Student advanced trauma management and skills (SATMAS) : a validation study

Introduction Despite trauma accounting 9% of global mortality, it has been demonstrated that undergraduate trauma teaching is inadequate nationally and worldwide. With COVID-19 exacerbating this situation, a scalable, accessible, and cost-effective undergraduate trauma teaching is required. Methods Our Continual Professional Development United Kingdom (CPUDK)-accredited University Hospitals Birmingham (UHB) Major Trauma Service (MTS) affiliated programme consisted of seven biweekly pre-recorded sessions that were delivered online through the Moodle educational platform to University of Birmingham students. Pre- and post-randomised session-specific multiple-choice questions (MCQs) and anonymous feedback forms were administered. Results There were 489 student responses, with 63 students completing all seven sessions. On an 8-point scale, students’ objective knowledge scores increased by a mean of 1.2 (p < 0.001). Using a 5-point Likert scale, students also showed improvement in subjective outcomes including their confidence in assessing trauma patient (absolute difference (AD) 1.38, p < 0.001), advising initial investigations and formulating initial management plans (AD 1.78, p < 0.001) and thereby their confidence to manage a trauma patient overall (AD 1.98, p < 0.001). A total of 410 student responses endorsed the online delivery of SATMAS through Moodle and recommended SATMAS to future medical students. Conclusion SATMAS has demonstrated positive student feedback and extensive recruitment from only one centre, demonstrating that our programme can be an indispensable low-cost learning resource that prepares undergraduate medical students for their trauma exams and informs the implementation of clinical skills required by all doctors. We publish our pilot study findings to encourage similar teaching programmes to be adopted at other universities nationally and internationally, to synergistically benefit students, tutors, and ultimately patients, on a larger scale

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Are trauma surgery simulation courses beneficial in low‐ and middle‐income countries—a systematic review and meta‐analysis

Despite trauma-related injuries being a leading cause of death worldwide, low- and middle-income countries (LMICs) lack the infrastructure and resources required to offer immediate surgical care, further perpetuating the risk of morbidity and mortality. In high-income countries, trauma surgery simulation courses are routinely delivered to surgeons, teaching the fundamental skills of operative trauma. This study aimed to assess whether similar courses are beneficial in LMICs and how they can be improved. We performed a systematic review and meta-analysis using MEDLINE, Embase and Google Scholar, analysing studies evaluating trauma surgery simulation in LMICs. The outcomes measured included clinical knowledge improvement, participant confidence and general course-feedback. The review was carried out in-line with PRISMA guidelines. Five studies were included, summating a population of 172 participants. In three studies, meta-analysis showed an overall significant weighted mean improvement of knowledge post-course by 22.91% (95%CI 19.53, 26.29; p &lt; 0.00001; I2 = 0%). One study reported a significant increase in participant confidence for 20/22 of operative skills taught (p &lt; 0.04). We conclude that these courses are beneficial in LMICs; however, further research is necessary to establish the optimum course design, and whether patient outcomes are improved following their implementation. Collaboration between international trauma institutions is essential for closing the educational resource inequality gap between higher- and lower-income countries

The Efficacy of Honey Compared to Silver Sulfadiazine for Burn Wound Dressing in Superficial and Partial Thickness Burns—A Systematic Review and Meta-Analysis

Burn dressings play a vital role in protecting the patient from infection and aiding in the wound healing process. At present, the best burn wound dressing remains unknown. This study aimed to assess the efficacy of honey versus silver sulfadiazine dressing (SSD) for the treatment of superficial and partial thickness burns. We performed a systematic review and meta-analysis using the PubMed, MEDLINE and Embase databases to find relevant randomised control trials (RCTs) for inclusion. The outcomes measures included complete burn wound healing time, the proportion of wounds rendered sterile and subjective pain relief associated with the respective dressing type. This review was completed in line with PRISMA guidelines and has been registered with PROSPERO (Study ID: CRD42022337433). All studies in the English language that assessed honey versus SSD for patients with superficial or partial thickness burns were included. Quality and risk of bias assessments were performed using the Cochrane RoB2 tool. Seven studies were identified: totalling a population of 582 patients. From three studies, meta-analysis showed no significant difference in complete wound healing time (p = 0.06). Meta-analysis from five studies highlighted an overall significant difference favouring honey dressing in the proportion of wounds rendered sterile at day 7 post-injury (OR 10.80; 95% CI [5.76, 20.26]; p 2 = 88%). We conclude that honey dressings may be as or more effective than SSD in the treatment of superficial and partial thickness burn injuries. However, due to the low quality of available studies in this field, further research is necessary to establish the optimum burn dressing. Ideally, this should be conducted in the form of prospective three-arm RCTs in accordance with the CONSORT statement

Immunohistochemical over expression of p53 in head and neck Squamous cell carcinoma: clinical and prognostic significance

Abstract Objective Immunohistochemical over expression of p53 is considered as a marker of poor prognosis in many cancers. Therefore, we aimed to evaluate immunohistochemical overexpression of p53 in 121 cases of head and neck Squamous cell carcinoma and its association with various clinicopathologic features and survival. Results Total 66.1% (80 cases) expressed positive p53 expression, 34% (29 cases) revealed no p53 expression, while focal positive p53 expression was noted in 9.9% (12 Cases). Moreover, high p53 expression (> 70%) was noted in 26.4% (32 cases), while 19% (23 cases) showed 51–70% p53 expression. On the basis of intensity of p53 staining; strong p53 expression was noted in 39.7% (48 cases), while 24.8% (30 cases) and 10.7% (13 cases) revealed intermediate and weak p53 expression respectively. Significant association of p53 intensity of expression with extranodal extension and higher tumor grade (grades II and III) was noted. p53 is useful prognostic biomarker in head and neck Squamous cell carcinoma and therefore we suggest that more large scale studies are needed to evaluate its prognostic significance in our population

Development and characterization of natural polyelectrolyte capsules for drug delivery applications

379-384Nanotechnology has provided numerous cutting-edge applications in drug delivery, biosensors, nanorobots, biomedical devices and nanocarriers. Polyelectrolyte mediated nanocapsules contributes a significant development as drug carriers for more than a decade. Majority of the nanocapsules employed in the drug delivery system are fabricated using synthetic materials leading to many health complications. In this research, natural polyelectrolyte capsules are prepared using carboxy methyl cellulose (CMC) and chitosan by dip coating technique. The capsules are used for the delivery of antibacterial drug by encapsulating ciprofloxacin hydrochloride into the capsule interiors. The drug release study has been carried out by altering the permeability of the capsule shell. The optimal pH for the drug encapsulation has been established at 2.3 pH and 381 μg of drug is loaded in 60 min. The drug release study is performed at three different pH conditions of 2.0 pH, 6.0 pH, and 7.2 pH respectively and the release media chosen is water and PBS. Maximum amount of drug release (367 μg) is achieved at pH 2.0 within 48 hours. The study demonstrates an easy and effective delivery of antibacterial drug from natural polyelectrolyte capsules