Patient characteristics,anaesthetic workload and techniques in the UK: an analysis from the 7th National Audit Project (NAP7) activity survey

Detailed contemporary knowledge of the characteristics of the surgical population, national anaesthetic workload, anaesthetic techniques and behaviours are essential to monitor productivity, inform policy and direct research themes. Every 3–4 years, the Royal College of Anaesthetists, as part of its National Audit Projects (NAP), performs a snapshot activity survey in all UK hospitals delivering anaesthesia, collecting patient-level encounter data from all cases under the care of an anaesthetist. During November 2021, as part of NAP7, anaesthetists recorded details of all cases undertaken over 4 days at their site through an online survey capturing anonymous patient characteristics and anaesthetic details. Of 416 hospital sites invited to participate, 352 (85%) completed the activity survey. From these, 24,177 reports were returned, of which 24,172 (99%) were included in the final dataset. The work patterns by day of the week, time of day and surgical specialty were similar to previous NAP activity surveys. However, in non-obstetric patients, between NAP5 (2013) and NAP7 (2021) activity surveys, the estimated median age of patients increased by 2.3 years from median (IQR) of 50.5 (28.4–69.1) to 52.8 (32.1–69.2) years. The median (IQR) BMI increased from 24.9 (21.5–29.5) to 26.7 (22.3–31.7) kg.m^–2. The proportion of patients who scored as ASA physical status 1 decreased from 37% in NAP5 to 24% in NAP7. The use of total intravenous anaesthesia increased from 8% of general anaesthesia cases to 26% between NAP5 and NAP7. Some changes may reflect the impact of the COVID-19 pandemic on the anaesthetic population, though patients with confirmed COVID-19 accounted for only 149 (1%) cases. These data show a rising burden of age, obesity and comorbidity in patients requiring anaesthesia care, likely to impact UK peri-operative services significantly.     

Timing of elective surgery and risk assessment after SARS-CoV-2 infection: an update

The impact of vaccination and new SARS-CoV-2 variants on peri-operative outcomes is unclear. We aimed to update previously published consensus recommendations on timing of elective surgery after SARS-CoV-2 infection to assist policymakers, administrative staff, clinicians and patients. The guidance remains that patients should avoid elective surgery within 7 weeks of infection, unless the benefits of doing so exceed the risk of waiting. We recommend individualised multidisciplinary risk assessment for patients requiring elective surgery within 7 weeks of SARS-CoV-2 infection. This should include baseline mortality risk calculation and assessment of risk modifiers (patient factors; SARS-CoV-2 infection; surgical factors). Asymptomatic SARS-CoV-2 infection with previous variants increased peri-operative mortality risk three-fold throughout the 6 weeks after infection, and assumptions that asymptomatic or mildly symptomatic omicron SARS-CoV-2 infection does not add risk are currently unfounded. Patients with persistent symptoms and those with moderate-to-severe COVID-19 may require a longer delay than 7 weeks. Elective surgery should not take place within 10 days of diagnosis of SARS-CoV-2 infection, predominantly because the patient may be infectious, which is a risk to surgical pathways, staff and other patients. We now emphasise that timing of surgery should include the assessment of baseline and increased risk, optimising vaccination and functional status, and shared decision-making. While these recommendations focus on the omicron variant and current evidence, the principles may also be of relevance to future variants. As further data emerge, these recommendations may be revised.     

Am I Ready to Be an Independent Neuroradiologist? Objective Trends in Neuroradiology Fellows' Performance during the Fellowship Year

BACKGROUND AND PURPOSE:Aside from basic Accreditation Council for Graduate Medical Education guidelines, few metrics are in place to monitor fellows'' progress. The purpose of this study was to determine objective trends in neuroradiology fellowship training on-call performance during an academic year.MATERIALS AND METHODS:We retrospectively reviewed the number of cross-sectional neuroimaging studies dictated with complete reports by neuroradiology fellows during independent call. Monthly trends in total call cases, report turnaround times, relationships between volume and report turnaround times, and words addended to preliminary reports by attending neuroradiologists were evaluated with regression models. Monthly variation in frequencies of call-discrepancy macros were assessed via χ² tests. Changes in frequencies of specific macro use between fellowship semesters were assessed via serial 2-sample tests of proportions.RESULTS:From 2012 to 2017, for 29 fellows, monthly median report turnaround times significantly decreased during the academic year: July (first month) = 79 minutes (95% CI, 71–86 minutes) and June (12th month) = 55 minutes (95% CI, 52–60 minutes; P value = .023). Monthly report turnaround times were inversely correlated with total volumes for CT (r = –0.70, F = 9.639, P value = .011) but not MR imaging. Words addended to preliminary reports, a surrogate measurement of report clarity, slightly improved and discrepancy rates decreased during the last 6 months of fellowship. A nadir for report turnaround times, discrepancy errors, and words addended to reports was seen in December and January.CONCLUSIONS:Progress through fellowship correlates with a decline in report turnaround times and discrepancy rates for cross-sectional neuroimaging call studies and slight improvement in indirect quantitative measurement of report clarity. These metrics can be tracked throughout the academic year, and the midyear would be a logical time point for programs to assess objective progress of fellows and address any deficiencies.

A fellow''s progress in an academic year is primarily assessed using qualitative, thus subjective, criteria, including achievement of Accreditation Council for Graduate Medical Education–prescribed milestones and faculty evaluations. While the Accreditation Council for Graduate Medical Education provides requirements for total yearly cases read¹ and individual programs may have internal metrics for fellows'' progress, there are no concrete external objective measurements for documenting fellows'' progress within the academic year. Often, fellows are unsure whether their efficiency in generating reports, report turnaround times (RTATs) for on-call examinations, or quality of on-call reports is satisfactory.The total number of studies dictated by the fellow and the RTATs of on-call studies may be reviewed by the attendings and program director with the fellows, but more meaningful interpretation of these numbers is lacking because there are no comparison benchmarks or quantitative checkpoints within the fellowship year. Knowledge of these factors is critical in a fellowship program so that program directors and fellows are jointly aware of progress throughout the year and remediation or additional focused training can be implemented, as necessary. More data on neuroradiology fellowship training are especially needed because a survey in 2016 demonstrated that 25% of practicing neuroradiologists in the United States believe that fellows'' abilities have declined.² Prior studies have analyzed various other factors related to radiology residency training, including total cases read, turnaround time, and on-call accuracy,^3,4 but to our knowledge, no studies have analyzed the quantitative trends in fellowship training during an academic year.We hypothesized that within an academic year, the RTAT for on-call studies dictated by fellows will decrease (ie, improve). Meanwhile, the discrepancy rates will decrease, and clarity of reports will improve. We also hypothesized that participating in independent call will have residual short-term effects on increasing clinical productivity during a subsequent regular work week.     

The behaviour change techniques used by Australian physiotherapists to promote non-treatment physical activity to patients with musculoskeletal conditions

Objectives

To determine: (i) the behaviour change techniques used by a sample of Australian physiotherapists to promote non-treatment physical activity; and (ii) whether those behaviour change techniques are different to the techniques used to encourage adherence to rehabilitation exercises.

A case of autonomic failure in post-craniectomy syndrome of the trephined

Clinical Autonomic Research -     

A Scoping Review of School-Based Efforts to Support Students Who Have Experienced Trauma

School Mental Health - The current review sought to describe the published literature relative to addressing trauma in schools. Through a systematic review of peer-reviewed publications as well as...