A universal, high-performance ECG signal processing engine to reduce clinical burden.

BACKGROUND: Electrocardiogram (ECG) signal conditioning is a vital step in the ECG signal processing chain that ensures effective noise removal and accurate feature extraction. OBJECTIVE: This study evaluates the performance of the FDA 510 (k) cleared HeartKey Signal Conditioning and QRS peak detection algorithms on a range of annotated public and proprietary ECG databases (HeartKey is a UK Registered Trademark of B-Secur Ltd). METHODS: Seven hundred fifty-one raw ECG files from a broad range of use cases were individually passed through the HeartKey signal processing engine. The algorithms include several advanced filtering steps to enable significant noise removal and accurate identification of the QRS complex. QRS detection statistics were generated against the annotated ECG files. RESULTS: HeartKey displayed robust performance across 14 ECG databases (seven public, seven proprietary), covering a range of healthy and unhealthy patient data, wet and dry electrode types, various lead configurations, hardware sources, and stationary/ambulatory recordings from clinical and non-clinical settings. Over the NSR, MIT-BIH, AHA, and MIT-AF public databases, average QRS Se and PPV values of 98.90% and 99.08% were achieved. Adaptable performance (Se 93.26%, PPV 90.53%) was similarly observed on the challenging NST database. Crucially, HeartKey's performance effectively translated to the dry electrode space, with an average QRS Se of 99.22% and PPV of 99.00% observed over eight dry electrode databases representing various use cases, including two challenging motion-based collection protocols. CONCLUSION: HeartKey demonstrated robust signal conditioning and QRS detection performance across the broad range of tested ECG signals. It should be emphasized that in no way have the algorithms been altered or trained to optimize performance on a given database, meaning that HeartKey is potentially a universal solution capable of maintaining a high level of performance across a broad range of clinical and everyday use cases.

"More than just a medical student": a mixed methods exploration of a structured volunteering programme for undergraduate medical students.

BACKGROUND: As a result of the COVID-19 pandemic Imperial College School of Medicine developed a structured volunteering programme involving 398 medical students, across eight teaching hospitals. This case study aims to explore the relationship between the processes, context, participant experiences and impacts of the programme so that lessons can be learned for future emergencies and service-learning programmes. METHODS: Using an illuminative approach to evaluation we invited all volunteers and supervisors to complete a mixed-methods survey. This explored differences in experience across demographics and contextual factors, correlations between aspects of induction, supervision and overall experience, and reviewed the impacts of the programme. Quantitative responses were statistically analysed and qualitative reflections were thematically coded to triangulate and explain quantitative findings. Follow up interviews were carried out to check back findings and co-create conclusions. RESULTS: We received responses from 61 students and 17 supervisors. Student participants described predominantly altruistic motivations and transformational changes to their professional identity driven by feeling included, having responsibility, and engaging in authentic workplace-based learning afforded by freedom from the assessed curriculum. They reported new perspectives on their future professional role within the multidisciplinary team and the value of workplace-based learning. They reported increases in wellbeing and self-esteem related to feeling included and valued, and positively contributing to service provision at a time of need. Significantly higher overall satisfaction was associated with a personalised induction, active supervision, earlier stage of training, and male gender. Gender-related differences were not explained through our data but have been reported elsewhere and warrant further study. The duration, intensity and type of role that volunteers performed was similar across demographics and did not appear to modulate their overall experience. CONCLUSIONS: Whilst acknowledging the uniqueness of emergency volunteering and the survey response rate of 15% of volunteers, we suggest the features of a successful service-learning programme include: a learner-centred induction, regular contact with engaged and appreciative supervisors, and roles where students feel valued. Programmes in similar settings may find that service learning is most impactful earlier in medical students' training and that students with altruistic motivations and meaningful work may flourish without formal outcomes and assessments.

Video-assisted reflection: improving OSCE feedback.

BACKGROUND: Objective Structured Clinical Examinations (OSCEs) are commonly used to provide feedback to students on their performance in formative examinations. However, students are often unable to act independently on the feedback they receive. This study explored how the use of video-assisted reflection in OSCEs can enhance students' ability to reflect and engage in sustainable feedback. METHODS: Twenty-one students undertaking a mock-final OSCE consented to have one of their examination stations filmed. Participants completed a series of reflective forms immediately after the OSCE, after verbal feedback from an examiner and finally, after watching the video of their own performance. Students were asked to predict their overall grade as well as list areas for improvement. Pearson r correlations examined the relationship between the examiners' grades and the candidates' self-predicted grades. Wilcoxon signed-rank tests were used to compare the length of reflections at each stage. Semi-structured interviews were conducted to explore students' beliefs on self-efficacy and how the video-assisted reflection altered their ability to act on feedback. RESULTS: The students' ability to self-assess and gauge their own performance improved significantly after undertaking the video-assisted reflection (p < 0.01). Furthermore, video-assisted reflection significantly increased the length of the student's reflections. In interviews, participants described multiple ways in which the video-assisted reflection improved their confidence and ability to act on feedback, highlighting a clear enhancement in self-efficacy. DISCUSSION: Video-assisted reflection of recorded OSCE stations represents an effective approach to increase student self-efficacy and subsequently improve engagement in sustainable feedback practice.

Unusual case of primary cutaneous signet-ring cell (histocytoid) carcinoma.

Signet-ring cell (histocytoid) carcinoma is a rare and aggressive skin neoplasm that most commonly affects elderly men. It typically originates from the upper or lower eyelid, with bilateral involvement only in rare cases, and results in a diffuse and infiltrative appearance clinically, radiologically, and histologically (the "monocle" sign). It is essential to carry out a full investigation to rule out metastasis from an internal origin.

A structured tool for delivering feedback on medical student clinical clerkings.

This article was migrated. The article was marked as recommended. Introduction: The initial history and examination is a fundamental aspect of clinical practice. Most medical students cultivate this skill through regular undertaking of 'clerkings' during their clinical placements. We designed a written, structured, proforma-based approach to delivery of feedback on student clerkings which also promoted the undertaking of a 'complete clerking' encouraging students to maintain a whole-system holistic approach. Within this paper, we present our findings following its introduction at a London teaching hospital. Methods: Sixty-one medical students on their first clinical attachment within acute medicine were asked to submit at least one full medical clerking for objective appraisal using the structured clerking feedback proforma by a clinical teaching fellow. Students completed a 'pre' and 'post' assessment using Likert Scales at the time of receiving their clerking feedback. Structured interviews of randomly selected students and senior medical educators were also undertaken. Results: Following introduction of the structured feedback proforma, there was a significant increase across all indices of student-perceived utility and satisfaction compared to previously received feedback (which was mostly ad-hoc verbal). Using Likert Scales (1 to 10: 1 representing least effect and 10 representing greatest effect) student assessment of usefulness was 9.0 (versus 6.34 for previous feedback); likelihood of influencing future practice was 8.8 (versus 6.47); extent to which it reinforced the message of a complete clerking was 9.5 (versus 6.13) and extent to which the feedback would encourage them to undertake complete clerkings was 9.0. Free text comments and subsequent interviews of randomly selected students and senior medical educators reinforced the positive perception of this approach. Conclusions: The introduction of a structured clerking feedback proforma can improve the quality and utility of the feedback delivered to medical students on their acute medical clerkings and can promote and reinforce the value of maintaining a whole-system holistic approach.

Abortion legislation: exploring perspectives of general practitioners and obstetrics and gynaecology clinicians.

Abortion legislation remains a contentious topic in the UK, which receives much attention from politicians, clinicians and professional bodies alike. In this study, the perspectives of general practitioners and obstetrics and gynaecology clinicians on the Abortion Act 1967 was explored. To this end, a short electronic questionnaire was distributed to all 211 GP and obstetrics and gynaecology clinicians affiliated with the University of Cambridge School of Clinical Medicine. Of the 100 anonymous responses collected, a significant majority felt that abortion law in Northern Ireland should be changed in line with the rest of the UK. The respondents' votes, however, were either opposed to or divided over any other changes to the Abortion Act, including altering the 24 week time limit, clarifying the legal definition of fetal abnormalities, introducing abortion purely on the woman's request, and modifying the requirement for two clinicians to approve any request for abortion. These perspectives were not entirely aligned with the recommendations of the Royal College of Obstetricians and Gynaecologists and the House of Commons Science and Technology Committee, or with current medical evidence and demographic data.

Rehabilitation of patients following major head and neck cancer surgery.

Cancer rehabilitation is accepted as an essential part of patient care, aiming to maximise the patient's quality of life. Patients who have received major surgery for head and neck cancer face many challenges and require a tailored rehabilitation programme. This review collate the evidence specific to head and neck cancer patients and divides the programme into five areas: functional, medical, aesthetic, psychological and social. This provides an overall framework in which to consider these unique rehabilitation requirements.

Current advances in facial reconstructive surgery following head and neck cancer surgery.

There are currently a number of options in routine clinical use for facial reconstruction following ablative procedures, as well as several budding advances that may provide alternative approaches in the future. This review aims to give an overview of the current status of facial reconstruction as well as an introduction to the new developments.