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"Cadaver England."
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The Royal College of Surgeons of England Damage Control Orthopaedic Trauma Skills course (DCOTS): resuscitative knowledge and confidence in surgical skills are reliably maintained at six months post course
Since 2012, the Damage Control Orthopaedic Trauma Skills course (DCOTS) has trained more than 250 surgeons in the principles and practice of damage control orthopaedics and early appropriate care. This Royal College of Surgeons of England (RCS England) course takes place at the RCS England Partner cadaver laboratory at Brighton and Sussex Medical School. Trauma is a leading cause of morbidity and mortality in the UK, and the course has tried to pass on the lessons of war and conflict from its military faculty and hard-won lessons of \"developed world\" trauma from its experienced civilian faculty.
Participating surgeons were invited to score their self-reported confidence before attending the DCOTS course, immediately afterwards and again 6 months later. A modified four-point Likert scale was used, with responses from 1 = No Confidence to 4 = Very Confident. Damage control resuscitation principles with damage control surgery showed the greatest retained increase at 6 months - 100% - which is extremely satisfying.
Self-reported confidence in pelvic external fixation was initially 93% dropping to 85%, which is also considered good to excellent. For pelvic packing, confidence was 90% at the end of the course, up from 19% precourse. This dropped to 62%, which was still considered good but low for the high standards of the course. This may relate to UK trainees' lack of familiarity with the concept.
Three of the main skills taught on the DCOTS are effectively retained at 6 months post course.
Journal Article
Analysis of laboratory-based laparoscopic colorectal surgery workshops within the English National Training Programme
Background
This study aimed to determine and compare the opinions of trainees and trainers attending courses using two simulation models (fresh frozen cadavers or anaesthetized pigs) and to assess trainees’ degree of insight into both the difficulty of different procedures and their operative performance in the simulated environment.
Methods
Trainers and trainees attending the training courses completed questionnaires. Performance was evaluated using the Global Assessment Score (GAS).
Results
Data were collected over a 12-month period from 26 trainers and 77 trainees. The overall satisfaction was high after attendance at either course (4.50 vs. 4.49;
p
= 0.83). When the opinions of the trainees and trainers in cadaveric and animal courses were compared, the findings rated the animal model as superior in terms of tissue quality (3.97 vs. 3.55;
p
= 0.02), persistence of air leak (1.43 vs. 2.40;
p
< 0.001), and lack of disturbance by odor (4.24 vs. 3.41;
p
< 0.001). The cadaveric model provided more realistic simulation for port placement (4.02 vs. 3.11;
p
< 0.001) and anatomy (4.25 vs. 3.00;
p
< 0.001) and was perceived to be superior as a training model (4.53 vs. 3.61;
p
= 0.001). The trainees demonstrated good insight into procedure difficulty and their operative performance. The trainees and trainers were shown to have a good concordance of scores. The trainees were more inclined to underrate and the peers to overrate their performance.
Conclusions
Trainees appear to have a good insight into procedure difficulty and their ability. Both training models have advantages and disadvantages, but overall, the cadaveric model is perceived to have a higher fidelity and greater educational value.
Journal Article
Earliest Directly-Dated Human Skull-Cups
The use of human braincases as drinking cups and containers has extensive historic and ethnographic documentation, but archaeological examples are extremely rare. In the Upper Palaeolithic of western Europe, cut-marked and broken human bones are widespread in the Magdalenian (∼15 to 12,000 years BP) and skull-cup preparation is an element of this tradition.
Here we describe the post-mortem processing of human heads at the Upper Palaeolithic site of Gough's Cave (Somerset, England) and identify a range of modifications associated with the production of skull-cups. New analyses of human remains from Gough's Cave demonstrate the skilled post-mortem manipulation of human bodies. Results of the research suggest the processing of cadavers for the consumption of body tissues (bone marrow), accompanied by meticulous shaping of cranial vaults. The distribution of cut-marks and percussion features indicates that the skulls were scrupulously 'cleaned' of any soft tissues, and subsequently modified by controlled removal of the facial region and breakage of the cranial base along a sub-horizontal plane. The vaults were also 'retouched', possibly to make the broken edges more regular. This manipulation suggests the shaping of skulls to produce skull-cups.
Three skull-cups have been identified amongst the human bones from Gough's Cave. New ultrafiltered radiocarbon determinations provide direct dates of about 14,700 cal BP, making these the oldest directly dated skull-cups and the only examples known from the British Isles.
Journal Article
The dangerous dead: dissecting the criminal corpse
William Hey Esq (1736-1819), FRS, Senior Surgeon to Leeds Infirmary, stiple engraving dated 1816Wellcome Library Collection Archive research from the University of Leicester's Harnessing the Power of the Criminal Corpse project has revised how medical historians interpret the Murder Act. [...]the criminal justice system relied on surgeons, not the executioner alone; for, as the cultural historian Thomas Laqueur reminds us, in the early modern era \"becoming really dead...took time\".
Journal Article
A Kidney Exchange Clearinghouse in New England
In September, 2004, the Renal Transplant Oversight Committee of New England approved the establishment of a clearinghouse for kidney exchange, proposed by Francis Delmonico, Susan Saidman, and the authors. This paper outlines the potential gains from kidney exchange and discusses practical constraints encountered as the authors began designing and implementing a matching mechanism.
Journal Article
Abiotic and Biotic Factors Associated with Tick Population Dynamics on a Mammalian Host: Ixodes hexagonus Infesting Otters, Lutra lutra
The Eurasian otter, Lutra lutra, hosts several parasites with zoonotic potential. As this semiaquatic mammal has large ranges across terrestrial, freshwater and marine habitats, it has the capacity for wide dispersion of pathogens. Despite this, parasites of otters have received relatively little attention. Here, we examine their ectoparasite load and assess whether this is influenced by abiotic or biotic variables. Climatic phenomena such as the North Atlantic Oscillation (NAO) affect weather conditions in northern Europe. Consequently parasite distributions, particularly species with life stages exposed to the external environment, can be affected. We assessed the extent to which inter-annual variations in large-scale weather patterns (specifically the NAO and Central England (CE) temperatures) and host characteristics influenced tick prevalence and intensity. Ectoparasites consisted of a single species, the nidiculous tick Ixodes hexagonus (prevalence = 24.3%; mean intensity = 7.2; range = 1-122; on n = 820 otter hosts). The prevalence, but not intensity of infestation, was associated with high CE temperatures, while both prevalence and intensity were associated with positive phases of the NAO. Such associations indicate that I. hexagonus are most abundant when weather conditions are warmer and wetter. Ticks were more prevalent on juvenile than sub-adult or adult otters, which probably reflects the length of time the hosts spend in the holt where these ticks quest. High tick number was associated with poor host condition, so either poor condition hosts are more susceptible to ticks, or tick infestations negatively impact on host condition. Otters are clearly an important and common host for I. hexagonus, which has implications for vector-borne diseases. This work is the first to consider the impacts of long-term weather patterns on I. hexagonus and uses wild-animal cadavers to illustrate the importance of abiotic and biotic pressures impacting parasitic populations.
Journal Article
Law and regulation of retained organs: the ethical issues
Organ retention has been with us for millennia. Walk into virtually any cathedral and many a church in Europe and you will nd an array of retained organs or tissue, allegedly originally the property of assorted saints, or even of God, and almost certainly collected without proper informed consent and retained in less than secure conditions. In our own time the complexities of organ collection, retention and use have proliferated.1 The events at Alder Hey Children's Hospital and the debates about the ethics of biobanking all over the world have dramatically highlighted the complexity, the difsiculty and the moral importance of these issues.2 Some of these issues have to do with the question of who can give permission for or consent to such removal and retention. Other issues involve consideration of whose rights or interests are engaged when cadaver organs and tissue are removed and retained, just what in particular is the nature, extent and force of those rights or interests, and how they are to be balanced against other moral considerations. These questions are the subject of this paper. We will not, however, here be concerned with the issues of genetic privacy, the security of genetic information.
Journal Article
A Pauper Dead-House: The Expansion of the Cambridge Anatomical Teaching School under the late-Victorian Poor Law, 1870–1914
In May 1901 an article appeared in the Yarmouth Advertiser and Gazette entitled ‘Alleged Traffic in Pauper Corpses—How the Medical Schools are Supplied—The Shadow of a Scandal’. It recounted that, although a pauper named Frank Hyde aged fifty had died in Yarmouth workhouse on 11 April 1901, his body was missing from the local cemetery. The case caused a public outcry because the workhouse death register stated that Hyde had been “buried by friends” in the parish five days after he had died. An editorial alleged that “the body was sent to Cambridge for dissection” instead and that the workhouse Master's clerk profited 15 shillings from the cadaver's sale. Following continued bad publicity, the visiting committee of Yarmouth Union investigated the allegations. They discovered that between 1880 and 1901 “26 bodies” had been sold for dissection and dismemberment under the terms of the Anatomy Act (1832) to the Cambridge anatomical teaching school situated at Downing College. The Master's clerk staged a false funeral each time a pauper died in his care. He arranged it so that “coffins were buried containing sand or sawdust or other ingredients but the body of the person whose name appeared on the outside [emphasis in original]” of each coffin never reached the grave. This was Hyde's fate too. Like many paupers who died in the care of Poor Law authorities in the nineteenth century, Hyde's friends and relatives lacked resources to fund his funeral expenses. Consequently, he underwent the ignominy of a pauper burial, but not in Yarmouth. His body was conveyed on the Great Eastern railway in a “death-box” to Cambridge anatomical teaching school. Following preservation, which took around four months, the cadaver was dissected and dismembered. It was interred eleven months after death in St Benedict's parish graveyard within Mill Road cemetery, Cambridge, on 8 March 1902. A basic Christian service was conducted by John Lane of the anatomy school before burial in a pauper grave containing a total of six bodies. The plot was unmarked and Frank Hyde disappeared from Poor Law records—the end product of pauperism.
Journal Article