"No drain, no gain": Validation of novel quinsy simulation model.

OBJECTIVES: To test a novel, low-cost, home-made model for needle aspiration of PTA.To ascertain whether simulation-based teaching using this model was superior to lecture-based teaching in increasing confidence and reducing anxiety relating to PTA aspiration.To assess whether there was an improvement in outcomes for PTA patients at one hospital following the delivery of a simulation-based training session using our model. METHODS: We designed two teaching sessions for junior doctors starting work in ENT: a simulation-based teaching session using a low-cost home-made simulation model and a lecture-based teaching session covering the same content. We asked the participants to complete pre- and post-session surveys regarding confidence and anxiety levels and analyzed this data. We also retrospectively collected data over 3 months for patients referred to ENT with suspected PTA and assessed their outcomes. We assessed patient outcomes before and after the delivery of a simulation-based training course using our model. RESULTS: Simulation-based teaching using our model was shown to be associated with a statistically significant increase in junior doctors' confidence levels. Reaccumulation and reattendance rates for PTA following aspiration were 16.67% and 22.7% respectively preintervention and 0% and 7.14% respectively postintervention. CONCLUSION: A regular simulation-based teaching session should be introduced using a PTA aspiration model for junior doctors as it leads to increased confidence levels, and reduced reaccumulation and recurrence rates of PTA. LEVEL OF EVIDENCE: Level 4.

Emergency airway training: "Who are you going to FONA?"

OBJECTIVES: To demonstrate face and content validity of a home-made simulation model as a training tool for front of neck access (FONA) procedures. DESIGN: This was a prospective evaluation study, in which experienced otolaryngologists and trainees were recruited to complete 3 tasks using our FONA model. SETTING: The study was completed during regular simulation training days and international conferences. PARTICIPANTS: A total of 52 participants completed the questionnaire and were included in the study; 25 were experts and 27 were trainees. MAIN OUTCOME MEASURES: All participants completed a validated 15-item questionnaire using a 5-point likert scale to assess the model across 4 domains: face validity (FV), global content (GC), task-specific content (TSC) and curriculum applicability (CTR). RESULTS: There were no statistically significant differences between the groups ratings for FV, GC, TSC or CTR (P = .76, .13, .4 and .67, respectively). The model achieved a median FV of 4 (IQR 4-5) with the agreement of experienced and trainee groups (68.9% and 92%, respectively). The median GC validity score was 5 (IQR 4-5) with the agreement of 87.6% and 98.4% in respected groups. The model achieved a median TSC of 4.8 (IQR 4-5) with the agreement of 54.5% and 99% in respected groups. The median CTR score was 5 (IQR 4-5) with the agreement of 54.4% and 100% in respected groups. CONCLUSION: Our home-made FONA model achieved face and content validity for training and is safe and affordable for teaching basic front of neck access skills to otolaryngology trainees.

More Than Meets the Eye: A Rare Case of Posterior Scleritis Masquerading as Orbital Cellulitis.

Posterior scleritis is a rare sight-threatening condition that typically presents with an acutely painful eye, often with associated reduced visual acuity. Diagnosis can be challenging and requires specialist ophthalmological assessment. Consequences of delayed treatment include permanent loss of vision. We present a case of posterior scleritis initially managed as periorbital cellulitis. We highlight the importance of broad differential diagnoses when assessing painful periorbital swelling, and present a review of current management strategies for posterior scleritis.

Specialty Showcase Days: Can Specialist Careers Workshops Improve The Consideration Of ENT For Medical Students?

OBJECTIVE: We hypothesize that poor consideration of specialist surgery is due to a lack of exposure to information about careers and practice itself. Ear, Nose, and Throat (ENT) surgery is given little weight in medical school curricula, despite ENT problems being extremely common. Our objective is to assess whether a specialty showcase day was sufficient to boost informed consideration of this career. DESIGN: We designed a half-day course involving an interactive careers workshop exploring ENT as a specialty choice, alongside simulation stations of commonly presenting ENT problems led by ENT doctors. We used pre- and post-course evaluation sheets to explore factors that encourage and discourage students from surgical careers and perceptions of ENT. SETTING: A large proportion of UK medical schools do not offer ENT placements, and of those that do, nearly half are not compulsory. This leaves students unaware of ENT as a career option and unclear about what an ENT career comprises. Our half-day course took place in the simulation suite at St Mary's Hospital, London. PARTICIPANTS: Medical students were mainly in their third year of study and had aspirations towards a variety of surgical and non-surgical careers, with a minority aspiring towards ENT before the course. RESULTS: Our results demonstrate that all students found the session useful and had a much better understanding of ENT practice, with almost all students leaving more likely to consider a career in ENT. CONCLUSION: We would like to repeat this session in different student year groups and compare their perceptions with our results. We find our results a good case for including informative careers workshops as part of medical school teaching. We pose that interactive workshops exploring specialist surgical careers are a valid way to enable students in making informed career decisions - particularly in specialties that are under-represented at medical school.

Acute presentation of an intraoral dermoid cyst causing airway compromise in a young child.

A 4-month-old boy presented with a cystic swelling at the floor of the mouth causing acute airway compromise. The only previous history of note, was a tongue tie release at 3 days old. CT scan suggested a dermoid cyst with extensive floor of mouth abscess. He had an excision of the cyst and drainage of the superimposed abscess and made a good recovery. The histology report revealed a dermoid cyst which is a rare diagnosis in a child, particularly within the oral cavity. Early treatment is required to remove these lesions especially when they cause airway compromise or swallowing difficulties. This is the first case to our knowledge which suggests tongue tie release procedures causes a predisposition to the development of dermoid cysts in the oral cavity.

Acute and chronic effects of kisspeptin-54 administration on GH, prolactin and TSH secretion in healthy women.

BACKGROUND: The peptide hormone kisspeptin is essential for human reproduction, acting on the hypothalamus to stimulate gonadotrophin-releasing hormone (GnRH) secretion. Kisspeptin is currently being evaluated as a novel therapeutic for women with infertility. However, some animal studies suggest that kisspeptin may also stimulate growth hormone (GH), prolactin and thyroid-stimulating hormone (TSH) secretion, with implications for its safety; no previous study has investigated whether kisspeptin stimulates these pituitary hormones in humans. AIM: To determine whether kisspeptin-54 modulates GH, prolactin and TSH secretion in healthy women. DESIGN AND PARTICIPANTS: Prospective, single-blinded, placebo-controlled, one-way crossover study. Five healthy women received 7 days of twice-daily subcutaneous bolus vehicle (month 1) or 6·4 nmol/kg kisspeptin-54 (month 2). MEASUREMENTS: Serum samples were analysed post hoc for GH, prolactin and TSH. RESULTS: Mean serum GH, PRL and TSH did not change during the first 4 h following kisspeptin-54 injection when compared with vehicle. The mean frequency or amplitude of GH pulses (which influence GH function) did not change acutely following kisspeptin-54 injection when compared with vehicle. No chronic changes in serum GH, PRL or TSH were observed over the 7-day period of twice-daily kisspeptin-54 injections when compared with vehicle. CONCLUSION: While we cannot exclude any effect of kisspeptin-54 on GH, prolactin or TSH secretion, we observed no significant changes in these hormones at a dose of kisspeptin-54 administration known to stimulate gonadotrophin secretion in a small study of healthy women. These data have important implications for the potential of kisspeptin to treat patients with infertility.