Multiple Specialties Research Articles

Secure app-based secondary healthcare clinical decision support to deployed forces in the UK Defence Medical Services

BackgroundModern instant messaging systems facilitate reach-back medical support for Defence Medical Services (DMS) by connecting deployed clinicians to remote specialists. The mobile app Pando (Forward Clinical, UK) has been used...

Holistic approach to care for patients with endometriosis.

Endometriosis is a chronic, often debilitating, disease which is typically managed with surgery and hormonal medications. However, many patients feel they lack agency when managing endometriosis symptoms. The purpose of this review is to discuss the mental and physical management strategies, the long-term health consequences, and the role of a multidisciplinary team in the treatment of endometriosis. Evidence is becoming more robust regarding the role of complementary care and physical activity in the management of endometriosis. Health risks such as infertility are well known and newer evidence is evolving regarding perinatal and cardiovascular health risks. There are also trends towards multiple specialist involvement in the care of endometriosis and the benefit of interdisciplinary collaboration. Endometriosis is a frequently recurrent condition requiring not only meticulous medical and surgical care, but also coordinated longitudinal disease management and impact mitigation. Gynecologists should be aware of the short-term and long-term implications of the disease to empower patients on the management of their overall health.

New Diagnostic Tools for Pulmonary Embolism Detection.

The presentation of pulmonary embolism (PE) varies from asymptomatic to life-threatening, and management involves multiple specialists. Timely diagnosis of PE is based on clinical presentation, D-dimer testing, and computed tomography pulmonary angiogram (CTPA), and assessment by a Pulmonary Embolism Response Team (PERT) is critical to management. Artificial intelligence (AI) technology plays a key role in the PE workflow with automated detection and flagging of suspected PE in CTPA imaging. HIPAA-compliant communication features of mobile and web-based applications may facilitate PERT workflow with immediate access to imaging, team activation, and real-time information sharing and collaboration. In this review, we describe contemporary diagnostic tools, specifically AI, that are important in the triage and diagnosis of PE.

Is Collaborative Care the Future of Medicine? Lessons Learned from the Care of Children with Colorectal Conditions.

The treatment of patients with colorectal disorders requires care from a wide variety of medical and surgical specialties over the course of their lifetime. This is ideally handled by a collaborative center which facilitates the assessment and development of patient care among multiple specialties which can enhance the quality and implementation of treatment plans, improve communication among different specialties, decrease morbidity, and improve patient satisfaction and outcomes. This collaborative approach can serve as a model for other parts of medicine requiring a similar multi-disciplinary and integrated method of care delivery. We describe the process, as well as the lessons learned in developing such a program.

Development and implementation of local pediatric anesthesia performance metrics at a Canadian children's hospital: a technical report.

In this project, we sought to develop and implement pediatric anesthesia metrics into electronic health records (EHR) in a hospital setting to improve quality and safety of patient care. While there has been an upsurge in metric-driven health care, specific metrics catering to pediatric anesthesia remain lacking despite widespread use of EHR. The rapid proliferation and implementation of EHR presents opportunities to develop and implement metrics appropriate to local patient care, in this case pediatric anesthesia, with the strategic goal of enhancing quality and safety of patient care, while also delivering transparency in reporting of such metrics. Using a quasi-nominal consensus group design, we collected requirements from attending anesthesiologists using Agile methodology. Forty-five metrics addressing quality of care (e.g., induction experience, anesthesia delivery, unanticipated events, and postanesthetic care unit stay) and provider performance (e.g., bundle-compliance, collaboration, skills assurance) were developed. Implementation involved integration into the EHR followed by transition from PDF-based feedback to interactive Power BI (Microsoft Corporation, Redmond, WA, USA) dashboards. We introduced and implemented customized pediatric anesthesia metrics within an academic pediatric hospital; however, this framework is easily adaptable across multiple clinical specialties and institutions. In harnessing data-collecting and reporting properties of EHR, the metrics we describe provide insights that facilitate real-time monitoring and foster a culture of continuous learning in line with strategic goals of high-reliability organizations.

Creating pragmatic, rapid‐cycle, evidence‐based innovation: The Kaiser Permanente Northern California Delivery Science and Applied Research (DARE) program

AbstractIntroductionOngoing crises in the quality, affordability, sustainability, value, and equity of U.S. healthcare call for rapid, massive‐scale innovations across multiple specialties. Physician groups and healthcare organizations commit significant monetary and personnel investments for innovation and improvement efforts, but most lack over‐arching systems theory‐supported conceptual frameworks for efficiently coordinating the timely, large‐volume idea generation, refinement, prioritization, evidence development, implementation, and re‐evaluation strategies needed for rapid‐cycle improvements in health care delivery, outcomes, and value.MethodsThis article describes one large‐scale, generalizable model: The Permanente Medical Group's (TPMG) Delivery Science and Applied Research (DARE) program within Kaiser Permanente Northern California. This organization‐level initiative was designed to: (1) elicit clinical innovation and quality concerns across clinical specialties; (2) prioritize these questions for next‐step evaluations; (3) create dedicated analytic, research, and clinical expertise to rapidly study the questions generated; (4) develop communities of clinician‐researchers, embedded within their specialties' clinical operations, who gather ideas for evaluation, generate evidence, and facilitate implementation of research results (a.k.a. evidence‐based innovators); and (5) broadly disseminate findings, to connect results with potential next‐step implementation.ResultsThe DARE program and its components rapidly led to more than 200 recently completed or ongoing projects, informed care changes, influenced national guidelines, developed communities of evidence‐based clinician innovators in 15 specialties, and empowered new paths for career diversity and physician wellness. Key factors in the DARE program's success include explicitly defining high‐impact ideas; engaging researchers with analysts experienced with large clinical data systems; developing several research funding mechanisms scaled to project size; prioritizing rapid and efficient project completion; supporting clinician‐investigators embedded within their specialties; and structured organization‐wide dissemination of findings for informing potential implementation.ConclusionsHigh‐volume, evidence‐based innovation programs can be important, scale‐able, reproducible models for different settings for increasing quality, affordability, sustainability, value, and equity in healthcare and furthering the difficult‐to‐achieve concept of developing sustainable learning healthcare systems.

Optimizing Educational Efficiency: Exploring the Relationship Between Bulk and Clinical Rotation Group Size in Medical Education Students’ Perspective in Busitema University Uganda

Clinical rotation group size plays a pivotal role in shaping the quality, efficiency, and overall student experience in medical education. Despite its significance, determining the ideal group size remains a daunting task. This research endeavors to delve into the correlation between group size and what is termed as "bulk," representing the comprehensive efficiency and productivity of clinical rotation groups. By examining this relationship, the study aims to offer valuable insights into potential strategies for optimizing group size, thereby enhancing the educational experience for medical students. The study employed a mixed-methods approach, combining quantitative analysis of productivity metrics with qualitative assessments of student and faculty perceptions. Surveys, interviews, and observational data were utilized to capture the nuances of group dynamics, learning outcomes, and resource utilization across different group sizes. Statistical techniques such as regression analysis and ANOVA were employed to identify significant correlations and differences. Data were collected from medical students undergoing clinical rotations across multiple specialties. Group sizes varied from small (2-3) and large (4 and more). The study measured bulk using indicators such as patient encounters per student, learning outcomes, and faculty-student interaction. Results indicated a nonlinear relationship between bulk and group size. Smaller groups showed higher individual student engagement, personalized learning experiences, and increased faculty-student interaction. Conversely, larger groups exhibited greater overall productivity due to economies of scale and enhanced peer learning. However, beyond a certain threshold, further increases in group size led to diminishing returns, compromising individualized attention and educational quality. The findings underscore the importance of balancing group size to optimize educational outcomes in clinical rotations. While larger groups may offer efficiency gains, they must be carefully managed to mitigate potential drawbacks such as reduced individualized attention and faculty-student interaction. Smaller groups foster a more personalized learning environment but may lack the resource utilization efficiency of larger cohorts. Institutions should consider contextual factors such as specialty, learning objectives, and available resources when determining optimal group sizes. In conclusion, the relationship between bulk and clinical rotation group size is complex, with both benefits and limitations associated with different group sizes. Institutions should strive to strike a balance between efficiency and educational quality by tailoring group sizes to specific contexts and objectives. Further research is needed to explore additional factors influencing bulk and to develop targeted interventions for optimizing clinical rotation experiences.

The role of primary care in rare disorders: A qualitative study of parents and patients managing complex vascular anomalies.

Patients with complex rare disorders often require the care of multiple specialists. Effective coordination between primary and specialty care is needed to ensure patients receive high-quality care. Previous research has documented the importance of primary care clinicians providing referrals to specialty care and the importance of specialists in helping patients reach a diagnosis. However, little is known about primary care clinicians' roles in the ongoing care of patients with rare disorders. In the current study, we explored the role of primary care clinicians in the care of rare and complex vascular anomalies. Data were collected using semi-structured qualitative interviews with 34 parents and 25 adult patients recruited from advocacy groups for patients with complex vascular anomalies participated. We asked participants about their diagnosis, care experiences, and communication with clinicians. We used thematic analysis to identify themes illustrating the roles of primary care clinicians. PCC roles were characterized by four behaviors. Supporting behaviors included learning more about vascular anomalies and asking participants about the care they received from specialists. Facilitating included providing referrals, ordering tests, and engaging in problem-solving. Interfering included failing to provide referrals or help participants coordinate care, ordering incorrect tests, or making inappropriate recommendations. Disregarding included focusing narrowly on primary care needs and not showing concern about the vascular anomaly. The results reveal opportunities to improve primary care for patients with vascular anomalies. Disregarding and interfering behaviors furthered the division between primary and specialty care for patients with vascular anomalies and prevented patients from receiving comprehensive primary care. Supporting and facilitating behaviors convey genuine interest in the care of the vascular anomaly and a commitment to helping the patient and parent.

Risk mitigations to prevent methotrexate dispensing errors in English hospitals: a mixed-methods exploratory study

Abstract Introduction Oral methotrexate is indicated for paediatric cancer indications and autoimmune diseases. Unfortunately, cases of inadvertent overdose due to confusion between 2.5mg and 10mg tablet strengths are widely documented. National guidance is available to prevent such errors; indeed, the overdose of methotrexate for non-cancer treatment is a Never Event.[1] At our organisation, the main mitigations to reduce the risk of dispensing errors were to segregate tablet strengths and restrict 10mg tablets to cancer indications.[2] Adherence had not been evaluated, and alternative risk mitigations had not been explored. Aim We aimed to 1) determine whether methotrexate 10mg tablets were restricted to cancer indications; and 2) explore strategies to prevent errors associated with methotrexate tablet strength at a sample of hospitals. Methods First, an audit approach was used to determine use of 10mg tablets; standards were derived from local policy.[2] The setting was a large teaching hospital providing acute, specialist, paediatric and cancer care. Dispensing transactions of 10mg tablets on the electronic pharmacy dispensing system between April 2022 and March 2023 were included. Details of prescription, dispensed quantity, dose instructions and speciality were recorded onto the data collection tool. Data were analysed descriptively. Second, a survey was conducted with a sample of twenty English hospitals (including the study site). These comprised ten large teaching hospitals and specialist paediatric cancer centres. A relevant pharmacist was contacted by email at each trust and asked a series of open questions about local risk strategies associated with methotrexate 10mg tablets. Notes were taken and data summarised descriptively. Results There were 79 dispensing issues for methotrexate 10mg tablets. Of those, 65 issues were for 13 cancer patients; the other 14 were erroneous issues where 10mg were dispensed instead of 2.5mg for non-cancer indications. Whilst most errors were rectified (n=13), one patient received a weekly dose of 40mg instead of 10mg, a four-times overdose. Nineteen (95%) trusts responded to our survey. There were three broad strategies reported: to only use 2.5mg tablets (n=9); isolate dispensing of 10mg tablets to dedicated cancer or paediatric dispensaries (n=5); or reliance on local protocol and physical segregation of 2.5mg and 10mg tablets within multi-service dispensaries (n=5). Conclusion It was encouraging that 10mg tablets were solely intended for cancer indications. However, the incidental discovery of errors highlighted the need for improvement. Findings suggest that eliminating 10mg tablets from practice was a feasible strategy, even for organisations providing cancer services. Findings have limited generalisability due to the small sample sizes, and detail provided in survey responses was variable. Nevertheless, the audit was effective in identifying a previously unknown Never Event. National Health Service organisations should acknowledge the risk associated with keeping 2.5mg and 10mg methotrexate tablets, particularly within dispensaries servicing multiple specialties. Dedicated cancer dispensaries are not commonplace, therefore eliminating 10mg tablets altogether should be considered. Indeed, the principle of limiting strengths is a well-established and effective medication risk management strategy. Further research should explore the potential negative implications for patients, such as increased tablet burden, if 2.5mg tablets are used exclusively for all indications. This may further inform national strategy to prevent Never Events.

Thematic Learning in the Independent Curriculum in Elementary Schools Based on the Islamic Montessori Method for Multiple Intelligence

Recently, the practice of categorizing intelligent students and unintelligent students is a deeply ingrained phenomenon within the realm of education in Indonesia. Indeed, multiple specialists have verified that the attributes of intelligence vary among individual students. Hence, this study aims to revolutionize theme education in primary schools by implementing an autonomous curriculum that is rooted in the Islamic Montessori for Multiple Intelligence approach. This study employs the library research methodology, utilizing primary and secondary data derived from printed or digital sources such as books, journals, and magazines. The outcome of this discussion is to generate a set of activities for different domains of learning. These activities include folding clothes or buttoning clothes for the Islamic Studies domain, hand washing for the practical life domain, matching pictures with zones for the sensorial domain, matching words for the language domain, matching numbers for the mathematical domain, matching fruit with pictures for the cultural realm, and drawing or creating ecobricks for the arts & crafts realm. These diverse educational approaches involve the creation of a curriculum centered around the Islamic Montessori for Multiple Intelligence method, with the aim of promoting a healthy and virtuous lifestyle. These methods can be effectively utilized by teachers during classroom instruction. Through the development of diverse learning activities, education will be conducted in a more comprehensive manner, tailored to the individual traits and capabilities of each student. This approach to designing educational activities can thereafter be implemented in the instruction of young children in primary schools.

A Deep Learning Approach to Classify Fabry Cardiomyopathy from Hypertrophic Cardiomyopathy Using Cine Imaging on Cardiac Magnetic Resonance.

A challenge in accurately identifying and classifying left ventricular hypertrophy (LVH) is distinguishing it from hypertrophic cardiomyopathy (HCM) and Fabry disease. The reliance on imaging techniques often requires the expertise of multiple specialists, including cardiologists, radiologists, and geneticists. This variability in the interpretation and classification of LVH leads to inconsistent diagnoses. LVH, HCM, and Fabry cardiomyopathy can be differentiated using T1 mapping on cardiac magnetic resonance imaging (MRI). However, differentiation between HCM and Fabry cardiomyopathy using echocardiography or MRI cine images is challenging for cardiologists. Our proposed system named the MRI short-axis view left ventricular hypertrophy classifier (MSLVHC) is a high-accuracy standardized imaging classification model developed using AI and trained on MRI short-axis (SAX) view cine images to distinguish between HCM and Fabry disease. The model achieved impressive performance, with an F1-score of 0.846, an accuracy of 0.909, and an AUC of 0.914 when tested on the Taipei Veterans General Hospital (TVGH) dataset. Additionally, a single-blinding study and external testing using data from the Taichung Veterans General Hospital (TCVGH) demonstrated the reliability and effectiveness of the model, achieving an F1-score of 0.727, an accuracy of 0.806, and an AUC of 0.918, demonstrating the model's reliability and usefulness. This AI model holds promise as a valuable tool for assisting specialists in diagnosing LVH diseases.

P013 A case report of posterior orbital inflammation associated with VEXAS(Vacuoles, E1 enzyme, X-linked, Autoinflammatory, Somatic) syndrome

Abstract Background/Aims VEXAS (Vacuoles, E1 enzyme, X-linked, Autoinflammatory, Somatic) syndrome is a newly recognised adult-onset acquired autoinflammatory disease caused by somatic mutations of the UBA1 gene in the blood precursor cells. It is characterised by systemic inflammation and haematologic abnormalities. Methods Here we report a case of a 66 year old male who presented with orbital inflammation as one of the striking features of his underlying VEXAS. Results Our patient has a history of type 1 insulin dependent diabetes, otitis externa and recurrent lower limb distal venous thrombosis. He presented to Eye Emergency in May 2023 with rapid onset painful diplopia, left retrobulbar pain and peri-orbital swelling. He had recently been referred to Haematology with new anaemia and constitutional symptoms. MRI demonstrated inflammatory changes of some left extraocular muscles and cranial nerves. He was pulsed with three days of intravenous methylprednisolone with significant clinical response. Bone marrow biopsy reported reactive morphology and no clear myelodysplasia. In August 2023, the patient re-attended eye clinic with right sided facial swelling. Rheumatology were consulted for further opinion. The patient had previously been known to the department over 10 years ago, after presenting with arthritis labelled as diabetic cherioarthropathy. Extensive autoimmune panel was requested, including normal IgG subclass, weakly positive c-ANCA with a negative PR3. The patient had a new macrocytic anaemia (Hb 103 g/L, MCV 103 fl) and previous thrombocytopenia. Inflammatory markers were raised, CRP between 8-180, ESR 60 to 110 and Ferritin 878. Ultrasound of neck showed normal parotid and small reactive lymph nodes. Urgent PET-CT reported bone marrow reactivation with no significant findings. Prednisolone 40mg was given with marked resolution of the facial swelling. Opinion was sought by Haematology about any features of VEXAS on previous myelodysplasia screening. A week later, we received the result of the genetic testing showing a mutation of the UBAE gene, consistent with the diagnosis of VEXAS. The patient had re-occurrence of his inflammatory symptoms on several occasions [including diplopia, headache, rash, ocular pain, or periocular swelling] which were all steroid responsive. After discussion with multiple specialities, including Haematology, Ophthalmology and Immunology colleagues with a specialist interest in VEXAS, Tocilizumab was felt to be the most appropriate initial treatment. The patient is due for their first infusion in October 2023. Conclusion We report a unique case of VEXAS who presented with orbital inflammation, a less well-characterised feature of VEXAS. VEXAS is perhaps not as exceptionally rare as we first thought, it is likely more similar cases will present and we need to have a high degree of clinical suspicion in patients with unexplained systemic inflammation, especially those presenting initially with ocular inflammation. These patients require a multi-disciplinary approach to ensure best management of a very challenging condition. Disclosure C.A. Zollinger-Read: None. A. Zewar: None. L. Dunkley: None. J. Jefferis: None.

Surgical appropriateness nudges: Developing behavioral science nudges to integrate appropriateness criteria into the decision making of spine surgeons.

Substantial variation exists in surgeon decision making. In response, multiple specialty societies have established criteria for the appropriate use of spine surgery. Yet few strategies exist to facilitate routine use of appropriateness criteria by surgeons. Behavioral science nudges are increasingly used to enhance decision making by clinicians. We sought to design "surgical appropriateness nudges" to support routine use of appropriateness criteria for degenerative lumbar scoliosis and spondylolisthesis. The work reflected Stage I of the NIH Stage Model for Behavioral Intervention Development and involved an iterative, multi-method approach, emphasizing qualitative methods. Study sites included two large referral centers for spine surgery. We recruited spine surgeons from both sites for two rounds of focus groups. To produce preliminary nudge prototypes, we examined sources of variation in surgeon decision making (Focus Group 1) and synthesized existing knowledge of appropriateness criteria, behavioral science nudge frameworks, electronic tools, and the surgical workflow. We refined nudge prototypes via feedback from content experts, site leaders, and spine surgeons (Focus Group 2). Concurrently, we collected data on surgical practices and outcomes at study sites. We pilot tested the refined nudge prototypes among spine surgeons, and surveyed them about nudge applicability, acceptability, and feasibility (scale 1-5, 5 = strongly agree). Fifteen surgeons participated in focus groups, giving substantive input and feedback on nudge design. Refined nudge prototypes included: individualized surgeon score cards (frameworks: descriptive social norms/peer comparison/feedback), online calculators embedded in the EHR (decision aid/mapping), a multispecialty case conference (injunctive norms/social influence), and a preoperative check (reminders/ salience of information/ accountable justification). Two nudges (score cards, preop checks) incorporated data on surgeon practices and outcomes. Six surgeons pilot tested the refined nudges, and five completed the survey (83%). The overall mean score was 4.0 (standard deviation [SD] 0.5), with scores of 3.9 (SD 0.5) for applicability, 4.1 (SD 0.5) for acceptability, and 4.0 (SD 0.5), for feasibility. Conferences had the highest scores 4.3 (SD 0.6) and calculators the lowest 3.9 (SD 0.4). Behavioral science nudges might be a promising strategy for facilitating incorporation of appropriateness criteria into the surgical workflow of spine surgeons. Future stages in intervention development will test whether these surgical appropriateness nudges can be implemented in practice and influence surgical decision making.

A quantitative and qualitative analysis of patient group narratives suggests common biopsychosocial red flags of undiagnosed rare disease

BackgroundThe ‘diagnostic odyssey’ is a common challenge faced by patients living with rare diseases and poses a significant burden for patients, their families and carers, and the healthcare system. The diagnosis of rare diseases in clinical settings is challenging, with patients typically experiencing a multitude of unnecessary tests and procedures. To improve diagnosis of rare disease, clinicians require evidence-based guidance on when their patient may be presenting with a rare disease. This study aims to identify common experiences amongst patients with rare diseases, to inform a series of ‘red flags’ that can aid diagnosis of rare diseases in non-specialist settings.A questionnaire was developed by Medics for Rare Diseases, informed by the experiences of clinicians, rare disease patients and patient advocates, and was shared with UK-based rare disease patient groups. Study participants were engaged via social media platforms, blogs and email newsletters of three umbrella rare disease organisations. The questionnaire, comprising 22 questions, was designed to identify typical experiences relating to physical and psychosocial manifestations and presentation of disease, patient interactions with healthcare providers, and family history.ResultsQuestionnaire responses were received from 79 different rare disease patient groups and the common experiences identified were used to inform seven red flags of rare disease: multi-system involvement (3 or more); genetic inheritance pattern; continued presentation throughout childhood and adulthood; difficulties at school, especially relating to absences, difficulty participating in physical education and experiences of bullying or social isolation; multiple specialist referrals; extended period with unexplained symptoms; and misdiagnosis. In light of the red flags identified, recommendations for primary care and education settings have been proposed, focusing on the need for holistic assessment and awareness of both physical and psychosocial factors.ConclusionsThis study identified key commonalities experienced by patients with rare disease across physical and psychosocial domains, in addition to understanding patients’ history and experiences with healthcare providers. These findings could be used to develop a clinical decision‑making tool to support non-specialist practitioners to consider when their patient may have an undiagnosed rare condition, which may minimise the challenges of the ‘diagnostic odyssey’ and improve the patient experience.

Linking genetic counseling communication skills to patient outcomes and experiences using a community-engagement and provider-engagement approach: research protocol for the GC-PRO mixed methods sequential explanatory study

IntroductionIn over 50 years since the genetic counseling (GC) profession began, a systematic study of GC communication skills and patient-reported outcomes in actual sessions across multiple clinical specialties has never...

Northwestern University resource and education development initiatives to advance collaborative artificial intelligence across the learning health system.

The rapid development of artificial intelligence (AI) in healthcare has exposed the unmet need for growing a multidisciplinary workforce that can collaborate effectively in the learning health systems. Maximizing the synergy among multiple teams is critical for Collaborative AI in Healthcare. We have developed a series of data, tools, and educational resources for cultivating the next generation of multidisciplinary workforce for Collaborative AI in Healthcare. We built bulk-natural language processing pipelines to extract structured information from clinical notes and stored them in common data models. We developed multimodal AI/machine learning (ML) tools and tutorials to enrich the toolbox of the multidisciplinary workforce to analyze multimodal healthcare data. We have created a fertile ground to cross-pollinate clinicians and AI scientists and train the next generation of AI health workforce to collaborate effectively. Our work has democratized access to unstructured health information, AI/ML tools and resources for healthcare, and collaborative education resources. From 2017 to 2022, this has enabled studies in multiple clinical specialties resulting in 68 peer-reviewed publications. In 2022, our cross-discipline efforts converged and institutionalized into the Center for Collaborative AI in Healthcare. Our Collaborative AI in Healthcare initiatives has created valuable educational and practical resources. They have enabled more clinicians, scientists, and hospital administrators to successfully apply AI methods in their daily research and practice, develop closer collaborations, and advanced the institution-level learning health system.

Cost of Training Crisis: Anaesthetics.

The anaesthetic training programme in the United Kingdom (UK) spans over seven years and is overseen by the Royal College of Anaesthetists (RCOA). Junior doctors in England are currently striking amid ongoing pay negotiations with the government, and almost all junior doctors are worried about the cost of living. This article provides an overview of the average financial cost of training for doctors in the anaesthetic training programme. The cost incurred by anaesthetic trainees illustrates the level of financial burden faced by trainees across multiple specialities. The cost includes: student loan repayment (with interest rates), compulsory membership fees (including the Royal College of Anaesthetists and General Medical Council), postgraduate examinations (Fellowship of the Royal College of Anaesthetist exams are compulsory to complete training) and medical indemnity. The average trainee spends between 5.6% and 7.4% of their annual salary on non-reimbursable costs. This article delineates for aforementioned expenses and compares them with the training programs in Australia and New Zealand, given their status as frequent emigration destinations for UK doctors.

Matching Against Men: 5 Years of Residency Match Data Show Disparities Still Exist.

Despite progress toward equal representation by sex in medical practice, women remain underrepresented in many specialties. This study sought to examine the current state of gender equality among recently graduated doctors in multiple specialties. Deidentified demographics, standardized examination scores, and Match results were gathered for 829 graduates. Participants were selected from an allopathic medical school between 2016 and 2020. Nineteen students (2.29%) were excluded from the study. Descriptive statistics were calculated, and χ2 tests for independence were used to compare proportions between reported sex and specialty and program Match results. One-way analysis of variance was then performed to test for differences in US Medical Licensing Examination Step 1 and Step 2 scores between sexes. P < 0.05 was considered statistically significant. Of the 829 individuals studied, 44.6% were women. A significantly smaller proportion of women matched into the most competitive specialties, despite no significant difference in US Medical Licensing Examination Step 1 scores between sexes. Furthermore, there was an overall significant trend of women matching into more competitive programs for any given specialty. In this study, we found that men matched into more highly competitive specialties, whereas women matched into more competitive residency program locations. Further research is needed to determine why women matched into specific specialties at lower rates than their male peers and seek to understand how sex affects the narrative of specialty choice.

Urinary retention induced by psychotropics: A case report

IntroductionNeurological bladder is considered a functional disability that has a significant impact on the quality of life and psychological state of patients. Psychotropic drugs, in turn, can worsen the urinary dysfunction caused by this disease.ObjectivesOur objective is to illustrate, through the case of a patient suffering from a neurological bladder decompensated by the treatment of a characterized depressive episode, the link between these two pathologies.MethodsWe report the case of Ms. M.W., aged 51, with a history of high blood pressure stabilized under nebivolol and a neurological bladder diagnosed 10 years ago with episodic pollakiuria, admitted to the psychiatric department for repeated suicide attempts. She had never used psychoactive substances and had no family psychiatric history. The patient presented depressive symptoms evolving for 5 months. The diagnosis of a characterized depressive episode with melancholic features was made and the patient was treated with sertraline. From the first intake of the drug, the patient presented acute urinary retention (UR) requiring the placement of a permanent bladder catheter. The urinary symptoms improved upon stopping the treatment. Sertraline was changed to olanzapine and escitalopram. The patient stopped the treatment after one month because of the worsening of urinary symptoms requiring the installation of a suprapubic catheter. The urinary problem, together with the cessation of treatment, were responsible for a worsening of psychiatric symptoms leading to multiple suicide attempts. Given the advanced stage of the neurological bladder demonstrated by the urodynamic tests, our patient was treated with paroxetine, quetiapine and oxazepam along with psychotherapeutic education. The evolution was characterized by improvement in psychiatric symptoms and the urinary symptoms were stable.ResultsThe lack of improvement after treatment discontinuation could be explained by an underlying neurological bladder manifesting with pollakiuria. The current literature on UR induced by psychotropic treatments is quite rare limited in case reports. This effect occurs especially when selective serotonin reuptake inhibitors (SSRIs) are prescribed in combination with other antipsychotics. Unlike first generation antipsychotics, atypical antipsychotics have muscarinic receptor antagonist properties which can induce UR. Among atypical antipsychotics, olanzapine has been shown to have the greatest antimuscarinic effects. Regarding SSRIs, they are associated with a lower risk of UR than other antidepressants and sertraline had the highest risk of UR.ConclusionsSSRIs can induce UR particularly in combination with atypical antipsychotics. Coordination of care across multiple specialties and understanding the side effects of psychotropic medications can enable faster diagnoses and adequate management.Disclosure of InterestNone Declared

Augmented reality: a new perspective in dental education

INTRODUCTION The Microsoft HoloLens is a mixed reality device with the capability to provide a real-time 3D platform using multiple sensors and holographic processing to display information, and even to simulate a virtual world. With rapidly evolving technology and virtual learning on the increase, the HoloLens can be used as a vital tool for education and surgical planning. The aim of this pilot study was to ascertain its benefit in dental education and in the surgical planning of complex oral surgery procedures. METHODS A cohort of postgraduate dentists working at the Eastman Dental Hospital in London were shown two holographic videos. Participation was voluntary and an email invitation was sent to all non-consultant grade dental staff across multiple dental specialties. The cases demonstrated were a mandibular third molar in close association with the inferior alveolar nerve and an impacted tooth. Each video had a narration and explanation by a consultant oral surgeon. After having watched the videos, participants were asked to rate seven statements using a Likert scale. RESULTS Eighty-two per cent of participants reported improved comprehension of orientating anatomical structures. All participants (100%) noted improved confidence in surgical planning. Ninety-four per cent believed that the technology was an invaluable surgical tool in postgraduate training. CONCLUSIONS Augmented reality has the potential to change the face of surgery in the 21st century. This technology can be used to improve surgical training, especially in an environment where hands-on training is limited and virtual learning is promoted.