Major incident preparation for acute hospitals: current state-of-the-art, training needs analysis, and the role of novel virtual worlds simulation technologies.

BACKGROUND: There is growing evidence that health systems in developed countries are poorly prepared to deal with major incidents. STUDY OBJECTIVES: This study aimed to determine the skills required for successful major incident response, the factors that contribute to a successful major incident exercise, and whether there is a role for using novel simulation training (virtual worlds) in preparing for major incidents. METHODS: This was a qualitative semi-structured interview study. Fourteen health care staff with experience of major incident planning and training in the United Kingdom were recruited. Interviews were content-analyzed to identify emergent themes. RESULTS: The aims and benefits of current exercises were categorized into three major themes: Organizational, Interpersonal, and Cognitive. Participants felt that the main objective of current exercises is to see how a major incident plan is implemented, rather than training individual staff. Communications was the most frequently commented-on area requiring improvement. Participants felt that lack of constructive feedback reduced the effectiveness of the exercises. All participants commented that virtual worlds technology could be successfully utilized for training. The creation of an immersive environment, increased training opportunity, and improved participant feedback were thought to be amongst the greatest benefits. CONCLUSION: There are clear deficiencies with current major incident preparation. Utilizing virtual worlds technology as an adjunct to existing exercises could improve training and response in the future.

Marathon-induced ischemic colitis: why running is not always good for you.

We present the case of a 31 year-old man who presented to the emergency department of University College Hospital London after collapsing upon finishing the London marathon. Contrast-enhanced multidetector computed tomography scanning revealed ischemic colitis of the cecum and ascending colon, which progressed to the development of clinical peritonism after 48 hours. This patient subsequently underwent a laparotomy and right hemicolectomy, with ileostomy formation, on the third day after admission. Operative and histologic findings confirmed ischemic colitis of the cecum and proximal colon. The postoperative recovery was uneventful, and he was discharged home well. Possible mechanisms of ischemia in marathon runners and those undergoing intense exercise include a combination of splanchnic vasoconstriction, dehydration, and hyperthermia, combined with mechanical forces. Most patients presenting with marathon-running-induced ischemic colitis respond to conservative treatment and the need for operative intervention is extremely rare.

"An Unusual Urological Tumour": Above the Collar and below the Belt.

Bladder lymphomas are rarely primary tumours and more commonly associated with systemic lymphoma, either as nonlocalised bladder lymphoma or as secondary bladder lymphoma. Primary bladder lymphomas (PBL) tend to be low-grade mucosa-associated lymphoid tissue (MALT) type, contrasting with diffuse large cell or follicular centre cell types more commonly seen in secondary bladder lymphoma. Bladder involvement by systemic lymphoma infers poor prognosis and patients often have no localising symptoms (typically a postmortem diagnosis). Other treatments are preferred over surgery for all bladder lymphomas, except where diagnosis is uncertain or for relief of irritative bladder symptoms. We describe a unique case of systemic high-grade B-cell lymphoma with simultaneous cutaneous renal and bladder lesions at presentation.