Peri-operative SARS-CoV-2 infection increases postoperative mortality. The aim of this study was to determine the optimal duration of planned delay before surgery in patients who have had SARS-CoV-2 infection. This international, multicentre, prospective cohort study included patients undergoing elective or emergency surgery during October 2020. Surgical patients with pre-operative SARS-CoV-2 infection were compared with those without previous SARS-CoV-2 infection. The primary outcome measure was 30-day postoperative mortality. Logistic regression models were used to calculate adjusted 30-day mortality rates stratified by time from diagnosis of SARS-CoV-2 infection to surgery. Among 140,231 patients (116 countries), 3127 patients (2.2%) had a pre-operative SARS-CoV-2 diagnosis. Adjusted 30-day mortality in patients without SARS-CoV-2 infection was 1.5% (95%CI 1.4-1.5). In patients with a pre-operative SARS-CoV-2 diagnosis, mortality was increased in patients having surgery within 0-2 weeks, 3-4 weeks and 5-6 weeks of the diagnosis (odds ratio (95%CI) 4.1 (3.3-4.8), 3.9 (2.6-5.1) and 3.6 (2.0-5.2), respectively). Surgery performed ≥ 7 weeks after SARS-CoV-2 diagnosis was associated with a similar mortality risk to baseline (odds ratio (95%CI) 1.5 (0.9-2.1)). After a ≥ 7 week delay in undertaking surgery following SARS-CoV-2 infection, patients with ongoing symptoms had a higher mortality than patients whose symptoms had resolved or who had been asymptomatic (6.0% (95%CI 3.2-8.7) vs. 2.4% (95%CI 1.4-3.4) vs. 1.3% (95%CI 0.6-2.0), respectively). Where possible, surgery should be delayed for at least 7 weeks following SARS-CoV-2 infection. Patients with ongoing symptoms ≥ 7 weeks from diagnosis may benefit from further delay.

Honesty and integrity are key characteristics expected of a doctor, although academic misconduct among medical students is not new.1 A survey of 428 American students in 1980 found that 58% reported cheating during medical school. 2 We assessed students' attitudes and behaviours on "cheating" and aimed to raise awareness of academic misconduct. Methods and resultsThe survey was initiated, designed, and conducted by students. An anonymous questionnaire was distributed to 676 medical students in all years at Dundee medical school (only half of the fourth years were present at this time). The questionnaire was completed at the end of a lecture and collected by the main researcher (SCR). The questionnaire had 14 scenarios in which a fictitious student, "John," engaged in dishonest behaviour. Students were asked to give their gender, year, and views on informing faculty about misconduct and signing a written declaration.For each scenario, students were asked whether they felt John was wrong and whether they had done or would consider doing the same. Responses were recorded "yes," "not sure," and "no" (students were not given the opportunity to distinguish between "have done" and "would consider doing"). Results were analysed with SPSS by using percentage frequency responses.A total of 461 students (68%) completed the questionnaire. Most students' attitude was that most of the scenarios were wrong. The exceptions were resubmitting work from a previous degree, chatting to a student about an objective structured clinical examination that one student has completed and the other is about to do, lending work to other students to look at, and copying text directly and simply listing the source in a reference list.The proportion of students reporting that they had engaged in or would consider engaging in the scenarios varied from 2% (95% confidence interval 1-3%) for copying answers in a degree examination to 56% (51-61%) for copying directly from published text and only listing it as a reference. About a third of students reported that they had engaged in or would consider engaging in the behaviour described in four of the scenarios: chatting about an objective structured clinical examination, writing "nervous system examination normal" when this hadn't been performed, lending work to others to look at, and copying text directly from published sources and simply listing the source in a reference list.

The results have two important implications. First, medical schools have to decide whether students have a duty to whistle blow and/or whether there is a need to devise clear procedures. Any procedures should take into account the reasons given for not whistle blowing, but should concentrate on positive motivating factors. Secondly the medical profession needs to consider the role of whistle blowing, as the results suggest that whistle blowing should not be the only method of detection of misconduct in an undergraduate setting.

Elderly patients who have sustained isolated severe TBI may present with a higher GCS than younger patients. Triage tools using GCS may need to be modified and validated for use in elderly patients with TBI.

SARS-CoV-2 has been associated with an increased rate of venous thromboembolism in critically ill patients. Since surgical patients are already at higher risk of venous thromboembolism than general populations, this study aimed to determine if patients with peri-operative or prior SARS-CoV-2 were at further increased risk of venous thromboembolism. We conducted a planned sub-study and analysis from an international, multicentre, prospective cohort study of elective and emergency patients undergoing surgery during October 2020. Patients from all surgical specialties were included. The primary outcome measure was venous thromboembolism (pulmonary embolism or deep vein thrombosis) within 30 days of surgery. SARS-CoV-2 diagnosis was defined as peri-operative (7 days before to 30 days after surgery); recent (1-6 weeks before surgery); previous (≥7 weeks before surgery); or none. Information on prophylaxis regimens or pre-operative anti-coagulation for baseline comorbidities was not available. Postoperative venous thromboembolism rate was 0.5% (666/123,591) in patients without SARS-CoV-2; 2.2% (50/2317) in patients with peri-operative SARS-CoV-2; 1.6% (15/953) in patients with recent SARS-CoV-2; and 1.0% (11/1148) in patients with previous SARS-CoV-2. After adjustment for confounding factors, patients with peri-operative (adjusted odds ratio 1.5 (95%CI 1.1-2.0)) and recent SARS-CoV-2 (1.9 (95%CI 1.2-3.3)) remained at higher risk of venous thromboembolism, with a borderline finding in previous SARS-CoV-2 (1.7 (95%CI 0.9-3.0)). Overall, venous thromboembolism was independently associated with 30-day mortality ). In patients with SARS-CoV-2, mortality without venous thromboembolism was 7.4% (319/4342) and with venous thromboembolism was 40.8% (31/76). Patients undergoing surgery with peri-operative or recent SARS-CoV-2 appear to be at increased risk of postoperative venous thromboembolism compared with patients with no history of SARS-CoV-2 infection. Optimal venous thromboembolism prophylaxis and treatment are unknown in this cohort of patients, and these data should be interpreted accordingly.