Bridging that gap: a qualitative study of perceptions of equality, diversity and inclusivity in colorectal surgery in the UK and Ireland.

BACKGROUND: There is a growing recognition on the importance of equality, diversity and inclusion (EDI) within surgery and the need to diversify the surgical community and its various organisations, in a bidto reflect the diverse populations they serve. To create, sustain and encourage a diverse surgical workforce requires an in-depth understanding of the current makeup of key surgical institutions, relevant issues pertaining to EDI and appropriate solutions and strategies to ensure tangible change. OBJECTIVES: Following on from the recent Kennedy Review into Diversity and Inclusion commissioned by the Royal College of Surgeons of England, the aim of this qualitative study was to understand the EDI issues which affected the membership of the Association of Coloproctology of Great Britain and Ireland, while seeking appropriate solutions to address them. DESIGN: Dedicated, online and qualitative focus groups. PARTICIPANTS: Colorectal surgeons, trainees and nurse specialists were recruited using a volunteer sampling strategy. METHODS: A series of online, dedicated, qualitative focus groups across the 20 chapter regions were held. Each focus group was run informed by a structured topic guide. All participants who were given the opportunity to remain anonymous were offered a debriefing at the end. This study has been reported in keeping with the Standards for Reporting Qualitative Research. RESULTS: Between April and May 2021, a total number of 20 focus groups were conducted, with a total of 260 participants across 19 chapter regions. Seven themes and one standalone code pertaining to EDI were identified: support, unconscious behaviours, psychological consequences, bystander behaviour, preconceptions, inclusivity and meritocracy and the one standalone code was institutional accountability. Five themes were identified pertaining to potential strategies and solutions: education, affirmative action, transparency, professional support and mentorship. CONCLUSION: The evidence presented here is of a range of EDI issues which affect the working lives of those within colorectal surgery in the UK and Ireland, and of potential strategies and solutions which can help build a more inclusive, equitable and diverse colorectal community.

Establishing core outcome sets for gastrointestinal recovery in studies of postoperative ileus and small bowel obstruction: protocol for a nested methodological study.

INTRODUCTION: Gastrointestinal recovery describes the restoration of normal bowel function in patients with bowel disease. This may be prolonged in two common clinical settings: postoperative ileus and small bowel obstruction. Improving gastrointestinal recovery is a research priority but researchers are limited by variation in outcome reporting across clinical studies. This protocol describes the development of core outcome sets for gastrointestinal recovery in the contexts of postoperative ileus and small bowel obstruction. METHOD: An international Steering Group consisting of patient and clinician representatives has been established. As overlap between clinical contexts is anticipated, both outcome sets will be co-developed and may be combined to form a common output with disease-specific domains. The development process will comprise three phases, including definition of outcomes relevant to postoperative ileus and small bowel obstruction from systematic literature reviews and nominal-group stakeholder discussions; online-facilitated Delphi surveys via international networks; and a consensus meeting to ratify the final output. A nested study will explore if the development of overlapping outcome sets can be rationalized. DISSEMINATION AND IMPLEMENTATION: The final output will be registered with the Core Outcome Measures in Effectiveness Trials initiative. A multi-faceted, quality improvement campaign for the reporting of gastrointestinal recovery in clinical studies will be launched, targeting international professional and patient groups, charitable organizations and editorial committees. Success will be explored via an updated systematic review of outcomes 5 years after registration of the core outcome set.

The Association of Coloproctology of Great Britain and Ireland consensus guidelines in surgery for inflammatory bowel disease.

AIM: There is a requirement of an expansive and up to date review of surgical management of inflammatory bowel disease (IBD) that can dovetail with the medical guidelines produced by the British Society of Gastroenterology. METHODS: Surgeons who are members of the ACPGBI with a recognised interest in IBD were invited to contribute various sections of the guidelines. They were directed to produce a procedure based document using literature searches that were systematic, comprehensible, transparent and reproducible. Levels of evidence were graded. An editorial board was convened to ensure consistency of style, presentation and quality. Each author was asked to provide a set of recommendations which were evidence based and unambiguous. These recommendations were submitted to the whole guideline group and scored. They were then refined and submitted to a second vote. Only those that achieved >80% consensus at level 5 (strongly agree) or level 4 (agree) after 2 votes were included in the guidelines. RESULTS: All aspects of surgical care for IBD have been included along with 157 recommendations for management. CONCLUSION: These guidelines provide an up to date and evidence based summary of the current surgical knowledge in the management of IBD and will serve as a useful practical text for clinicians performing this type of surgery.

Predictors of Treatment Non-Adherence in an Inpatient Substance Abuse Rehabilitation Programme

The research study aimed to identify the factors contributing to premature termination of treatment for substance addiction. The investigation took the form of a differential research design based on archival data obtained from patient files at an inpatient drug rehabilitation centre in Gauteng. One independent variable (treatment adherence) and five dependent variables (past and present patterns of scheduled medication use; legal history and DSM-IV-TR Axis I and II co-morbidity) were chosen. Eighty-five patient files were drawn; constituting 41 treatment adherent and 44 treatment non-adherent addicts. Extraneous variables of age; age of onset; duration of addiction; previous treatment history; drug of choice; current physical health status; gender; race; and level of education were equivalent in both samples. Univariate analysis indicated that treatment adherent and drop-out groups differed significantly in terms of legal history (Fisher's exact test = 12.369; p = 0.002) and past patterns of use of scheduled medication (Fisher's exact test = 29.131; p = 0.000). A logistic regression indicated that a history of abusing a combination of scheduled psychiatric and other medication prior to treatment is the single most accurate predictor of treatment non-adherence (Wald statistic = 11.1035; p = 0.0009). Although certain combinations of past medication patterns and legal history increase predicted probabilities of treatment non-adherence; legal history on its own failed to explain any further variance that past medication could not explain on its own

The life and work of the Birmingham radiologist Dr James Brailsford (1888-1961).

James Brailsford went from humble beginnings to become an eminent radiologist through his ability, determination and immense diligence. He made a late start in medicine but became one of the world's leading authorities on skeletal diseases; he wrote the classic textbook The Radiology of Bones and Joints and described the eponymous Morquio-Brailsford syndrome. In 1934 he was elected first President of the British Association of Radiologists, of which he was founder. This later became the Faculty of Radiologists at the Royal College of Surgeons and is now the Royal College of Radiologists.

Migrating from target-controlled infusion to closed-loop control in general anaesthesia.

The target-controlled infusion (TCI) technique has been successfully and commercially used in clinical general anaesthesia with the intravenous anaesthetic agent propofol. The technique is based on a population pharmacokinetic model and is an open-loop control system. Closed-loop control requires a reliable and consistent signal for feedback utilisation. With all anaesthetic agents the somatosensory evoked potentials (SEP) have been shown to give increased latency as anaesthetic depth is increased. Using infusion rate and SEP response data from rats anaesthetised with propofol a mathematical model was derived to describe the anaesthetic process. This model was used as a design reference to develop a proportional integral (PI) closed-loop control system using SEP as the feedback measure. A serials of 10 trials were conducted to investigate the difference between continuous bolus injection and infusion, all under closed-loop control. The trials showed that the use of SEPs in closed-loop control of anaesthesia is feasible.

Minoan and Mycenaean medicine and its Near Eastern contacts.

Few scholars of ancient medicine have considered that Hippocratic practice may be based in part upon the experience and tradition, handed-down from generation to generation, starting before the end of the Bronze Age in 1100 BC. This paper examines the evidence for medical practitioners in the Aegean in the second millennium BC, and of medical contacts between the Aegean and contemporary bronze age societies of Egypt and the Near East at this time, and suggests that some of these contacts may have been the start of Near Eastern influence on Greek medicine.

Morphology of physiologically characterised ventral cochlear nucleus stellate cells.

Stellate cells within the ventral cochlear nucleus (VCN) are a diverse cell group that have been classified according to their size and morphology. Some of these stellate cell types constitute major projection neurones into the brainstem and directly into the inferior colliculus, while others are implicated in more local processing. It is still not clear whether a specific physiological profile is uniquely associated with each distinct type of stellate cell. To investigate such associations, we have analysed 23 units with a battery of physiological stimuli in vivo and then examined their shape and outputs following juxtacellular labelling with biocytin. Five physiologically identified groups of cells were filled. These formed two major response classes: onset cells and chopper cells. The two classes could be separated purely on morphological grounds. The onset cells had large somata, large symmetrical dendritic trees and profuse axonal branches that were restricted to the cochlear nucleus on one (On-L) or both sides (On-C) of the brainstem. The chopper cells had smaller, asymmetric, dendritic trees, which were either planar or marginal, had smaller somata and an output axon that left via the trapezoid body. We have confirmed profuse projections into the dorsal cochlear nucleus from all onset cells, and more focal projections from some members of all three groups of chopper cells.

The University of Birmingham Medical School and the history of medicine.

The publication in 1993 by the General Medical Council of Tomorrow's Doctors-Recommendations on Undergraduate Medical Education provided the first real opportunity for many medical schools to advance the introduction of the history of medicine into the undergraduate medical curriculum. While the University of Birmingham Medical School, was not one of the first to introduce the subject, it has been at the forefront of the introduction of the history of medicine into the undergraduate medical curriculum since 1997, and can now boast a number of special study modules in the subject and the second largest intercalated BMedSc (History of Medicine) degree programme in the country. This article tells the story of why and how we introduced history into the curriculum and how important it is that tomorrow's doctors know something of the history of the profession they are about to enter.

The ability of inferior colliculus neurons to signal differences in interaural delay.

Sound localization in humans depends largely on interaural time delay (ITD). The ability to discriminate differences in ITD is highly accurate. ITD discrimination (Delta ITD) thresholds, under some circumstances, are as low as 10-20 micros. It has been assumed that thresholds this low could only be obtained if the outputs from many neurons were combined. Here we use Receiver Operating Characteristic analysis to compute neuronal Delta ITD thresholds from 53 cells in the inferior colliculus in guinea pigs. The Delta ITD thresholds of single neurons range from several hundreds of micros down to 20-30 micros. The lowest single-cell thresholds are comparable to human thresholds determined with similar stimuli. This finding suggests that the highly accurate sound localization of human observers is consistent with the resolution of single cells and need not reflect the combined activity of many neurons.

Somatosensory evoked potentials for closed-loop control of anaesthetic depth using propofol in the urethane-anaesthetized rat.

Primary somatosensory cortical mass responses have been shown to exhibit dose-dependent changes in latency when general anaesthetics are administered. Here we describe a system in which the latency of evoked responses was measured automatically in real time in five animals. Latency changes were used to operate a closed-loop control of propofol delivery by intravenous infusion. The system attempted to induce and maintain a 1 ms increase in evoked response latency; this was reversed when infusion was discontinued. Allowing for the rapid and large biological fluctuations in the evoked response, this was achieved successfully. The system maintained a mean increase in latency of 1.27 (SD 0.42) ms. The mean statistical dispersion index of data obtained during the controlled period was 1.23 (0.3); in an ideal controllable system it approximates to 1. Such a system may provide a means for the automatic delivery of anaesthetics.

Coronal suture response to distraction osteogenesis in rabbits with delayed-onset craniosynostosis.

Recent studies have identified a subpopulation of persons with craniosynostosis who exhibit progressive or delayed-onset synostosis and mild cranial vault deformities. These persons may be good candidates for nonextirpation distraction osteogenesis. The present studies were designed to determine force-displacement parameters and assess the effects of distraction osteogenesis on coronal suture growth and morphologic characteristics in a rabbit model with congenital, delayed-onset craniosynostosis. Data were collected from a total of 178 rabbits: 71 normal controls; 16 normal controls with distraction; 72 with delayed-onset coronal suture synostosis; and 19 with delayed-onset coronal suture synostosis and distraction. At 10 days of age, all rabbits had amalgam markers placed on both sides of the coronal suture. In the force-displacement study, force-displacement distractors were placed across the coronal suture and distracted acutely for 1.0 mm at 42 days of age. Force-displacement curves for the coronal suture were best described by a third-order polynomial regression equation for both normal and synostosed groups. Significant differences (P < 0.05) were found in the mean force necessary to distract a normal suture 1 mm in distance (13.72 kg) compared with a suture with delayed-onset synostosis (48.39 kg). A significant (P < 0.05) relationship was also found between the extent of synostosis and the distractive force in rabbits with delayed-onset synostosis. In the distraction study, internal distractors were fixed across the coronal suture at 25 days of age and percutaneously and intermittently activated at an average of 0.11 mm/day for 42 days (4.54 mm total). Serial radiographs were taken at 10, 25, 42, and 84 days of age. Results revealed that rabbits with delayed-onset synostosis and distraction had significantly (P < 0.01) more coronal suture growth rates compared with rabbits with delayed-onset synostosis and no distraction. Coronal sutures were harvested at 84 days of age for qualitative histologic examination. Normal, distracted coronal sutures showed widened sutural ligaments and thin, active osteogenic fronts. In contrast, distracted coronal sutures from rabbits with delayed-onset synostosis showed narrowed sutural ligaments, thickened and blunt osteogenic fronts, and increased collagen and bony matrix deposition compared with controls. Results suggest that distraction osteogenesis without corticotomy may be a treatment alternative in persons with progressive, delayed-onset synostosis. However, these preliminary data also suggest that distractive forces may accelerate or stimulate osteogenesis differentially in persons with craniosynostosis, possibly through an underlying genetic disorder of bone and cytokine regulation. These differential osteogenic responses to distraction, if validated clinically, will need to be taken into account when planning distraction rate and rhythm protocols for patients with craniosynostosis.

The effect of etomidate on sensory transmission in the dorsal column pathway in the urethane-anaesthetized rat.

The effect of Etomidate, a general anaesthetic, on sensory afferent transmission was measured in the dorsal column pathway in urethane-anaesthetized rats. Extracellular recordings were made of peripherally evoked responses by single cells in the cuneate nucleus, ventroposterolateral nucleus of the thalamus and laminae IV-VI of the primary somatosensory cortex. Cortical mass responses were also recorded. In further experiments, cortical mass responses were evoked antidromically by stimulation in the pyramidal tract. The effect of incremental administration of Etomidate on evoked responses was recorded. These results are compared with the previously reported effects of urethane, a 'conventional' anaesthetic. Etomidate did not alter cuneate or ventroposterolateral thalamic cell responses but it caused a dose-dependent reduction in cortical cell responsiveness. It failed to alter antidromically evoked cortical mass responses. Etomidate differs from the majority of anaesthetics, which act in the thalamus, and appears to cause perturbation at the cortical level.

Substance use among rural secondary schools in Zimbabwe: patterns and prevalence.

OBJECTIVE: To survey drug use among rural secondary school students. DESIGN: Self reported questionnaires developed by the World Health Organisation and translated into Shona were distributed to randomly selected students from 36 schools. SETTING: Nyanga District secondary schools, Zimbabwe. SUBJECTS: 1,000 secondary school students, males and females, forms one to six. MAIN OUTCOME MEASURES: Demographic variables, prevalence rates, frequency of drug use, first time usage, breakdown by age, sex and school type. RESULTS: Alcohol was the commonest "ever taken" substance (34.9pc), followed by tobacco (18.5pc), solvents (6.9pc) and cannabis (34.9pc). Frequency of use was low and use of other categories of drugs was negligible. CONCLUSIONS: Appropriate educational programmes need to be formulated and tailored to meet the needs of rural adolescents.

Healing and medicine in the Aegean Bronze Age.

Since the discovery of the Minoan and Mycenaean civilizations of Crete and Greek mainland, a systematic understanding has been gained of their material culture and social structures. Nevertheless, because of the absence of textual and pictorial evidence of medicine of the kind which exists in the contemporary societies of Egypt and the Near East, little work has been produced on the subject of disease and the practice of medicine in the period. However, new pathological evidence throws much light on this hitherto largely unknown aspect of their civilization.