Tracking physical activity using smart phone apps: assessing the ability of a current app and systematically collecting patient recommendations for future development.

BACKGROUND: Within the United Kingdom's National Health System (NHS), patients suffering from obesity may be provided with bariatric surgery. After receiving surgery many of these patients require further support to continue to lose more weight or to maintain a healthy weight. Remotely monitoring such patients' physical activity and other health-related variables could provide healthworkers with a more 'ecologically valid' picture of these patients' behaviours to then provide more personalised support. The current study assesses the feasibility of two smartphone apps to do so. In addition, the study looks at the barriers and facilitators patients experience to using these apps effectively. METHODS: Participants with a BMI > 35 kg/m2 being considered for and who had previously undergone bariatric surgery were recruited. Participants were asked to install two mobile phone apps. The 'Moves' app automatically tracked participants' physical activity and the 'WLCompanion' app prompted participants to set goals and input other health-related information. Then, to learn about participants' facilitators and barriers to using the apps, some participants were asked to complete a survey informed by the Theoretical Domains Framework. The data were analysed using regressions and descriptive statistics. RESULTS: Of the 494 participants originally enrolled, 274 participants data were included in the analyses about their activity pre- and/or post-bariatric surgery (ages 18-65, M = 44.02, SD ± 11.29). Further analyses were performed on those 36 participants whose activity was tracked both pre- and post-surgery. Participants' activity levels pre- and post-surgery did not differ. In addition, 54 participants' survey responses suggested that the main facilitator to their continued use of the Moves app was its automatic nature, and the main barrier was its battery drain. CONCLUSIONS: The current study tracked physical activity in patients considered for and who had previously undergone bariatric surgery. The results should be interpreted with caution because of the small number of participants whose data meet the inclusion criteria and the barriers participants encountered to using the apps. Future studies should take note of the barriers to develop more user-friendly apps. TRIAL REGISTRATION: ClinicalTrials.gov- NCT01365416 on the 3rd of June 2011.

The effect of alcohol on surgical skills.

INTRODUCTION: The General Medical Council states 'a surgeon must not work when their health state is adversely influenced by fatigue, disease, drugs or alcohol'. However, there are no defined criteria for acceptable blood alcohol levels when operating. The aim of this study was to measure the effect of varying amounts of alcohol on surgical dexterity, cognitive abilities and the social interactions required to ensure patient safety during a routine ear, nose and throat (ENT) operation. METHODS: ENT surgeons were asked to perform a microlaryngoscopy with excision of a predetermined glottic lesion on a validated laryngeal model. The procedure was repeated four times over a period of four hours with varying doses of alcohol (no alcohol control, one glass, three glasses and six glasses of wine). The parameters recorded included theatre etiquette, surgical time, operative skills and patient safety. Scores were adjudicated by two independent observers. RESULTS: The more glasses of wine consumed, the more detrimental the effect was on the surgical performance of all participants. There was a global reduction in ability of 7.25% after three glasses and 19.25% after six glasses of alcohol. No domain showed an improvement following sequential increase in blood alcohol concentration. CONCLUSIONS: This study suggests that there are no deleterious effects on surgical performance following the consumption of one glass of wine 45 minutes prior to microlaryngoscopy among ENT surgeons of varying experience. However, there is clear evidence that with three or more glasses of wine there is an adverse effect on performance, with decreased surgical dexterity, cognition functions and professionalism.

Surgical trainees benefit from good consultant working practices: an audit on the effect on training of a new consultant rota.

PURPOSE: To retrospectively assess operative supervision for orthopaedic trainees over an 18 week period when trauma and orthopaedic consultants changed their on call working practice from one week on call to a four day/three day block, during a fortnight period. OUTCOME: The rota changes had important implications on workload and consultant availability to supervise juniors during operation with a positive effect upon training such that trauma surgery supervision rates increased significantly (p<0.001) after the introduction of these new working arrangements. Working life for consultants and ultimately patient care were also felt to improve and consultants' working hours were closer to the European working hours directives.