Functional neurological disorder: A common reason for a neurology inpatient referral.

BACKGROUND AND PURPOSE: In 2021, the European Academy of Neurology's training requirements were updated to include functional neurological disorder (FND) as a core topic for the first time. To reinforce these changes, we aimed to understand the proportion of inpatients (in non-neurology settings) who are diagnosed with FND. METHODS: We prospectively collected data on diagnoses made after inpatient ward reviews from neurology trainees at three tertiary neurology centres in Scotland from April to September 2021. We assessed healthcare utilization data for patients with a diagnosis of FND, epilepsy and epileptic seizures, or a neuroinflammatory disorder over the preceding 12 months. RESULTS: There were 437 inpatient reviews for 424 patients by 13 trainees. The largest single diagnosis was FND (n = 80, 18%), followed by epilepsy (n = 64, 14%), primary headache disorder (n = 40, 9%) and neuroinflammatory disorders (n = 28, 6%). There was an uncertain diagnosis for 48 reviews (11%). Compared to patients with epilepsy or neuroinflammatory disorders, patients with FND had a similar number of admissions (2 vs. 2 vs. 1) and brain/spine imaging studies (2 vs. 1 vs. 2). CONCLUSIONS: In Scotland, FND was the most common diagnosis made after a request for an inpatient review by a neurologist from another department in the hospital. Patients with FND have similar health resource needs to those with other common neurological disorders when they present to hospitals with tertiary neurology centres. This data supports the inclusion of FND as a core curriculum topic in neurology training.

Reflective practice and transcultural psychiatry peer e-learning between Somaliland and the UK: a qualitative evaluation.

BACKGROUND: Reflective practice is a key skill for healthcare professionals. E-learning programmes have the potential to develop reflective practice in remote settings and low- and middle-income countries (LMICs), where access to in-person reflective groups may be reduced. 'Aqoon' is a global mental health peer-to-peer e-learning programme between Somaliland and UK medical students. We aimed to explore participants' experiences of participating in the Aqoon programme, including their experiences of reflective practice. METHODS: Thirty-three medical students (22 Somaliland, 11 UK) enrolled in Aqoon. We matched volunteer learners in trios, to meet online to discuss anonymised clinical cases relevant to chapters of the World Health Organization's mental health gap action programme (mhGAP) intervention guide. We conducted thematic analysis of learners' reflective writing and post-programme focus group transcripts. RESULTS: Twenty-four students (73%) attended at least three online discussions (14 Somaliland, 10 UK). Somaliland and UK students described improved reflective skills and greater recognition of stigma towards mental ill-health. Themes included gaining memorable insights from peer discussions which would impact their medical education. UK students emphasised improved cultural understanding of common psychiatric presentations whilst Somaliland students reflected on increased clinical confidence. DISCUSSION: Integrating reflective practice into Aqoon showed the potential for low-cost e-learning interventions to develop cross-cultural reflective practice among medical students in diverse settings.

How interprofessional education could benefit the future of healthcare - medical students' perspective.

As British medical students, we believe the impact that interprofessional education can have upon the future of healthcare to be a positive one. This is if it is implemented in health professions' pre-registration curricula worldwide. Our motivations for producing this article stem from our own experiences with IPE or rather our limited experiences during our medical school journey. We have exemplified the UK's NHS to demonstrate how IPE would positively impact a nation's healthcare system. With patient safety, patient experience and the economical functioning of the NHS always pertaining mainstream topics of discussion within the healthcare field, the need for improved interprofessional cohesion is now more important than ever before; especially with an increasingly demanding population. Through this article, we deeply analyse and expand upon the significance IPE has in enhancing interprofessional interactions at a pre-registration stage, in preparation for work within the NHS.

Biomarker measurement in non-invasively sampled colorectal mucus as a novel approach to colorectal cancer detection: screening and triage implications.

BACKGROUND: Faecal tests are widely applied for colorectal cancer (CRC) screening and considered for triaging symptomatic patients with suspected CRC. However, faecal tests can be inconvenient, complex and expensive. Colorectal mucus (CM) sampled using our new patient-friendly non-invasive technique is rich in CRC biomarkers. This study aimed to evaluate diagnostic accuracy of CRC detection by measuring protein biomarkers in CM. METHODS: Colorectal mucus samples were provided by 35 healthy controls, 62 CRC-free symptomatic patients and 40 CRC patients. Biomarkers were quantified by ELISA. Diagnostic performances of haemoglobin, C-reactive protein, tissue inhibitor of metalloproteinases-1, M2-pyruvate kinase, matrix metalloproteinase-9, peptidyl arginine deiminase-4, epidermal growth factor receptor, calprotectin and eosinophil-derived neurotoxin were assessed using receiver operating characteristic (ROC) curve analysis. RESULTS: Colorectal mucus haemoglobin was superior compared to other biomarkers. For haemoglobin, the areas under the curve for discriminating between CRC and healthy groups ('screening') and between CRC and symptomatic patients ('triage') were 0.921 and 0.854 respectively. The sensitivity of 80.0% and specificities of 94.3% and 85.5% for the two settings respectively were obtained. CONCLUSIONS: Haemoglobin quantification in CM reliably detects CRC. This patient-friendly approach presents an attractive alternative to faecal immunochemical test; however, the two methods need to be directly compared in larger studies.

Colorectal cancer detection by biomarker quantification in noninvasively collected colorectal mucus: preliminary comparison of 24 protein biomarkers.

OBJECTIVES: Noninvasive colorectal cancer detection and screening remain global diagnostic challenges because the existing stool tests either lack sensitivity or are complex and expensive. Moreover, colorectal cancer screening uptake is low due to stool sampling inconvenience. We have developed a simple and patient-friendly noninvasive technique for collecting highly informative colorectal mucus. In this study, we aimed to comparatively assess a range of candidate biomarkers in colorectal mucus samples for colorectal cancer detection. METHODS: The study included 17 patients with colorectal cancer and 35 healthy controls, who provided noninvasively collected colorectal mucus samples. Protein biomarker quantification in these samples by enzyme-linked immunosorbent assays allowed comparing diagnostic performances of 24 candidate biomarkers that comprised haemoglobin, D-dimer, M2-pyruvate kinase, carcinoembryonic antigen, C-reactive protein, calprotectin, eosinophil-derived neurotoxin, protein S100A12, tumour necrosis factor α, clusterin, soluble cytokeratin 18, caspase-cleaved cytokeratin 18, citrullinated histone H3, peptidyl arginine deiminase 4, epidermal growth factor, epidermal growth factor receptor, matrix metalloproteinase 9, tissue inhibitor of metalloproteinase 1, periostin, vascular endothelial growth factor A, vascular endothelial growth factor receptor 1, vascular cell adhesion molecule 1, intercellular adhesion molecule 1 and mucin 2. Tested biomarkers were ranked for colorectal cancer detection efficiency using receiver operating characteristic curve analysis. RESULTS: High area under the curve values between 0.943 and 0.768 were observed for haemoglobin, tissue inhibitor of metalloproteinase 1, M2-pyruvate kinase, peptidyl arginine deiminase 4, C-reactive protein, matrix metalloproteinase 9, epidermal growth factor receptor, eosinophil-derived neurotoxin and calprotectin. CONCLUSION: Quantification of protein biomarkers in noninvasively collected samples of colorectal mucus certainly allows detecting colorectal cancer. Further clinical evaluation of the optimal biomarkers identified by this study is needed.

Declining interest in general surgical training - Challenging misconceptions and improving access at undergraduate level.

BACKGROUND: In recent years, general surgery has faced a decline in applicants for postgraduate training. The St. George's Surgical Society hosted a national surgical conference with an aim to explore the reasons for the decline and to investigate the effectiveness of a one-day intervention on students' perceptions of general surgery and surgical skills. MATERIALS AND METHODS: The conference took place on 20th January 2018 at St. George's, University of London. During the conference, medical students received lectures on "careers in surgery" and small-group workshops introducing students to simulation-based laparoscopic machines. Delegates were invited to complete before and after questionnaires looking at various domains; (1) Perceptions of general surgery, (2) Simulation skills, and (3) Usefulness of the day. RESULTS: There were significant impacts on student perceptions of the speciality such as increases in the views that "general surgery contained the opportunities for personal and professional development" (26%, p = 0.04), and of "general surgery as a rewarding speciality" (26%, p = 0.05). There were also negative changes such as an increase in the perception that "general surgery is female unfriendly" (+32%, p = 0.01). There were positive findings in all aspects relating to the use of laparoscopic simulation. DISCUSSION: The challenges faced in improving access to general surgery has been highlighted. More importantly the benefits of a one day intervention in addressing misconceptions and improving knowledge was seen. This study also shows the benefits of simulation teaching in the undergraduate curriculum. CONCLUSION: The intervention has improved the perceptions on general surgery, surgical skills and knowledge and provided a platform for engaging students and clinicians.

The association between deep learning approach and case based learning.

Being medical students, and having experienced different learning approaches ourselves, here, we discuss and critically analyse the importance of the deep learning approach that Chonkar et al. have presented, alongside emphasizing Case Based Learning, and their roles in life long medical learning.

Response to 'using social media to support small group learning'.

This letter serves to respond to the article from the point of view of medical students. It offers critical perspectives on how to take the research further in certain areas and alternatives that can be investigated. It also reinforces conclusions made by the article, as well as bringing to light new ideas, advantages, and limitations of the findings of the study.