Urology simulation boot camp: A perspective from non-UK delegates

BACKGROUND

Medical simulation has become an integral part of modern-day surgical training. Despite its benefits, it is still not widely incorporated in the curriculum of trainees. The Urology Boot Camp (USBC) is an innovative 5-day course aimed at trainees entering the UK training scheme. Since its implementation, there's been increasing interest by non-UK trainees.

OBJECTIVE

To assess the experiences of non-UK trainees in the USBC, both quantitatively and qualitatively, including skills progression analysis.

DESIGN, SETTING AND PARTICIPANTS

This double-group cohort retrospective study included 20 delegates from non-UK countries and 76 trainees from UK who attended the USBC in 2017 and 2018. Trainees undertook pre- and post-course MCQs, pre-course operative experience questionnaires and a 12-month post-course survey on the usefulness of the skills acquired.

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS

Differences in mean MCQ scores between UK and non-UK delegates at baseline and after the course were assessed by the independent T-test. Each core urology procedural skill was evaluated by an expert and graded according to a Likert scale (1-5). The Kruskal-Wallis test was used to assess the differences in the scores between both groups on endourological techniques. A Likert scale (1-5) was used to grade the participants' answers to the post-course 12-month survey.

RESULTS AND LIMITATIONS

Trainees from UK scored significantly higher in the pre-course MCQ assessment, however after completion of the boot camp, no significant difference was noted. There were no differences between the groups at e-BLUS completion times, and both groups significantly improved their results. A 12-month post-course survey on the utility of training during the boot camp and qualitative evaluation of the course by overseas delegates was very positive.

CONCLUSIONS

The USBC is a valuable learning experience that leads to improvement of technical and soft skills of UK and non-UK trainees alike.

Association between road accidents and low-grade hepatic encephalopathy among Sri Lankan drivers with cirrhosis: a prospective case control study

Background

Low-grade hepatic encephalopathy (LGHE) comprises minimal hepatic encephalopathy (MHE) and grade 1 hepatic encephalopathy. LGHE has no or minimal recognizable symptoms but has mild cognitive and psychomotor deficits. Studies in Western countries have demonstrated increased road accidents (RA) among patients with MHE. Our objective was to investigate the association between Sri Lankan LGHE phenotype and RA.

Study design and methods

A prospective, case–control study was conducted in the University Medical Unit, North Colombo Teaching Hospital, Ragama Sri Lanka. Patients with cirrhosis of any aetiology, without OHE, who had been driving during previous 1 month were included. A similar number of age matched, healthy control drivers were also enrolled. Both groups were subjected to five pencil-paper based psychometric tests used to detect LGHE in cirrhotics. Self-reported RA during the previous 1 month were recorded: categorized as ‘major’ when resulted in hospitalization of the involved, ‘minor’ when there were injuries, but not serious enough for hospitalization of the involved and ‘other’ when limited to damages to vehicle or environment without injuries.

Results

Among 55 drivers with cirrhosis and LGHE [males, median age 53 years (range 30–60)], 7 (12.7 %) reported RA compared to 6 (10.9 %) among 55 controls [males; median age 51 years (range 30–60)]. There were no ‘major’ accidents in either group. 2/55 (3.6 %) cases and 2/55 (3.6 %) controls reported ‘minor’ accidents.

Conclusion

There was no increased frequency of RA among Sri Lankan drivers with LGHE compared to healthy controls. This is with the limitation of the study based only on self reported RA.

Morphological features of naevoid melanoma: results of a multicentre study of the International Dermoscopy Society

BACKGROUND

Naevoid melanoma (NeM), a rare variant of melanoma, can be difficult to detect as its clinical and histopathological morphology can simulate a naevus.

OBJECTIVES

To describe the clinical and dermoscopic features associated with NeM.

METHODS

Lesions with a histopathological diagnosis of NeM were collected via an e-mail request sent to all members of the International Dermoscopy Society. All lesions were histopathologically reviewed and only lesions fulfilling a set of predefined histopathological criteria were included in the study and analysed for their clinical and dermoscopic features.

RESULTS

Twenty-seven of 58 cases (47%) fulfilled the predefined histopathological criteria for NeM and were included in the study. Clinically, 16 of the 27 NeMs presented as a nodular lesion (59%), eight (30%) as plaque type and three (11%) as papular. Analysis of the global dermoscopic pattern identified three types of NeM. The first were naevus-like tumours (n = 13, 48%), typified by a papillomatous surface resembling a dermal naevus. In these lesions local dermoscopic features included irregular dots/globules (46%), multiple milia-like cysts (38%) and atypical vascular structures (46%). The second type were amelanotic tumours (n = 8, 30%), typified by an atypical vascular pattern (75%). The third type consisted of tumours displaying a multicomponent pattern (n = 4, 15%), characterized by classical local melanoma-specific criteria. Two lesions (7%) were classified as mixed-pattern tumours as they did not manifest any of the aforementioned patterns.

CONCLUSIONS

While NeMs may be clinically difficult to differentiate from naevi, any papillomatous lesion displaying dermoscopically atypical vessels and/or irregular dots/globules should prompt consideration for the possible diagnosis of NeM.

Preventing caries in young children of immigrant Bangladeshi families in New York: perspectives of mothers and paediatricians

OBJECTIVE

Childhood caries is common in South Asian immigrant families. Few children visit a dentist by 12 months, as recommended by current guidelines. The paediatric visit has important potential for linking children to preventive care. The aim of this study was to understand the barriers and facilitators to caries prevention for young children of immigrant Bangladeshi families in New York. Qualitative data were collected as a preliminary step in the development of an oral health counselling intervention for South Asian children.

BASIC DESIGN

Qualitative interviews on child feeding and oral health prevention were conducted with Bangladeshi mothers. Qualitative interviews were conducted with paediatricians regarding their experiences with providing care. The data were analysed using standard qualitative approaches.

SETTING

Paediatric practices serving low income Bangladeshi immigrants in New York City.

PARTICIPANTS

26 mothers of children aged 6-24 months receiving services in five paediatric settings and 15 paediatricians providing care in these settings.

RESULTS

Both mothers and their paediatricians described risky feeding practices, communication problems and a lack of compliance. Oral health for young children was a low priority for some mothers. Most, however, were concerned about childhood caries but lacked skills or resources to decrease caries risk.

CONCLUSIONS

Results support our plan to develop an empowerment-based counselling intervention to address caries risk in children. Paediatric dentists should be aware of the barriers to caries prevention in this group.

Abstract LB-340: High pain prevalence is reported by patients with head and neck cancer: systematic review

Background: Pain is a major symptom in patients with cancer; however information on head and neck cancer (HNC) related pain is limited. Aim: To investigate the prevalence of pain and associated factors among patients with HNC. Materials and Methods: The systematic review used a wide searching strategy to December 2011. Cancers of the oral mucosa, oropharynx, hypopharynx and larynx were included in this review with pain as main outcome. The review was restricted to full research reports of observational studies published in English. A checklist was used to assess the quality of selected studies. Results: There were 82 studies included in the review and most of them (84%) were conducted in the past ten years. Studies were relatively small, with a median of 80 patients (IQR 44, 154). The quality of reporting was variable, for example only 67% of the articles stated the study design and none of the papers justified sample size. The majority of the papers (84%) did not report efforts that were taken to address potential sources of bias and 35% did not specify the participation rate. Most studies (77%) used self-administered quality of life questionnaires, where pain was a component of the overall scale. Only 32 studies reported pain prevalence in HNC patients (combined estimate from meta-analysis 49%, 95% CI 41% - 57%), in contrast to levels of pain (scale 0-100: mean 55, 95% CI 51 - 59 based on 12 studies). Only 55 studies (67%) considered associated factors, mostly tumour- or treatment-related. Three out of ten studies reported higher levels of pain at older ages and three out of twelve found higher levels in women. There was no consistent evidence of an association with smoking and alcohol. Conclusion: The study has shown high levels of pain prevalence and some factors associated with higher levels of pain. There is a need for higher quality studies in a priority area for the care of patients with HNC.

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr LB-340. doi:1538-7445.AM2012-LB-340

Head and neck cancer pain: systematic review of prevalence and associated factors

OBJECTIVES

Pain is a major symptom in patients with cancer; however information on head and neck cancer related pain is limited. The aim of this review was to investigate the prevalence of pain and associated factors among patients with HNC.

MATERIAL AND METHODS

The systematic review used search of MEDLINE, EMBASE and CINAHL databases to December 2011. Cancers of the oral mucosa, oropharynx, hypopharynx and larynx were included in this review with pain as main outcome. The review was restricted to full research reports of observational studies published in English. A checklist was used to assess the quality of selected studies.

RESULTS

There were 82 studies included in the review and most of them (84%) were conducted in the past ten years. Studies were relatively small, with a median of 80 patients (IQR 44, 154). The quality of reporting was variable. Most studies (77%) used self-administered quality of life questionnaires, where pain was a component of the overall scale. Only 33 studies reported pain prevalence in HNC patients (combined estimate from meta-analysis before (57%, 95% CI 43% - 70%) and after (42%, 95% CI 33% - 50%) treatment. Only 49 studies (60%) considered associated factors, mostly tumour- or treatment-related.

CONCLUSIONS

The study has shown high levels of pain prevalence and some factors associated with higher levels of pain. There is a need for higher quality studies in a priority area for the care of patients with head and neck cancer.

Changes in elastic fibres in the small airways and alveoli in COPD

Small airways are the major site of airflow obstruction in chronic obstructive pulmonary disease (COPD). This is attributed to loss of elastin in alveoli and fibrosis in small airways. In the present study, it was hypothesised that changes to elastic fibres in alveoli might be paralleled by a similar reduction in elastic fibres in small airways. Tissue blocks from patients who had lobectomy for bronchial carcinoma were studied. Patients were classified as COPD (forced expiratory volume in one second (FEV(1)) < 80% predicted, FEV(1)/forced vital capacity (FVC) < 0.7) or controls (FEV(1) > or = 80% pred, FEV(1)/FVC > or = 0.7). Elastic fibres were visualised using Elastic van Gieson staining and the volume fraction (v/f) of elastic fibres was determined as a percentage of tissue volume using point counting. Elastic fibre networks were also visualised by confocal microscopy. The v/f for elastic fibres in alveoli was 18.6% for COPD and 32.8% in controls. In the airways the v/f was 14.6% for COPD and 25.5% in controls. FEV(1)% predicted was correlated with v/f in both alveoli and small airways. The volume fraction of elastic fibres was reduced to a similar extent in small airways and alveoli in chronic obstructive pulmonary disease and both were correlated with the extent of airflow obstruction. Loss of elastic fibres in small airways may contribute to the development of airflow obstruction in chronic obstructive pulmonary disease.

An alternative to "brutacaine": a comparison of low dose intramuscular ketamine with intranasal midazolam in children before suturing

OBJECTIVE

To compare the use of low dose intramuscular ketamine with high dose intranasal midazolam in children before suturing.

METHODS

Altogether 102 children with simple wounds between 1 and 7 years old were allocated to the two study groups.

RESULTS

Two children were excluded from the study because of deviation from the agreed protocol. The 50 children in the ketamine group were less likely to cry or need to be restrained during the procedure than those in the midazolam group (p < 0.01). The median oxygen saturation was 97% in both groups. There was no difference in the recovery behaviour and the range of time at which children were ready for discharge, although the median time for the latter was shorter in the midazolam group (75 v 82 minutes). Vomiting occurred in nine of the ketamine and four of the midazolam group. After discharge both groups had an unsteady gait (73% v 71%) which usually resolved within two hours.

CONCLUSION

Intranasal midazolam (0.5 mg/kg) effectively sedated the children in that none could remember the suturing. However a significant number still had to be restrained (86% v 14%). Intramuscular ketamine (2.5 mg/kg) produced dissociative anaesthesia in the majority of cases and was the preferred drug of nurse, doctor, and parent.