Is it time for integration of surgical skills simulation into the United Kingdom undergraduate medical curriculum? A perspective from King’s College London School of Medicine

PURPOSE: Changes in undergraduate medical curricula, combined with reforms in postgraduate education, have training implications for surgical skills acquisition in a climate of reduced clinical exposure. Confidence and prior experience influences the educational impact of learning. Currently there is no basic surgical skills (BSS) programme integrated into undergraduate curricula in the United Kingdom. We explored the role of a dedicated BSS programme for undergraduates in improving confidence and influencing careers in King's College London School of Medicine, and the programme was evaluated. METHODS: A programme was designed in-line with the established Royal College of Surgeons course. Undergraduates were taught four key skills over four weeks: knot-tying, basic-suturing, tying-at-depth and chest-drain insertion, using low-fidelity bench-top models. A Likert-style questionnaire was designed to determine educational value and influence on career choice. Qualitative data was collected. RESULTS: Only 29% and 42% of students had undertaken previous practice in knot-tying and basic suturing, respectively. 96% agreed that skills exposure prior to starting surgical rotations was essential and felt a dedicated course would augment undergraduate training. There was a significant increase in confidence in the practice and knowledge of all skills taught (p<0.01), with a greater motivation to be actively involved in the surgical firm and theatres. CONCLUSION: A simple, structured BSS programme can increase the confidence and motivation of students. Early surgical skills targeting is valuable for students entering surgical, related allied, and even traditionally non-surgical specialties such as general practice. Such experience can increase the confidence of future junior doctors and trainees. We advocate the introduction of a BSS programme into United Kingdom undergraduate curricula

Research priorities in light of current trends in microsurgical training: revalidation, simulation, cross-training, and standardisation.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/ licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly citedPlastic surgery training worldwide has seen a thorough restructuring over the past decade, with the introduction of formal training curricula and work-based assessment tools. Part of this process has been the introduction of revalidation and a greater use of simulation in training delivery. Simulation is an increasingly important tool for educators because it provides a way to reduce risks to both trainees and patients, whilst facilitating improved technical proficiency. Current microsurgery training interventions are often predicated on theories of skill acquisition and development that follow a 'practice makes perfect' model. Given the changing landscape of surgical training and advances in educational theories related to skill development, research is needed to assess the potential benefits of alternative models, particularly cross-training, a model now widely used in non-medical areas with significant benefits. Furthermore, with the proliferation of microsurgery training interventions and therefore diversity in length, cost, content and models used, appropriate standardisation will be an important factor to ensure that courses deliver consistent and effective training that achieves appropriate levels of competency. Key research requirements should be gathered and used in directing further research in these areas to achieve on-going improvement of microsurgery training

Management interventions for amputation stump neuromas : evidence based review and cost-benefit analysis

Amputation is a common military and civilian surgery with high morbidity. Patients without prostheses due to neuroma pain lose productivity and lifelong contributions, which is often underestimated. The surgical and non-surgical treatment of painful stump neuromas is controversial. An evidence-based assessment and cost-benefit analysis of painful stump neuroma management modalities emphasizes institutional awareness and disruptive technologies. An Oxford Centre for Evidence Based Methodology critical appraisal and structured literature review were used in the research. We found 154 records using a reproducible literature search strategy that included electronic databases and references. A full review of 27 manuscripts after exclusion criteria yielded data for analysis. Surgical, injectable, and electromagnetic spectrum methods were used. Surgical interventions had longer follow-up times than injection and radiofrequency treatments, which affected outcomes. CEBM level 4 evidence dominated primary literature, indicating low quality. No therapy was superior, but the risks varied. Injection therapies like sclerosing alcohol had limited success and side effects. Despite limited evidence, electromagnetic spectrum modalities showed potential. Including direct and indirect costs, amputation stump refitting costs millions annually. Compared to outpatient non-surgical interventions, laser therapy could save a lot of money. According to the study, surgical interventions are common but expensive and have limited functional success. Low-risk non-surgical methods like co-ablation, pulsed radiofrequency, and transcutaneous laser therapy have mixed results. The short follow-up of all non-surgical studies seems to limit them. Follow-up duration is crucial to outcome assessment. Long-term, low-risk laser-induced thermotherapy is promising for future research. This study emphasizes the need for more research and the economic benefits of disruptive technologies in treating painful stump neuromas.peer-reviewe

Exploring G-Protein-Coupled Receptors Regulation, Specificity and Controllability of Exosomes Release in the Neuronal Cell Line SH-SY5Y

Parkinson's disease is a neurodegenerative disease characterized by the buildup of aggregated and spread of misfolded alpha-synuclein. How the misfolded alpha-synuclein contributing to the toxicity and death of neuronal cells has been the focal point of research. The spread of alpha-synuclein has been attributed to many mechanisms, one of which is via cell-derived vesicles called exosomes. This project aims to examine the controllability of exosome release. SH-SY5Y, MCF-7 and CHO-K1 cells were transfected with dopamine receptor 3-green fluorescent protein, G-protein receptor 143 or green fluorescent protein and treated with either dopamine or L-DOPA. Medium was harvested and subjected to ultracentrifugation and a silver stain and western blot were performed. There was no significant difference in the total protein in the exosome fraction lanes between the treatment groups or within them. Another aim was to test the specificity of exosomes. Exosomes isolated from SH-SY5Y or MCF-7 were labeled with Exo-Red dye and introduced to wells containing SH-SY5Y, MCF-7 and CHO-K1 cells at room temperature and -4C. At room temperature, exosomes were observed intercellular in all of the cell lines, however, they did not deliver their content. At -4C exosome uptake was halted and they remained on the surface of the cells. Exo-Red labeled SH-SY5Y exosomes were treated with proteinase K and were introduced to CHO-K1 cells at -4C and room temperature. CHO-K1 did not take up exosomes, suggesting exosomes contain one or more necessary proteins needed to interact with the cellular membrane to initiate internalization. CHO-K1 cells were treated with versene to examine the involvement of integrin proteins. Exo-Red labeled SH-SY5Y exosomes were trapped on the surface of CHO-K1 after versene treatment. Lastly, Exo-Red labeled SH-SY5Y exosomes were biotinylated and magnetically captured then introduced to SH-SY5Y and MCF-7 cells and a silver stain and a biotinylated blot were performed. MCF-7 bound more Exo-Red labeled SH-SY5Y exosomes

Investigation Into the Role of BAP1 in DNA Damage and Repair

The DNA of living organisms is constantly experiencing wide range of DNA damaging agents that can result in altered DNA bases or more serious damage such as double-strand breaks (DSBs). Unrepaired DNA damage can lead to genome instability and it is implicated in disease process including cancer.TP53 binding-protein 1 (53BP1) is a key DSB repair protein that regulates the repair pathway choice1. It is implicated in PARP inhibitor resistance in BRCA1-dificient tumors2,3. In order to identify novel 53BP1 regulators, we performed a screen using an siRNA library against the human deubiquitinating (DUBs) enzymes with 53BP1 ionizing radiation induced foci as a read out. Two DUBs achieved a top negative score; BRCA1 Associated protein 1 (BAP1). BAP1 is an important tumor suppressor protein whose function is lost in more than 7% of all cancers4. Here we demonstrate that BAP1 stabilizes 53BP1 by preventing its ubiquitination and degradation by the proteasome. BAP1 associates with 53BP1 and it is required for 53BP1 ionizing radiation (IR)-induced foci (IRIF) formation, G2/M checkpoint and radiation sensitivity. Similar to 53BP1, BAP1 deficiency confers PARP inhibitor resistance in BRCA1-deficient cells, and it leads to impaired immunoglobulin class switch recombination. Additionally, we discovered a ubiquitin ligase, UBE2O interaction with 53BP1 diminished after IR damage, and overexpression of UBE2O leads to diminished 53BP1 IRIF formation. We show evidence that BAP1 and UBE2O binds 53BP1 nuclear localization signal (NLS) basic stretch within its minimal focus forming region (FFR), and they regulate FFR ubiquitination and recruitment to the histone basic patch. Through further work, we discovered that an NLS binding family (Karyopherin (KPNA) family) interacts with and regulates 53BP1 recruitment. Our findings shed light into important aspects of 53BP1 regulation through deubiquitination and provide mechanistic insights into the function of an important tumor suppressor BAP1

An investigation of changes in NMDA-receptor evoked monoamine efflux following administration of antidepressant drugs: a microdialysis study in vivo

It is widely accepted that the symptoms of depression are due, in part, to abnormal monoaminergic tone in the brain, primarily serotonin, noradrenaline and to a lesser extent dopamine. This constitutes the monoamine theory of depression. Antidepressants (ADs) work by increasing the extracellular concentration of monoamines at the synapse. Though, their mechanism is not fully understood, it has been suggested that chronic AD treatments can affect NMDA receptor function in the brain. Using in vivo microdialysis in freely moving rats, the effects of acute, 7-day subchronic and chronic doses of the ADs paroxetine and clomipramine treatment on the NMDA- evoked efflux of extracellular DA, 5-HT and their metabolites, DOPAC and 5-HIAA respectively in the frontal cortex were investigated. The duration of these effects after 48 hours and 14 days of drug cessation, and the effect of the co-administration of NMDA antagonists with paroxetine on monoamine levels and their metabolites was also investigated. Acute injection of paroxetine (10 and 20 mg/kg i.p.) did not affect dialysate DA or 5-HT content in the frontal cortex. Clomipramine at 10 and 20 mg/kg caused a decrease in extracellular DA without exerting any influence on dialysate 5-HT levels. Local infusion of 100μM NMDA into the frontal cortex decreased both extracellular DA and 5-HT levels in this region. 21 day treatment of rats with paroxetine and clomipramine increased 5-HT levels to 150% and 147% above basal levels respectively. The same treatment increased DA levels to 200% and 186% above basal levels. When NMDA infusion was preceded by a single injection of paroxetine/clomipramine no marked differences between NMDA and NMDA+paroxetine/clomipramine treated groups were observed. Subchronic (7-days) and chronic (21-days) treatment with paroxetine/clomipramine were able to abolish the NMDA-evoked decrease in dialysate DA and 5-HT levels. This effect lasted for a period of 48 hours but was abolished following a 14-day 'drug holiday'. This suggests that adaptive functional changes occur in NMDA receptor function during treatment with AD drugs. These results suggest that the NMDA receptor is subject to adaptive changes following chronic AD treatment. Interestingly, the co-administration of acute paroxetine with NMDA antagonists (amantadine, budipine, CGP 40116 and ifenprodil) causes an increase in extracellular 5-HT which may prove to have clinical implications

An investigation of changes in NMDA-receptor evoked monoamine efflux following administration of antidepressant drugs : a microdialysis study

EThOS - Electronic Theses Online ServiceGBUnited Kingdo

How educational theory can inform the training and practice of plastic surgeons

It is important to optimize our current learning and teaching models, particularly in a climate of decreased clinical exposure. With technical advancements and clinical care now more accountable, traditional methods of skill acquisition need to be revisited. The past decade has seen changes in plastic surgery curricula. There has also been a shift toward competency-based training programs reflecting the growing emphasis on outcomes-based surgical education. This review explores the role of educational theory in promoting effective learning in practical skills teaching. Key models of educational theory are presented and their application to plastic surgery training to an expert level are highlighted. These models include (1) learning within communities of practice (Lave and Wenger’s theory); (2) the role of the zone of proximal development and importance of the availability of expert assistance (Vygotsky’s theory); (3) skill acquisition and retention (Dreyfus’ and Dreyfus’, and Fitts’ and Posner’s theories); (4) development of expertise after repeated practice and regular reinforcement (Ericsson’s theory); and (5) the assessment of competence (Miller’s triangle). Future plastic surgeons need to possess a thorough understanding of the technical and nontechnical skills required to manage patients effectively. Surgical educators are therefore compelled to develop practical training programs that can teach each of these skills in a safe, learner-centric manner. It is hoped that new approaches to surgical skills training are designed in light of our understanding of educational theory to optimize the training of the next generation of plastic surgeons