Medical student views of and responses to expectations of professionalism

Funding this study is part of the corresponding author's (EAS) doctoral programme of research funded by the University of Aberdeen, and supervised by EH and JC. Acknowledgements we thank all the students who took part in this project, and Professor Rona Patey, the Director of the Institute of Education for Medical and Dental Sciences, University of Aberdeen, for her support of this project.Peer reviewedPostprin

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe

Genetic and lifestyle risk factors for MRI-defined brain infarcts in a population-based setting

OBJECTIVE: To explore genetic and lifestyle risk factors of MRI-defined brain infarcts (BI) in large population-based cohorts.METHODS: We performed meta-analyses of genome-wide association studies (GWAS) and examined associations of vascular risk factors and their genetic risk scores (GRS) with MRI-defined BI and a subset of BI, namely, small subcortical BI (SSBI), in 18 population-based cohorts (n = 20,949) from 5 ethnicities (3,726 with BI, 2,021 with SSBI). Top loci were followed up in 7 population-based cohorts (n = 6,862; 1,483 with BI, 630 with SBBI), and we tested associations with related phenotypes including ischemic stroke and pathologically defined BI.RESULTS: The mean prevalence was 17.7% for BI and 10.5% for SSBI, steeply rising after age 65. Two loci showed genome-wide significant association with BI: FBN2, p = 1.77 × 10-8; and LINC00539/ZDHHC20, p = 5.82 × 10-9. Both have been associated with blood pressure (BP)-related phenotypes, but did not replicate in the smaller follow-up sample or show associations with related phenotypes. Age- and sex-adjusted associations with BI and SSBI were observed for BP traits (p value for BI, p [BI] = 9.38 × 10-25; p [SSBI] = 5.23 × 10-14 for hypertension), smoking (p [BI] = 4.4 × 10-10; p [SSBI] = 1.2 × 10-4), diabetes (p [BI] = 1.7 × 10-8; p [SSBI] = 2.8 × 10-3), previous cardiovascular disease (p [BI] = 1.0 × 10-18; p [SSBI] = 2.3 × 10-7), stroke (p [BI] = 3.9 × 10-69; p [SSBI] = 3.2 × 10-24), and MRI-defined white matter hyperintensity burden (p [BI] = 1.43 × 10-157; p [SSBI] = 3.16 × 10-106), but not with body mass index or cholesterol. GRS of BP traits were associated with BI and SSBI (p ≤ 0.0022), without indication of directional pleiotropy.CONCLUSION: In this multiethnic GWAS meta-analysis, including over 20,000 population-based participants, we identified genetic risk loci for BI requiring validation once additional large datasets become available. High BP, including genetically determined, was the most significant modifiable, causal risk factor for BI.</p

Global variation in anastomosis and end colostomy formation following left-sided colorectal resection

Background End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001). Conclusion Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone

Location of Ferrule and Its Effect on Fracture Resistance of Endodontically Treated Mandibular Premolar: An in-vitro Study

INTRODUCTION: Presence of ferrule during delivery of a fixed prosthesis onto an endodontically treated tooth is important for fracture resistance of the tooth in function. AIM: This study aims to investigate the location of ferrule on fracture resistance of endodontically treated extracted mandibular premolars. MATERIALS AND METHOD: Sixty extracted mandibular premolars were divided into 6 groups where each group consisted of 10 teeth. The groups were as follows: control group, GHT; endodontically treated teeth without endodontic posts and crowns, GCF; teeth with a 2 mm circumferential ferrule, GBF; teeth with a 2 mm buccal ferrule; GLF, teeth with a 2 mm lingual ferrule; GBLF, teeth with a 2 mm buccal and lingual ferrule; and teeth without ferrule, GWF. All the teeth were endodontically treated and glass fibre posts were cemented and crowns were luted. All the teeth were loaded in a universal testing machine until fractured. Fracture lines were also assessed according to their location onto the teeth. The results were recorded and were statistically analyzed. RESULTS: Mean ±SD loads for the groups ranged from 770.3 ±212.9 N to 1008.1 ±176.5 N. One way ANOVA revealed a statistically significant difference between the groups (P_.05). However, no statistically significant differences were observed among groups (P&gt;.05), except between GHT (control group) and group GWF (without ferrule). CONCLUSION: The study reported that although the presence of ferrule leads to improved fracture resistance, specific location of the ferrule had no significant differences in the fracture strength of endodontically treated teeth restored with glass fiber posts

Knowledge, Awareness and Attitude of Precision Attachments among Dental Practitioners: A Questionnaire Based Study

INTRODUCTION: Precision attachments are an important aspect of prosthetic dentistry by providing retention to the prosthesis with aesthetics compared to conventional retainers that are visible clinically. AIM: To access the implementation of this practical concept by dental practitioners in their routine practice, a questionnaire based survey was conducted on dental practitioners and lab technicians. MATERIALS AND METHOD: A questionnaire containing 15 questions was distributed among dentists and lab technicians via Google forms and the responses were analyzed to evaluate knowledge, awareness and towards the concept of precision attachments. Data analysed was based on qualification (i.e. BDS, MDS in Prosthodontics, MDS Others, OTHERS i.e., DCI recognized diploma and fellowship courses post-BDS) and years of experience (0-10, 11-20 &amp;&gt;20 years) for the dentist-based survey and based on years of experience (0-10, 11-20 &amp;&gt;20 years) for the lab technician-based survey. Data was subjected to Chi- square test using Statistical Package of Social Sciences (SPSS) Software. RESULTS: Out of 336 participants, 45% were BDS, 30% were MDS in Prosthodontics, 23% were MDS in other fields and 2% were from others category. It was reported that ‘MDS in Prosthodontics’ with 11-20 years of experience seem to have the maximum confidence to handle cases of precision attachments. ‘BDS’ with 0-10 years of experience group have the least confidence to handle cases of precision attachment and the results was found to be statistically significant (p=0.02) indicating that while dentists are aware of this treatment modality but it’s implementation is limited to the prosthodontists. Responses of lab technicians also highlighted lack of knowledge and skill of dental practitioners to handle cases of precision attachment optimally(p=0.02.) CONCLUSION: Among dental practitioners, very less number have general knowledge and skills of this treatment modality. Therefore, its usage in current clinical scenario is still a challenging one