Sharps injuries during dissection : a five-year retrospective study in the context of safety

The supplementation of lecture‐based anatomy teaching with laboratory sessions, involving dissection or anatomical specimens, is commonly used. Hands‐on dissection allows students to handle instruments correctly while actively exploring three‐dimensional anatomy. However, dissection carries a potential risk of sharps and splash injuries. The aim of this study was to quantify the frequency rate of such cases per 1,000 student‐hours of dissection and identify potential factors than might influence safety in anatomy laboratories. Data were retrospectively collected from September 2013 to June 2018 at the University of St Andrews, Scotland, UK. Overall, 35 sharps injuries were recorded in undergraduate medical students, with a frequency rate of 0.384 and no splash cases. A statistically significant, moderate negative association between year of study and frequency rate (rho(25) = −0.663; P < 0.001) was noted. A statistically significant difference in the frequency rate between different semester modules (χ2(4) = 13.577, P = 0.009) was observed with the difference being between Year 1 Semester 2 and Year 3 Semester 1 (P = 0.004). The decreasing trend with advancing year of study might be linked to increasing dissecting experience or the surface area of the region dissected. The following factors might have contributed to increased safety influencing frequency rates: single‐handed blade removal systems; mandatory personal protective equipment; and having only one student dissecting at a given time. The authors propose that safety familiarization alongside standardized training and safety measures, as part of an evidence‐based culture shift, will instill safety conscious behaviors and reduce injuries in anatomy laboratories.PostprintPeer reviewe

A contextual thematic analysis of the accessory nerve in Scottish historical medical collections of the Royal Colleges of Edinburgh and Glasgow

Funding: Authors acknowledge that this work was conducted as part of the University of St Andrews Laidlaw Undergraduate Research and Leadership Programme, which funded Henry Marles’ summer scholarship for 2017/18 and 2018/19.Introduction The classification of the accessory nerve (CN XI) remains a source of debate; its exact function has not been fully elucidated having also an atypical morphology for a cranial nerve. A better insight into its anatomical and physiological features is of clinical relevance. The aim was to conduct a review of 18th and 19th century books from the Royal Medical/Surgical Colleges in Scotland, UK. A contextual historical analysis of the depictions and descriptions of the accessory nerve could provide insight into the disparity in the current descriptions. Materials and Methods Online archive catalogues were systematically searched and, during site visits, resources were formally and contextually analyzed, with the information then thematically analyzed. The themes were discussed against a widely known reference textbook of the era. Results Based on the thematic analysis, the resources were categorized either as practical anatomy books or field‐specific anatomy books including neuroanatomy atlases. This intended use, along with the target audience, influenced the scope and detail of information, typically with general anatomy for students in the practical resources, and specialist information in the field‐specific resources. The authors’ professional background also influenced the way the accessory nerve was described and/or depicted, with surgeons/physicians placing emphasis on the clinical aspects. Content variations could also be attributed to communication restrictions of the era, and associated purchasing costs. Conclusions Although scientific advances are nowadays disseminated at a faster pace, actively bridging the gap between anatomical sciences and clinical research is still needed when considering the accessory nerve to further elucidate the mysteries of this structure.Publisher PDFPeer reviewe

Resin-embedded anatomical cross-sections as a teaching adjunct for medical curricula : is this technique an alternative to potting and plastination?

With an ever expanding use of cross-sectional imaging for diagnostic and therapeutic purposes, there has also been an increase in the need for exposure to such radiological and anatomical views at the undergraduate and postgraduate level to allow for early familiarisation with the relevant anatomy. Cadaveric cross-sections offer an excellent link between the two-dimensional radiological images and the three-dimensional anatomical structures. For such cross-sections to be useful and informative within educational settings, they need to be: i) safe for students and trainees to handle; ii) robust enough to withstand repeated handling; and iii) display anatomy clearly and accurately. There are various ways in which cross-sections can be prepared and presented; plastinated, potted, vacuum sealed or unmounted. Each of these approaches have advantages and disadvantages in terms of technical complexity, cost and quality. As an alternative to the above methods and their limitations, we propose the presentation of cadaveric cross-sections in a transparent polyester resin. This technique has been used extensively in craft and artistic industries, yet it is not publicised in anatomy teaching settings. The sections were layered in polyester resin contained within a mould. The set resin required finishing by sanding and polishing. The final cross-sections were safe to handle, durable and maintained excellent anatomical relationships of the contained structures. The transparency of the set resin was water-clear and did not obstruct the visibility of the anatomy. The cost of the process was found to be significantly lower, requiring less infrastructure when compared to alternative methods. The following trivial technical difficulties were noted during the resin-embedding process: trapped air causing organs to float; retained water in the anatomical specimens creating bubbles and discolouration; and microbubbles emerging from the solution affecting the finished surface. However, solutions to these minor limitations have been discussed within the paper with the aim of future proofing this technique. The sections have been used in undergraduate medical teaching for four years and they have shown no signs of degradation or discolouration. We believe that this method is a viable and cost effective alternative to other approaches of displaying cross-sectional cadaveric material and will help students and trainees bridge the gap between the traditional three-dimensional anatomy and two-dimensional images.PostprintPeer reviewe

Takatāpui/LGBTIQ+ People’s Experiences of Homelessness and Sex Work in Aotearoa New Zealand

At present, there is limited research on the intersection of sex work, takatāpui/LGBTIQ+ communities, and experiences of homelessness in Aotearoa New Zealand. This paper helps to bridge this gap, exploring how takatāpui/LGBTIQ+ people who had been failed by the welfare state engaged in sex work during periods of homelessness, and expressed agency in difficult circumstances. Specifically, we look at sex and sex work as a means to secure basic needs, and in the context of exploitative relationships; the emotional effects of sex work; and safety and policing. A stronger welfare state is needed to provide sufficient support for people to realise an adequate standard of living and treat them with dignity and respect

Identifying the emergence of the superficial peroneal nerve through deep fascia on ultrasound and by dissection:Implications for regional anesthesia in foot and ankle surgery

Regional anesthesia relies on a sound understanding of anatomy and the utility of ultrasound in identifying relevant structures. We assessed the ability to identify the point at which the superficial peroneal nerve (SPN) emerges through the deep fascia by ultrasound on 26 volunteers (mean age 27.85 years ± 13.186; equal male: female). This point was identified, characterized in relation to surrounding bony landmarks (lateral malleolus and head of the fibula), and compared to data from 16 formalin‐fixed human cadavers (mean age 82.88 years ± 6.964; equal male: female). The SPN was identified bilaterally in all subjects. On ultrasound it was found to pierce the deep fascia of the leg at a point 0.31 (±0.066) of the way along a straight line from the lateral malleolus to the head of the fibula (LM‐HF line). This occurred on or anterior to the line in all cases. Dissection of cadavers found this point to be 0.30 (±0.062) along the LM‐HF line, with no statistically significant difference between the two groups (U = 764.000; exact two‐tailed P = 0.534). It was always on or anterior to the LM‐HF line, anterior by 0.74 cm (±0.624) on ultrasound and by 1.51 cm (±0.509) during dissection. This point was significantly further anterior to the LM‐HF line in cadavers (U = 257.700, exact two‐tailed P < 0.001). Dissection revealed the nerve to divide prior to emergence in 46.88% (n = 15) limbs, which was not identified on ultrasound (although not specifically assessed). Such information can guide clinicians when patient factors (e.g., obesity and peripheral edema) make ultrasound‐guided nerve localization more technically challenging.PostprintPeer reviewe

Developing a Methodology Protocol for Identifying the Superficial Peroneal Nerve in Living Models Sonographically and Formalin-Fixed Cadavers Morphologically: a Proof of Concept Study

The superficial peroneal nerve (SPN) provides cutaneous innervation to the distal anterolateral leg and dorsum of foot.1 Knowing the position where the SPN penetrates the deep fascia, to become superficial, is useful in clinical practice (e.g. ankle blocks and internal fixation of distal fibular fractures). However, there is variability in the literature as to where the SPN penetrates the deep fascia as well as the methodology to identify it with no standardised guidelines. Our primary aim was to identify this point and create a methodology protocol that could be implemented in clinical practice. The study involved sonography of living healthy adult volunteers and dissection of formalin-fixed cadavers with no past history of pathology or surgery affecting the SPN. During sonography, the bony prominences of the fibular head and lateral malleolus were identified and marked with a straight line. A 6-12 MHz linear array ultrasound probe was positioned anterior to the lateral malleolus and moved proximally to identify the location where the SPN penetrates the deep fascia to lie in a superficial plane. The lateral malleolus-fibular head (length of fibula) and lateral malleolus-SPN distances were measured. The distance of emergence from the deep fascia of the SPN anterior or posterior to the length of fibula was measured (fig 1). In the cadavers, a skin incision was made from the tibial tuberosity to the anterior intermalleolar line and the skin reflected laterally to a line posterior to fibula. The superficial fascia was explored to identify the SPN and branches (fig 2). The same bony landmarks/measurements as in the sonography were marked and measured to allow for comparison with the sonographic methodology. We successfully developed a protocol that can provide standardisation for identifying the SPN. This can reduce incorrect identification and improve success rates of clinical procedures, though individual variation must be considered. Reference: 1. STANDRING, S (Editor) 2008. Gray’s Anatomy The Anatomical Basis of Clinical Practice (Fortieth Edition). London: Churchill Livingstone ELSEVIER, page 1427. Acknowledgements: For their help and support in this study, we would to thank the volunteers, the anatomy technical staff, and the clinical skills suite manager from the University of St Andrews Medical School

Developing a Methodology Protocol for Identifying the Superficial Peroneal Nerve in Living Models Sonographically and Formalin-Fixed Cadavers Morphologically: a Proof of Concept Study

The superficial peroneal nerve (SPN) provides cutaneous innervation to the distal anterolateral leg and dorsum of foot.1 Knowing the position where the SPN penetrates the deep fascia, to become superficial, is useful in clinical practice (e.g. ankle blocks and internal fixation of distal fibular fractures). However, there is variability in the literature as to where the SPN penetrates the deep fascia as well as the methodology to identify it with no standardised guidelines. Our primary aim was to identify this point and create a methodology protocol that could be implemented in clinical practice. The study involved sonography of living healthy adult volunteers and dissection of formalin-fixed cadavers with no past history of pathology or surgery affecting the SPN. During sonography, the bony prominences of the fibular head and lateral malleolus were identified and marked with a straight line. A 6-12 MHz linear array ultrasound probe was positioned anterior to the lateral malleolus and moved proximally to identify the location where the SPN penetrates the deep fascia to lie in a superficial plane. The lateral malleolus-fibular head (length of fibula) and lateral malleolus-SPN distances were measured. The distance of emergence from the deep fascia of the SPN anterior or posterior to the length of fibula was measured (fig 1). In the cadavers, a skin incision was made from the tibial tuberosity to the anterior intermalleolar line and the skin reflected laterally to a line posterior to fibula. The superficial fascia was explored to identify the SPN and branches (fig 2). The same bony landmarks/measurements as in the sonography were marked and measured to allow for comparison with the sonographic methodology. We successfully developed a protocol that can provide standardisation for identifying the SPN. This can reduce incorrect identification and improve success rates of clinical procedures, though individual variation must be considered. Reference: 1. STANDRING, S (Editor) 2008. Gray’s Anatomy The Anatomical Basis of Clinical Practice (Fortieth Edition). London: Churchill Livingstone ELSEVIER, page 1427. Acknowledgements: For their help and support in this study, we would to thank the volunteers, the anatomy technical staff, and the clinical skills suite manager from the University of St Andrews Medical School

Identifying variant anatomy during ultrasound-guided regional anaesthesia:opportunities for clinical improvement

No abstract available

A marking of the cricothyroid membrane with extended neck returns to correct position after neck manipulation and repositioning

Background: Emergency front of neck airway access by anaesthetists carries a high failure rate and it is recommended to identify the cricothyroid membrane before induction of anaesthesia in patients with a predicted difficult airway. We have investigated whether a marking of the cricothyroid membrane done in the extended neck position remains correct after the patient's neck has been manipulated and subsequently repositioned METHODS: The subject was first placed in the extended head and neck position and had the cricothyroid membrane identified and marked with three methods, palpation, 'laryngeal handshake' and ultrasonography and the distance from the suprasternal notch to the cricothyroid membrane was measured. The subject then moved off the table and sat on a chair and subsequently returned to the extended neck position and examinations were repeated. Results: Skin markings of all 11 subjects lay within the boundaries of the cricothyroid membrane when the subject was repositioned back to the extended neck position and the median difference between the two measurements of the distance from the suprasternal notch was 0 mm (range 0-2 mm). Conclusion: The cricothyroid membrane can be identified and marked with the subject in the extended neck position. Then the patient's position can be changed as needed, for example to the 'sniffing' neck position for conventional intubation. If a front of neck airway access is required during subsequent airway management, the patient can be returned expediently to the extended-neck position, and the marking of the centre of the membrane will still be in the correct place