AimsThis study investigated the perceptions of medical students regarding the barriers to pursuing a career in trauma and orthopaedics (T&O); and whether these perceptions were altered by attending an event promoting women in T&O.MethodsAn event consisting of presentations and interactive sessions from two female T&O trainees was hosted online. Attendees completed pre and post-event questionnaires. Students were asked about their previous exposure to T&O, perceptions of gender imbalances in T&O and what barriers they perceived prevented women from entering T&O. Univariate analysis was performed to identify changes in perceptions following the event.ResultsPre-event questionnaires were completed by 102 people; and post-event by 52. Although 64/102 respondents were considering a career in T&O, 26/102 were dissuaded by perceived gender disparities. Perceptions of gender disparities were significantly higher in UK based attendees compared to other nationalities (p = 0.047). Attendees were more likely to want to pursue a career in T&O if they had been directly exposed at medical school (p = 0.044), but exposure did not alter perceptions of women in T&O. The most common perceived barrier was the orthopaedic stereotype followed by male dominated workplace culture, and lack of female role models. Pre and post-event responses did not differ significantly for any areas examined.ConclusionThere are significant concerns amongst medical students regarding gender based discrimination within T&O, and these perceptions were not altered by attending a one-off women in T&O event. Early exposure to T&O appears important to improve interest in orthopaedics, whereas negative stereotyping is a barrier.

Sickle cell disease (SCD) induces a chronic prothrombotic state. Central venous access devices (CVADs) are commonly used for chronic transfusions and iron chelation in this population. CVADs are an additional venous thromboembolism (VTE) risk factor. The role of thromboprophylaxis in this setting is uncertain. The objectives are: (1) to determine whether thromboprophylaxis reduces VTE risk in SCD patients with CVAD and (2) to explore characteristics associated with VTE risk. We identified adults with SCD and CVAD intended for chronic use (≥3 months) at two comprehensive SCD centers. Thromboprophylaxis presence; type; intensity; and patient-, catheter-, and treatment-related VTE risk factors were recorded. Among 949 patients, 49 had a CVAD (25 without and 24 with VTE prophylaxis). Thromboprophylaxis type and intensity varied widely. Patients without thromboprophylaxis had higher VTE rates (rate ratio (RR) = 4.0 (95% confidence interval: 1.2–12.6), p = 0.02). Hydroxyurea was associated with lower VTE rates (RR = 20.5 (6.4–65.3), p < 0.001). PICC lines and Vortex and Xcela Power implantable devices were associated with higher rates compared with Port-a-Cath (RR = 5.8 (1.3–25.9), p = 0.02, and RR = 58.2 (15.0–225.0), p < 0.001, respectively). Thromboprophylaxis, hydroxyurea, and CVAD subtype were independently associated with VTE. The potentially protective role of thromboprophylaxis and hydroxyurea for VTE prevention in patients with SCD and CVAD merits further exploration.

To evaluate the status of UK undergraduate urology teaching against the British Association of Urological Surgeons (BAUS) Undergraduate Syllabus for Urology. Secondary objectives included evaluating the type and quantity of teaching provided, the reported performance rate of General Medical Council (GMC)-mandated urological procedures, and the proportion of undergraduates considering urology as a career. Subjects and MethodsThe uroLogical tEAching in bRitish medical schools Nationally (LEARN) study was a national multicentre cross-sectional evaluation. Year 2 to Year 5 medical students and Foundation Year (FY) 1 doctors were invited to complete a survey between 3 October and 20 December 2020, retrospectively assessing the urology teaching received to date. Results are reported according to the Checklist for Reporting Results of Internet E-Surveys (CHERRIES). ResultsIn all, 7063/8346 (84.6%) responses from all 39 UK medical schools were included; 1127/7063 (16.0%) were from FY1 doctors who reported that the most frequently taught topics in undergraduate training were on urinary tract infection (96.5%), acute kidney injury (95.9%) and haematuria (94.4%). The most infrequently taught topics were male urinary incontinence (59.4%), male infertility (52.4%) and erectile dysfunction (43.8%). Male and female catheterisation on patients as undergraduates was performed by 92.1% and 73.0% of FY1 doctors respectively, and 16.9% had considered a career in urology. Theory-based teaching was mainly prevalent in the early years of medical school, with clinical skills teaching, and

Introduction: Chronic transfusion is a therapeutic modality in the prevention and treatment of end-organ damage in sickle cell disease (SCD) patients. Central venous access devices (CVAD) are commonly used in many SCD patients due to poor venous access. However, CVAD is a known risk factor for venous thromboembolism (VTE) (Evans et al, 2010), with right atrial thrombi prevalence estimated between 5.4 and 12.5% (Shah et al., 2004; Gilon et al., 1998). Although SCD is a prothrombotic state (Wun et al, 2013), it is not known whether this risk factor interacts with CVADs in a synergistic manner to increase the overall risk of VTE. No study has specifically addressed the role of thromboprophylaxis for CVAD-related VTEs in SCD, and as such the practice of prophylactic anticoagulation and/or antiplatelet therapy for CVAD is heterogeneous. We therefore conducted a quality improvement study to investigate whether thromboprophylaxis is a protective factor for new catheter-related thrombi (CRT). Methods: By cross-referencing imaging, thrombosis clinic, and sickle cell clinic databases, we identified adult SCD patients (≥ 18) of all genotypes followed within the Toronto General Hospital SCD center between January 1, 2009 and December 31, 2017 who had a CVAD intended for long-term use (≥3 months). CRT was defined as a VTE that developed while the CVAD was in place. Patients with no VTE during CVAD placement were assigned to the comparator group. Patients who were on anticoagulation for any alternative reason prior to CVAD insertion were excluded. The presence, type, and intensity of pharmacological thromboprophylaxis at the time of CRT or line insertion were recorded. Patient, catheter, and treatment-related risk factors of VTE were extracted from electronic patient records. Fisher-exact and chi-square tests were conducted to explore possible associations between categorical co-variates, and thromboprophylaxis use. Linear regression was performed for continuous variables; while binary logistic regression was conducted to examine the potential association between thromboprophylaxis use and CRT, while adjusting for sex, genotype, hydroxyurea use, and concomitant thrombosis risk factors. Results: We identified 52 unique patients from 3 databases. After applying the inclusion and exclusion criteria, 25 patients were retained as stated in Figure 1-CONSORT Flow Diagram. Patient characteristics are summarized in Table 1-Patient Demographics and Characteristics. Events were distributed as follows: 3 deep venous thrombi, 1 superficial venous thrombus, 1 pulmonary emboli, 2 right atrial thrombi, and 2 thrombi from other sites. Patients with CRT incurred significant sequelae, including open heart surgery to remove the clot in the two patients with right atrial thrombi. Univariate analysis illustrated association between the development of a CRT and the use of thromboprophylaxis, type of thromboprophylaxis, and dose intensity (p=0.011, p=0.011 and p=0.017, respectively). HU use showed a trend towards lower risk for CRT (OR 0.129, p=0.061). However, CRT was not associated with gender, genotype, type, site of insertion, year of insertion, duration of insertion, indication for CVAD, BMI, or ferritin. Association between CVAD thromboprophylaxis and CRT remained significant despite adjusting for sex, genotype, HU and concomitant thrombosis risk factors in binary logistic regression (p=0.032). Patients who received pharmacologic thromboprophylaxis for CVAD were 30.9 times less likely to have a CRT. Due to the limited sample size, not all variables could be included in the logistic regression. Conclusion: The presence of a CVAD is a significant risk factor for VTE in SCD patients. The retrospective study demonstrated that CRTs are associated with the absence of pharmacological thromboprophylaxis for CVADs. In addition, the potential role of HU in reducing thromboembolic risk in SCD patients with CVADs, requires further exploration. Finally, in the event that a CVAD is unavoidable we recommend consideration of pharmacologic thromboprophylaxis, in order to reduce patient morbidity and health-care associated costs. Disclosures Forté: Novartis: Honoraria.

Introduction An ERAS (Enhanced Recovery After Surgery) programme was created to reduce length of stay (LoS) and improve outcomes following renal transplant surgery. This aimed to reduce post-operative hospital-acquired infection, especially COVID-19. Methods The ERAS protocol was finalised following a literature review and MDT discussion. ERAS information, with post-operative exercise advice, was distributed to patients on the renal transplant waitlist. LOS was evaluated, comparing ERAS with pre-ERAS recipients and, to remove pandemic bias, pre-pandemic (December 2019) recipients. Secondary outcomes were opiate use, mobilisation, bowel function and patient-reported outcomes. ERAS protocol compliance was monitored. Data analysis was with student t-test and Chi-2 test in GraphPad Prism. Results Some 35 consecutive recipients completed ERAS protocol (March 2021). Baseline characteristics were comparable between live-donor recipients 9/35 vs 13/35 pre-ERAS and 12/35 pre-COVID. BMI&gt;30 was higher in ERAS group (19vs. 11vs. 8). Median LoS was significantly reduced: ERAS - 5 days, pre-ERAS - 7 days, pre-COVID - 8 days (p=0.01). 51% of ERAS discharges were within 5 days vs. 17% pre-ERAS vs. none pre-COVID (X2 12.59, p&lt;0.001). For overstayers (&gt;5 days), potential preventable reasons were identified. 79.2% of ERAS recipients mobilised on day 1 post-op. ERAS indicated no significant reduced opiate use. Two ERAS recipients were readmitted within 30 days (vs.9/70 pre-ERAS) and one returned to theatre (vs.5/70 pre-ERAS). Conclusion This ERAS programme successfully reduced the LoS by 2 days in comparative population with minimal adverse events. Patient and staff feedback was positive. It's hypothesised that assigning a specialist ERAS nurse will improve compliance.