Response article to commentary on our article titled ‘Volvulus of the gastrointestinal tract’

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Place-names, land and lordship in the medieval earldom of Strathearn

The first aim of this thesis is to present a comprehensive toponymic listing and analysis for six parishes of Western Strathearn, and this is done in Part One where approximately 2500 place-names are considered. The medieval parishes of BQR, COM, TEX, MUT, MZX and MXZ form a continuous, largely upland, area, topographically distinct from the Strathearn parishes to the east, and with the exception of Innerpeffray (part of MXZ, see esp. Part Two, Appendix 1b) somewhat less affected, in the 12c to 14c at least, by inward migration of Anglo-Norman and other non-Gaelic groups or individuals. Thus we might expect this western area to be the most conservative part of an earldom that Cynthia Neville has characterised as conservative and insular as late as 13c when compared to other major Scottish earldoms and lordships (Neville 1983, eg vol i, 156, Neville 2000, 76). The core lands of the more easterly medieval parish of FOW were subjected to the same comprehensive toponymic analysis. Though that toponymic material could not be included for reasons of space, it has contributed, along with the material from the six parishes covered in the gazetteers below, to the second main aspect of the thesis, the discussion of lordship and land organisation in Part Two. In Part Two will also be found an introduction to the earldom of Strathearn and a discussion of a number of aspects of its history, as well as appendices giving additional information relevant to the topics discussed in the body of the thesis. The parish unit was chosen as the basis for the organisation of this thesis since John Rogers (Rogers 1992, esp. 125-7) has shown the fundamental link between the form of the ecclesiastical parishes, whose creation was complete by 12c, and pre-existing units of land usually referred to as multiple estates, a multiple estate being a group of individual estates, not necessarily contiguous, organised and operated as a coherent social, tenurial and economic unit. As Rogers puts it, multiple estates were essentially units of lordship, taking the form of a principal settlement or caput with a number of dependent settlements. They contained within their bounds all the resources required to support their economies and to produce the necessary renders. Accordingly they were arranged in the landscape to exploit those resources, a process which often produced irregular geographical forms, including areas detached from the main body of the estate. This process frequently led to a specialisation of function, such as the management of pasture, amongst the component settlements. Jones (1976) discusses the multiple estate in the context of the early British Isles, Dodgshon (1981, esp. 58ff) in a Scottish context. The latter writer says (op. cit., 58) that in their variety of scale, multiple estates have often been likened to a parish, though some were undoubtedly larger, adding that lordship was exercised over them by a tribal chief, a king or a feudal baron. Many of these characteristics will be found relevant to the discussion of land organisation and lordship in Part Two. In our present state of knowledge, then, the medieval parishes are the best representation we have of the patterns of land organisation in Strathearn as they may have been in the time of the late Pictish and early Scottish kingdoms. A practical demonstration of the relevance of parish boundaries lies in the fact that it is rare indeed to find a settlement place-name whose area of reference straddles the boundary of a medieval parish. It is overwhelmingly within the context of the original parish that the place-names of an area have coherence and are most likely to give up their secrets

Randomised controlled trial comparing rubber band ligation with stapled haemorrhoidopexy for Grade II circumferential haemorrhoids : Long-term results

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Teaching webside manner: development and initial evaluation of a video consultation skills training module for undergraduate medical students

Background Video consultations are increasingly used to communicate with patients, particularly during the current COVID-19 pandemic. However, training in video consultation skills receives scant attention in the literature. We sought to introduce this important topic to our undergraduate medical school curriculum. Objective To increase final year medical students’ video consultation skills and knowledge. Methods We used Plan, Do, Study, Act (PDSA) quality improvement methodology with a pre-post study design to develop a teaching session for 5th year medical students, informed by a literature review and online clinician survey. The 2 hour session comprised an introduction and three practical stations: patient selection and ethics, technology and example videos, and simulation. Subjective pre- and post-session confidence was reported by students across seven domains using 5-point scales (1: not at all confident; 5: extremely confident). Students and facilitators completed post-session feedback forms. Results The 40 students and 3 facilitators who attended, over two separate teaching sessions, provided unanimously positive feedback. All students considered the session relevant. Subjective confidence ratings (n = 34) significantly increased from pre- to post-session (mean increase 1.78, p < 0.001). Conclusions The inaugural teaching session was well-received and subjective assessment measures showed improvement in taught skills. This pilot has informed a UK-wide multi-centre study with subjective and objective data collection

Assessment of causal link between psychological factors and symptom exacerbation in inflammatory bowel disease:a protocol for systematic review of prospective cohort studies

Background Inflammatory bowel disease is an idiopathic chronic disease that affects around 28 million people worldwide. Symptoms are distressing and have a detrimental effect on patients’ quality of life. A possible link between exacerbation of symptoms and psychological factors has been suspected but not established. Previous reviews concerned with this link had conceptual and methodological limitations. In this paper we set out a protocol that lays the foundations for a systematic review that will address these shortcomings. The aim of this review is to provide researchers and clinicians with clarity on the role of psychological factors in inflammatory bowel disease symptom exacerbation.Method/design We will identify all original, published, peer reviewed studies relevant to the topic and published in English from inception to November 2012. The databases MEDLINE, EMBASE, CINAHL and PsychINFO will be systematically searched. The search terms will include: inflammatory bowel disease, Crohn’s disease, ulcerative colitis, psychological stress, mental stress, life stress, family stress, hassles, social stress, coping, mood disorders, anxiety and depression in sequential combinations.Studies will be screened according to predetermined inclusion and exclusion criteria by two reviewers. We will include clinical prospective cohort studies of all human participants aged 18 years or over with a diagnosis of inflammatory bowel disease. All eligible papers will be independently and critically appraised using the Critical Appraisal Skills Programme (CASP) tool by two reviewers. Two reviewers will independently extract and synthesise data from the studies using a predefined data extraction sheet. Disagreements will be resolved by discussion between reviewers and a third party will be consulted if agreement is not reached. Synthesised data will be analysed using Bradford Hill criterion for causality. If data permits, meta-analysis will be performed.Discussion This study will provide the most comprehensive review and synthesis of current evidence around the link between psychological factors and symptom exacerbation in inflammatory bowel disease. Results will inform clinicians in appropriate intervention development for this patient group that would reduce symptom exacerbation and therefore improve patients’ quality of life

Grossly delayed massive subcutaneous emphysema following laparoscopic left hemicolectomy: A case report

AbstractINTRODUCTIONSurgical emphysema is a known early complication of laparoscopic surgery, common during upper gastrointestinal and gynaecological surgery; the authors present the first case of delayed subcutaneous emphysema following a laparoscopic left hemicolectomy.PRESENTATION OF CASEA 52-year-old woman underwent a laparoscopic left hemicolectomy for a sigmoid malignancy; on the third post-operative day after an uneventful procedure, she developed a massive surgical emphysema involving her face, neck and chest with associated pneumoperitoneum but without any evidence of pneumothorax. A gastrograffin enema ruled out an anastomotic leak. Apart from a borderline tachycardia, mildly low saturations and an area of erythema in her right flank, she was totally asymptomatic. The emphysema resolved spontaneously around the 6th post-operative day.DISCUSSIONMassive subcutaneous surgical emphysema after laparoscopic colorectal surgery is a rare complication and can me managed conservatively with a good outcome.CONCLUSIONTo our knowledge, this represents the first case of delayed massive surgical emphysema following colorectal surgery, the aetiology of which has still not been clearly explained, after exclusion of the most common causes

Associations between patient factors and successful colon capsule endoscopy – a prospective cohort study

Funding statement This study was funded by an NHS Highland Research Development and Innovation grant. Acknowledgements We would like to thank all patients and staff involved in the ScotCap evaluation. We would also like to thank The Data Lab for their contribution to the project.Peer reviewedPostprin

The use of mindfulness-based cognitive therapy for improving quality of life for inflammatory bowel disease patients:study protocol for a pilot randomised controlled trial with embedded process evaluation

Background: Inflammatory bowel disease (IBD) is a chronic condition with an unpredictable disease course. Rates of anxiety and depression among IBD patients in relapse (active disease symptoms) as well as in remission are higher than in the general population. Previous studies suggest that the prolonged effect of pain, anxiety, distress and depression have a detrimental effect on patients’ quality of life (QoL). Poor QoL in itself is associated with further symptom relapse. Mindfulness based cognitive therapy (MBCT) is a psychological group intervention that has the potential to improve QoL. When used in other chronic conditions, it demonstrated reduced negative effect from pain and psychological factors at completion of an 8-week MBCT course. The effect of MBCT has never been researched in IBD. The aim of this study is to obtain the information required to design a full scale randomised controlled trial (RCT) that will examine the effectiveness of MBCT in improving quality of life for IBD patients.Methods/Design: This is an exploratory RCT with embedded process evaluation. Forty IBD patients will be recruited from NHS outpatient gastroenterology clinics and will be randomised to either a MBCT (intervention) group or to await-list (control) group. All participants will undergo 16 h of structured group training over an 8-week period, with the control group starting 6 months later than the intervention group. Primary outcomes are recruitment, completion/retention rates and adherence and adaptation to the MBCT manual for IBD patients. The secondary outcome is to assess the feasibility of collecting reliable and valid data on proposed outcome measures such as quality of life, anxiety, depression, disease activity and mindful awareness. The process evaluation will use a survey and focus groups to assess the acceptability of the intervention and trial procedures for IBD patients.Discussion: The outcomes of this study will help define the barriers, uptake and perceived benefits of MBCT program for IBD patients. This information will enable the design of a full-scale study assessing the effect of MBCT on quality of life for IBD patients

Colon capsule endoscopy investigation based on faecal haemoglobin concentration in symptomatic patients to detect bowel disease

We would like to thank the biochemistry laboratory staff at Raigmore and Ninewells Hospital for processing and analysing FIT samples, and all the patients who participated in the ScotCap evaluation.Peer reviewe

Colon capsule endoscopy investigation based on faecal haemoglobin concentration in symptomatic patients to detect bowel disease

We would like to thank the biochemistry laboratory staff at Raigmore and Ninewells Hospital for processing and analysing FIT samples, and all the patients who participated in the ScotCap evaluation.Peer reviewe