Attitudes and perceptions of medical and dental students on the implementation of non-surgical facial aesthetics in their curricula.

There is an accelerated demand for non-surgical facial aesthetics (NSFA) encompassing the use of botulinum toxin and dermal fillers. Healthcare professionals may either treat NSFA-related complications in the public sector or practise in the private sector. Currently, there is no standardised undergraduate teaching in the UK to educate healthcare professionals on NSFA. The aim of our study was to compare medical and dental undergraduate students' perceptions and awareness of NSFA, and to understand its role if implemented in each curriculum in the UK. An online questionnaire was devised and distributed via social media platforms to medical and dental students across the UK. Student responses were anonymised and collated as quantitative data, and subsequently analysed. Of the 146 respondents, 89% had no previous teaching on NSFA. Ninety-three per cent of medics and 75% of dentists agreed or strongly agreed that non-surgical aestheticians require dental or medical knowledge to deliver NSFA, and 66% of medics and 75% of dentists agreed or strongly agreed that NSFA should be incorporated into the undergraduate curriculum. Only 7% of medics and 8% of dentists were aware of the steps required to practise NSFA. Incoming doctors and dentists are showing interest in the field yet have no formal teaching in the area. Requiring healthcare professionals to have some baseline understanding of NSFA and its associated complications means that implementing formal education on the subject in the medical and dental curricula is an important consideration.

Dynamic hip screws versus cephalocondylic intramedullary nails for unstable extracapsular hip fractures in 2021: A systematic review and meta-analysis of randomised trials.

Background: Extracapsular hip fractures comprise approximately half of all hip fractures and the incidence of hip fractures is exponentially increasing. Extramedullary fixation using a dynamic hip screw (DHS) has been the gold standard method of operative treatment for unstable extracapsular fractures, however, in recent years, intramedullary nails (IMN) have become a popular alternative. IMN versus DHS is continuously discussed and debated in literature. Therefore, the purpose of this systematic review and meta-analysis is to directly compare the peri- and post-operative outcomes of these two techniques to provide an up-to-date analysis of which method of fixation is superior. Methods: The MEDLINE/PubMed, Embase and Web of Science Database were searched for eligible studies from 2008 to April 2022 that compared peri- and post-operational outcomes for patients undergoing IMN or DHS operations for fixation of unstable extracapsular hip fractures (PROSPERO registration ID:CRD42021228335). Primary outcomes included mortality rate and re-operation rate. Secondary outcomes included operation time, blood loss, transfusion requirement, complication, and failure of fixation rate. The risk of bias and quality of evidence were assessed using the Cochrane RoB 2.0 tool and GRADE analysis tool, respectively. Results: Of the 6776 records identified, 22 studies involving 3151 patients were included in the final review. Our meta-analysis showed no significant differences between mortality rates (10 studies, OR 0.98; 95% CI 0.80 to 1.22, p = 0.88) or re-operation rates (10 studies, OR 1.03; 95% CI 0.64 to 1.64, p = 0.91) between the two procedures. There were also no significant differences found between complication rates (17 studies, OR 1.29; 95% CI 0.79 to 2.12, p = 0.31) and failure of fixation rates (14 studies, OR 1.32; 95% CI 0.74 to 2.38, p = 0.35). However, DHS operations had a significantly longer operation time (p < 0.0001) and blood loss (p < 0.00001) than IMN operations. Conclusion: Overall, based on the outcomes assessed, this review has demonstrated that there is no significant difference in the post-operative outcomes for DHS vs IMN, however a significant difference exists in two of the intraoperative outcomes assessed in this review.

Long-term outcomes of outpatient laser ablation for recurrent non-muscle invasive bladder cancer: A retrospective cohort study.

Objectives: The objective of this study is to determine the long-term efficacy and safety of office-based Holmium:YAG laser ablation for the treatment of recurrent non-muscle-invasive bladder cancer (NMIBC). Methods: We retrospectively reviewed the medical records of all consecutive patients who underwent office-based laser ablation for recurrent bladder cancer between 2008 and 2016. The following data were collected: original histology, date of original histology, date of laser ablation, number of repeat laser ablation procedures required, date of tumor recurrence or progression, number of general anesthesia procedures (transurethral resection or cystodiathermy) required after first laser ablation, and number and severity of complications. Kaplan-Meier survival curves were produced for recurrence-free survival, progression-free survival, and overall survival. Results: A total of 97 patients, with an average age of 84 (62-98) years and an average Charlson Comorbidity Index of 6.9 (4-13), were included. The median follow-up was 61 (2-150) months. Fifty-five (56.7%) patients presented with tumor recurrence, and the median recurrence-free survival time was 1.69 years (95% CI 1.20-2.25). Only 9 (9.3%) patients had evidence of tumor progression to a higher grade or stage, 8 (89%) of which initially had low-grade tumors; however, no patient progressed to muscle-invasive disease. The median progression-free survival time was 5.70 years (95% CI 4.10-7.60), and the median overall survival time was 7.60 years (95% CI 4.90-8.70). No patient required emergency inpatient admission after laser ablation. Conclusion: Office-based Holmium:YAG laser ablation offers a safe and effective alternative method for treating low-volume, low-grade recurrent NMIBC, especially in elderly patients with significant co-morbidity, while avoiding general anesthesia and inpatient admission.

Evaluating the utility of an international webinar as a platform to educate students and doctors on the UK core surgical training portfolio.

BACKGROUND: Core Surgical Training (CST) is a competitive two-year postgraduate training program in the UK that is scored based on three equally weighted stations: management, clinical and portfolio. Preparing a surgical portfolio can start in medical school, however, there is limited guidance on what forms a competitive portfolio with the majority of advice coming from university resources and national societies which are variable throughout the country. Our aim was to assess the utility of a webinar to educate students and doctors on the CST portfolio to address this disparity. METHODS: Pre- and post-event questionnaires that included demographic data, 10-point Likert scales to self-report confidence on the understanding of the CST portfolio and its domains, and questions on utilising webinars were distributed to attendees. Pre- and post-event responses were paired, and scores were assessed for normality via the Shapiro-Wilk test; the Mann-Whitney U test was used to assess statistical significance. Cohen's d effect sizes were calculated to report standardised differences between pre-and post-event scores. RESULTS: A total of 177 participants from over 24 countries responded to both questionnaires. A statistically significant improvement in awareness of how to score maximum points was demonstrated across all nine CST domains (p < 0.0001). Regardless of whether they were UK-based or international, approximately half of the participants stated a preference for a webinar over an in-person format. Interestingly, most attendees did not feel that their university had provided them with adequate information on preparing for a surgical career with over half of the attendees stating that they had to attend events by external organisations to obtain such information. CONCLUSIONS: This study has demonstrated that a webinar can be effectively utilised to educate students and doctors on the various domains of the CST portfolio and how to maximise points in each section. Such events could address the variability of university resources and national societies across the country and provide equal opportunities for students. Further studies that directly compare webinars with in-person events and investigate long-term outcomes, such as success in CST applications, are required.

Assessing the utility of virtual OSCE sessions as an educational tool: a national pilot study.

BACKGROUND: Objective Structured Clinical Examinations (OSCEs) are a common form of assessment used across medical schools in the UK to assess clinical competence and practical skills and are traditionally held in an in-person format. In the past, medical students have often prepared for such exams through in-person peer-assisted learning (PAL), however, due to the recent Covid-19 pandemic, many in-person teaching sessions transitioned to online-based formats. There is currently a paucity of research on the utility of virtual PAL OSCE sessions and thus, we carried out a national pilot study to determine the feasibility of virtual OSCE teaching via feedback from participants and examiners. METHODS: A total of 85 students from 19 UK-based medical schools with eight students based internationally attended the series of online OSCE workshops delivered via Zoom®. All students and examiners completed a feedback questionnaire at the end of each session regarding parameters, which included questions on pre-and post-workshop confidence in three OSCE domains: history-taking, communication and data interpretation. A Likert scale using 5 Likert items was used to self-report confidence, and the results were analysed using the Mann-Whitney U test after assessing for normality using the Shapiro-Wilk test. RESULTS: Results from student feedback showed an increase in confidence for all three OSCE domains after each event (p < 0.001) with 69.4% agreeing or strongly agreeing that online OSCE sessions could sufficiently prepare them for in-person exams. Questionnaire feedback revealed that 97.6% of students and 86.7% of examiners agreed that virtual OSCE teaching would be useful for preparing for in-person OSCE examinations after the pandemic. CONCLUSION: Most participants in the virtual OSCE sessions reported an improvement in their confidence in history-taking, communication and data interpretation skills. Of the participants and examiners that had also experienced in-person OSCE examinations, the majority also reported that they found virtual OSCE sessions to be as engaging and as interactive as in-person teaching. This study has demonstrated that virtual OSCE workshops are a feasible option with the potential to be beneficial beyond the pandemic. However, more studies are required to assess the overall impact on student learning and to determine the value of virtual OSCE workshops on exam performance.

A Systematic Review of the Efficacy and Safety of Outpatient Bladder Tumour Ablation.

CONTEXT: Management of non-muscle-invasive bladder cancer (NMIBC) is costly and associated with negative health-related quality-of-life effects, in part because of the frequent need for repeated transurethral resections under general/regional anaesthesia. Outpatient-based diathermy or laser ablation is another option, but evidence for its efficacy is mixed and its use is controversial. OBJECTIVE: To systematically review evidence regarding the efficacy and safety of outpatient diathermy and laser ablation for the treatment of recurrent NMIBC. EVIDENCE ACQUISITION: The EMBASE, MEDLINE/PubMed, and Cochrane Library were searched from inception to June 26, 2020. All studies evaluating the use of diathermy or laser ablation for bladder tumours (new or recurrent) in an outpatient setting under local anaesthetic were included. Two reviewers independently screened all articles, searched the reference lists of retrieved articles, and performed the data extraction. The quality of evidence and risk of bias were assessed using the GRADE and ROBINS-I tools. EVIDENCE SYNTHESIS: The search yielded 1328 studies. After excluding duplicates, 1319 titles and abstracts were screened and 17 studies (1584 patients) were eligible for inclusion in the final review. The majority of patients had small, low-grade tumours, but there was heterogeneity in the inclusion criteria. Overall, laser ablation and diathermy resulted in mean recurrence rates of 47% and 32% at follow-up of 22-38 mo, respectively, with a mean progression rate of 3-12% (low certainty of evidence). Both procedures were well tolerated, with low pain scores and low periprocedural complication rates (moderate certainty of evidence). CONCLUSIONS: Outpatient diathermy and laser ablation have good short-term efficacy in patients with low-grade NMIBC and reduce the need for intervention under general/regional anaesthesia. The procedures are well tolerated with low complication rates. The overall certainty of evidence is low, with heterogeneity between studies and methodological limitations. However, we have highlighted the need for randomised trials with long-term follow-up using standardised risk classification and outcome measures. Despite these limitations, the findings will aid in patient counselling regarding this less invasive treatment option that avoids the morbidity of transurethral resection. PATIENT SUMMARY: Outpatient diathermy and laser ablation have good success rates in treating recurrent low-grade bladder tumours in the short term, avoiding the need for more invasive procedures under general/regional anaesthesia, with low rates of side effects. Further studies are needed to determine whether these treatments remain safe and effective in the long term.

Applicability and efficacy of diatom indices in water quality evaluation of the Chambal River in Central India.

Diatom indices have gained considerable popularity in estimation of the trophic state and degree of pollution in lotic ecosystems. However, their applicability and efficacy have rarely been tested in Indian streams and rivers. In the present study, benthic diatom assemblages were sampled at 27 sites along the Chambal River in Central India. PCA revealed three groups of sites, namely, heavily polluted (HVPL), moderately polluted (MDPL), and least polluted (SANT). A total of 100 diatom taxa belonging to 40 genera were identified. Brachysira vitrea (Grunow) was the most abundant species recorded from the least polluted sites with an average relative abundance of 29.52. Nitzschia amphibia (Grunow) was representative of heavily polluted sites (average relative abundance 31.71) whereas moderately polluted sites displayed a dominance of Achnanthidium minutissimum (Kϋtzing) with an average relative abundance of 26.33. CCA was used to explore the relationship between diatom assemblage composition and environmental variables. Seventeen different diatom indices were calculated using diatom assemblage data. The relationship between measured water quality variables and index scores was also investigated. Most of the diatom indices exhibited strong correlations with water quality variables including BOD, COD, conductivity, and nutrients, particularly phosphate. Best results were obtained for TDI and IPS indices which showed a high level of resolution with respect to discrimination of sites on the basis of pollution gradients. Water quality maps for the Chambal River were hence prepared in accordance with these two indices. However, satisfactory results with respect to water quality evaluation were also obtained by the application of EPI-D and IGD indices. The present study suggests that TDI and IPS are applicable for biomonitoring of rivers of Central India. Diatom indices, which are simpler to use such as IGD, may be considered, at least for a coarser evaluation of water quality.