The Influence of a ‘Gap Year’ on Medical Students

This study reports the views of second year medical students from 6 Universities on the value or not of deferring entry to medical school in order to take a ‘Gap Year’ obtained from an anonymous questionnaire. Data were analysed using Fisher’s exact test to produce a two tailed P value, with significance defined as p <0.05. A total of 184 questionnaires returned, 79 from gap year students and 105 non gap year students. Nearly all who had taken a gap year (77/79) would advise current school leavers to take one, compared to only 48/105 who had not (p <0.0001). A similar difference was observed between the two groups when asked if they thought a gap year helped students become more mature (78/79 v 46/105, p <0.0001). Similarly, gap year students were significantly more likely to consider that a gap year made it easier for them to make friends (70/79 v 26/105, p <0.0001). There was no significant difference between the two groups in finding it difficult to settle into work at University (31/79 v 36/105, p=0.5373). This study shows overwhelming support for deferring entry to medical school and taking a gap year from those students who took one, and nearly half of those students who did not. Medical school entrance committees should re-consider their advice to students who wish to defer entry in order to take a ‘gap year’

A ward-round non-technical skills for surgery (WANTSS) taxonomy.

Background: Around half of surgical adverse events occur outside the operating room. However the majority of non-technical skills (NTS) training programs have been developed for the intra-operative environment. Ward rounds are a crucial part of extra-operative care and to date no specific NTS training manual has been developed targeting emergency general surgical ward rounds. Aim: To develop a NTS taxonomy for emergency general surgical ward rounds that can be used to improve surgical team members’ NTS and improve outcomes. Methods: A literature review of existing NTS taxonomies was conducted, followed by semi-structured interviews and observational data collection, to determine good and poor surgical ward round behaviours. These behaviours were reviewed by a panel of subject matter experts and categorised into a taxonomy, using the Non-Technical Skills for Surgeons (NOTSS) taxonomy framework as a guide. Results: The Ward-round Non-Technical Skills for Surgery (WANTSS) taxonomy includes examples of good and poor ward round specific behaviours, grouped into elements and categories. The taxonomy can be used as both a training and teaching manual for the surgical team. Conclusion: Ward rounds are a crucial part of extra-operative surgical care. The WANTSS taxonomy provides surgical teams with a manual to help them improve their ward round NTS

Leg Fidgeting Improves Executive Function following Prolonged Sitting with a Typical Western Meal: A Randomized, Controlled Cross-Over Trial.

Prolonged uninterrupted sitting and a typical Western meal, high in fat and refined sugar, can additively impair cognitive and cerebrovascular functions. However, it is unknown whether interrupting these behaviours, with a simple desk-based activity, can attenuate the impairment. The aim of this study was to determine whether regular leg fidgeting can off-set the detrimental effects of prolonged sitting following the consumption of a typical Western meal, on executive and cerebrovascular function. Using a randomized cross-over design, 13 healthy males consumed a Western meal and completed 180-min of prolonged sitting with leg fidgeting of 1 min on/4 min off (intervention [INT]) and without (control [CON]). Cognitive function was assessed pre and post sitting using the Trail Maker Test (TMT) parts A and B. Common carotid artery (CCA) blood flow, as an index of brain flow, was measured pre and post, and cerebral (FP1) perfusion was measured continuously. For TMT B the CON trial signifi-cantly increased (worsened) completion time (mean difference [MD]=5.2s, d= 0.38), the number of errors (MD=3.33, d= 0.68) and cognitive fatigue (MD=0.73, d= 0.92). Compared to CON, the INT trial significantly improved completion time (MD=2.3s, d= 0.97), and prevented declines in cognitive fatigue and a reduction in the number of errors. No significant changes in cerebral perfusion or CCA blood flow were found. Leg fidgeting for 1-min on/4-min off following a meal high in fats and refined sugars attenuated the impairment in executive function. This attenuation in executive function may not be caused by al-terations in CCA blood flow or cerebral perfusion

Central and peripheral arterial stiffness responses to uninterrupted prolonged sitting combined with a high-fat meal: a randomized, controlled cross-over trial

Background and aims: Independently, prolonged uninterrupted sitting and the consumption of a meal high in saturated fats acutely disrupt normal cardiovascular function. Currently the acute effects of these behaviours performed in combination on arterial stiffness, a marker of cardiovascular health, is unknown. This study sought to determine the effect of consuming a high-fat meal (Δ= 51 g fat) in conjunction with prolonged uninterrupted sitting (180 min) on measures of central and peripheral arterial stiffness. Methods: Using a randomized crossover design, thirteen young healthy males consumed a high-fat (61 g) or low-fat (10 g) meal before 180 min of uninterrupted sitting. Carotid-femoral (cf-) and femoral-ankle (fa-) pulse wave velocity (PWV), aortic-femoral stiffness gradient (af-SG), superficial femoral PWV beta (β), and oscillometric pulse wave analysis outcomes were assessed pre and post sitting. Results: cfPWV increased significantly more following the high-fat (mean difference [MD]= 0.59 m·s-1) when compared to the low-fat (MD= 0.2 m·s-1) meal, with no change in faPWV in either condition. The af-SG significantly decreased (worsened) (ηp2= 0.569) overtime in high and low-fat conditions (ratio= 0.1 and 0.1 respectively). Superficial femoral PWVβ significantly increased over time in high- and low-fat conditions (ηp2= 0.321; 0.8 and 0.4 m·s-1 respectively). A significant interaction found that triglycerides increased over time in the high fat trial only (ηp2= 0.761). There were no significant changes in blood pressures. Conclusions: Consuming a high-fat meal prior to 180 min of uninterrupted sitting augments markers of cardiovascular disease risk more than sitting following a low-fat meal

Strategies for improving quality and safety in global health:Lessons from nontechnical skills for surgery implementation in rwanda

The Non-Technical Skills for Surgeons (NOTSS) framework is a taxonomy of cognitive and social skills that foster expertise and medical knowledge in the operating room. This framework can be used as a method to improve the quality of surgical care in global efforts to improve access to affordable surgery

Influenza Vaccine Effectiveness against Hospitalisation with Confirmed Influenza in the 2010-11 Seasons: A Test-negative Observational Study

Immunisation programs are designed to reduce serious morbidity and mortality from influenza, but most evidence supporting the effectiveness of this intervention has focused on disease in the community or in primary care settings. We aimed to examine the effectiveness of influenza vaccination against hospitalisation with confirmed influenza. We compared influenza vaccination status in patients hospitalised with PCR-confirmed influenza with patients hospitalised with influenza-negative respiratory infections in an Australian sentinel surveillance system. Vaccine effectiveness was estimated from the odds ratio of vaccination in cases and controls. We performed both simple multivariate regression and a stratified analysis based on propensity score of vaccination. Vaccination status was ascertained in 333 of 598 patients with confirmed influenza and 785 of 1384 test-negative patients. Overall estimated crude vaccine effectiveness was 57% (41%, 68%). After adjusting for age, chronic comorbidities and pregnancy status, the estimated vaccine effectiveness was 37% (95% CI: 12%, 55%). In an analysis accounting for a propensity score for vaccination, the estimated vaccine effectiveness was 48.3% (95% CI: 30.0, 61.8%). Influenza vaccination was moderately protective against hospitalisation with influenza in the 2010 and 2011 seasons