Andrew Renwick

Early experience of a virtual journal club

Traditional journal club models based on didactic presentation sessions followed by group discussion have many limitations. To overcome some of these shortcomings, a virtual journal club (VJC) using social media and e–mail was developed. The aim of this study was to report the initial experience of this novel multimodal e–learning platform to facilitate journal club discussion and promote the development of critical appraisal skills.

Re: Bacteriological study in perianal abscess is not useful and not cost‐effective

Winter et al. concluded that open appendicectomy (OA) appears to be a safer approach for pregnant patients with suspected appendicitis. The observational data set was unbalanced with a zero event rate in the OA group and the total event rate was too small for valid regression analysis. Propensity score matching (PSM) was used for causal inference. However, recent evidence demonstrated that PSM generates higher levels of imbalance, model dependence and bias. Furthermore, boosted regression cannot overcome non-informative predictors or important predictors that have been overlooked. A straightforward test (exact, unconditional) of difference in two binomial proportions showed a difference of 5.6% foetal risk between OA and laparoscopic appendicectomy (LA). As the data were acquired neither by random sampling nor by randomization, there is no population to which one could refer and thus no meaning could be attached to the 95% confidence interval stated. The authors claimed that the results showed clinically relevant foetal risk but how was ‘clinically relevant’ defined? LA for pregnant mothers have consistently demonstrated benefits in terms of shorter operative times, length of stay and fewer postoperative complications compared with OA – ‘the best way to take care of the baby is to take care of the mother’. As yet, there is no evidence-based pathophysiological explanation for the observed foetal risk with LA. Until then, there will be conflicting reports in the literature. To summarize, factors other than the surgical approach might have caused the observed difference and this study has not ruled out bias, confounding and chance and should not serve as an argument against the use of LA for suspected appendicitis in pregnancy. In observational studies, causality can be established only on non-statistical grounds.

PWE-414 A designated eras nurse consistently achieves eras goals with significant cost reductions for the nhs

Introduction Enhanced recovery after surgery (ERAS) optimises patient outcomes after elective surgery. The role of designated ERAS nurse has rarely been assessed with limited information on any potential cost savings. Method 3 separate time periods were compared: n = 36, group 1 (ERAS established, no designated nurse, 3 months duration); n = 64, group 2 (5 month introductory period for ERAS Nurse) and group 3, n = 204 (12 months following introductory period) Total numbers of patients; length of hospital stay (LOS); re-admission rates were calculated with daily patient costs estimated using £541 / surgical ward. Results LOS reduced in group 2 and further reduced in group 3: 9 (3–36) vs. 8 (3–15) vs. 7 (3–68) [Groups 1, 2 and 3 respectively]. The re-admission rate reduced: 8% vs. 4.7% vs. 5.4%; length of re-admission stay shorter: 4.5 days vs. 1.7 vs. 1.7. The two day LOS reduction saved 408 bed days: potential cost reduction of £1082/patient/ hospital stay or alternatively, allowed extra 58 patients to have surgery. Conclusion A designated ERAS Nurse has substantially increased the number of patients undergoing surgery, with further reductions in hospital stay and re-admission rates; a designated ERAS Nurse has vital and cost-effective role in current surgical practice. Disclosure of interest None Declared.

Salmonellosis as a differential diagnosis.

With a low incidence of Salmonella infection, salmonellosis is an uncommon problem in Scotland. It occurs in both immune-compromised and immune-competent patients. We present two cases of salmonellosis in immune-competent patients who had had a history of gastroenteritis. Diagnosis was delayed in one patient; however, both patients received appropriate treatment and made good recovery following their respective illnesses. Apart from acting as a reminder to consider salmonellosis as a differential diagnosis when managing patients with infective process, the cases also highlight the importance of concise history taking, and the importance of cultures-and-sensitivities in managing infectious cases.

The use of mini-CEX in UK foundation training six years following its introduction: Lessons still to be learned and the benefit of formal teaching regarding its utility

We read with interest the recent article that explored the experiences, opinions and attitudes of foundation year one (FY1) doctors in one foundation school towards the miniclinical evaluation exercise (mini-CEX) (Weston & Smith 2014). Determining the value and utility of currently used learning and assessment tools is vital. However, there are a few aspects of this article that require further clarification and comment. First, the low response rate (19.4%), female preponderance and lack of views from non-UK trained medical graduates suggest these results are unlikely to be representative of the opinion of current FY1s and thus not generalizable to other areas of the UK. As acknowledged by the authors, such a poor response rate allows significant bias to be introduced. All subsequent results and recommendations should therefore be interpreted with a degree of caution. Second, it is reported that the majority of FY1s do not find the mini-CEX tool useful as part of their postgraduate training. However, it seems slightly erroneous to suggest that those who received training as an undergraduate had a significantly higher benefit from mini-CEX when the median Likert score was 3 (neutral). It would therefore be more accurate to say that those who received no formal teaching found the use of miniCEX to be significantly more unhelpful. Third, the examination of specific barriers towards successful use of work-based assessments (WBAs) is to be commended. The use of qualitative methodology is therefore ideal to identify common themes relating to aspects of the mini-CEX process that require improvement. It would appear that time constraints and prioritization of service provision over educational assessment are key themes to emerge. However, the presentation of free text answers (qualitative) by frequency/percentage (quantitative) is misleading and lacks depth. A more detailed qualitative approach using focus groups or structured interviews would have enabled a more thorough investigation of attitudes and barriers to the successful use of the mini-CEX. Finally, this article examines only the opinions of FY1s without examining those of the assessors. As the mini-CEX tool requires engagement from both parties, a full picture of attitudes towards and problems with this WBA cannot be fully formed. It will soon be a decade after mini-CEX were introduced for FY1 educational development and assessment. However, this article suggests that it remains poorly regarded with limited usefulness. Further detailed research to improve the utility, acceptance and benefit of such educational tools is therefore desirable.