INTRODUCTION:Children's surgery remains underfunded after COVID-19 and waiting list times have risen. Children with inguinal hernias (IH) come into this group, and there has been concern that these delays put children at higher risk of morbidity and increases the burden on resources. The aim of this study was to evaluate trends in waiting times and establish the impact on children in a large tertiary unit. METHODS:Retrospective review of all IH operations at a tertiary unit, 1st March 2022 - 31st March 2023 (Cohort 1) and 1st April 2023 - 30th April 2024 (Cohort 2). Federation of Surgical Speciality Associations guidance was used to define prioritisation status and breaches. RESULTS:414 patients were included in the study (180 Cohort 1, 234 Cohort 2). Alongside the increase in overall operations, the proportion of emergency operations in cohort 2 was significantly higher (56/234 vs 19/180, p < 0.001). There were also increases in the median waiting times for P2 patients, from 9.9 to 21.5 weeks (p = 0.0272). For P3, this increase was from 10.1 to 23.0 weeks (p = 0.0001). In total 29 patients required an emergency operation (on the waiting list) and of these 18/29 had breached their intended target. Length of stay for emergency patients was 3 days, compared to 1 day for electives. CONCLUSION:Children with IH are experiencing longer waiting times resulting in more emergency procedures and higher hospital bed days. Increased provision of elective operating lists is needed to tackle this problem and reduce the overall burden on hospital resources.
Background Recommendations for surgery in patients with renal hyperparathyroidism lack evidence. This study analysed outcomes of first-time renal parathyroidectomy in United Kingdom Registry of Endocrine and Thyroid Surgery (UKRETS) to establish risk factors for adverse outcomes. Methods Data from 2005 to 2020 was analysed. Entries with missing data, age <15 and >85 years, and length of stay (LOS) >28 days were excluded. Outcome variables included temporary hypocalcaemia, persistent disease, re-operation for bleeding, general complications, readmission and LOS. Persistent disease was only analysed in tertiary hyperparathyroidism. Four gland excision was categorised as total, 3.5 subtotal and <3.5 less than subtotal (LTST). Results 2135 patients underwent first-time surgery, 67.6% (1443/2477) were analysed, 54.0% (779) total, 18.4% (266) sub-total 27.6% (398) LTST. Temporary hypocalcaemia occurred in 47.5% (685/1443), reoperation for bleeding 0.5% (9/1443), complications 5.6% (81/1443), readmission 2.6% (37/1443), and mean LOS 3.5 days. Temporary hypocalcaemia 59.2% (461/779, p < 0.001) and complications 6.8% (53/779, P = 0.033) were significantly higher in total parathyroidectomy. Multivariable analysis showed LTST (OR 0.317 95% CI 0.243-0.415 p < 0.001), increasing age (OR 0.985 95% CI 0.977-0.992 p < 0.001), imaging (OR 0.632 95% CI 0.494-0.809 p < 0.001), and tertiary hyperparathyroism (OR 0.789 95% CI 0.628-0.991 p = 0.042) significantly decreased the risk of temporary hypocalcaemia. Persistent disease occurred in 4.9% (28/576) of patients with tertiary hyperparathyroidism. Multivariable analysis found this was significantly higher (OR 5.35 95% CI 2.253-12.703 p < 0.001) in LTST. Conclusions Total parathyroidectomy was the commonest operation. The incidence of temporary hypocalcaemia was high, and although this was reduced in LTST, this operation was associated with an unacceptably high incidence of persistent disease in tertiary hyperparathyroidism.
OBJECTIVES:Lumbar spondylosthesis is a relatively common complication. This study was designed and conducted with the aim of investigating the role of Modic changes in the surgical results of patients with spondylolisthesis who undergo posterolateral fusion with pedicle screws. METHODS:In this prospective cohort study, 83 patients diagnosed with degenerative spondylolisthesis with or without Modic changes and candidates for posterolateral fusion surgery with pedicle screws were included. The patients were divided into three groups: Modic 0, 35 people; Modic I, 26 people; and Modic II, 22 people. The surgical outcome was determined based on the visual analogue scale (VAS) and Oswestry Disability Index (ODI) criteria. RESULTS:The average age of patients in the group with and without Modic changes is 56.97 ± 7.03 and 58.00 ± 9.38, respectively (P-value = 0.58). There was no relationship between the grade of spondylolisthesis and the presence or absence of Modic changes (P-value = 0.15). The VAS of the patients before the fusion operation was 7.48 ± 1.50, and ODI of the patients before the fusion operation was 69.62 ± 5.06, which did not have a significant difference between the study groups. In the initial follow-up period, the VAS level decreased significantly and reached 4.27 ± 2.01. (P-value = 0.001). And the amount of ODI decreased significantly, reaching 49.79 ± 5.06. (P-value = 0.0001) In the final follow-up period, the VAS and ODI were 1.56 ± 2.23 and 39.29 ± 2.89, respectively, indicating that there was no significant difference between the studied groups. CONCLUSION:The present study showed no statistically significant difference in surgical outcomes (VAS and ODI) among patients with degenerative spondylolisthesis undergoing posterolateral fusion with or without Modic changes. Further large-scale prospective studies are warranted to validate these results. LEVEL OF EVIDENCE:Level 1 (higher quality of evidence).
BACKGROUND:Neurodiversity encompasses natural variations in cognitive functioning, including autism spectrum disorder, ADHD, and specific learning difficulties. While the concept is increasingly recognised in education and general workplaces, its relevance in medicine and particularly in surgery, remains underexplored. METHODS:We conducted a systematic review in accordance with PRISMA 2020. Searches of PubMed, Embase, Medline, Global Health and PsycINFO databases up to July 2025 identified studies on neurodivergence among surgeons and healthcare professionals. Eligible publications addressed neurodiversity explicitly or reported disability data inclusive of neurodivergent surgeons. Two reviewers independently screened, extracted, and appraised studies using JBI and MMAT tools. Narrative synthesis was organised into five domains: prevalence/disclosure, challenges and attainment, cognitive strengths, workplace supports, and cultural implications. RESULTS:Of 13268 records, four studies met inclusion criteria: two retrospective cohorts, one cross-sectional, and one mixed-methods study from Turkey, Canada, and the UK. Prevalence estimates varied: ADHD symptoms were identified in 31.6 % of included Turkish surgical trainees who participated in the study, while 6-8 % of UK trainees declared disabilities, most commonly specific learning difficulties. Neurodivergent trainees reported challenges with assessments, sensory environments, and professional expectations, with lower pass rates in early postgraduate exams. Strengths including creativity, attention to detail, and resilience were frequently cited. Evidence suggested that supportive interventions and fair recruitment processes can mitigate disadvantage. CONCLUSIONS:Neurodiversity in surgery is under-recognised yet integral to workforce diversity. Neurodivergent surgeons contribute valuable skills but face systemic and cultural barriers. Greater awareness, structured accommodations, and inclusive training frameworks are needed to reduce stigma, promote disclosure, and enable all surgeons to thrive.
Background This study sets out to review our experience with the management of abdominal shotgun wounds (SGWs). The aim of this study was to review the spectrum, injury pattern, clinical outcome as well as the applicability of selective non-operative management (SNOM) to abdominal SGWs managed at our institution. Methods Patients presenting with abdominal gunshot wounds (GSWs) between January 2012 to December 2024, were retrospectively reviewed from the Hybrid Electronic Medical Registry (HEMR). During the same study period, direct comparison was made between abdominal GSWs and SGWs. Data included demographics, injury pattern, body region injuries, diagnostic imaging, operative interventions and clinical outcome. Results During the twelve-year study period, a total of 1060 patients sustained an abdominal GSW of which 41 (4 %) sustained an abdominal SGW and were included in the study. 30 abdominal SGW patients (73 %) required a laparotomy, and of these, 14 (47 %) were damage control laparotomies (DCL). There was a more liberal use of computed tomography (CT) scans in patients with SGWs (83 % versus 54 %, p < 0.001) however, there were no statistical significances in SNOM attempt rates (28 % versus 32 %, p = 0.602) and success rates (85 % versus 95 %, p = 0.161). Conclusion The management of abdominal SGWs is challenging and imaging is essential due to the unpredictable behaviour of the multiple pellets. Although there is a significant rate of operation with a high rate of damage control surgery, a select cohort can be managed non-operatively without increased mortality.
INTRODUCTION:The growing adoption of robotic platforms necessitates structured training to ensure safe, competent and confident use by the next generation of surgeons. Current robotic surgery training in Ireland is informal, opportunistic and inconsistent, limiting the ability of trainees to gain meaningful experience. Transitioning to robotic practice therefore is far from routine and requires exposure, experience and guidance. A curriculum for robotic surgery training to address these gaps by providing a structured, scalable, and vendor-neutral training pathway has been identified as a potential solution to address these shortcomings. METHODS:The Royal College of Surgeons Ireland (RCSI) robot surgery curriculum was designed using Kern's Six-Step Framework for curriculum development, an evidence-based approach utilising six aspects for development to ensure a scalable, reproducible and practical model fit for purpose. By identifying training gaps in robotic training, essential learning outcomes were defined and appropriate educational methods designed to provide a flexible structure that can evolve over time with changes in the robotic surgery landscape. Development of the educational content was designed in consultation with the RCSI Surgical Leads Group and influenced by international best practice, namely bodies such as ERUS, BAUS and the Fundamentals of Robotic Surgery (FRS) while being uniquely adapted for the Irish training and healthcare landscape. RESULTS:A curriculum focusing on a vendor-neutral, pan speciality approach to training was developed to develop an equitable, adaptable and strong foundational opt-in approach. Delivered over three years, initial technical skills focus is on VR simulation followed by hands-on structured training days on the foundations of assisting and robotic skills fundamentals on high fidelity hydrogel and animal models. Core human factors themes such as communication, leadership and role clarity as well as emergency preparedness are embedded in the curriculum from the outset. Success in a final knowledge and skills assessment equips the trainee with a certificate of completion. Practicalities such as supply, demand, equipment and infrastructural considerations are also discussed. Trainee and trainer feedback as well as evaluation metrics ensures the curriculum evolves and remains relevant. CONCLUSION:The RCSI robotic surgery curriculum provides a national strategy to the standardisation of robotic training for those who wish to pursue it, across all specialities in a vendor neutral fashion. Central to the design is to integrate essential, structured non-technical skills such as team communication, role clarity, emergency response and situational awareness to ensure a broader focus on human factors as well as technical proficiency based on theory, simulation and repetitive practice to prepare trainees for the complex team-based reality of robotic surgery.
Introduction Biliary pathology can have an enormous burden on both the patient and the health service with acute cholecystitis being diagnosed in 10 % of patients that present with acute abdominal pain. Emergency or elective laparoscopic cholecystectomy is the recommended treatment option for these patients. It has been shown previously that surgical and hospital volume affect outcomes from emergency abdominal surgery in Ireland, but no such investigation has been done specifically for cholecystectomies. Aim To determine if there is a link between the hospital and surgeon volume of cholecystectomies performed and their associated outcomes in Irish hospitals. Methods This was a retrospective registry study using National Quality Assurance & Improvement System (NQAIS). All patients who underwent cholecystectomy in Irish public hospitals from January 2017 until December 2023 were identified. Hospitals and surgeons were divided into groups of high, medium and low volume based on the number of cholecystectomies performed per year during the study period. Data including the demographics, admission details and outcomes of patients who underwent cholecystectomy were extracted from the database for analysis. Results A total of 28,835 patients in 35 hospitals were included. Adverse outcomes were reported in 1952 patients who underwent a cholecystectomy. An association was found between adverse outcomes including bile duct injury (0.10 % vs 0.03 %, p < 0.001) and critical care admission (2.7 % vs 1.97 %, p < 0.022) and patients who had surgery in low volume hospitals compared to high volume centres. No statistically significant difference in adverse outcome was reported for the low surgical volume patients. Risk factors associated with adverse outcome following cholecystectomy were age >65, high pre-operative morbidity, emergency surgery and low hospital volume (p < 0.001). Discussion Patients undergoing cholecystectomy in low volume hospitals have a higher risk of adverse events. Surgeons who perform low volumes of cholecystectomies appear to perform a higher percentage of emergency cholecystectomies without a statistically significant difference in their outcomes.
INTRODUCTION:Major trauma is associated with significant morbidity and mortality. Facial injuries are often present in those sustaining major trauma. We sought to examine the Irish trauma registry to further assess this association. MATERIALS AND METHODS:A retrospective analysis of the Irish trauma registry, the Major Trauma Audit, from 2017 to 2022 was performed. Patients over 16 years who had sustained major trauma were included in the analysis. The presence of an associated facial injury was further analysed. RESULTS:A total of 8943 patients were included in the analysis. A facial injury was seen in 18.9 % of patients. The majority of those sustaining a concurrent facial injury were male (69 %) and the median age was 59 years. Falls <2m (42.9 %) and road traffic collisions (27.6 %) were the commonest mechanisms of injury. A significant head injury was more commonly seen in those who also sustained facial trauma (84.9 % vs 58 %). CONCLUSION:Facial injuries are commonly seen in patients who sustain major trauma. They may also indicate the presence of a concurrent head injury.
BACKGROUND:The Lancet Commission on Global Surgery (LCoGS) highlighted a critical gap in global health by emphasising the lack of access to safe surgery in low- and middle-income countries (LMICs). With five billion people unable to access safe and affordable surgical care, the commission called for innovations tailored to local needs rather than high-income solutions. The Karad Consensus further emphasised the need for context-specific solutions for India's rural populations, advocating for innovative approaches to tackle surgical disparities. Inspired by these calls, the Innovations in Global Surgery (IGS) group was formed, aiming to foster a multidisciplinary and collaborative ecosystem to address surgical access challenges in LMICs. METHODS:This consensus statement, derived from three international conferences, explores key challenges and offers actionable solutions in areas such as context-specific surgical needs, training, communication between medical and engineering professionals, funding, credibility building, and regulatory processes. RESULTS:The IGS group emphasises the importance of inclusive and frugal innovations that involve end-users and respond to the unique challenges of resource-limited settings. It aims to bridge the gap between disciplines and regions, ensuring that new technologies and practices can be effectively adapted and scaled to meet the needs of underserved populations. The proposed action items will be tested and refined over the coming years to enhance global surgical care and improve health equity. CONCLUSION:This consensus statement serves as a roadmap for driving sustainable, context-aware innovations in global surgery, leveraging the expertise of multidisciplinary stakeholders and creating a platform for continuous collaboration and knowledge sharing.
Background Burnout among surgical trainees is a growing concern, with UK urology trainees facing unique stressors including increasing service demands, prolonged training, and limited specialty-specific data. This narrative review synthesizes current evidence on burnout and satisfaction among UK urology trainees and evaluates available interventions and contrast it to international cohorts. Methods A systematic search was conducted following PRISMA guidelines across six databases. Studies published over the last 25 years addressing burnout in UK urology trainees were identified, screened, and analyzed thematically. Results Four studies met inclusion criteria, underscoring the scarcity of targeted research. Burnout prevalence among UK urology trainees ranged from 28.4 % to 56 %. Key contributing factors included rota gaps, excessive workloads, limited protected training time, financial strain, and toxic organizational culture. Despite these challenges, 69 % of trainees reported they would choose the specialty again, highlighting the mitigating role of job satisfaction drivers such as operative experience, team camaraderie, and patient impact. Intervention-wise, the Reboot-C coaching program demonstrated a 12 % reduction in burnout scores and improved resilience, although its scalability and long-term effects remain uncertain. Broader cultural and structural interventions, such as mentorship programs, flexible training pathways, and resilience training, show promise but require further evaluation. Conclusion Burnout among UK urology trainees is a significant and multifactorial issue. While isolated interventions show benefit, systemic reform is essential. Future research should adopt longitudinal, intersectional approaches to inform evidence-based policy and workforce planning.
INTRODUCTION:Even after two major RCTs, the BEST CLI and BASIL II, the debate about best strategy to address infra-inguinal arterial disease continues. Damage of distal outflow vessels after failed angioplasties and compromise to future options remains the main concern of bypass-first strategy advocates versus endovascular enthusiasts. OBJECTIVES:To assess the degree of target outflow vessels damage after failed angioplasties. METHODS:This was a retrospective study looking at all episodes of failed angioplasties for infra-inguinal arterial disease over 5 years. Primary end points were the presence and extent of damage to target outflow vessels. Secondary endpoints included complications, mortality, re-intervention types, and their success rates. RESULTS:There were 101 failed episodes out of 724 infra-inguinal angioplasties (primary success 86 %). The mean age of failed angioplasty cases was 73 (+- 10.5) years. There was no damage to target outflow vessels after failed angioplasty in 78.2 % of the episodes. Redo angioplasty was attempted in 43 %, with 42 % success rate (p-value 0.069), while Open surgical bypass "OSB" was performed for 21 % of the cases with a success rate of 91 % (p-value 0.009) CONCLUSION: An endovascular-first strategy for treatment of peripheral arterial disease "PAD is safe and effective. The concern for compromised future options is not justified.
AIM:We aim to describe our centre's one-year experience after establishing our robotic programme for colorectal surgery. METHOD:Demographic, peri-operative, and follow-up data from a prospectively maintained database were collected for all laparoscopic and robotic-assisted colorectal procedures carried out at our centre. All robotic colorectal resections were completed with the DaVinci Xi (Intuitive Surgical, USA) robotic platform. RESULTS:Fifty-eight robotic colorectal resections were compared to 58 from the laparoscopic cohort, all indicated for malignancy. No statistical difference was observed between the demographics of the two cohorts regarding sex, age, body mass index (BMI), and American Society of Anesthesiologists (ASA) grade. 33/58 (56.9 %) robotic resections were left-sided compared to 36/58 (62.1 %) laparoscopic resections. One robotic case was converted to open (1.7 %), with four (6.9 %) in the laparoscopic group converted to open. Laparoscopic procedures were shorter (median operative time 282 min compared to 384 min, p < 0.001, Wilcoxon rank-sum). Subgroup analysis for patients with ASA grades 1&2 showed shorter operative times in the laparoscopic cohort compared to the robotic cohort (p = 0.003, Wilcoxon rank-sum). The median length of stay was five days for both cohorts. Significant postoperative complications (Clavien-Dindo ≥3) occurred in 3.45 % (n = 2/58) vs. 10.3 % (n = 6/58), which was not significantly different statistically. No mortalities were recorded within 90 days of the procedures in both cohorts, but at one-year follow-up, we observed one mortality in each cohort. CONCLUSIONS:Other than longer operative times for ASA grades 1/2 patients, robotic colorectal resection outcomes in a small district hospital setting are comparable to laparoscopic resections.
BACKGROUND:Peritoneal metastases (PM) are a common site of spread in colorectal cancer (CRC) and are associated with poor survival outcomes. The true burden of disease is difficult to quantify due to limitations in imaging and limited symptoms until advanced disease. Systemic therapy has limited benefits and there is an increasing interest in the use of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). This narrative review summarises the current literature on epidemiology of PM in CRC and evidence based current management strategies. METHODS:PubMed was search for the terms "Peritoneal Metastases" or "Peritoneal carcinomatosis" and "Colorectal Cancer" from inception to December 2024. Titles of all English language articles were considered and backwards referencing screening was undertaken in key articles. Inclusion criteria included all original articles with a focus on the clinical management of PM and CRC. FINDINGS:PM occur in 5-10 % of patients with CRC. The current literature likely underestimates the true burden of disease due to reliance on accurate registry data, and little is published on UK data. Systemic therapy has limited benefit in patients with PM. The PRODIGE-7 trial highlighted the benefits of CRS in select patients but raised questions about the benefits of HIPEC. Prophylactic HIPEC remains controversial but the findings of HIPECT4 show promising results. CONCLUSION:The true burden of PM and CRC remains unclear particularly in the UK population. CRS has clear benefits in patients that undergo complete cytoreduction. Further work is required to determine the benefits of HIPEC and how to optimise this for patients.
BACKGROUND:and methods: Robotic-assisted surgery has become a cornerstone of modern surgical innovation, offering enhanced precision, minimal invasiveness, and improved recovery compared with conventional techniques. Its rapid adoption across multiple specialties in Ireland has brought substantial benefits for patients but also challenges regarding surgeon training, programme oversight, and patient safety. Until recently, Ireland lacked a unified national governance framework for robotic surgery. In recognition of this, the Royal College of Surgeons in Ireland (RCSI) established the National Robotic Surgery Leads Group in 2023, tasked with creating national standards for governance, training, and safe practice. RESULTS:This paper outlines the framework developed by the Leads Group, presenting a model that balances innovation with robust clinical governance. Central to this approach is the establishment of hospital-based Robotic Surgery Governance Committees (RSGCs), responsible for credentialing, training oversight, and monitoring key safety indicators. Training is structured around vendor-led pathways, mentorship, modular component training, and telementoring, with hybrid approaches recommended to optimise safety. Safety monitoring includes key performance indicators such as case volume, console times, transfusion rates, conversion to open surgery, ICU admissions, and morbidity and mortality outcomes. Additional considerations addressed include recognition of surgeon vulnerability during the early learning curve, emergency preparedness, case-mix management, consent processes, and the safe introduction of new robotic platforms. CONCLUSION:A national survey of all robotic surgeons in Ireland, with a 76 % response rate, demonstrated overwhelming support for the establishment of RSGCs and KPI monitoring. This framework represents Ireland's first national governance model for robotic surgery and positions the country as a leader in fostering a culture of safety, innovation, and excellence in surgical care.
BACKGROUND:Clinical documentation is essential for safe and effective patient care but places a considerable clerical burden on clinicians. Ambient artificial intelligence (AI) systems, which capture clinical conversations and generate structured notes in real time, have shown promise in primary and outpatient care but remain underexplored in the inpatient setting. This study examined the impact of an ambient AI scribe on documentation timing, quality, and workload in a simulated orthopaedic inpatient setting. METHODS:Seven postgraduate year one junior doctors participated in simulated orthopaedic ward rounds incorporating an ambient AI scribe (Heidi Health, Melbourne, Australia). A total of 150 clinical documents were generated: 120 progress notes (60 manual, written retrospectively, and 60 produced in real time using ambient AI) and 30 discharge summaries (15 manual and 15 AI-generated). Documentation time was recorded, and quality was assessed using the Physician Documentation Quality Instrument-9 (PDQI-9) for each clinical document. Workload was evaluated using the NASA-TLX instrument. RESULTS:Ambient AI significantly reduced documentation time for both progress notes (median 27s vs. 128s; P < .0001) and discharge summaries (median 114s vs. 459s; P < .0001). Time savings persisted across all complexity levels. AI-generated progress notes achieved higher overall PDQI-9 scores than manual notes (median 43.5 vs. 41; P = .002), with significant gains in thoroughness, currency, and usefulness, without compromising accuracy. Similarly, AI-generated discharge summaries scored higher (median 40 vs. 33; P < .0001), with improvements in comprehensibility, organisation, internal consistency, and synthesis. Junior doctors reported reduced workload across all NASA-TLX domains, with the largest improvements in frustration (-79 %) and effort (-81 %). CONCLUSION:In simulated orthopaedic ward rounds, ambient AI substantially reduced documentation time, improved document quality, and alleviated workload for junior doctors.
BACKGROUND:Older adults have high rates of morbidity and mortality following traumatic spinal cord injuries (SCI) but are also at increased risk of intraoperative and postoperative complications compared to younger counterparts. This study aims to identify the optimal time to surgical intervention in elderly patients presenting with traumatic SCI. METHODS:A retrospective review was carried out at our centre from 2016 to 2020 to identify geriatric patients (≥65 years old) presenting with a traumatic SCI, managed surgically. Cohorts were categorised and compared for outcomes based on their time from injury to surgery. The different time intervals assessed include: 24 h and 72 h. RESULTS:72 patients were identified. 13/72 (18.1 %) underwent surgery within 24 h of their injury and 32/72 (44.4 %) underwent surgery within 72 h of their injury. Overall, the results favoured delayed surgical intervention for both time intervals in terms of high dependency unit (HDU) requirement (p = 0.004 and p = 0.048), intensive care unit (ICU) requirement (p = 0.001 and p = 0.015) and intraoperative complications (p = 0.043 and p = 0.02). Of the patients with preoperative American Spinal Injury Association (ASIA) Impairment Scale (AIS) A grade, those who underwent surgical decompression after 72 h had greater neurological improvement (p = 0.019) and a smaller proportion of HDU (p = 0.006) and ICU (p = 0.047) requirement. CONCLUSION:To the authors' knowledge, this is the first study to compare surgical outcomes in geriatric patients with traumatic spinal cord injury (SCI) based on injury-to-surgery time intervals. The findings are hypothesis-generating and suggest a potential benefit to delayed surgical intervention in a subset of these patients. Further prospective research is needed to better define optimal timing and management strategies in this complex and vulnerable population.
BACKGROUND:The National Health Service (NHS) in the UK aims to deliver healthcare services around the clock. Major Trauma Centres (MTCs) are crucial in this operation, requiring continual 24/7 operations. Despite efforts to provide on-site nurseries catering to children aged 3 months to 5 years, there remains a significant gap in childcare provision for on-call workers. This shortfall particularly affects surgeons, nurses and military medical personnel whose shifts extend beyond standard nursery operating hours. This discrepancy raises concerns about the sufficiency of support for healthcare professionals with irregular schedules. AIMS:This study delves into the existing childcare facilities in NHS major trauma centres, aiming to identify challenges faced by on-call workers and propose strategies to bridge this childcare gap. By addressing these issues, the study contributes to discussions on how to best support healthcare professionals working 24/7 while ensuring the well-being of their children. METHODS:The research involved a review of in-house childcare facilities across all 27 MTCs in England. Data from named nurseries affiliated with the MTC official NHS websites were examined, including nursery names, capacity, operating hours, and available services such as weekend placements and emergency out-of-hours cover. RESULTS:Results showed that out of 27 MTCs, 26 had on-site nurseries. However, only a fraction of these operated beyond standard hours, with none offering emergency or weekend services. This highlighted a significant deficit in comprehensive childcare support. The lack of childcare services tailored to the irregular schedules of NHS workers might impact career choices. This discrepancy sharply contrasts with childcare benefits provided in the private sector and government settings. CONCLUSION:The current NHS childcare provision falls short of meeting the demands of a 24/7 service, posing challenges for on-call workers. This underscores the urgent need for 24-h childcare facilities that align with the operational requirements of the NHS. Reforms in this critical area are imperative to address these shortcomings.
BACKGROUND:Given changing demographics in surgery, this study aimed to assess the representation and diversity of speaker pool in the last decade of Conjoint Scientific Congresses by analysing the participating speakers, both the invited speakers and presenting trainees, in terms of their gender, affiliations and origin. METHODS:This study retrospectively reviewed online program leaflets to collect information on the gender, origin, presentation role, invitation status, and affiliation of speakers. Information on invited speakers were evaluated from 2013 to 2022, and for presenting trainees, from 2015 to 2023, due to data availability. RESULTS:This study identified 1817 speakers, including invited speakers (2013-2023) and 791 trainees (2015-2023). The percentage of female invited speakers increased significantly from 7.7 % in 2013 to 27.5 % in 2023 (p < 0.05; 95 % CI [0.46, 0.95]). The mean percentage of female trainees was 37.4 % (range 28.7 %-48.7 %), and there was no significant change in this percentage over the years (p = 0.44; 95 % CI). Local speakers increased significantly from 69.2 % in 2013 to 83.8 % in 2022 (p < 0.05; 95 % CI [0.91, 0.99]), associated with a greater involvement from the public sector, from 57.8 % in 2013 to 92.3 % in 2023 (p < 0.05; 95 % CI [0.64, 0.96]). CONCLUSION:Over the years, female invited speakers increased, and female trainee participation remained similar, suggesting better representation of surgical community. There was an increasing participation of local speakers, particularly in the public sector, which may lead to potentially less diversity in the speaker pool.
INTRODUCTION:Surgical care is an essential, resource-intensive component of healthcare. It contributes a significant carbon footprint and waste production. As part of Ireland's commitment to achieving net-zero emissions by 2050, surgical services have emerged as a critical focus area for sustainability reforms. AIMS:This review explores national policies, research contributions, and the leadership role of institutions in driving sustainable practices. DISCUSSION:Ireland has made significant strides in incorporating sustainability into its healthcare system, particularly within surgical care. National initiatives and efforts led by institutions are commendable steps toward reducing the environmental footprint of healthcare. The integration of sustainability into education and research is assessed, along with challenges and barriers to systemic change. Significant gaps remain in terms of implementing Ireland's sustainability policies effectively across all hospitals. Issues include the disparity in resources between urban and rural hospitals and patient engagement practices. RECOMMENDATIONS:Four key findings are recommended. Stronger national policies on sustainability audits and practices are essential. An increased focus on sustainability in research is required. An emphasis on training and teaching sustainable surgical practices is needed. Improving patient education will aid in the goal of increasing surgical sustainability in Ireland. CONCLUSIONS:Ireland continues to focus on enhancing policy frameworks, expanding research, building capacity across the healthcare workforce, and engaging the public in sustainable healthcare practices. Several challenges persist that hinder the scaling and broad implementation of these initiatives. Evidence from global studies supports actionable recommendations for Ireland's future sustainability agenda.
