Latest news with #surgeons
Daily Mail
8 hours ago
- Health
- Daily Mail
EXCLUSIVE Respected surgeon groped the breasts and bottoms of female colleagues and pulled down a ward sister's top, trial hears
A highly respected surgeon groped the breasts and bottoms of female colleagues including a doctor and several nurses, a court heard today. Dr Amal Bose, 55, allegedly pulled down a ward sister's top, exposing her bra and breasts, and told her: 'I thought that is where you put my cup of tea.' On at least two occasions when female staff were on their knees completing a hospital task, a jury heard the 'rude and arrogant' surgeon told them: 'I like it when you are down there.' 'Creepy' Dr Bose told one nurse that his fantasy was to tie her up and tried to persuade her to go back to a hotel room to 'show her a good time', it was alleged. However medical staff felt unable to challenge the 'toxic and sexualised' culture he created due to his 'position and authority as a senior consultant', according to the prosecution. Instead hospital workers would attempt to dismiss his behaviour by saying 'That's just Amal', the trial heard. When he was arrested on March 21, 2023, Dr Bose was recorded on police video telling the officer: 'It was only flirting.' He went on trial today charged with 14 counts of sexual assault on female colleagues. The surgeon is accused of assaulting six women between 2017 and 2022. They accuse him of feeling their breasts, slapping their bottoms and, in one case, slipping his hand inside a nurse's wrap-around skirt to touch her groin, Preston Crown Court heard. Dr Bose denies all the charges. The trial heard that doctors at the hospital swapped 'banter and sexualised joking' on WhatsApp groups with names such as Cardiac Sluts and Work Slags. Huw Edwards, prosecuting, told jurors that all the assaults took place at Blackpool Victoria Hospital in Lancashire. 'This was an abuse of his position and authority as a senior consultant at the hospital,' he said. 'It was a toxic and sexualised environment that he created by his behaviour with his sexualised jokes and comments and his slapping nurses' bottoms and grabbing their breasts. 'The complainants we have here were employed by the hospital in roles significantly below Dr Bose who were not in a position to challenge his behaviour. 'It was a toxic and sexualised culture under his leadership. 'His behaviour was a well-known fact in the department and new staff were advised on how to deal with it. 'People would say "that's just Amal".' Mr Edwards said nine of the 14 counts involve the same woman. Dr Bose allegedly targeted her repeatedly, on occasion 'flicking' her breasts, slapping her bottom and making inappropriate comments about how he would like to touch her groin. The woman, who cannot be identified, 'struggled' so much with his behaviour that she asked to be put on a four-day week and only returned to full-time working after Dr Bose was suspended, the prosecutor said. A nurse claimed Dr Bose told her his fantasy was to tie her up. One night after a staff party he tried to persuade her to go back to his hotel room where he would 'show her a good time', it was alleged. A ward sister told police she met Dr Bose a corridor and told him she had moved his cup of tea. He allegedly pulled down her top, exposing her bra and breasts. When she retorted 'That's enough of that' she said he smirked and told her: 'I thought that is where you put my cup of tea.' Dr Bose had a leading reputation in his field which made it harder for colleagues to make a complaint against him, Preston Crown Court (pictured) heard today The court heard that Dr Bose was thought of as a top class doctor with a leading reputation in his field and that this made it harder for people to make a complaint against him. One junior doctor who worked under him told how she was shocked when he grabbed her breasts from behind. When she later complained to him about his behaviour he said he could not remember it. Mr Edwards said the woman later asked to be moved, adding: 'Tellingly, she did not want to take her compliant further because she feared it might affect her career. 'He was a man is a position of power.' Dr Neil Britton, a consultant anaesthetist at the hospital who worked with Dr Bose, told the court he was 'creepy especially around female members of staff'. 'I know all workplaces have a level of banter but it was quite different with Dr Bose,' he said. 'There was a lot of sexual jokes although I can't remember exactly what they were. 'But if he saw that his jokes were making someone uncomfortable it would seem to encourage him. 'I do know he told me that one female member of staff needed "a good shag". 'I remember he would take a lot of young students into his office and they seemed to be always female.' Dr Britton it 'made me feel sick' when he was told what language one member of staff was subjected to. But he agreed with defending barrister Tom Price KC that 'banter and sexualised joking' were part and parcel of many workplace environments, especially in highly pressurized ones like hospitals. He was also asked if he knew of a WhatsApp group called Cardiac Sluts to which he said: 'No.' But he admitted to belonging to another group called Work Slags to which he sent a picture of a camper van which bore the legend Dr Wiggles Weiner Wagon. He captioned it: 'Got a picture of Amal's new car at the weekend.' Several messages on the group referred directly to Dr Bose but also contained pictures of things like a supposed scented candle called Sweaty Bollocks. Mr Price said: 'It shows the level of humour in the department, doesn't it?' Dr Britton agreed but said no one in the group was 'uncomfortable about it'. Another doctor who gave evidence, Dr Gillian Hardman, told the court that one female colleague told her: 'The first time he groped me I just went to the bathroom and cried.' Dr Hardman - who is not one of the alleged victims - described Dr Bose as 'rude and arrogant'. She admitted there was some sexual banter on the wards and that it continued on WhatsApp groups like Work Slags.
Telegraph
9 hours ago
- Business
- Telegraph
The NHS teams mopping up sloppy foreign surgery
As consultant plastic surgeon at Manchester's busy Wythenshawe Hospital, a typical day for Dr Fouzia Choukairi involves spending hours in the operating theatre reconstructing someone's limbs following a terrible traffic accident. But every few weeks, she or an on-call colleague will be buzzed to the A&E department where, among the melee of broken bones, bleeding gashes and limping children, she will face a different challenge: performing sometimes life-saving treatment on a patient who has returned from overseas having had cosmetic surgery. 'They may have had tummy tucks [abdominoplasty] or breast implants,' she explains. 'But then they will have got a wound or implant infection after flying home, and they may be very, very sick. They can need life-saving treatment, and it can involve a huge team – not just the A&E staff but surgeons, microbiologists, intensive care specialists, anaesthetists, nurses, wound care and rehabilitation staff. 'The patients are often very grateful, and sometimes verbally regret having had the surgery,' she adds. 'I guess you're not going to stop people from going abroad for surgery, but we do feel patients are not well-informed or well-equipped to deal with any complications.' For years, NHS staff have voiced concern at having to 'mop up the mess' caused by foreign cosmetic procedures mostly undertaken in Turkey, considered the medical tourism capital of the world. All too often, they say, the promise of cheap liposuction, BBLs (Brazilian butt lifts), facelifts and hair transplants promoted online and sold as part of 'luxury holiday packages' can result instead in infections, blood clots, sepsis, deformities and even death. Now, however, they are warning of a new issue – that of antibiotic-resistant superbugs being brought back from overseas into UK hospitals by these patients. 'Turkey is a gateway between East and West,' explains Dr Choukairi, who also works at Hale Private Clinic in Manchester. 'You have a huge mixture of people from all over the world flowing through these hospitals, airports and hotels. The patient would have travelled back on a plane, perhaps with open wounds or dressings, and they can pick up multi-resistant bugs at any of these steps. 'Usually, antibiotics can target infections very efficiently but if you're faced with a multi-resistant bug or an unusual bug, you have to throw broad-spectrum antibiotics at it, which are not as efficient and may take longer to clear it. 'If the person is very sick and requires intensive care, this is the worst-case scenario. And, of course, there is a small risk these bugs can be passed onto the person in the next bed if, say, they are immunosuppressed or also have open wounds.' Alarming developments Her concern over antibiotic-resistant bugs being brought into the NHS is not in isolation. At the recent Royal College of Nursing annual conference in Liverpool, NHS nurses spoke of 'horrific' wounds and infections seen in patients following overseas surgery. Nykoma Hamilton, an infection control nurse in Fife, Scotland, said patients were increasingly infected with bacteria resistant to even the strongest antibiotics – a group of drugs called carbapenems, which are used as a last resort when all other antibiotics have proved ineffective. Describing the superbugs as the 'absolute granddaddy of resistance', she told the conference that NHS hospitals and clinics in her area had recorded a 'near 30 per cent' increase in carbapenem-resistant bacteria in recent years. 'Our concerns relate to the fact that a lot of people are colonised with a lot of extensively drug-resistant organisms,' she said. It is an alarming development. The World Health Organisation has previously warned that the world is heading for a 'post-antibiotic' era, with figures from the UK Health Security Agency showing the number of antibiotic-resistant infections across the UK has grown by seven per cent in recent years, up from around 62,000 in 2019 to nearly 67,000 in 2023. Doctors are also warning the risk of such infections is only likely to grow due to the numbers having foreign cosmetic surgery rising each year. Last year, an estimated 150,000 Brits travelled to Turkey for beauty tweaks – with some saying the rise of NHS weight loss drugs such as Wegovy and Mounjaro have fuelled the trend. 'Massive weight loss can result in loose skin on the face, tummy, arms and thighs,' says Dr Mo Akhavani, consultant plastic surgeon at the Royal Free Hospital in Hampstead, London, who regularly deals with post-operative complications. 'People understandably don't want to live with this, but the NHS has finite resources and, although the health benefits are well known, the procedure is deemed low priority, so people go overseas for cheap surgery. He adds: 'The surgeons in Turkey are often very good and the vast majority of operations go right, but the aftercare can be a problem.' Dr Akhavani, who also works at London's Plastic Surgery Group, says he has helped a 'growing' number of patients, especially since Covid. In 2023, figures from the British Association of Aesthetic Plastic Surgeons (BAAPS) also showed a 94 per cent rise in three years of people needing corrective surgery on the NHS – with the total cost to the taxpayer being around £4.8 million. 'There are factors leading to this increased risk,' he tells The Telegraph. 'First, if a patient has had huge weight loss, they may well have had other conditions such as diabetes and high blood pressure, which can cause complications. 'Then they may have multi-site surgery, which UK doctors wouldn't advise doing, where loose or fat skin is removed from several areas, and perhaps combined with breast implants or other procedures, meaning longer on the operating table and an increased risk of blood clots and even death. 'Thirdly, patients must also refrain from getting on a flight for six weeks post-surgery but they often fly straight home, which can lead to wound-healing problems.' Dr Akhavani adds, 'We see them in A&E sometimes with gaping wounds and pus pouring out. They need antibiotic drips, then can be taken into theatre to wash out the infection, and may end up in intensive care for weeks. Often we are giving life-saving treatment but we will not correct deformities, such as removed implants, from the emergency surgery. This is the NHS and that ultimately means taxpayers' money needs to be protected.' In previous years, both the BAAPS and the British Medical Association (BMA) have highlighted the risks involved with the $4.5 billion (£3.5 billion) global industry. These include the lack of proper consultations and risk assessments, paperwork in a foreign language, and a financial commitment to the surgery prior to travel. Aftercare concerns With surgery tied to luxury packages, patients may often have top hotels and transport, but no health monitoring post-surgery. One doctor told The Telegraph in graphic detail of a patient who had had a BBL, but then flew home, with the fat seeping out of the wound while on the plane. The patient needed three separate surgeries to repair it and was left 'traumatised'. A second nurse at the recent RCN conference recounted a young woman who had skin removal in Turkey, then returned to the UK with a large thigh wound only loosely held together with stitches. She also had dying tissue and sepsis. 'All she told me about was how fantastic the hotel was after she'd had her surgery and that they took her back to a posh car,' she said. 'But there was no blood pressure testing, no aftercare for this woman at all. In fact, I'm surprised she made it back on the flight. It's really scary.' In 2022, a mother from Berkshire, known only as Carrie, contracted a flesh-eating virus after having a £4,500 tummy tuck in Istanbul. Four days after returning to the UK, she was rushed to hospital and treated for sepsis and organ failure. The same year, Pinky Jolley required treatment in two Liverpool hospitals following botched £2,100 gastric sleeve surgery abroad that left her with multiple infections, sepsis and a permanently damaged oesophagus and stomach. She was left needing a feeding tube and largely bed bound. The growing probability of superbugs has also been highlighted, with the BAAPS saying: 'Some people are returning with multi-resistant bacteria that are hard to treat and may infect other people.' In November 2024, following a spate of deaths of women who had flown to Turkey for BBLs, these concerns reached the top of government, with Wes Streeting, the Health Secretary, urging people to 'think very carefully' before going overseas for surgery. Back on the NHS front line, however, doctors see little chance of this happening. Dr Amer Hussain is a plastic surgeon at Leeds Teaching Hospitals. His work involves reconstructing breasts for women who have had mastectomies following cancer. But at times he has to postpone such operations due to hospital bed shortages caused by beds occupied by those in need of urgent care. 'Patients come in following Turkey operations with infected breast implants,' he says. 'They have redness, fever or discharge from the wound and the implant needs to be removed. We are also seeing bad infections – with the bugs not even necessarily endemic to Turkey, meaning they are coming from elsewhere in the world.' Like all doctors, he is aware of the strain on the NHS. 'I do major breast reconstruction, often for cancer patients, and the backlog of these operations due to Covid has still not been reduced,' he explains. 'So doing these emergency surgeries does have an impact on waiting times, beds and theatre time. 'The problem is that this is high-volume surgery abroad, without checks and balances, and the NHS is being forced to step in. But it is frustrating, because at the end of the day, where resources are precious, they should be for patients who need them the most.'
National Post
3 days ago
- Business
- National Post
Michael Higgins: A doctor's quest to connect patients with private health-care options
Article content 'There are lots of rules and regulations and they can be a little complex, but we're trying to make that a little less veiled in secrecy and trying to make it more open and transparent,' said Haffey. Article content Surgeons on the platform will focus on elective procedures — the surgeries that the health-care system deems non-urgent, but can severely impact a person's life. Article content 'The most commonly associated procedures are going to be things like joint replacement, hip and shoulders and ankles, gynecological procedures for things like urinary incontinence or pelvic organ prolapse, and non-cancer indications for urologic, ENT, plastics and spinal surgeries,' he said. Article content 'My efforts are mostly targeted at orthopedic surgeons … just because their wait times are ballooning out of control. In some provinces, they're exceeding two years, which is just insane.' Article content Haffey is now including surgeons from other specialties, while avoiding some areas. Article content 'We decided not to focus on cancer or cardiovascular or vascular limb surgeries, first of all because the public system works really well at getting patients care when it is urgent. People might wait a little longer than they're comfortable with, but generally speaking, the public system is good with those life-threatening indications,' he said. Article content The platform has 100 surgeons listed so far, but Haffey hopes to have 500 by the end of the year. Article content 'I wanted to try fixing the system from the inside. Waiting around for policy changes and for the system to fix itself over the past few decades have proven to be an ineffectual way of going about it,' said Haffey. Article content 'I just wanted to build a tool that I wish I had and is something that other primary-care physicians can share with their patients and say, 'Just so you know, there's this free tool and it's something that can help explore your options more.' ' Article content The new platform will probably upset those who see it as another advance of private health care, to the detriment of the universal system. Article content But Haffey sees it as a complement to a system in which, all too often, patients see their conditions spiral out of control before they can even see a surgeon. Article content
Medscape
5 days ago
- Health
- Medscape
Scientists Invent a Literal Thinking Cap
This transcript has been edited for clarity. Welcome to Impact Factor , your weekly dose of commentary on a new medical study. I'm Dr F. Perry Wilson from the Yale School of Medicine. My job (my real job) as a clinical researcher is complex. It's cognitively challenging; there are multiple studies to keep track of, grants and papers to write, a large group of mentees and trainees and staff in the lab to manage. It's emotionally stressful too — recently more than ever, in fact. But if I'm tired, or I ate a bad burrito for lunch, or I get some bad news on a personal level, it's not a crisis. I'm not making life-or-death decisions in a split second. I can take a break, gather myself, prioritize, and come back when I'm feeling better. Not every job has that luxury. A surgeon doesn't get to take a break in the middle of an operation if they feel like they are not at 100%. An air traffic controller can't walk away from ensuring that planes land safely because their kid woke them up in the middle of the night. These jobs and others like them have a unique challenge: a constant cognitive workload in a high-stakes environment. And the problem with constant cognitive work is that your brain can't do it all the time. If you force it to, you start to make mistakes. You can literally get tired of thinking. Think of how the world might change if we knew exactly how overloaded our cognitive processes were. I'm not talking about a subjective rating scale; I'm talking about a way to measure the brain's cognitive output, and to warn us when our ability to keep thinking hard is waning before we make those critical mistakes. We're closer than you think. The standard metric for assessing cognitive workload is the NASA Task Load Index. Yes, that NASA. The Task Load Index is a survey designed to assess how hard a task is. It was originally designed to be used in human-machine interactions, like piloting a spaceship. It's subjective. It asks you to rate how mentally demanding a task is, how frustrating, how much effort it takes, and so on. Cognitive researchers have used this scale to demonstrate how successive mentally stressful tasks degrade task performance. Science has demonstrated that taking breaks is a good thing. I know — news at 11. The problem with subjective scales, though, is that people have a tough time being objective with them. Astronauts might tell you a task was easier than it really was because they want to be chosen to ride on the rocket. Or a doctor might evaluate a complex surgery as less mentally taxing so they can continue to operate that day. Bringing objectivity to the brain is hard. Sure, you can do an fMRI scan, but sitting inside a metal tube is not conducive to real-world scenarios. You can measure brain fatigue in the real world with an EEG, though. The problem is that an EEG involves wires everywhere. You're tethered. And the goo, the sticky stuff that they use to put the electrodes on your head, is very sensitive to motion. In anywhere but a dedicated neuroscience lab, this isn't going to work. I thought the day of real-time monitoring of cognitive load would be pretty far off because of these limitations, and then I saw this study, appearing this week in the journal Device, from CellPress. It reimagines the EEG in a way that could honestly be transformational. There's a not-too-distant future when you'll be able to recognize people with highly cognitively intense jobs because they will look something like this. What you're looking at is a completely wireless EEG system. The central tech here is what the researchers call an 'e-tattoo' — but think of it like those temporary tattoos your kids wear. Conductive wires are printed on a thin transparent backing which conforms to the forehead. Electrodes make contact with the skin via a new type of conductive adhesive. The squiggles in the wires allow you to flex and move without breaking connections. That whole printed setup is made to be disposable; apparently the material cost is something like $20. The blue square is the ghost in the machine, a processor that receives the signals from the electrodes and transmits them, via low-energy Bluetooth, to whatever device you want. It's got a tiny battery inside and lasts for around 28 hours. In other words, even in this prototype phase, you could wear this thing at your cognitively intense job all day. And yeah, you might get a few looks, but the joke will be on them when the algorithm says your brain is full and you need to take a 15-minute rest. Of course, cool tech like this is only cool if it actually works, so let's take a look at those metrics. The first thing to test was whether the device could perform as well as an EEG on a simple task. Six adults were recruited and wore the tattoo at the same time as a conventional EEG. They were then asked to open and close their eyes. There's a standard finding here that with eyes closed, alpha frequencies, mid-range brain oscillations, dominate. You can see the patterns recorded by the standard EEG and the new tattoo system here. They are basically indistinguishable. But the tattoo system, with its flexible design, offers some particular advantages. One of the problems with conventional EEGs is how sensitive they are to motion. You turn your head, you get a bunch of noise. Walk around, and the signal becomes useless. Not so with the tattoo. These graphs show the electronic noise levels when the participant was doing various motions. Broadly speaking, you can see that the tattoo continues providing solid, reliable recordings even when walking or running, while the EEG goes all over the place with noise. The only exception to this was with eyebrow raising — maybe not surprising because the tattoo goes on the forehead. But I didn't start off telling you we have a new flexible EEG tech. I told you we had tech that could quantify our cognitive load. Here's how they tested this. In the lab, they had their volunteers do a cognitive task called the N-back test. It starts at level 0. Basically, they ask you to click a button whenever you see the letter Q or something. Easy. Level 1 is a bit harder. You have to click the button when the image on the screen matches, in either location or content, the image from one screen ago — one image back. Get it? Level 2 is even harder. You click when the current image matches, in content or location, the image from two screens ago. Level 3 gets really stressful. You have to click when you see something that matches three screens ago. And, of course, this keeps going, so you have to keep this information in your memory as the test continues. It's hard. It taxes the brain. Here are the results on the NASA survey scale. This is what the participants reported as to how mentally taxed they were. As the N gets higher, the cognitive stress gets higher. So the system works. The participants, you won't be surprised to hear, performed worse as the N increased. At higher N, the detection rate — the rate at which matches were appropriately clicked — declined. The reaction time increased. False alarms went up. All hallmarks of cognitive stress. And the e-tattoo could tell. Feeding its wireless output into a machine learning model, the researchers could predict the level of cognitive stress the participant was under. They show the results for the participant where the system worked the best — a bit of cherry-picking, certainly, but it will illustrate the point. The blue line indicates what level of the N-back test the participant was actually taking. The red line is what the machine learning model thought the participant was doing, just from reading their brain waves. They match pretty well. Again, that was just the time the experiment worked best. The overall results aren't quite as good, with a weighted accuracy metric ranging from 65% to 74% depending on the subject. Clearly better than chance, but not perfect. Still, these are early days. It seems to me that the researchers here have solved a major problem with monitoring people doing cognitively intense tasks — a way to read brain waves that does not completely interfere with the task itself. That's a big hurdle. As for the accuracy, even an imperfect system may be better than what we have now, since what we have now is nothing. But I have no doubt that with more data and refinement, accuracy will increase here. When it does, the next step will be to test whether using these systems on the job — in air traffic control towers, in operating rooms, in spaceships — will lead to more awareness of cognitive strain, more rest when it is needed, and better decision-making in the heat of the moment.
Medscape
6 days ago
- Health
- Medscape
Team Familiarity: Key to Better Outcomes in Surgery?
Familiarity between surgeons and anesthesiologists was associated with improved outcomes in gastrointestinal, gynecologic oncologic, and spine surgeries, with each additional procedure performed together associated with reduced odds of 90-day postoperative major morbidity. METHODOLOGY: Researchers conducted a retrospective cohort study using administrative healthcare data in Canada to assess the link between how often teams of surgeons and anesthesiologists worked together and outcomes for their patients. They included men and women aged 18 years or older who underwent high-risk elective surgeries with a postoperative stay over 24 hours from 2009 to 2019. Clinician familiarity was measured by case volume, defined as the average annual number of procedures performed by the same surgeon-anesthesiologist pair in the 4 years prior to the index operation. Procedures included cardiac, high- and low-risk GI, genitourinary, gynecologic oncologic, orthopedic, neurosurgery, spine, thoracic, vascular, and head and neck surgeries. The primary outcome was 90-day major morbidity. TAKEAWAY: The analysis included 711,006 procedures. For most surgeries, the median dyad volume was three or fewer procedures per team per year, except for cardiac and orthopedic surgeries, which had median volumes of nine and eight procedures per group per year, respectively. Each additional procedure per year for the same surgeon-anesthesiologist pair was associated with a 4% reduction in the odds of 90-day morbidity for low-risk GI surgery (adjusted odds ratio [aOR], 0.96; 95% CI, 0.95-0.98) and an 8% reduction in the odds for high-risk GI surgery (aOR, 0.92; 95% CI, 0.88-0.96). For gynecologic oncologic and spine surgeries, each additional procedure performed per year by the same surgeon-anesthesiologist pair was associated with a 3% reduction in the odds of 90-day morbidity (aOR, 0.97; 95% CI, 0.94-0.99 and aOR, 0.97; 95% CI, 0.96-0.99, respectively). No significant association was found for other procedures. Dyad volume was also independently associated with 30-day major morbidity for high-risk (aOR, 0.90; 95% CI, 0.86-0.94) and low-risk (aOR, 0.96; 95% CI, 0.94-0.97) GI surgeries. IN PRACTICE: 'These findings indicate that for each additional procedure performed by a specific surgeon-anesthesiologist dyad, there is a corresponding decrease in the likelihood of experiencing 90-day major morbidity. Each procedure done together matters,' the authors of the study wrote. 'Increasing the familiarity of surgeon-anesthesiologist dyads or the number of procedures they do together represents an opportunity to improve patient outcomes for GI, gynecology oncology, and spine surgery,' they added. 'These results make coordinated scheduling of consistent surgeon-anesthesiologist dyads (and nurse staffing) an attractive process measure for surgical quality improvement,' experts wrote in an commentary accompanying the journal article. SOURCE: The study was led by Julie Hallet, MD, MSc, of the Department of Surgery at the University of Toronto, Toronto, Ontario, Canada. It was published online on May 28, 2025, in JAMA Surgery . LIMITATIONS: The use of routinely collected health administrative data may have introduced the risk for misclassification and limited the details on factors affecting patient outcomes. Owing to the focus on surgeon-anesthesiologist dyads, the contributions from other team members, such as nurses, trainees, and assistants, were excluded. The analysis was limited to high-risk and elective surgeries. DISCLOSURES: This study was supported by ICES, which is funded by the Ontario Ministry of Health and the Ministry of Long-Term Care and the Sunnybrook AFP Innovation Fund. One author reported receiving grants during the conduct of the study and personal fees and grants outside the submitted work. Another author reported receiving consulting fees from pharmaceutical and medical device companies.
