Neurophobia Among Medical Students: Is Virtual Teaching the Answer?

OBJECTIVE: Neurophobia is well recognized as dissuading medical students from neurocentric specialties and limiting the success of neurology and neurosurgery teaching at medical school. Past studies have associated neurophobia with deficiencies in medical education. We performed a cross-sectional analysis of medical students' confidence and perceived level of knowledge in recognizing the following neurosurgical and neurological emergencies: ischemic stroke, hemorrhagic stroke, status epilepticus, subarachnoid hemorrhage, increased intracranial pressure, acute hydrocephalus, spinal cord injury, cauda equina syndrome, and traumatic brain injury. In addition, we assessed the usefulness of virtual seminars in neurosurgery and neurology teaching. METHODS: Medical students from King's College London were invited to a virtual teaching session. We obtained preteaching and postteaching scores for students' subjective ability to recognize specific neurologic and neurosurgical emergencies, along with their confidence in the subject. RESULTS: Ninety-seven medical students attended the teaching session. For our sample group's subjective rating on their confidence in neurology or neurosurgery as a subject, we obtained a mean score of 3.87 and a median score of 4. Across all domains, there was a significant forward shift in the distribution curve of scores after teaching. We obtained statistically significant differences for all 9 neurologic and neurosurgical emergencies evaluated in our questionnaire (asymptotic significance <0.001). Median scores for all 9 conditions improved after the teaching session, with >50% positive ranks seen within each group. Across the teaching modalities compared, placement teaching was the highest scoring, whereas online lectures received a better rating than in-person lectures. CONCLUSIONS: In neurosurgery teaching, virtual seminars may compensate for deficiencies that exist within medical education, hence limiting the effects of neurophobia.

Device profile of EndoAnchors for aortic stent graft implantation: overview of their safety and efficacy.

INTRODUCTION: Endovascular aneurysm repair (EVAR) and thoracic endovascular aneurysm repair (TEVAR) are established techniques to treat abdominal aortic aneurysms (AAA) and thoracic aortic aneurysms (TAA). However, there are limitations when challenging proximal neck anatomy is present. Heli-FX EndoAnchors have been used in addition to EVAR and TEVAR to improve proximal sealing of a stent-graft, but there are limited data available on their outcomes, safety, and efficacy. AREAS COVERED: The properties and development of Heli-FX EndoAnchors are evaluated. The evidence of various clinical outcomes, safety, and efficacy is interrogated with the augmented use of Heli-FX EndoAnchors with EVAR or TEVAR. EXPERT OPINION: Challenging proximal neck anatomy can be problematic during EVAR or TEVAR. EndoAnchors may be part of the solution - used either prophylactically or therapeutically. The safety and efficacy databases are building but long-term data are still not available for this device and there remains inadequate data to support its routine use. Judicious patient selection is still needed.

The effectiveness of the Guy's Rapid Diagnostic Clinic (RDC) in detecting cancer and serious conditions in vague symptom patients.

BACKGROUND: Rapid Diagnostic Clinics (RDC) are being expanded nationally by NHS England. Guy's RDC established a pathway for GPs and internal referrals for patients with symptoms concerning for malignancy not suitable for a site-specific 2WW referral. However, little data assessing the effectiveness of RDC models are available in an English population. METHODS: We evaluated all patients referred to Guy's RDC between December 2016 and June 2019 (n = 1341) to assess the rate of cancer diagnoses, frequency of benign conditions and effectiveness of the service. RESULTS: There were 96 new cancer diagnoses (7.2%): lung (16%), haematological (13%) and colorectal (12%)-with stage IV being most frequent (40%). Median time to definitive cancer diagnosis was 28 days (IQR 15-47) and treatment 56 days (IQR 32-84). In all, 75% were suitable for treatment: surgery (26%), systemic (24%) and radiotherapy (14%). Over 180 serious non-neoplastic conditions were diagnosed (35.8%) of patients with no significant findings in two-third of patients (57.0%). CONCLUSIONS: RDCs provide GPs with a streamlined pathway for patients with complex non-site-specific symptoms that can be challenging for primary care. The 7% rate of cancer diagnosis exceeds many 2WW pathways and a third of patients presented with significant non-cancer diagnoses, which justifies the need for rapid diagnostics. Rapid Diagnostic Centres (RDCs) are being rolled out nationally by NHS England and NHS Improvement as part of the NHS long-term plan. The aim is for a primary care referral pathway that streamlines diagnostics, patient journey, clinical outcomes and patient experience. This pilot study of 1341 patients provides an in-depth analysis of the largest single RDC in England. Cancer was diagnosed in 7% of patients and serious non-cancer conditions in 36%-justifying the RDC approach in vague symptom patients.