64 results found
Park C, Sugand K, Aframian A, et al., 2021, Impact of COVID-19 pandemic on hip fractures: the central London experience COVID-related urgent geriatric hip trauma (COUGH) study COVERT ( COVid Emergency-Related Trauma and orthopaedics) collaborative, Irish Journal of Medical Science, ISSN: 0021-1265
Introduction:COVID-19 has been recognized as the unprecedented global health crisis in modern times. The purpose of this study was to assess the impact of COVID-19 on treatment of neck of femur fractures (NOFF) against the current guidelines and meeting best practice key performance indicators (KPIs) according to the National Hip Fracture Database (NHFD) in two large central London hospitals.Materials and methodsA multi-center, longitudinal, retrospective, observational study of NOFF patients was performed for the first ‘golden’ month following the lockdown measures introduced in mid-March 2020. This was compared to the same time period in 2019.Results:A total of 78 cases were observed. NOFFs accounted for 11% more of all acute referrals during the COVID era. There were fewer overall breaches in KPIs in time to theatre in 2020 and also for those awaiting an orthogeriatric review. Time to discharge from the trust during the pandemic was improved by 54% (p < 0.00001) but patients were 51% less likely to return to their usual residence (p = 0.007). The odds ratio was significantly higher for consultant surgeon-led operations and consultant orthogeriatric-led review in the post-COVID era. There was no significant difference in using aerosol-generating anaesthetic procedures or immortality rates between both years.Conclusion:The impact of COVID-19 pandemic has not adversely affected the KPIs for the treatment of NOFF patients with significant improvement in numerous care domains. These findings may represent the efforts to ensure that these vulnerable patients are treated promptly to minimize their risks from the coronavirus.
Bhattacharyya R, Al-Obaidi B, Sugand K, et al., 2021, Evaluating the effectiveness of the Imperial Femoral Intramedullary Nailing Cognitive Task Analysis (IFINCTA) tool in a real-time simulation setting (Distributed Interactive Simulation): a randomized controlled trial., Injury
INTRODUCTION: Working time regulations, senior led service delivery and increasing complexity of surgical technology has led to significant strains in surgical training. Additionally, the current COVID-19 pandemic has placed substantial limitations on surgical training worldwide. Contact free, remote, web-based, validated learning tools which are easily accessible and allows repeated, sustained practice are the need of the hour. Cognitive Task Analysis (CTA) have been used extensively to train pilots and military personnel and has shown excellent early results within orthopaedic training. We designed a femoral nailing CTA tool which showed objective benefits in the enhancement of cognitive knowledge in medical students. The aim of this study was to evaluate the effectiveness of this CTA tool to enhance practical skills in orthopaedic trainees in a real time interactive simulation setting (Distributed Interactive Simulation (DIS)). METHODS: This was a double blinded, randomized controlled trial. 14 junior orthopaedic residents who met the inclusion criteria were recruited in the study. They were randomized into two equal groups. The intervention group were given the CTA learning tool, the control group were given a standard operative technique manual used for antegrade femoral intramedullary nailing. The participants were assessed on a high-fidelity phantom femur model with actual femoral nailing instruments in a simulation mobile operating theatre where the candidate had a simulation patient, an acting anesthetist and a scrub nurse (DIS). They were assessed using the modified Objective Structured Assessment of Technical Skills (OSATS) rating scale which has been validated for orthopaedic trauma. RESULTS: The median OSATS score in the intervention group was 49 (±4.93, range 39-55) compared to 17 in the control group (±14.98, range 12-51). The median improvement was by 32 points (p = 0.02). The ICC between the two raters was 0.977. CONCLUSIONS:
Ashdown T, Park C, Begum F, et al., 2021, Do Patients Accurately Represent Their Experiences After Hip and Knee Replacements?, CUREUS, Vol: 13
Narang A, Chan G, Aframian A, et al., 2020, Thirty-day mortality following surgical management of hip fractures during the COVID-19 pandemic: findings from a prospective multi-centre UK study (Aug, 10.1007/s00264-020-04739-y, 2020), INTERNATIONAL ORTHOPAEDICS, Vol: 44, Pages: 2819-2819, ISSN: 0341-2695
Narang A, Chan G, Aframian A, et al., 2020, Thirty-day mortality following surgical management of hip fractures during the COVID-19 pandemic: findings from a prospective multi-centre UK study, International Orthopaedics, Vol: 45, Pages: 23-31, ISSN: 0341-2695
PurposeThirty-day mortality of patients with hip fracture is well researched and predictive; validated scoring tools have been developed (Nottingham Hip Fracture Score, NHFS). COVID-19 has significantly greater mortality in the elderly and comorbid patients which includes hip fracture patients. Non-operative treatment is not appropriate due to significantly higher mortality, and therefore, these patients are often exposed to COVID-19 in the peri-operative period. What is unclear is the effect of concomitant COVID-19 infection in these patients.MethodsA multicentre prospective study across ten sites in the United Kingdom (responsible for 7% of hip fracture patients per annum in the UK). Demographic and background information were collected by independent chart review. Data on surgical factors included American Society of Anesthesiologists (ASA) score, time to theatre, Nottingham Hip fracture score (NHFS) and classification of fracture were also collected between 1st March 2020 and 30th April 2020 with a matched cohort from the same period in 2019.ResultsActual and expected 30-day mortality was found to be significantly higher than expected for 2020 COVID-19 positive patients (RR 3.00 95% CI 1.57–5.75, p < 0.001), with 30 observed deaths compared against the 10 expected from NHFS risk stratification.ConclusionCOVID-19 infection appears to be an independent risk factor for increased mortality in hip fracture patients. Whilst non-operative management of these fractures is not suggested due to the documented increased risks and mortality, this study provides evidence to the emerging literature of the severity of COVID-19 infection in surgical patients and the potential impact of COVID-19 on elective surgical patients in the peri-operative period.
Sugand K, Park C, Morgan C, et al., 2020, Impact of the COVID-19 pandemic on paediatric orthopaedic trauma workload in central London: a multi-centre longitudinal observational study over the "golden weeks" The COVid Emergency Related Trauma and orthopaedics (COVERT) Collaborative, Acta Orthopaedica, Vol: 91, Pages: 633-638, ISSN: 0001-6470
Background and purpose — The COVID-19 pandemic has been recognised as an unprecedented global health crisis. This study assesses the impact on a large acute paediatric hospital service in London, evaluating the trends in the acute paediatric orthopaedic trauma referral caseload and operative casemix before (2019) and during (2020) COVID-19 lockdown.Patients and methods — A longitudinal retrospective observational prevalence study of both acute paediatric orthopaedic trauma referrals and operative caseload was performed for the first 6 “golden weeks” of lockdown. These data were compared with the same period in 2019. Statistical analyses included median (± median absolute deviation), risk and odds ratios as well as Fisher’s exact test to calculate the statistical significance, set at p ≤ 0.05.Results — Acute paediatric trauma referrals in 2020 were reduced by two-thirds compared with 2019 (n = 302 vs. 97) with a halving risk (RR 0.55) and odds ratios (OR 0.43) of sporting-related mechanism of injuries (p = 0.002). There was a greater use of outpatient telemedicine in the COVID-19 period with more Virtual Fracture Clinic use (OR 97, RR 84, p < 0.001), and fewer patients being seen for consultation and followed up face to face (OR 0.55, RR 0.05, p < 0.001).Interpretation — The impact of the COVID-19 pandemic has led to a decline in the number of acute paediatric trauma referrals, admissions, and operations during the COVID period. There has also been a significant change in the patient pathway with more being reviewed via the means of telemedicine to reduce the risk of COVID-19 transmission and exposure. More work is required to observe for similar trends nationwide and globally as the pandemic has permanently affected the entire healthcare infrastructure.
Park C, Sugand K, Nathwani D, et al., 2020, Impact of the COVID-19 pandemic on orthopedic trauma workload in a London level 1 trauma center: the "golden month" The COVid Emergency Related Trauma and orthopaedics (COVERT) Collaborative, ACTA ORTHOPAEDICA, Vol: 91, Pages: 556-561, ISSN: 1745-3674
Tsang CLN, Cao J, Sugand K, et al., 2020, Face, content, construct validity and training effect of touch surgery (TM) as a surgical decision-making trainer for novices in open appendicectomy, INTERNATIONAL JOURNAL OF SURGERY PROTOCOLS, Vol: 22, Pages: 19-23, ISSN: 2468-3574
Wang H, Lyu F, Sugand K, et al., 2019, Learning Acetabular Fracture Classification using a Three-Dimensional Interactive Software: A Randomized Controlled Trial, ANATOMICAL SCIENCES EDUCATION, Vol: 12, Pages: 655-663, ISSN: 1935-9772
Sugand K, Wescott RA, Carrington R, et al., 2019, Training and Transfer Effect of FluoroSim, an Augmented Reality Fluoroscopic Simulator for Dynamic Hip Screw Guidewire Insertion A Single-Blinded Randomized Controlled Trial, JOURNAL OF BONE AND JOINT SURGERY-AMERICAN VOLUME, Vol: 101, ISSN: 0021-9355
Adebayo O, Sugand K, 2019, Cognitive Task Mobile Application Simulation for Learning Anterior Cruciate Ligament Reconstruction Surgery, International Surgical Conference of the Association-of-Surgeons-in-Training (ASIT), Publisher: WILEY, Pages: 8-8, ISSN: 0007-1323
Sugand K, Malik HH, Newman S, et al., 2019, Does using anatomical models improve patient satisfaction in orthopaedic consenting? Single-blinded randomised controlled trial, SURGEON-JOURNAL OF THE ROYAL COLLEGES OF SURGEONS OF EDINBURGH AND IRELAND, Vol: 17, Pages: 146-155, ISSN: 1479-666X
Sugand K, Berry M, Yusuf I, et al., 2019, Oxford Handbook for Medical School, Publisher: Oxford University Press, USA, ISBN: 9780199681907
This handbook includes quick-access summaries covering the crucial information for your preclinical years and for each clinical specialty.
Wang H, Sugand K, Newman S, et al., 2019, Are multiple views superior to a single view when teaching hip surgery? A single-blinded randomized controlled trial of technical skill acquisition, PLoS ONE, Vol: 14, ISSN: 1932-6203
s Metrics Comments Media Coverage Abstract Introduction Materials and methods Results Discussion Conclusion Supporting information References Reader Comments (0) Media Coverage (0) FiguresAbstractPurposeSurgical education videos currently all use a single point of view (POV) with the trainee locked onto a fixed viewpoint, which may not deliver sufficient information for complex procedures. We developed a novel multiple POV video system and evaluated its training outcome compared with traditional single POV.MethodsWe filmed a hip resurfacing procedure performed by an expert attending using 8 cameras in theatre. 30 medical students were randomly and equally allocated to learn the procedure using the multiple POV (experiment group [EG]) versus single POV system (control group [CG]). Participants advanced a pin into the femoral head as demonstrated in the video. We measured the drilling trajectories and compared it with pre-operative plan to evaluate distance of the pin insertion and angular deviations. Two orthopedic attendings expertly evaluated the participants’ performance using a modified global rating scale (GRS). There was a pre-video knowledge test that was repeated post-simulation alongside a Likert-scale questionnaire.ResultsThe angular deviation of the pin in EG was significantly less by 29% compared to CG (p = 0.037), with no significant difference in the entry point’s distance between groups (p = 0.204). The GRS scores for EG were 3.5% higher than CG (p = 0.046). There was a 32% higher overall knowledge test score (p<0.001) and 21% improved Likert-scale questionnaire score (p = 0.002) after video-learning in EG than CG, albeit no significant difference in the knowledge test score before video-learning (p = 0.721).ConclusionThe novel multiple POV provided significant objective and subjective advantages over single POV for acquisition of technical skills in hip surgery.
Bhattacharyya R, Davidson DJ, Sugand K, et al., 2018, Knee Arthroscopy: A Simulation Demonstrating the Imperial Knee Arthroscopy Cognitive Task Analysis (IKACTA) Tool., JBJS Essent Surg Tech, Vol: 8, Pages: e32-e32, ISSN: 2160-2204
Background: Virtual reality and cadaveric simulations are expensive and not readily accessible1. Innovative and accessible training adjuncts are required to help meet training needs. Cognitive task analysis (CTA) has been used extensively to train pilots and surgeons in other surgical specialties2-6. However, the use of CTA tools within orthopaedics is in its infancy. Arthroscopic procedures are minimally invasive and require a different skill set compared with open surgery. Residents often feel poorly prepared to perform this in the operating room because of the steep learning curve associated with acquiring basic arthroscopic skills. We designed the Imperial Knee Arthroscopy Cognitive Task Analysis (IKACTA) tool, which is, to our knowledge, the first CTA tool described in the orthopaedic literature, demonstrating significant objective benefits in training novices to perform diagnostic knee arthroscopy. Description: The IKACTA tool, which is the combination of the written description of the phases below and the videos (with superimposed audio recordings) of each phase, utilizes simultaneous written and audiovisual modalities to teach diagnostic knee arthroscopy. The procedure was divided into 7 phases: (1) operating room and patient setup, (2) preparation and draping, (3) anterolateral portal placement, (4) examination of the patellofemoral joint and the lateral gutter, (5) examination of the medial compartment and anteromedial portal placement, (6) examination of the intercondylar notch and the lateral compartment, and (7) postoperative care and rehabilitation.For each phase, there are sections on the technical steps, cognitive decision-making behind each technical step, and potential errors and solutions. Video clips recorded by an expert surgeon in the operating room specific to each phase and audio voice recordings explaining each phase superimposed on the video clips were combined with the written information to design the IKACTA tool. Alternatives: Not applic
Bhattacharyya R, Sugand K, Al-Obaidi B, et al., 2018, Trauma simulation training: a randomized controlled trial -evaluating the effectiveness of the Imperial Femoral Intramedullary Nailing Cognitive Task Analysis (IFINCTA) tool, Acta Orthopaedica, Vol: 89, Pages: 689-695, ISSN: 1745-3674
Background and purpose - Cognitive task analysis (CTA) has been used extensively to train pilots and in other surgical specialties. However, the use of CTA within orthopedics is in its infancy. We evaluated the effectiveness of a novel CTA tool to improve understanding of the procedural steps in antegrade femoral intramedullary nailing. Material and methods - Design: A modified Delphi technique was used to generate a CTA from 3 expert orthopedic trauma surgeons for antegrade femoral intramedullary nailing. The written and audiovisual information was combined to describe the technical steps, decision points, and errors for each phase of this procedure Validation: A randomized double-blind controlled trial was undertaken with 22 medical students (novices) randomized into 2 equal groups. The intervention group were given the CTA tool and the control group were given a standard operative technique manual. They were assessed using the validated "Touch Surgery™" application assessment tool on femoral intramedullary nailing. Results - The pre-test scores between the two groups were similar. However, the post-test scores were statistically significantly better in the intervention group compared with the control group. The improvement (post-test median scores) in the intervention group compared with the control group was 20% for patient positioning and preparation, 21% for femoral preparation, 10% for proximal locking, and 19% for distal locking respectively (p < 0.001 for all comparisons). Interpretation - This is the first multimedia CTA tool in femoral intramedullary nailing that is easily accessible, user-friendly, and has demonstrated significant benefits in training novices over the traditional use of operative technique manuals.
Sugand K, Gupte CM, 2018, ABC of Orthopaedics and Trauma, Publisher: John Wiley & Sons, ISBN: 9781118561218
The ABC series is the essential and dependable source of up-to-date information for all practitioners and students in general practice. To receive automatic updates on books and journals in your specialty, join our email list.
Sugand K, Wescott RA, Carrington R, et al., 2018, Teaching basic trauma: validating FluoroSim, a digital fluoroscopic simulator for guide-wire insertion in hip surgery., Acta Orthopaedica, Vol: 89, Pages: 1-6, ISSN: 1745-3674
Background and purpose - Simulation is an adjunct to surgical education. However, nothing can accurately simulate fluoroscopic procedures in orthopedic trauma. Current options for training with fluoroscopy are either intraoperative, which risks radiation, or use of expensive and unrealistic virtual reality simulators. We introduce FluoroSim, an inexpensive digital fluoroscopy simulator without the need for radiation. Patients and methods - This was a multicenter study with 26 surgeons in which everyone completed 1 attempt at inserting a guide-wire into a femoral dry bone using surgical equipment and FluoroSim. 5 objective performance metrics were recorded in real-time to assess construct validity. The surgeons were categorized based on the number of dynamic hip screws (DHS) performed: novices (< 10), intermediates (10-39) and experts (≥ 40). A 7-point Likert scale questionnaire assessed the face and content validity of FluoroSim. Results - Construct validity was present for 2 clinically validated metrics in DHS surgery. Experts and intermediates statistically significantly outperformed novices for tip-apex distance and for cut-out rate. Novices took the least number of radiographs. Face and content validity were also observed. Interpretation - FluoroSim discriminated between novice and intermediate or expert surgeons based on tip-apex distance and cut-out rate while demonstrating face and content validity. FluoroSim provides a useful adjunct to orthopedic training. Our findings concur with results from studies using other simulation modalities. FluoroSim can be implemented for education easily and cheaply away from theater in a safe and controlled environment.
van Duren BH, Sugand K, Wescott R, et al., 2018, Augmented reality fluoroscopy simulation of the guide-wire insertion in DHS surgery: A proof of concept study, MEDICAL ENGINEERING & PHYSICS, Vol: 55, Pages: 52-59, ISSN: 1350-4533
Gupte CM, 2017, Knee Arthroscopy SimulationA Randomized Controlled Trial Evaluating the Effectiveness of the Imperial Knee Arthroscopy Cognitive Task Analysis (IKACTA) Tool, Journal of Bone and Joint Surgery, American Volume, ISSN: 0021-9355
Metcalfe D, Sugand K, Thrumurthy SG, et al., 2016, Diagnosis of ruptured abdominal aortic aneurysm: a multicentre cohort study, EUROPEAN JOURNAL OF EMERGENCY MEDICINE, Vol: 23, Pages: 386-390, ISSN: 0969-9546
Akhtar K, Sugand K, Wijendra A, et al., 2016, The Transferability of Generic Minimally Invasive Surgical Skills: Is There Crossover of Core Skills Between Laparoscopy and Arthroscopy?, JOURNAL OF SURGICAL EDUCATION, Vol: 73, Pages: 329-338, ISSN: 1931-7204
Sugand K, Mawkin M, Gupte C, 2016, Training effect of using Touch Surgery (TM) for intramedullary femoral nailing, INJURY-INTERNATIONAL JOURNAL OF THE CARE OF THE INJURED, Vol: 47, Pages: 448-452, ISSN: 0020-1383
Sugand K, Akhtar K, Khatri C, et al., 2015, Training effect of a virtual reality haptics-enabled dynamic hip screw simulator., Acta Orthopaedica, Vol: 86, Pages: 695-701, ISSN: 1745-3682
Background and purpose - Virtual reality (VR) simulation offers a safe, controlled, and effective environment to complement training but requires extensive validation before it can be implemented within the curriculum. The main objective was to assess whether VR dynamic hip screw (DHS) simulation has a training effect to improve objective performance metrics. Patients and methods - 52 surgical trainees who were naïve to DHS procedures were randomized to 2 groups: the training group, which had 5 attempts, and the control group, which had only one attempt. After 1 week, both cohorts repeated the same number of attempts. Objective performance metrics included total procedural time (sec), fluoroscopy time (sec), number of radiographs (n), tip-apex distance (TAD; mm), attempts at guide-wire insertion (n), and probability of cut-out (%). Mean scores (with SD) and learning curves were calculated. Significance was set as p < 0.05. Results - The training group was 68% quicker than the control group, used 75% less fluoroscopy, took 66% fewer radiographs, had 82% less retries at guide-wire insertion, achieved a reduced TAD (by 41%), had lower probability of cut-out (by 85%), and obtained an increased global score (by 63%). All these results were statistically significant (p < 0.001). The participants agreed that the simulator provided a realistic learning environment, they stated that they had enjoyed using the simulator, and they recognized the need for the simulator in formal training. Interpretation - We found a significant training effect on the VR DHS simulator in improving objective performance metrics of naïve surgical trainees. Patient safety, an important priority, was not compromised.
Sugand K, Mawkin M, Gupte C, 2015, Validating Touch Surgery (TM): A cognitive task simulation and rehearsal app for intramedullary femoral nailing, INJURY-INTERNATIONAL JOURNAL OF THE CARE OF THE INJURED, Vol: 46, Pages: 2212-2216, ISSN: 0020-1383
Thrumurthy S, Metcalfe D, Sugand K, 2015, Factors Influencing Misdiagnosis of Ruptured Abdominal Aortic Aneurysm: a Multi-centre Cohort Study, International Surgical Congress of the Association-of-Surgeons-of-Great-Britain-and-Ireland, Publisher: WILEY-BLACKWELL, Pages: 129-129, ISSN: 0007-1323
Akhtar K, Sugand K, Sperrin M, et al., 2015, Training safer orthopedic surgeons Construct validation of a virtual-reality simulator for hip fracture surgery, ACTA ORTHOPAEDICA, Vol: 86, Pages: 616-621, ISSN: 1745-3674
Background and purpose — Virtual-reality (VR) simulation inorthopedic training is still in its infancy, and much of the work hasbeen focused on arthroscopy. We evaluated the construct validityof a new VR trauma simulator for performing dynamic hip screw(DHS) fixation of a trochanteric femoral fracture.Patients and methods — 30 volunteers were divided into 3groups according to the number of postgraduate (PG) years andthe amount of clinical experience: novice (1–4 PG years; less than10 DHS procedures); intermediate (5–12 PG years; 10–100 procedures);expert (> 12 PG years; > 100 procedures). Each participantperformed a DHS procedure and objective performancemetrics were recorded. These data were analyzed with each performancemetric taken as the dependent variable in 3 regressionmodels.Results — There were statistically significant differences inperformance between groups for (1) number of attempts at guidewireinsertion, (2) total fluoroscopy time, (3) tip-apex distance,(4) probability of screw cutout, and (5) overall simulator score.The intermediate group performed the procedure most quickly,with the lowest fluoroscopy time, the lowest tip-apex distance,the lowest probability of cutout, and the highest simulator score,which correlated with their frequency of exposure to running thetrauma lists for hip fracture surgery.Interpretation — This study demonstrates the construct validityof a haptic VR trauma simulator with surgeons undertakingthe procedure most frequently performing best on the simulator.VR simulation may be a means of addressing restrictionson working hours and allows trainees to practice technical taskswithout putting patients at risk. The VR DHS simulator evaluatedin this study may provide valid assessment of technical skill.
Sugand K, Boyer N, Sarraf K, et al., 2015, Using online mutlimedia to teach orthopaedic trauma emergencies, Annual Meeting of the Society-of-Academic-and-Research-Surgery (SARS(, Publisher: WILEY-BLACKWELL, Pages: 34-34, ISSN: 0007-1323
Bahsoun AN, Sugand K, Mawkin M, et al., 2015, Validation of touch surgery, a surgical cognitive task trainer, Annual Meeting of the Society-of-Academic-and-Research-Surgery (SARS(, Publisher: WILEY-BLACKWELL, Pages: 20-20, ISSN: 0007-1323
Akhtar K, Sugand K, Wijendra A, et al., 2015, Training safer surgeons: How do patients view the role of simulation in orthopaedic training?, Patient Safety in Surgery, Vol: 9, ISSN: 1754-9493
BACKGROUND: Simulation allows training without posing risk to patient safety. It has developed in response to the demand for patient safety and the reduced training times for surgeons. Whilst there is an increasing role of simulation in orthopaedic training, the perception of patients and the general public of this novel method is yet unknown. Patients and the public were given the opportunity to perform a diagnostic knee arthroscopy on a virtual reality ARTHRO Mentor simulator. After their practice session, participants answered a validated questionnaire based on a 5-point Likert Scale assessing their opinions on arthroscopic simulation. Primary objective was observing perception of patients on orthopaedic virtual reality simulation. FINDINGS: There were a total of 159 respondents, of which 86% were of the opinion that simulators are widely used in surgical training and 94% felt that they should be compulsory. 91% would feel safer having an operation by a surgeon trained on simulators, 87% desired their surgeon to be trained on simulators and 72% believed that additional simulator training resulted in better surgeons. Moreover, none of the respondents would want their operation to be performed by a surgeon who had not trained on a simulator. Cronbach's alpha was 0.969. CONCLUSIONS: There is also a clear public consensus for this method of training to be more widely utilised and it would enhance public perception of safer training of orthopaedic surgeons. This study of public perception provides a mandate to increase investment and infrastructure in orthopaedic simulation as part of promoting clinical governance.
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