COVID-19 impact on junior doctor education and training: a scoping review.

COVID-19 has had a significant impact on healthcare resources and the medical workforce. Clinically-based medical education is the principal source of learning, and this has been profoundly impacted by restrictions due to COVID-19. It follows that junior medical staff and their education would be significantly impacted due to the altered volume and breadth of their clinical exposure. Some literature has been published regarding the impact to medical training during COVID-19. This study sought to review junior medical staff perceptions and their reported impact of the COVID-19 pandemic on their education and training.Nine databases (three Ovid MEDLINE databases, Embase, Web of Science, Scopus, Cumulative Index to Nursing and Allied Health Literature, Educational Resources Information Centre and PsychINFO) were searched for studies published in 1 January 2020 through 24 August 2020. Via a scoping review protocol, an iterative process was used to perform the identification, review and charting analysis of the reported outcomes and themes. Descriptive analysis was performed using quantitative and qualitative methods.Of the 25 343 sources identified, 32 were included in the review. There were studies published from nearly all continents, predominantly in surgical journals, with a wide spread of specialties. Themes identified included the current impact of the pandemic in relation to continuation of and modifications to training programmes, as well as the future impact due to training requirements and career progression.Junior medical staff report that the COVID-19 pandemic has had a significant impact on their education and training. Whether the changes imposed by the pandemic on education are temporary measures or permanent fixtures, and whether standards of competence may be impacted, is not yet known. This scoping review forms a basis for further investigation in the field.

Lymphoedema rates in pedicled anterolateral thigh flaps for coverage of irradiated groin defects.

BACKGROUND: Limb salvage surgery in conjunction with adjuvant radiotherapy is the preferred treatment for soft tissue sarcoma. This study aims to determine if ipsilateral pedicled anterolateral thigh (ALT) flap reconstruction of groin defects post soft tissue sarcoma resection results in acceptable rates of lymphoedema, while also providing good soft tissue cover and minimal donor site morbidity. METHODS: A retrospective chart audit was conducted with ethics approval, obtaining a case series of 16 patients operated on at a single institution by the senior surgeon. Patients who underwent ipsilateral pedicled ALT flap coverage of irradiated groin defects following soft tissue sarcoma resection were included. Comparative six-point limb circumference measurements were utilized to diagnose lymphoedema, with a difference of 10% when compared to the non-operative side being deemed significant. RESULTS: Lymphoedema was noted in three patients (18.8%) with an average follow-up period of 40.9 (range 8-59) months. CONCLUSION: Previously published lymphoedema rates in sarcoma limb salvage surgery of 15.5-30% are comparable to the rates obtained in this cohort. Lymphoedema rates do not appear to be higher in patients undergoing ipsilateral pedicled ALT flap reconstruction, thus making it a useful soft tissue coverage technique in this cohort.

A Review of the Literature on the Management of Silicone Implant Incompatibility Syndrome.

BACKGROUND: Silicone implant breast augmentation has been routinely performed since the 1960s. Emerging literature suggests the existence of a clinical syndrome, silicone implant incompatibility syndrome (SIIS) resulting from silicone implants. Autoimmune reactivity develops, with subsequent symptoms including myalgias, arthralgias, chronic fatigue, sleep disturbance and cognitive impairment. While the existence of a clinical entity is currently being established in the literature, there are currently no guidelines on management. METHOD: Literature review was conducted using Medline and PubMed databases with key terms searched for, prior to hand-searching and bibliographical review until February 2019. The relevant literature was reviewed to determine whether consensus exists on the most appropriate management strategy. RESULTS: Forty-nine articles relevant to SIIS were identified with twenty-one of these specifically outlining treatment. Of these, only five provided data on larger cohorts, three provided conclusions from literature reviews, and the remainder were small case series or isolated case reports. Improvement in symptoms was obtained by medical management of their immune response, by explantation and by simply counselling on the condition itself. CONCLUSIONS: A new clinical condition is being described that appears to suggest a link between silicone implant use and various symptoms in a cohort of patients. The subsequent treatment of SIIS is yet to be agreed upon. Further research is required to establish guidelines for diagnosis and ensure evidence-based treatment, and that patients and clinicians have a more refined understanding of the potential risks of silicone breast implant use. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .