A practical approach to Events Medicine provision.

In the past three decades, mass casualty incidents have occurred worldwide at multiple sporting events and other mass gatherings. Organisational safety and healthcare provision can consequently be scrutinised post-event. Within the UK, such incidents in the 1980s provided incentives to improve medical services and subsequent high profile UK-based international sporting events (London Olympics and Paralympics 2012, Glasgow Commonwealth Games 2014, Rugby World Cup 2015) added a further catalyst for developing services. Furthermore in the aftermath of the abandoned France versus Germany association football match at the Stade de France (Paris Terrorist Attacks, November 2015) and the 2016 UK report from HM Coroner on the Hillsborough Inquest, medical cover at sporting events is being further reviewed. Doctors providing spectator cover therefore need to have an awareness of their likely roles at sporting venues. Formal guidance exists in many countries for the provision of such cover but remains generic even though Events Medicine is increasingly recognised as a necessary service. The current evidence base is limited with best practice examples often anecdotally cited by acute care specialists (eg, emergency medicine) who provide cover. This article is therefore intended to present an overview for doctors of the knowledge and skills required to treat ill and injured spectators and enable them to adequately risk-assess venues in cooperation with other health and safety providers, including preparation for a major incident. It also gives guidance on how activity can be adequately assessed and how doctors can have management roles in Events Medicine.

Video assessment of basic surgical trainees' operative skills.

BACKGROUND: We previously described a feasible, reliable, valid, and acceptable clinical assessment form for basic surgical trainees (BSTs). We now recently assessed tissue-handling skills using real-time assessment (RTA) and video assessment (VA) and addressed feasibility, reliability, validity, and trainer-trainee agreement using the same assessment form. METHODS: Nine BSTs were videotaped as they performed open inguinal hernia repairs at 6 and 12 months of surgical training. Edited videotapes were independently rated by 7 consultants and 5 trainees using the technical part of the Edinburgh BST Assessment Form (EBSTAF-Tech), the Toronto Global Rating Scale of Surgical Performance (Toronto scale), and a visual analogue scale. RESULTS: RTA and VA both proved to be reliable tools (RTA alpha > or = .85; VA alpha > or = .76; interclass correlation coefficient [ICC] > or = .69, rho > or = .694 [P < or = .004]), but RTA was not construct valid. VA scores distinguished consultant from trainee operators (Mann-Whitney P < .02), with trainers able to discriminate between trainee levels (Wilcoxon P = .01 to .023). Concurrent validity was demonstrated by the VA (trainers tau-b = .71 to .79 [P < .001] and trainees tau-b = .79 to .82 [P < .001]) with good trainer-trainee agreement (EBSTAF-Tech tau-b = .35 [P = .03), Toronto tau-b = .46 [P = .006), and visual analogue scale tau-b = .46 [P = .006]). CONCLUSIONS: VA of BST tissue-handling skills is feasible, reliable, valid, and highly sensitive. It may also improve trainee self-assessment skills by promoting reflective practice.

Late malignant change in an ileal conduit.

Around 3000 bowel segment transpositions are performed in the UK each year and although malignancy is well-recognized following ureterosigmoidostomy, reports of similar changes in ileal conduits are sparse. We report a case of ileal adenocarcinoma in a 67-year-old lady some 49 years after ileal conduit, demonstrating previously unassociated histopathological features similar to those seen in collagenous colitis.

Trainees' opinions of the skills required of basic surgical trainees.

BACKGROUND: The Edinburgh Basic Surgical Trainee Assessment Form (EBSTAF) is a feasible, reliable and construct valid tool for assessment of surgical trainees. Our aim was to determine its acceptability as a formative training tool. METHODS: Thirty-three trainees on the South-East Scotland Basic Surgical Training Program ranked the 70 skills examined by the form as essential, important, useful, or irrelevant. Responses were compared with those of consultant surgeons obtained during development of the form. RESULTS: There was total agreement in 44 skills (63%, kappa = 0.34). Trainees assigned greater importance to 24 (34%). For individual skills domains, trainees assigned significantly greater value: communication, 86% versus 78%; application of knowledge, 75% versus 67%; team-working, 84% versus 77%; clinical skills, 86% versus 83%; and technical skills, 84% versus 79%. Responses were internally consistent (alpha = 0.74 to 0.93). CONCLUSIONS; Trainees attach greater value than consultants to the qualities assessed by EBSTAF. Trainees therefore agree with consultant opinion on what is important in a surgical trainee, supporting use of this form as a formative training tool.

An in vivo study of peripheral nerves in continuity: biomechanical and physiological responses to elongation.

Using an animal model, the in vivo visco-elastic properties of peripheral nerve in continuity were examined. The nerves were stretched by either 1 cm - Group A (8.8% strain) or 2 cm - Group B (16.1% strain). At constant strain, the stress-relaxation curves were plotted. Maximal relaxation was observed in the first 20 min. After 1 h, the decrease in tensions in Groups A and B were 36.8% and 41.8%, respectively. Throughout this hour and for 30 min after the release of tension, regular recordings of nerve blood flow using laser doppler flowmetry and peak nerve conduction velocity were taken. Nerve blood flow was reduced by similar amounts (Group A, 70%; Group B, 78%) by application of traction. On release, however, Group A displayed a reactive hyperaemia (blood flow 151% starting value) while Group B failed to recover (50% starting value at 30 min). Peak nerve conduction velocity was not significantly altered in Group A in response to traction, whereas in Group B the result was a gradual, but significant reduction in peak velocity to 66% starting value. The lack of correlation between blood flow and peak nerve conduction velocity in these studies suggests that ischaemia is not solely responsible for the increased latency.