Consultant Supervision Research Articles

Prevalence, knowledge, and awareness of hallux valgus among females in the eastern province of Saudi Arabia. A cross-sectional study

Background: The most prevalent foot deformity is Hallux valgus (HV). It is a progressive foot deformity that affects the first metatarsophalangeal joint and is frequently accompanied by severe functional impairment, excruciating foot pain, and a decreased quality of life. Therefore, this study aimed to determine the prevalence, knowledge, and awareness of HV in the population of Saudi Arabia's eastern province. Methods: A cross-sectional study was conducted using an online questionnaire developed under the supervision of consultants in the field of interest. The questionnaire for this study included demographic information, medical history, foot shape, wearing habits, and HV awareness. Results: Around 52.7% of participants had heard about HV, and 20.7% were aware of the risk factors for the appearance of HV, whereas 12.9% were aware of the importance of taking protective measures to prevent HV. Conclusion: This research showed that the risk factors, like wearing high heels and shoes with a narrow or very narrow toe box, are primarily the reason why HV is more prevalent among women. Therefore, educating women about HV risk factors and preventative measures is essential.

Comparison of the Efficacy of Absorbable Versus Non-Absorbable Sutures after Lichtenstein Mesh Hernioplasty Regarding Post Operative Pain

Objective: Comparison of the efficacy of absorbable versus non-absorbable sutures after Lichtenstein mesh hernioplasty. Methodology: We planned this Randomized Control Trial consisting of 200 cases, from Surgical outdoor booked for hernioplasty. All patients were examined in a comfortable environment. All the information was kept confidential. The patients were not aware of the randomization arm and selected via lottery method. All patients underwent Lichtenstein mesh hernioplasty under local anesthesia. Before surgery, a course of prophylactic antibiotics consisting of 1 g of IV cefazolin was administered to each patient. All procedures were done by skilled post graduate general surgical residents under consultant supervision. Predictable bias and confounding factors were controlled by restriction (inclusion and exclusion criteria) and randomization. Rest was addressed during final analysis through stratification. GROUP A patients undergo mesh fixation using Prolene 1. (non-absorbable) GROUP B patients undergo mesh fixation using Vicryl 0. (absorbable). For all treatments, a conventional tension-free uniformed surgical method was adopted. Patients were evaluated at 3 months followup to record the efficacy. Results: Mean age was calculated as 44.7+9.45, mean pain score on VAS was calculated as 2.04+0.72 in Group-A and 1.54+0.76 in Group-B,p-value=0.018. Comparison of efficacy of absorbable versus non-absorbable sutures after Lichtenstein mesh Hernioplasty shows that 83(n=83%) in Group-A and 94(n=94) in Group-B had efficacy while, p value 0.014 showing a significant difference. Conclusion: Our findings indicate that, following Lichtenstein mesh hernioplasty, absorbable suture is more effective than non-absorbable suture regarding post operative pain. Keywords: Inguinal hernia, hernioplasty, absorbable versus non-absorbable sutures, efficacy

Repair of Cracks in Nicol Blocks of a Reinforced Earth Wall

Abstract: Bangladesh's first access-controlled expressway is the Dhaka-Khulna (N-8) Expressway. The project consists of 8 lane road of 55 km length, 54 culverts, 20 underpasses, 2 interchanges, 4 major bridges, 25 minor bridges, and 5 flyovers. Teghoria Interchange of this project is structured with 19 Reinforced Earth Wall, out of which a crack appeared in a wall that has 146 meters length and 7 meters height. Detailed inspection and analysis were followed by repair and rectification work. The aim of this paper was to find out the likely causes of this crack, discuss detailed retrofitting methodology and bring forth some recommendation. This crack may form due to weak workmanship during compaction and installation of tendons of reinforced earth, environmental load, heavy-loaded vehicle travel above the RE wall etc. The specialist team of the consultants of the project and experts from development partner inspected the problem and worked out how to repair the cracked area. The development partner developed repair methodology and executed the crack repair work as well as the treatment plan under strict supervision of consultants. Surface preparation, preparation of precast veneer & epoxy-based mortar, placement and finishing work make up the treatment process.

Development and evaluation of remote supervision in clinical ethics consultation training

During clinical ethics consultation training, hands-on practice after acquiring the necessary knowledge under an experienced clinical ethics consultant's supervision is an effective method of obtaining technical and practical skills. However, in regions where clinical ethics consultation is still nascent, few experienced clinical ethics consultants exist. The number of clinical ethics consultation cases is small, making on-the-job training significantly difficult. To address this problem, this study developed a remote supervision program using e-mail and ZOOM and evaluated its effectiveness using Kirkpatrick's learning effectiveness model. The findings confirmed the good learning effects of both programs. In particular, ZOOM's learning effectiveness was greater than e-mail's in Level 2 learning effects. Nevertheless, remote supervision may be an effective method when in-person training is difficult, such as in countries with developing clinical ethics consultations or during the outbreak of infection.

Deliberate practice of consultation communication skills: A randomized controlled trial.

Consultation is a key competency area for school psychologists, though much is unknown about how school psychologists develop the competency to consult. Deliberate practice (DP) is a promising approach to enhance use of communication skills, thereby supporting consultation competence. DP training included multiple opportunities for video-recorded consultation practice in response to a consultee's request for assistance, self-reflection on skill application, and corrective supervisory feedback. In this randomized controlled trial, 109 school psychology graduate students across 45 training programs received either consultation training as usual delivered through their first consultation course (control group; n = 61) or a supplemental DP training intervention in addition to their first consultation course (treatment group; n = 48). Students who completed the DP training significantly increased their use of communication skills during a simulated practice opportunity, while the control group participants did not. Students in the DP condition also reported significantly greater self-efficacy than students in the control group, although students in both groups reported significantly greater self-efficacy over time. DP participants also reported high levels of training satisfaction. Implications of these findings for the design and delivery of consultation training and supervision are discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

The association between surgeon grade and risk of revision following total hip arthroplasty : an analysis of National Joint Registry data.

Total hip arthroplasties (THAs) are performed by surgeons at various stages in training with varying levels of supervision, but we do not know if this is safe practice with comparable outcomes to consultant-performed THA. Our aim was to examine the association between surgeon grade, the senior supervision of trainees, and the risk of revision following THA. We performed an observational study using National Joint Registry (NJR) data. We included adult patients who underwent primary THA for osteoarthritis, recorded in the NJR between 2003 and 2016. Exposures were operating surgeon grade (consultant or trainee) and whether or not trainees were directly supervised by a scrubbed consultant. Outcomes were all-cause revision and the indication for revision up to ten years. We used methods of survival analysis, adjusted for patient, operation, and healthcare setting factors. We included 603,474 THAs, of which 58,137 (9.6%) procedures were performed by a trainee. There was no association between surgeon grade and all-cause revision up to ten years (crude hazard ratio (HR) 1.00 (95% confidence interval (CI) 0.94 to 1.07); p = 0.966), a finding which persisted with adjusted analysis. Fully adjusted analysis demonstrated an association between trainees operating without scrubbed consultant supervision and an increased risk of all-cause revision (HR 1.10 (95% CI 1.00 to 1.21); p = 0.045). There was an association between trainee-performed THA and revision for instability (HR 1.14 (95% CI 1.01 to 1.30); p = 0.039). However, this was not observed in adjusted models, or when trainees were supervised by a scrubbed consultant. Within the current training system in England and Wales, appropriately supervised trainees achieve comparable THA survival to consultants. Trainees who are supervised by a scrubbed consultant achieve superior outcomes compared to trainees who are not supervised by a scrubbed consultant, particularly in terms of revision for instability. Cite this article: Bone Joint J2022;104-B(3):341-351.

The Learning Curve of Urodynamics for the Evaluation of Lower Urinary Tract Symptoms.

Background and Objectives: Urodynamics is considered the gold standard for lower urinary tract functional assessment. However, it requires very specific skills and training, which are currently difficult to master due to its reduced use. Moreover, no studies or data are available to define the workload and the learning curve of this diagnostic tool. As a consequence, we aimed to evaluate the learning curve of residents with no previous experience to correctly perform and interpret urodynamics, and properly address and manage patients with pelvic floor disorders based on urodynamics findings. Materials and Methods: This prospective study analyzed a series of proficiency parameters in residents performing urodynamics under consultant supervision, including the following: duration of procedure, perceived difficulty, need for consultant intervention, accuracy of interpretation, and therapeutic proposal. The number of procedures performed was then divided into groups of five to evaluate the progressive grade of autonomy (technical and full management autonomy) reached by each resident. Results: In total, 69 patients underwent urodynamics performed by three residents, with every resident performing at least 20 exams. Duration of procedure, perceived difficulty, need for consultant intervention, accuracy of interpretation, and the appropriateness of the hypothetical proposal of management/treatment based on their interpretation of clinical data and urodynamic findings was shown to be directly related to the number of exams performed. Technical autonomy in the execution of uroflowmetry was reached in the group performing 6–10 procedures, while technical autonomy in the execution of cystomanometry with pressure/flow study was obtained in the group of 16–20 procedures. The latter corresponded also to the gain of full autonomy which also included an optimal therapeutic proposal. Conclusion: We found that there is a tangible learning curve for urodynamics in terms of several proficiency parameters. A workload of 5 uroflowmetries and 15 cystomanometries with pressure/flow studies may be adequate to complete the learning curve.

Pericardiocentesis over 3 years at a tertiary referral Australian hospital

Abstract Funding Acknowledgements Type of funding sources: None. Background Pericardiocentesis is a lifesaving intervention performed both percutaneously or surgically. We analysed 3 years of experience in a major tertiary hospital in Sydney Australia. Purpose To examine the indications, safety and delivery of a pericardiocentesis service at a major teaching hospital. Methods We retrospectively audited consecutive patients who underwent pericardiocentesis for pericardial effusion[PE] at a major teaching hospital from February 2018 to December 2020. Eligible patients were identified from the electronic medical records with this coding diagnosis. Results 89 patients identified with mean age 60.8 ± 18.9years and 58.4%(51/89) male. Follow-up to August 2021 showed 41.5% had died, with an index hospitalisation mortality of 19%(17/89). Malignancy was the most common aetiology 30.3%(27/89) and attributable cause of hospitalisation death in 29.4%. Alternate causes included pericarditis 14.6%, idiopathic 13.4%, percutaneous-coronary-intervention(PCI) 5.6%(6/89) and electrophysiology 4.5%(4/89) complications. Three patients had aortic dissection (3.3%) and two were fatal. Clinical tamponade was present in 66.2%(55/89), PE identification occurred via echocardiography(TTE) in 55% cases (49/89) and incidental CT-diagnosis in 20.2%. TTE findings: right atrial collapse 54%(47/87), right ventricular collapse 60.9%(53/87), fixed and dilated inferior vena cava 64.7%. Pericardiocentesis was performed by cardiology trainees in 90.5% cases, 64.5% with consultant supervision and during working hours in 57.3% of cases. Percutaneous drainage was successful in 96%(72/75) of cases and was performed in the coronary care unit (30.3%), catheterisation laboratory (23.5%), emergency department (19.1%) and ICU (11.2%). Subxiphoid approach in 70%(62/89) was the most common then trans-apical 15%(13/89), parasternal 3%(3/89) and surgical 16%(14/89). TTE confirmed drain position in 76%(54/71), fluoroscopy in 28.5%(6/21) and agitated saline in 38.9%(30/77). Haemo-serous fluid noted in 77%(67/87) with average initial fluid drainage 480 ± 326mls and mean drain removal time 54 ± 33hrs. 17%(15/89) required re-drainage with adenocarcinoma found in 33.3%(5/15). Background antiplatelet treatment in 30.6%(27/88) and of these 67%(18/27) were on dual antiplatelets. 33%(29/89) patients were anticoagulated and 31.3%(9/29) required reversal prior to drainage. Complications were rare, 4%(3/75) had right heart chamber perforation needing emergency surgery. Two were post complex PCI (one died during admission from multiorgan failure) and one with pericarditis . Conclusions Pericardiocentesis is a safe and effective procedure for tamponade treatment and largely guided by echocardiography in our experience. Complications are rare and prognosis depends on aetiology with malignancy the most common. Drainage is often successfully performed emergently where the patient is located. Tamponade resulting from procedural complications are rare in our cohort.

Task shifting to enhanced physical therapy in musculoskeletal secondary care. An evidence-based narrative review


 Background: The World Health Organization defines task shifting as the rational redistribution of tasks among the healthcare workforce teams. The transfer of tasks to physical therapy is well suited for musculoskeletal conditions, either where exercise and physical activity are an important part of the treatment, or to sort the flow of emergency patients. 
 Methods: What are the benefits, limits and implementation challenges associated to the employment of enhanced physical therapy in the redistribution of secondary healthcare workforce? The aim of this narrative review is to collect evidence from the most recent publications, in order to address clinical studies, policy making and further research. 
 Results: A clear correlation between healthcare system and type of service was not found, supporting that task shifting can be employed to meet different needs. In emergency departments, enhanced physical therapists are employed to improve the flow of musculoskeletal patients, reduce waiting time, length of stay and free up professionals in support of more complex conditions. Otherwise, enhanced physical therapists are employed to sort the flow of chronic musculoskeletal patients, triaging to orthopaedic surgery, and performing follow-up. Clinical outcomes were equal or better than those achieved by other professionals. Appropriate diagnoses and referrals were also demonstrated, despite two studies show enhanced physical therapy to be effective but dependent by medical support. Specific training is therefore fundamental. 
 Conclusion: Task shifting is a promising innovation which is worthy introducing in the management of chronic musculoskeletal conditions, when most of the treatments may be repeated under the supervision of medical consultants. 

Have advances in surgical implants and techniques in hemiarthroplasty for intracapsular hip fractures improved patient outcomes compared to THA? A systematic review and meta-analysis of the evidence

IntroductionHip fractures are common orthopaedic hospital admissions and result in considerable morbidity and mortality in the patients affected. The aim of this study is to review how advances in surgical implants and techniques have impacted on outcomes of Hemiarthroplasty (HA) vs Total Hip Arthroplasty (THA) for displaced intracapsular neck of femur fractures. MethodsA systematic review and meta-analysis of randomised controlled trials was performed and reported in accordance with the Preferred Reporting Items for Systematic Reviews & Meta-analyses (PRISMA) statement. We included all studies that were prospective randomised controlled trials comparing the outcomes THA versus HA in patients with displaced intracapsular neck of femur fractures. Results13 randomised controlled trial met the eligibility criteria; the overall pooled sample size was 3050 patients. The evidence suggests that the short-term functional outcomes favour THA, without strong evidence of a clinically significant benefit. More recent larger RCTs suggest limited functional improvement conferred by THA vs. HA, whilst the risks of complications may outweigh these small gains. Overall, THA is associated with higher dislocation rates without a significant need for re-operation, but no increase in infection or need for transfusion over HA. Consultant or equivalent supervision has a positive effect on outcomes in both groups. ConclusionThe literature supports a change in direction, this meta-analysis confirms HA surgery has equivalent clinical outcomes and possibly a lower mortality in octogenarians and provides further evidence for the stratification of THA treatment in displaced intracapsular neck of femur fractures is urgently required. Level of evidence1.

Collegial, Competent, and Consultative Supervision: A Peer Supervision Approach for School Counselors

Collegial, competent, and consultative supervision is a practical, innovative approach to peer supervision for practicing school counselors. This integrative approach is inspired by Cheston’s Ways Paradigm framework, uses the Ronnestad and Skovholt model of counselor development, and is supported by empirical studies about peer consultation and supervision. This article suggests strategies for practicing school counselors to engage in peer supervision in collegial, competent, and consultative ways. It addresses limitations, implications, and future research directions.

Learning Curve of Botulinum Toxin Bladder Injection for the Treatment of Refractory Overactive Bladder.

PurposeIntradetrusor botulinum toxin injections is an established second-line treatment for patients with refractory overactive bladder syndrome (OAB). We aimed to evaluate the learning curve of intradetrusor injections with botulinum toxin for the treatment of refractory OAB.Patients and MethodsThis retrospective study analyzed all women with idiopathic and refractory OAB who underwent botulinum toxin bladder injections performed by residents with no previous experience with operative cystoscopy under consultant supervision. Baseline International Consultation on Incontinence Questionnaire-Short Form questionnaire (ICIQ-SF) and Euroqol (EQ-5D) questionnaires were collected. Procedural data (operative time, number of valid injections, complications, subjective easiness, perceived tolerability) and patients’ outcomes (Patients Global Impression of Improvement (PGI-I), ΔICIQ-SF, ΔEQ-5D, need for self intermittent catheterization, duration of efficacy) were considered as markers to evaluate learning curves for each resident.ResultsTwenty-seven patients underwent intravesical injection of botulinum toxin performed by residents. Only a grade 1 Clavien-Dindo complication occurred, and none of the patients had urinary retention. PGI-I was very satisfactory, scoring 1.4 ± 0.9. Both ICIQ-SF and EQ-5D 2–2 were statistically improved (p < 0.00001 and p = 0.04, respectively). The mean duration of efficacy resulted to be 8.0±4.3 months. A positive effect of the learning curve was observed only for operative time, subjective easiness, and perceived tolerability.ConclusionIntradetrusor botulinum toxin injection for the treatment of refractory OAB is characterized by high efficacy and very low complications even at the very beginning of the learning curve when performed under proper mentorship.

Outcomes for open and laparoscopic appendicectomy for complicated appendicitis in children

The study aimed to compare the outcomes of paediatric laparoscopic appendectomy (LA) with open appendectomy (OA) for complicated appendicitis (CA). All trainees could perform OA without supervision.This is a single-centre, retrospective, non-randomised review of children 4-12 years of age, who had either an OA or LA for CA. The data was collected from August 2012 to June 2016. Nineteen surgical trainees were initially supervised by a consultant until deemed able to perform LA safely. The on-call surgeon decided on operative approach. Intra- and postoperative complications were analysed. Primary endpoint was comparison of infection rates between groups, simultaneous differences between the two procedures performed by surgical trainees and consultants were evaluated.One hundred and fifty-five patients had appendicectomy for CA during the study period. Fourteen patients with incomplete information were excluded. Ninety had OAs and 51 LAs. Both groups were well matched demographically. Postoperative infective complications occurred in 13/51 (25.5%) of the LAs, and in 23/90 (25.6%) of the OA (p = 0.159). Fourteen trainees performed 27 LAs without consultant supervision by the conclusion of the study. The mean duration of LA surgery for surgical trainees was 110.35 minutes (IQR 22.5) and for consultants 93.87 minutes (IQR 35, p = 0.497).There is no difference in intra- and postoperative complications between LA and OA for CA. Duration of surgery between surgical trainees and consultants were comparable. This indicates that surgical trainees acquire LA skill over a short period of time and that LA as a laparoscopic teaching procedure merits consideration.

Responses of paediatric emergency departments to the first wave of the COVID-19 pandemic in Europe: a cross-sectional survey study

ObjectiveUnderstanding how paediatric emergency departments (PEDs) across Europe adapted their healthcare pathways in response to COVID-19 will help guide responses to ongoing waves of COVID-19 and potential future pandemics. This...

Pediatric Surgical Volume at the TASH: Experience after the Expansion of Pediatric Surgery Program.

Ethiopia has a high unmet need for pediatric surgical conditions. Over the past 5 years, new changes have been introduced to the pediatric surgery division at Addis Ababa University to overcome this issue. The changes include initiation of pediatric surgery residency, allocating operating room for pediatric surgery, weekend surgical campaign and starting ultrasound guided hydrostatic reduction. We conducted this study to evaluate the pattern and outcome of pediatric surgical cases after these changes. The study was a retrospective review conducted at Tikur Anbessa Hospital from Jan - Dec 2019. Data was collected from duty report forms that included emergency procedures, admissions and mortalities. Data on elective procedures was collected from operation theater log books. Overall, a total of 1590 pediatric surgical procedures were performed during 2019 of which 942 cases were elective and 648 were emergency. This was an increment in number of surgeries performed by 75%. The leading emergency procedure was aerodigestive foreign body removal which increased by 46%. Surgery for intussusception has decreased by 30% with increasing use of hydrostatic reduction. Overall, average morbidity and mortality was 3.5% and 6.9% respectively. Morbidity and mortality rates were similar throughout the year. The study shows increased productivity over the past year with the changes made in the department. There is also no increment in morbidity and mortality during the start of the academic year. This implies adequate consultant supervision of residents during transition.

Trainee participation does not adversely affect the safety of thyroid surgery: Systematic review and meta‐analysis

Surgical traineeship is essential but must be safe for patients. In thyroid surgery, surgeon volume correlates with improved clinical/economic outcomes. However, it is presently unclear how far does trainee participation affect post-thyroidectomy complication rates in real-world and randomized data. We systematically searched four databases for associations of trainee participation with any post-thyroidectomy outcome. We conducted univariate meta-analyses, sensitivity analyses, and assessed publication bias qualitatively and quantitatively. We included 1 randomized and 15 observational studies from 3755 records, comprising 34 774 thyroid surgical patients. Trainee participation was associated with 12 min longer operative time, but not higher complication rates (hypoparathyroidism, recurrent laryngeal nerve palsy, hematoma, blood loss, return to operating room, hospitalization duration, readmission, and mortality). Sensitivity, publication bias, and multivariate analyses did not change our findings. Real-world and limited randomized data suggest that trainee participation in thyroid surgery is safe, given adequate consultant supervision and appropriate case selection.

SP2.1.7Navigating surgical training: a game of trust

Abstract Introduction One premise of the Improved Surgical Training (IST) pilot is delivery of better quality of early years surgical training. However, the quality of the trainee-trainer relationship can positively or negatively impact trainees’ experiences of the specialty. Trust is a key determinant of the relationship, which is influenced by trainers’ level of risk aversion and trainees’ motivation. Game theory provides a framework to understand cooperation amongst rational ‘players’. This study explores how trainee-trainer relationships impact trainees’ experiences through the IST curricular reform. Methods Using a qualitative case study approach, data were obtained from interviews with core surgical trainees across Scotland. Data coding and inductive thematic analysis were undertaken. Results Forty-six trainees participated. Trainees and trainers regularly interacting in clinical activities demonstrated growing levels of trust, aided by: specialty rotations of 6 months or more duration, working at junior registrar level with structured weekly clinical activities and direct consultant supervision, individual goal-setting and regular progress check, and meaningful and timely feedback. Cooperative relationships led to individual fulfilment, growth, and trainee autonomy. Factors hindering development of trust included: temporal and/or geographical distance between trainee-trainer, poor communication and understanding of expectations and training needs, and lack of interest and enthusiasm from either party. Conclusion Cohesive trainee-trainer relationships demonstrated cooperative equilibrium; both trainees and trainers met each other’s expectations and positively impacted on trainees’ experiences. On the contrary, ‘players’ in relationships deficient in trust achieved the minimum to ensure trainee progression. Addressing factors fostering a cooperative trainee-trainer relationship positively impacts trainees’ experiences.

Laparoscopic totally extraperitoneal hernia repair performed by surgical trainees: overcoming the learning curve.

Surgical trainees struggle to obtain experience in laparoscopic inguinal hernia repair (LIHR) due to a perceived steep learning curve. The purpose of this study was to compare outcomes in totally extraperitoneal (TEP) repair performed by surgical consultants and trainees under supervision as part of a standardised training regimen to assess the safety of residency training in this technique. A retrospective review of patients managed by TEP repair by either a consultant or a supervised trainee was performed. Demographic, perioperative and postoperative data were collected and compared. All trainees underwent a standardised approach to teaching TEP repair. Trainees performed 133 procedures and consultants performed 121 procedures. Estimated blood loss was minimal in both cohorts. A significant difference was noted in mean operating time between consultants and trainees (33 vs. 50 min). However, it was also observed that the trainee mean operating time reduced significantly with experience (from 61 to 42 min). No statistically significant difference was demonstrated in postoperative complications, recurrence rate or length of stay. All trainees achieved the ability to complete a laparoscopic TEP repair under unscrubbed consultant supervision during a 1-year placement. With senior supervision and in the presence of a structured training regimen, trainees can safely and effectively perform LIHR, progressing to performing the procedure under unscrubbed consultant supervision. This is valuable information that can serve to inform the structure and direction of surgical training programmes as the ability to offer LIHR is increasingly becoming an expectation of consultant surgeons.

Intramedullary Fixation of Trochanteric Fractures Can Be Safely Performed by Senior Residents Without Immediate Consultant Supervision

To assess the safety of senior residents performing trochanteric hip fracture surgery without immediate consultant supervision DESIGN: A retrospective chart review of trochanteric hip fractures (AO-OTA 31-A) operated in a single center between years 2011 and 2016 (inclusive). Operations were divided into three groups: Group 1 - surgeon was a senior resident without any immediate supervision; Group 2 - surgeon was a consultant and Group 3 - surgeon was a senior resident supervised by a consultant. The follow-up period was a minimum of 2 years or until death. All re-operations and surgical related mortality were assessed. Helsinki University Hospital, Finland. A tertiary level trauma center. 987 consecutive trochanteric fractures on 966 patients treated by operative fixation of an intertrochanteric fracture with an intramedullary nail between 2011and 2016 (inclusive). The total number of reoperations was smaller in Group 1 where the surgeon was a senior resident without any immediate supervision compared to Group 2 where the surgeon was a consultant (5.5 % vs 8.8 %, p < 0.05). There were no significant differences in mortality or length of surgery. The total rate of mechanical complications was 2.0 %, with no significant differences between groups. The observed blade cut-out rate was low: 1.3 %, suggesting a good overall quality of surgery. Senior residents can safely perform intramedullary nailing of trochanteric fractures without immediate supervision.

The impact of the acute surgical assessment unit on the management of acute appendicitis: a single-centre review

BackgroundAcute surgical assessment units (ASAUs) aim to optimise management of surgical patients compared to the traditional ‘on-call’ emergency department (ED) system. Acute appendicitis (AA) is the most common acute surgical condition requiring emergency surgery.AimWe set out to assess if the ASAU improved care provided to patients with AA compared to those managed through the ED.MethodsPatients admitted via the ED with AA in the 6 months prior to opening the ASAU were compared to those admitted via the ASAU in the first six months following its implementation. Relevant data was collected on key performance indicators from their charts.ResultsIn the ASAU cohort, the mean time to be seen was one hour less than the ED cohort (21 min vs 74 min). The mean time to surgery was also 8.8 h shorter. Most patients in the ASAU group (78.6%) underwent surgery during the day, compared to 40.3% of ED patients. The ASAU patients also had a lower postoperative complication rate (0.9% vs 3.9%), as well as a lower negative appendicectomy rate (14.2% vs 18.6%) and lower conversion-to-open surgery rate. Greater consultant supervision and presence was observed. ConclusionsThe ASAU has resulted in better outcomes for patients with AA than those admitted via ED. More operations were performed in safer daytime hours with greater consultant presence, allowing for improved senior support for trainee surgeons. Our study supports the role of the ASAU in improving the quality and efficiency of emergency general surgery.