Facial trauma aggravating paediatric orbital cellulitis.

We describe a case of paediatric orbital cellulitis with subperiosteal abscess following blunt facial trauma. Clinical features of orbital cellulitis developed on day 1 post-trauma. A subperiosteal collection subsequently formed lateral to the globe, causing significant ocular compromise. Surgical drainage and sinus washout were performed via external incisions, with satisfactory outcome. This case highlights how trauma may represent a non-sinogenic aggravating factor in orbital cellulitis. We describe how a subperiosteal abscess may vary depending on its aetiology, and how the surgical approach can be modified to locate and drain a laterally sited subperiosteal abscess.

Comparing the academic performance of graduate-entry and undergraduate medical students at a UK medical school.

BACKGROUND: The aim of the study was to assess whether graduate-entry (GE) medicine is a valid route to medical school in the United Kingdom. We set out to analyze the academic performance of GE students when compared with undergraduate (UG) students by assessing the representation of high achievers and students with fail grades within the two cohorts. METHODS: Using the Freedom of Information Act, we requested examination result data for the academic year 2013-2014 at St. George's Medical School, London, UK. We analyzed the number of students gaining distinction (top 7.5%) and those in the first two deciles. RESULTS: There were 389 GE and 548 UG students in the clinical years. A total of 61.3% of the first or second decile places were awarded to GEs, with 38.7% going to UGs (P < 0.0005). The proportion of GEs achieving the first or second decile was 30.1% compared to 12.8% of UGs (P < 0.01). The proportion of GEs awarded distinction was 12.3% compared to 2.9% of UGs (P < 0.02). The total number of students failing a year at the first attempt was 103. The failure rate within each group was 12.1% for GE and 10.2% for UG. DISCUSSION: Our study found that GE students were overrepresented in the high-achieving groups when compared to UG students. GE students were significantly more likely to be placed in the first or second decile or attain a distinction award. However, GE and UG have a similar failure rate. This study shows that GE programs are a valid entry route to medical courses in the UK.

Medical student perceptions of clinical neurosurgery teaching in an undergraduate medical school curriculum.

AIM: The aim of this study was to evaluate undergraduate medical student perceptions as to the value of different types of neurosurgical teaching to their general neuroscience education, delivered in the penultimate year of a U.K medical school. METHODS: We surveyed penultimate-year medical students at St George's Hospital Medical School, University of London (SGUL), who were undertaking their clinical neuroscience attachment from August 2014 to July 2015. A questionnaire comprising closed Likert scale questions and an open question inviting participants to comment freely was used to assess student perception about the value of Neurosurgical sessions within their overall neuroscience education. RESULTS: Of the 316 students in the year we surveyed 247 (78.2%), of whom 201 responded (response rate 81.4%). On average, 82.8% of students either agreed or strongly agreed that neurosurgical teaching sessions made a valuable contribution to their learning. In particular, lectures by neurosurgeons, clinical teaching on the Glasgow Coma Scale in neuro-ITU, bedside teaching and neurosurgical clinics were considered the most beneficial. The majority of students felt the sessions improved their understanding of neurological examination, signs, and 'red-flags'. The sessions were also beneficial for learning neuro-imaging and understanding of neurosurgical emergencies. Over two thirds felt that theatre sessions were beneficial, significantly more so amongst students invited to 'scrub-in'. CONCLUSIONS: Students rated neurosurgical sessions highly and valued the contribution they made not only to their learning of neurosurgical conditions and emergencies, but also to their learning of general neurology and clinical neurosciences overall. Student perceived learning from theatre sessions was significantly correlated with whether or not the student had been invited to 'scrub-in'. Expert neurosurgical teaching can make a valuable, and arguably essential contribution to the undergraduate medical curriculum.

A report on 15 years of clinical negligence claims in rhinology.

BACKGROUND: This study was designed to determine the characteristics of medical negligence claims in rhinology. In 2010-2011 the National Health Service (NHS) litigation bill surpassed 1 billion Great British Pounds (GBP; 1.52 billion U.S. dollars [US$]). Systematic analysis of malpractice complaints allows for the identification of errors and can thereby improve patient safety and reduce the burden of litigation claims on health services. METHODS: Claims relating to ear, nose, and throat between 1995 and 2010 were obtained from the NHS Litigation Authority and were analyzed. RESULTS: The series contains 65 closed claims that resulted in payment totaling 3.1 million GBP (US$4.7 million). Fifty claims were related to surgical complications. Functional endoscopic sinus surgery and septoplasty were the procedures most commonly associated with successful claims. There were 11 cases of orbital injury including 6 cases of visual loss and 5 cases of diplopia. The most common cause of a claim was failure to recognize the complication or manage it appropriately. Lack of informed consent was claimed in eight cases. Other claims arose because of errors in outpatient procedures (two), diagnosis (six), delayed surgery (one), and errors in medical management (three). CONCLUSION: This is the first study to report the outcomes of negligence claims in rhinology in the United Kingdom. Claims in rhinology are associated with a high success rate. Steps that can be taken to reduce litigation include careful patient workup and ensuring adequate informed consent. Where there is a suspicion of orbital damage early recognition and intervention is needed to reduce long-term injury to the patient.