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  1. Article ; Online: Economic cost-utility analysis of stage-directed oesophageal cancer treatment.

    Herbert, Geraint L / Robinson, David B T / Powell, Arfon G / Abdelrahman, Tarig / Khalid, Usman / Lewis, Wyn G

    BJS open

    2024  Volume 8, Issue 2

    MeSH term(s) Humans ; Cost-Benefit Analysis ; Esophageal Neoplasms/therapy ; Adenocarcinoma/therapy
    Language English
    Publishing date 2024-04-01
    Publishing country England
    Document type Journal Article
    ISSN 2474-9842
    ISSN (online) 2474-9842
    DOI 10.1093/bjsopen/zrad159
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: A retrospective cohort study of differential attainment, COVID and chaos: taking the difference out of a terrible trinity.

    James, Osian P / Mellor, Katie / Luton, Oliver / Robinson, David B T / Walsh, Leona / Hemington-Gorse, Sarah / Egan, Richard J / Lewis, Wyn G

    International journal of surgery (London, England)

    2023  Volume 109, Issue 8, Page(s) 2359–2364

    Abstract: Background: This study aimed to evaluate core surgical training (CST) differential attainment related to coronavirus disease 2019 (COVID-19), gender and ethnicity. The hypothesis was that COVID-19 adversely influenced CST outcomes.: Methods: A ... ...

    Abstract Background: This study aimed to evaluate core surgical training (CST) differential attainment related to coronavirus disease 2019 (COVID-19), gender and ethnicity. The hypothesis was that COVID-19 adversely influenced CST outcomes.
    Methods: A retrospective cohort study of 271 anonymised CST records was undertaken at a UK Statutory Education Body. Primary effect measures were Annual Review of Competency Progression Outcome (ARCPO), Membership of the Royal College of Surgeons (MRCS) examination pass and Higher Surgical Training National Training Number (NTN) appointment. Data were collected prospectively at ARCP and analysed with non-parametric statistical methods in SPSS.
    Results: CSTs numbering 138 completed training pre-COVID and 133 peri-COVID. ARCPO 1, 2 and 6 were 71.9% pre-COVID versus 74.4% peri-COVID ( P =0.844). MRCS pass rates were 69.6% pre-COVID versus 71.1% peri-COVID ( P =0.968), but NTN appointment rates diminished (pre-COVID 47.4% vs. peri-COVID 36.9%, P =0.324); none of the above varied by gender or ethnicity. Multivariable analyses by three models revealed: ARCPO was associated with gender [m:f 1:0.87, odds ratio (OR) 0.53, P =0.043] and CST theme (Plastics vs. General OR 16.82, P =0.007); MRCS pass with theme (Plastics vs. General OR 8.97, P =0.004); NTN with the Improving Surgical Training run-through programme (OR 5.00, P <0.001). Programme retention improved peri-COVID (OR 0.20, P =0.014) with pan University Hospital rotations performing better than Mixed or District General-only rotations (OR 6.63, P =0.018).
    Conclusion: Differential attainment profiles varied 17-fold, yet COVID-19 did not influence ARCPO or MRCS pass rates. NTN appointment fell by one-fifth peri-COVID, but overall training outcome metrics remained robust despite the existential threat.
    MeSH term(s) Humans ; Retrospective Studies ; Clinical Competence ; COVID-19/epidemiology ; Surgeons/education ; Educational Measurement ; United Kingdom/epidemiology
    Language English
    Publishing date 2023-08-01
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2212038-5
    ISSN 1743-9159 ; 1743-9191
    ISSN (online) 1743-9159
    ISSN 1743-9191
    DOI 10.1097/JS9.0000000000000488
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: Enhanced Stress Resilience Training for UK Surgical Trainees; Effect and Evolution Evaluated.

    Luton, Oliver W / James, Osian P / Mellor, Katie / Eley, Catherine / Hopkins, Luke / Robinson, David B T / Barlow, Emma / Lebares, Carter C / Lewis, Wyn G / Egan, Richard J

    Journal of surgical education

    2023  Volume 80, Issue 10, Page(s) 1395–1402

    Abstract: Introduction: Core Surgical Training (CST) programs are associated with high burnout. This study aimed to assess the influence of Enhanced Stress Resilience Training (ESRT) over a 2-year period in a single UK Statutory Education Body.: Method: CSTs ... ...

    Abstract Introduction: Core Surgical Training (CST) programs are associated with high burnout. This study aimed to assess the influence of Enhanced Stress Resilience Training (ESRT) over a 2-year period in a single UK Statutory Education Body.
    Method: CSTs participated in 5-weeks of formal ESRT to address work stressors. The primary outcome measure was career progression related to curriculum metrics and National Training Number (NTN) appointment. Secondary measures related to burnout using validated psychological inventories.
    Results: Of 42 CSTs, 13 engaged fully with ESRT (31.0%; male 8, female 5, median age 28 year.), 11 engaged partially, and 18 did not. ESRT engagement was associated with better NTN appointment (ESRT 8/13 (61.5%) vs. not 1/18 (5.6%), p = 0.025), less burnout [aMBI; mean 5.14 (SD ± 2.35) vs. 3.14 (±2.25), F 6.637, p = 0.002, η
    Discussion: ESRT was associated with less stress and burnout, better mindfulness, and most importantly 13-fold better career progression.
    Language English
    Publishing date 2023-08-09
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2277538-9
    ISSN 1878-7452 ; 1931-7204
    ISSN (online) 1878-7452
    ISSN 1931-7204
    DOI 10.1016/j.jsurg.2023.07.017
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: Consumer-grade biosensor validation for examining stress in healthcare professionals.

    Hopkins, Luke / Stacey, Benjamin / Robinson, David B T / James, Osian P / Brown, Christopher / Egan, Richard J / Lewis, Wyn G / Bailey, Damian M

    Physiological reports

    2020  Volume 8, Issue 11, Page(s) e14454

    Abstract: Introduction: A high prevalence of stress and burnout has been reported among healthcare professionals; however, the current tools utilized to quantify such metrics are not in keeping with doctors' busy lifestyles, and moreover do not comply with ... ...

    Abstract Introduction: A high prevalence of stress and burnout has been reported among healthcare professionals; however, the current tools utilized to quantify such metrics are not in keeping with doctors' busy lifestyles, and moreover do not comply with infection prevention policies. Given that increased stress can subsequently impact both the healthcare profession and the patient in care, this study aimed to assess the validity of a wearable biosensor to monitor and manage stress experienced by healthcare professionals.
    Methods: In all, 12 healthy, male volunteers completed an incremental exercise protocol to volitional exhaustion, which aimed to induce physiological stress in a graded manner. A wearable consumer-grade biosensor (Vital Scout, VivaLNK, Inc.) was used to measure stress, energy expenditure, respiration rate, and activity throughout the exercise protocol. These variables were validated against online breath-by-breath analysis (MedGraphics Ultima Series).
    Results: When compared against online "gold standard" measurements, the Vital Scout biosensor demonstrated a high level of accuracy to measure energy expenditure (r = .776, p < .001) and respiration rate (r = .744, p < .001). The
    Conclusion: The Vital Scout biosensor provided an accurate assessment of energy expenditure and respiration when compared to the "gold standard" assessment of these parameters. Biosensors have the potential to measure stress and deserve further research in the peri-hospital environment.
    MeSH term(s) Adult ; Biosensing Techniques/instrumentation ; Biosensing Techniques/methods ; Energy Metabolism ; Exercise/physiology ; Health Personnel ; Humans ; Male ; Monitoring, Physiologic/instrumentation ; Monitoring, Physiologic/methods ; Respiratory Rate ; Stress, Physiological ; Stress, Psychological/diagnosis ; Wearable Electronic Devices
    Language English
    Publishing date 2020-06-03
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't ; Validation Study
    ZDB-ID 2724325-4
    ISSN 2051-817X ; 2051-817X
    ISSN (online) 2051-817X
    ISSN 2051-817X
    DOI 10.14814/phy2.14454
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article ; Online: Trauma and Orthopedic Surgery Curriculum Concordance: An Operative Learning Curve Trajectory Perspective.

    Hopkins, Luke / Robinson, David B T / Brown, Christopher / Egan, Richard / Iorwerth, Awen / Holt, Mark / Lewis, Wyn G

    Journal of surgical education

    2019  Volume 76, Issue 6, Page(s) 1569–1578

    Abstract: Introduction: Certification of completion of training in Trauma and Orthopedic (T&O) surgery in the UK requires the demonstration of operative competence in 12 index procedures, achieved through attaining a level 4 consultant-validated procedure-based ... ...

    Abstract Introduction: Certification of completion of training in Trauma and Orthopedic (T&O) surgery in the UK requires the demonstration of operative competence in 12 index procedures, achieved through attaining a level 4 consultant-validated procedure-based assessment (PBA). The aim of this study was to evaluate the trajectory of operative learning curves related to PBA performance with respect to operative caseload and training time.
    Design: Logbook data from consecutive 24 higher T&O trainees were compared with PBA evaluations to determine the relationship between PBA level, operative experience, training time, and indicative numbers. Learning curve gradients were calculated using trigonometry related to operative experience and training time.
    Setting: A higher surgical orthopedic training program serving a single UK (Wales) Deanery.
    Participants: Twenty-four consecutive higher T&O surgery trainees.
    Results: Median caseload to achieve level 4 competences ranged from 9 (interquartile range 6-12) for tension band wiring (olecranon or patella) to 101 (61-127) for arthroscopy, with significant variation between all 12 procedures (p < 0.001). Median number of PBAs to reach level 4 competences was 4 (2-6) with significant variation between procedures (p < 0.001). Median learning curve gradients to achieve level 4 competence for tension band wiring were 68.2° and 33.7° by caseload and training time respectively, compared with 12.2° and 45° for arthroscopy, with significant learning curve variation for all procedures related to caseload between first level 3 and first level 4 PBA (p < 0.001). Competence ratios were <1 (median 0.99, range 0.70-2.53) for 6 of the 12 indicative procedures.
    Conclusions: Significant learning curve trajectory variance was observed, with discrepancies between indicative operative numbers and the point at which competence was judged achieved. Numbers of index operations to achieve certification of completion of training warrant further examination.
    MeSH term(s) Certification ; Clinical Competence ; Curriculum ; Learning Curve ; Orthopedics/education ; Traumatology/education ; United Kingdom
    Language English
    Publishing date 2019-05-27
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2277538-9
    ISSN 1878-7452 ; 1931-7204
    ISSN (online) 1878-7452
    ISSN 1931-7204
    DOI 10.1016/j.jsurg.2019.05.009
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article ; Online: Author response to: Personal protective equipment impairs pulmonary gas exchange causing systemic hypercapnia-hypoxaemia and cerebral hyperperfusion-induced cephalalgia.

    James, Osian P / Stacey, Benjamin / Hopkins, Luke / Robinson, David B T / Luton, Oliver / Williams, Ian M / Egan, Richard J / Bailey, Damian M / Lewis, Wyn G

    The British journal of surgery

    2021  Volume 108, Issue 12, Page(s) e412

    MeSH term(s) Headache ; Humans ; Hypercapnia ; Hypoxia ; Personal Protective Equipment ; Pulmonary Gas Exchange
    Language English
    Publishing date 2021-11-04
    Publishing country England
    Document type Journal Article ; Research Support, Non-U.S. Gov't ; Comment
    ZDB-ID 2985-3
    ISSN 1365-2168 ; 0263-1202 ; 0007-1323 ; 1355-7688
    ISSN (online) 1365-2168
    ISSN 0263-1202 ; 0007-1323 ; 1355-7688
    DOI 10.1093/bjs/znab369
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  7. Article ; Online: Relative Value of Adapted Novel Bibliometrics in Evaluating Surgical Academic Impact and Reach.

    Robinson, David B T / Hopkins, Luke / Brown, Chris / Abdelrahman, Tarig / Powell, Arfon G / Egan, Richard J / Lewis, Wyn G

    World journal of surgery

    2018  Volume 43, Issue 4, Page(s) 967–972

    Abstract: Background: The Hirsch index, often used to assess research impact, suffers from questionable validity within the context of General Surgery, and consequently adapted bibliometrics and altmetrics have emerged, including the r-index, m-index, g-index and ...

    Abstract Background: The Hirsch index, often used to assess research impact, suffers from questionable validity within the context of General Surgery, and consequently adapted bibliometrics and altmetrics have emerged, including the r-index, m-index, g-index and i10-index. This study aimed to assess the relative value of these novel bibliometrics in a single UK Deanery General Surgical Consultant cohort.
    Method: Five indices (h, r, m, g and i10) and altmetric scores (AS) were calculated for 151 general surgical consultants in a UK Deanery. Indices and AS were calculated from publication data via the Scopus search engine with assessment of construct validity and reliability.
    Results: The median number of publications, h-index, r-index, m-index, g-index and i10-index were 13 (range 0-389), 5 (range 0-63), 5.2 (range 0-64.8), 0.33 (range 0-1.5), 10 (range 0-125) and 4 (range 0-245), respectively. Correlation coefficients of r-index, m-index, g-index and i10-index with h-index were 0.913 (p < 0.001), 0.716 (p < 0.001), 0.961 (p < 0.001) and 0.939 (p < 0.001), respectively. Significant variance was observed when the cohort was ranked by individual bibliometric measures; the median ranking shifts were: r-index - 2 (- 46 to + 23); m-index - 6.5 (- 53 to + 22); g-index - 0.5 (- 24 to + 13); and i10-index 0 (- 8 to + 11), respectively (p < 0.001). The median altmetric score and AS index were 0 (range 0-225.5) and 1 (range 0-10), respectively; AS index correlated strongly with h-index (correlation coefficient 0.390, p < 0.001).
    Conclusions: Adapted bibliometric indices appear to be equally valid measures of evaluating academic productivity, impact and reach.
    MeSH term(s) Bibliometrics ; Consultants ; Publications/statistics & numerical data ; Reproducibility of Results ; Specialties, Surgical/statistics & numerical data
    Language English
    Publishing date 2018-12-18
    Publishing country United States
    Document type Journal Article
    ZDB-ID 224043-9
    ISSN 1432-2323 ; 0364-2313
    ISSN (online) 1432-2323
    ISSN 0364-2313
    DOI 10.1007/s00268-018-04893-w
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  8. Article ; Online: Biosensors, Biomarkers and Biometrics: a Bootcamp Perspective.

    James, Osian P / Robinson, David B T / Hopkins, Luke / Bowman, Chris / Powell, Arfon G M T / Brown, Chris / Bailey, Damian M / Egan, Richard J / Lewis, Wyn G

    BMJ simulation & technology enhanced learning

    2020  Volume 7, Issue 4, Page(s) 188–193

    Abstract: Introduction: Competitive physical performance is routinely monitored by wearable technology (biosensors), yet professional healthcare is not, despite high prevalence of trainee stress and burnout, notwithstanding the corresponding risk to patient ... ...

    Abstract Introduction: Competitive physical performance is routinely monitored by wearable technology (biosensors), yet professional healthcare is not, despite high prevalence of trainee stress and burnout, notwithstanding the corresponding risk to patient safety. This study aimed to document the physiological stress response of UK Core Surgical Trainees (CSTs) during simulation training.
    Methods: CSTs (n=20, 10 male) were fitted with Vital Scout Wellness Monitors (VivaLNK, Campbell, California, USA) for an intensive 3-day training bootcamp. In addition to physiological parameters, CST demographics, event diaries and Maslach Burnout Inventory scores were recorded prospectively during exposure to three scenarios: interactive lectures, clinical skills simulation and non-technical (communication) training.
    Results: Baseline heart rate (BHR, 60 bpm (range 39-81 bpm)) and baseline respiratory rate (14/min (11-18/min)) varied considerably and did not correlate (rho 0.076, p=0.772). BHR was associated with weekly exercise performed (66 bpm (<1 hour) vs 43 bpm (>5 hour), rho -0.663, p=0.004). Trainee response (standardised median heart rate vs BHR) revealed heart rate was related proportionately to lectures (71 bpm, p<0.001), non-technical skills training (79 bpm, p<0.001) and clinical skills simulation (88 bpm, p<0.001). Respiratory rate responded similarly (p<0.001 in each case). Heart rate during clinical skills simulation was associated with
    Discussion: Stress response, as derived from positive sympathetic heart rate drive varied over two-fold, with a direct implication on oxygen uptake and energy expenditure, and highlighting the daily physical demands placed upon clinicians.
    Language English
    Publishing date 2020-08-13
    Publishing country England
    Document type Journal Article
    ZDB-ID 2799014-X
    ISSN 2056-6697 ; 2056-6697
    ISSN (online) 2056-6697
    ISSN 2056-6697
    DOI 10.1136/bmjstel-2020-000631
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  9. Article ; Online: Stress and Burnout in Training; Requiem for the Surgical Dream.

    Robinson, David B T / James, Osian P / Hopkins, Luke / Brown, Chris / Bowman, Chris / Abdelrahman, Tarig / Pollitt, Michael J / Egan, Richard J / Bailey, Damian M / Lewis, Wyn G

    Journal of surgical education

    2019  Volume 77, Issue 1, Page(s) e1–e8

    Abstract: Objective: Burnout among trainee doctors is common with as many as two-thirds reporting poor health. This study aimed to assess burnout in a cohort of UK core and higher general surgical trainees.: Design: The Maslach Burnout Inventory for Medical ... ...

    Abstract Objective: Burnout among trainee doctors is common with as many as two-thirds reporting poor health. This study aimed to assess burnout in a cohort of UK core and higher general surgical trainees.
    Design: The Maslach Burnout Inventory for Medical Personnel was distributed to 158 surgical trainees to evaluate emotional exhaustion (EE), depersonalization (DP), and personal accomplishment (PA). High EE (≥27) and DP (≥10), low PA (≤33) scores were taken to indicate burnout.
    Setting: A single UK (Wales) Deanery.
    Participants: One hundred responses were received; 65 core surgical trainees, 31 Higher Surgical Trainees (HST), and 4 not specified.
    Results: Median EE, DP, and PA scores were 22.0 (range 2-50), 7.5 (0-25), and 36.0 (19-47), respectively. High burnout by domain was: EE (n = 33), DP (n = 39), PA (n = 34), with 59% of trainees demonstrating burnout in ≥1 one domain, with strong interdomain correlation (EE:DP r = 0.351, p < 0.001; EE:PA r = -0.455, p < 0.001; DP:PA r = -0.446, p < 0.001). Female gender (p = 0.020), core surgical training grade (p = 0.012), and being childless (p = 0.033) were independently associated with higher levels of EE; whereas HST grade (p = 0.007), age >30 years (p = 0.010), married/partner status (p = 0.001), and parenthood (p = 0.015), were associated with lower levels of burnout with regard to DP. Binary logistic regression revealed lower burnout in all domains to be associated with HST status (hazard ratio 0.116, 95% confidence interval 0.014-0.980, p = 0.048) and male gender (hazard ratio 4.365, (1.246-15.293), p = 0.021).
    Conclusions: Burnout among surgical trainees was common in at least 1 Maslach Burnout Inventory domain. Urgent counter measures are required to protect the health and wellbeing of trainees at risk, which ought to be associated with commensurate improvement in patient safety.
    MeSH term(s) Adult ; Burnout, Professional/epidemiology ; Burnout, Psychological ; Female ; Health Personnel ; Humans ; Male ; Physicians ; Surveys and Questionnaires
    Language English
    Publishing date 2019-07-31
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2277538-9
    ISSN 1878-7452 ; 1931-7204
    ISSN (online) 1878-7452
    ISSN 1931-7204
    DOI 10.1016/j.jsurg.2019.07.002
    Database MEDical Literature Analysis and Retrieval System OnLINE

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