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Yeah. Okay. Yeah. My duty to welcome everybody tonight on to this and our CM 2020 to virtual webinar. Um, with the dragon's done and five presentations off some excellent studies where this array of dragons is going to be very discerning and choose a winner on a study. Um, and we'll look forward to that. We've got a really high quality setting dragon. Set it up. I've got just five minutes to introduce The dragon's so rattled through quite quickly. First of all, my name is David Beers. I'm Professor Musculoskeletal and Surgical Science at the University of Oxford on one of the directors of the Royal College of Surgeons Surgical Trials unit. The first diagonal like to introduce is Professor James. Please be she's professor surgery University Crystal on on any consultant, a G I. Surgeon at University University Hospitals, Bristol and Western NHS Foundation Trust. He directs the Bristol Center for Research on the Surgical Innovation being off the breast and I job by a medical research center chief. Investigate your several studies, including the Vibrams supports many other studies in route called including Romeo on sunflowers, study lots of math, a logical expertise and outcome of what we, Jane for many years. Uh huh. Deliver the Bostick course together. Measurement on reporting and anything to do with surgical study Design A member of calm it on the MRC trials method. A logical research partnership. So lots of collaborative working and lots of experience. She's also a senior investigator on, but she has a lover boating. And if you want to see her, she cannot be seen rubbing around in a car. A port in Bristol Harbor. Our next dragon is there a stock. And she's a professor on director off surgical interventions, diagnostics and devices at your university of leads up. Picked up on on the clinical trials unit there she that I s I d D division host. The leads are CS Surgical Trial Center, which many others are representing tonight. On this form, the affiliates with the National Institute of Health Research leads med Tech on in vitro a diagnostic so lots of med tech from depths. I think she has a broad spectrum knowledge on experience, including several and I chart and charity peer reviewed funding trials. Large portfolio lots of early phase safety studies to multi center international studies on has a research interesting surgeon device and diagnostics, lots of statistical, interesting adopted design and multi various diagnostic predictions, Um, on an oversight committee and I childlike many of us in terms of trans Deering committee. So again, a really wide range of experience. So thank you, Debra, on what Deborah is. Um, it'd probably in her little mini bioz. Actually is a statistician by training. So not somebody to get some next to a conference. Don't table. Now. Mark Edwards is the third drug, and I wish to introduce on. He's a consultant. They can't speak back to me at the moment so I can say what I like just to let you know. Mark is a consultant. Anesthesiology perioperative, Medicine of University Hospital. It's a Hampton on an honoree associate professor at certain companies. Well, he's completed his higher degree at University College, London and Peri Operative Medicine Immunology on lots of clinical activities in anesthesia, the major adult surgery on peri operative medicine. He's got several academic interests, including peri operative hemodynamic, optimization and mechanisms, or peri operative. Morbidity on has several studies as well, including the flow He'll a study Camelot on day, which is a direct a sheath and juicy and murder to laparotomy and is the deputy chief investigator of the optimize trial is also deputy director Off the UK is Perioperative medical medicine, Clinical trials network uninvolved in the West, and I chart CR and special degree. So Mark for me is the only dragon I don't know well out to this group. So I know that he will bring up the quality off the group. So welcome, markets. Right. See you. Clelland is our second toe last dragon to introduce on Gramma's Professor of medical statistics of the University of Aberdeen. So we've got some northern representation. He directs the Center for Healthcare Randomized Trials chart within the health services, researching it there on down just newly appointed the the Aberdeen Roll College of Surgeons Surgical Trial Center within us, um, centers that we've got from the role colleges, surgeons He's got an overarching interest in designing fair and I would question that prescribed to my knowledge has never be in fairness life, especially at the bar tests of healthcare treatments and policies with a specific interest in evaluating surgical on complex interventions. He's also interested improving the design conduct and, um Alice Report in clinical trials on the development of anything new in the math. A logical area, a particular interest in chart, of course. So welcome, Gram, and thank you for joining us on then. Last but not least, we have Rupert Pierce, who is a professor of intensive care medicine, on his physical duties on your doctrine critical care unit. But the Royal London he leads the critical care and periodic medicine research between Mary and his main in research and trust isn't improving patient outcomes following major surgery is lead numerous large scale, multi center and most control trials and epidemiological studies. Several mixed methods studies as well, and he devotes increasing proportion of his time and to research these days to improve perioperative care. So we've got that covered in in spades today, which is great on D also has an interest in low and middle income countries. Now, Rupert has been seen quite a lot recently during Kobe it and hurt some wonderful blog's and coverage on. But I believe that channel for now in the process of making a film about his life. So we'll do that. Yeah, Okay, so that's the dragon's introduced on DNA. Now we need to go straight away, I think, to the presentation's. We've got five minute presentations on. There's going to be 55 minutes president, followed by seven minutes of questions from the Dragon's. I'll come to each of the dragon's on gas. Their opinion a tienda of the of the presentation. The abstracts have been presented to you, I believe a separate on separate documents. You may be out again, right? Let's make a start on. I believe the first one is a multi center perspective study on the use of surgical education on the use of surgical education checklist in theatre on. This is Tricia Tape, who's an F one from the Lancaster. And it's also a company by popular regimen. I think I'm gonna pass over to, you know, Tricia, is that correct? Yes. Hello. Until I'm Trish, I mean it. Gym. I mean, Okay, can you see my screen? So I have an image Tricia away. So I mean, I come in every F one, Beta Lancaster. So I'm proposing a multi centers that wise cluster end of my strong on the use of surgical education. Check this on in theater, and so I drive any conflicts of interest to declare. And, um so, as we all know surgically in the past two years because of Cold Bit with had 1.2 million less upper elective operations, as since the side was called me at 19 pandemics. And so and it all in the thought of different ways and from personal to tackle this back look so from personal experience and ended up to accounts of trade, he's the amount of operating. Assisting really depends on the witness off the trainer to teach trainings, prior experiences and training experiences in the procedure. So the surgical education check this was developed by Ms Poppy. Redman, a surgical trainee based in New Zealand, was commonly undertaking a masters in medicine, good education, and this is recommended by JC STS. It boater in 2021 in the document on Done on Making Better. And this is kind of being pilot in a small number of centers. However, nothing I can see from the chest and published in the literature yet. So hence this prospective study it and proposing aims investigative activeness off this checklist in Byetta, and it's part of the pilot study. Of course, a study well on the train in trainers inspected will also be investigated. So a pickle analysis. So we'll include the training and trainers, the surgical scrap team, liver, some of the opinions as well and if possible, patients. So including criteria will be all eligible and HS hospitals with emergencies and elected services and interventual be the use of this checklist versus for five weeks versus another team. This is another hospital which does not use this so but so they can't begin. It was a look it whether within the hospital itself again. Also. Okay, whether it's morning or it will be done in the morning or start listing brief assist. Those with this did not use it in terms of outcome. It's mainly the aim at the old days to provide structure in forming stuff of the steps involved and which of what will be conducted by the trade E and train a different stages, so quality quantitatively really relates to look at the time. 14. Breathe debrief any changes and complications rate and edit the difference of time of procedure stressed by by level trade E court. Relieve us. A specialty of us is high trainees drain out with numbers, whether they more likely to be so we know whether they're like assisting with the trainer scrub unscrambling on. And it will definitely require some statistical and methodologically support because we do know, actually, no the same power and sample size to to the back off literature in terms of qualitatively will try and get that. We'll get the training and Trina satisfaction using your life, that five point scale, how, before and after using it and, uh, something verbal feedback from staff and also got patients, if any. It was, um, improvement off this, especially non technical skills or trainees. And also it was improved off the checklist, whether it's a shortened or questions in the end of the five weeks. So the timeline. Yes, we can see you so we'll start off with a packet. Group gets up, do it small pilot study. You know that I'll center and want to sit some centers and they will develop in the learning package for treating and trainers intervention on different by all. And he checks school specials with inclusion criteria or eligible and HS hospitals, and I will. Random, I sent is according to those would have had it dresses those who presents those who doesn't have it. And and in the centers that located today, intervention, um, trainees and tree nuts will be encouraged to complete and learning package. And at the end of the five weeks, we'll do a survey of trainees and train us. Which a lot of variables that we discussed previously for this cop table was carpet. This diagram is ah, copy from the equal trial. Because we think we're thinking of a step wise. Try out so that we can set wise which which trial? So that we can include a smelly centers as possible and to look at the impact off this on on surgery in general. And then the conclusion. What I really think like the limitations that system Celtic up train us, uh, and trainees that the staff time for the learning in terms of my qualitatively some limitation, we might need some time for quantitative analysis of the feet. That an interview, Um, and we think that it's likely to be increased type of team brief, and some people might feel that there may be too many questions. So that's something that has to find it. But at the moment from elect, I can see from Bubble from talking to copy yourself, and it's now in New Zealand. It has been The questions are appropriate, and it's actually quite good from my own experience in the center in New Zealand. So it's summary. The step which went to my study will help the sex effectiveness off surgical training checklist promote surgical education. Stuff sent. Improve the quality of training while the any checks catches up with the back off cases. So my vision is that he just like how that every eight little checklist one starter it was implemented the NHS into some three to the other night it can. This can also be used in every operation. Thank you you very much indeed. Treasures for opening proceedings tonight That's excellent. And long time is well, which is great, which were a little bit late with introductions, but we'll try and catch up a fraction. Just pretty rest of the audience is well on there. You may wish to ask you question yourself. I can't guarantee that will get ramps and depends. We got a a good panel here to ask questions, but we'll try to get a few questions in from the audience. A swell. So let's go straight to the Panelists. I'm gonna open with Jane. She's pressed on my screen here and very pertinent indeed for this. Training for acid talking about a trainee checklist. Jane, any questions? Enjoyed the presentation. Thank you very much. It's a great idea, and I would like to see it down in the any chest. My question will you is if you're going around to my whole hospitals. Who's gonna give consent to be randomized is at what level is that being done on? The second part of that question is say, in one hospital that is randomized to receive the checklist before beginning. What if not all the surgeons in the hospital want to deliver the checklist? How are you going to manage that? Two questions. Questions. You want to try that? What was it? They don't want to be involved. Which is often the case. People busy. So this will definitely required for the first think you for your questions over the first question. Um, how are we going to do this random? Well, it would be a departmental effort that you will have to get them together to do it on. Um, just like a departmental consensus. So if surgeons do not want it, I do believe they can actually opt out. Some surgeons me choose the opt out, but ideally, it should be the whole team so that we can have a power. We can probably power this, but he and so, um reduce. Um, reduce bias in uncle. Been on study. So right. Thank you. Tricia. Deborah Me Move to your question from you at all high. That brilliant presentation. Thank you. And always difficult, I think to be the first start up swelled. Um, my question was around the ast. I understand the track this does come from New Zealand, so that will need translating into a kind of UK NHS setting on. Then it's gonna be developed further into any learning module. I just wanted you to expand a little bit about how you were taking it from what have been developed in New Zealand through to the loaning module on bowel confident you wear that your intervention was was fully developed to be able to then take it into the trial. This is a really good question. I think this is something that, uh, Poppy and I will have to discuss it further in detail. She's still currently doing her own little trial in New Zealand and actually offer yourself is wrong. Yorkshire. So this is based off also some of it from her own experience working at the church, training in your shin. Yeah, just so, um while that she's not here with the last, he's not in the not in the any genital. She is something that she hopes to still mean. She's really hoping that it can be implemented across the whole lot. The UK in the any Yes, so it sounds are model wise. So that's why, in the first part of the study, we going to do a qualitative analysis First closing survey, asking trainers in small pilot doing a small kind of study, whether the what areas of improvement we can do to refine this so that we can actually integrate it into the team grease. And okay. Thank you, Treasure. And Professor Edwards from an anesthetic point of you, anything for your perspective here. Still, doctor, for now less 100 s. So if I understand correctly, this is a check list which essentially tries to maximize training opportunities for trainings and simple question for the quantitative part of the study. What is your single headline? Primary outcome, please. Do you think it is more for cough is evaluate the effectiveness off the checklist. In terms of outcomes, it can. It might be more qualitative, more straining satisfaction. Trainer satisfaction more than actually, time difference, type time, increasing in team grease and all. So happy with that. Yeah. Okay, well, we'll go to the last two, then quickly just to finish with festival parent grandma plan in question from you, not catch quite in your body. You may have something that you want to pick up on. I was gonna ask the same thing that Deb did. What were the oddity? Starts dishes with the same question We group thing. So, Tricia, what? What was what? I was gonna ask you how I will, You know that this is being a successful checklist, know quite the same as marks. You know, What's your primary? I come how Well, you know that it's done what it says on the 10. Well, it is a really good prize to this audience. How you know it's worked. Hold I nodes. Well, we'll have to compare of us in the arm that's not had this checklist and then we'll see whether these satisfaction has changed. Trainers inspection has changed in any way and ideally, just like the behavioral checklist, even other behavioral techniques had a constipated and point, which is patient safety. But here we go Qualitative and pulling off. That's came back, stretcher and then lastly in just in just a time, go to group a professor group Pierce, Just for a question again on aesthetics. But you might be different slant on this road. And so, Tricia, lovely talk on great idea. Eso All the best questions have been asked now, So I'm gonna have to throw to the bottom of the barrel, and that's the difficult ones. So if the dragon's got together and decided that there was too much to do in your project on that, you have to kind of reduce the work learned what things are you gonna take out? Question? You put in too much. What do you take a thing? They get to make it work. I think I would actually take out the m the randomization bit and just phentermine according to what? Just centers preference, whether they like to be part of it and just compare with the previous, previous what were they done previously? Which is probably more so. We'll set this, have not used it at all. So we previous Peter good on. So there's lots of different types of crust a trial, and they don't have to be stepped. Wedge. I might have mentioned that today that 12 years you have indeed going on that that's that is a good answer. We don't always need to do around the most important. To start with something that's useful to just find out in the first place is well, well done. Great. That concludes this round. And also your presentation treasure. So I'm the only one so access to be able to get around person. Well done. Thank you very much. Okay, moving on then. So our next presenter is going to be just mean Bates on. She's a medical student from the University of Birmingham who we know well on. She's gonna be presenting on using the tool mobile device to reduce any chest routine Cataract waiting list. So we're from I surgeon this case. Ramallah. Gee on. Be interesting to see what you got. Sager's have beans. Are you ready to present for us? Okay. Yes, it's getting a slide in the sights, huh? You? Yeah, we can see you that soon. That's excellent. Okay, so I I'm just mean Bates as kind introduced crime, the funding your medical student at the University of Birmingham. And I'm going to be talking to you today about enhancing the cataract surgery pathway using the toilet meditate, repair ear device. I've got no complected interests. So the problem here that we have that it starts that it starts off with that. Cataract surgery is the most commonly performed surgery elective surgery in the entire world. And it has the highest positive impact on objective quality of life. However, between 2019 and 2021 given the circumstances, there was 83.6% increase in cataract surgery waiting lists also in a chest. England have asked elective activity services to increase the activity by 30% by 2024 2025 on percent. A potential solution is introducing an enhanced patient, probably using the tool device which he's is a HEPA filtration system to create a ultra clean sterile. A zone that could be directed right of the surgical field is that for instruments in 2021 research is conducted a days to a study in three different locations and hair culture, employing 1269 cataract patients where they had a cataract surgery done in outpatient clean rooms instead of operating rooms, and found this to be a safe, efficient and effective cataracts. Surgery. Part weight with hae Patient Satisfaction. The similar study in Italy, looking at 3838 injections into the I, found the 26% cost reduction her injection when the injections were done in the ophthalmologist's office rather than in the operating room. So the logical next step is to use an ideal based to be studying Teo. Have a pragmatic evaluation or scaling this the pants halfway across the NHS. The main question is, is incorporating an enhanced outpatient pathway using the tall a minute after advice for the delivery of routine low risk cataract surgery, effective scaleable and feasible four patients on elected waiting lists in order to reduce the waiting list times the past way that was used by patella tile that was found to be safe, effective. The safe and effective is clearly explained where patients come in, they have their people violation process begun. They go out with a remote pager and they called back. You know, on the dilation process is complete on Have the cataract surgery done in an outpatient clean room? Well, this reduces the time that patients spend in the department from the target set by the world College. Welcome ologist of the 19, and it's about 75 minutes. It reduces thie interaction with patients on multiple members of staff and also with multiple other patients as well on further considerations to make here well, continuing, um, cataract surgery in normal operating rooms ensures that we're still meeting the RC up will roll colleges drive to increase surgical training for trainings, and that there were nine surgeons used in the past way. You were considering forming a collaborative research group for the study. The population I don't patients in routine cataract waiting list scoring grade one on the key on scoring system, which equates to low risk, straightforward surgeries for hospitals with capacity. This is going to be the exposure group. Um, patients are to be put on insurance pathway where they have their surgery done in an outpatient setting on this toe. Happen in addition to the routine cataract surgery still happening in operating thirties. To compare this with just having operating, they're discontinuing it alone and to have a primary outcome measure or the effectiveness and feasibility of this. So what I mean by this is the time spent in the department the rate of escalation to a senior referral to surgery time find successful operation rates a patient according outcome measure tint to look at is the cat problem. Five question now to look at during consenting proves that's in one month postoperatively complications on operative cost expenditure. Overall, this is a comparative perspective. Multi center Kobel study spanning on predicted six months off least 50 different UK hospitals on that there are to be patient partners in the deliberating design of this project. Something's that was still considering all whether to include a sample size calculation, how to communicate the pathway to you, and sure adherents helps modify how to model the capacity of departments to use this partly and how best to include. Make sure there's a device, a diverse inclusion and patient treatment, and also to how best to measure the operational costs associated with the, uh, Hans Parkway. Thank you. And here, in my references myself, that's great. Thank you very much indeed. Just be Now, if you extend inquiries there, but understandable at this stage in in the development. So let's go to the Dragon's. I'm gonna think about the three people who might be more interested in this and just go in various sort of reverse order. So I think you put up scaling and things that beginning Jane on Deborah and Rupert for this. So we're going to start off this time, please? In terms of testing. Yeah, just a fantastic presentation and really interesting idea. Um, so but this is quite edgy, isn't it? I mean, you're actually making quite a radical change to operate in pathways. So I suppose my question is, that is, um or, uh, trouble. Everyone. What? What so support Have you got behind you to make sure that you've got the firepower when somebody went some, but he starts complaining from some else. Where's hospital? That that's crazy. Person is wanting us to operate in in the car park and God knows what's going on. You got behind to support you to show that what you're doing is legitimate, this important, that it brings really value. Well, I think the study Thank you for the question. I think that a study done in 2021 by the toilet all, um showed that patients did actually how high satisfaction. They were quite happy with this procedure and, you know, it's still simulates the environment, often operating room on there, still the same, the same behaviors of the surgeons and masses. And it's the same kind of routines there say Oh, I think including patients as collaborators in the design of this study would be very important to see what the patient's think, you know, going forward into this and also a consideration that we've been having is whether to use patients from the 2021 study. He has gone through the pathway, whether tease them will include them rather as collaborators as well. To see we're looking back, Is there a difference? You know, in patients looking forward to see would they be happy with this pathway and patients looking back to say, Well, I was or I wasn't happy with this. Probably been considering those two factors would be important in answering the question. And I hope I have answered that question. Not really on, but so I'm really after you saying that you've got a big, ugly academic ophthalmology surgeon views going to beat up anybody who doesn't back you on support you or make your life difficult in any way. I mean, a lot of people myself stage. Do you find those have something to do that just supporting people are making sure that they have visible credibility through the support of senior researchers behind them, because it really does. Open up your ability to you go and talk to people and so on. Uh, maybe that you've already got that in place. But certainly it's something to think about if you just If you was maybe being to kind of what we have in place, that you don't want to research infrastructure, these things really important. We always say that. So I haven't great ideas. You gotta have the back up behind you to be able to deliver them, which is what numbers making a quick just before we go to Deborah. The quest quick question from the audience down strongly. How can you be sure about a basic premise of this question? I could be sure it's due to lack of operating theater slots. Is the problem the bottle rather than surgeons or other resources? How do you know that's the problem? Because it's all based around that is to just be yes, that's a very good question, actually, Onda that plays into one of the outstanding queries he has about how to best model the capacity about the laundry departments, whether it's about the lack of operating rooms, whether it's about time, table in problems, whether it's about a lack of operating staff available, you know the rearranging of stock during okay bid Pandemic has had a massive impact on elective surgery, an elective services in general, So I think developing a good model would answer that question better than then. I'm speculating, but I think with surgical services in general trying to get back on that feet, I think Room does play a part and enhancing or expanding the reaming to operate into outpatient apartments, outpatient clean rooms, woods potentially improve the waiting list. Um, it might be in place. Probably first is it's a basic premise to New York, but I kind of take yeah, Deborah, come in, please. On this nights, just being brilliant presentation. I'm kid, I really enjoyed us. Um, So just just to pick up on something that Rupert was saying, I think also around the cats surgical support I was interested in think it's really important that you get the patient perspective and I think maybe it's in the previous to do you might You might have some information about that, but I think it would be really key to make sure that the patients from board with this because I think it is quite it is quite novel on then, sort of linked to that. My question is around the risk. Then what? What is the perceived additional risk patients on, you know, from it from a a clinical plate of you. The patients perceive that to be the same. Risk is there are a different risk that they maybe they are concerned about on bowel. You monitor that throughout the study, so not at the end study. If there's a risk doing the study on unexpected with How would he monitor that? And how will you address that? It's good question. Thank you. While using the tool device has been shown in other studies in different countries a swell, um, and for different surgical specialties, inches in your surgery and all three plastys and so on, um, that using the tool device reduces the risk of surgical site infections in ophthalmology. The criminal of the Endo colitis? Um, well, the seems to be in him. It's there hasn't been a randomized controlled trial. That case study analysis has shown that there's potentially benefit in terms of risks from surgery. And I think communicating up to patients is a massive rate would be a massive reassurance to them. Um, the main risk clinically, perhaps, would be not having everything that is present in an operating room right there in the outpatient clean room department. And I think in during the study on this would be documented. As a sudden, it goes along documenting you know what, what modifications do we have to make to the clean room as the city progresses on By the end of the study, would probably have a good picture of how to mitigate that problem, right? Thank you very much. I'm Jane. Glassy in the last minute. Would you just briefly, really interesting. I love this idea of a big culture shift and everything changes. I'm thinking about the next step evaluation because it's critical that the NHS knows that this intervention is cost effective as well as effective on. Have you, at this stage thought anything about how you're doing include or measured costs or think about the design of collecting cost? Eight in that the next Lord Definitive comparative study. Yes, it's a very good question. We have thought about it. Um, I think in terms off this trial effectiveness is the main focused. How the cost, of course, is an important focus on dumb with still, it's it's still something. I'm talking to my seniors seniors supervisor in this project about that watch is the best way to measure operational costs in the capital cost of bitters. We know that operating rooms cost a lot more to maintain the van clean res. Um, I think 15.7 times is created by the Department of Health on, and how best team actually measure that in practice and in real life is quite tricky. So it's something I can't answer straight in a straightforward way right now. But it's it's a discussion, Thank you very much. Does it mean that's wonderful on? I'm going to do the same as I have done with everybody and give you the round of applause from the side. You can see the others. And I was I should have that recorded applause Shouldn't second toe last presentation and paper. Now on we moved down the road. Zero did dermatology on. But we've got a question set for the next paper, which is, Will the number of referrals for benign conditions, including separate territories, sees decrease interesting it through that in but decreased following intervention with an e learning module in conjunction with an observational clinic. So we're talking about the learning to try and teach people to do things better. I'm well, vax change the number of referrals for these benign conditions. And that was a medical student from the University of Edinburgh is presenting this. I've got your first name. It's very new it on p Mohandas. So welcome. I'm probably see you all name when you come on up you, is it? Sorry. It's Vivian, baby. And thank you very much, maybe. And I'm going from to me. What? Welcome on. We can see your presentation now, so look for to hear from it. Perfect. Thank you. So good evening, everyone in a steam dragons. My name is Vivian, and I'm 1/5 year medical student. This evening I'm moving to convince you that teaching clinics and the learning modules have the potential to reduce referrals of benign lesions. So I have no complex just before we get started. But I have recently finished my dermatology rotation where I got the opportunity to say in on a two week weight clinic. However, throughout the morning, had another 15 were confirmed benign through examination alone and subsequently discharged. But nine lesions come in all shapes and colors, and we're very hard to distinguish, especially for me as a medical student. But there's an issue here. Given the nature of two week wait clinics, these lesions need to be seen within two weeks. This means that dermatology department are adding more clinics to accommodate for the increase of girl at the expense of general dermatology clinics. But the story is the same. The majority of these lesions are benign. My colleagues conducted a single best answer questions with 10 questions, which had both dramatic scopic and macroscopic imaging on various pigmented lesions. Representative of real life referrals the GPS were then ask to make a diagnosis and write their confidence with With that given diagnosis on a scale 1 to 10 10 being the most confident on dramatic sculpting imaging the GPS that correctly identified they're separate keratosis and malignant melanomas redid their confidence as five out of 10. If you just looked at those who answered in correctly, their confidence levels were not much lower. Commonly in primary care. Doctor Moscow is under utilized, and we know that the supplement of this diagnostic skill can improve the diagnostic accuracy. So we want to upscale. Our colleagues with this GBS have been the key frontline workers throughout the pandemic with an already overwhelming workload, they're probably seeing a rising influx of patients that have previously been hesitant to see their geeky for various reasons as we begin to revert back to pre pandemic life. Richard, one of our registered called It's didn't auto Over furled in the East London, and it shows that prevailing of melanoma with similar 2019 and 2020. If anything, it was increasing. However, if you look at the viral rates, it was 441 in 2019, but this number have in 2020. Given that the prevalence is undoubtedly increasing, there is undiagnosed melanoma in the community. Therefore, it is imperative that when they present to primary care, our colleagues know empowered and have the confidence to distinguish between benign and malignant conditions. What every proposing. We're proposing three different levels of intervention, with level one being the most time and cost have you. This will include a short interacted the learning module in conjunction with the two week weight clinic with a consultant dermatologist. I'll explain the logistics of the clinic shortly, but one level down will be the GP practices only engaging in that you learn in clinic. And finally our control group will be those who engage in either our population are proposed. Population is north each London Online model. So I was speaking about online module. But what exactly does that entail? The past few years have highlighted in the qualities with skin color representation, particularly in dermatology, with north east London and the wider UK being so multicultural. We aim for a model to income a module to encompass a large and representative population. So this is a draft up, but the user will lock into a site that shows various lesions like I'm seeing in two weeks late clinics. Once electing the right one, a green square will appear around it, and with that a question or a picture bank of similar lesions. If the user clicks more involved, they'll see dramatic scopic characteristics that the dermatologist dermatologists are looking for. But we also want to propose a pilot face. If we want to empower GPS and support their confidence in diagnosing, benign versus moving them. Let's ask them directly about what would be most helpful. What do they want to get out of this online module? What's not as useful? We want to collaborate with the GPS and GP trains for the ultimate goal. Provided a resource. So the logistics of the clinic I mentioned earlier clinic. But how is that going to work? Well, we're going to invite 2 to 3 G p is to a two week break clinic and give them a list about 10 patients the GPS will diagnose, and then the consultant dermatologist will either support or a few based on factories X, Y and Z. This will provide hands on Realty I'm and collaborative learning. What's our primary outcome? Well, ultimately, we hope these levels of intervention empowered GP colleagues and help them increase their own confidence when Facebook, countless lesions amongst they're already busy schedule. Overall, we want Teo allow for less to equate clinics with piracy. Priors. I try ization given back to more malignant conditions, and hopefully we can increase our capacity for more general term clinics. What's next? What if this works well, Let's not stop that North East London. We could work with the RC GP to develop more formal modules and with the Academic Health Service network, with the overall goal to improve help outcomes. If GPS are feeling empowered and up skilled, let's not stop there. And let's do this in a different commission group and see if it works as well. I hope I've convinced you that there are a lot of two week wait referral clinics and going to the nature of skin cancer and the targets of the NHS to equate. Referrals are prioritized over other Derm clinics, but if we streamline the service, then we can ultimately other doing clinics. You want to work with our primary care colleagues and empower them and give them the confidence to check around shade benign versus malignant. Through small interventions like that, you're learning module or even more intensive ones, like the supervised clinics, appropriate triaging and collaborative teamwork. Allow form or efficient use of energy just services with the goal of improving health out in streamlining. Thank you. Wonderful. Thank you very much indeed. Maybe in the presentation. So let's not have about the street to Deborah to ask some questions about this from the panel from the Dragons. Thank you for incipient. Um, so I got a little bit confused with the three difference intervention. So let me just try and work this out. So you're trying to empower the GPS, which is that relying on on a GP behavior change? Some of that's going to be through an online learning. And my first question was, Are the GPS involved into signing that? And you answered that question in your and your presentation was replaced about last and then you follow some of those up with with some face to face because I think it's about the confidence in the behavior change. It's only gonna work if you if you get that behaviour changed to the GP, which I think is then to the calm, their confidence in incorrectly purring on, I can see how that would be picked up in a face to face training. I was less concert. I was a little bit more concerned about how the online training, which you would assess the confidence to then be able to take up to a clinic. So so that's my first. My first question. I think the second question is, How you going to assess when What were you going to do in the researcher GPS? Get it wrong? Uh, there will be medicine. Learning curve is to how you use the tool and then taking it into practice with patients. Some of those patients might be in correctly, then diagnose. So what's the backup plan? If if the GP gets it wrong in those early stages, well, let Well, they're learning to use the tool. Okay, Thanks. So, Vivian, which ones you answer first. What happens is GPS. Get it wrong. We're going to go for the first question. I would like to go for the first question, please. All right, thank you. That's a really good question. So your question again, if I'm remembering correctly, is how are we improving their confidence? And how is this learning module supposed to do that and have recess it. So I mentioned earlier about a single best answer question there and that assess their confidence, buy directly asking them on a scale 1 to 10. Our goal is at the end, maybe a year later, a specific timeline. We re give that same questionnaire. Maybe not the same, but very similar lesions and see if are you learning module had an impact. And that's why I also opposed to three levels of intervention. Is there a difference with more intensive intervention, which is the two week weight clinic, as opposed to just having the online module? Or how can we improve? We just want to work out where the pitfalls are, really how we can help GPS because they're already going through so much. So we really wanted part of them and have that collaboration and the second question back up. We're all learning in medicine. I'm learning. All this happened. I'm sure everyone here can agree. Um, and again, I would like to reiterate my previous point working. This is about identifying the gaps, the knowledge gaps, where we can I wear. We can really help them and the learning modules taking into account what they are struggling to differentiate, or just anyone in general. What then? We can emphasize that more in subsequent modules, or we can make a medicine module like That's what's really great about online. It's almost constantly changing, and we can constantly change with it. That's great. Thank you very much. Well answered, Rupert, come to you and explain if I may, as a friend, you are a spastic question, David. So mother, wife said GP with dermatology special interest on. But I feel like listening to this talk is tradition of some kind that I might get into trouble. So what? What I'm interested in knowing Vivian. It is that they'll be a certain group of patients, that what happens if your GP says to you? Look, I know it's a separate kerotosis. I'm cool with that, but we just need to check. How are you going to deal with the fact that that the GP actually feels that they are confident in their diagnosis? But they still feel that the A dermatologist needs to see the patient, and, uh, you're gonna be able to measure that new ones in terms off referrals is a very, very crude nation. They're all sorts of reasons. Why patient that's referred up. Sometimes the patient group insists on it that there are There are other reasons too. So how will you sift down that new one? Sort of which aspect, uh, off the federals has been influenced by your intervention? Kind of actually one that one's ability. Question are, you know, validate. Now you said, Yeah. No, that's a really good question, Really good thinking. Thank you. I just want to say yes. So people were for for a lot of reasons, patient anxieties. Even just seeing a healthcare practitioner is really important to them. I know I get a lot of reassurance seeing a doctor as well, but the goal of this learn learning module is not to completely replace a dermatologist or two week weight clinic. It's wide there, but it's too more streamline, appropriate, more appropriate but nine conditions and those that are easy in the door separate kerotosis. These can be managed, and so again, it's just giving the GPS that confidence. To be able to say yes, this is benign. This or this is malignant or questions suspected malignant. Let's refer it up. But it's not saying because of this you learning module. You now are all dermatologists you can do. You can accurately do it. It's not replacing it in any means. And if GPS are questioning in any doubt, I don't think the dermatologists would be in any way hesitant to accept that referral. But it's only again toe up school and increase their confidence. Okay. Thank you. Mark. Do you have a question that a lot. You don't have to have, like, a move on, But I just wonder if you've got one prepared. Then we can move you. Yes, very short it goes. Why, no randomize. Okay, that is good question. Um, I think the reason behind choosing the specific population that I did was because people in my team have strong putting their doctor. Mohandas is a consult room told us in Bart's and She is very well aware of the area, and we just want to see if it works in one place first again, just like mentioning with my previous, um, like colleagues presentation. Let's see if it works and then we go forth, but and then we can. Also, because of the data we have, we can also see what kind of referrals air coming from which GP clinic. So with inequalities in, let's say, a GPS, so many patients they might need a bit more support. But we can identify that through the data we have already. So for the person since I would say no. Okay, I guess you could have it as a pilot randomized trial with some learning outcomes. Yeah, open to suggestions. It's all collaborative. That's great. Thank you very much. Thank you. There's a couple of things on from the the audience, which I'll just draw your attention to be in no particular questions but gym glass. But he's just mentioning to give you some ideas about A I. Tools and deep learning is giving you some connections and links there, which would be helpful, and Emily tow things a great idea. But what about tell me dermatology is an option as well. Um, has just suggested that, um gel I mean, you see, is he learning the best way to empower people? Maybe, Maybe not. But we've kind of covered that you have a look at the chat and see if any. Yeah, I'd like to address the telling her mythology because that is a really good point. And it's something that I've talked to a few GPS about because they have also brought that which is very acceptable. Tell a dermatology is from my understanding where you got really good. It's dependent on a really good image that takes time. That takes money that takes, you have to have the resource to do that. And then the GP send it off and it's usually about a few days, and then the dermatologist will respond back. There's still that increase of time. There's still using those resource is. And that's not, in my opinion, most efficient resource or a deficient way we can use our services. Why don't we work together with the GP? Is like I keep saying I sound like a broken record. Now I apologize, but let's work with the GPS empower them so that they don't even need to send it to the dermatologist. They either are very confident what they do, or they can just refer up. So that was my reasoning behind. Not include the dermatology, the family. That's great. Same old story. Be clipped from May. Thank you, baby. Right Last one, we were about five minutes behind. I think we may not catch that. We may catch a minute up, but it's okay. We want to give everybody the right chance. So let's go to the wilderness. Inguinal Hernias on the development and feasibility assessment of a self surveillance program to enable conservative management off minimally symptomatic inguinal Hernias on this has come up So James and leads on Jack Helliwell. Who's a CT too is going to present to us. And, um, I think, actually, the various people who you know on this the White Rose Surgical Collaborative as well. So, Jack, are you there? Please, I am confused. My screen. Okay, can it did. That's great. I'll leave it to you. Super Good evening, everyone. My name's Jack Helliwell and I'm in a CF. It'll eat. I'm presenting. Proposed to be entitled development and feasibility assessment of a self surveillance program to enable conservative management of minimally symptomatic inguinal hernia. This is presented on behalf of the white Row Surgical Collaborative. Inguinal hernia is a highly prevalent condition in the NHS. Rising demands on waiting lists have led to 57% of clinical commissioning groups restricting access to these procedures, which is distressing for patients who are most in need of elective repair. Some patients presenting to prime it care with inguinal hernia have minimal or no symptoms. Current guidelines recommend surgical repair for this group due to risk of progression and worse outcomes over time. How weather? These patients must accept the attendant risk of surgery. I eat chronic pain along with unclear gains and quality of life. Conservative management in a program of education and self surveillance may be a viable alternative for this carefully defined Coke or, if say, feasible and acceptable, it could lead to more timely surgery that those in most lead current recommendations. The surgical repair of asymptomatic minimally symptomatic earlier based on three are CT's and subsequent long term follow up. Although these trials don't know difference in health related quality of life, subsequent long term followup found High rates crossover from Watchful Waiting to Operative Management. The just effect justification for revisiting this is two fold. Firstly, an education of self surveillance program may have to reduce crossover whilst maintaining quality of life. Secondly, although these trials are low risk of bias, their quite old and we've seen in similar set in such a biliary colic and the C goal our CT a surgical dogma has been challenged. A future randomized assessment should explore whether quality of life is equivalent in minimally symptomatic patients managed operatively versus those enrolled in education and self surveillance program. The specifics of this trial, yet to be defined on will be, but would be designed with key stakeholders in mind. This might look something like this. So participants aged over 18 years of age with a pain discomfort score of 01 on education or self surveillance program. Compared to operative management either an open or lathroscope approach. The primary outcome health related quality of life most likely measured at two years, and it's like the A sample size of around 7 to 800 would be required for transit process based on previous trials. But before embarking on such a trial, some development and feasibility questions must be addressed first, and these these abilities questions are what the key components of an education and self surveillance program. Can such a program be delivered in the NHS safely and with high fidelity? And is the program acceptable to patients on wood? Clinicians support a future definitive trial. The study we proposed or therefore comprise of three work streams. The first would involve a serious of roundtable co development events hosted by the collaborative to define the intervention patients, their family surgeons, GPS and CCG representatives would work together to iterated Lee, define a prototype program. The design of this will be done in line with the MRC framework for developing and evaluating complex intentions. The output of this would be an educational intervention with agreed core components, a former time scales and delivery ready for its first assessment in the NHS. The second work stream would be a non randomized feasibility assessment of this educational program in an HS general practice. This would focus on intervention feasibility I Fidelity safety at any unexpected consequences. 70 patients presenting to the GP with a union actual minimally symptomatic inguinal hernia would be recruited. Did ality to call components of the education program would be assessed and treatment failure rates on on pound admissions within 24 months would be recorded to assess safety bees ability. Criteria would be defined perspectively and amber outcomes considered by the team and patient public involvement. The third work stream will be a nested qualitative assessment within work stream to aiming to explore acceptability, unexpected barriers and equipoise. Interviews will be undertaken with a sample of patients, their family, GPS and surgeons. The end product of this overall feasibility assessment is a refined educational intervention that's ready for assessment of clinical cost effectiveness. This has the potential to improve care, rationalize three sources and maximize value by in power insight to patients to co monitor the condition. But the white Roast surgical that collaborative This is a unique opportunity to diversify activities by using a variety of research methods, including consent, census work and mixed methods to engage the extended surgical T, specifically non medical professionals, which is a priority for NIH. I'll I'm 30 also to create links with primary care within surgical research. We have to do not see what happens to search for patients in prime occur, including the burden of care and also the cost. Thank you very much for listening. Yeah, thank you very much indeed. That's excellent. So, um, last done. But by no means least I'm gonna come. Jane, this has to be up your street. I'm gonna come to you straight away for this. One of the first projects they ever did was, um, simple asymptomatic inguinal hernia in the community. So that was very interesting. I definitely like the idea of you wanting to challenge searchable dogma. So my question for you is how how you gonna find these patients? Because you say the current practices not to refer people. So GPC used to not referring them. And and if that kind of low risk a symptom, I think sometimes patients don't even come forward now. And you said, as there aren't really think Are you targeting the right route? You're targeting the GP. Is that have you thought about screening patients ending at population level type? I have you got a lump in your growing type questions And I even concerned about you want to get 70 patients in one phase of the study, But how many practices. Well, you have to monitor for a long time to get to literally get 70 patients with small green lump that may or may not be an inguinal hernia. So I'm just concerned how you gonna find them. So in terms of the population that we'd be aiming, it is interesting point about kind of screening the population, and I completely agree. That's probably a subset of patients out there who were perhaps living with a groin lump on. Then they reach perhaps two or three years down the line, and they finally present to the GP the population of patients that we'd be aiming this. That would be those patients who have who have perhaps put up with it for a little bit of time. Or they might just have noticed it for the first time. They present to the GP because they don't know what this going on this, or perhaps it's causing them a little bit of discomfort. Usually, patients may refer that patient, then to secondary care for consideration of operative management, where folks in to see whether or not we can reduce that by the south of them. So it's not a subset of patients that we're focusing on. But my worry is you're just gonna have to leave study a GP practice for two years or something to get to just find these patients, cause they don't present that commonly, that's my That's my concern. I guess what we'd have to do is it be really crucial for us to make sure that we get a network of GPS who are kind of involved in this. I I agree. This would be one of the main challenges of this type of study. Because we have to find GPS. Who are you feel involved in? A bigger to participate. But we probably have to make sure that this was at least national. So it with this, like, say it would it would be a challenge of in terms we get the necessary recruitment. Good. Thank you. I like the word feasibility in there. And I like the word fidelity. So soon You got some appeal that I have Great. And, um, no, that's That's the feasibility in the early stage. But again, you know, new surgical trials, You know, you're absolutely impression at risk. Oh, Well, Jack, you mentioned the dreaded equivalents work I would prepare yourself goes any further two months and months of going around in circles about whether you really mean equivalents. Um or are you thinking about uneven worst word, which is known? Inferiority? Um, you what? I think it's probably worth including this in your, um, pilot work. I think around by, you know, Do you have a feeling for what is it that that surgeons? What evidence isn't that they want to know? Do this procedure or to stop doing this procedure where evidence isn't the GPS want to recommend this on would pick patients with the accept it. You know what they they take part in another video, doctor. That really is a vial. You late were thought one. So you have you Have you thought about these things? And so I I'll be honest. I've know thought much about crippling versus noninferiority. So avoid as much that can get you that with you in terms of whether this would be something that patients would want on whether or not this is what we want to look at. To say that this is what we should do in terms of surgeons and patients and GPS. I think the first step would be showing that quality of life is no jeopardized by patients being enrolled in the cell surveillance program, at least initially during the first two years. And we'd also then have to do a longer term follower to check that that quality of life is then maintained over a sustained period of time. And then the other interesting point to look at would be what proportion of patients cross over from self surveillance education toe operative management. What we'd be looking to do is by using the education platform, hopefully engage patients and power patients to reduce uncertainty on hope that that reduces the crossover from watchful waiting self surveillance toe operative punishment. So I guess those are the three key things that you're interested to see whether also something that's worthwhile. Did you follow up? Question David. Sorry, I'm so I don't I never liked the word cross over because I'm pretty sure you're not wanting to bomb this operation in the future. So some of the people who get conservatively managed will require an operation for a legitimate reason. So it's not crossover, Have you? Have you thought about how you would differentiate between those put cross over and someone who needs a hernia operation, I guess we'd have we'd have to measure the So if a patient is initially in the Education Self Surveillance Group and then they then end up going to have operative intervention, we have to record the reason for that. Okay, Yeah, there we go. You could run it as a management study as well. Where it's a. It's an expected outcome in some ways, which was starting to do now where you put it's part of the management and it's not a crossover per se, because understood have expected. But that's good. Okay, too quick. Sorry. March were bit later, and you do want to give you an opportunity, much just to say great presentation is always good to hear surgeons trying to do less surgery. I'm all for that. So if you could just give a poorly educated the knee that it's just a little bit more background context, snappy headline figures for sort of percentage of all these hernias just to reassure us on safety. What sort of percent it'll her knees will just stay there, not really create a problem for patients. What percent it might go on to somehow reduce their quality of life. And what percentage will go on to give the patient a potentially life threatening problem? Um, it's really good question, and it's difficult for me to give you true the Acura kind of data on that. Really, because a lot of this kind of natural history of an inguinal hernia is based on the our cities I mentioned before. They'll be a proportion patients that we've discussed before who will have a a groin lump you may never present to the GP on. It's difficult to kind of capture that data. There's a step that patient to do present to the GP and who don't have an operative management on were based in how they then progress on these previous our cities and, like, say, they're from quite a while ago. The data from that suggested that as many a 70% of patients would then crossover. I'll try it to avoid using that word into the operative management group, but the reason for that it's unclear on it's this, perhaps a proportion who it's the hernia gets bigger. They have increase in symptoms. But what we're interested in is it? Is it the fact that patients have just uncertain? They're not sure about the condition, and that's why they then crossed over into the Operative Management group but intended just a rough figure. The previous RCTV's have suggested around 70% about 7 to 9 years would then go on to have an operation. And in terms of safety, the our cities did suggest that this is safe on that. Very few patients who didn't receive in operative intervention ended up having an incarcerated or strangulated hernia. Um, so that just gives you an idea as to the natural history of a ninja? No hernia. Okay, thank you very much indeed. That's very quick. Last question on this last, I'll do really quick. I promise I'll be really quick. This is so It's a statistician. I don't know whether missed it in presentation, but, um, your educational intervention that you develop in this complex intention I just wanted what it may look like. What is your starting point? You know what, What, what what kind of education is being researched before what's out there? What works, what what's not being shown to work? But you know how do you start collecting, what components of that intervention are? You know what? He's starting? Very good question. And I was expecting to answer. Ask that because obviously I'm presented an education salt surveillance program and I'm giving you a very little detail as to what that actually is gonna look like. I think perhaps one of the strengths of the eyes, the fact that maybe we should not have any in connection is to exactly or lean way into what what it might might be in the future and really just be very open to what the GPS want. What the surgeon but most crucial, what the patients want, what's most useful to them. I think it be important to consider very a few important things of the format that we're going to use, how we're going to deliver it and the timing of these education self surveillance. And as I said before, it could be anything it could be on online, you learn, and it could be a nap. It could be written information. It could be in person. Um, ultimately, it should be something that patients are able to engage with, see, to get maximum from an interesting it might be that it's all of those things and we have flexibility in terms of this intervention so that we're flexible toe have a particular format that is right for that individual patient. And so I'm I'm conscious that I'm not kind of giving you if it's but we've considered various things that it could look like. But I think it's important that we a openminded with a view to it, folks in on engaging patients and reducing the uncertainty. That's fine, Thank you very much indeed. So well done. And weld on everybody round of applause for you to finish on. Well, um, that's great. So now we're going to send the dragon's off into postulated chin and consideration on Do they have to be a little room? So just for that dragon sake you think you're not, you're doing You do have to leave this call on, then come back to it later. But I think they will advise you on that. So you we will lose the dragon's for a second. I'll just give you 30 seconds to to leave. But the next part of of the evening, um, is going to be a something which is a great honor to do. Actually on that is to introduce the asset and are CM Grant winner, which, uh, this I mean, this whole night is wonderful. Really. I'll come to that at the end of the presentation, but we're going to introduce Harry Spears. Who is when is he gonna get to talk about a study called the coli Co bit? Study on. It's part of the colon Kobe collaborative on. But we know Harry from the past and he comes from the University of Cambridge. I believe he's now in a cf your collector's on that. But I'd like to welcome Harriet just before I do in introduction. Just to be clear that this prize is sponsored by the association surgeons and training acid, which you all know on a on organization very close to many of our hearts. So thank you for that on they represent advocates for surgical training is across the UK and in Ireland, which again is important in there. Surgical careers and acid has been a long term supporter of collaborative research in the NC on our cm. Honest, very well doing that. So, doing these projects that we've heard tonight of them have been great. A xrylix excellent route to improve patient care on, particularly with surgical training, is to sort of cut their teeth on, be introduced and enhance their research skills. So thank you very much to acid for sponsoring this. And with that, I'm gonna hand you over to a hair is about a 10 minute talk, and then we'll come back to the dragon's afterwards. So welcome, Harry. And thank you. I'm Professor bid. Can you hear me? All right. And you see, most agree have, indeed be fantastic. Well, thank you very much for the kind introduction and thank you very much to acid in the RCMP for inviting me long to present on behalf of the collaborative tonight. It's a huge honor for us to to win the grant, and it means a huge difference for us moving forward. So them in brief. I'm Harry on on a CF down in Cambridge on I'm here on behalf of the collaborative today to talk about the Colocort big study, which was an international multi center appraisal of the management of acute cholecystitis during the coated 19 pandemic. So, first of all, no conflicts of interest to declare, as we all know, Coated 19 significantly impacted our ability to deliver surgical care across the world. In particular, Emergency said she cooks care suffered various kind of various councils. RCs, Australian body of surgeon suggested that nonoperative treatment options should be considered wherever possible for emergency presentations early on in the pandemic. Given it acute colecystitis is one of the commonest emergency presentations to surgical teams. We sort of identify what this actually meant for this cohort of patients. So the aim of our study was to quantify the severity of acute. Cholecystitis admitted to hospital jury the pandemic to explore changes in the management of the Q colecystitis and also understand the outcomes of patients admitting admitted with acute cholecystitis during the pandemic. So to do this, we started the Codeine Covert Collaborative, which is a team of over 1000 collaborators from many countries across the world who have put a lot of hard work in to make order this possible. And the studies started by collecting data recruiting patients in two distinct eight week study periods, 18 week period, preplanned Eric as a control or comparative group, and then 18 week period from the start of the pandemics of the Declaration by the WH Show on the 12th of March. Um 2020 we'll his years ago now we included all patients over the age of 18, admitted with their first presentation of acute cholecystitis. And that was defined according to the very well validated Tokyo Guidelines for Diagnosis, which requires to off the three. We then followed these patients for 30 days from index admission on additional 30 days if they underwent cholecystectomy. When we gathered baseline demographics there severity of acute cholecystitis, which was graded according to the very well validated Tokyo severity grading, which gives him a mild, moderate or severe their imaging and treatment option. They're coated 19 status on mortality and for the study, particularly early period, we've held to import to capture the global picture. So we allow patients to be positive for covert if they had a positive swab or bronchoalveolar lavage, sample or positive X ray CT for X findings or a clinical diagnosis of covert 19. For those places that didn't have access to the resource is awful mentioned. So what we did was local teams gathered together. They registered the protocol, according with the ethical guidelines and then they updated the Red Cap database, which is Secure Online Survey run through the University of Manchester on What we did was we ended up gathering data on 9875 patients in 254 centers from 40 countries across the world, which is a phenomenal collaborative effort on these. Break down into 5529 pre pandemic 4346 during the pandemic. On when we compare them their baseline demographics, we're almost identical. Only difference during the pandemic was a slightly increase in the number of males and reduction in the number of females coming to any with coalition. We saw a shift from mild colecystitis two more predominantly moderate and severe. We saw an increase in moderate and severe colecystitis during the pandemic. However, despite this increase in severity grading, there was a reduction in the number of people admitted to critical care with acute cholecystitis. When we saw that an increase in the number of patients who are having CT scans as a first line imaging modality during the pandemic, we then looked at the intervention these patients hand So a number of patients having antibiotics on loans you're conservative treatment, the number having percutaneously drainage of their goal better, which is what we call the police cystostomy. Those numbers increased during the pandemic, so on nonoperative numbers increased, and we saw a 10% reduction in the number of patients having cholecystectomy during the day. And interestingly, we saw a statistically significant but perhaps not clinically significant necessarily increase in mortality from 2 to 2.7% during the panda. In terms of the colon positive cohorts, actually relatively small to a 4.5% of our patients, the key Conus cystitis had to code it off. Those only 35.8% were positive pre admission. And I actually found that during admission, 4.2% of patients tested positive, 20% of whom had previously tested negative. So we said, which potentially suggest that they call it coded in hospital, all the important for us to acknowledge there was quite a large number of unknown Cupid status of this data set on to try and better understand what really drove the changes in mortality that we saw, we undertook a three way mediation al assists, which essentially allows us to look at the relationship between the time period. So the fact that the patients were admitted during the pandemic on their 30 day mortality and what it shows is that if we just for patient disease patient into these characteristics and we're just for the coated 19 infection, what we see is that actually 90% of the mortality we see is due to a change in intervention type from baseline. So the fact that their management changed from perhaps a cholecystectomy preplanned emmick to being conservative managed during the pandemic that was a significant mediator off their mortality that we saw. So the findings of our studies show there's clearly evidence of a change in the management of patient to the Q colecystitis during the pandemic. And there was a shift towards more patients with Tokyo Agree three disease so very severe colitis scientist, despite more being managing antibiotics alone and also more managed my colon cystostomy. In addition, we did see a higher 30 day mortality rate for these patients. It's important to set these findings in the recently published Cupid PAN study, which looked at patients with acute pancreatitis and what they found was out of their cohort of 1358 over negative UK patients with 12 month follow up, that 620 of these actually had a gallstone etiology for the pancreatitis. The treatment, the definitive treatment for which is usually a cholecystectomy at index admission on what we see is that when we remove those who had previous cholecystectomy over unfit, they're still 77% of patients with gallstone pancreatitis waiting for cholecystectomy. That's to be thought about in the context of our studies showing a reduction. A number of patients have been cholecystectomy so in conclusion, the indirect harm caused by the coated 19 lb that they had seen in the management of these patients in a lot participating centers in our global study. I'm moving forward, particularly with the grant funding and support from acid and RCM. It's important for us to follow up with these patients to see which of these patients have recurrent symptoms or further Billary of Sorry Goldstone related events in the mission is the hospital. We need to ensure that we improve access to colecystitis to cholecystectomy both emergency and elective And that's for those patients who colecystitis and also your stone pancreatitis. And we need to make sure that we validate the priority scoring system is to ensure patients correctly prioritized on the waiting list. The scoring system have come in to use two on the pandemic, and they may perhaps not benefit those patients who are a risk of recurrent Billary problems. And we need to better understand which patients are at risk and change their scoring system. And finally, a huge thank you to the whole team of incredibly patient and diligent group of it's kind of steering group. All of the supporting societies, the collaborators all across the world and finally a huge thank you toe acid on the NRC em for their support in prolonging us to present today. Thank you very much. Many thanks, Harry. And I'm gonna give you a random pills. And I know being on these virtual conferences are devoid of that sort of interacting, which is a shame, but you have to magnify it by a fair number. So we're just waiting for the dragon's to come back on while they're doing so. I I've got a couple of questions for you if I If I like best physical Congratulations on a on an excellent study and these global studies are are increasing in popularity. But they're very difficult that, you know that the machinations and the logistics are, um are very difficult to deliver. So well done on that one that struck me was that did you not expect the having the post pandemic era to have more more more mortality and more mobility? I mean, I think I expect it to be more deaths there to be, quite honestly, when you're going to show that. But that didn't look like it come to pass it all. No. So you're right so that that pandemic period is purely from the declaration by the wh for off the pandemic. So it's the eight weeks of that early pandemic, and that probably reflects. So that was in your right. So we I had expected to see a higher mortality rate, but I think what it potentially reflect is actually, we had a relatively small number of patients with Kobe 19 positive infection, which we know is a mediated mortality in the surgical patients. Yeah, it also is that we actually captured the early parts of the pandemic and selling a lot of places actually started relatively okay in terms of managing. And actually it was later down the line when we had no beds and when we weren't operating and people were coming actually with so that their first episode of Colecystitis was treated conservatively. They went home with fine and then actually came back with gallstone pancreatitis That sound be killed them up later down the line. And that's why I'll follow up. Study is important because it may show that actually, the longer 12 month mortality is much higher. Yeah, I do agree. And do you think with that, do you get a bit of a field? Because people move to a non surgical management of it? I noticed that he's going on about to report on this, but did you get a bit of a feel for the efficacy for the two? So again, people might be surprised that no, that's obscene results that you got with the comparisons in the two types of management. Yeah, so you're you're right. So I think the interesting thing for me is that looking at the patients that did have cholecystectomy is because when we when I didn't show is we did a comparison looking at high versus low middle income countries. And the reduction in cholecystectomy was far more profound in higher income countries because we had the resource of the interventional radiology to do these percutaneously where some of our colleagues, in less advantage backgrounds didn't have that. And so they carried on taking out good bladder's. And actually, we found that their complication and their postoperative mortality rates there was no statistically significant difference. I'm not really a huge clinical difference, so actually, it does provide some evidence that perhaps the conservative management and the percutaneously a niche is feasible. And again, I think it's what we don't have data on it. The moment is the number of those patients that are readmit ID with further Hillary complications, which can be perhaps more severe in the recurrent form. Yeah, no, that makes sense again, and that's the last question for me before we practically back to the Dragons are a couple of things, just a couple of housekeeping wise. The would you do anything different again. So, you know, again, big study needed to say, but with writing that court you out just as a learning exercise with people who are doing these things, because sometimes you go, Oh, I wouldn't do that chance again. Maybe a couple of things I don't know anything with. With hindsight in reflection that you might do, it's a good question. So I think the first thing to say is that my team were phenomenal. They're absolutely brilliant and having the right team on board you. You can't scrimping, save on team. You have to have a good team. I think what I would probably have done is have built in the 12 month follow up to the original study because, well, people do their best to keep track of these patients. They do get lost over time on the numbers of who's been, who's corresponds to which Red Cap entry gets lost a local centers. So inevitably, you lose some of that valuable follow up data. So I think I would have built that in a zoo compulsory part of the original protocol. Um and then I think, you know, what would I have done differently? I think also going, I would probably with with this study, I think again it's we see a snapshot right as you raised, only we only got the first eight weeks of the pandemic. And actually, having perhaps longer time periods or further snapshots down the line actually allows these. It's like the big global studies were huge by in to provide more data on a higher granularity that's more useful rather than just suggesting what Perhaps we already know. Yeah, no, absolutely right. And again, just last one. We're still waiting for them to deliberate and come back to this. But these studies are very much dependent upon people entering the data. Yes, I like to do that on. That's not always the case in Kobe times you can see where there's a there's a desire and people will be forthcoming. To do that. I would love to see these sorts of data sets being produced across the world, just as a matter of course, to see what's going on in healthcare. Do you think that's possible? Or do you think it's always gonna be in a special circumstance where people go so we'll do this time? But we might not do it again? I share your dream. I do hear your dream on and I think it's important, and I hope that the generation of surgeons and clinicians amongst us here we'll do that moving forward. I think the two main challenges are coding. Every trust seems to coat things differently, and it makes it very hard to, um, alcohol use data sets automatically and using A I know we need to have a better baseline coding system, which I think is doable. Um, and I also think that it should. For me, I think it should be compulsory. The Bridges Association of Endocrine and Thyroid Surgeons. They have to put in a compulsory data sent for every single fire electively that they do, and as a result, they haven't enormous, very well documented granular data registry. And I think there's no reason that we can't do that in other surgical specialties. I think it's very easy to do. Yeah, no, I agree entirely. I mean, I think it should be more widespread across the peace. True seems that we provide such expensive and complicated intervention day, too. Sometimes to say that it's worked or not. You know, we teach Children at school and testament and exam afterwards to see what the teacher has been successful, but you don't seem to do in healthcare. Seems you know. There. There we are. That's great. Well, thank you very much for your presentation. Congratulations. Once again and I could see that Dragon's is starting to filter back. So well done. And good luck with rank. You take everyone good luck to all the president of this evening. So dragons back had deliberated. That's great. I'm just gonna go to the chat just very briefly, First of all, so Kenneth McLean Sorry, Mr Question, before you were talking about the digital education system. But can it has mentioned on behalf of acid? There is a virtual room under the Sessions tab. If you do want to chat about acid and I recommend that you do very supportive group, then please go and and follow tennis. I bias their go to the virtual under the sessions tab on the left. Good. Okay. So our stellar panel and I do mean that which we've got back. You won't often get a collection of individuals like this to decide on your study. Believe may. I'm not sure I've seen it before, but anyway, they have come back. I'm sure they've been arguing to live alone the face. If I know the people there, it was not a straight forward, but they've come to a conclusion. And I will ask you presume? It'll a spokesperson who's gonna talk through unless you're sharing it? I don't know. So we won't. Probably a short summary without going into too much detail. Just Prime Minister. Or so what? We've got a surgical education checklist and theater. We've got mobile device, cataract surgery. We've got mental health, orthopedic waiting less. We've got the learning and dermatology on. We've got self surveillance in her knee. So lovely cross section of subjects to think about. And who am I coming to to summer rise and give us your results? Hi. Yes, that we need to give him the task. Excellent. Yeah. Yeah. Eh. So, um, first, just to say to a large speakers. Thank you, Andre. Well done. I mean, we've been really impressed by the quality not just of the work that is being proposed, but also the quality of presentations, the thought of sitting, making that sort of presentation of that caliber in front of not too scary, but a fairly scary a bunch of Panelists and and a large online audience is something anything I could have ever conceived when I was a student or junior dog so well done on. We've been really impressed by that. The quality. So I I think just, uh, initially go through the presentation, just give her a brief overview. So with the surgical education checklist, we felt it was a huge number of strengths to that. We show is very relevant to the needs for recovery of the moment. Way felt. Perhaps that could be instructed a little bit by really focusing on what, what outcomes would have been used. That, and perhaps just think about simplifying that that cluster randomization down something. That practice got a slightly more nimble and simple design. Teo, Josephine Bates and the the normal Way Off doing track surgery, we felt again, this was another very strong proposal. We felt that this is the time for making bold changes to the way we work when we've got such a huge backwater to recover from. We felt there were a few things that could be considered so, for example, that the health, economic and the cost effectiveness aspects of this would be very important to think about on also just the background resourcing. You've got a sort of a novel technique, but is the space truly available for our staff truly available to take that work on? So that was sort of things that I think about for that project for the future. So from a parent again, we felt this was a really important topic that, you know, it was a real good opportunity to look at psychological, mental health. Well, people are awaiting surgery. We would like to hear a little bit more about sample size and whether this could get bigger on the other comment to perhaps strength and things was just consider Is the intervention really exactly what you're? You're sort of wanting to target there because the moment seems to be more about assessment, rather intervention. Is there the evidence based to suggest we need that in a minute? Or can we think about perhaps combining it, combining it more with a novel intervention to support site little health with our fourth presentation again, Thank you very much. This was again fascinating. We have some insight from it from a dragon with some inside knowledge of GPS and dermatology, which is very interesting again, a very valid topic. This is also a big workload for dermatologists on also for GPS. So something that is good to address, I suppose, in terms off future strengthening for the project, we felt that there be some quite careful work needed with the GPS to really have credibility with them and travel on side and certainly GP co investigators to get there inside. I think would be a really important part of that on also considering. Perhaps, is this the optimal intervention, or are there other techniques that might actually suit this sort of a busy GP setting Even better, such as using something like a Iowa or other tools? Teo actually sort of put that intervention place and then last. No means least Jack on being little hernia self surveillance thing again. Really important topic. There's also lots of these lumps out there. They could present a very large workload on way. See, it still seem to be a bit uncertain when and if one should operate on them. So really important case for need, a very polished presentation. Ah, really interesting package of work that is being proposed there by a great team. We fought in terms of strengthening things. The really concern, I guess from from one of the dragon's was that looking at the epidemiological data, it might actually be quite changing to to really find these patients and to find the appropriate patients for this study. And that was something that could do is perhaps a little bit more thought in terms of working this up. But overall, we felt that was a good Polish presentation. So So to come onto to the awards were absolutely delighted to say that the Dragon's would like Teo, make this award to to Josephine Bates for her presentation and proposed project looking at novel way off before in cataracts surgery using the tool device. So congratulations to Josephine. Well, then just be on. Actually, we will also, like sister give a special commendation to to our last presentation from Jack Helliwell for what we felt was very published. Um, well, put together a proposal for planned problem of work. So congratulations all to to Jack, but yes, well, I'm just feeling it was a very impressive, uh, proposal particular considering, you know, you're still at medical school, so we were. We were pretty blown away by that mother. Thank you very much, Mark. And for all the dragon's for putting that work it in to get to that point. And congratulations. So it's we have a winner will bring me the the evening to ACLU's. Now I believe we've got Emily. So just a couple things from me. First of all, thank you to the dragon's fantastic on Do Minute. You got a really fortunate group of individuals to share with us this evening. Use their expertise, all the presentations of it. So thank you. Presentations have been fabulous on. I just echoed what Mark said that it's very difficult to do that stage of that. Some of your act on. We were very, very impressed. But I am particularly myself. Some of the language and some of the nomenclature and methodology understanding was, was really how you would not have seen that 10 years ago talking about Peco's and aspects of research methodology on some thought into the questions as well. So really well done, Emily Curcumin, Lauren Dixon, the NRC um, President's of this year and the joint is also on stage on game A want to say a couple of words. I don't know. Do I need to pass it to you or just quickly? Yeah. I just want to reiterate what I'm forbid. Said so. A master thank you to our panel here, Steve Dragons Proof beard for sharing the event. So basically, on deviously the 5% parental that you've had, Um, it's been really amazing evening. And if I could just say of really big thank you to the organizing committee who have been working really hard for those behind the scenes over the last few months to put together thieving for you all a big thank you to asset for supporting us along the way and for supporting the prize. Probably winner on finally, just to all of you watching at home. Thank you very much for joining us in supporting collaborative research in the UK Thank you. Here. Please stay involved. It's great to see you. Well, hopefully we could have running a face to face coming up shortly at some stage. Thanks, everybody. I think you could just let everybody go now. Is that right? Let me. Thanks, everybody. Thank you.