Scottish Medical Journal最新文献

{"title":"How do surgeons experience burnout? It's relevance to the workforce of the future.","authors":"Stephen R Payne","doi":"10.1177/00369330221132487","DOIUrl":"https://doi.org/10.1177/00369330221132487","url":null,"abstract":"Burnout is an easy word to use, and is something that has become commonplace on many doctors lips over the last 10 years. This has especially been so at difficult times in service provision like the recent COVID-19 pandemic, something that has been amplified by the outcomes for both trainees and trainers mental health, in the very recent GMC 2022 National Training Survey. A career in surgery has never been easy. It was always assumed that surgeons had greater resilience to the underlying causes of burnout, workplacebased stress, but this has now been suggested, perhaps, not to be the case. There are multitudinous factors contributing to stress during surgical careers, from incomplete training for the consultant role, unrealistic expectations of work intensity through to excessive stressors from non-clinical commitments and complaint management. Recognition of the roles these different factors play in the generation of burnout in surgeons has been demonstrated, although the objective definition of what constitutes burnout for the individual is often absent. Those studies that have taken place with scientific rigour have mainly used the Maslach inventory as their benchmark of stress, and generated a score based upon the result. The relevance of Maslach’s domains to a contemporary understanding of workplace-based stress, and its effect on the workforce, isn’t, however, particularly comprehensible to the majority of individuals who work in a surgical environment. Al-Ghunaim and colleagues have adopted a different structure to their study, reported this month. They purposively sampled trainee and consultant surgeons for indicators of burnout prior to the COVID-19 pandemic. Reflective data was collected from structured interviews about how burnout affected the surgeon individually, whether burnout constituted a personal crisis for them or created a vulnerability at work. They also enquired about how burnout affected their relationships with patients, whether it increased their risk of making errors, made teamworking less effective and them less motivated. These are all concepts practicing surgeons will be able to relate to. Although this was only a small study of 9 consultants and five trainees, data processing by thematic analysis, with crosscorrelation between raters, found that respondents had poor knowledge of what burnout was and that workplace-based stress induced burnout, with a negative impact on all of the parameters measured. Objectively, they quantified how burnout affected surgeons personally, and how it could also affect patient safety. Their terms of reference are couched in language that practicing clinicians will find easier to relate to than a psychological scoring methodology. This small study points the way for further research into the impact of work and how it, and its environment, affect surgeons during their careers. Management of expectation of what a surgeon’s career involves, or modification or amelioration, of the stresses in","PeriodicalId":21683,"journal":{"name":"Scottish Medical Journal","volume":" ","pages":"196"},"PeriodicalIF":2.7,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40454314","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Design and testing of the safety of the SARUS-CPR hood for novice resuscitators.","authors":"P Wasik,&nbsp;G A McLeod,&nbsp;R Mountain,&nbsp;S Watts,&nbsp;H Briggs,&nbsp;N Maini,&nbsp;I Belford,&nbsp;B McGuire,&nbsp;W Brown,&nbsp;R Clark,&nbsp;I Eley,&nbsp;E Richardson,&nbsp;P Stonebridge","doi":"10.1177/00369330221112186","DOIUrl":"https://doi.org/10.1177/00369330221112186","url":null,"abstract":"<p><strong>Background and aims: </strong>Bystanders should be protected against aerosols, droplets, saliva, blood and vomitus during resuscitation after cardiac arrest The SARUS (safer - airway - resuscitation) CPR airway hood™ is a clear plastic cover and integrated mask that envelopes the head and torso. Our objectives were to test leakage using saline aerosol generation tests, then assess the performance of the hood during mock cardio-pulmonary resuscitation on a manikin.</p><p><strong>Methods: </strong>A checklist was validated by comparing the performance of 10 novices against 10 experts during mock resuscitation. Thereafter, 15 novices were tested with and without the hood, in a randomised cross-over study, one week apart.</p><p><strong>Results: </strong>Laboratory analysis showed a > 99% reduction of saline particles detected 5 cm, 75 cm and 165 cm above volunteers wearing the hood. On manikins, experts scored better compared to novices, 8.5 (0.7) vs 7.6 (1.2), difference (95%CI) 0.9 (0.4-1.3), P = 0.0004. Novice performance was equivalent using the hood and standard equipment, 7.3 (1.4) vs 7.3 (1.1) respectively, difference (90%CI) 0.0 (-0.3 - 0.3), P = 0.90.</p><p><strong>Conclusion: </strong>Aerosol transmission reduced in the breathing zone. Simulated resuscitation by novices was equivalent with and without the hood.</p>","PeriodicalId":21683,"journal":{"name":"Scottish Medical Journal","volume":" ","pages":"189-195"},"PeriodicalIF":2.7,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40595545","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cytogenetic and molecular characterization of a patient having infertility and mild intellectual disability with a very rare unstable ring chromosome 13.","authors":"Murat Kaya,&nbsp;Ilknur Suer,&nbsp;Tugba Kalayci,&nbsp;Birsen Karaman,&nbsp;Sukru Ozturk,&nbsp;Sukru Palanduz","doi":"10.1177/00369330221114426","DOIUrl":"https://doi.org/10.1177/00369330221114426","url":null,"abstract":"<p><strong>Introduction: </strong>Ring chromosomes arise from breakage and fusion at distal regions of short and long arms of the chromosomes. The effect of the ring chromosome on the phenotype may vary widely depending on the amount of the deletion in the chromosomal areas and genes implicated in these regions.</p><p><strong>Case presentation: </strong>We present a 35-year-old male patient with infertility and mild intellectual disability (MID) who has de novo ring 13 (r(13)) chromosomes. To determine chromosomal abnormality, we performed karyotype analysis, Y chromosome microdeletion analysis, FISH, and aCGH techniques.</p><p><strong>Conclusion: </strong>The patient's karyotype analysis result was mos46,XY,r(13)(p13q34)[75]/45,XY,-13[14]/46,XY,dic (13;13)[8]/47,XY,r(13), + r(13)[2]/46,XY,tetrac r(13;13;13;13)[1]. FISH analysis supported the findings of the cytogenetic analysis. Y microdeletion analysis showed that the AZF region was intact. On aCGH analysis, we detected a 1.5 megabase deletion at the end of chromosome 13, including the <i>CHAMP1</i> gene. The loss of the <i>CHAMP1</i> gene, in particular, may explain our patient's MID, and the other deleted genes at 13q34 may explain our patient's infertility.</p>","PeriodicalId":21683,"journal":{"name":"Scottish Medical Journal","volume":" ","pages":"173-177"},"PeriodicalIF":2.7,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40623072","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical procedure time and postoperative complications: Quality assurance of intraoperative events.","authors":"Ghulam Nabi","doi":"10.1177/00369330221112128","DOIUrl":"https://doi.org/10.1177/00369330221112128","url":null,"abstract":"Welcome to September 2022 issue of Scottish Medical Journal. The issue highlights advancements in medical education and researcha basic ambitions of journal since its inception more than 100 years back. Hassan et al. bring in new knowledge on methods of teaching in neuroanatomy. Khatkar and colleagues discuss virtual reality simulation questionnaire survey and reminds us importance of snap-shot assessment. Domenic G et al. report relationship of body composition and BMI with colorectal cancer. In another common cancer in young men, Alifrangis et al. provide a glimpse of current practise perspective of testicular cancer (Seminoma). Clinicians are exposed to risk of radiation injuries and in particularly those working in orthopaedics surgery. Snowden et al. provide an assessment of knowledge amongst orthopaedic surgeons about radiation safety. Li et al. in a meta-analysis describe an interesting association of polycystic ovarian syndrome with various cancers. Finally, Yitgin et al. share their knowledge about optimal duration of surgical procedure for renal stones. They report a lower postoperative complications rate following retrograde intrarenal surgery in patients where procedural time is more than 60 min. There are several implications of these findings: First, it will improve delivery of information to urological surgeons so that careful planning is considered in reducing complications; second, it will help in better patient counselling and may be discuss alternate therapeutic approaches. Collins TC et al. in a previous study reported intraoperative blood transfusion, operative time, return to the operating room, and the number of complications as strong predictors of length of stay in hospital for patients following surgery. These events are inter-related and hence quality assurance of intra-operative events should be focus of quality assurance in the future. I trust the issue will be an enjoyable reading and generate discussion amongst colleagues and the future generations.","PeriodicalId":21683,"journal":{"name":"Scottish Medical Journal","volume":" ","pages":"79"},"PeriodicalIF":2.7,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40672803","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A constructivist approach to teach neuroanatomy lab: Students’ perceptions of an active learning environment","authors":"Sherif S. Hassan, Fauzia Nausheen, Frank Scali, Hina Mohsin, Charity Thomann","doi":"10.1177/00369330221107101","DOIUrl":"https://doi.org/10.1177/00369330221107101","url":null,"abstract":"Background A recent trend in medical education is developing a more dynamic and integrated curriculum. Team-based learning (TBL) increases students’ engagement and the active construction of anatomical knowledge. This initial study aimed to empirically observe medical students’ perceptions of their achievement of learning outcomes and the construction of their neuroanatomy knowledge, critical thinking, and problem-solving using an interactive whiteboard (IWB) as a teaching strategy. Methods An independent neuroanatomy lab survey collected students’ perceptions and comments about their learning experiences using the IWB on a questionnaire using a 5-point Likert scale. Results Student participants felt that using the IWB has facilitated their learning experience. 94.2% of student participants endorsed feelings that new technology has helped them achieve their learning outcomes, helped them integrate both their basic science and clinical science/skills knowledge (90.4%), enhanced their problem-solving skills (92.3%), facilitated their interaction with the neuroanatomy faculty (96.2%) and increase their critical thinking (88.4%). Conclusion Collecting such empirical data about students’ perceptions and their learning environment should help neurosciences faculty in medical schools better outline their activities to faculty at other medical institutions. Applying these methods may enhance the learning process, save time during neuroanatomy lab, and it could also help overcome the shortage of qualified neuroanatomy educators.","PeriodicalId":21683,"journal":{"name":"Scottish Medical Journal","volume":"67 1","pages":"80 - 86"},"PeriodicalIF":2.7,"publicationDate":"2022-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42309423","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Polycystic ovary syndrome and the risk of endometrial, ovarian and breast cancer: An updated meta-analysis","authors":"Zhen Li, Yuhua Wang, Linlin Wang, Dingtao Hu, Ying Teng, Tingyu Zhang, Ziye Yan, Fang Wang, Y. Zou","doi":"10.1177/00369330221107099","DOIUrl":"https://doi.org/10.1177/00369330221107099","url":null,"abstract":"Background and Aims This updated meta-analysis aimed to further quantify the risk of endometrial, ovarian, and breast cancer in patients with polycystic ovary syndrome (PCOS), thus providing updated and more reliable estimates. Methods and Results We identified relevant articles by searching electronic databases of PubMed, Embase, Web of Science, and Chinese Biological Medical Literature (CBM) published up to March 20, 2021. The pooled effect estimates and their 95% confidence intervals (CIs) were calculated using the random-effect model or the fixed-effect model. A total of 26 eligible studies were included. We found that PCOS was significantly associated with endometrial cancer (odds ratios [OR]: 3.66, 95%CI: 2.05–6.54, P < 0.001), but not with ovarian or breast cancer (OR: 1.23, 95%CI: 0.99–1.53, P = 0.059; OR: 0.94, 95%CI: 0.78–1.14, P = 0.551, respectively). However, in subgroups of high-quality studies, cohort studies, younger women (54 years or less or premenopausal), and studies with unadjusted body mass index (BMI), PCOS patients had a significantly higher risk of ovarian cancer. Conclusion These results indicated that PCOS is a significant risk factor for endometrial cancer independent of BMI, but not for breast cancer. PCOS may increase the risk of ovarian cancer in younger women.","PeriodicalId":21683,"journal":{"name":"Scottish Medical Journal","volume":"67 1","pages":"109 - 120"},"PeriodicalIF":2.7,"publicationDate":"2022-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41717379","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing the attitude of surgical trainees towards virtual reality simulation: A national cross-sectional questionnaire study","authors":"Harman Khatkar, Ashley Ferro, Sanjeev Kotecha, M. Prokopenko, A. Evans, J. Kyriakides, Jonathan Botterill, Miljyot Singh Sangha, Abbas See, Ryan Kerstein","doi":"10.1177/00369330221103279","DOIUrl":"https://doi.org/10.1177/00369330221103279","url":null,"abstract":"Background We performed a cross sectional study to determine the attitudes of surgical trainees and medical students towards virtual reality (VR) simulation in surgical training. A survey was devised through an iterative process before distribution to surgical trainees, foundation year doctors and medical students through online platforms. Methods The survey was disseminated within the United Kingdom through social media and email correspondence, in co-operation with national surgical organisations. 91 trainees responded from a variety of clinical specialities. Results VR technology in surgical training was viewed positively, with 91.3% of trainees agreeing that VR should be both an adjunct in surgical training as well as a competency-based assessment tool. Barriers to access were present, with access notably more challenging for senior surgeons. Conclusion Virtual reality surgical simulation in surgical training is beginning to emerge as a genuine high-fidelity, low-risk solution to the lack of surgical case volume trainees are currently experiencing.","PeriodicalId":21683,"journal":{"name":"Scottish Medical Journal","volume":"67 1","pages":"87 - 92"},"PeriodicalIF":2.7,"publicationDate":"2022-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43851591","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Relationship between BMI, CT-derived body composition and colorectal neoplasia in a bowel screening population","authors":"Domenic Di Rollo, J. McGovern, Christopher Morton, Gillian Miller, R. Dolan, P. Horgan, D. McMillan, D. Mansouri","doi":"10.1177/00369330221102237","DOIUrl":"https://doi.org/10.1177/00369330221102237","url":null,"abstract":"Introduction Obesity is associated with an increased risk of colorectal cancer (CRC). Unlike the indirect measures such as BMI, CT-Body composition (CT-BC) allows for the assessment of both volume and distribution of adipose tissue. Therefore, the aim of this study was to examine the relationship between host characteristics, BMI, CT-BC measurements and the incidence of colorectal neoplasia. Methods Patients undergoing CT Colonography (CTC) as part of the Scottish Bowel Screening Programme, between July 2009 and February 2016, were eligible for inclusion. Data were collected including demographic data, clinicopathological variables and CT-BC measurements including skeletal muscle index (SMI), subcutaneous fat index (SFI) and visceral fat area (VFA). CTC, colonoscopy, and pathology reports were used to identify CRC incidence. Associations between demographic data, clinicopathological variables, CT-BC measurements, colorectal neoplasia and advanced colorectal neoplasia were analysed using univariate and multivariate binary logistics regression. Results 286 patients met the inclusion criteria. Neoplasia was detected in 105 (37%) of the patients with advanced neoplasia being detected in 72 (69%) of patients. On multivariate analysis sex (p < 0.05) and high VFA (p < 0.001) remained independently associated with colorectal neoplasia. On multivariate analysis a high SFI (p < 0.01) remained independently associated with advanced colorectal neoplasia. BMI was not associated with either colorectal neoplasia or advanced colorectal neoplasia. Conclusion When directly compared to BMI, CT derived fat measurements were more closely associated with the degree of neoplasia in patients undergoing colorectal cancer screening. In patients investigated with CT colonography, CT adipose measures may stratify the risk and grade of neoplasia.","PeriodicalId":21683,"journal":{"name":"Scottish Medical Journal","volume":"67 1","pages":"93 - 102"},"PeriodicalIF":2.7,"publicationDate":"2022-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44860727","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Radiation safety awareness and practices amongst orthopaedic surgeons in Scotland","authors":"Gordon T Snowden, M. Jabbal, A. Akhtar","doi":"10.1177/00369330221099620","DOIUrl":"https://doi.org/10.1177/00369330221099620","url":null,"abstract":"As orthopaedic surgeons we use x-rays every day; not only when diagnosing pathology but often to assist in operative management of said pathology or ensure satisfactory outcomes for our patients in clinic. An awareness of the correct use of ionising radiation in the form of fluoroscopic imaging is therefore of great importance to reduce intraoperative exposure and has led to the development of the As Little As Reasonably Achievable (ALARA) principle. The primary aim of this study is to determine the knowledge and practises of radiation safety amongst orthopaedic surgeons in Scotland. Secondary aim is to assess the prevalence of back pain and relation to lead gowns. A google forms survey containing 20 questions about both an individual's radiation practises, and knowledge and departmental practises were distributed to all 4 deaneries in Scotland. In total 72 responses were received from 20 hospitals across all 4 Scottish deaneries. This included 28 Consultants, 23 Senior trainees and 21 Junior trainees. We found that the level of radiation training and knowledge varied considerably across seniority and the nation. Of those surveyed 100% reported always wear lead aprons/gowns however only 46.2% (n = 34) frequently or always wear thyroid protection when using X-rays. Only 55% (n = 40) of those surveyed had completed a radiation safety course with this being far less likely amongst junior trainees (29%, n = 6) than amongst Consultants (82%, n = 23) and senior trainees (48%, n = 11) (p < 0.0001). To our knowledge this is the most extensive survey into the radiation practises of Orthopaedic Surgeons in the literature and shows the need for increased education and awareness of radiation safety practises, particularly amongst junior trainees.","PeriodicalId":21683,"journal":{"name":"Scottish Medical Journal","volume":"67 1","pages":"103 - 108"},"PeriodicalIF":2.7,"publicationDate":"2022-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48565073","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of stage II seminoma: a contemporary UK perspective","authors":"C. Alifrangis, D. Nicol, J. Shamash, P. Rajan","doi":"10.1177/00369330221099619","DOIUrl":"https://doi.org/10.1177/00369330221099619","url":null,"abstract":"Background and Aims Testicular Germ Cell Tumours (TGCTs) are the commonest young adult male cancer, with excellent survival outcomes even with metastatic disease. Chemotherapy, radiotherapy, and surgery are international guideline-dictated standard of care (SOC) treatments for International Germ Cell Cancer Collaborative Group (IGCCCG) “good risk” TGCT, but are associated with significant toxicities. Therapy de-escalation aims to reduce treatment morbidity whilst preserving cure rates, and has been adopted by some centres for stage IIA/B seminoma. Here, we report on the contemporary UK treatment landscape for stage IIA/B seminoma. Methods A questionnaire-based survey of NHS England-designated specialist cancer centres hosting supra-regional specialist multi-disciplinary team (sMDT) services (n = 13) as well those within NHS Scotland, NHS Wales and Health and Social Care Northern Ireland. Respondents were asked to order preferences of SOC and therapy de-escalation treatments for stage IIA/B seminoma. Results We identified significant geographical heterogeneity in treatment preferences. Whilst up to a third of centres have adopted a treatment de-escalation regimen, the majority deliver combination chemotherapy or radiotherapy. Conclusion A wider recognition of UK treatment heterogeneity and consideration of therapy de-escalation strategies at supra-regional sMDTs will increase stage IIA/B seminoma treatment options as part of clinical trials with oncological and quality of life endpoints.","PeriodicalId":21683,"journal":{"name":"Scottish Medical Journal","volume":"67 1","pages":"126 - 128"},"PeriodicalIF":2.7,"publicationDate":"2022-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47785319","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}