Introducing endovenous laser therapy ablation to a national health service vascular surgical unit e the aberdeen experience

Objectives: To report early clinical outcomes and learning experience following the introduction of endovenous laser ablation (EVLA) to an NHS vascular unit. Design: Prospective observational study. Results: Between February 2006 and January 2008, 631 consecutive patients underwent EVLA to 704 refluxing truncal veins e 579 GSV, 119 SSV and 6 straight segments of anterior accessory GSV. 275/631 (44%) patients had local anaesthesia (LA) plus sedation, 237 (38%) had LA only and 119 (18%) had general anaesthesia. All were treated using the 810 nm diode laser. Adjuvant procedures on-table included foam sclerotherapy 129/704 (18%), multiple stab avulsions 53/ 704 (8%) and 3 limbs had both. Three-month follow-up with duplex examination is complete in 635/704 limbs (90%). Complete occlusion was noted in 610 veins (96%), 14 (2.2%) were partially occluded and 11 (1.7%) showed no occlusion. 193 (30%) of the 635 limbs seen at follow-up required further treatment for residual varicosities using foam sclerotherapy. There has been one non-fatal pulmonary embolus associated with EVLA and no other complications. Conclusions: EVLA is safe and technically effective. It has a defined learning curve requiring new operator skills which can be readily acquired.peer-reviewe

Relationship between acute stress and clinical performance in medical students : a pilot simulation study

Funding: This study ran as part of the MBChB curriculum at the University of Aberdeen and no additional funding was required.Peer reviewedPostprin

Endothelin ETA receptors predominate in chronic thromboembolic pulmonary hypertension.

AIMS: Endothelin-1 levels are raised in chronic thromboembolic pulmonary hypertension. Our aim in this study was to identify the presence of endothelin receptors in patients with CTEPH by analysing tissue removed at pulmonary endarterectomy. MAIN METHODS: Pulmonary endarterectomy tissue cross-sections were analysed using autoradiography with [(125)I]-ET-1 using ligands selective for ETA or ETB to determine sub-type distribution. The precise cellular localisation of ETA and ETB receptors was determined using selective antisera to both sub-types and compared with haematoxylin and eosin, Elastic Van Gieson and smooth muscle actin labelled sections. KEY FINDINGS: Two patterns of ET-1 binding were found. In sections with frequent recanalised channels, ET-1 bound to the smooth muscle cells surrounding the channels. In sections where there was less organised thrombus with no obvious re-canalisation, minimal ET-1 binding was observed. Some contractile type smooth muscle cells not associated with recanalised channels and diffusely spread throughout the PEA material were associated with ET receptor antibody binding on immunohistochemistry. There was a greater expression of the ETA receptor type in the specimens. SIGNIFICANCE: The presence of ET-1 receptors in the chronic thrombus in proximal CTEPH suggests ET-1 could act not only on the distal vasculopathy in the unobstructed vessels but may also stimulate smooth muscle cell proliferation within chronic clot. The abundance of ET receptors within the tissue provides evidence that the ET pathway is involved in the pathology of chronic thrombus reorganisation leading to CTEPH providing a rationale for the repurposing of ET receptor antagonists in the treatment of this condition.We acknowledge the support of the referring UK centres for PH; the Pulmonary Hypertension Association-UK, Wellcome Trust award WT107715/Z/15/Z, Programmes in Translational Medicines and Therapeutics (085686) and in Metabolic and Cardiovascular Disease (096822/Z/11/Z), the British Heart Foundation PG/09/050/27734, MRC and the NIHR Cambridge Biomedical Research Centre. We also acknowledge the support of the Cambridge NIHR BRC Cell Phenotyping Hub and the Papworth Hospital Research Tissue Bank.This is the final version of the article. It first appeared from Elsevier via https://doi.org/10.1016/j.lfs.2016.02.03

Incorporating patient partner scores into high stakes assessment : an observational study into opinions and attitudes

Peer reviewedPublisher PD

Predictive validity of the UK clinical aptitude test in the final years of medical school:a prospective cohort study

Peer reviewedPublisher PD

Chronic venous insufficiency and lower limb ulceration : aetiology, treatment and provision of care

Study 1:  Outcomes after superficial venous surgery 1a: Quality of life (QoL) after varicose vein (VV) surgery.  203 consecutive patients undergoing VV surgery completed the Aberdeen Varicose Vein Severity Score (AVSS) QoL questionnaire pre-operatively, 4 weeks, 6 months and 2 years post-operatively.  VV surgery leads to a significant improvement in AVSS, sustained at 2 years.  Patients having surgery for recurrent VV score worse at all time-points than patients with primary VV but still enjoy a significant improvement in QoL. 1b:  The effect of long saphenous vein (LSV) stripping on QoL.  66 of the 203 patients in study 1a had pre- and post-operative venous duplex.  Even in a specialised vascular unit where stripping is routinely attempted, only 25/66 (38%) had their LSV completely stripped to the level of the knee.  Complete (as opposed to incomplete) stripping to the knee was associated with an additional improvement in AVSS above that seen in study 1a.  In those with pre-operative deep venous reflux (DVR) complete stripping did not confer this additional advantage. 1c:  The effect of long saphenous vein stripping on deep venous reflux (DVR).  In 77 limbs of 62 patients from study 1b, complete stripping was associated with reversal of pre-operative superficial femoral and popliteal vein reflux.  Incomplete stripping was associated with the development of DVR in previously normal deep veins. Study 2:  Lower limb ulceration:  delivery of care and aetiology.  2a:  Delivery of care for lower limb ulceration.  128 patients were assessed at a one-stop leg ulcer clinic, 79% of whom had purely venous ulceration. 2b:  Aetiology of CVU:  thrombophilia.  41% of 88 patients with CVU had an identifiable thrombophilic abnormality.  Thrombophilia was 3-20 times more common than in the general population, but similar to rates reported in patients with a first episode of venous thrombosis.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

OSCE rater cognition – an international multi-centre qualitative study

Introduction: This study aimed to explore the decision-making processes of raters during objective structured clinical examinations (OSCEs), in particular to explore the tacit assumptions and beliefs of raters as well as rater idiosyncrasies. Methods: Thinking aloud protocol interviews were used to gather data on the thoughts of examiners during their decision-making, while watching trigger OSCE videos and rating candidates. A purposeful recruiting strategy was taken, with a view to interviewing both examiners with many years of experience (greater than six years) and those with less experience examining at final medical examination level. Results: Thirty-one interviews were conducted in three centres in three different countries. Three themes were identifed during data analysis, entitled ‘OSCEs are inauthentic’, ‘looking for glimpses of truth’ and ‘evolution with experience’. Conclusion: Raters perceive that the shortcomings of OSCEs can have unwanted effects on student behaviour. Some examiners, more likely the more experienced group, may deviate from an organisations directions due to perceived shortcomings of the assessment. No method of assessment is without flaw, and it is important to be aware of the limitations and shortcomings of assessment methods on student performance and examiner perception. Further study of assessor and student perception of OSCE performance would be helpful

Additional file 1: of Incorporating patient partner scores into high stakes assessment: an observational study into opinions and attitudes

Patient Partner Questionnaire design of questionnaire agreed by all authors and distributed to the sample population for the study. (DOCX 68 kb