Practical tips for teaching academic integrity in the digital age.

This article was migrated. The article was marked as recommended. Background: Medical education, as with other areas of healthcare education, is susceptible to cheating, with national and international examples cited in the literature. There are documented examples in the lay press, but limited scholarly activity in the field, which can be a challenging area to research and tackle. We have begun to explicitly address academic integrity within our undergraduate curriculum, including a focus on plagiarism, self-plagiarism, and covert sharing of questions. We believe this is an important curricular topic as exhibiting unprofessional behaviours can correlate with professional practice and can potentially have implications for practitioners and patients. Aim: To present 12 tips on teaching academic integrity in the digital age to medical students. Method: The tips presented are based on our experiences of teaching academic digital integrity to medical students, primarily in the form of a scenario based quiz. We do also extrapolate from content on academic integrity elsewhere within our professionalism syllabus. Results: The tips suggest that early, contemporary and contextualised material that is co-produced with students may offer a useful prophylactic approach to teaching about academic integrity. Conclusions: The principles presented could be adapted to other healthcare students and settings, including postgraduate education.

Reduction in hospital reattendance due to improved preoperative patient education following hemorrhoidectomy.

INTRODUCTION: To improve quality of healthcare, patient information must be thorough and easy to understand. This is important in day surgery where patients are seen less often by health practitioners. We looked at the impact of improving patient information in the setting of day-case hemorrhoidectomy in terms of patient satisfaction and whether medical attention was sought after the operation. METHODS: A retrospective, comparative study was performed on 60 patients undergoing day-case hemorrhoidectomy and on 60 patients undergoing the same operation with improved patient information. Comparisons were made between the groups regarding patient satisfaction scores, those seeking medical attention, the numbers of patients requesting a 6-week outpatient follow-up and the reasons for seeking medical advice. RESULTS: There was a significant improvement in the patient satisfaction scores in the second study group who received the improved information. This group sought medical attention significantly less and they felt less need for a routine follow-up. CONCLUSIONS: This study has shown that by improving the quality of patient information for day-case hemorrhoidectomy, patient satisfaction was higher and fewer patients sought medical attention, which has beneficial financial indications for the NHS Trust and improvement of healthcare for the patient.

Colopexy as a treatment option for the management of acute transverse colon volvulus: a case report.

INTRODUCTION: Transverse colon volvulus is an uncommon acute surgical presentation associated with a higher rate of mortality than volvulae at other locations along the colon. Surgical resection or correction is the only treatment, and various methods have been described in case report literature to relieve the volvulus and prevent recurrence. CASE PRESENTATION: We present the case of a 25-year-old Caucasian woman who was admitted with a three-day history of abdominal pain, absolute constipation and abdominal distension. Subsequent radiographic and computed tomography imaging revealed right-sided colonic dilatation suggestive of a volvulus. An emergency laparotomy was performed during which the dilated proximal bowel was decompressed and colopexy executed by using the greater omentum to fix the transverse colon at the hepatic and splenic flexures. CONCLUSIONS: Volvulus of the transverse colon is rare but must form part of the clinician's differential diagnosis when encountering a patient with suspected bowel obstruction, especially in younger patients with no previous surgical history. Laparotomy is the treatment of choice and the technique of using the greater omentum as a fixing point for redundant bowel to the lateral abdominal wall is an option that may be considered especially when the bowel appears viable.

Optimal thromboprophylaxis following bioprosthetic aortic valve replacement: still a matter of debate?

Optimal thromboprophylaxis following bioprosthetic aortic valve replacement (AVR) remains controversial. The main objective, which is the effective prevention of central nervous or peripheral embolic events, especially in the early postoperative period, will have to be weighed against the haemorrhagic risk that is associated with the utilization of different antithrombotic regimes. Most governing bodies in cardiovascular medicine have issued recommendations on thromboprophylaxis after the surgical implantation of aortic bioprostheses. However, the level of evidence to support these recommendations remains low, largely due to the inherent limitations of conducting appropriately randomized and adequately powered clinical research in this area. It is apparent from the recent surveys and large registries that there is a great variability in antithrombotic practice at an institutional or individual-clinician level reflecting this controversy and the lack of robust evidence. While organizational, financial or conceptual limitations could hinder the conduct and availability of conclusive research on optimal thromboprophylaxis after aortic bioprosthesis, it is imperative that all evidence is presented in a systematic way in order to assist the decision-making for the modern clinician. In this review, we provide an outline of the current recommendations for thromboprophylaxis, followed by a comprehensive and analytical presentation of all comparative studies examining anticoagulation vs. antiplatelet therapy after bioprosthetic AVR.

Surgical ablation for atrial fibrillation.

This paper reviews the history of surgical procedures developed for eradication of atrial fibrillation (AF) during cardiac surgery for structural heart disease, and in patients with AF without other indication for cardiac surgery. Current evidence indicates that, despite their proven efficacy, the Cox-Maze procedure and its modifications require cardiopulmonary bypass and cannot be easily justified in the case of AF without other indication for cardiac surgery. In patients undergoing cardiac surgery for mitral valve disease, concomitant ablation techniques using modifications of the Maze and alternative energy sources appear to be safe and effective in treating AF, especially in non-rheumatic disease. Minimally invasive epicardial ablation has been recently developed and can be performed on a beating heart through small access incision ports. Various techniques combining pulmonary vein isolation, ganglionated plexi ablation, and left atrial lines have been tried. Initial results are promising but further clinical experience is required to establish ideal lesion sets, appropriate energy sources, and the benefit-risk ratio of such an approach in patients without other indication for cardiac surgery. The role of surgical ablation in the current management of AF is under investigation.

Focused preoperative patient stoma education, prior to ileostomy formation after anterior resection, contributes to a reduction in delayed discharge within the enhanced recovery programme.

PURPOSE: Stoma formation is a well-known cause for delayed discharge following colorectal surgery. This has been addressed by the enhanced recovery programme (ERP) preoperatively through stoma counselling sessions. These aim to promote independent stoma management post-operatively, thus expediting hospital discharge. We compared the numbers of patients with prolonged hospital stay secondary to delayed independent stoma management prior to and following the introduction of an enhanced recovery programme with preoperative stoma education. METHODS: Data collection on patients undergoing anterior resection with the formation of a loop ileostomy was carried out retrospectively prior to ERP (January 2006 to August 2008) and prospectively following the introduction of ERP (September 2008 to October 2010). Comparisons were made in patients with prolonged hospital stay (defined as hospital stay of more than 5 days) secondary to stoma management. RESULTS: Two hundred forty patients underwent elective anterior resection with the formation of a loop ileostomy, 120 prior ERP and 120 post-ERP. Average length of hospital stay was 14 days before ERP introduction, with a range of 7-25 days. The mean length of stay amongst the ERP patients was 8 days (p = 0.17), ranging from 3 to 17 days. Twenty-one patients in the pre-ERP group (17.5%) experienced postponed hospital discharge due to a delay in independent stoma management, compared to one patient experiencing such a delay after the introduction of ERP (0.8%, p < 0.0001). CONCLUSIONS: Delayed discharge secondary to independent stoma management can be significantly reduced with preoperative stoma management teaching as part of an enhanced recovery programme.

Genetic variation in alcohol dehydrogenase 1C and the beneficial effect of alcohol intake on coronary heart disease risk in the Second Northwick Park Heart Study.

Alcohol dehydrogenase 1C (ADH1C or ADH3) genotype reportedly modifies the association between alcohol consumption and coronary heart disease (CHD) risk, as well as influencing plasma high-density lipoprotein (HDL) levels [Hines LM, Stampfer MJ, Ma J, et al. Genetic variation in alcohol dehydrogenase and the beneficial effect of moderate alcohol consumption on myocardial infarction. N Engl J Med 2001;344:549-55]. This relationship has been examined in a sample of middle-aged (50-61 years) men (total of 2773 with 220 CHD events), participating in the prospective Second Northwick Park Heart Study (NPHS II). Alcohol consumption was assessed by questionnaire as the number of units consumed in the previous week. Drinkers experienced lower CHD risk than abstainers [hazard ratio (HR) 0.73 (95% confidence intervals (CI) 0.53, 0.99; p=0.04)] and had significantly higher HDL and apolipoprotein (apo)AI concentrations (both p<0.0001) and a lower fibrinogen (p=0.02). Overall, there was no effect of ADHC1 gamma1>gamma2 genotype on plasma levels of HDL, apoAI or fibrinogen or on CHD risk. To consider whether the effect of alcohol consumption on risk was modulated by genotype, the men were divided into abstainers, modest drinkers (1-3 units/week) and those who consumed more than 3 units/week. Significant alcohol:genotype interaction on CHD risk was observed (p=0.02), with gamma2 homozygotes, who were modest drinkers, displaying 78% CHD risk reduction compared to gamma1 homozygotes (HR=0.22, 95% CI 0.05-0.94). There was, however, no association between genotype and apoAI, HDL or fibrinogen and this was not altered when alcohol intake was considered. These findings confirm that the cardiovascular benefit of modest alcohol consumption. ADH1C genotype modifies the relationship between alcohol consumption and CHD risk but at lower levels than previously reported.