"More than just a medical student": a mixed methods exploration of a structured volunteering programme for undergraduate medical students.

BACKGROUND: As a result of the COVID-19 pandemic Imperial College School of Medicine developed a structured volunteering programme involving 398 medical students, across eight teaching hospitals. This case study aims to explore the relationship between the processes, context, participant experiences and impacts of the programme so that lessons can be learned for future emergencies and service-learning programmes. METHODS: Using an illuminative approach to evaluation we invited all volunteers and supervisors to complete a mixed-methods survey. This explored differences in experience across demographics and contextual factors, correlations between aspects of induction, supervision and overall experience, and reviewed the impacts of the programme. Quantitative responses were statistically analysed and qualitative reflections were thematically coded to triangulate and explain quantitative findings. Follow up interviews were carried out to check back findings and co-create conclusions. RESULTS: We received responses from 61 students and 17 supervisors. Student participants described predominantly altruistic motivations and transformational changes to their professional identity driven by feeling included, having responsibility, and engaging in authentic workplace-based learning afforded by freedom from the assessed curriculum. They reported new perspectives on their future professional role within the multidisciplinary team and the value of workplace-based learning. They reported increases in wellbeing and self-esteem related to feeling included and valued, and positively contributing to service provision at a time of need. Significantly higher overall satisfaction was associated with a personalised induction, active supervision, earlier stage of training, and male gender. Gender-related differences were not explained through our data but have been reported elsewhere and warrant further study. The duration, intensity and type of role that volunteers performed was similar across demographics and did not appear to modulate their overall experience. CONCLUSIONS: Whilst acknowledging the uniqueness of emergency volunteering and the survey response rate of 15% of volunteers, we suggest the features of a successful service-learning programme include: a learner-centred induction, regular contact with engaged and appreciative supervisors, and roles where students feel valued. Programmes in similar settings may find that service learning is most impactful earlier in medical students' training and that students with altruistic motivations and meaningful work may flourish without formal outcomes and assessments.

The Role of Neutrophil-Lymphocyte-Ratio (NLR) and Platelet-Lymphocyte-Ratio (PLR) as a Biomarker for Distinguishing Between Complicated and Uncomplicated Appendicitis.

Introduction Acute appendicitis (AA) is one of the most common acute general surgical presentations affecting 7% of the population at some point in their lifetime. The ability to assess the risk of complicated appendicitis (CA) from uncomplicated appendicitis (UA) in acute appendicitis (AA) could reduce the associated morbidity and mortality. The value of platelet lymphocyte ratio (PLR) as an inflammatory marker increases when its fluctuations are interpreted along with other complementary hematologic indices, such as neutrophil-to-lymphocyte ratio (NLR), which provides additional information about the disease activity. Hence, we postulated that NLR and/or PLR could serve as a potential surrogate marker in assessing the severity of AA. Aim This study aims to investigate the use of PLR and/or NLR as a surrogate biomarker in differentiating uncomplicated from complicated appendicitis. Material and methods This retrospective study was conducted at Russells Hall Hospital from January 1, 2017, to December 31, 2020. Data of all patients over age 16 years that had histologically confirmed appendicitis were retrieved. NLR and PLR were calculated from the admission hemogram, and the ratios were compared between uncomplicated (UA) or complicated appendicitis (CA). Cut-off values were calculated using the summarized ROC curve; in addition, the sensitivity and specificity with 95% confidence intervals were determined using SPSS 25.0 (IBM Corp., Armonk, NY). Results A total of 799 patients were analyzed, of which 469 (58.7%) were female. The median age was 31.2 years. The difference between NLR and PLR within the two appendicitis groups was significant (P=0.05; Kruskal-Wallis). Cohen's kappa (degree of inter-rater agreement) between NLR and PLR showed a moderate agreement of 0.589 (P<0.001). We equally demonstrated an exponential relationship between PLR and NLR (R2 =0.510, P<0.05). For UA, the area under the curve (AUC) and the cut-off for NLR and PLR were 0.715, 4.75 with a confidence interval (CI) of 0.678-0.653 and 0.632, 155 with a CI of 0.591-0.672, respectively. For CA, using NLR and PLR, the AUC and cut-off were 0.727, 6.96 with a CI of 0.687-0.768 and 0.653, 180.5 with a CI of 0.602-0.703, respectively; all were significant with a P of <0.001. Conclusion NLR and PLR are a reliable, less cumbersome surrogate biomarker for assessing the severity of acute appendicitis.

Predicting the Severity of Acute Appendicitis in Children Using Neutrophil-to-Lymphocyte Ratio (NLR) and Platelet-to-Lymphocyte Ratio (PLR).

Introduction The ability to predict risk of perforation in acute appendicitis (AA) could direct timely management and reduce morbidity. Platelet-to-lymphocyte ratio (PLR) and neutrophil-to-lymphocyte ratio (NLR) are surrogate severity markers in infections. This study investigates the use of PLR and NLR as a marker for distinguishing uncomplicated (UA) and complicated appendicitis (CA) in children. Materials and methods This retrospective single-center study collected data between January 1, 2014, and December 31, 2020. Children between five and 17 years of age with histologically confirmed appendicitis were included. Cut-off values for NLR and PLR were determined by employing the receiver operating characteristic (ROC) curve with sensitivity and specificity in addition to regression analysis. Results A total of 701 patients were included with a median age of 13 years. Out of which 52% of the cohort was female. The difference between the NLR and PLR ratios between UA and CA was significant (p=0.05, Kruskal-Wallis). For UA, the area under the ROC curve (AUC) and cut-off for NLR and PLR were 0.741, 3.80 with 95% CI of 0.701-0.781 and 0.660, 149.25 with 95% CI of 0.618-0.703, respectively. In CA, using NLR and PLR, AUC and cut-off were 0.776, 8.86 with 95%CI of 0.730-0.822 and 0.694, 193.67 with 95%CI of 0.634-0.755, respectively. All were significant with p<0.001. Conclusions NLR and PLR are reliable, synergistic markers predicting complicated appendicitis which can guide non-operative management in children.