Senior Doctors Research Articles

#1301 Orellanine intoxication—a case report

Abstract Background and Aims This is a case report presenting a patient with orellanine-caused acute kidney failure. Cortinarius rubellus is a mushroom containing orellanine which is a selective nephrotoxin that destroys the proximal tubule cells of the kidney. Intake of just a few mushrooms is enough to cause irreversible damage and furthermore lead to severe kidney failure. Symptoms as gastrointestinal irritation usually occur 3-7 days after intake. Anti-oxidative medication and steroids have been evaluated but have not shown any effect on the kidney damage. The aim of this case report was to raise awareness about the clinical manifestations of orellanine poisoning, diagnostic challenges, and potentially severe consequences. Method The junior doctors (IA, LT, AS) and the senior doctor (JM) took care of the patient at the ED, the internal medicine ward and the dialysis clinic. All data was extracted from the medical record. Informed consent was obtained from the patient. An attempt to analyze orellanine in the kidney biopsy was made. Results A 40-year-old male entered the emergency department with abdominal pain, fever, nausea and vomiting. The creatinine concentration was 278 µmol/L (3.14 mg/dl) where acute kidney failure due to prerenal cause was suspected. The patient was recommended to stay but declined due to personal reasons, and instead a follow-up next day was planned. The following day, the creatinine concentration was increased to 477 µmol/L (5.39 mg/dl). The junior doctor specifically asked for mushroom intake. The patient confirmed that three days before, he had been in the forest picking mushrooms, of which he consumed two raw and the rest in a stew. Acute renal failure from mushroom poisoning was now suspected. The patient was admitted, and serum creatinine increased to 817 µmol/L (9.24 mg/dl) the following day. The urine production decreased, and the patient was anuric 7 days after intake. Hemodialysis was initiated due to uremic symptoms and volume overload. After showing the patient different photos of mushrooms it was suspected that he had consumed Cortinarius Rubellus. A renal biopsy was performed 12 days after the mushroom intake, which showed a fulminant acute tubular necrosis, no sign of glomerulonephritis, vasculitis, or interstitial nephritis. The attempt to analyze orellanine in the kidney biopsy material was not successful. Orellanine would not be detected in the urine or blood samples because they were collected 72 hours after intake. The half-life of orellanine in otherwise healthy humans is considered to be around 2-4 hours. The patient stayed at the hospital for a total of 14 days. He was on hemodialysis for 14 months and was then successfully kidney transplanted. Conclusion Orellanine is a very potent toxin leading to severe damage of the kidney tubules. Due to the diagnostic challenges, it is important to keep this in mind when managing a patient with acute renal failure.

Reverse mentoring – a useful tool for integrating into the system and making a change

Introduction: Reverse mentoring is useful for closing the generational gap,improving inclusion, and developing skills. Here, a junior team membermentors a senior team member. The scheme run by the Future LeadersProgram is open to International Medical Graduates (IMGs) in Yorkshireand Humber. The aim is to close the differential attainment gap byencouraging Equality, Diversity, and Inclusion (EDI) conversations.Method: Matching is done by MentorNet®. Mentor training consists ofhandbook, induction, and supervision meetings. We planned for threevirtual meetings within 6 months.• Session 1 – Aims and lived experience.• Session 2 – What does it take to feel safe, valued, and accepted?• Session 3: Setting up IMGs to succeed and the impact of the first placementon their careers.Discussion: Reverse mentoring is beyond sharing bad experiences as itcreates avenues for reflection and insights on how to better integrate intothe system.We do not need to have a bad experience before we advocate for EDIin our workplace. Sharing positive experiences is a powerful tool.Pairing Nigerian Junior doctors in the UK with senior doctors inNigeria would reduce the impact of ‘brain drain’ and be a positive toolfor exchanging knowledge and skills with the Nigerian workforce.’

Hand Motion Analysis Using Accelerometer-Based Sensors and Sheep's Head Model for Basic Training in Functional Endoscopic Sinus Surgery.

Motion analysis, the study of movement patterns to evaluate performance, plays a crucial role in surgical training. It provides objective data that canbe usedto assess and improve trainee's precision, efficiency, and overall surgical technique. The primary aim of this study is to employ accelerometer-based sensors placed on the wrist to analyze hand motions during endoscopic sinus surgery training using the sheep's head. By capturing detailed movement data, the study seeks to quantify the motion characteristics that distinguish different levels of surgical expertise. This approach seeks to quantify motion characteristics indicative of surgical expertise and enhance the objectivity and effectiveness of surgical training feedback mechanisms. Twenty-four participantswere dividedinto three groups based on their experience with endoscopic endonasal surgery. Each participantwas tasked with performingspecified procedures on an individual sheep's head, concentrating on exploring both nasal passages. A single Bluetooth Accelerometer WitMotion sensorwas mountedon the dorsal surface of each hand.Thisfacilitates the evaluation of efficiency parameters such as time, path length, and acceleration during the training procedures. Accelerometer data were collected and imported in CSV format (comma-separated values) for each group of surgeons-senior, specialist, and resident-mean values and standard deviationswere computed. The Shapiro-Wilk Test assessed the normality of the distribution. The Kruskal-Wallis test was employed to compare procedural time, acceleration, and path length differences across the three surgeon experience levels. For the procedural time, statistical significance appears in all surgical steps (p<0.001), with thebiggestdifference in the septoplasty group in favor of the senior group. A clear difference can be observed between the resulting acceleration of the dominant hands (instrument hand) and the non-dominant hand (endoscopic hand) and between the study groups. The difference between groups reaches statistical significance with a p-value <0.001. A statistically significant difference canbe seenbetween the paths covered by each hand of every participant (p<0.001). Also, senior doctors covered significantly less movement with both hands than the specialists and the resident doctors (p<0.001). The data showa clearlearning curve from resident to senior,with residents taking more time and using more hand movementsto complete the same tasks. Specialists are in the intermediate phase, showing signs of honing their technique towards efficiency. This comprehensive data set can help tailor training programs to focus onbothefficiency (quicker procedures) and economy of motion (reduced path length and acceleration), especially in more complex procedures where the difference in performance ismore pronounced.

Clinical efficacy and kinematic analysis of Chinese knotting technique-assisted posterior cruciate ligament reconstruction: A retrospective analysis.

To investigate the clinical efficacy and knee joint kinematic changes of posterior cruciate ligament (PCL) reconstruction assisted by Chinese knotting technique (CKT). A retrospective analysis was conducted on 88 cases of PCL reconstructive surgery admitted between September 2016 and September 2020. All patients were operated on by the same senior doctor and his team. The patients were divided into 2 groups according to whether the CKT was applied, with 44 cases in each group. Both groups received active rehabilitation treatment after surgery. All patients were followed up for more than 2 years. International knee documentation committee, hospital for special surgery (HSS), and Lysholm scores were used to evaluate the clinical efficacy of the 2 methods at 3, 12, and 24 months after surgery. The motion cycle and kinematic indices of the knee joint were measured by the Opti_Knee three-dimensional motion measurement system before surgery and at 3, 12, and 24 months after surgery. A secondary arthroscopic examination was performed at 12 months after surgery, MAS score was used to evaluate the secondary endoscopic examination of PCL. All the patients had wound healing in stage I without infection. International Knee in both sets Documentation Committee scores, HSS scores and Lysholm scores were gradually improved at all time points (P < .05); compared with the traditional group, the HSS score was higher in the reduction group 12 months after surgery (P < .05), but there was no significant difference at 24 months after surgery. 12 months and 24 months after 3 dimensional motion measurement system using Opti_Knee showed a reduction group before and after displacement and displacement of upper and lower range than the traditional group (P < 0. 05). One year after surgery, the good and good rate of MAS score reduction group was higher than traditional group. CKT assisted PCL reconstruction can improve the subjective function score of the affected knee joint and the results of secondary microscopy. Satisfactory knee kinematic function can be obtained in the early stage, and the anteroposteric relaxation of the knee joint can be reduced.

Factors Influencing the Preference of Medical Students at Umm Al-Qura University for Otorhinolaryngology-Head and Neck Surgery as a Future Specialty: A Cross-Sectional Study.

Otorhinolaryngology (ORL) specialists treat patients of different ages, ranging from elderly patients with head and neck tumors to neonates with respiratory problems. No studies have been conducted to explore the factors that affect the preference for ORL among Umm Al-Qura University students. We aimed to investigate factors and motivators influencing medical students at Umm Al-Qura University in Makkah, Saudi Arabia, who choose to pursue a career in ORL-head and neck surgery. This cross-sectional study was conducted over two months in 2023 among 439 students in the pre-clinical, clinical, and internship years of the Faculty of Medicine at Umm Al-Qura University, Saudi Arabia.We shared a Google Forms questionnaire(Google, Inc., Mountain View, CA) and explored factors associated with interest in ear, nose, and throat (ENT) as a future specialty.We used Pearson's chi-squaretest to arrive at the results. A total of 339 (77.2%) participants were female. Participants were evenly divided between pre-clinical years (213 (48.5%)) and clinical years (207 (47.2%)), with a smaller percentage in the internship category (19 (4.3%)). ORL involvement was reported in 159 (36.2%) of the participants. The surgical specialty of ORL focuses mostly on conditions affecting the head, neck, nose, and ears. Since students found this specialty fascinating, we recommend that senior doctors make a greater effort to enlighten doctors-in-training about this field of expertise through lectures and campaigns at hospitals and universities.

Trends and determinants of clinical staff retention in the English NHS: a double retrospective cohort study

ObjectivesTo investigate how demographic, contractual and organisational factors are related to the retention of hospital workers in the English NHS. The study will specifically examine the trends in age-retention profiles.DesignA...

Value of radiomics-based automatic grading of muscle edema in polymyositis/dermatomyositis based on MRI fat-suppressed T2-weighted images.

The precise and objective assessment of thigh muscle edema is pivotal in diagnosing and monitoring the treatment of dermatomyositis (DM) and polymyositis (PM). Radiomic features are extracted from fat-suppressed (FS) T2-weighted (T2W) magnetic resonance imaging (MRI) of thigh muscles to enable automatic grading of muscle edema in cases of polymyositis and dermatomyositis. A total of 241 MR images were analyzed and classified into five levels using the Stramare criteria. The correlation between muscle edema grading and T2-mapping values was assessed using Spearman's correlation. The dataset was divided into a 7:3 ratio of training (168 samples) and testing (73 samples). Thigh muscle boundaries in FS T2W images were manually delineated with 3D-Slicer. Radiomics features were extracted using Python 3.7, applying Z-score normalization, Pearson correlation analysis, and recursive feature elimination for reduction. A Naive Bayes classifier was trained, and diagnostic performance was evaluated using receiver operating characteristic (ROC) curves and comparing sensitivity and specificity with senior doctors. A total of 1198 radiomics parameters were extracted and reduced to 18 features for Naive Bayes modeling. In the testing set, the model achieved an area under the ROC curve of 0.97, sensitivity of 0.85, specificity of 0.98, and accuracy of 0.91. The Naive Bayes classifier demonstrated grading performance comparable to senior doctors. A significant correlation (r = 0.82, P <0.05) was observed between Stramare edema grading and T2-mapping values. The Naive Bayes model, utilizing radiomics features extracted from thigh FS T2W images, accurately assesses the severity of muscle edema in cases of PM/DM.

Computer-aided diagnostic system with automated deep learning method based on the AutoGluon framework improved the diagnostic accuracy of early esophageal cancer.

There have been studies on the application of computer-aided diagnosis (CAD) in the endoscopic diagnosis of early esophageal cancer (EEC), but there is still a significant gap from clinical application. We developed an endoscopic CAD system for EEC based on the AutoGluon framework, aiming to explore the feasibility of automatic deep learning (DL) in clinical application. The endoscopic pictures of normal esophagus, esophagitis, and EEC were collected from The First Affiliated Hospital of Soochow University (September 2015 to December 2021) and the Norwegian HyperKvasir database. All images of non-cancerous esophageal lesions and EEC in this study were pathologically examined. There were three tasks: task A was normal vs. lesion classification under non-magnifying endoscopy (n=932 vs. 1,092); task B was non-cancer lesion vs. EEC classification under non-magnifying endoscopy (n=594 vs. 429); and task C was non-cancer lesion vs. EEC classification under magnifying endoscopy (n=505 vs. 824). In all classification tasks, we took 100 pictures as the verification set, and the rest comprised as the training set. The CAD system was established based on the AutoGluon framework. Diagnostic performance of the model was compared with that of endoscopists grouped according to years of experience (senior >15 years; junior <5 years). Model evaluation indicators included accuracy, recall rate, precision, F1 value, interpretation time, and the area under the receiver operating characteristic (ROC) curve (AUC). In tasks A and B, the accuracies of medium-performance CAD and high-performance CAD were lower than those of junior doctors and senior doctors. In task C, the medium-performance and high-performance CAD accuracies were close to those of junior doctors and senior doctors. The high-performance CAD model outperformed the junior doctors in both task A (0.850 vs. 0.830) and task C (0.840 vs. 0.830) in sensitivity comparison, but there was still a large gap between high-performance CAD models and doctors in sensitivity comparison. In task A, with the aid of CAD pre-interpretation, the accuracy of junior and senior physicians were significantly improved (from 0.880 to 0.915 and from 0.920 to 0.945, respectively); the time spent on film reading was significantly shortened (junior: from 11.3 to 8.7 s; senior: from 6.7 to 5.5 s). In task C, with the aid of CAD pre-interpretation, the accuracy of junior and senior physicians were significantly improved (from 0.850 to 0.865 and from 0.915 to 0.935, respectively); the reading time was significantly shortened (junior: from 9.5 to 7.7 s; senior: from 5.6 to 3.0 s). The CAD system based on the AutoGluon framework can assist doctors to improve the diagnostic accuracy and reading time of EEC under endoscopy. This study reveals that automatic DL methods are promising in clinical application.

Obstetrics and gynecology patients' perceptions about bedside teaching at a Saudi teaching hospital.

Bedside teaching (BST) is a crucial component of medical education. It entails the interaction of students with patients in outpatient clinics and inpatient wards under the supervision of their tutors in order to improve the clinical skills of the students and, ultimately, patient outcomes. This teaching relies heavily on patients' willingness and cooperation. The aim of this study was to assess the perception of Obstetrics and Gynecology (OB/GYN) patients regarding the presence and participation of medical students in BST. A cross-sectional survey was conducted among OB/GYN patients at the outpatient clinics and inpatient wards at King Fahd Hospital of the University (KFHU) in Al-Khobar from January 1 to April 30, 2023. Data were collected online through the Google Drive survey tool using a validated and pilot tested questionnaire. Data were analyzed utilizing SPSS version 26.0. Chi-squared test was employed to test for association between two categorical variables. Multiple logistic regression model was used to determine variables associated with positive attitudes. A total of 507 patients completed online questionnaire. A highly positive patients' attitude was observed toward the presence and participation of medical students during BST with a mean score of 81.8 ± 10.4. The acceptance rates were higher for female students compared to male students (91.9% vs 61.7%) and for senior doctors compared to junior doctors (89.9% vs 58.9%). Patients who came to the outpatient clinics were also more likely to accept students' presence than those who went to hospital wards. Age, marital status, and previous clinic visits were positively associated with the acceptance level of the presence and involvement of medical students in BST without a significant difference. In general, patients had a good perception of medical students' engagement in their care and that the gender of the medical students/doctors and clinical setting could affect this perception. Raising patients' awareness of their valuable role in male medical students' and doctors' education should be raised, as this will increase their acceptance during BST.

Vaginal Delivery in a Tracheostomised Woman: A Rare Case Scenario.

Spontaneous vaginal delivery in a tracheostomised woman is rare and literature concerning the same is also very limited, hence this might help in considering vaginal delivery at term as an option in such patients when there are no medical or obstetrical contraindications for the same. We present a case of a 24 years female patient hailing from Tamil Nadu in South India, who was tracheostomised secondary to subglottic stenosis, presented to Otorhinolaryngology department at thirty-eight weeks of gestation to know the possibility of a vaginal delivery at term. Since the patient had an uneventful obstetrical history and no medical or obstetrical contraindications for a vaginal delivery, patient was advised breathing exercises including Valsalva manoeuvre and kept under close follow up. Patient went to labor at term at thirty-nine weeks and five days of gestation, and with the help of a panel of senior doctors underwent spontaneous vaginal delivery with no complications. Vaginal delivery can be attempted in tracheostomised women, in the absence of any medical or obstetrical contra indications, if the patient is motivated and we have a panel of expert doctors from all concerned departments.

N-of-1 Trials of Antimicrobial Stewardship Interventions to Optimize Antibiotic Prescribing for Upper Respiratory Tract Infection in Emergency Departments: Protocol for a Quasi-Experimental Study.

Antimicrobial stewardship programs attempting to optimize antibiotic therapy and clinical outcomes mainly focus on inpatient and outpatient settings. The lack of antimicrobial stewardship program studies in the emergency department (ED) represents a gap in tackling the problem of antimicrobial resistance as EDs treat a substantial number of upper respiratory tract infection cases throughout the year. We intend to implement two evidence-based interventions: (1) patient education and (2) providing physician feedback on their prescribing rates. We will incorporate evidence from a literature review and contextualizing the interventions based on findings from a local qualitative study. Our study uses a quasi-experimental design to evaluate the effects of interventions over time in the EDs of 4 public hospitals in Singapore. We will include an initial control period of 18 months. In the next 6 months, we will randomize 2 EDs to receive 1 intervention (ie, patient education) and the other 2 EDs to receive the alternative intervention (ie, physician feedback). All EDs will receive the second intervention in the subsequent 6 months on top of the ongoing intervention. Data will be collected for another 6 months to assess the persistence of the intervention effects. The information leaflets will be handed to patients at the EDs before they consult with the physician, while feedback to individual physicians by senior doctors is in the form of electronic text messages. The feedback will contain the physicians' antibiotic prescribing rate compared with the departments' overall antibiotic prescribing rate and a bite-size message on good antibiotic prescribing practices. We will analyze the data using segmented regression with difference-in-difference estimation to account for concurrent cluster comparisons. Our proposed study assesses the effectiveness of evidence-based, context-specific interventions to optimize antibiotic prescribing in EDs. These interventions are aligned with Singapore's national effort to tackle antimicrobial resistance and can be scaled up if successful. ClinicalTrials.gov NCT05451863; https://clinicaltrials.gov/study/NCT05451836. DERR1-10.2196/50417.

Dermatology teaching for undergraduate medical students in clinical routine - a structured four-week curriculum.

Dermatology teaching is fundamental for the promotion of young colleagues in our specialty. However, traditional teaching methods are being scrutinized by students of the 'Generation Y and Z', which can pose new challenges for teaching institutions. We therefore aimed to assess the motivational impact and reception of a newly created four-week curriculum containing modernized teaching methods integrated into clinical routine. In this single-center study, 67 medical students completed this curriculum composed of weekly learning objectives including knowledge of morphological terms, 10 common dermatoses, communication and presentation skills. The participants provided information on their level of interest in dermatology each week as well as positive and negative aspects of the curriculum. During the curriculum a significant median increase in interest in dermatology was reported with no differences between the genders. Low initial interest could be improved, high initial interest maintained. Participants with an interest in scientific work (20.9%) were more motivated during the curriculum. The variety, quality of teaching and structure were the main aspects rated positively. Suggestions for improvement included the need for more teaching by senior doctors, transfer of responsibility, and a working environment updated to the latest technology standards. The presented curriculum was well received by the participants and allowed to better define learning preferences of new generations which can be helpful to modernize traditional teaching methods. Interest in scientific work could be a factor to identify students with a particularly strong interest in dermatology.

The anatomy of coercive practices in healthcare settings.

In healthcare settings, there can be a fine distinction between genuine performance management and vexatious complaints occurring in the context of bullying. The most common manifestation of such behaviour involves repetitive interpersonal abusive behaviours within the context of a power hierarchy. These interactions might well be experienced as bullying behaviour; however, the interpersonal dynamics underpinning such behaviours remains largely unexplored. This paper offers a psychological perspective on bullying and harassment and adopts a psychodynamic case study approach, utilising a case vignette involving a senior and junior doctor within a general practice context. Conflict can be mitigated by understanding the intra- and interpersonal dynamics that interfere with rational performance management. Psychological processes such as projection, displacement and projective identification are useful in understanding the genesis of bullying and harassment within demanding workplaces. Reflecting upon the psychological processes underpinning such conflict might help mitigate coercive workplace behaviour.

Multi-purposed diagnostic system for ovarian endometrioma using CNN and transformer networks in ultrasound

ObjectiveOvarian endometrioma (OMA) is one of the most common ovarian cysts worldwide, seriously impairing the reproductive function of females. Accurate diagnosis is of great significance for appropriate clinical treatment. Nowadays, the definitive diagnosis of OMA is based on its clinical manifestations, while ultrasound is widely employed as a routine diagnostic modality for OMA. However, the ultrasound diagnosis of OMA, which has various challenges, is contingent upon the expertise and experience of doctors. MethodsTo overcome this, we propose an automated method based on deep learning, which performs cyst segmentation and binary OMA (i.e. OMA and non-OMA) classification simultaneously. The features provided by the segmentation branch are fused with the classification features with the assistance of the attention mechanism. In this manner, the classification branch can better focus on the cyst regions of the image and learn more specific information, thereby improving the accuracy of classification. ResultsWe evaluate the method on an extensive dataset containing 1501 images. The proposed model achieved a classification accuracy of 91.36 % and a Dice score of 85.42 %, which outperformed several popular networks involved in this study. What’s more, further reader study revealed that our model demonstrates comparable performance with that of the senior doctors, while superior to that of the junior doctors. Conclusion and significanceTo the best of our knowledge, this is the first deep learning method specially designed for OMA diagnosis. This indicates that our model has the potential to assist junior doctors in improving their diagnostic accuracy.

Association between long working hours of doctors and the seriousness of adverse events: a cross-sectional study using national adverse event reporting system data in Japan.

The association between doctors' long working hours and the seriousness of adverse events with high patient impact has not been fully confirmed. Most previous studies were based on work hour regulations using more than 80 hours per week as an indicator of long working hours. We aimed to assess the association using a shorter indicator as the cut-off for long working hours among hospital doctors including senior doctors. This cross-sectional study used 12,245 adverse event reports from the Japan Council for Quality Health Care. We defined long working hours as 55 hours or more in the week before the adverse event and assessed the association with the seriousness of adverse events with high patient impact. The results showed that doctors working 55 or more hours in the preceding week were more likely to be involved in serious adverse events than those working fewer hours (odds ratio (OR) 1.22, 95% confidence interval (CI): 1.12-1.32). This association remained significant after adjusting for all covariates (OR 1.18, 95% CI: 1.08-1.28). Senior doctors were more likely to be involved in serious adverse events. Long working hours among doctors were associated with the seriousness of adverse events.

The Impact of Psychological, Social, Societal, and Economic Factors Leading to Relapse in Patients Recovered from Addiction

Abstract Background: The problem of using psychotropic substances and addiction has become one of the major problems in the world. Despite the significant increase in treatment programs of addiction, many studies indicate that the rate of relapse globally is very high, especially when treatment is limited to the medical side only. Aims: The study aims to determine the percentage of influence of psychological, societal, social, economic, and other factors that lead to relapse when recovering from addiction. Methods: This study conducted in two main hospitals for the treatment of substance use disorders in Baghdad (Ibn Rushud Teaching Hospital for Psychiatry and Al-Ataa Center for Addiction Treatment) through the period from January 10, 2023, to June 10, 2023. All (300 inpatient) who are suffering from relapse to addiction after recovery were included in the study. The scale was prepared for the psychological, social, therapeutic, environmental, and economic factors, which was used by a group of senior doctors working in the field of treatment of addiction and rehabilitation centers, who unanimously agreed with their expertise on these factors. Results: This study revealed that the most important factor for relapse is the availability of addictive substances (91%); other factors include psychological, social pressures that the addict is exposed to in his social environment, in addition to the loss of social support (76%). The pressure of friends or peers with a rate of (78%) and the weakness of family control (44%) in addition to the influence of other factors that were examined in this study. Conclusion: There are many factors affecting the return of those recovering from addiction to addiction again, and the most prominent of these factors is the abundance or ease of access to psychoactive substances in addition to other factors, which include (psychological, social, societal, and economic factors). Society must realize that the responsibility for preventing addiction should not be borne by the medical treatment alone, because it is a problem that must be dealt with collectively by all parties to enable recovered patients from addiction to build their lives with confidence.

Informing the development of a scoring system for National Health Service Clinical Impact Awards; a Delphi process and simulated scoring exercise.

To establish principles informing a new scoring system for the UK's Clinical Impact Awards and pilot a system based on those principles. A three-round online Delphi process was used to generate consensus from experts on principles a scoring system should follow. We conducted a shadow scoring exercise of 20 anonymised, historic applications using a new scoring system incorporating those principles. Assessment of clinical excellence awards for senior doctors and dentists in England and Wales. The Delphi panel comprised 45 members including clinical excellence award assessors and representatives of professional bodies. The shadow scoring exercise was completed by 24 current clinical excellence award assessors. The Delphi panel rated the appropriateness of a series of items. In the shadow scoring exercise, a novel scoring system was used with each of five domains rated on a 0-10 scale. Consensus was achieved around principles that could underpin a future scoring system; in particular, a 0-10 scale with the lowest point on the scale reflecting someone operating below the expectations of their job plan was agreed as appropriate. The shadow scoring exercise showed similar levels of reliability between the novel scoring system and that used historically, but with potentially better distinguishing performance at higher levels of performance. Clinical excellence awards represent substantial public spending and thus far the deployment of these funds has lacked a strong evidence base. We have developed a new scoring system in a robust manner which shows improvements over current arrangements.

Analysis of factors associated with delayed diagnosis and treatment of testicular torsion in 1005 cases from Chongqing city, China: a cross-sectional study

This study aimed to investigate the clinical and social factors of delayed treatment for testicular torsion (TT) and to explore the risk factors of testicular excision in China. The clinical data of 1005 patients with TT who were admitted to 48 medical institutions in Chongqing city (China) from January 2012 to December 2021 were retrospectively analyzed. It was revealed that the misdiagnosis rates of non-senior (junior and middle) grade doctors and senior doctors were 25.1% and 9.6%, respectively. The proportion of TT patients who received timely treatment (within 6 h after onset of symptoms) was 23.8%. The results of the multivariable logistic regression analysis indicated that absent cremasteric reflex was a protective factor for delayed surgery of more than 6 h from onset of symptoms to surgery. Misdiagnosis, consultation with a non-urologist as the first consultant doctor, absence blood flow in color Doppler ultrasound, negative high-riding testis findings, the presence of fever, and non-manual detorsion were identified as risk factors associated with delayed surgery (more than 6 h from the onset of symptoms) for TT. Furthermore, misdiagnosis, non-urologist first-consultant doctor, absent blood flow in DUS, non-manual detorsion, fever, degree of cord twisting > 180, and the initial diagnosis in tertiary hospitals were risk factors for orchidectomy. Having TT on the right side, and the presence of nausea and vomiting were identified as protective factors for orchidectomy. Technical training in the diagnosis and treatment of TT should be extended to primary hospitals and doctors to significantly improve their accuracy in managing this condition.

Impact of automatic acquisition of key clinical information on the accuracy of electrocardiogram interpretation: a cross-sectional study

BackgroundThe accuracy of electrocardiogram (ECG) interpretation by doctors are affected by the available clinical information. However, having a complete set of clinical details before making a diagnosis is very difficult in the clinical setting especially in the early stages of the admission process. Therefore, we developed an artificial intelligence-assisted ECG diagnostic system (AI-ECG) using natural language processing to provide screened key clinical information during ECG interpretation.MethodsDoctors with varying levels of training were asked to make diagnoses from 50 ECGs using a common ECG diagnosis system that does not contain clinical information. After a two-week-blanking period, the same set of ECGs was reinterpreted by the same doctors with AI-ECG containing clinical information. Two cardiologists independently provided diagnostic criteria for 50 ECGs, and discrepancies were resolved by consensus or, if necessary, by a third cardiologist. The accuracy of ECG interpretation was assessed, with each response scored as correct/partially correct = 1 or incorrect = 0.ResultsThe mean accuracy of ECG interpretation was 30.2% and 36.2% with the common ECG system and AI-ECG system, respectively. Compared to the unaided ECG system, the accuracy of interpretation was significantly improved with the AI-ECG system (P for paired t-test = 0.002). For senior doctors, no improvement was found in ECG interpretation accuracy, while an AI-ECG system was associated with 27% higher mean scores (24.3 ± 9.4% vs. 30.9 ± 10.6%, P = 0.005) for junior doctors.ConclusionIntelligently screened key clinical information could improve the accuracy of ECG interpretation by doctors, especially for junior doctors.

S22: Social Connectedness, Ageing and Mental Health in Doctors

Being a doctor is tough, especially in a post-pandemic world. Never has the field of doctors’ health been so stretched by need. Senior doctors, and medical leaders in particular, have been particularly taxed, as have their families. Unpacking some of the insights gleaned about medical leadership and wisdom in medicine, and conversely when this is lacking, is important for the sake of patients and doctors alike. In this symposium we will address new perspectives in doctors’ health tailored to this new healthcare world. Topics include: (i) Systemic interventions to support senior medical leadership; (ii) Wisdom in medicine; (iii) The dysfunctional or disruptive physician in healthcare; (iv) Senior doctors and their families; (v) Medical retirement in a post-pandemic world. Strong audience participation will be encouraged in this symposium.