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before we start our Suppose you It's given great opportunity to hear from Chris Bremerton, who's going to tell us a little bit about the NMR c itself and will heal it little bit from Richard Wilkinson about the really exciting associate. You know, I scheme someone hand over to quest now. Great. Thanks again. Yes, I Chris, I am the trouble Three registrar on down on the chair of the National Research Collaborative. I'm just going to tell you a bit about you know what? We do our lips or got started, and hopefully our we can help you. So they saw we will have this idea this time last year at the end. I'll see, um, in 2019, that was a new castle. And so various training reps from the training organizations were enjoying their around a table, enjoying some collaborators. Got dizzy of Helen and their team on we thought would be good to try and create an organization to help share collaborative research ideas and get everyone together. And so Kenneth McLean then set the ball rolling by coming up with the Constitution for this and electing this committee, which we got elected a couple months ago. So I'm going to tell you about you know who we are on what would be not to. So we've got a mix of students to senior trainees. We've got medics, surgeons and everyone in between. So you know, we've got Adam. Well, Grace D and Adam Kenneth's, um Tom and maybe you, um this basically means that the NLCS looking for uneducated rep on be this good for you. And I'll tell you how you could apply for that attend talk. So this is a bit about what we've been up to, a more open to achieve. So a lot of this is going to be based around the NRC websites, and I'm just going to show you a little demo of this. So it's already based around the national research, doc. Oh dot UK. So this is gonna be essential. Point to host. Collaborative resource is on on. Also, it's gonna be a next ra way too. Potentially be a website for collaborative that don't have one. So, for instance, if you type in 2020 here, uh, hopefully you're going to see it takes you to this template for the NLCS website, but but Similarly, if you don't want to go to, the idea is that you're put in something your specialty, so you can put it also. And you'll have a normal, pretty website premade and ready for you on. You know, Can you put in respiratory? You have a respiratory website, and that's also that's more collaborative. Is that perhaps you haven't gotten any website expertise or funds can have a website, a central sore four running that collaborative. We'll have a collaborative map on there on updated map. We hope that's gonna encourage really great team ups. Now you know your copay surgeons been panned specialty. It's been international on D. Hopefully we can encourage more of those types of collaborations. We're also gonna have somehow to guides and Sam or shoot reps, creating some nice how to guys, templates and all the shit guides where the project reported tree Well, the Coogle Group, which is currently on currently and got about 200 members on, and we'll have a nice another. What's that group? Just because you can never have too many of those I'm also gonna try, and Russian likes funding so rather than, for instance, having 200 a collaborative, each paying 5 lbs a month for a website. Maybe they could all be hosted. On what site? For free on several E for resource is like zoom and red cap. We're going to try and rationalize all that, and then you can use that money to do better things on General, we're going to give you educational resource Is so you anyone be the star or midway through your research career. You know you're gonna have stepping stones, that's all progress. And so in summary. Please do join the Google Group. Follow us on Twitter. Keep your eyes peeled for the walks up invite, and please do apply to be the NLCS occasion. Repeat, there's a little little QR code if you want to quickly snap that and apply otherwise, it will be going out by Twitter and various things. And the deadline for that will be a couple of weeks. So thanks for listening. And I'm very happy. Take some questions or just heal for here. So the general ideas about anything else you think you like the NRC to do for you Thank you. Thanks a lot, Chris. That's really fascinating. Interesting stuff coming up in the future. So, yeah, if you've got any quick questions, do you put them into the trap? But, Chris, otherwise, the way we want to. Richard. So you're okay on bridges? Lives up coming up shortly. It doesn't look like I can share my screen that moons. I'll try and stop. So you might. Yeah, Well, okay. So, like very much for us to talk about the associate pee, I skin just say that Well done to the Bristol team for organizing this conference in such challenging times, I'm sure the effort and work there's been put in beside behind the scenes has been really considerable to make it smooth running for us. So I'm gonna talk about it. So soup and I scream and give you a little flavor of it on about where it's going. Forwards on this is a bit about where it came from. So they recognize that, actually, people were doing lots of this already, but not really being having any reward for it or acknowledgement for it. And they were being that summer intern. But but nothing to come of it on delivery. Where that this is not a new idea. There are other, uh, it orations of the same thing. But I think you see, as we work through that this has got some unique points towards it. So in case you haven't heard about what the associate pee I scheme is, it's national scheme. Run crucially by the NIH are on the CT. Use the clinical trials units across the country that they're a little bought into the scheme and all of a got at least one trial with scheme of present. It provides a framework of activities for people to engage with trial trials in their local center on be really part of it is disseminating it across their center. What people get out of it is that they are they concertos, um, evidence of their work on a trial on locally leading a trial, uh, on as a little knot of what might come in the future. I think the certainly from inside the scheme we see it was only increasing importance for people going forwards. So the trial is that the scheme is there to try and develop P i Z of the future. These are associate be eyes, Trina. Trainees in the broader sense of the word on it so that his junior doctors it's open to nurses. Allied health professionals is all about local leadership. Center level off trials with support of people that are they're doing it already on is to try and recognize people's efforts and work consistently across all of the night. Charcoal Folio trials on Don't mention more of that in a second. So very quickly. If you're are you eligible for? The short answer is yes. It's very broad inclusion criteria. The one sticking point is that if your job role is employed to run that trial such a a research fellow, etcetera, then then you're not eligible. But everyone else that works on these trials kind of a zone extra that certainly eligible. So what should you be doing? Well before your rotation, finding out what trials are open in the center, contacting the local team. Seeing if what, what positions are they're available. Should be meeting with the P I in the first month and trying to set up being that associate pee I. The most important thing is that you check the website on the website can be difficult to find, but the night Charles surgery associate B I Web site. If you Google or otherwise an eye chart surgery, it's the top hit on. You'll be able to find it, but that is the key thing you need to do. Look on the website all the instructions of there as you work through. There's a checklist of tasks that you need to complete on day. Include research meetings with the local team, constant promotion of the trial in the center, etcetera. It's really important that towards the end of the trial, you meet again with the P I and the research team on completely checklists, and then you send it into the trials unit so that it could be ratified and then you can get the output from it. And now that output is a certificate to show that you've been the associate pee eye on. That's likely to only increase in. There are bigger plans about how we knowledge people on the portal for how we collect that again. Check the website. It's all on the website with clear instructions. So what's open of what's running the associate price scheme? So these are the specialties that are running it. You can give me a second to guess what? Specialties are already signed up. The royal colleges that have endorsed the scheme on it's running in the in been trying. This is surgery's general surgery in its complete breath, uh, under the Royal College of Surgeons. Um possum, right? There's the Royal College of Physicians on day Radiologists, three ambulances, emergency medics. The building, somewhat cryptically, is the top hit. If you search for the statistics, I don't know why either, but it is on. Then top right is the recovery trial. So this is the latest development in the associate Pee I scheme that it's running across the recovery trial on. That's obviously an urgent public health trial, and there are a few modifications to it to allow it to fit in with the trial schemer. But that's very exciting on both both sides, Really, as you could see, it started in general surgery. It's spreading across the night job. All folio Ondas suspect that there will be more and more specialties coming online in time. So what's going on in the future for it? Well, we're always looking to refine the checklist that the scheme relies on its checklists that people could complete asses they go along in there. Placement. We're always looking to refine that checklist than the process for assessing it. As I said, we're looking Teo spread mawr more across the actual portfolio. So if you are listening today from a different specialty and you've not been mentioned, then please do get in touch with the scheme, get in touch with your C isa of trials to say, Why are we involved? We want to be doing this on the The one thing that I'm pleased to announce this evening is that the the associate pee I steering committee have agreed that they will be in the annual award for the top associate Pee I each year on our plan that we are to discuss with the NRC Um committee would be that that could be presented each year of this event as a marker for people so are very happy to take any questions on this scheme. Any facet of it. If you do have questions after the event, then please do. First, we'll check the frequent ask questions on the website on. Remember, if you Google NIH are and surgery, then you'll find the website or there are a couple of email address is there that you're very welcome to contact for any questions about it. Thank you. Thanks a lot for that. Rich is really fascinating scheme. Thank you. I would like to point out that rather enormous building is a roll. Call Germany situs. I'm afraid it's not quite as grand is the rocal gyn surgeons better is in London. Red line square, Right. Thank you so much for that. I'm not gonna invite it. Richard on mats, and we'll begin with our first tool. There's gonna be delivered by Paul Foster this evening. He was gonna talk about sustaining medical education in the lock down environment. Welcome home. Thank you so much. Thank you for having me. Um, it's a really great event on DA. It's pretty to be here. So, uh, let me just see. Can you see my slides? Yeah. Great. Excellent. Brilliant. So, yes, I think for having me on the full faster My day job is a clinical teaching fellow in drama orthopedics in Southwest. But along with John Pasko's that they can't be here tonight. A few others we set up a smile over the lock down which stands for sustaining medical education in a lock down environment. We've heard all the jokes about the tenuousness of our of our name before you make any so just brief introduction about what we are and what we did. So, uh, tell you that 2020 is being a time of great change for medicine in general and medical education in particular, we found a large number of online lecture platforms and teaching platforms were set up on Do use the primary educational resource. So we set up a thing right at the start of lock down. Actually, um, it's sort of originally was just us in our gardens and, uh, living rooms, delivering lectures to, Ah, a few dozen students. And then it eventually turned into something where we were getting 1000 plus students for a recession and doing one or two a day, Um, with lots of different lectures. And we did what any good doctor would I would do with a platform, a group like that, and try to work out a way of getting some research out of it. And so one of the projects that we looked at was whether we could demonstrate that free, accessible online learning platforms could be crazy. Quickly made, available. Love number of people did, along with many others, to demonstrate that students would participate in sequential sessions on tape on testing despite not really having anything anything to gain from it. Apart from knowledge, they're not part of a formal institute that marks are depending on it on to investigate whether free online learning webinars can provide an effective back belong to him. Learning, looking at medicine specifically, uh, so the way that we did that sort of on the flight with without a huge amount of preparation. But, uh, we sort of just use the resources that we have available to us. We set up the's focus groups on social media platforms on. We were looking at three hours in particular. So urology, endocrinology, it's in and draw a little bit with this session on each in the way that we did it was that students for us to sign up on about a part that's complete five tasks, which was 23 session test, attend the lecture on our platform repeated test immediately after the lecture, and then we sent out the test again at two weeks and four weeks after the lecture on the same test with the same questions on down allies. The results, eh? So we're we did this virus surveymonkey. The questions were burying difficulty, but they were all covered. You're in the lecture on the students that started up with the only ones who have access to this Sort of make sure we've got the same people staying every time. So the results that we got a PSA, you see, for the first one, he hematuria's which had 600 people fill in the first survey. The numbers dropped off, which was, ah thing a recurring theme that we found over this, unsurprisingly. But we did see that there was a, uh, an improvement school is not just immediately after the lecture, but also being sit here in the green or two weeks. And at one month, there was actually a sustained improvement in in their knowledge. On the same is true for for the endocrine one that we did on also for the session on bone infections and infections and tumors. So obviously this is this isn't a controlled trial. This isn't, you know, in depth, groundbreaking research, but more and more now we're seeing that despite what everyone was thinking of start of this crisis, MAWR medical education is moving into the online space. There's less reliance on face to face contact on, but at least what we can show him. This is that from online learning that forms, you can see a definite improvement in performance testing but before and after a lecture on. But there is some improved performance after long time periods as well. Looking at two and four week periods, we should showed, on average about 30% improvement in schools over that time. Um, what we take from this will look, there's a high dropout rate over extensive testing periods. I'm afraid your time is up. Pull. And so we'll be gone. Two questions from Richard and Matt. Sure. Okay. Thanks for that. That was quite interesting. It's looking at your questions because you have your evidence for engagement. Comes from the change in the questions at the responses to questions in proportion. Right. You've got a lot of drop off towards the 10th question. Yeah. Are you, um, over those are we, um Are we is up because the question is getting harder or did you have them in a random order to sort of mix it up a bit. So they weren't seeing a really difficult question on bone tumors. This question 10 that everyone wanted to get away from. Ah, so I think I'm better. Yeah, that's good point. We tried to mix them up much as possible, but actually, I think just, uh, partly because of bias in the people in the presenters who design their own questions, they probably left one of the hardest question still last. So I think it was more an accidental thing than anything else, but yeah, we tried to mix them up much as possible. And were you getting sorry, Rich? And when you get in this, we getting the same groups of people signing up for each of the sessions. That was urology, orthopedics and the crime. So you're getting, you know, people who might be a bit more interesting orthopedic signing up for that and getting the responded bias in that way, you know? Yeah, I think I think we certainly were a zoo. Well, and also we were getting the same people toe. The people who signed up for these sessions were, um also probably almost engaged in our our most, some of some of the brightest students that we were getting, I think, out of the range. So, yeah, there's definitely some bias their asses. Well, in terms of who is actually signing up for a sort of a more intensive experience, I'm afraid, Richard, out time is up. You'll get first dibs on fashions next time. Thank you very much for what you're on to. Lorna Leandro. He's going to put us about systemic corticosteroid used in you, the itis. Well, no, I everyone thanks very inviting me to speak site. Can you see my slides? Yeah, thank you. Drink, say, this evening, I'll be talking to you about a collaborative study that I lead in ophthalmology, looking at steroid prescribing in the UK for non infectious uveitis, which is just inflammation in the eye in terms of bit of background. So steroids are the mainstay of treatment for non infectious uveitis, and they can be prescribed either as a maintenance course, either several months or is high does courses. And as we all know, there's an extensive side effect profile of steroids, both systemically and within the eye itself, on in terms of guidelines that are out there at the moment. So they recommended maximum maintenance does of 7.5 to 10 mg per day of prednisone lane on they recommend to start. Immunomodulator e therapy is a steroid sparing agent. If patients are requiring more than 10 mg per day on other specialties, such as gastroenterology and rheumatology, that used it off steroids as well have similar guidelines. So for our study, we wanted to festival, see if we were actually adhering to the target of less than 7.5 mg per day of steroids. We wanted to see actually how often we were prescribing these high dose courses of steroids because they haven't really been reported before on we also wanted to see whether the excess steroid we're prescribing was avoidable or not on for our study. Don't sorry for our study. The definition of excess steroid that we used was a maintenance dose of or over 7.5 a day of prednisone for more than three consecutive months, or more than one course of high dose steroids, either or alive e. So be around the study in two phases. On initially, we e mailed the members of the Uveitis National Clinical Study Group, which is a group of clinicians that's specializing uveitis on. We had 11 sites response saying they working to participate. Unfortunately, only had sites in England respond. But we did invite other sites in Scotland and Ireland to participate as well on. We created a survey or questionnaire on Red Cap that we sent to the consultants across England on they had to fill out this questionnaire for consecutive patients coming through the uveitis clinics for a six week period on. We collect the data on the diagnosis of the patients, whether there was any active inflammation at the time and you cite threatening features. They might have been a lot of treatments they had received in the past year. And then we ran a second phase where we looked at the patients who were prescribed excess steroid as per our definition on. Then we invited those sites to participate in face, too. So we had five sites that responded and agreed to participate in face, too, and we had anonymous notes that were reviewed by an independent specialist, either the same site or a different sites, and they apply the scoring matrix which is also in Red Cap to the case notes to see whether actually the excess story prescribing was avoidable or unavoidable and just again threesome quick results. So we had a very 600 patients participates if a 42% of patients had been treated with steroids in the last year on every third of those were prescribed excess steroids. And then when we looked at whether it was avoidable or not, we found that your quarter of excess the road prescribing was avoidable. So in terms of running a collaborative study, I thought I had mentioned a few lessons learned So I thought is really great to have several people involved at the very early stages when designing the study, especially designing the survey itself. So a few consultants could sort of look at the questionnaire, see whether we both sort of capturing the Ms important information and whether it be feasible to actually fill it out in clinic with the real time pressures. I think you have to be very organized because inevitably, a collaborative study involves a lot of data, so you have to make sure you're keeping tabs on everything on following on from that you have to be prepared for some sites and participants to make mistakes a swell. So I'd really recommend actually looking through your data as you're collecting it, rather than leaving it a little the end because you can identify if there's any inconsistencies or mistakes, and you can get in touch with relevant people early and make sure you keep tabs on things. I think having continuous communication throughout is really important to minimize what I just mentioned and also when it came to writing up the paper actually was quite useful to have a writing committee with different people involved that could add there different strengths toe the right up. Um, so in conclusion for our study, we find that actually a third of patients met the criteria for access prescribing, which is quite a lot. We had a significant dependence on the maintenance doses of started rather than the Hydrosport forces, and we found that there potentially an opportunity for reducing the steroid exposure and a quarter of cases on. The main reason for that was because we found that the main reason of avoidable steroid was because there was a lack of evidence of consideration of alternative strategies other than steroids. But we did find that 75% of excess prescribing is unavoidable on. But we looked at whether these patients on excess story that had been prescribed immunomodulator therapy or not. We actually found that they had been prescribed more of it than the patient who went on access steroids. So actually, there's no evidence that were under treating with immunomodulatory therapy. Weight is going on that very much right. We move on to the judges. Uh, it's been now, isn't it? Mark, You get Get uh, so the Lord that that was really good on well done for getting a national study up in your specialty. You got 11 side? Yes, in phase one, at least now, to the ignorant amongst us, then uveitis seems like it would be around the place that how many sites are there in the UK that we treat it? So I think there's a mixture of tertiary referral sites. The vitals on all of our participants were from tertiary sites, which is not very representative of the country. But you got it is treated across all the DJ. Jesus. Well, um, unless it's complex uveitis, which would be referred to a tertiary slight. Okay, so I guess that potentially brings ah, bit of a bias in who you or it gives you a population that you're looking at on on the other thing that we'll struggle with our Our big audits are about whether we capture the whole of that population that we're aiming for. Do you have any handle about whether you got your consecutive patients that you asked for or not? So, yes, every site actually filled out. Ah, dates a six week period, and we go over 100 up to 100 patients per science C six weeks might not be representative of everyone coming through clinic, but it was the Ms Feasible, uh, timeframe that we could do. Right. Well, thank you very much. We're gonna have to move on. So we're gonna institutes in a Kadouri, tell us about how about the research aping of the diagnostic pathways? But he matured during the Covitz era. Geez, um hum. Thank you. I hope you can hear me and see my slides. Okay, on go. My name's an ankle. Jury. Thank you for the opportunity to talk about important piece of research in urology, reshaping the diagnostic pathways for the investigation of hematuria after. Call it on. This is a diagnostic accuracy analysis from the Identify Cohort study, which was run by bust. But we all know that carb it has impacted surgery on is estimated to have increased mortality in people with cancer during the first way. The urological international guidelines suggested altered hematuria pathways during cover it and these were largely non evidence based. A common theme was to drop non visible hematuria investigation on downgrade visible hematuria to routine investigation. Obviously, this caused a huge backlog of investigations on top of what was already a long waiting list. We know that people have bladder cancer. It's important to have really diagnosis and treatment. Otherwise, it affects their overall survival. Identifies the largest global perspective Observational study on Patient referred with hematuria for newly suspected urinary tract cancer, we had over 11,000 patients and 26 countries in 110 hospitals. Unsurprisingly, the most prevalent cancer was bladder cancer. On most people were referred with visible hematuria. Both standard guidelines, even before copied, used a gyn type of hematuria to risk stratify patients for referral. They also recommend that everyone gets a flexible cystoscopy and an imaging test commonly ultrasound or CT, as part of their standard investigation. So we wanted to use the's to find a practical solution to triage patients awaiting hematuria investigation. So we used the identified data and looked at the diagnostic accuracy of ultrasound and CT and bladder cancer, the most prevalent cancer on Like the guidelines suggested we stratified by age and type of hematuria. But crucially, we use the imaging test to triage. Patients on found the best positive predictive value to triage patients straight to a bladder resection on different values of the negative predictive value to triage them either to a non urgent, flexible cystoscope be or to discharge them all together. So this creates a big, complex table of different age groups and type of hematuria with their diagnostic accuracy. Ease from that you can pull the best age cut offs, which leaves you with an algorithm such a Z. This so your patient comes in with visible hematuria or is referred to invisible. He maturity. You stratify them by their age and perform an imaging test. Based on that, you can triage them either straight for surgery. or for further investigations with a flexible cystoscopy on. Actually, you're saving on the number of flexible cystoscopy is you do because only these people in the red box needed the others are going to surgery or being discharged and you can play around with the type of imaging. For example, here we put a CT in the middle age group, but you need to be where, off the radiation risk in younger age group and you do the same algorithm for non visible hematuria as well. And what we found was that using this evidence based and in comparison to the other urological international guidelines, we actually had a lower proportion of missed bladder cancer using this tree. Our strategy. So in conclusion, we found an evidence based approach to stratify patients by the same risk factors that guidelines suggest. Onda. We have crucially done this by triaging through an imaging test, hopefully to diagnose bladder cancer in a timely manner to improve morbidity and mortality. Andre, we have demonstrated you can save money by saving on flexible pasta pee and resources. I'd like to thank our sponsors collaborators and thank you for listening, not me. Thank you. Very much for that. Not rigid, Yes. So just very rich. Um, Virgin pen. Just to think you just start that. So this is a secondary analysis off the identify study, which was a pre covered studies that correct. That is correct. Yeah. Okay. Call that a joint need to get my head around around whether it waas Did you have something rich? Well, I can't hear you, rich. I'm afraid of your, um you errors. So I miss some of the stats is they came through. Just have a comment about sensitivity in specificity on the different tests. Yeah. So I'm it largely depends so largely depends on the age on the type of hematuria. Obviously, the older people in those with visible hematuria have a higher risk off cancer anyway. And so we found that, you know, the imaging tests were picking up more cancer. So the sensitivities were better on that One is one of the reasons for treating, arguing or for creating these categories of different different age categories and different type of hematuria. Um, we looked at the best positive predictive value and negative predictive value rather than sensitivities and specificities, cause that's on. Do what you want to know when you run an imaging task based on the corporation rather than the test accuracy, if you see what I mean. So, you know, a patient would be more interested in what's the rate of missed cancer if I have this test and that's what we want to know. This is just one more quick corn, if that's all right. Yeah, and seconds. Okay. The population of people referred through four investigation during the coverage period is likely changed. How do you think that's gonna affect your predicted model based on peace time data? Well, what we found actually use a lot of patients were still in primary care on GPS. Haven't referred them through, but they are eventually going to get referred on. There's gonna be a huge battle of patients. Okay, Little country. Eventually. What? We think you know, discussion isn't that we can carry on hoping it's carrying on in the break, but we've got to move on. Thank you so much. Done. We're going to re want to Ryan priests who's gonna talk to us about the ankles of vascular on endovascular, intimate once during the pandemic. Yeah. You see that? Okay, effect Really privileged. They plan on behalf of all collaborators. The results from tier two bones cover study looking at patient outcomes following vascular on endovascular interventions doing the copay pandemic so that could be bundled because an unprecedented impact on the provisional vascular services across the world To fully assess the impact ofhis Vince up the three tiered global cover study Tier one was already been published in the beach. Yes, and I was looking at individual unit changes to see if this provision you can see from this graph here they're across the world. There was a global reduction in muscular see, it was originally units and this is actually more marks across the UK sentence. Tier two, which I've been talking about today, is looking a patient outcomes following massacre interventions perform during the pandemic on tier three. It was like an individual changes the patient care and it's long to impact. So specific names of Tier two were primarily to report on in all in hospital outcomes following vascular interventions perform during the copay pandemic across the globe, secondary outcomes wanted to look a comparing in hospital mortality rates. So what we would have expected in pre pandemic grates on also to assess where the units of changing what interventions they were performing doing the pandemic. So to do this, we set up our perspective. Cover study. We have taken the NHS rack and HR A approval on this date. Data I'll be presenting today well from all procedures performed you're in April, May in June of 2020. So, in a sense of enrolled in a study, we included all patients who underwent the vascular intervention for a period of 12 weeks from study start eight outcomes measured included in hospital morbidity and mortality rates. We also ask centers to tell us whether the interventional performed is significantly different what they would have performed in pre pandemic times. So I just want to point out this is a truly global study. We included 57 different centers from 19 different countries, making it the largest ever train the lad vascular collaborative study. And that wouldn't have been possible that fantastic sponsors. You see the here publicized study so well down to the results. We managed to include 1200 patients, 1100 of who had data, complete discharge or death. The mean age is just in the 70 years and three quarters of our patients were male Caucasian ethnicity, about 4% of patients. Why the confirmed or suspected of having Kobe 19 look across the interventions. Unsurprisingly, most of the interventions perform during the pandemic. Well, I had the lower limb revascularizations, or amputations with lower numbers of aortic and carotid interventions. Been performed. Median length of stay do the pandemic was five days. 6% of patients require to return to theater. 4% of patients about mood infections or some of common complication. 3% of patients about prosperity complications for stop. So the main headline figure from this study is that the overall in hospital mortality rate for a patient undergo know vascular or endovascular intervention. Doing the pandemic was 11%. Looking at a small subset of patients who are co been positive, the mortality went up to 20%. Looking across different types of interventions. The mortality rate is pretty consistent around 10% or there was highest overall for aortic interventions of 15%. Comparing these mentality rates to what we would have expected, preplanned Amick reported Siris across the board in much higher. What's interesting is actually for aortic interventions. The mortality rates following emergency repairs were pretty constant between compared to people democrats. It was doing the elective repairs where we saw a rise in numbers specifically looking at aortic mentalities. Unsurprisingly, most of the modalities came from symptomatic ruptured or acute aortic syndromes on the mortality rate swallowing open and er appear pretty consistent when reformed regression analysis to look for risk factors for, you know, supplemental it. You just threw up some interesting results. So actually found the Caucasian at this city was associated with a reduced dose or a higher risk of in hospital mortality rates, which contradicts a lot of other studies suggesting Behm ethnicities to be at higher risk presence of COPD, your current just infections and surprisingly increased risk of hospital mortality becoming status. Did no usage of anti platelet therapy or romantic I go on therapy was associated with the reduced risk being hospital mortality. Thanks. She's looking at whether you know it's changed interventions overall, 6% of it procedures performed in the pandemic with different what would have been performed in the people that make period. This is mainly and lower limb amputation work. 80% of the codeine positive patients had a change in their intervention. Only 2% of patients of the change in the anesthetic or postop destination. But you don't include 11% mortality rate for inbasket interventions doing the pandemic. I was pretty consistent across all types of procedures and in the context of a loon and Kobe positive rate of 4% suggests an important multi factorial imprints on the high side with me. Thank you. Well, not Richard. And can I be a little controversial on So what? You've got vascular patients that have a high mortality? Isn't that something new already on? Does this just selection bias again on your just cooking out certain group of patients? No, I think you're cured. Mortality rates were compared it from the pre op periods to the post, that sort of pre pandemic periods to the pandemic period across the board for all interventions in much higher. I think part of the reasons we're seeing the higher mortality rates on the fact that patients representing late on we also changed the thresholds across the country. So we're only proven aortic repairs, a much higher larger diameter Triple A sizes, which we know is associate of the higher rates of mortality. Do you know what they died of? Way? Haven't we didn't collected John's cause of death in this study. So you don't know if it's related to code it or system things or, Well, what there? We don't know whether it's related to cover it, but actually, you know, the co bit positive rate was only 4% in the studies. The majority of deaths from non reposited patients. I just wonder, is well on on a similar theme too rich there. I wonder if you have any data on things like I t u A N h new use. Because if you got systemic pressures that could think that could be something that is pushing, people are quick, and so they're perhaps getting back down toward level really than what you might expect. Yes, that's something we were thinking about, whether actually patients weren't going to try to you as planned. And then, you know, people doing intervention where they normally would have gone to 80 you back to go into the boards are the only 2% of procedures were documented. Us having a change in their picture in place the postop. Careful. That doesn't actually seem to be associating between quite surprised to see from the friend. We're going to stop it, right? And really interesting. You don't have a camera for a long time. Thank you for not drying on. Thinking for everybody to ever here we've heard from so far be really interesting to hear. We're going to take a short break now. Good evening. Thank you very much for coming back. So we've got six more or talks that we're gonna have and we're going to begin with. Joshua Clement is going talk to us about the effects of the coronavirus on the work based assessment off surgical trainees just run off you go. Great. So, pecans in the sides here. Me. Okay, great. And so and this is a study of it. Hopefully, just about to kick off. Very certain and really looking at the effects off, coordinating on our operative and work. Best assessment actively. And so I'm ST sex in general surgery and part of the acid executive, and also being the lead for the latest covered star collaborative study, which I'm sure, um, a number of people in the event tonight of being involved with and to recap, I suppose, and there's been a huge amount of collaborative efforts from a number of the subspecialty training organizations over the past six months looking into the effects off of it, and you can see them all linked. They're ultimately this and the Little Star cause it'd on study wouldn't have been possible fight and not interest. So we really at this stage, we weigh still probably don't know the overall effect of Corbett's potentially how long Now? The fact is, is going to have. But today it's well, what what way? How far we got down. Straighten the question of what impact is called a 19 hard on the surgical training. So through the The Covered Star Survey and that was that was performed sort of around the summertime. And we have got somebody in terms of this sort of immediate short term impact off the quality of side of thing. So from our national pounds surgical specially service that was standard across, um, all fashion organizations when they eat 110 people that responded and the feeling really was it has been a significant impact upon. They're they're treating two d, it obviously coinciding with the the mass changes in the heart of a surgical services of being delivered as they're having an effect on people's, um, ability to again treating opportunities. Um, obviously no love, the extra curricular things to be have been affected. And you can see there on the far right on site and specifically to water fact, that's hard. And so, you know, cultivating qualitatively that, um, a number off response of saying that they're experienced the attack as being effective. That's really so I suppose. Well, one side of the coin I'm really the purpose off the study that we have No, I found, is to look up the actual quarter to the fingers and find out exactly what the hot high body may have. Things being infected and numbers eso We hope that part in observation off study Thean is to look out of three defying creek over it on then covered period on the sidelines and in 29 2019 2020 periods. And we have, um, essentially submitted on on occasion through the ICP requests for us. All of the anonymous dinner that from ICG on the overlapping little book, um, for all special breads on Ultram he grids that are registered on the ICP websites in terms off a little bit of statistics. Thean is to look at the actual effects sizes well. We hope to try and report those that incident rate ratios with 95% confidence intervals. Expect obviously, that the numbers off both operative KIIS activity and WVA is to be significant. That's our primary Commager to to look at the impact off, create precoma and uncovered time periods. Look at the tree of fact sized between the time on prom Attar's. We will then also do some some analyses looking specifically us, um, training regions, um by training grid. Um, and I smoke specifically by specially although I mention it there we have a successful optic Asian through. Um, the ICT did analysis on a research group I'm on. All this data will be held, um, in accordance to JC STDs, uh, sherry on processing agreements in terms of seconds. And Joshua? Yeah, sure. So we we expected, obviously call it has coinciding with the colon impact that we quantitatively We'll see. Um, a big impact to be this is gonna be a a large scale quantitative assessment of all grades. It's relevant. Everybody, um, it's hopefully will inform, um, a number of our kids stakeholders that are involved in the theophylline it bridge upon it off, uh, surgical training. So that's That's lovely. Thank you very much. We'll hold it in at around rich. Thanks. Um, for jumpin rich. Thanks. So, two things just want do you think you are? You might be missing a trick by not looking good Looking to time points, which a one year apart we're now insult Wave to we might be waived three by January. Did not think there's a Do you think that might be value in collecting data from sometime around Now, when we're meant to be trying to get services back up running because it is going to be another impacted? Um, my other question was that was a question I had. The question is, are you going to look at numbers of people? See CT? Because that's also one of the concerns of trainees that this time, yes. So in terms off the actual one, the time process to actually put a request through that was channels the landscape of the dynamic off covered Williams is there sort of beating that that process of the process is taking a couple of months to do it. You're absolutely right. Revisions of the other request, looking specifically at like, um 10 Deiter would be with again would be very valuable at something. We're just that the point now I got all that out of which is a little hearts upset of the anus of the primary. Primary analysis would be, but absolutely right. Come tens and the impact of them people are coming off the top people entering so critical time points. Absolutely. I agree entirely. And it's just not something that, but within the original submission, very, very quick one. And has this been done because I've seen data that says that 50% of the the with 50% numbers down. So it turned? Yes. So the JC, if they have done some very preliminary analyses, Teo, look, yesterday it's become harder to, you know, to say that is the kiss This this really was a sort of a more formal eye, virginal. But some of the theory of sort of really coincided haven't harmed. So, yes, there may well be a degree of duplication, but Um, yes. If again. It's like the recorded announcement that we that we want to formally find. All right. Thank you very much. Josh, we're gonna move suddenly on to actually swim. Sure. He's going to tell us about the post study. Looking at very prosthetic fractures you had, actually. Yeah. Thanks. Good evening. One is actually an orthopedic registrar up in the northeast of England on gonna talk about our project. All composed today, mainly lead by Corning, which is Ah, regional orthopedic Research Collaborative. So for those of you who are not orthopedically minded, the's of peri prosthetic fractures. So typical ones that actually you sharing the slides. Okay. Uh, sorry. Okay. Is that better? Yes, that's it. Thank you. Great. These are paraprosthetic fractures, Hips. These quite common, but increasingly seen shoulder elbow. Ankle replacements on the factors around them. Eso bit of background to the project. It's a long going project on Be that the impotence around this was a very prosthetic. Fractures are on. The rise is in part due to increasing numbers of drinking placements. But then the patients that have joint to pretend to are aging and living longer, So high risk of paraprosthetic fractures. That's a complex, often complex and difficult injuries to treat with significantly associative mobility, mortality and cost. But you could see from those X rays is quite a Trojan, a group of injuries, the different joints factor patterns involved, and they're wide variety of treatments. Uh, the current evidence based around management approach prosthetic fractures is is limited. There's been about it doesn't systematic reviews around this, but only one could make any stab it. Recommendations of treatment on all of these reviews actually comment that there's, ah, significant lack of high quality evidence on control groups to to actually direct management of these injuries. Okay, okay, there's interest from the NIH are actually funding research into very prosthetic fractures on this was brought up a HT commissioning panel last year, but the gist of that conversation was it was unclear what the research question should be because of a lack of existing research. It was unclear which patient groups or injury Patton's sister trial should study what interventions should be chosen, what the comparison would look like. I keep what's appropriate primary outcome would be for this group of patients. Um, so really, that was the impetus for putting together the composed project on the objective of the project is really to fulfill those NHL criteria to guide for the research. So looking to describe the population that sustained these fractures, uh, the incidence of, uh, off those structures on their management Andre obtained data on clinical outcomes. Like to stay complications. Readmissions exception. The project is, as I say, lead by corn. It and it's trainee, developed and delivered Project. Have a small grant fund from a a U. K you're affiliated with beer. A trial June it in York and subs Subspecialty leads from the Societies of the Vicious Knee Society Hits elbows and trauma society. Um, the date today bringing of the project is managed by South seas. Um, as with many of these projects, it's ah, multi center service evaluation reading across the UK uh, Legislature that the lead trust It's a retrospective data collection using the red cap tool, which I think quite a few of these products seem to use. Looking at preoperative inter operative and postoperative data. Um, looking over 12 months period on looking to get 12 months follow up data. So we're looking from January to December 18 with the follow up period running to December 19. Uh, the current plan is to close to data collection at the end of December that may be extended to the end of January. Um, depending on the interest, it's right about these projects. Again, we go for a collaborative authorship model for the trainees and the P I Z very involved. And there's some small prizes available to try and encourage healthy competition along surgical orthopedic trainees. Not that they need which help her imagine 30 seconds left. Thanks, so so far, it's going pretty well. We've got 24 sites set up across the U. K, with another four getting approvals in in progress. The that involves a regional training collaborative. And so far, as of today, we've got 451 patient records to really get to finish. It's a project that being still ongoing. If anyone out there is interested, Do Drop is a line. Were very keen to get more centers and mortar, and he's involved. So it's ah, big meaningful date to set to guide future driver. Thanks. Which is not, uh can I go rich? Go ahead. You think so? Eso ash you part of your preamble Waas that? You know, NHL said it. Couldn't you know each other? Wasn't sure what the question was to be asked. The systematic reviews can't propose anything because all the research out there isn't, you know, brilliant quality. Informative. So you gone for a retrospective cohort design? Um, you relying on the quality of notes and a lot of a lot biased there, and he's gonna be looking at predominantly clinical outcomes. And so why did you choose a retrospective design over, say, a prospective designed to help get the data? Yes. So the idea is to try and get this done quickly. A decent time frame is obviously why most people go for a retrospective design. Actually, the limitation of the existing evidence is that the patient you trying to get a description of the patient population that tend to be very small case series. So, you know, half a dozen fractures in the single unit or is what tends to get published. So the idea is yes, you're right, it's it's It's the first step in this process, but it to try and get a big cohort from multiple centers across the country to try and guide and identify who gets these fractures. What happens to them to then try and develop a trial. But yeah, you're right. The next plan is to do it to go for this H t A Funding didn't go for a prospective trial in the future. Okay, well, that's time up. Thank you very much. Actually, we're going to only see if you can. I help you with the audience that if you've got questions, please do put them in the chance for the event. We will do our best to keep you on that and ask on the half matters text me to say is really struggling for questions. So please do send them in. Thank you very much with that ridge. So we're gonna move on to a hand, uh, given large, he's going to tell us about a train. The lead research collaborative of the time for bids. Your head hunter. I am a sudden my name is from and I am a general surgical or destroy the lead research fellow for the co bit higher. Um, which is had appendicitis resolved on record Emergency morbidity and mortality Collaborative group. Um, so as you can tell from the name of our primary interest is an appendicitis up getting off the pandemic with lots of reports of angry for Palestinian in patients that were infected with the virus undergoing operations, No risk with that was convinced. The lack of stop it depends it back to me, which is a normal treatment of the pen decide is, um, causing virus a refill ization and infecting here to stop. So the guidelines changed on the recommendation for the first time ever. And then you play the game that we treat these pages with athletics, which have been done a little bit in Europe and in Americans and randomized trials. But it wasn't really a very viable option. Everything. The UK well, it was important to try and capture these patients. Apple, um, so set up a international multi center ordered off appendicitis patients being managed even with an operation or with antibiotics on with 90 day boat. And it all started with our stooling group. Really, there are a number of training trying to get this going in a few regions on, we joined up other, so our student really was training at this 14 of us and it's 50 50 training to consultants on Rather and usually for anything a surgery. It's actually 50 50 melt mail as well on we fallen really quickly. So our group percent up within two weeks of national lock down, being and post. Our first patient was on red Cap on days later, our 500 patient was on red car. 20 days later on, I was pounds and patient was on red count another 10 days after that. I'm really a large part. It was due to this. So you don't know This is a screen grab of our Twitter account. So most of our sites were recruited. Um, either online or three social media. We have help from the GBI on the Road College of Surgeons of England, who helped put the size and give us a platform for its call on bear are cooperative groups with training on. We also used with mouth between trainees texting each other in other regions to recruit sites. In the end, we got a huge amount of buying from the surgical community. So I got 101 sites from the UK and island 470 collapses in total on in turn, they loaded me 3500 patients in a three month timeframe. Well, this was really helped. I am matter. Buy in from local Culture Cup guardians audit services that recognized how dynamic this all waas on got us up in a fraction of time that it would normally take to get these approvals on. We've had some good apple. It's so we published our protocol in the British General Surgery on in July, was published an intern, Alice, in the 1st 500 of our patients, which has now been downloaded more than 5000 times on as a metric, it was 73. But what we're most proud of is, um, the industry guy really helped us. They gave us a platform to Who's the webinar? Early on before we were in starting to get published where we could talk about the initial results of our study on. We've got a lot of interest, then recruited a lot more sites from that. Okay, so whether we go now, well, our final arm assists of on 90 day for data it's ongoing on, we're hoping to publish it early. Next, Jim, uh, just presented in the European color to Congress. We're hoping to get another SGB I weapon out in the spring to talk about this. And today analysis on what we're really excited about is we're invited all of our 101 sites to cut back and collaborate with again in the summer. Do you do a one year follow up or did pull of these appendicitis patients? So I would say, if you know your sight participated or you're interested these followers on Twitter and stay tuned, we're talking about all in the new year. Great, thank you very much. And, uh, well well, I don't to rich. And maybe that's what he questions, obviously. And that's great. Thanks. Thie eso This is talking about how to set up a very quick group to spread a study. Is that right? Rather than the results of the study itself? Yeah, I think most most general surgeons are tired of hearing the results on So the what would you say? The top three things are that you did that spread it quickest. So enlisting local surgical societies. So how we already have regional research, Claritin groups and sounds my local in these Midland's They've got huge Twitter followings as two places like Dude, it's an asset will help share on grow up following that got loads of contacts through that that way eventually signed up to a slight other things, I think have your protocol available online. If they can download it online and don't have to Camilion for it, everyone's ready, knows what they're getting into, I guess. Think of other things other than just publishing by a papers because it takes ages and doesn't get your results out there. That's enough. In sort of a dynamic situation like this on what are you gonna do with your network that you have? You've developed going forwards. We also were already our group enlisted some HPV surgeons on. We're collaborating on getting up the prince study, which is going to be looking a pancreatitis in, um, April to him. So we're looking at other general surgical conditions that we can use the same groups of the same compacts to keep looking at things with. I know we've got a quick question on and the chat, which is more about the clinical aspect. We're so I think if you could direct maybe people to where they can find the clinical results. We all data? Yes. So the sgpt I webinar was uploaded on YouTube s. So it's open access. So, um, if you type in undecided a TBI on YouTube, you can get the entire webinar, which have spots are insured results. And it's also published in techniques of color proctology, which is also assess if you want to connect, Thank you very much. So hopefully that helps us that question. Thank you much. Hannah, we're gonna move swiftly on to our double up for the evening. So that is gonna be some law day and Isabel trout, and they're gonna talk about the mortality and particle complications off of it over to you guys. Well, so thank you very much for having us. Uh, my name's Emily on, uh, on on track, Stomach to nickel, fellow in general surgery base in Bristol. Can you see the screen, right? Yes, you can. Thank you very much. That I'm is about I have a medical student not even investigate about me in on were here together to present the mortality and Pommery complications. Um, in patients undergoing surgery with peri operative size copy to infections on international cohort study on. Then we just want to say a massive thank you, too. Everyone who collaborated is part of this. It was published in The Lancet under a single author, comfortable, or the ship model on Thank you much all of our sponsors who we would not have been able to do this without on. So some said, This is an international Love Center cohort study on you, including patients who had a parakeet. IBS cells could be to infection. This could have been diagnosed anytime within the time period up seven days before or 30 days after surgery. We expected most patients that have a laboratory or CT confirmed diagnosis, but because we wanted to include patients from centers and Ellen my things who may not, um, hero incentives remain all that access to the services. We also allowed clinical diagnosis himself, too. Primary outcome was there. Today was housing on our secretary outcome was that staying hungry? Complications. So we'll include a 1128 patients from Toujeo best for hospitals on frontal countries. On about cause I had a preoperative cells could be to diagnosis and the rest postoperative the lot. Bart bath majority will abort your CT scan confirmed, which is really good for the validity of the study. Um, quite large proportion. Where emergency procedures approximately half about nine. Disease on 1st, 3% where. Gastrointestinal procedures. But we actually had all surgical specialties represented. It's a very old study. So Thursday, more tired. She waits for cost ball patients was 23.8, then on for elective surgeries 18.9 and emergency 25.6. So this is slightly higher than we might have expected to see. An elective surgery for patients undergoing preoperative is 21.3. Post Operative Diagnosis 25.6. That's quite similar time of the test in Seem to make much difference on both of them will have rates for major minor surgery, which we cast if I was using the being progressive occasion, and this is quite high for minor surgery on which is 16.4% on so all started. Probably complication rates was 23.6 then, as I already said on vacation, to have no public postoperative probably complications had an alt of 8.7. Obviously those who did had a mortality rate 38%. So this is a clear driver of mortality. The most common PPC was moaning up. Um however, the most lethal was hard. Yes, uh, hands don't be Some of the take home message is the king Here is that elective surgery was really associated Quite high risk of mortality on We really needed to refine unless again in order pounding for this and some of the other. So way had this cohort study and we weren't quite sure what to do with the state. And you wanted to do some wrist ratification to try and identify the patients. That what highest risk off mortality on. So we broke up, broke everything down into patients over under the age of 70 broken down by gender by major minor surgery by elective on do emergency surgery. And as you can see there that you've got incredibly high more little itty rates in male patients over the age of 70 having major emergency surgery about a post operative mortality of 44% which ah, numbers much hard. Then we kind of seen any other part in any of the published data. And so we did a multilevel logistic regression to create words ratio on Constance intervals for a lot of these factors. And so for patients over the age of 70 80 had adjusted odd ratios for 30 day mortality of 2.3. So patients at the age of 70 arm or than twice a lunch die postoperatively with the peri operative size copy to infection. We did the same course gender safe agenda and essay. And unsurprisingly, so men have a hard mortality rate as patient with a higher say on the diagnosis in indication of surgery didn't seem to make much difference. Emergency and major surgery had a big impact for mortality, but interestingly, whether patients were diagnosed for your POSTOP, he didn't make a difference the mortality and then take home messages. So we should be raising our fresh up the surgery do in the covered 19 pandemic and trying to utilize data to prepare for future waves, which you can see from the other output from the covered search group. Right? And your time's up there. Thank you very much, guys. And I don't know whether they found with that back on. Otherwise, Richie, get on a post question time. Fantastic. Been trying to get rid of them for ages. Eso the you show different factors involved in the mortality rates. Is there factors of different and systems? Was that looked at by different systems? You mean kind of specialty, know, location or kind of high low middle income or areas of the world or types of healthcare system? So we used we used patients locations. So bed, that was hospital Onda country is part of the Marty district regression to try and control for that We didn't necessarily didn't look at it as a driver for mortality, but we tried to control for it when we were looking at kind of preoperative factors not may have another case, I definitely do. So the so the part of the problem here, you'll take home message. We should be raising the threshold on who we operate on in a pandemic. I would put it you because we can't not seen any day to really risk adjusting at the patient level. On. We got this mix of things. Pats were operating on people who were too sick to survivor complication. So we're not gonna be raising the threshold but should be targeting at that lower risk population. Start with brother differing until it becomes a calamity. I agree. But lots of the patients who were included would have been elective surgery. These weren't kind of really sick patients undergoing an emergency laparotomy. These were patients going undergoing elective minor procedures. Who may have had a one of the coop had a positive test. I appreciate it's quite difficult for us. We have been able to control it as to whether people were symptomatic or not. But we are including. People were going low risk, elective procedures. And so I think I'm not sure that works out. You guys. It's a little low today, thank you very much. And there's a bit more on the chat, but we'll see whether maybe, you know, we could do something at the end. But thank you for getting you off the having the correct authorship model of, ah, collaborative projects. Being a corporate model. Yeah, great work. Well, don't nice gonna move on now. Two corner Jones, little us about engagement. A surgical research through the virtual network of the robot Surgical averaging in the western corner. One Okay, he's there. And he's not, Then yeah, it is Yeah, but I can have one here. Me? Yeah. Thank you. Excellent. Because he must. Let's see. Yeah, perfect. Excellent. So my name is kind of Jones. I'm delighted to representing a new collaborative product out of the University of Bristol called Robo. Such research started at the beginning of lock down on was born out of the realization for medical students and trainees Opportunities for engagements and surgical research. We're going to be limited by coated 19. In response we developed. And so what's the develop? A virtual network to allow the remote engagement in surgical research and to provide training in methodologies for contacts. This is the DaVinci robot. And this is what most people think of when they think of robot assisted surgery approved by the FDA in the year 2000. To date, over six million procedures have performed using the system. And although it was initially designed for using cardiothoracic surgery, so it was a found utilization for this and system within also surgical specialties. However, the enthusiasm for this technology has not necessarily been matched by thorough evaluation. Robo surgeon thinks that conductors Siris of systematic reviews to evaluate the evidence surrounding the introduction of robot assisted surgery cost seven procedures within the upper GI I. Briefly. Each review aims two and summarize important study design and reporting features and is guided by recommendation suggested in the ideal collaborative data with croup. It will be presented at the narrative synthesis on published on the collaborative All the ship. For further information of each of the individual projects, please see the posters in the postal in terms of how the projects organized, we have a central group who are responsible for the protocol development, Development of guidance, notes and general administration Recruitment was conducted largely through social media. On article screening was also initially done mainly by the management group, but we're now bringing more and more students into that process. Collaborators A Divided Into Teams Each team has a captain who's responsible for the delicate for the distribution of papers to collaborators and full on supporting collaborators. Within that team. Collaborators on extract date of directly into a red cap form, which is then validated by a senior member of the team. Any changes made a locked and reviewed by third review and detailed feedback is provided to one of the collaborators on their extractions on that feedback is a really essential step in this process, not only to ensure consistency across extractions, but also it. It serves as an educational tool so that junior collaborators can begin bad eight in the work of others as they become become more and more experienced. Process is going well. So far we have found over 100 30 collaborators registered from across the UK, ranging from second year medical students through to senior registrars to systematic reviews at data extraction produces matter Reviews has already been completed using this process, and we have a third review well underway with 1/4 and fifth ready to go and we're still learning as we go. But but working to share the lessons that we've learned on those would be to invest time in the project set up and guidance on. Given the range of experience of collaborators on, it's really important to ensure that everyone's on the same page from the start. The team based approach to extraction only shares the workload, but also enables take let's support the individuals within each team and communication is K not only between members of the core team but also with collaborators. And we do that then by regular newsletters, which gives regular study updates but also target any frequently, ask questions on areas of concern and finally, empower collaborators to take on new roles. So we regularly provide training is with with feedback and enable them to begin moving into new roles, including that senior reviewer on presenting presenting data on our behalf. And so, in conclusion, robo surges developed a network and method the logical framework. Sorry, just a time at 30 seconds. Okay, Rose, I developed a network and method a logical framework for the remote conduction of systematic reviews which can be utilized to engage in train students in certain research. Frank, thank you very much that we've got a question from the chat, which is how did you manage to get students to participate in engaged with your data collection? And so we advertised mainly three Twitter on. What we found is that a soon as medical students started to get involved and they saw that progress and where quickly spread throughout medical schools on, we received a lot of emails from people say my foot, my friends involved in this project, I'm going to get involved. So where the math is really important, You know, sometimes the old ways of the best. Excellent. Any other questions? And did you did you had funding for this from anywhere, or or is it or unfunded? Like a lot of this stuff is No, this is This is all unfunded on the University of Bristol were very generous in the providing red cap accounts for first to complete this work, but otherwise kind of everyone in there in time. This this time it is just offered that time. And if I got time for another quick question, so this will. It sounds like the aim of this is to produce people that can produce reviews. Is that right? That that's where I would say so in addition to the content of the reviews themselves on. But we we wanted to give medical students and junior trainees that skills of how to run a systematic review, how to do data extraction on, but hopefully will engage more and more in the analysis and then the presentation side of things. All right. Thank you very much, Corner. And we'll move on to John. Rock is going to tell us about the tonsillectomy and parodontal abscesses during the whole bit era and the gym. Thanks. Can you see my slides? Yep. You can see this. I just makes the medical screen. What? Right. So I'm minding John Rock. How many? Anti registrar on? I've got the pleasure of representing into great riches Are you K e n t Trading research network during the first way that the Crohn a virus outbreak. And in April May this year, we undertook one audit of practice looking at new guidance relating to tonsillitis and parodontal abscess with the aim of reducing admissions and patient and healthcare worker contact. So we take ourselves back to early 2020 is quite easy to forget what it was like and they were unprecedented challenges to all conditions, but one specific to ent for the fact that we I'm working in the the nose and throats, which is where the virus is known to reside. We get quite close to our patients to examine those areas, and there was concern over the aerosol generating procedures that we're undertaking on the potential and risk of that would pose to ent conditions. As a result, our governing body and tuk released numerous guidance on this is what a one related to adult tonsillitis and Quincy presentations and certainly haven't got enough time to go through in detail with the take home message was that they advised ambulatory management in these patients, um, quick intravenous fluid resuscitation where appropriate and IV steroids and antibiotics followed by review 3 to 4 hours later on, then a decision about whether the patient needed to be admitted with discharge that point. So how was this ordered born? So on the first of April, what's that message went out to our integrate group and asking for volunteers to get together to see how we could help in in monitoring how the guidance were implemented and particularly related to patient safety. And if there's anything like that, we could learn with changes in the in the way people are approaching the management of these patients to recreated a few documents and these the documents that created a use a guide for each collaborator, the protocol on an E CRF ritual going to later, we had meetings oh to resume to ratify them. We also involved the Committee of People that actually designed the guideline itself to make sure that they were happy with the design of the order that we're undertaking. And then we sent it out to our our network. And you can see that. What's that? Medicine to percent on April Fool's Day, and just five days later, we sent out asking people to start submitting data and registering there this project at their sites. So how did we get the message out? We did it through the Association of Otolaryngologists and training through E N. T. U K R Twitter and Twitter handles there at the bottom for anyone interested on also on our website, which has information relating to the new MS other projects that we're undertaking a moment. So this is the CRF for the data tool that we used and it really was bulletproof, just like Teo kind of mention John Hardman, who really lead the's audits that window took and he created this. I've been asking him for a just tell me how he did it and I even offer did money. But he hasn't. He hasn't had, um, come up with the good gesture and because of its its nature and how how you use it was to fill it. If the days completely was 99.2% you can see it the top there details that we collected related to each presentation of tonsillitis and parodontal abscess on our main outcome. Leisure was unschedule re Presentation Hospital. Before 10 days, you can see the spread of sites that we included on each month during the study was running were released. Interim reports. It is a good way of getting data out there without a publication. Teo demonstrate that the guidelines were safe on but also encourage more people to get involved with the study. And by the end, we got 83 centers involved, which is almost two thirds of all Tell a double centers across the United Kingdom, and we had a participant from all four nations, so I'm not unable to go through a lot of debt of the data that we collected in detail, but a few key points we had 17 65 to get on slightest case is 40 60 and peritoneal abscess is on instant, much lower a paradox, Lab said. Compared to previous order, it's steroids were given in two thirds and a quarter of parodontal abscesses have no drainage repaired safe. The main take home point was the the over 50% were discharged, which is but much greater again compared to previous order. It's where was 8% are repressive. A shin late was low, and there's no significant predict is a real presentation. Reuse the collaborative Ortho chips down like to thank all those that took part on Be recently got it accepted to clinical otolaryngology. So please, do you read the four manuscript Lovely. Thank you very much as it don't have any questions. So rich him up first, we'll say, Well done for having one of the best collaborative group names. I think that's quite strong. The do the assume this is useful data to have that's been kind of forced through because of a pandemic. Um, how do you think the state is going to be used in the future? So I certainly think that will be used in the formation of more guidance going forwards at the time on these guidelines were being released, left, right and center without the perhaps the normal ratification processes. They certainly need to be looked at again on demonstrated that on the large Coke or patients that we can perhaps treat more aggressively on discharge on where appropriate. And again, You know, no one wants to stay in hospital in a hospital bed noise environment. So if we can continue to do that on deduce are in patient population about stepping the best psycho bid or no code, just a quick point to clarify the this is spread out by ent people on it says discharged from any So is that that they've been seen and sorted by ent and then discharged as an ambulatory case or properly not not really entered past the, uh, mine is Keep it cool. Yeah, so and this order, it was undertaken completely by ent trainees eso it required the patient to be referred to ent secondary care service. So the patients were only included if they were heard to ent um, secondary care. So they don't include those that were solely treated by the emergency department and didn't reach any anti clinician. So is the is the managed in any a marker of hospital flow and capacity rather than the anti management, potentially but on the kind of ambulatory portion of it could have been conducted in any expose. It's wishful thinking, but if you got there early, you could observe them for a few hours, potentially in that four hour window mean on potentially know. But some of those patients will have been seeing in a knee. And yet, who knows? We didn't collect a from whether or not they were how long? They're in a any four, but yeah, those were the ones that were kind of seen by ent and and A And he had never reached award. All right, thank you very much. Afraid that's the treatment of this question up. And and that was our last talk. Thank you so much for all this brilliant speakers. And thank you for coming along for this evening in joining us. And also thank you to map rich for being some fabulous judges.