Some bubbles to toast handing over bleep 2615 (gen surg registrar on call) at the end of my last reg on call block. A day of interesting operating, and hopefully made some people better.
9 years on this tier rota, lots learned.
#surgicallife
#SoMe4Surgery
Very proud to wear these robes and receive my
#PhD
from
@sheffielduni
today. Pictured with my wife who was equal parts supportive and tolerant throughout the time! Thanks to my supervisors and mentors for their support too! Rerum cognoscere causas.
#graduation
#surgicalresearch
Spent 8 of last 11 yrs at
@SheffieldHosp
(CST/PhD/HST in general/colorectal surgery).
End of an era.
Excellent training & mentorship throughout. Grateful for experiences and support. Strongly recommend to all.
On to a locum role
@LeedsEGS
for a little while.
#some4surgery
You know what, I really enjoy my job.
I get to do
#surgery
things
I get to do
#research
things
Both complement each other, and both bring massive satisfaction. Have been having chats about plans for 2022, and am excited for what we try to do next.
#surgicalresearch
Your F1 calls you about a laparotomy & adhesiolysis from 3 days ago. Someone did a random troponin for reasons unclear. No chest pain reported, ECG normal.
Does a raised post-op trop with no ECG changes matter in non-cardiac
#surgery
? Does it change what you do?
🧵 1/5
Last night I dreamed that I was doing a lap chole and this person had four gallbladders laid on top of each other, and each time I thought I was finished there was another one behind it to take out.
Interpretations welcome.
#some4surgery
I'd particularly like to thank reviewer 3 for missing the point of the manuscript, then dissecting grammar issues that reflect transatlantic differences in English and should be dealt with by the copy editor. Heres your 3 pages of point by point response.
#AcWri
For this weeks
#MAfriday
26M presents to ED with 3/7hx of severe abdominal pain and vomiting. No PMH or surgical hx.
Temp 36.5, BP 125/82, 98bpm, 98% RA, RR 20
On exam, distended tender abdomen
Labs: WCC 16, otherwise normal
Next investigation?
Finally got the post op delirium paper accepted. Wooo!
Will be open access. Uses a bit of an interesting method, and has interesting findings, so will tweet and share when in press.
#surgicalresearch
MASH is published! The main findings from the study are now available through BJS A big thank you to all of our collaborators for making this possible
#hernia
#emergsurg
#collaborate
Today's emergency list kicked off just after 0800, finished last general case at 2010. Minimal to no gaps in theatre use. Theatre team were on form so it was super efficient! And fun.
Brilliant stuff.
@SheffieldHosp
#teamwork
#canwesend
#wealreadyhave
Fantastic trip to
#PISA
for
@WSESurgery
2023 last week.
Broad content relevant to
#emgensurg
or
#trauma
practices
Rescue, frailty, futility, robots, mycotic infections. Free papers also of a good standard. Networking also 👍.
Lots to think about
#surgicalresearch
Started the academic year with a full house of decisions coming back yesterday:
Accept without revisions X1
Reject without review x1
Minor amendments x2
Can't win them all.
#surgicalresearch
The 🇬🇧 normal appendicectomy rate (NAR) in people aged 16-45 in 2017 was 20%. The rate was much higher in women🚺 (28%) than men🚹 (12%).
Amongst patients in 🇮🇪🇮🇹🇵🇹🇪🇸 NARs were much lower than in 🇬🇧: 10% in women🚺 & just 3% in men🚹!
#RIFTstudy
:
The most frustrating parts of my
#surgicalresearch
training is securing the follow-on job.
A small number of Unis have funding for senior lecturers, otherwise its no job without a competitively funded personal fellowship.
Pretty demoralising after 7+ years of effort.
Today:
Paper edits on the train📝
Ward round including some teaching🚶♂️
Operating with
@pinkney_t
and
@Melissa__Cunha
😷
Then a quick post work beer with some of the juniors.
Really enjoy my job.
#some4surgery
@timricketts_
With apologies for my handwriting
Good test will give Dx and stratify rapidly. This is a CT. All AXR does is give bonus radiation for no benefit.
And delays
Which are bad.
Bowel sounds not useful for DX or stratification really.
#some4surgery
@ASGBI_MA
Excited to be giving a talk on the state of the art of small bowel obstruction at
#DKS2022
Prepping talk has made me look really critically at what we think we know.
Punchline is there's lots to do. Watch this space...
#emgensurg
@sheffunimdh
#surgicalresearch
Redoing charts on a Sunday evening so they are ready for
@ASiTofficial
meeting. What would you rather be doing than
#rstats
?
ps
#ggsci
is one of my favourites
There is an entity called MINS (myocardial injury after non-cardiac surgery). It is essentially evidence of cellular damage w/o ECG changes. The new european cardiology guidelines recommend screening for it post-op...
But does it impact outcomes?
🧵2/5
Non-covid news: Pleased to hear the
@nasbo2017
main paper achieved a high Altmetric in
@BjsOpen
- and was one of the most downloaded articles (2,400ish downloads).
The
#hernia
paper will hopefully be in the same journal soon!
It's great to see what
#collaboration
can achieve!
@drkeithsiau
Or follow the
@NCEPOD
and
@NASBO2017
recommendations and do a CT instead of AXR (which has poor sensitivity and specificity, and patient will still get a ct.)
Think I might have achieved something educational - asked one of our fy1's to give indications for abdominal xr. 'The only reason would be to check gastrografin in
#SBO
'.
Having an educational chat with
@stevebrownsheff
this afternoon and he has suggested that I should aim to emulate this man - Lawson Tait. Is it for his many contributions to the field? No. His sideburns are better than mine and I should aim to surpass them.
#surgicaltraining
Looking for some UK based surgeons to tell us their thoughts on acute umbilical
#hernia
management to inform a trial (CST-Consultant). If you could spare 5 mins for a survey please send a DM and I'll send a link. Cheers
#emgensurg
#surgicalresearch
@asgbi
@ACPGBI
Off to Copenhagen to talk about
#SBO
and (controversially?)
#postopaf
at the Danish Surgical Society Meeting.
@Neil_J_Smart
says its a great meeting. Look forward to it!
#Surgery
🎇 Real-world practice and outcomes in pilonidal surgery: Pilonidal Sinus Treatment Studying The Options (PITSTOP) cohort
😷The aim of this study was to provide real-world data on current surgical practice and report patient and risk-adjusted outcomes, informing future trial
'There is a lack of successors in the 35-40 bracket'
Yep. Because securing a clinical academic post at Consultant/SL level now seems to demand a fully funded research fellowship, which have around 8% overall success rate if looking at NIHR stats.
Lack of clinical academics threatens NHS research and teaching, “The foundations [of university medicine] are starting to be eroded,” she said. “The pipeline for clinical academics is really looking quite frightening . . . & it is not being talked about.”
Our
#metaanalysis
in
@BjsOpen
found MINS assoc/w death rates of
-9% at 1mon
-8% at 66mo
-25% at 1yr)
MINS was associated with a 21% rate of major adverse cardiovascular events (e.g. MI, arrhythmia, CVA, cardiac death, amputation)
Pretty stark.
🧵3/5
Really great collaboration across sites during a challenging period. Grateful to all for support of the study and
@BritishHernia
for funding.
#rct
ideas brewing - watch this space...
Outstanding presentation of
@MASH_2019_
at
#Hernia2021
by Vicky Proctor. Wide variation in UK practice regarding acutely symptomatic hernias. Opportunities for RCTs in the future.