Wishaw General Hospital

Abstract Background The COVID-19 pandemic posed an existential challenge on medical education (Ferrel & Ryan, 2020; Sahi et al., 2020). Complete removal of medical students from clinical rotations and limitations on physical interactions drastically affected the in-person learning opportunities available and demanded innovation toward online education. Though COVID-19 restrictions have eased, limitations on in-person teaching will persist due to infection control measures, logistical difficulties, and with the expectation of other epidemics in the future (Marani et al., 2021). OSCE (Observed Structured Clinical Examination) Prep UK developed a virtual learning environment to characterise and mitigate the disruptive impact that the COVID-19 pandemic caused to medical education. The overarching goal was to provide an accessible, reproducible, and scalable platform to aid and enhance future medical student learning. Aim To assess and mitigate negative disruptions in undergraduate medical education caused by COVID-19, through a data driven interactive virtual learning environment. Methods Medical students completed online questionnaires detailing COVID-19 related training disruption. 29 hour-long interactive system-specific clinical examination tutorials were delivered with accompanying asynchronous online content. Pre-and-post session questionnaires assessed quantitative changes in knowledge and confidence, and qualitative perceptions of the value of the materials. Results 1693 participants completed the COVID-19 survey. >75% described reduced patient contact, bedside teaching, and clinical skills training. 69% reported university teaching gaps. <20% were satisfied with clinical skills training. <35% felt competent performing expected clinical examinations. >85% desired supplemental teaching. Over 689 attendances, >95% of participants, agreed that sessions: enhanced locally organised teaching; led to achieved learning outcomes and were relevant to their curriculum. Median increases in knowledge and confidence scores were 25% (IQR:0-60%, p<0.01) and 43% (IQR:23-81%, p<0.01) respectively. Discussion Medical students reported significant medical education disruptions and shortfalls due to COVID-19. OSCE Prep UK’s virtual learning environment was highly valued, in great demand and demonstrated significant improvements in student knowledge and confidence. This extremely scalable and reproducible educational model can continue to improve accessibility, efficiency, and efficacy of undergraduate medical education, particularly when physical resources are limited.

Neurofibroma is a benign tumor of nerve sheath of peripheral nervous system. It frequently involves the skin and rarely the oral mucosa. The pattern of the disease has been recognized as hereditary with an autosomal dominant trait with variable penetrance. The most common variant is neurofibromatosis type I (NF-I). The oral lesions occur as discrete, nonulcerated nodules, which tend to be of the same color as the surrounding mucosa. Usually occurs on the buccal mucosa, palate, alveolar mucosa, vestibule and the tongue. A case of asymptomatic swelling of the right side of the tongue near the tip since 02 years is presented. The swelling was gradual in onset and slowly increased in size. It was a solitary diffuse, smooth, firm and non-tender swelling of the right side of the tongue near the tip. Excision was done under lingual nerve block by local anesthetics (2% Lidocain with Adrenalin) and biopsy was performed and histological examination revealed spindle cells having serpentine nuclei, arranged in bundle and fascicles is a fibrillary background. Bangladesh J Otorhinolaryngology 2025; 31 (1) Page-42-46

Psychological problems are associated with substantially reduced life expectancy. Addressing the clinical needs of children and young people presenting with suicidal thoughts, self-harm, and eating disorders is critical for preventing premature mortality and promoting wellbeing. However, there may be some uncertainty around how well Scottish Child and Adolescent Mental Health Services (CAMHS) achieve this goal. This article describes some of the key innovations that have been introduced in NHS Lanarkshire CAMHS over recent years to meet the clinical needs of children and young people at risk of premature mortality. As well as being a moral imperative, addressing the needs of this important population is consistent with the CAMHS NHS Scotland national service specification and the Scottish NHS Recovery Plan following the Covid-19 pandemic. We have endeavoured to develop and deliver high-quality clinical services for children and young people at risk of premature mortality and are committed to continually improving the efficiency and effectiveness of the services we offer.

Breast cancer remains a prevalent disease in women worldwide. Though advancements in breast cancer care have improved patient survival, a breast cancer diagnosis, and subsequent interventions have a lasting impact on patients' lived experiences during the pandemic. We present the collaborative learning process from this patient engagement workshop series as a community-academic partnership. Narrative medicine tools were used to recount patients' lived experiences following diagnosis, where both patients and researchers shared their cancer research activities in each workshop, and the role of the multidisciplinary healthcare team was discussed. We used an iterative approach to cohort building, narrative development, and the use of multiple media formats to capture stories. Over 20 patients with breast cancer shared their stories for the first time since their diagnosis with a wider audience. Here, we present the learning process and considerations from this event. Understanding patients' lived experiences can support researchers and healthcare professionals in developing an empathetic approach to shared healthcare decision making. Moreover, understanding the lived experiences of patients is critical to addressing disparities in healthcare.

Abstract Aims Determine human factors implicated in cases submitted to the Confidential Reporting System in Surgery (CORESS), using the non-technical skills for surgeons (NOTSS) framework. Methods Consecutive cases submitted to CORESS, between 2005 and 2011 were evaluated as an interim analysis. The type of case, whether patient harm occurred, Clavien-Dindo (CD) classification, and the location of the incident were collected. Demographic data was not collected because they are often changed to protect patient identification. Each case was reviewed according to the non-technical skills for surgeons (NOTSS) taxonomy. Results There were 100 cases included in this interim analysis. The most common types of cases were delayed diagnosis (n=19), known complications (n=10), near misses (n=10), poor surgical technique (n=9), misuse of equipment/device (n=8), and wrong site surgery (n=5). Two-thirds of patients were harmed, with complications ranging from minor to life-threatening (9 CD I, 10 CD II, 32 CD III, 12 CD IV), and 4 resulting in death (CD V). Incidents occurred most frequently in the operating theatre (n=54), the ward (n=16), or the emergency department (n=9). There were 71 incidents that endangered patient safety related to deficiencies in situational awareness, 59 to poor communication and teamwork, 48 to poor decision-making, and 48 related to leadership failures. Conclusions The main human factors implicated in surgical patient safety incidents related to errors in situational awareness, communication and teamwork, and to a lesser extent, decision-making, and leadership. Efforts to prevent medical errors should be focused on clinician human factors training.

Abstract Aims Determine the desired future operative role of dedicated Emergency General Surgery (EGS) surgeons in the United Kingdom (UK) and the Republic of Ireland (ROI), and how to improve the attractiveness of an EGS post. Methods A live interactive online survey, designed and endorsed by ASGBI, was completed by attendees at two ASGBI conferences in 2023. The study was conducted according to CHERRIES and exempt from REC according to HRA. Consent was obtained from study participants, who were asked using a Likert scale which operations a dedicated EGS surgeon should perform and how an EGS post could be more attractive. Results The survey was completed by 156/371 eligible participants, of which 132 responses were analysed once duplicate responses (n=16), and non-UK/ROI respondents (n=8), were excluded. Participants included consultants (34%), surgical trainees (42%), and other doctors (23%), 61% were male and 39% were female, aged between 25 and 69. Respondents stated the desired future operative role of EGS surgeons included most EGS operations, including for torso trauma. Few believed EGS surgeons should perform emergency colonic resection for cancer (49%) or inflammatory bowel disease (37%), gastric volvulus (34%), bariatric complications (26%), or Boerhaaves (28%). The vast majority agreed that EGS posts could be improved by including elective general and subspecialty operating lists, continuing professional development, minimally-invasive (laparoscopic/robotic) opportunities, rest days post-on-call, family-friendly hours, EGS ambulatory and follow-up clinics, and major trauma responsibility. Conclusions EGS surgeons should operate on the majority of EGS patients. Job plans that include elective operating, professional development, and patient follow-up may improve recruitment and retention.

AimsOccult (clinical) injuries represent 15% of all scaphoid fractures, posing significant challenges to the clinician. MRI has been suggested as the gold standard for diagnosis, but remains expensive, time-consuming, and is in high demand. Conventional management with immobilization and serial radiography typically results in multiple follow-up attendances to clinic, radiation exposure, and delays return to work. Suboptimal management can result in significant disability and, frequently, litigation.MethodsWe present a service evaluation report following the introduction of a quality-improvement themed, streamlined, clinical scaphoid pathway. Patients are offered a removable wrist splint with verbal and written instructions to remove it two weeks following injury, for self-assessment. The persistence of pain is the patient’s guide to ‘opt-in’ and to self-refer for a follow-up appointment with a senior emergency physician. On confirmation of ongoing signs of clinical scaphoid injury, an urgent outpatient ‘fast’-wrist protocol MRI scan is ordered, with instructions to maintain wrist immobilization. Patients with positive scan results are referred for specialist orthopaedic assessment via a virtual fracture clinic.ResultsFrom February 2018 to January 2019, there were 442 patients diagnosed as clinical scaphoid fractures. 122 patients (28%) self-referred back to the emergency department at two weeks. Following clinical review, 53 patients were discharged; MRI was booked for 69 patients (16%). Overall, six patients (< 2% of total; 10% of those scanned) had positive scans for a scaphoid fracture. There were no known missed fractures, long-term non-unions or malunions resulting from this pathway. Costs were saved by avoiding face-to-face clinical review and MRI scanning.ConclusionA patient-focused opt-in approach is safe and effective to managing the suspected occult (clinical) scaphoid fracture.Cite this article: Bone Jt Open 2024;5(2):117–122.

Abstract Background Faecal calprotectin (FCAL) rises rapidly in children with Crohn’s disease (CD) following treatment with exclusive enteral nutrition (EEN). We aimed to identify clinical, dietary and diet-related microbial metabolites which associate with the recurrence of FCAL above 250 mg/kg after 21 days of food reintroduction. Methods Children with CD (age 6-17 years), clinically responding to EEN, were recruited, prospectively, from 11 UK hospitals (January 2020-May 2023, NCT04225689). They provided a single faecal sample before EEN completion (timepoint A) and 6 serial samples (timepoints B-G; 3, 6, 9, 12, 15, 21 days) in the first 21 days of food reintroduction. Faecal short (SCFA) and branched (BCFA) chain fatty acids were measured as proxies of fibre and protein bacterial fermentation, respectively. In faeces, pH, water content (%), Bristol stool score, total microbial load (qPCR) and starch output were measured. Clinical parameters, medications, CRP, ESR, albumin and anthropometry were recorded at EEN completion. Nutrient and food group intake was analysed with Nutritics®. Relationships with FCAL levels were explored. Results Thirty children provided 209/210 (99%) of expected faecal samples. FCAL (median [Q1, Q3], mg/kg) increased within 12 days of food reintroduction (EEN completion: 328 [154, 2370] vs 12 days post-EEN: 1123 (451, 2073), p&amp;lt;0.01) and remained high throughout follow-up. Negative correlations were observed between FCAL with acetate, whereas positive correlations were noted with BCFA (isovalerate and isobutyrate) and their ratio over acetate; the latter remained significant at all 7 timepoints (Figure 1A). Use of immunosuppressants, blood inflammatory markers, clinical and anthropometry at EEN completion were not predictive of FCAL increase post-EEN. In a subset of patients with FCAL&amp;lt;250 mg/kg at EEN completion, (n=13/30), subset regression using ‘end of EEN’ diet-related microbial data, generated a model with 91% accuracy to predict FCAL increase over 250 mg/kg at 21 days of food reintroduction, with isovalerate being the sole predictor of FCAL recurrence (Figure 1B). Average intake of cereal products (median [Q1, Q3], g/day) over 21 days was lower in patients who experienced an FCAL recurrence (FCAL&amp;lt;250mg/kg: 313 (223, 370) vs FCAL&amp;gt;250mg/kg: 186 (167, 217), p=0.013). Positive correlations were observed between the 21-day average intake of cereal products and concentration of SCFA at 21 days post-EEN; acetate (rho=0.38, p=0.041), butyrate (rho=0.46, p=0.0.01) and total SCFA (rho=0.41, p=0.026). Conclusion This study suggests that early FCAL rebound, following treatment with EEN, is related to an increased ratio of dietary protein to fibre bacterial fermentation and a lower intake of cereal products.

ObjectivesAnterior cruciate ligament (ACL) repair for proximal tears, where the ligament is re-attached and augmented with suture tape, can negate the need for graft harvest, thereby maintaining native anatomy. Autograft harvest has been associated with persistent deficits in lower limb muscle strength after recovery from ACL reconstruction. The aim of this study is to compare lower limb muscle strength following ACL repair and reconstruction. MethodsNineteen ACL repair patients augmented with suture tape and nineteen ipsilateral semitendinosus-gracilis autograft ACL reconstruction patients (both mean 4 years postoperatively) were recruited, along with twenty healthy volunteers. Patient-reported outcome measures (PROMs) were obtained using the Knee Injury and Osteoarthritis Outcome Score (KOOS), Lysholm, and Tegner scores. Maximal isometric quadriceps and hamstring strength at 90° knee flexion were measured using a fixed Myometer after a warm-up and three maximal-effort contractions. ResultsMean hamstring strength of the reconstructed legs was lower than that of healthy volunteers by 0.29 Nm/kg. The hamstring strength ratio of the operated side to the uninjured side was greater in the repair (95% ​± ​13) than in the reconstruction (81% ​± ​18) group. There were no statistically significant differences between sides for quadriceps peak torque or for hamstrings in the volunteer or repair group. PROMs scores for the reconstruction group were significantly lower than volunteers across all domains and lower than repair for KOOS activities of daily living and Lysholm scores. ConclusionHamstring weakness seen following ACL reconstruction is not evident following ACL repair with suture tape augmentation. Strength asymmetry could contribute to re-injury risk and influence functional performance, while altered loads affect knee biomechanics and may lead to osteoarthritis progression. The absence of these deficits in the repair group demonstrates a potential benefit of this technique when used in appropriate patients. Level of evidenceII.