Background: There is concern about the detrimental effects of shift-workers' increasing working hours particularly when driving sleep deprived. The approach to measuring the magnitude of driving impairment caused by sleep deprivation was by comparing it to alcohol. The study compared driving performance after 24-h of wakefulness to performance with a BrAC of just over 22 μg/100mls of breath which is equal to 50 mg of alcohol per 100mls of blood (Scottish drink-drive limit). The effectiveness of coffee as a countermeasure for driver fatigue and the association between subjective impairment and actual performance was also investigated.Methods: A study of 30 participants (11 male and 19 female; mean age 21) was conducted. Subjects were tested under three conditions: fully rested, sleep deprived, and alcohol intoxicated -BrAC mean [SD] 25.95 μg [2.78]. Under each condition, subjects were tested before and after coffee ingestion. This involved driving simulation (Lane Change Task and Reaction Test) and subjective Likert scales (Karolinska Sleepiness Scale and driver impairment scale). Outcome measures included lane tracking adaptive mean deviation, reaction time, and subjective sleepiness and impairment ratings. Results: Compared to alcohol, sleep deprived mean reaction times were slower (2.86 s vs. 2.34 s) and lateral control of the vehicle was reduced (lane tracking adaptive mean deviation: 0.5 vs. 0.3). Coffee did not produce an improvement when sleep deprived, and instead, performance deteriorated. Females were less impaired following sleep deprivation than males. Following prolonged wakefulness, the correlation between subjective impairment and actual performance was significant.Conclusions: It was concluded that sleep deprivation has a greater impact on driving performance than a BrAC of 22 μg/100mls of breath, as measured by driving simulation. Coffee is not an effective countermeasure for sleep deprived driving and drivers' ability to judge this impairment is suggested to be limited.

Aims The Covid-19 pandemic has significantly impacted emergency and elective surgical activities. Multiple surgical professional bodies initially recommended appendicitis be managed conservatively or with judicious open surgery to mitigate potential risks with Covid-19 transmission. This study compares the investigation, operative findings and outcomes of patients who underwent appendicectomy before and after the National lockdown. Methods A multicentre retrospective cohort study of patients who had emergency appendicectomy in four West of Scotland hospitals between September 2019 and November 2020. Electronic records were interrogated and patients dichotomised into two groups with those presenting before the introduction of the UK National lockdown of 23rd March 2020 compared to those presenting post-lockdown. Results A total of 559 appendicectomies were performed (280 pre-lockdown and 279 post-lockdown) in four hospitals and included in the analyses. More males than females had appendicectomy in the post-lockdown period (60.6% vs 52.1%, p 0.044). Pre-operative CT scanning was performed more often post-lockdown (71.7% vs 56.8%, p < 0.001) and an open approach was adopted more frequently post-lockdown (19.0% vs 3.6%, p < 0.001). The proportion of operations for complicated appendicitis increased post-lockdown (31.9% vs 22.1%, p = 0.009). Median hospital stay was equal in both groups (3 vs 3 days, p = 0.787). Post-operative complication rates were similar in both groups apart from a higher 30-day re-admission rate post-lockdown (7.9% vs 3.6%, p = 0.028). Conclusion Covid-19 has resulted in significant modifications to the pre-operative work-up and surgical approach to patients undergoing emergency appendicectomy. Whilst the proportion of patients with complicated appendicitis has increased post-lockdown, overall clinical outcomes remain similar.

Aims Appendicectomy is one of the commonest emergency General Surgical operations performed. However, there exists minimal published literature exploring whether there are differences between males and females undergoing appendicectomy.  This study aimed to investigate the demographics, pre-operative investigation, intra-operative findings and clinical outcomes between both genders having an emergency appendicectomy. Methods A multicentre retrospective cohort study of all patients who had an emergency appendicectomy within four UK hospitals between September 2019 and November 2020. Electronic records were interrogated and patients dichotomised by gender and the results compared. Results 559 emergency appendicectomies (315 (56.4%) male and 244 (43.6%) female patients) were included.  Males undergoing appendicectomy were younger (median age: 33 vs 41 years, p < 0.001).  American Society of Anaesthesiologists classification was equally matched.  Whilst no difference in mean white cell or neutrophil count was identified, C-reactive protein was lower (mean 108 vs 137, p = 0.001) and bilirubin higher (mean 21 vs 15, p < 0.001) in male patients pre-operatively.  Pre-operative imaging was performed more often in females: ultrasound (16.0 vs 1.3%, p < 0.001) and CT scan (69.3 vs 60.3%, p = 0.029).  Male patients underwent more open surgery (13.7 vs 8.2%, p = 0.043).  The intra-operative severity of appendicitis was equally matched.  No differences in overall hospital length of stay (median 3 vs 3 days, p = 0.183), post-operative complication rates or 30-day readmission rates were identified. Conclusions This study demonstrates that differences exist between males and females who have emergency appendicectomy in terms of age, use of pre-operative imaging and operative approach, however, clinical outcomes are similar.