Introduction British military forces remain heavily committed on combat operations overseas. UK military operations in Afghanistan (Operation HERRICK) are currently supported by a surgical facility at Camp Bastion, in Helmand Province, in the south of the country. There have been no large published series of surgical workload on Operation HERRICK. The aim of this study is to evaluate this information in order to determine the appropriate skill set for the modern military surgical team. Method A retrospective analysis of operating theatre records between 1st May 2006 and 1st May 2008 was performed. Data was collated on a monthly basis and included patient demographics, operation type and time of operation. Results During the study period 1668 cases required 2210 procedures. Thirty-two per cent were coalition forces (ISAF), 27% were Afghan security forces (ANSF) and 39% were civilians. Paediatric casualties accounted for 14.7% of all cases. Ninety-three per cent of cases were secondary to battle injury and of these 51.3% were emergencies. The breakdown of procedures, by specialty, was 66% (1463) orthopaedic, 21% (465) general surgery, 6% (139) head and neck, 5% (104) burns surgery and a further 4% (50) non-battle, non-emergency procedures. There was an almost twofold increase in surgical workload in the second year (1103 cases) compared to the first year of the deployment (565 cases, p  Discussion Surgical workload over the study period has clearly increased markedly since the initial deployment of ISAF forces to Helmand Province. A 6-week deployment to Helmand Province currently provides an equivalent exposure to penetrating trauma as 3 years trauma experience in the UK NHS. The spectrum of injuries seen and the requisite skill set that the military surgeon must possess is outside that usually employed within the NHS. A number of different strategies; including the deployment of trainee specialist registrars to combat hospitals, more focused pre-deployment military surgery training courses, and wet-laboratory work are proposed to prepare for future generations of surgeons operating in conflict environments.

Skill sets and competencies for the modern military surgeon: lessons from UK military operations in Southern Afghanistan.

Background: There has been considerable discussion on the national level on the future of trauma surgery as a specialty. One of the leading directions for the field is the integration of emergency general surgery as a wider and more attractive scope of practice. However, there is currently no information on how the addition of an emergency general surgery practice will affect the care of injured patients. We hypothesized that the care of trauma patients would be negatively affected by adding emergency general surgery responsibilities to a trauma service. Methods: Our institution underwent a system change in August 2001, where an emergency general surgery (ES) practice was added to an established trauma service. The ES practice included emergency department and in-house consultations for all urgent surgical problems except thoracic and vascular diseases. There were no trauma staff changes during the study period. Trauma registry data (demographics, injuries, injury severity, and procedures) and performance improvement data (peer-review judgments for all identified errors, denied days, audit filters, and deaths) were ed for two 15-month periods surrounding this system change. Chi-square, Fisher's exact, and t tests provided between-group comparisons. Results: The trauma staff evaluated a total of 5,874 patients during the 30-month study. There were 1,400 (51%) trauma admissions in the pre-ES group and 1,504 (48%) in the post-ES group, of which 1,278 and 1,434, respectively, met severity criteria for report to our state-wide database (Pennsylvania Trauma Outcome Study [PTOS]). There were 163 (12.7% of PTOS) deaths in the pre-ES group compared with 171 (11.9% PTOS) deaths in the post-ES group (p = not significant [NS]). There was one death determined to be preventable by the peer review process for the pre-ES group, and none in the post-ES group. Both groups had 10 potentially preventable deaths, with the remaining mortalities being categorized as nonpreventable (p = NS). Unexpected deaths by TRISS methodology were 36 (2.8%) and 41 (2.9%) for the two groups, respectively (p = NS). There was no difference in the number of provider-specific complications between the groups (23, [1.8%] vs. 19 [1.3%], p = NS). The addition of emergency surgery has resulted in an additional average daily workload of 1.3 cases and 1.2 admissions. Conclusion: Despite an increase in trauma volume over the study period, the addition of emergency surgery to a trauma service did not affect the care of injured patients. The concept of adding emergency surgery responsibilities to trauma surgeons appears to be a valid way to increase operative experience without compromising care of the injured patient.

Integrating emergency general surgery with a trauma service: impact on the care of injured patients.

Hypothesis: The mechanism by which trauma systems improve mortality is unknown. Outcomes may be influencedbyexperiencedtraumasurgeonstreatingmore patients (surgeon effect) or improving the overall system of care (system effect). We hypothesized that mortality is lower in patients treated by a fellowship-trained senior trauma program director (experienced) vs firstyeargeneralsurgeryattendingsurgeon(novice)andthat patient mortality for novice surgeons would improve after adding a new senior trauma director.

https://jamanetwork.com/journals/jamasurgery/articlepdf/405211/soa80049_759_764.pdf

Surgeon- and system-based influences on trauma mortality.

The rapid growth of medical imaging has placed increasing demands on radiologists. In this scenario, artificial intelligence (AI) has become an attractive partner, one that may complement case interpretation and may aid in various non-interpretive aspects of the work in the radiological clinic. In this review, we discuss interpretative and non-interpretative uses of AI in the clinical practice, as well as report on the barriers to AI's adoption in the clinic. We show that AI currently has a modest to moderate penetration in the clinical practice, with many radiologists still being unconvinced of its value and the return on its investment. Moreover, we discuss the radiologists' liabilities regarding the AI decisions, and explain how we currently do not have regulation to guide the implementation of explainable AI or of self-learning algorithms.

Clinical applications of artificial intelligence in radiology.

Efficacy of Trauma Surgery Technical Skills Training Courses.

BACKGROUND: The report Better Carefor the Severely Injured [London: The Royal College of Surgeons of England and the British Orthopaedic Association; 2000] states that an experienced general surgeon trained in the techniques required to perform life-saving emergency surgery is vital in the management of major trauma. The experience and training of general surgeons in the UK in the management of trauma to the abdomen, thorax and major vessels has never been assessed. METHOD: Postal questionnaire sent to UK general surgical consultants and Higher Surgical Trainees (HSTs). RESULTS: A total of 854 (48%) questionnaires were completed. Of respondents, 85% believe that major trauma should be directed to hospitals that provide a dedicated trauma service. Of non-vascular specialists, 43% felt their training was adequate to manage vascular trauma and only one-third of general surgical consultants felt adequately prepared to manage acute cardiothoracic injuries. The median number of trauma laparotomies undertaken annually was 2 for blunt injury and 1 for penetrating injury. Of HSTs, 21% had not performed a splenectomy for trauma and 44% had no experience of packing for liver injuries. CONCLUSIONS: There is limited experience and training in the surgical management of torso trauma in the UK. Implementation of the recommendations from Better Care for the Severely Injured will be hampered unless steps are taken to maximise experience and improve training.

The experience and training of British general surgeons in trauma surgery for the abdomen, thorax and major vessels.

Assessment of performances of a deep learning algorithm for the detection of limbs and pelvic fractures, dislocations, focal bone lesions, and elbow effusions on trauma X-rays.

Iliac periostitis revealing acute leukemia.

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The experience and training of British general surgeons in trauma surgery for the abdomen, thorax and major vessels.

Assessment of performances of a deep learning algorithm for the detection of limbs and pelvic fractures, dislocations, focal bone lesions, and elbow effusions on trauma X-rays.

Iliac periostitis revealing acute leukemia.