Explore the vast range of titles available.

IntroductionDeciding whether to proceed with a major lower limb amputation is life-changing and complex, and it is crucial that the right decision is made at the right time. However, medical specialists are known to poorly predict risk when assessing patients for major surgery, and there is little guidance and research regarding decisions about amputation. The process of shared decision-making between doctors and patients during surgical consultations is also little understood. Therefore, the aim of this study is to analyse in depth the communication, consent, risk prediction and decision-making process in relation to major lower limb amputation.Methods and analysisConsultations between patients and surgeons at which major lower limb amputation is discussed will be audio-recorded for 10–15 patients. Semi-structured follow-up interviews with patients (and relatives/carers) will then be conducted at two time points: as soon as possible/appropriate after a decision has been reached regarding surgery, and approximately 6 months later. Semi-structured interviews will also be conducted with 10–15 healthcare professionals working in the UK National Health Service (NHS) involved in amputation decision-making. This will include surgeons, anaesthetists and specialist physiotherapists at 2–4 NHS Health Boards/Trusts in Wales and England. Discourse analysis will be used to analyse the recorded consultations; interviews will be analysed thematically. Finally, workshops will be held with patients and healthcare professionals to help synthesise and interpret findings.Ethics and disseminationThe study has been approved by Wales REC 7 (20/WA/0351). Study findings will be published in international peer-reviewed journal(s) and presented at national and international scientific meetings. Findings will also be disseminated to a wide NHS and lay audience via presentations at meetings and written summaries for key stakeholder groups.

Basic surgical skills training is rarely emphasised in undergraduate medical curricula. However, the provision of skills tutorials requires significant commitment from time-constrained surgical faculty. We aimed to determine how a peer-assisted suturing workshop could enhance surgical skills competency among medical students and enthuse them towards a career in surgery. Senior student tutors delivered two suturing workshops to second- and third- year medical students. Suturing performance was assessed before and after teaching in a 10-min suturing exercise (variables measured included number of sutures completed, suture tension, and inter-suture distance). Following the workshop, students completed a questionnaire assessing the effect of the workshop on their suturing technique and their intention to pursue a surgical career. Thirty-five students attended. Eighty-one percent believed their medical school course provided insufficient basic surgical skills training. The mean number of sutures completed post-teaching increased significantly (p < 0.001), and the standard deviation of mean inter-suture distance halved from ± 4.7 mm pre-teaching, to ± 2.6 mm post-teaching. All students found the teaching environment to be relaxed, and all felt the workshop helped to improve their suturing technique and confidence; 87% found the peer-taught workshop had increased their desire to undertake a career in surgery. Peer-assisted learning suturing workshops can enhance medical students' competence with surgical skills and inspire them towards a career in surgery. With very little staff faculty contribution, it is a cheap and sustainable way to ensure ongoing undergraduate surgical skills exposure.

Simulation is becoming an increasingly popular educational tool in numerous surgical specialities, including urology. This article reviews the current role of urological simulators; discussing their need, availability, incorporation and current limitations. A literature review of the electronic databases Medline, Embase and Google Scholar was performed. For increasingly limited urological training programs, simulation can act as a valuable adjunct to clinical training. Evidence suggests that simulation enables the trainee to bypass the early, error-prone part of the surgical learning curve. It should be incorporated into proficiency-based curricula, with junior trainees initially beginning with low fidelity simulators to grasp basic surgical skills before moving onto full-procedural simulation as they progress through their training. A wide variety of simulators of differing fidelity are currently available, teaching both technical (eg. cystoscopy) and non-technical (eg. communication) urological surgical skills. Whist numerous studies have assessed the face, content and construct validity of various urological simulators, further work needs to be undertaken to determine whether the skills learnt actually improve trainee performance in the operating room. Then, educators will be able to make informed decisions about whether these resource demanding (financially and in terms of demands on faculty) simulators are a worthwhile educational tool. Although further investigation is required, urological simulators appear to have a considerable role for developing both technical and non-technical urological skills in an increasingly restricted educational environment in modern urogynecology.

Surgical site infections (SSIs) of groin wounds are a common and potentially preventable cause of morbidity, mortality, and healthcare costs in vascular surgery. Our aim was to define the contemporaneous rate of groin SSIs, determine clinical sequelae, and identify risk factors for SSI. An international multicentre prospective observational cohort study of consecutive patients undergoing groin incision for femoral vessel access in vascular surgery was undertaken over 3 months, follow‐up was 90 days. The primary outcome was the incidence of groin wound SSI. 1337 groin incisions (1039 patients) from 37 centres were included. 115 groin incisions (8.6%) developed SSI, of which 62 (4.6%) were superficial. Patients who developed an SSI had a significantly longer length of hospital stay (6 versus 5 days, P = .005), a significantly higher rate of post‐operative acute kidney injury (19.6% versus 11.7%, P = .018), with no significant difference in 90‐day mortality. Female sex, Body mass index≥30 kg/m2, ischaemic heart disease, aqueous betadine skin preparation, bypass/patch use (vein, xenograft, or prosthetic), and increased operative time were independent predictors of SSI. Groin infections, which are clinically apparent to the treating vascular unit, are frequent and their development carries significant clinical sequelae. Risk factors include modifiable and non‐modifiable variables.

The coronavirus (COVID-19) pandemic continues to affect the NHS. The Vascular and Endovascular Research Network (VERN) COvid Vascular sERvice (COVER) study has prospectively shown the significant global impact of the COVID-19 pandemic on vascular surgery. The aim of this study is to investigate the way in which this second wave has affected surgeons' ability to treat patients with urgent vascular conditions, using contemporaneous snapshot data from 30 UK vascular centres. This is a contemporary (18-28 January 2021) re-run of the Tier 1 COVER survey. This used closed and open questions, related to centres' provision of common vascular services, threshold for treatment, imaging, screening, staff and theatre availability, multidisciplinary team input, clinics, personal protective equipment, vaccination policies and case-backlogs. The survey was disseminated to clinicians via email. A service reduction score was calculated. Forty-two complete responses were received from 30 vascular centres (England, Northern Ireland, Scotland and Wales). Overall, 56.7% of units are performing only urgent procedures. The threshold for abdominal aortic aneurysm (AAA) repair has increased in the majority of UK centres (60%). One in six AAA screening programmes have stopped all screening activity: 30% having a significantly reduced programme and only half running as normal. Waiting lists are increasing for AAA, lower limb revascularisation and venous disease. Overall, these data suggest that vascular care in the NHS is facing unprecedented pressures due to COVID-19. Vascular stakeholders will have to urgently address these issues in the coming months. ISRCTN 80453162 (registered prospectively).

IntroductionInterpreting, performing and applying research is a key part of evidence-based medical practice, however, incorporating these within curricula is challenging. This study aimed to explore current provision of research skills training within medical school curricula, provide a student-focused needs assessment and prioritise research competencies.MethodsA international, cross-sectional survey of final year UK and Irish medical students was disseminated at each participating university. The questionnaire investigated research experience, and confidence in the Medical Education in Europe (MEDINE) 2 consensus survey research competencies.ResultsFully completed responses were received from 521 final year medical students from 32 medical schools (43.4% male, mean age 24.3 years). Of these, 55.3% had an additional academic qualification (49.5% Bachelor’s degree), and 38.8% had been a named author on an academic publication. Considering audit and research opportunities and teaching experience, 47.2% reported no formal audit training compared with 27.1% who reported no formal research training. As part of their medical school course, 53.4% had not performed an audit, compared with 29.9% who had not participated in any clinical or basic science research. Nearly a quarter of those who had participated in research reported doing so outside of their medical degree course. Low confidence areas included selecting and performing the appropriate statistical test, selecting the appropriate research method, and critical appraisal. Following adjustment, several factors were associated with increased confidence including previous clinical research experience (OR 4.21, 2.66 to 6.81, P<0.001), additional degrees (OR 2.34, 1.47 to 3.75, P<0.001), and male gender (OR 1.90, 1.25 to 2.09, P=0.003). Factors associated with an increase in perceived opportunities included formal research training in the curriculum (OR 1.66, 1.12 to 2.46, P=0.012), audit skills training in the curriculum (OR 1.52, 1.03 to 2.26, P= 0.036) and research methods taught in a student selected component (OR 1.75, 1.21 to 2.54, P=0.003).DiscussionNearly one-third of students lacked formal training on undertaking research, and half of students lacked formal audit training and opportunities to undertake audit as part of their medical school course. The presence of research training in the cirriculum was associated with an increase in perceived opportunities to participate in MEDINE2 research competencies. Female gender and a lack of previous research experience were significant factors influencing confidence and participation in research.

Background Basic surgical skills training is rarely emphasised in undergraduate medical curricula. However, the provision of skills tutorials requires significant commitment from time-constrained surgical faculty. Purpose We aimed to determine how a peer-assisted suturing workshop could enhance surgical skills competency among medical students and enthuse them towards a career in surgery. Methods Senior student tutors delivered two suturing workshops to second- and third- year medical students. Suturing performance was assessed before and after teaching in a 10-min suturing exercise (variables measured included number of sutures completed, suture tension, and inter-suture distance). Following the workshop, students completed a questionnaire assessing the effect of the workshop on their suturing technique and their intention to pursue a surgical career. Results Thirty-five students attended. Eighty-one percent believed their medical school course provided insufficient basic surgical skills training. The mean number of sutures completed post-teaching increased significantly (p<0.001), and the standard deviation of mean inter-suture distance halved from ±4.7 mm pre-teaching, to ±2.6 mm post-teaching. All students found the teaching environment to be relaxed, and all felt the workshop helped to improve their suturing technique and confidence; 87% found the peer-taught workshop had increased their desire to undertake a career in surgery. Discussion Peer-assisted learning suturing workshops can enhance medical students' competence with surgical skills and inspire them towards a career in surgery. With very little staff faculty contribution, it is a cheap and sustainable way to ensure ongoing undergraduate surgical skills exposure.

Basic surgical skills training is rarely emphasised in undergraduate medical curricula. However, the provision of skills tutorials requires significant commitment from time-constrained surgical faculty. We aimed to determine how a peer-assisted suturing workshop could enhance surgical skills competency among medical students and enthuse them towards a career in surgery. Senior student tutors delivered two suturing workshops to second- and third- year medical students. Suturing performance was assessed before and after teaching in a 10-min suturing exercise (variables measured included number of sutures completed, suture tension, and inter-suture distance). Following the workshop, students completed a questionnaire assessing the effect of the workshop on their suturing technique and their intention to pursue a surgical career. Thirty-five students attended. Eighty-one percent believed their medical school course provided insufficient basic surgical skills training. The mean number of sutures completed post-teaching increased significantly (p<0.001), and the standard deviation of mean inter-suture distance halved from ±4.7 mm pre-teaching, to ±2.6 mm post-teaching. All students found the teaching environment to be relaxed, and all felt the workshop helped to improve their suturing technique and confidence; 87% found the peer-taught workshop had increased their desire to undertake a career in surgery. Peer-assisted learning suturing workshops can enhance medical students' competence with surgical skills and inspire them towards a career in surgery. With very little staff faculty contribution, it is a cheap and sustainable way to ensure ongoing undergraduate surgical skills exposure.

ObjectiveThe objective of the article is to assess changes in splenic volume in the setting of hypovolemic shock; splenic enhancement in hypovolemic shock is also assessed.Materials/methods71 consecutive adult patients with the hypovolemic shock complex on computed tomography (CT) were identified. Spleen volume and enhancement were compared to a baseline CT scan (without shock) or to height- and sex-corrected normal values and a control population when a comparison CT was unavailable.ResultsSplenic volume was significantly lower in the setting of shock. Average splenic volume in adult patients with shock was 107 ± 63 cm3 compared to 220 ± 164 cm3 in the control population (P < 0.001). All shock patients with a comparison CT (n = 35) had decreased splenic volume in the setting of shock. The area under the receiver operating characteristic (ROC) curve for spleen volume predicting shock was 0.83. Splenic enhancement was also significantly lower in the setting of shock. Mean splenic attenuation value in our shock population was 105 ± 34 HU compared to 134 ± 25 HU in the control population (P < 0.001). Decreased splenic enhancement was present in 25 of 71 shock patients and in none of the control patients (P < 0.001).ConclusionDecreased splenic volume is a ubiquitous and reliable sign of hypovolemic shock and should be considered a member of the hypovolemic shock complex. It is of particular utility when a prior study is available. Splenic hypoenhancement has high specificity and a high positive predictive value for hypovolemic shock in the correct patient population.

Development of RNAi-based therapeutics has the potential to revolutionize treatment options for a range of human diseases. However, as with gene therapy, a major barrier to progress is the lack of methods to achieve and measure efficient delivery for systemic administration. We have developed a positive-readout pharmacodynamic transgenic reporter mouse model allowing noninvasive real-time assessment of siRNA activity. The model combines a luciferase reporter gene under the control of regulatory elements from the lac operon of Escherichia coli. Introduction of siRNA targeting lac repressor results in increased luciferase expression in cells where siRNA is biologically active. Five founder luciferase-expressing and three founder Lac-expressing lines were generated and characterized. Mating of ubiquitously expressing luciferase and lac lines generated progeny in which luciferase expression was significantly reduced compared with the parental line. Administration of isopropyl β-D-1-thiogalactopyranoside either in drinking water or given intraperitoneally increased luciferase expression in eight of the mice examined, which fell rapidly when withdrawn. Intraperitoneal administration of siRNA targeting lac in combination with Lipofectamine 2000 resulted in increased luciferase expression in the liver while control nontargeting siRNA had no effect. We believe a sensitive positive readout pharmacodynamics reporter model will be of use to the research community in RNAi-based vector development.