Background: Surgeons urgently need guidance on how to deliver surgical services safely and effectively during the COVID-19 pandemic. The aim was to identify the key domains that should be considered when developing pandemic preparedness plans for surgical services. Methods: A scoping search was conducted to identify published articles relating to management of surgical patients during pandemics. Key informant interviews were conducted with surgeons and anaesthetists with direct experience of working during infectious disease outbreaks, in order to identify key challenges and solutions to delivering effective surgical services during the COVID-19 pandemic.Results: Thirteen articles were identified from the scoping search, and surgeons and anaesthetists representing 11 territories were interviewed. To mount an effective response to COVID-19, a pandemic response plan for surgical services should be developed in advance. Key domains that should be included are: provision of staff training (such as patient transfers, donning and doffing personal protection equipment, recognizing and managing COVID-19 infection); support for the overall hospital response to COVID-19 (reduction in non-urgent activities such as clinics, endoscopy, non-urgent elective surgery); establishment of a team-based approach for running emergency services; and recognition and management of COVID-19 infection in patients treated as an emergency and those who have had surgery. A backlog of procedures after the end of the COVID-19 pandemic is inevitable, and hospitals should plan how to address this effectively to ensure that patients having elective treatment have the best possible outcomes.

Aim The aim was to determine the importance of a colorectal surgeon's personality to patients and its influence on their decision-making. Methods We present a two-part mixed methods study using the Guidance for Reporting Involvement of Patients and the Public (GRIPP-2) long form. Part 1 was an online survey (25 questions) and Part 2 a faceto-face patient and public involvement exercise. Part 1 included patient demographics, details of surgery, overall patient satisfaction (net promoter score) and patient views on surgeon personality (Gosling 10 Item Personality Index). The thematic analysis of free-text responses generated four themes that were taken forward to Part 2. These themes were used to structure focus group discussions on surgeon-patient interactions. Results Part 1 yielded 296 responses: 72% women, 75.3% UK-based and 55.1% aged 40-59 years. Inflammatory bowel disease (45.3%) and cancer (40.2%) were the main indications. 84.1% of respondents reported satisfaction with their surgical experience (net promoter score). Four key themes were generated from Part 1 and validated in Part 2: (i) surgeon personality stereotypes (media differed from patients' perspective); (ii) favourable and unfavourable surgical personality traits (openness, conscientiousness, emotional stability preferred over risk-taking and narcissism); (iii) patient-surgeon interaction (mutual respect and rapport valued); (iv) impact of surgeon personality on decision-making (majority unaware of second opinion option; management of postoperative complications). Conclusion Patients believe surgeon personality influences shared decision-making. Low levels of emotional stability and conscientiousness are perceived by patients to increase the likelihood of postoperative adverse events. Further work is required to explore the potential influence of surgeon personality on shared decisionmaking and postoperative outcomes. Keywords surgeon, personality, patient and public involvement, PPI What does this paper add to the literature? This is the first study to explore patient perceptions of the influence of the surgeon's personality on shared decision-making. Patients believe high levels of openness, conscientiousness and emotional stability are positive personality traits in surgeons and believe that, if lacking, the management of postoperative outcomes can be negatively influenced.

Objectives and settingThe aim of this study was to create a hashtag #SoMe4Surgery on the social network application Twitter, and to examine the natural history of the resulting online community.Design and outcome measuresA prospective, four-stage framework was proposed and used: (1) inception phase (connection): users were actively invited to participate; (2) dissemination phase (contagion): several tweetchats were designed, scheduled and run; (3) adherence phase (feedback): Twitonomy and NodeXL summaries were regularly posted on Twitter; and (4) impact phase (outcomes): abstracts and manuscripts, and related projects on Twitter. Tweets, influencers and interactions were analysed, and a brief survey was shared with participants to assess demographics and motivations of social media use.ParticipantsUsers engaging with the #SoMe4Surgery hashtag.ResultsUsers of the hashtag came from a wide variety of specialties and geographical locations, as well as varying in age and stage of training. The inception of #SoMe4Surgery was followed by an increase in the follower count and impressions of users. A total of 675 tweeters posted 11 855 tweets with 30 122 retweets between 28 July and 27 December inclusive. There were new contributors and activity throughout the period. There were many more retweeters than accounts posting original content. Over a 10-day period ending on 31 December 2018, the number of followers of the 10 most influential accounts was higher than the number of followers of the 10 most engaging accounts (p=0.002). The mean (SD) number of tweetchat participants was 121 (64), who posted 719 (365) tweets and had a potential reach of 3 825 155 (1 887 205) accounts. Spin-off projects included surveys from low and medium-income countries, subspecialised hashtags, presentations and one publication.ConclusionsThe creation of a cohesive online surgical community may allow a flattened hierarchy, with increased engagement between surgeons, other healthcare professionals, researchers and patients.

AimTo explore the experiences of support garments when adjusting to bodily change following bowel stoma formation.DesignThematic analyses of free-text responses in a cross-sectional survey of the stoma population in 2018.MethodsFree-text responses were invited so that respondents could describe their experiences in more detail. A process of induction was chosen to allow for themes to emerge directly from the data. The concept ‘embodiment’ was used as a theoretical framework during interpretation.Results1425 people with a bowel stoma responded to the survey, of whom 598 provided free-text responses. Four themes about experiences of support garments in the context of changed bodily experiences following stoma formation were identified: body complications, which is about experiences of using support garments to prevent or self-manage parastomal hernia; body appearance, which is about hiding the stoma and stoma appliance; body function, which is about managing stoma appliance complications; and body sensation, which is mainly about negative experiences of ill-fitting garments.ConclusionSupport garments can be understood as items that are used by people during an ongoing process of adjusting to bodily changes following stoma formation and as part of an ongoing process of reconstructing new embodied selves.ImpactThis is the first study to explore people’s experiences of support garments following bowel stoma formation. Support garments are used in the self-management of body complications, appearance, function and sensations. Stoma nurses may draw on the findings of this study to advise patients about the benefits of garments for adjusting to bodily change, and garment suppliers should address people’s negative experiences by improving garments.

Aim: Discussions regarding sex after colorectal and pelvic floor surgery are often overlooked by clinicians. This is the first patient designed and delivered study to explore sexual function and practices after colorectal surgery. The aim was to explore the questions about sex that matter to patients and their partners following colorectal or pelvic floor surgery through a patient and public involvement survey. The results of this work will underpin the creation of a sex patient reported outcome measure.Methods: An anonymous online survey tool (Survey Monkey™) was disseminated via social media (Twitter, Facebook). Thematic analysis was applied to 130 free text comments posted by participants to identify key themes.Results: Some 632 individuals completed the survey. Most respondents were women (80% n = 507), 49.5% (n = 312) were married and 14% (n = 87) identified as LGBT+ (lesbian, gay, bisexual and transgender +). Indications for surgery varied: 34% were treated for ulcerative colitis (n = 214); 31% Crohn's (n = 196); 17% (n = 109) cancer; and 17%(n = 110) for perianal fistula. For patients who had a stoma formed (85%, n = 540), over half (51%, n = 324) lived with their stoma for 1-5 years. Respondents reported substantial alterations to their preferences for sexual positions, sexual activity and body confidence following surgery. Most respondents indicated that they were not offered advice about sex by a healthcare professional. Conclusions:The survey showed a substantial impact on the mechanics of sex following colorectal surgery. Few patients were offered preoperative information regarding sex, which has implications for informed consent. This study demonstrates a clear unmet need, voiced by patients, that open dialogue is necessary preoperatively to discuss sexual (dys)function.