EP.FRI.960 USS appraisal in females of child bearing age presented with possible appendicitis

Aims

Appendicitis remains the most common acute surgical condition.  No standard guidelines for the use of imaging studies, and there is a discrepancy between the published data regarding accuracy of these modalities and our practical findings. Yet the growing number of USS reported as “appendix not visualized” has led us to rethink about the value of USS in acute appendicitis. 

Methods

A retrospective single centre study for all females (15-45 years) underwent emergency appendectomy for suspected acute appendicitis. Analysis of preoperative clinical, radiographic and postoperative histopathological data was done.

Results

632 cases analysed over 18months, out of those 238 (37%) were females (15-45 years). USS was done in 129(54%) cases. 25(10.5) cases had both USS and CTAP. 32(13%) cases had only CTAP. The mean rate of appendix visualization in the USS was 30%(71cases) two thirds reported by radiologist versus one third by sonographers. Our negative appendectomy rate dropped from 25 to 15% after a positive scan. 

Conclusions

Traditional preference for ultrasound in the UK compared to CTAP in young population is mostly due to the potential hazards of irradiation, but USS commonly does not visualise the appendix in our practice (70%), and has low sensitivity and specificity for appendicitis.  However, following a positive USS, NAR dropped to 15%. Radiologists had a higher visualization rate of appendix compared to sonographers. Commitment to improve the performance of ultrasonography by allocating adequately timed sessions to the most experienced radiologists and increasing the use of low dose CT scans are possible solutions.

EP.FRI.96 Negative appendectomy rate in young females, between theory and practice. Full audit cycle

Aims

Females of child bearing age are at higher risk of negative appendectomy rate, the accepted overall NAR is up to (20-25%). Presented is our study to examine the real NAR in the female’s cohort aged (15-45 years) in the form of quality improvement project to improve patient’s outcome.

Methodology

Retrospective study in the form of Full audit cycle over 18 months, the first cycle was conducted over 12 months period, followed by the action plan and reassessment over 6 months. Preoperative clinical, laboratory, radiographic and histopathological data were collected.

Results

Over the whole audit period 632 cases were analysed, 238 cases were females in the child bearing age included in our cohort. Over the first phase 419 appendectomy cases were performed, among those 156(37%) were females in child bearing age. Overall NAR was 29% and in our females cohort was 43.5%. Over the second cycle, 213 cases performed, out of which 82(38%) cases included in our cohort. Overall NAR reduced to 25% and in our cohort was 37%

Conclusions

Despite the advances in diagnostic modalities, Females are at significantly higher risk of NAR 37%. Our overall NAR reduced from 29% to 25% compared to the young females cohort, the rate dropped from 43% to 37%. specific consideration and regular auditing of results regards this cohort are highly recommended. Validation of appendicitis scores for risk stratification, Serial examinations and radiological adjuncts are possible solutions to reduce the NAR among this group.

Twelve tips for medical students to make the best use of ward-based learning

BACKGROUND

With a multitude of healthcare professionals willing to teach, a placement on a ward is an invaluable learning opportunity; yet as students, we often struggle to maximize this placements' potential.

AIM

This article provides 12 tips for medical students to optimize their learning in a ward-based environment.

METHODS

Current literature and personal experiences of the authors were used to develop the tips.

RESULTS

The 12 tips are (1) prepare yourself, (2) identify knowledge, skills, and attributes, (3) engage in peer-to-peer learning, (4) get to know the interprofessional team, (5) talk to the patient first, (6) present findings and gain feedback, (7) tap into seniors' experience, (8) immerse yourself and be proactive, (9) check patient notes, (10) manage the clock, (11) enhance your CV, and (12) embrace the spirit of lifelong learning.

CONCLUSION

These tips will enable us to effectively improve our learning and positively shape us into outstanding future doctors.

Equipping future doctors: incorporating management and leadership into medical curriculums in the United Kingdom

Throughout their careers, doctors are likely to come across complex management and leadership scenarios that many would not have had prior training in. Expectations of doctors are rising and it is becoming increasingly necessary to be able to astutely handle a variety of situations. Medical curricula must reflect this change and adapt to include the teaching of key management and leadership skills. Despite budgeting pressures, the National Health Service continues to spend vast sums of money on external management consultants. The 2013 Francis Report stressed the need for better management skills and leadership, especially in doctors who were identified as the spearheads of change. This view is backed up by senior professionals who stress that by incorporating it into undergraduate curricula, doctors will be equipped with the skills to flourish in the future. The challenges of doing so must be highlighted, since the teaching of managerial and leadership concepts must effectively combine theoretical approaches with practical applications. Empowering students of today will enable them as tomorrow's doctors to tackle the challenges of modern medicine.

Positive pressure technique for removal of nasal foreign bodies

Nasal foreign bodies represent a common ENT problem in children. Ninety percent of these can be removed without otorhinolaryngologic intervention. Numerous documented techniques exist, employing instruments, which pose problems in children. Positive pressure technique avoids the need for instrumentation, therefore bypassing the disadvantages met by other techniques. Positive pressure technique is both safe and effective, highlighted by a success rate of 62.5% in 8 patients presenting acutely. Promising result of this small study warrantees further study in larger number of paediatric population. In contrast to previous documentation, children nursed prone tolerated the procedure better. Hollow objects were resilient to this technique and require other methods of removal. Positive pressure technique should be considered to remove foreign bodies from the paediatric nose especially in emergency department setting.

Gustatory sweating of the external auditory canal

Gustatory sweating of the external auditory canal is extremely rare. A clinical case, that is only the second in the English literature, is presented. The potential pathogenesis and its treatment options are discussed.