🔥6 modern lessons in appendicitis every uptodate surgeon should know 👉

Appendicitis is common, it’s hard to diagnose, and every surgeon has an opinion.

I’ve been reading, publishing, and reviewing on it since 2011, since one of the first collaborative research projects ever:

So here are 6 modern, evidence-based lessons every surgeon around the world should know🧵:pubmed.ncbi.nlm.nih.gov/23842836/ 1. Perform a Risk Score on every patient with Right Iliac Fossa pain

Most patients don’t have appendicitis and don’t need to be admitted or scanned. Low risk patients can very safely be managed on an ambulatory pathway. Use any risk score, but the Adult Appendicitis Score performs best. Provide regular training to new junior doctors entering your department.

bjssjournals.onlinelibrary.wiley.com/doi/full/10.10…

🔥The downward spiral of elective surgery

🧵Small downgrades to elective care eventually lead to a downward spiral of emergency care, where crisis becomes the norm. Waiting lists are the iceberg; this is a whole system and a global problem, with the NHS acting as an exemplar due to its data completeness and transparency. So without splitting up hospitals and primary care, looking beyond surgery alone, and without singling out the #NHS, this is why (9 tweets/no pictures):

1- The perfect storm begins:
>Population growth
>Population aging and multimorbidity
>Fewer per captia hospital beds
>Fewer per captia doctors
>Underlying healthcare costs skyrocketing everywhere

@dnepo @Sivesh93 @MariaPicciochi @VirginiaLedda @yanelizabethli @DrJamesGlasbey @BJSAcademy @BJSurgery @RCSnews @CovidSurg @InstituteGC @GlobalSurg @Imperial_IGHI 2- A few of people leave their problems, and eventually they become bad enough that they go to the Emergency Department. Think:

>small groin hernia becomes bigger and eventually get stuck, leading to strangulation @MariaPicciochi
>an early cancer that has now become late, obstructing bowel
>untreated high blood pressure leading to TIAs and strokes
>poorly controlled diabetes leading to acute coronary syndromes

🔥7 key career steps to becoming a full Professor of Global Surgery🔥

I'm delighted to have been appointed by the @unibirmingham and @UoB_IAHR, starting August 1st 2023.

Here are 7 key career steps that got me there:

1. West Midlands Research Collaborative @WMRC_UK

💎taught me collaboration is key
💎networks are cool
💎only do things that matter to patients

🔥10 surgical randomised controlled trials every surgeon-researcher should read🔥

Variety, methodology, interesting findings, good reading. 10 recent RCTs you should read:

1. 2.

1. With 50million+ cancelled operations globally due to #COVID19, I’ve received several questions & comments around this controversial area. Why the #Nightingale Hospitals **cannot** be safely used for surgery: 2. To get one patient through surgery, 25 staff members are needed. This level of care will strip out major NHS hospitals and is the main reason elective surgery needs to be cancelled at the height of the pandemic.

theguardian.com/society/2020/o…