ST3 Level Research Articles

The Causes of Thyrotoxicosis, Clinical Features, and Treatment Strategies in a Former Iodine Deficient Area

Thyrotoxicosis is a hypermetabolic condition caused by excess thyroid hormones in the circulation with/without increased production from the thyroid gland. In this prospective study, we aimed to investigate the causes of thyrotoxicosis, clinical features, and treatment strategies in a former iodine-deficient area. Thyroid function tests, antithyroid and antithyroid receptor antibodies, and routine thyroid ultrasonography was obtained, and a thyroid scintigraphy/radioactive iodine uptake test was performed on need. A statistically significant difference was found between toxic multinodular goiter (TMNG) and Graves’ disease (GD) groups when mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), alanine aminotransferase (ALT), and aspartate aminotransferase (AST) values were analyzed. TSH levels were significantly lower in GD patients compared to those in TMNG and TNG patients, but free triiodothyronine (FT3) and free thyroxine (FT4) values were higher. A high level of TSH receptor antibody (TRAb) was observed in patients with normal antithyroid peroxidase (Anti-TPO). TRAb levels were found to be high. Anti-TPO and anti-thyroglobulin (Anti-Tg) levels were observed to be positively correlated with sT3 and sT4 levels. TMNG is the leading cause of thyrotoxicosis; despite sufficient iodide intake in our former iodine-deficient region, TMNG is characteristically seen in older patients with much lower thyroid hormone levels than GD. According to the study results, the diagnosis of patients with thyrotoxicosis, their clinical presentation, the treatment they will receive, early detection of postoperative complications were predicted

A pilot study of performance enhancement coaching for newly appointed urology registrars.

To assess the feasibility of performance enhancement coaching (PEC) for newly appointed Urology registrars (ST3s), specifically: whether the concept appealed, and which areas beyond technical skills acquisition were felt to be most relevant or useful. All delegates on the Urology Bootcamp 2023 were invited to take part in an online survey before and after a 2-hour PEC workshop, collecting: basic demographic data, performance challenges, and the important aspects to include in, and consider with, a coaching programme. The workshop was delivered by a surgeon with a professional coaching qualification, to groups of four delegates at a time over 4 days. Ten pre-defined areas were offered during the session. On a scale of 1 (poor) to 10 (excellent), the 62 participants' overall health was reported as a median of 8/10 (physical) and 7/10 (mental). Anxiety during performance was the most common concern (63%) and was accompanied by a tremor in 55%. The next most popular concerns, with 19% of responses each, were: sleep, insufficient operative skill or expertise, and worry about relationships with trainers. The commonest topics discussed were 'the inner critic' (100%), 'autonomic modulation' (69%), 'not working, well' (13%) and 'optimising study' (6%). Seventy-seven per cent were unaware of PEC for practising surgeons. All respondents felt that they would benefit from PEC to some extent (80% ≥8/10 where 10/10 was 'very useful'), ideally at the ST3 level. Sixty-two percent of respondents said there should be a fee for trainees, whereas 38% thought it should be free and paid for by their training authorities. The concept of PEC is acceptable to ST3 Urology trainees, with particular interest in techniques to mitigate negative self-talk and autonomic modulation techniques. Existing barriers to coaching for the surgical community would need to be addressed in designing an acceptable coaching programme.

Evaluation of the relationship of digital phototrichogram findings of patients with diffuse hair loss with blood TSH, ferritin and vitamin B12 levels.

Telogen effluvium (TE) is a type of alopecia that is frequently seen in women. Among factors resulting in hair loss, many reasons such as endocrine diseases, nutrition disorders, stress, anemia, low ferritin levels, vitamin B12 deficiency, and thyroid diseases are found. A digital phototrichogram is one of the non-invasive methods of diagnosis in the evaluation of alopecia. In this study, it was aimed to compare biochemical parameters of female patients with diffuse hair loss with phototrichogram findings. 108 female patients with diffuse hair loss were included in the study. Patients were divided into two groups: acute and chronic TE, and a hair pull test was applied. Total blood count, blood biochemistry, iron, iron binding capacity, ferritin, thyroid stimulating hormone (TSH), sT3, sT4, folic acid, and vitamin B12 levels were examined. The telogen/anagen ratios and hair densities of patients were determined with a phototrichogram. The serum biochemical parameters (aspartate aminotransferase, alanine aminotransferase, urea, creatinine), TSH, sT3, sT4, and folic acid levels of patients were within normal limits. Telogen ratio, anagen ratio, hair density, number of shed hairs, family history, blood ferritin, TSH, and vitamin B12 levels were found to be similar between groups having acute and chronic TE. In our study, while mean anagen and telogen ratios with trichoscan were similar to literature data, no statistically significant correlation was determined between patients' ages and examined trichoscan findings (p>0.05). The hair pull test positivity of patients with chronic TE was higher compared to patients with acute TE (p<0.05). In patients with positive hair pull tests, the telogen ratio and hair density were found to be higher. In the group with <40 ng/mL ferritin level, the mean telogen ratio was detected to be significantly higher than the mean anagen ratio (p<0.05). No significant correlation was determined between vitamin B12 and TSH levels in patients and phototrichogram findings (p>0.05). The findings of this study showed that ferritin has an important role in diffuse hair loss, and the phototrichogram method is an auxiliary method for the physician in the diagnosis of TE.

Management of Traumatic Cerebral Venous Sinus Thrombosis: A United Kingdom and Ireland Survey on Practice Variation.

Traumatic cerebral venous sinus thrombosis (tCVST) is an increasingly recognized sequela of traumatic brain injury (TBI), with skull fractures and extradural hematomas overlying venous sinuses recognized as risk factors. Although it may be treated with anticoagulation, the decision to treat tCVST is nuanced by the risk of new or worsening hemorrhage. Presently, there are no guidelines on the investigation and management of tCVST. Therefore, we conducted a UK- and Ireland-wide practice variation survey. A 17-question survey was sent via Google Forms to neurosurgeons and intensive care doctors of at least ST3 (registrar) level and above in the UK and Ireland and distributed by the Society of British Neurological Surgeons and investigators of the Sugar or Salt trial between May 9, 2023, and September 15, 2023. Data were extracted from the survey for both qualitative and quantitative analyses. There were 41 respondents to the survey, 18 (43.9%) of whom were consultant neurosurgeons. Fifty-four percent of the respondents performed a computed tomography intracranial venogram to investigate for tCVST where there was a skull fracture overlying or adjacent to a venous sinus, whereas 43.9% performed these at the time of TBI diagnosis. Around three-fourth of the respondents anticoagulate for tCVST, largely within 3 days post-TBI. A range of hemorrhagic and thrombotic complications have been observed following decisions to treat and withhold treatment of tCVST, respectively. Around two-third of the respondents conducted follow-up imaging in confirmed tCVST. None of the respondents had an established departmental protocol for the management of tCVST. This UK- and Ireland-wide survey on the management of tCVST revealed a variation in its diagnosis, treatment, and follow-up with no departmental protocol established. The optimal diagnostic pathway, management protocol, and follow-up of patients with tCVST remain unknown and should be the subject of future studies.

Experimental and kinetic investigation of the explosive behavior and free radical spectroscopic characteristics of hydrogen/propane mixed gas

A detailed investigation of the explosion mechanism of hydrogen (H2) - propane (C3H8) mixture gas is the prerequisite for effective prevention of its explosion. This study delved into the explosion pressure and the spectral intensity of free radicals within the H2-C3H8 mixture, conducting a comprehensive investigation of reaction kinetics to elucidate reaction rates, elementary reaction sensitivity, and reaction path. Our findings unveiled a relationship between hydrogen augmentation and heightened explosion pressure, particularly when the hydrogen mixing ratio exceeded 80.0%, and the explosion index reached to St3 level, thereby indicating an exceeding safety risk. Moreover, a discernible augmentation was observed in the spectral intensities of H•, OH•, and O• radicals in tandem with an increased hydrogen mixing ratio. Notably, a linear correlation emerged between the explosion pressure and the spectral intensities of these free radicals. R1: H•+O2 =O•+OH• was the most important reaction step. As the ignition starts, H2 burns prior to C3H8, giving rise to the generation of H• radicals. These H• radicals, in turn, actively participate in the dehydrogenation of C3H8, effectively catalyzing the overall chemical reaction. These results can provide potent scientific support and guidance for the prevention and management of H2-C3H8 explosions.

The role of Grey Scale Inversion Imaging (GSII) as a diagnostic tool of neck of femur fractures: is it more effective?

Grey Scale Inversion Imaging (GSII), a radiology reading software, has been utilized to improve anatomical and pathological delineation and consequently increase the diagnostic accuracy in a variety of trauma and Orthopaedic conditions. The objective of this study was to assess whether Grey Scale Inversion Imaging (GSII) has any impact on the diagnostic accuracy and inter-observer reliability in diagnosing neck of femur fractures. We performed a retrospective, single-centre study, to identify 50 consecutive anteroposterior (AP) pelvis radiographs of patients who presented to our unit with suspected neck of femur fractures between 2020 and 2021. The images included a combination of normal pelvic radiographs and others with features suggestive either intracapsular or extracapsular neck of femur fractures, which had been confirmed on computed tomography (CT), magnetic resonance imaging (MRI) and/or subsequent surgery. Four independent observers (two Trauma and Orthopaedics (T&O) consultants, one T&O Trainee Registrar (ST3 level) and one Trainee Senior House Officer (SHO in T&O) reviewed the images and graded each radiograph image using the Likert scale in response to the statement "there is a fracture". Following this, the same radiographs were inverted to Grey Scale Inversion Imaging (GSII) grey scale images and reassessed. RAND correlation was used for statistical analysis. Overall, observers appeared to have similar accuracy with normal radiographic imaging and with GSI sequences. Grey Scale Inversion Imaging (GSII) of digital radiographs did not affect the diagnostic accuracy of detecting neck of femur fractures in our study.

The correlations between serum thyroid hormone levels, crime, impulsivity and aggression in high-security forensic psychiatry service patients

Objective: High security forensic psychiatry services (HSFP) are increasingly popular institutions in Turkey, since they play a key role in the follow-up and treatment of patients. Thyroid hormone is known to be associated with certain psychiatric diseases. We investigated the correlations between serum thyroid hormone levels, criminality, impulsivity and aggression in criminal patients who received treatment in HSFP.&#x0D; Material and method: The study was conducted with 115 patients who presented in HSFP and met the study criteria and 115 healthy controls. Sociodemographic and Clinical Data Forms, Barratt Impulsivity Scale Short Form (BrIS-SF-11), Buss-Perry Aggression Scale (BPAS) were applied to all participants. Furthermore, serum TSH, serum free T3 and T4 levels were determined in the patient and control groups.&#x0D; Results: The sT3 and sT4 levels were significantly higher in the patient group when compared to the control group (p0.001). There was no significant difference between the TSH levels in the two groups (p&gt;0.001). Furthermore, it was determined that BrIS-SF-11 sub-dimension scores and the total score, BPRS sub-dimension scores and the total score were significantly higher in the patient group when compared to the healthy controls (p

Debt experience and sources of funding in OMFS training: A survey of current and aspirant OMFS trainees

Oral and Maxillofacial Surgery is unique specialty requiring dual qualification in medicine and dentistry. Since the inception of national recruitment a decade ago, only 70% of available posts have been filled. In a 2019 round, this was a worrying 30%. Questionnaires were sent to trainees at various levels via the Facebook JTG and Registrar groups. Data were collected on debt experience, and awareness of and access to financial assistance. We received 66 responses. The most important sources of funding were NHS work (46%), followed by student finance (25%). Of those surveyed, 79% were ‘concerned’ or ‘very concerned’ about debt. Respondents were interested in receiving more information on a range of sources of funding, such as non-NHS bursaries (81%), NHS bursaries (59%) and NHS work in OMFS (56%). Respondents identified the financial impact (44%), and the effect of personal and family life (41%) as the two biggest drawbacks to second-degree studies. In view of the persistent recruitment issues at the ST3 level in OMFS, it is important to address concerns surrounding second-degree study. Awareness of available support must be raised in order to safeguard the future of our specialty in its current format.

ST3 national selection for surgical specialty training in the UK: a comparative analysis

Introduction National recruitment at ST3 level is the point for aspiring surgical trainees to obtain a national training number and progress to consultancy. In the 2020 recruitment year, face-to-face interviews were not possible owing to the COVID-19 pandemic. This highlighted wide ranging variability in recruitment processes for different surgical specialties. Methods Person specification details and portfolio scoring matrices were accessed through the Oriel recruitment portal. These were analysed and broken down into common domains for comparison purposes by two authors. Overall scores were totalled. Each domain was assessed in terms of its importance to each specialty by calculating its percentage contribution to overall portfolio marks. Results There was variability in all aspects of portfolio assessment and scoring. This started with how many overall ranking marks were contributed by the portfolio to each specialty. Further analysis and comparison of scoring domains demonstrated heterogeneity in how each specialty assesses and awards candidates marks based on achievements. Large emphasis is placed on certain domains by some specialties but not others. Conclusions The degree of variation in ST3 portfolio assessment and the differences between surgical specialties in how the scoring domains are valued has implications for core surgical trainees and those looking to apply for higher surgical training at ST3 level. Currently, core surgical trainees are assessed using a common process of annual review of competence progression that may not be suited to helping prepare candidates for gaining a national training number. There is no available evidence to account for variability between surgical specialty recruitment processes. Further work is needed to assess whether ST3 selection scoring variation has any impact on trainee progression to higher surgical training.

962 COVID-19 And ST3 National Selection in Surgery: What Happens to Core Surgical Trainees When We Remove the Face-to-Face Interview?

IntroductionThe 2020 ST3 recruitment year for Higher Surgical Training (HST) did not have a face-to-face interview due to COVID-19. Candidates were solely scored on portfolio self-assessment alone. We have assessed the impact on Core Surgical Trainee progression into ST3 by comparing the 2020 recruitment year with 2019.MethodTotal numbers of applicants to ST3 for all 7 surgical sub-specialties that recruit at ST3 level were obtained via Freedom of Information requests from Health Education England (HEE). These were sorted by those who were in CST, had completed CST or had an alternative equivalence certificate.ResultsOverall applicant numbers were up in 2020, mainly from an increase in applicants with a Certificate of Readiness to Enter Higher Surgical Training. Overall ST3 positions appointed to were down. CST progression rate was down slightly, with an increase in appointees >10 years since graduation.ConclusionsThe 2020 recruitment year for ST3 HST had a higher number of applicants and lower places available than 2019. The majority of the extra applicants were trainees who have not completed CST in the UK. CST progression rate to HST was down slightly. The lack of face-to-face interview may benefit some candidates graduating >10 years ago.

Neurosurgery specialty training in the UK: What you need to know to be shortlisted for an interview

Neurosurgery is one of the most competitive specialties in the UK. In 2019, securing an ST1 post in neurosurgery corresponds to competition ration of 6.54 whereas a CST1 post 2.93. Further, at ST3 level, neurosurgery is the most competitive. In addition, the number of neurosurgical training posts are likely to be reduced in the coming years. A number of very specific shortlisting criteria, aiming to filter and select the best candidates for interview exist. In the context of the high competition ratios and the specific shortlisting criteria, developing an interest in the neurosciences early on will allow individuals more time to meet the necessary standards for neurosurgery. Here, we aim to outline the shortlisting criteria and offer advice on how to achieve maximum scores, increasing the likelihood to be shortlisted for an interview.

Workforce planning in neurosurgery

Purpose: Since the introduction of run-through training in UK Neurosurgery in 2007, there has been no limit on the number of posts deaneries may apply for. The rationale for run-through training was based on the premise that the number of trainees recruited would match the number of consultant posts eight years later. There has been no formal survey of the number of consultant neurosurgeons in the UK for several years. A survey was undertaken to measure the current Neurosurgical workforce.Methods: The Specialist Advisory Committee undertook a survey to establish the current workforce and estimate how best to ensure that the correct number of trainees are being recruited. Data was also obtained from public bodies including the GMC, NHS Jobs and JCST.Results: Since 1993 the number of Neurosurgeons in UK and Ireland has increased from 132.5 to 389 whole time equivalents (4.4% curvilinear annual increase). The number of registered neurosurgical trainees fell 9% from 278 in 2012 to 248 in 2017. The number of UK graduates in Neurosurgical training has remained constant. The number of trainees failing to complete training has increased from 1.25 per annum in 2009–2012 to 5–6 in 2014–2017. The number of ST1 level trainees recruited has risen, which a fall in the number of trainees entering at the ST3 level has partially offset. The number of doctors with a CCT in Neurosurgery but no substantive consultant post has risen from 26 to 43 between 2015 and 2018.Conclusions: Neurosurgical workforce data should be collected regularly and a workforce planning process should be implemented. Consultant expansion is required to reduce the number of CCT holders without consultant jobs. The specialty should prevent any further increase in the number of trainees recruited and we should consider a marginal reduction in recruitment.

The potential value of surrogate performance markers at caesarean section for the assessment of surgical competence

ObjectivesWe hypothsised that surrogate markers of competence (procedure time and estimated surgical blood loss) could be of value when assessing competence for trainees learning to undertake lower segment caesarean section (LSCS). The study aim was to investigate differences in surrogate markers of surgical competence at LSCS between different training grades of primary surgeon and for different grades of surgical assistant; to assess the potential value of using these surrogate markers in overall assessments of surgical competence. Study designOperating records for elective LSCS were reviewed from January 2007 to January 2015. Uncomplicated LSCS where a junior trainee (ST2/ST3) or a senior trainee (ST6+) was the primary surgeon were included. Inclusion criteria were LSCS with body mass index less than 35, singleton pregnancy, greater than 34 weeks’ gestation, no more than one previous caesarean section and no low-lying placenta. Procedure time, estimated blood loss and the effect of the grade of surgical assistant (consultant or trainee) on these were compared overall for all surgeons at ST2 level, ST3 level and senior level (ST6+) using Student’s t test and effect size calculation (Cohen test). ResultsDuring the study period 3099 uncomplicated LSCS were performed by 60 trainees: 1367 by ST2, 1085 by ST3 and 646 by senior trainees (ST6+). Mean procedure times and recorded estimated blood loss decreased significantly for each level of training (p < 0.05). The degree of experience of the surgical assistant was also associated with reduced procedure times and blood loss, this was significant for trainees in ST2 when assisted by a consultant (p < 0.05). ConclusionsTraining progression is associated with a reduction in procedure time and estimated blood loss, which are both surrogate markers of competence at LSCS. Current objective structured assessments of technical competence for trainees (OSATS) do not take these metrics into account when assessing performance. An enhanced assessment of trainees undertaking LSCS is suggested, reviewing both objective structured assessments of technical performance (OSATS) and surrogate markers of performance recorded in a surgical logbook to provide a more comprehensive assessment of overall competence.

Learning from and fearing failure

One specialist registrar's best-laid plans were upended when a difficult interview at ST3 level cost him his national training number. Here, he describes how he dealt with the failure, and used it to his benefit.

Three members of Medicago truncatula ST family are ubiquitous during development and modulated by nutritional status (MtST1) and dehydration (MtST2 and MtST3)

BackgroundShooT specific/Specific Tissue (ST) belong to a protein family of unknown function characterized by the DUF2775 domain and produced in specific taxonomic plant families, mainly Fabaceae and Asteraceae, with the Medicago truncatula ST family being the largest. The putative roles proposed for this family are cell elongation, biotic interactions, abiotic stress and N reserve. The aim of this work was to go deeper into the role of three M. truncatula ST proteins, namely ST1, ST2 and ST3. Our starting hypothesis was that each member of the family could perform a specific role, and hence, each ST gene would be subjected to a different type of regulation.ResultsThe search for cis-acting regulatory elements (CREs) in silico in pST1, pST2 and pST3 promoters showed prevalence of tissue/organ specific motifs, especially root- and seed-specific ones. Light, hormone, biotic and abiotic related motifs were also present. None of these pSTs showed the same combination of CREs, or presented the same activity pattern. In general, pST activity was associated with the vascular cylinder, mainly in roots. Promoter activation was highly specific and dissimilar during reproductive development. The ST1, ST2 and ST3 transcripts accumulated in most of the organs and developmental stages analysed - decreasing with age - and expression was higher in the roots than in the aerial parts and more abundant in light-grown plants. The effect of the different treatments on transcript accumulation indicated that ST1 behaved differently from ST2 and ST3, mainly in response to several hormones and dehydration treatments (NaCl or mannitol), upon which ST1 transcript levels decreased and ST2 and ST3 levels increased. Finally, the ST1 protein was located in the cell wall whereas ST2 and ST3 were present both in the cytoplasm and in the cell wall.ConclusionsThe ST proteins studied are ubiquitous proteins that could perform distinct/complementary roles in plant biology as they are encoded by differentially regulated genes. Based on these differences we have established two functional groups among the three STs. ST1 would participate in processes affected by nutritional status, while ST2 and ST3 seem to act when plants are challenged with abiotic stresses related to water stress and in physiologically controlled desiccation processes such as the seed maturation.

What vascular skills do general surgery trainees need to learn?

Vascular surgery has recently been recognised as a full surgical specialty in the UK. Major vascular interventions are centralised into hub units where sufficient volume of cases exists to achieve good outcomes and support training. 1 If no consolidation onto a single site has occurred, clinical networks have formed to provide emergency vascular cover for their catchment area. In local district hospitals, visiting vascular surgeons can run clinics, perform day-case minor elective surgery and offer a vascular opinion. 1 In 2013 the first round of trainee recruitment at ST3 level in vascular surgery, separate from general surgery, was completed. Vascular trainees will do less general surgery and as consultants they will work on a pure vascular rota. 2

Subclinical hypothyroidism in childhood and adolescense.

Subclinical hypothyroidism (SH) is defined as a serum thyroid-stimulating hormone (TSH) level above the reference range with normal serum free thyroxin (sT4) and free triiodothyronine (sT3) levels. The prevalence of SH in children and adolescents is reported between 1.7% and 9.5%. Hashimoto's thyroiditis is the most prevalent cause of SH in children. Although it has been suggested that SH is entirely an asymptomatic laboratory diagnosis, typical hypothyroid symptoms as well have been reported in some patients. Results of the adult studies on SH revealed that SH had unfavorable effects on cardiovascular system (atherosclerosis); metabolic parameters (dyslipidemia, insulin resistance, etc.); neuromuscular system; and cognitive functions in the long term. The number of studies investigating the effect of childhood SH on growth, bone maturation, lipid parameters, carbohydrate metabolism, neuromuscular system, and cognitive and cardiac function is limited. Knowledge about the natural history of SH is unclear even though there are numerous studies upon this subject. In children and adults, treatment of SH with L-T₄ is still a matter of debate, and there is no consensus on this issue yet.

A new national introductory simulation based course for ST3 level cardiothoracic surgical trainees

A new national introductory simulation based course for ST3 level cardiothoracic surgical trainees

Thyroid diseases in pregnancy: The importance of anamnesis

Primary objective of our study was to evaluate the efficiency of detailed medical history and thyroid examination of the pregnant women presenting to our clinic from Rize province and nearby which was an endemic goiter region. It was aimed to investigate the frequency of thyroid diseases, pregnancy outcomes and the efficiency of screening with thyroid function tests during the first trimester of pregnancy as secondary endpoint. Methodology : A prospective clinical study was conducted with 998 pregnant women between the ages of 17-48 years. In the first step of our study, a detailed medical history was obtained and a detailed thyroid gland examination was performed in all the patients (n=998). In the patients diagnosed with thyroid disease or considered to have thyroid disease with these results (n=107), thyroid diseases were evaluated with thyroid function tests and imagining methods. Analyses of socio-demographic data and nutrition were also made. In the second step, thyroid stimulating hormone (TSH), free T3 and free T4 tests were performed in the first antenatal examination of the pregnant cases considered not to have thyroid disease after medical history and examination (n=891). Parameters of thyroid peroxidase antibodies (TPOAb), thyroglobulin antibodies (TgAb) and TSH receptor auto antibodies (TRAb) were investigated in the cases whose TSH, sT3 and sT4 levels were different than the reference values after examination of the endocrinologist. Thyroid ultrasonography was performed. Urinary iodine levels in 24 hour urine were investigated. During pregnancy, the incidence of hyperthyroidism and hypothyroidism in the whole study group were 2.8% (28/998) and 4.3% (43/998), respectively, 6.7% of the patients (67/998) had a diagnosis of thyroid disease before pregnancy. Hyperthyroidism and hypothyroidism depending on the TSH screening results were 1.9% (17/891) and 1.1% (10/891) respectively and the incidence of overt hyperthyroidism and overt hypothyroidism were 0.2% (2/891) and 0.2% (2/891) in the pregnant cases considered not to have thyroid disease with medical history and examination. Detailed medical history and family history obtained during the first trimester of pregnancy helped us to identify 6.7% of thyroid diseases among the pregnant women. This result effectively emphasizes the importance of detailed first prenatal examination regarding the thyroid.

PTU-015 Trainee Endoscopic Procedures by Deanery and Year of Training in the United Kingdom: August 2011 to July 2012. are we doing Enough?

IntroductionThe burden of acute medicine on specialty trainee registrars (StR) is rising. Anecdotal evidence suggests that fewer endoscopic procedures are being performed by gastroenterology (GI) StR’s and that trainees although...