Temporal Trends in the Investigation, Management and Outcomes of Acute Appendicitis over 15 Years in the North of England: A Retrospective Cohort Study.

BACKGROUND: Acute appendicitis is a common surgical emergency with an estimated lifetime prevalence of 8.6% for males and 6.7% for females. Despite the frequency of presentation, considerable variation in clinical practice exists. Our study aimed to explore temporal trends in the investigation, treatment and outcomes for patients with appendicitis between 2002 and 2016. METHODS: Data collected included all patients aged ≥16 years across the NHS trusts in Northern England between 01/01/2002 and 31/12/2016 diagnosed with appendicitis. Patient demographics, co-morbidity and management strategies were included. Outcomes of interest were length of stay and inpatient mortality. RESULTS: Over a 15 years period, 22,137 patients were admitted with acute appendicitis. A consistent male preponderance (n = 11,952, 54%) was observed, and median age increased over time (2002-2006: 36.4 vs. 2012-2016: 39.5, p < 0.001). Comorbidity of patients also increased (p < 0.001) in recent years. Computed tomography (CT) use increased from 0.8 to 21.9% (p < 0.001) over the study period. Following CT scanning, there was a longer time to theatre (1.22 vs. 0.70 days, p < 0.001), and patients were more frequently managed non-operatively (23.8% vs. 5.7%, p < 0.001). The utilisation of laparoscopic approaches significantly increased from 4.1 to 70.4% (p < 0.001). Laparoscopic patients had a shorter median length of stay (2.97 days) when compared with open surgery (4.44 days) or non-operative (6.19 days) patients. The 30-day mortality rate was 0.33% overall and decreased with time (p = 0.004). CONCLUSIONS: CT and laparoscopic surgery are increasingly utilised in the management of appendicitis. Along with other advances in clinical practice, they have led to reduced lengths of stay and mortality.

Virtual Reality and Physical Models in Undergraduate Orthopaedic Education: A Modified Randomised Crossover Trial.

BACKGROUND: Orthopaedic surgery is underrepresented in the United Kingdom medical school curriculum, with an average of less than 3 weeks of exposure over the five-year degree. This study evaluates the effectiveness of high-fidelity virtual reality (VR) and physical model simulation in teaching undergraduate orthopaedic concepts. METHODS: A modified randomised crossover trial was used. Forty-nine students were randomly allocated to two groups, with thirty-three finishing the six-week follow-up assessment. All undergraduate medical students were eligible for inclusion. Both groups were given introductory lectures, before completing a pre-test with questions on the principles of fracture fixation and osteotomy. Each group then received a lecture on these topics with the same content, but one was delivered with VR and the other with physical models. Both groups completed the post-course assessments. Knowledge was assessed by way of questionnaire immediately before, immediately after, and six-weeks after. RESULTS: In the VR group, participants improved their post-training score by 192.1% (U=32; p<0.00001). In the physical models group, participants improved their post-training scores by 163.1% (U=8.5; p<0.00001). Overall, there was no statistically significant difference in the total means of post-training test scores between the VR and the physical models study groups (U=260.5; p=0.4354). CONCLUSION: Both VR and physical models represent valuable educational adjuncts for the undergraduate medical curriculum. Both have demonstrated improvements in immediate and long-term knowledge retention of key orthopaedic concepts.

The Role of Technology in Anatomy Teaching: Striking the Right Balance.

BACKGROUND: This study assesses the scope for using technology to supplement the undergraduate anatomy curriculum at medical school. METHODS: A narrative literature review explored the current landscape of anatomy learning. Medical student usage and preferences of technological interventions for anatomy learning were then explored through a cross-sectional survey. RESULTS: The literature review revealed the current teaching strategies for anatomy learning, exploring recent multimedia innovations. The survey demonstrated that technology usage was ubiquitous among medical students with 98% of medical students owning smartphones. Medical education apps were used by 64.3% of medical students, with 61.9% of these apps covering anatomy, and 60.4% of students preferring traditional cadaveric teaching to other technological interventions. CONCLUSION: Novel technological innovations present the opportunity to deliver accessible and standardised teaching of anatomy to medical students. Many students already use smartphone applications as part of their anatomy learning. Uptake of smartphones and other devices provides opportunities to reach larger target audiences. However, traditional cadaveric teaching remains the learning resource of choice for medical students, and technological interventions are best designed as adjuncts or supplements to cadaveric teaching.