Evidence of bacterial biofilms within acute wounds: a systematic review.

OBJECTIVE: The prevalence and role of biofilm formation in acute wounds has seldom been investigated. Understanding the presence of biofilm in acute wounds would allow earlier, biofilm-targeted management, thus decreasing the morbidity and mortality associated with wound infection, improving patient experience and potentially reducing healthcare costs. The purpose of this study was to summarise the evidence for biofilm formation within acute wounds. METHOD: We conducted a systematic literature review for studies which reported evidence of bacterial biofilm formation in acute wounds. An electronic search of four databases was carried out, without restrictions on date. The search terms included 'bacteria', 'biofilm', 'acute' and 'wound'. RESULTS: A total of 13 studies met the inclusion criteria. Of the studies, 69.2% showed evidence of biofilm formation within 14 days of acute wound formation, with 38.5% showing evidence of biofilm 48 hours after wound formed. CONCLUSION: The evidence from this review suggests that biofilm formation plays a greater role within acute wounds than previously considered.

Effect of medical school attended on the chances of successfully embarking on a clinical-academic career in the UK.

PURPOSE OF THE STUDY: This study aimed to investigate whether, in the UK, medical school attended influences the propensity to apply to and be successful in obtaining an offer from the Academic Foundation Programme (AFP), thus taking the first step to embarking on a clinical-academic career. STUDY DESIGN: A retrospective observational study was performed. Using the UK Foundation Programme's yearly statistical report data, mean application rates to, and mean offer rates from the AFP were calculated by medical school, between the years 2017-2019. Mean application and mean offer rates were subsequently correlated with metrics of medical school academic performance and research focus. RESULTS: Mean application rates to the AFP were higher in medical schools that had a mandatory intercalated degree as part of the undergraduate medical curriculum (mean=33.99%, SD=13.93 vs mean=19.44%, SD=6.88, p<0.001), lower numerical rank in the Times Higher Education 2019 World Rankings (correlation with higher numerical rank, r=-0.50, p=0.004), and lower numerical rank in the Research Excellence Framework 2014 UK rankings (correlation with higher numerical rank, r=-0.37, p=0.004). Mean offer rates from the AFP were not correlated with any metric of medical school academic performance or research focus. CONCLUSIONS: Students attending a medical school with greater academic performance and research focus are more likely to apply and subsequently embark on a clinical-academic career. However, students wishing to embark a clinical-academic career from any medical school have an equal chance of success.

Current Status of Technical Skills Assessment Tools in Surgery: A Systematic Review.

BACKGROUND: Tools for assessment of technical skills are a crucial part of surgical education. They provide trainees with quantitative feedback highlighting both proficiency and areas for improvement. For this to be relevant to day-to-day practice, the tools used have to be validated and relevant to each surgical situation. This study aims to evaluate the validity of assessment tools used within surgery. MATERIALS AND METHODS: Following Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, a systematic review was conducted searching the MEDLINE and Embase databases (International Prospective Register of Systematic Reviews: CRD42018104674). Studies utilizing any assessment tool in any surgical specialty were included. Messick's criteria were used for literature evaluation, and the Modified Educational Oxford Centre for Evidence-Based Medicine was used to assess levels of recommendation. RESULTS: A total of 303 studies and 76 tools were included. The most commonly used tool was Objective Structured Assessment Tool Skills (OSATS; n = 137, 45.2%). OSATS was used in conjunction with another tool or tools in an additional 55 studies (18.2%). Seven further tools were used in at least 3 studies. A total of five studies evaluated contained all five aspects of Messick's validity. CONCLUSIONS: There are several widely validated tools for assessing technical skills, the most common of which is OSATS. There is an emerging trend for crowdsourcing as a quick, cheap method for assessment of technical skills. This technique has been validated using both GEARS and GOALS. Numerous tools were found to be used only once and demonstrate a tendency for units to create their own tools for a specific task or specialty.

Ischaemic priapism: A clinical review.

OBJECTIVE: Ischaemic priapism is a rare condition characterised by little or no cavernosal blood flow, pain and rigidity of the penis. Immediate intervention is required to restore blood flow, prevent necrosis and erectile dysfunction. This review was conducted to determine the best course of treatment and identify areas in current guidelines to which improvements could be made. MATERIAL AND METHODS: PubMed, Ovid, MEDLINE (1946-December 2016) and the Cochrane Library were searched as sources for literature. Key studies in each of the areas of management were identified and analysed. RESULTS: A total of 45 articles were reviewed. The first step in treatment should be aspiration of corporeal blood. Further studies are needed to make firm recommendations as to whether irrigation should follow, as currently literature is inconclusive. If this fails to cause detumescence, sympathomimetics should be injected. The sympathomimetic of choice is phenylephrine as it is effective, specific and causes minimal cardiovascular side effects. It should be injected at a concentration of 100-500 µg/mL, with 1 mL being injected every 3-5 minutes for up to an hour (maximum 1mg in an hour). Surgical shunting is the next step, except in the cases of delayed priapism (48-72 hours duration) where immediate penile prosthesis insertion may be considered more appropriate. Distal shunts should be performed first, followed by proximal ones to minimise damage leading to erectile dysfunction. There exists little evidence recommending one shunting procedure over another. The final intervention is insertion of a penile prosthesis. Literature suggests that an inflatable prosthesis inserted immediately will yield the greatest patient satisfaction. CONCLUSION: A review of the literature has highlighted areas in which further research needs to be done to make conclusive recommendations, including whether irrigation should accompany aspiration and efficacy of shunting procedures. Further studies are required to ensure that patients receive the treatment most likely to cause detumescence and maintain erectile function.