least amount of blood loss, despite similar or longer surgical times. Within 1 year of follow-up, 7 device-related and 7 surgery-related serious adverse events (SAEs) had been recorded. Assessment of fusion was hindered by the effects of COVID-19. In total, 196 out of 340 (57.6%) patients were assessed. The aggregate fusion rate for anterolateral approaches was 88.1% and for posterior approaches 85.1% at 12 months of follow-up. Conclusion: All 6 approaches for MI-LIF surgery demonstrate favourable patient-reported and surgical outcomes for patients with DLD. Continuing data collection up to 5 years after surgery will yield information on long-term effectiveness, safety, health economics and revision surgery and on the long-term impact of surgeons' choice of approach.

Ethical issues in surgery during COVID-19 pandemic

Surgeons were facing considerable ethical dilemma during this COVID-19 pandemic-whichpatient to select for surgery and which patient to be deferred for a later date. Surgeons also had a difficult taskof protecting themselves and their team and perform a safe surgery without infecting the patient. There were also ethical issues of using Oxygen or an Intensive Care Unit (ICU) bed during this time for the surgical patient when it was in short supply. A critical factorwas balancing the benefit of surgery for the patient against the risk of contacting the COVID-19 virus and the complications of the disease process.

Making Sense of Sentiments for Aesthetic Plastic Surgery

With social media pervading all aspects of our life, the opinions expressed by netizens are a gold mine ready to be exploited in a meaningful way to influence all major public do-mains. Sentiment analysis is a way to interpret this unstructured data using AI tools. It is a well-known fact that there has been a 'Zoom Boom' in the field of aesthetic plastic surgery due to the COVID-19 pandemic and the same has put the focus of attention sharply on our appearance. Polarity detection of tweets published on popular aesthetic plastic surgery procedures before and after the onset of COVID can provide great insights for aesthetic plastic surgeons and the health industry at large. In this work, we develop an end-to-end system for the sentiment analysis of such tweets incorporating a state-of-the-art fine-tuned deep learning model, an ingenious 'keyword search and filter approach' and SenticNet. Our system was tested on a large database of 196,900 tweets and the results were visualized using affectively correct word clouds and also subjected to rigorous statistical hypothesis testing to draw meaningful inferences. The results showed a high level of statistical significance. © 2022 IEEE.

Brachycephalic obstructive airway syndrome: an overview

One of the conformational issues by the explosion Of pet ownership throughout the COVID 19 pandemic is the Ming number dunes of brachycephalic obstructive envay syndrome (BOAS), which is a condition prevalent in some of the UK's most copular dog breeds The challenges the veterinary profession is not only to identify and treat affected individuals from within the population of dogs presenting to primary care clinicians, using surgical and non-surgical options but also to educate clients on how to recognise clinical signs of the disease as early as possible.