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Article: Prognostic significance of Deprivation on Esophago-Gastro-Duodenoscopy (EGD) outcome

Eley, Catherine / Hawkes, Neil D / Barlow, Emma / Egan, Richard John / Lewis, Wyn

2024

Abstract: Introduction: Socio-Economic Deprivation has long been associated with many gastrointestinal diseases yet its influence on esophago-gastro-duodenoscopy (EGD) diagnosis has not been evaluated. The aim of this study was to investigate the influence of ... ...

Abstract	Introduction: Socio-Economic Deprivation has long been associated with many gastrointestinal diseases yet its influence on esophago-gastro-duodenoscopy (EGD) diagnosis has not been evaluated. The aim of this study was to investigate the influence of deprivation on outcomes of EGD irrespective of referral reason. Method: Two-thousand consecutive patients presenting to four Health Boards in Wales from June 2019 were studied retrospectively with deprivation scores calculated using the Wales Indices of Multiple Deprivation (WIMD). Patients were sub-classified into quintiles for analysis (Q1 most, Q5 least Deprived). Results: Inhabitants of the most deprived areas were more likely to be diagnosed with Peptic Ulcer (Q1 7.9%, Q5 4.7%; OR 0.498, p=0.018), Severe Esophagitis (LA4, Q1 2.7% v Q5 0%, OR 0.089, p=0.002), Helicobacter Pylori infection (Q1 5.4%, Q5 1.7%; OR 0.284, p=0.002), but less likely to be diagnosed with Barrett’s Eesophagus (Q1 6.3% v Q5 12.3%, OR 2.146, p=0.004) than those from least deprived areas. New cancer diagnoses numbered 53 and were proportionately higher after Urgent Suspected Cancer (USC, n=35, 4.6%) than routine referral (n=3, 0.6%, p<0.001). Deprivation was associated with more advanced staged cancer (stage III Q1 16.7% v Q5 5.6%, OR 0.997, p=0.006: stage IV Q1 16.7% v Q2 38.9% v Q5 22.2%, OR 0.998, p=0.049). Conclusion: Deprivation was associated with two-fold more peptic ulcer disease, three-fold more Helicobacter Pylori infection, and 12-fold more severe esophagitis, and more advanced cancer stage.
Language	English
Publishing date	2024-04-02
Publisher	Georg Thieme Verlag KG
Publishing place	Stuttgart ; New York
Document type	Article
ZDB-ID	2761052-4
ISSN	2196-9736 ; 2364-3722 ; 2196-9736
ISSN (online)	2196-9736
ISSN	2364-3722 ; 2196-9736
DOI	10.1055/a-2297-9905
Database	Thieme publisher's database

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Article ; Online: Prognostic significance of drivers at work and learning styles in surgical training.

Mellor, Katie / Hopkins, Luke / Robinson, David Bryan Thomas / James, Osian Penri / Luton, Oliver / Brown, Chris / Egan, Richard John / Lewis, Wyn G

Postgraduate medical journal

2023 Volume 98, Issue 1165, Page(s) 855–859

Abstract: Purpose of the study: Drivers at work (DW) and Learning Styles (LS) refer to contentious theories that aim to account for differential career development yet seldom feature in assessment. This study aimed to quantify the influence of core surgical ... ...

Abstract	Purpose of the study: Drivers at work (DW) and Learning Styles (LS) refer to contentious theories that aim to account for differential career development yet seldom feature in assessment. This study aimed to quantify the influence of core surgical trainees' (CST) DW and LS on career progress. Study design: DW questionnaires and Kolb LS inventories were distributed to 168 CSTs during five consecutive induction boot camps in a single-statutory education body. Primary outcome measures were membership of the Royal College of Surgeons (MRCS) examination and national training number (NTN) success. Results: Of 108 responses received (response rate 64.3%), 64.8% were male and 35.2% female (p=0.003). DW spectrum was: please people (25.0%), be perfect (21.3%), hurry up (18.5%), be strong (13.9%) and try hard (0%, p<0.001). DW was either equivocal (n=14) or not provided (n=9) by 21.3% of CSTs. LS were: converging (34.3%), accommodating (28.7%), diverging (23.1%) and assimilating (13.9%, p=0.021). Men were more likely to be convergers (29/70, 41.4%), and women divergers (15/38, 39.5%, p=0.018) also preferring team-based LS (accommodating/diverging, 26/38 (68.4%) vs 30/70 (42.9%), p=0.010). MRCS success was not associated with DW (p=0.329) or LS (p=0.459). On multivariable analysis, NTN success was associated with LS (accommodators 64.5%, divergers 32.0%, OR 10.90, p=0.014), scholarly activity (OR 1.71, p=0.001), improving surgical training programme (OR 36.22, p=0.019) and universal ARCP 1 outcome (OR 183.77, p<0.001). Conclusions: LS are associated with important differences in career progress with accommodator twofold more likely than diverger to achieve NTN.
MeSH term(s)	Humans ; Male ; Female ; Learning ; Prognosis ; Educational Status ; Surveys and Questionnaires ; Surgeons
Language	English
Publishing date	2023-04-16
Publishing country	England
Document type	Journal Article
ZDB-ID	80325-x
ISSN	1469-0756 ; 0032-5473
ISSN (online)	1469-0756
ISSN	0032-5473
DOI	10.1136/postgradmedj-2021-140930
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Article ; Online: The hidden curriculum: requiem for a surgical dream.

Brown, Chris / Egan, Richard John / Lewis, Wyn

Postgraduate medical journal

2019 Volume 95, Issue 1123, Page(s) 237–239

MeSH term(s)	Bullying ; Burnout, Psychological ; Career Choice ; Curriculum ; Education, Medical, Continuing ; Humans ; Organizational Culture ; Sleep Deprivation ; Socioeconomic Factors ; Specialties, Surgical/education ; Students, Medical/psychology
Language	English
Publishing date	2019-04-17
Publishing country	England
Document type	Editorial
ZDB-ID	80325-x
ISSN	1469-0756 ; 0032-5473
ISSN (online)	1469-0756
ISSN	0032-5473
DOI	10.1136/postgradmedj-2018-136076
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Article ; Online: Surgical training salvage during COVID-19: a hospital quality perspective.

Luton, Oliver / Mellor, Katie / Eley, Catherine / James, Osian / Robinson, David Brian Thomas / Hopkins, Luke / Lewis, Wyn Griffith / Egan, Richard John

BJS open

2022 Volume 6, Issue 2

MeSH term(s)	COVID-19 ; Hospitals ; Humans
Language	English
Publishing date	2022-04-05
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ISSN	2474-9842
ISSN (online)	2474-9842
DOI	10.1093/bjsopen/zrac019
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Article ; Online: Differential attainment in higher surgical training: scoping pan-specialty spectra.

Luton, Oliver William / Mellor, Katie / Robinson, David Bryan Thomas / Barber, Zoe / James, Osian Penri / Powell, Arfon Gethyn Morgan Tregellis / Hemington-Gorse, Sarah / Walsh, Leona / Egan, Richard John / Lewis, Wyn Griffith

Postgraduate medical journal

2023 Volume 99, Issue 1174, Page(s) 849–854

MeSH term(s)	Pregnancy ; Male ; Humans ; Female ; Medicine ; Education, Medical, Graduate ; Ethnicity ; Educational Measurement ; Surgeons ; Clinical Competence ; United Kingdom
Language	English
Publishing date	2023-05-19
Publishing country	England
Document type	Journal Article
ZDB-ID	80325-x
ISSN	1469-0756 ; 0032-5473
ISSN (online)	1469-0756
ISSN	0032-5473
DOI	10.1136/postgradmedj-2022-141638
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Article ; Online: Gongs galore: phaleristic study of the relative risk of a healing art related New Year Honour.

Mellor, Katie / Powell, Arfon Gmt / James, Osian P / Robinson, David B / Hopkins, Luke / Egan, Richard John / Lewis, Wyn G

Postgraduate medical journal

2021 Volume 98, Issue 1158, Page(s) 252–257

Abstract: Objectives: To compare proportional representation of healthcare specialty workers, in receipt of New Year Honours (NYHs) and examine system bias.: Design: Observational study of UK honours system including comparative analysis of proportional ... ...

Abstract	Objectives: To compare proportional representation of healthcare specialty workers, in receipt of New Year Honours (NYHs) and examine system bias. Design: Observational study of UK honours system including comparative analysis of proportional representation of the UK medical workforce. Participants: Recipients of NYHs from 2010 to 2019. Main outcome measures: Absolute risk of receiving an NYH, related to medical specialty, gender and geographical region. Relative risk (RR) of receiving an NYH for services to healthcare related to specialty. Results: 11 207 NYHs were bestowed, with 368 (3.3%) awarded to healthcare professionals: 212 (57.6%) women, 156 (42.4%) men. The RR of a healthcare professional receiving an NYH was 0.76 (95% CI 0.68 to 0.84, p<0.001) when compared with the remaining UK workforce. Doctors received most NYHs (n=181), with public health, clinical oncology and general medicine specialties most likely to be rewarded (RR 20.35 (95% CI 9.61 to 43.08, p<0.001), 8.43 (95% CI 2.70 to 26.30, p<0.001) and 8.22 (95% CI 6.22 to 10.86, p<0.001)), respectively; anaesthetists received fewest NYHs (RR 0.52 (95% CI 0.13 to 2.10), p=0.305). Men were more likely to receive NYHs than women (OR 0.44, 95% CI 0.36 to 0.54; p<0.001). Two hundred and fifty-four NYHs (69.0%) were bestowed on residents of England (60, 16.3% London), 49 (13.3%) Scotland (p=0.003), 39 (10.6%) Wales (p<0.001) and 26 (7.1%) Northern-Ireland (p<0.001). Conclusions: Relative risk of receiving an NYH varied over 150-fold by specialty, twofold by gender and threefold by geographical location. Public health physicians are perceived to be the pick of the parade.
MeSH term(s)	Awards and Prizes ; Female ; General Practice ; Humans ; Male ; Physicians ; Risk ; Workforce
Language	English
Publishing date	2021-02-09
Publishing country	England
Document type	Journal Article ; Observational Study
ZDB-ID	80325-x
ISSN	1469-0756 ; 0032-5473
ISSN (online)	1469-0756
ISSN	0032-5473
DOI	10.1136/postgradmedj-2020-139368
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Article ; Online: Trainee burnout: when does the fire start?

Robinson, David Bryan Thomas / James, Osian Penri / Hopkins, Luke / Brown, Chris / Powell, Arfon / Abdelrahman, Tarig / Egan, Richard John / Lewis, Wyn

Postgraduate medical journal

2020 Volume 98, Issue 1156, Page(s) 124–130

Abstract: Purpose of the study: Burnout is an increasingly recognised phenomenon in acute healthcare specialities and associated with depersonalisation, ill health and training programme attrition. This study aimed to quantify contributory physiological variables ...

Abstract	Purpose of the study: Burnout is an increasingly recognised phenomenon in acute healthcare specialities and associated with depersonalisation, ill health and training programme attrition. This study aimed to quantify contributory physiological variables that may indicate stress in newly qualified doctors. Study design: Post Graduate Year 1 doctors (n=13, 7 f, 6 m) were fitted with a VivaLNK wellness device during four prior induction days, followed by their first 14 days work as qualified doctors. Minute-by-minute Heart Rate (HR), Respiratory Rate (RR), and Stress Index (SI) data were correlated with Maslach Burnout Inventories, Short Grit Scales (SGS) and clinical rota duties: Induction vs Normal Working-Day (NWD) versus On-call shift. Results: In a total 125 recorded shift episodes, on comparing Induction versus NWD versus On-call shift work, no variation was observed in HR above baseline (25.47 vs 27.14 vs 24.34, p=0.240), RR above baseline (2.21 vs 1.86 vs 1.54, p=0.126) or SI (32.98 vs 38.02 vs 35.47, p=0.449). However, analysis of participant-specific temporal SIs correlated with shift-related clinical duties; that is, study participants who were most stressed during a NWD, were also more stressed during Induction (R Conclusion: Stress and burnout stimulus appear to start on day one of induction for susceptible PGY1 doctors, and continues into front-line clinical work irrespective of shift pattern. Short Grit Scale questionnaires appear an effective tool to facilitate targeted stress countermeasures.
MeSH term(s)	Adult ; Burnout, Professional/epidemiology ; Female ; Humans ; Internship and Residency ; Male ; Occupational Stress/psychology ; Physicians/psychology ; Surveys and Questionnaires ; Workload
Language	English
Publishing date	2020-11-04
Publishing country	England
Document type	Journal Article
ZDB-ID	80325-x
ISSN	1469-0756 ; 0032-5473
ISSN (online)	1469-0756
ISSN	0032-5473
DOI	10.1136/postgradmedj-2020-137839
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Article ; Online: Strategic organisational skills predict surgical training success.

James, Osian Penri / Robinson, David Bryan Thomas / Hopkins, Luke / Bowman, Chris / Powell, Arfon / Brown, Chris / Hemington-Gorse, Sarah / Egan, Richard John / Lewis, Wyn G

Postgraduate medical journal

2020 Volume 98, Issue 1155, Page(s) 29–34

Abstract: Introduction: Surgical career progression is determined by examination success and Annual Review of Competence Progression (ARCP) outcome, yet data on organisational skills are sparse. This study aimed to determine whether organisational skills related ... ...

Abstract	Introduction: Surgical career progression is determined by examination success and Annual Review of Competence Progression (ARCP) outcome, yet data on organisational skills are sparse. This study aimed to determine whether organisational skills related to Core Surgical Training (CST) outcome. Primary outcome measures include operative experience, publications, examination success (Membership of the Royal College of Surgeons or the Diploma in Otolaryngology-Head and Neck Surgery (MRCS/DO-HNS)) and ARCP outcome. Methods: The study was conducted prospectively at three consecutive CST induction boot camps (2017-2019) providing clinical and simulation training for 125 trainees. Arrival time at course registration was the selected surrogate for organisational skills. Trainees were advised to arrive promptly at 8:45 for registration and that the course would start at 9:00. Trainee arrival times were grouped as follows: Setting: Health Education and Improvement Wales' School of Surgery, UK. Results: Median arrival time was 8:53 (range 7:55-10:03), with 29 trainees (23.2%) arriving early, 63 (50.4%) on-time and 33 (26.4%) late. Arrival time was associated with operative experience (early vs late; 206 vs 164 cases, p=0.012), publication (63.2% vs 18.5%, p=0.005), MRCS/DO-HNS success (44.8% vs 15.2%, p=0.029), ARCP outcome (86.2% vs 60.6% Outcome 1, p=0.053), but not National Training Number success (60.0% vs 53.3%, p=0.772). Conclusions: Better-prepared trainees achieved 25% more operative experience, were four-fold more likely to publish and pass MRCS, which aligned with consistent desirable ARCP outcome. Timely arrival at training events represents a skills-composite of travel planning and is a useful marker of strategic organisational skills.
MeSH term(s)	Clinical Competence ; Data Collection ; Educational Status ; Efficiency ; Humans ; Prospective Studies ; Simulation Training/organization & administration ; Surgeons
Keywords	covid19
Language	English
Publishing date	2020-11-12
Publishing country	England
Document type	Journal Article
ZDB-ID	80325-x
ISSN	1469-0756 ; 0032-5473
ISSN (online)	1469-0756
ISSN	0032-5473
DOI	10.1136/postgradmedj-2020-138763
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Article ; Online: Egalitarianism in surgical training: let equity prevail.

Robinson, David Bryan Thomas / Hopkins, Luke / James, Osian Penri / Brown, Chris / Powell, Arfon Gmt / Abdelrahman, Tarig / Hemington-Gorse, Sarah / Walsh, Leona / Egan, Richard John / Lewis, Wyn

Postgraduate medical journal

2020 Volume 96, Issue 1141, Page(s) 650–654

Abstract: This study aimed to quantify core surgical trainee (CST) differential attainment (DA) related to three cohorts; white UK graduate (White UKG) versus black and minority ethnic UKG (BME UKG) versus international medical graduates (IMGs). The primary ... ...

Abstract	This study aimed to quantify core surgical trainee (CST) differential attainment (DA) related to three cohorts; white UK graduate (White UKG) versus black and minority ethnic UKG (BME UKG) versus international medical graduates (IMGs). The primary outcome measures were annual review of competence progression (ARCP) outcome, intercollegiate Membership of the Royal College of Surgeons (iMRCS) examination pass and national training number (NTN) selection. Intercollegiate Surgical Curriculum Programme (ISCP) portfolios of 264 consecutive CSTs (2010-2017, 168 white UKG, 66 BME UKG, 30 IMG) from a single UK regional post graduate medical region (Wales) were examined. Data collected prospectively over an 8-year time period was analysed retrospectively. ARCP outcomes were similar irrespective of ethnicity or nationality (ARCP outcome 1, white UKG 60.7% vs BME UKG 62.1% vs IMG 53.3%, p=0.395). iMRCS pass rates for white UKG vs BME UKG vs IMG were 71.4% vs 71.2% vs 50.0% (p=0.042), respectively. NTN success rates for white UKG vs BME UKG vs IMG were 36.9% vs 36.4% vs 6.7% (p=0.023), respectively. On multivariable analysis, operative experience (OR 1.002, 95% CI 1.001 to 1.004, p=0.004), bootcamp attendance (OR 2.615, 95% CI 1.403 to 4.871, p=0.002), and UKG (OR 7.081, 95% CI 1.556 to 32.230, p=0.011), were associated with NTN appointment. Although outcomes related to BME DA were equitable, important DA variation was apparent among IMGs, with iMRCS pass 21.4% lower and NTN success sixfold less likely than UKG. Targeted counter measures are required to let equity prevail in UK CST programmes.
MeSH term(s)	Analysis of Variance ; Clinical Competence ; Data Collection ; Education/methods ; Education/standards ; Education, Medical, Graduate/methods ; Education, Medical, Graduate/standards ; Education, Medical, Graduate/statistics & numerical data ; Educational Measurement/methods ; Educational Measurement/statistics & numerical data ; Educational Status ; Ethnic Groups/education ; Foreign Medical Graduates/education ; Foreign Medical Graduates/statistics & numerical data ; General Surgery/education ; Humans ; United Kingdom
Language	English
Publishing date	2020-05-05
Publishing country	England
Document type	Journal Article
ZDB-ID	80325-x
ISSN	1469-0756 ; 0032-5473
ISSN (online)	1469-0756
ISSN	0032-5473
DOI	10.1136/postgradmedj-2020-137563
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Article ; Online: The reporting of gastric band slip and related complications; a review of the literature.

Egan, Richard John / Monkhouse, Simon J W / Meredith, Hayley E / Bates, Sharon E / Morgan, Justin D T / Norton, Sally A

Obesity surgery

2010 Volume 21, Issue 8, Page(s) 1280–1288

Abstract: Laparoscopic adjustable gastric banding is a safe and effective treatment for morbid obesity. Long-term complications include band slippage, gastric pouch dilatation and gastric erosion. Rates of band slippage reported in the literature range from less ... ...

Abstract	Laparoscopic adjustable gastric banding is a safe and effective treatment for morbid obesity. Long-term complications include band slippage, gastric pouch dilatation and gastric erosion. Rates of band slippage reported in the literature range from less than 1% to over 20%. The aim of this review was to explore whether differences in the reporting of this complication contributed to the variability in this outcome measure. A full literature search was undertaken using EMBASE and MEDLINE search engines. Forty studies were selected for analysis based on inclusion and exclusion criteria. Each was scrutinised for outcome reporting methods and related fields. Accurate definitions for relevant terms were derived from the best available evidence. Considerable variations in device deployed, operative approach, band fixation technique, and outcome reporting mechanisms were seen between the studies. The explanation and definition of terms used within manuscripts were also seen to vary between studies. A consensus needs to be reached on how best to report complications such as gastric band slippage. We suggest which information should be included by authors to allow for accurate and reproducible reporting of such outcomes in the future.
MeSH term(s)	Foreign-Body Migration/epidemiology ; Gastric Dilatation/epidemiology ; Gastric Dilatation/etiology ; Gastroplasty/instrumentation ; Gastroplasty/methods ; Humans ; Laparoscopy ; Obesity, Morbid/surgery ; Outcome Assessment, Health Care ; Postoperative Complications/epidemiology ; Prostheses and Implants/adverse effects ; Silicones
Chemical Substances	Silicones
Language	English
Publishing date	2010-12-24
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	1070827-3
ISSN	1708-0428 ; 0960-8923
ISSN (online)	1708-0428
ISSN	0960-8923
DOI	10.1007/s11695-010-0344-3
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