Paediatric radiology training in the UK: a national trainee survey by the British Society of Paediatric Radiologists (BSPR).

AIM: To survey current UK radiology trainee experiences and opinions regarding the quality of paediatric radiology training encountered in their core years, and assess their career ambitions with regards to paediatric radiology. MATERIALS AND METHODS: A 22-question online survey, approved by the BSPR committee, was promoted over 12 months (1 February 2022 to 31 January 2023) across current radiology trainees and fellows via regional radiology training programme directors (TPDs), Junior Radiology Forum (JRF) trainee representatives, at BSPR Junior Forum webinar teaching sessions, and via social media/word of mouth. RESULTS: Eighty-three UK survey responses were received from 17/19 (89%) training schemes. Sixty of the 83 (72%) had taken or were due to take a 2-4 month core paediatric radiology placement partly at tertiary centres (66/83, 80%), with 67/83 (81%) receiving dedicated didactic teaching. Only 26/83 (31%) reported fulfilling core curriculum competencies and 32/83 (39%) reported not receiving enough paediatric radiology training. Almost a quarter (18/83, 22%) reported <2 months of paediatric radiology rotation during core training and 12% (10/83) across six training schemes, reported no dedicated paediatric teaching sessions. Respondents who left negative comments around their experience were more likely to reject paediatric radiology as a future career option (p<0.05). CONCLUSIONS: Only 31% of UK radiology trainees reported having enough paediatric radiology training to achieve core competencies. Standardised training, teaching, and increased on-call support could improve confidence in dealing with emergency cases and encourage interest in paediatric radiology beyond junior years.

Impact of the SARS-CoV-2 epidemic on private ENT consulting practice during the first month of lockdown in Réunion Island in 2020.

OBJECTIVE: To analyze the impact of the first month of lockdown related to the 2020 SARS-Cov-2 epidemic on the consulting activity of private ENT physicians in Réunion Island. MATERIAL AND METHODS: A multicenter prospective study analyzed the consulting activity of 12 ENT physicians in full-time private practice. The main endpoints were the number, characteristics and conditions of consultations. Secondary endpoints comprised presenting symptoms, diagnosis, prescriptions, adverse effects, and progression of monthly consulting turnover. RESULTS: Six hundred and ninety three consultations were performed during the study period (Appendix 1), with 50% emergency consultations. In 57.9% were face-to-face, 28.4% by phone and 13.7% video. In face-to-face consultation, the physician wore gloves in 53.8% of cases and a mask in 92.2%: surgical mask in 71.6% of cases and FFP2 in 28.4%. The three most frequent symptoms (48.5% of cases) were otalgia, hearing impairment, and vertigo. The three most frequent diagnoses (60.6% of cases) were otitis, intra-auricular foreign body (including wax), and pharyngeal infection. The three most frequently prescribed complementary exams (74.3% of cases) were imaging, hearing work-up, and specialist opinion. The three most frequently prescribed treatments (52.7% of cases) were intra-auricular drops, oral antibiotics, and nasal spray. The incidence of adverse effects was 0.001%. None of the physicians or patients seemed to have been infected by Covid-19 during the study period. There was a 47.3-91% (median, 75.6%) drop in monthly consultation turnover. CONCLUSION: The present study underscored the availability and adaptability of ENT physicians in the Réunion Island in an epidemic context, although economic impact was detrimental.

Report from the 19th annual Western Canadian Gastrointestinal Cancer Consensus Conference; Winnipeg, Manitoba; 29-30 September 2017.

The 19th annual Western Canadian Gastrointestinal Cancer Consensus Conference (wcgccc) was held in Winnipeg, Manitoba, 29-30 September 2017. The wcgccc is an interactive multidisciplinary conference attended by health care professionals from across Western Canada (British Columbia, Alberta, Saskatchewan, and Manitoba) who are involved in the care of patients with gastrointestinal cancer. Surgical, medical, and radiation oncologists; pathologists; radiologists; and allied health care professionals participated in presentation and discussion sessions for the purpose of developing the recommendations presented here. This consensus statement addresses current issues in the management of colorectal cancer.

Multidetector computed tomography sizing of aortic annulus prior to transcatheter aortic valve replacement (TAVR): Variability and impact of observer experience.

PURPOSE: To evaluate intra- and inter-observer variability of multidetector computed tomography (MDCT) sizing of the aortic annulus before transcatheter aortic valve replacement (TAVR) and the effect of observer experience, aortic valve calcification and image quality. METHODS: MDCT examinations of 52 consecutive patients with tricuspid aortic valve (30 women, 22 men) with a mean age of 83±7 (SD) years (range: 64-93 years) were evaluated retrospectively. The maximum and minimum diameters, area and circumference of the aortic annulus were measured twice at diastole and systole with a standardized approach by three independent observers with different levels of experience (expert [observer 1]; resident with intensive 6 months practice [observer 2]; trained resident with starting experience [observer 3]). Observers were requested to recommend the valve prosthesis size. Calcification volume of the aortic valve and signal to noise ratio were evaluated. RESULTS: Intra- and inter-observer reproducibility was excellent for all aortic annulus dimensions, with an intraclass correlation coefficient ranging respectively from 0.84 to 0.98 and from 0.82 to 0.97. Agreement for selection of prosthesis size was almost perfect between the two most experienced observers (k=0.82) and substantial with the inexperienced observer (k=0.67). Aortic valve calcification did not influence intra-observer reproducibility. Image quality influenced reproducibility of the inexperienced observer. CONCLUSION: Intra- and inter-observer variability of aortic annulus sizing by MDCT is low. Nevertheless, the less experienced observer showed lower reliability suggesting a learning curve.

Shoulder injuries from alpine skiing and snowboarding. Aetiology, treatment and prevention.

There has been a decrease in the overall injury rate and the rate of lower extremity injuries for alpine skiing, with a resultant increase in the ratio of upper extremity to lower extremity injuries. Upper extremity injuries account for 20 to 35% of all injuries during alpine skiing and nearly 50% of all injuries during snowboarding. The most common upper extremity injuries during skiing are sprain of the thumb metacarpal-phalangeal joint ulnar collateral ligament, and the most common in snowboarding is wrist fracture. Shoulder injuries from skiing and snowboarding have been less well characterised. With the increased ratio of upper to lower extremity injuries during alpine skiing and the boom in popularity of snowboarding, shoulder injuries will be seen with increasing frequency by those who care for alpine sport injuries. Shoulder injuries account for 4 to 11% of all alpine skiing injuries and 22 to 41% of upper extremity injuries. The rate of shoulder injuries during alpine skiing is 0.2 to 0.5 injuries per thousand skier-days. During snowboarding, shoulder injuries account for 8 to 16% of all injuries and 20 to 34% of upper extremity injuries. Falls are the most common mechanism of shoulder injury, in addition to pole planting during skiing and aerial manoeuvres during snowboarding. Common shoulder injuries during skiing and snowboarding are glenohumeral instability, rotator cuff strains, acromioclavicular separations and clavicle fractures. Less common shoulder injuries include greater tuberosity fractures, trapezius strains, proximal humerus fractures, biceps strains, glenoid fractures, scapula fractures, humeral head fractures, sterno-clavicular separations, acromion fractures and biceps tendon dislocation. Prevention of shoulder injuries during skiing and snowboarding may be possible through interventions in education and technique, conditioning and equipment and environment.

Traumatic rupture of the stomach secondary to Heimlich maneuver.

The case of a 93-year-old man who received a Heimlich maneuver while choking is reported. After the procedure, the patient presented with abdominal pain and ultimately was found to have developed a gastric rupture. He was hospitalized for 66 days. Review of the literature showed that only four gastric perforations related to the Heimlich maneuver have been documented. Other complications have occurred. It is reasonable to perform the procedure as an alternative to asphyxiation, but emergency physicians must be aware of the fact that life-threatening complications may ensue.

Proteases of Melilotus alba mesophyll protoplasts : II. General properties and effectiveness in degradation of cytosolic and vacuolar enzymes.

Proteases from mesophyll protoplasts of Melilotus alba were identified by standard proteolytic assays and separated using different chromatographic techniques. Their characterization also included their subcellular location. Besides the evidence for the multiplicity of the proteolytic enzymes, two protease sets were distinguished endopeptidases, which are exclusively vacuolar, and aminopeptidases, which are widely distributed throughout the cell. Cytosol-located enzymes were tested as substrates of the two sets of proteases, by studying comparatively the time-course changes of enzyme activities during incubation in total protoplast extracts, or in cytosol fractions devoid of vacuolar proteases. The degradation of phosphoenolpyruvate-carboxylase protein, a typical cytosolic enzyme, in the presence of purified amino-and endopeptidases, was also estimated by immunoprecipitation studies. Only the vacuolar endopeptidases are effective in the degradation of cytosolic enzymes. Hydrolytic enzyme activities mostly of vacuolar origin were very stable during incubation in total protoplast extracts. These proteins therefore appear to be particularly resistant to proteolytic attack. The results indicate that, in plants, the effective proteolytic system acting on cytosolic enzymes seems to be vacuole-located, and that the selectivity in protein degradation may be imposed by the susceptibility of the protein being degraded and by its transfer into the vacuoles.

Investigations on the efficacy of surface disinfection and surface cleaning procedures. 1. Tests under real-life conditions.

The suitability of disinfection preparations is assessed on the basis of laboratory tests, different methods being used in the various countries. Since such model tests are rather inadequate when it comes to judging surface disinfectants, additional in-use tests are desirable. They might, in any case, serve as a reference system for judging the evaluation criteria which still differ widely at the moment. The experiments described in this study were chiefly designed to establish the effect of cleaning and disinfection measures on bacteria normally present on surfaces and on the artificial contamination of surfaces with Sarcinae as model germs. The tests were carried out in the halls on 5 floors of a medical (lift landings). "Rodac" plates were used to identify the germs. 3 disinfectants (aldehydes, phenol derivative), 3 disinfectant cleaning agents and soft soap were used. The preparations reduced the normal germ count by approx. 80 per cent. The reduction was mainly due to the cleaning effect (soft soap was as effective as the preparations with disinfectant properties). The effect on the "normal germ count" cannot, therefore, be used as sole criterion of disinfectant action. When the various preparations were applied in twice the concentration recommended for Staphylococcus hospitalism, the Sarcina count was reduced by 99 to 99.9 per cent within 2 hours. The efficacy of disinfectants and disinfectant cleaning agents was practically the same. Additional laboratory tests are necessary before the effect of soft soap can be finally assessed. In actual practice the unit count of pathogenic germs- such as Staphylococci and Klebsiellae- is too low to enable an objective assessment of a disinfectant to be made. On the other hand, artificial contamination with such pathogens is not possible because of the risk involved. The use of Sarcina lutea as test germ is therefore subjects to certain limitations. One of the prerequisites for using it is, for example, prior reduction of the normal germ count to values of less than 500/100 cm2. The second communication will report on investigations into the chemoresistance of Sarcina and how this compares with that of Staphylococcus aureus and Klebsiella. The need for such studies arose from our present investigation.