From chaos to a new norm: The Birmingham experience of restructuring the largest plastics department in the UK in response to the COVID-19 pandemic.

The coronavirus disease 2019 (COVID-19) pandemic presented unprecedented challenges for healthcare systems worldwide. The Queen Elizabeth Hospital, Birmingham, has one of the largest burns, hands and plastics department in the UK, totalling 83 doctors. Our response to the COVID-19 response was uniquely far reaching, with our department being given responsibility of an entire 36 bed medical COVID-19 ward in addition to our commitment to specialty-specific work, and saw half of our work force re-deployed to Intensive Treatment Unit (ITU). Our aim was to exploit the high calibre of doctors found in plastic surgery, and to demonstrate, we were able to support the COVID-19 effort beyond our normal scope of practice. In order to achieve this aim, the department underwent significant structural and leadership changes. Factors considered included: rota and shift pattern changes to implement depth and resilience to sudden fluctuations in staffing levels; a preparatory phase for focussed upskilling and relevant training packages to be delivered; managing the COVID-19 ward cover and ITU deployment; adjustments to our front of house and elective specialty-specific service, including developing alternative and streamlined patient pathways; mitigating the effects on plastic surgical training during the pandemic; the importance of communications for patient care and physician wellbeing; and leadership techniques and styles we considered important. By sharing our experience during this pandemic, we hope to reflect on and share lessons learned, as well as to demonstrate that it is possible to rapidly mobilise and retrain plastic surgeons at all levels to contribute safely and productively beyond a specialty-specific scope of care.

Oncoplastic techniques: Attitudes and changing practice amongst breast and plastic surgeons in Great Britain.

PURPOSE: The availability, acceptability and practice of oncoplastic surgery has increased over the last 5 years. This study aims to describe how the breast and plastic surgical workforce has adapted to provide oncoplastic breast surgery. METHODS: A questionnaire was distributed to members of the Association of Breast Surgery and BAPRAS, and results compared to a survey completed in 2010. RESULTS: In 2010, 228 respondents completed the survey compared to 237 in 2015, of whom 204 were consultants (105 General or Breast Surgeons and 99 Plastic Surgeons). The range of procedures performed by Plastic Surgeons has remained static, the General and Breast Surgeons are performing proportionally more therapeutic mammaplasty (p < 0.001), breast reduction/mastopexy, and latissimus dorsi reconstructions. In 2015, surgeons are less concerned about the risks of lipomodelling than in 2010, with an increase the proportion of breast (55% vs. 26%) and plastic (91% vs. 58%) surgeons performing the technique. DISCUSSION: Specific concerns about oncoplastic surgery have decreased over the last five years, with a greater proportion of surgeons performing oncoplastic surgery including lipomodelling. The majority of breast surgeons in 2015 remain interested in further training in oncoplastic techniques (75%) but over the last 5 years, plastic surgeons interest in further training in oncoplastic surgery has dropped from 62% to 27%. About half of all breast and plastic surgeons felt that oncoplastic surgery should be available for all women and oncological and wound healing concerns had significantly reduced between 2010 and 2015 (p < 0.05).

The efficacy and safety of GR38032F in the prophylaxis of ifosfamide-induced nausea and vomiting.

The novel 5HT3 receptor antagonist GR38032F was evaluated in the control of emesis induced by the cyclophosphamide analogue ifosfamide. At a dose of 4 mg q 6 h, GR38032F was given to six patients receiving their first dose of ifosfamide infusion (4-6 g/m2 over 24 h); over the 42-h study period, major control of retching and vomiting was achieved in five patients. In the second phase of the study six further patients, in whom high-dose metoclopramide had failed to control emesis, were given 8 mg GR38032F q 6 h; major control of emesis was again observed in five patients. Toxicity attributed to GR38032F was minimal. This selective 5HT3 antagonist is effective and safe in the control of ifosfamide-induced emesis, even in patients resistant to high-dose metoclopramide.

'Correctable undetected visual acuity deficit' in patients aged 65 and over attending an accident and emergency department.

The rate of occurrence of correctable undetected visual acuity deficit (CUVAD) in a population of patients aged 65 and over was investigated, using a pinhole screening method, to compare the sociodemographic and optical eye care habits of patients with or without a functionally significant CUVAD. Of 136 patients 46 (34%) were found to have a functionally significant CUVAD in one or both eyes which was not significantly associated with optician or general practitioner contact, age, sex, social class, living situation, or number of medications. Half the patients with significant CUVAD had not attended for 2 years mainly because of financial considerations. Three quarters attended of their own volition; only one in seven were prompted by opticians' postal invitations. It was concluded that a significant degree of CUVAD could be detected using a simple procedure which can be carried out by general practitioners as part of their general elderly health screen.

A theoretical analysis of the effects of varying fibrinogen concentration and haematocrit on the flow characteristics of blood in cylindrical tubes.

The viscosity: shear rate relationship of whole blood is shown to be described to a good approximation by a bi-linear plot on log: log axes. This has allowed an analytical solution to be obtained which gives a full description of the flow properties of blood in rigid tubes of a size where the Fahraeus-Lindqvist effect is minimal. As a result the profound effects that changing haematocrit has on blood flow in such tubes can be quantitated. The analysis also shows that in similar circumstances altering fibrinogen concentration is of rheological significance only at flow rates below the normal physiological range.

A study of the haematological and haemorheological consequences of venesection.

A study has been made of a number of haematological and haemorheological factors following venesection therapy. Haematocrit was very effectively reduced by the venesection regimen and led to a fall in whole blood viscosity in spite of the microcytosis that was eventually induced in all the subjects. No clinically significant coagulation changes were observed. It is concluded that a simple venesection regimen without volume replacement is a safe procedure for improving blood rheology.

Prevention of emesis in patients receiving cytotoxic drugs by GR38032F, a selective 5-HT3 receptor antagonist.

15 patients receiving cytotoxic drugs (other than cisplatin) that had previously produced nausea and vomiting refractory to first-line antiemetics were given a selective 5-HT3 receptor antagonist (GR38032F), 4 mg intravenously and 4 mg orally, immediately before chemotherapy, the oral dose being repeated 5 and 10 h later. Nausea, vomiting, and side-effects were recorded for the ensuing 24 h. The 15 patients received a total of thirty-one courses of chemotherapy. Only 1 patient vomited. The only adverse events were dryness of the mouth in 1 patient, mild sedation in 1, and diarrhoea in 1, and these were not clearly drug related.