Randomised controlled trial comparing rubber band ligation with stapled haemorrhoidopexy for Grade II circumferential haemorrhoids : Long-term results

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Place-names, land and lordship in the medieval earldom of Strathearn

The first aim of this thesis is to present a comprehensive toponymic listing and analysis for six parishes of Western Strathearn, and this is done in Part One where approximately 2500 place-names are considered. The medieval parishes of BQR, COM, TEX, MUT, MZX and MXZ form a continuous, largely upland, area, topographically distinct from the Strathearn parishes to the east, and with the exception of Innerpeffray (part of MXZ, see esp. Part Two, Appendix 1b) somewhat less affected, in the 12c to 14c at least, by inward migration of Anglo-Norman and other non-Gaelic groups or individuals. Thus we might expect this western area to be the most conservative part of an earldom that Cynthia Neville has characterised as conservative and insular as late as 13c when compared to other major Scottish earldoms and lordships (Neville 1983, eg vol i, 156, Neville 2000, 76). The core lands of the more easterly medieval parish of FOW were subjected to the same comprehensive toponymic analysis. Though that toponymic material could not be included for reasons of space, it has contributed, along with the material from the six parishes covered in the gazetteers below, to the second main aspect of the thesis, the discussion of lordship and land organisation in Part Two. In Part Two will also be found an introduction to the earldom of Strathearn and a discussion of a number of aspects of its history, as well as appendices giving additional information relevant to the topics discussed in the body of the thesis. The parish unit was chosen as the basis for the organisation of this thesis since John Rogers (Rogers 1992, esp. 125-7) has shown the fundamental link between the form of the ecclesiastical parishes, whose creation was complete by 12c, and pre-existing units of land usually referred to as multiple estates, a multiple estate being a group of individual estates, not necessarily contiguous, organised and operated as a coherent social, tenurial and economic unit. As Rogers puts it, multiple estates were essentially units of lordship, taking the form of a principal settlement or caput with a number of dependent settlements. They contained within their bounds all the resources required to support their economies and to produce the necessary renders. Accordingly they were arranged in the landscape to exploit those resources, a process which often produced irregular geographical forms, including areas detached from the main body of the estate. This process frequently led to a specialisation of function, such as the management of pasture, amongst the component settlements. Jones (1976) discusses the multiple estate in the context of the early British Isles, Dodgshon (1981, esp. 58ff) in a Scottish context. The latter writer says (op. cit., 58) that in their variety of scale, multiple estates have often been likened to a parish, though some were undoubtedly larger, adding that lordship was exercised over them by a tribal chief, a king or a feudal baron. Many of these characteristics will be found relevant to the discussion of land organisation and lordship in Part Two. In our present state of knowledge, then, the medieval parishes are the best representation we have of the patterns of land organisation in Strathearn as they may have been in the time of the late Pictish and early Scottish kingdoms. A practical demonstration of the relevance of parish boundaries lies in the fact that it is rare indeed to find a settlement place-name whose area of reference straddles the boundary of a medieval parish. It is overwhelmingly within the context of the original parish that the place-names of an area have coherence and are most likely to give up their secrets

Teaching webside manner: development and initial evaluation of a video consultation skills training module for undergraduate medical students

Background Video consultations are increasingly used to communicate with patients, particularly during the current COVID-19 pandemic. However, training in video consultation skills receives scant attention in the literature. We sought to introduce this important topic to our undergraduate medical school curriculum. Objective To increase final year medical students’ video consultation skills and knowledge. Methods We used Plan, Do, Study, Act (PDSA) quality improvement methodology with a pre-post study design to develop a teaching session for 5th year medical students, informed by a literature review and online clinician survey. The 2 hour session comprised an introduction and three practical stations: patient selection and ethics, technology and example videos, and simulation. Subjective pre- and post-session confidence was reported by students across seven domains using 5-point scales (1: not at all confident; 5: extremely confident). Students and facilitators completed post-session feedback forms. Results The 40 students and 3 facilitators who attended, over two separate teaching sessions, provided unanimously positive feedback. All students considered the session relevant. Subjective confidence ratings (n = 34) significantly increased from pre- to post-session (mean increase 1.78, p < 0.001). Conclusions The inaugural teaching session was well-received and subjective assessment measures showed improvement in taught skills. This pilot has informed a UK-wide multi-centre study with subjective and objective data collection

Grossly delayed massive subcutaneous emphysema following laparoscopic left hemicolectomy: A case report

AbstractINTRODUCTIONSurgical emphysema is a known early complication of laparoscopic surgery, common during upper gastrointestinal and gynaecological surgery; the authors present the first case of delayed subcutaneous emphysema following a laparoscopic left hemicolectomy.PRESENTATION OF CASEA 52-year-old woman underwent a laparoscopic left hemicolectomy for a sigmoid malignancy; on the third post-operative day after an uneventful procedure, she developed a massive surgical emphysema involving her face, neck and chest with associated pneumoperitoneum but without any evidence of pneumothorax. A gastrograffin enema ruled out an anastomotic leak. Apart from a borderline tachycardia, mildly low saturations and an area of erythema in her right flank, she was totally asymptomatic. The emphysema resolved spontaneously around the 6th post-operative day.DISCUSSIONMassive subcutaneous surgical emphysema after laparoscopic colorectal surgery is a rare complication and can me managed conservatively with a good outcome.CONCLUSIONTo our knowledge, this represents the first case of delayed massive surgical emphysema following colorectal surgery, the aetiology of which has still not been clearly explained, after exclusion of the most common causes

Associations between patient factors and successful colon capsule endoscopy – a prospective cohort study

Funding statement This study was funded by an NHS Highland Research Development and Innovation grant. Acknowledgements We would like to thank all patients and staff involved in the ScotCap evaluation. We would also like to thank The Data Lab for their contribution to the project.Peer reviewedPostprin

Effects of Short-Term Training With Uncoupled Cranks in Trained Cyclists

Purpose: Manufacturers of uncoupled cycling cranks claim that their use will increase economy of motion and gross efficiency. Purportedly, this occurs by altering the muscle-recruitment patterns contributing to the resistive forces occurring during the recovery phase of the pedal stroke. Uncoupled cranks use an independentclutch design by which each leg cycles independently of the other (ie, the cranks are not fixed together). However, research examining the efficacy of training with uncoupled cranks is equivocal. The purpose of this study was to determine the effect of short-term training with uncoupled cranks on the performance-related variables economy of motion, gross efficiency, maximal oxygen uptake (VO 2max), and muscle-activation patterns. Methods: Sixteen trained cyclists were matched-paired into either an uncoupled-crank or a normal-crank training group. Both groups performed 5 wk of training on their assigned cranks. Before and after training, participants completed a graded exercise test using normal cranks. Expired gases were collected to determine economy of motion, gross efficiency, and VO 2max, while integrated electromyography (iEMG) was used to examine muscle-activation patterns of the vastus lateralis, biceps femoris, and gastrocnemius. Results: No significant changes between groups were observed for economy of motion, gross efficiency, VO 2max, or iEMG in the uncoupled- or normal-crank group. Conclusions: Five weeks of training with uncoupled cycling cranks had no effect on economy of motion, gross efficiency, muscle recruitment, or VO 2max compared with training on normal cranks

Reducing surgical site infection rates in colorectal surgery – a quality improvement approach to implementing a comprehensive bundle

Funding Information: Funding for project management time was received from the Scottish Patient Safety Programme.Peer reviewedPublisher PD