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Knowledge and attitudes of medical students towards organ donation and transplantation
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Abstracts / Annals of Medicine and Surgery 3 (2014) 47–50
incontinence. However, the significant difference in body image observed echoes findings in earlier studies. KNOWLEDGE AND ATTITUDES OF MEDICAL STUDENTS TOWARDS ORGAN DONATION AND TRANSPLANTATION K.K. Bedi*, A. Hakeem, R. Dave, K.R. Prasad, N. Ahmad. Leeds Aims: The shortage of organ donors is still a fundamental problem in the UK. Many strategies have been put forward to overcome this, one of which aims to improve awareness of organ donation and transplantation (ODT) at medical student level. This survey seeks to identify current knowledge and attitudes of medical students towards ODT. Methods: A 33-item online questionnaire was distributed to 957 medical students at the University of Leeds (October-December 2012). Results: There were 215 (22.5%) respondents. Students were aware of kidney, heart and liver transplantation (98.5%, 95.5% and 93.0%). Awareness of small intestine (39.5%) and limb (39.0%) transplants were poor. Students understood the term Brain Stem Death (BSD, 88.1%), however they lacked understanding of criteria used for BSD testing (59.2%). Despite 59.5% indicating they would feel comfortable addressing a patient's questions about ODT, 43.3% were unhappy with their current knowledge. 87.6% agree that ODT teaching should be included in the curriculum. 63.8% would select a topic of transplantation for their studentselected module. Conclusion: Students have basic understanding of ODT but they lack detailed knowledge. They accept its importance and desire further teaching to supplement their current knowledge in order to be able to truly understand the issues related to ODT. VILLUS MORPHOGENESIS DURING INTESTINAL DEVELOPMENT: A PROXIMAL-DISTAL SIGNALLING CASCADE OR INTRINSIC TRIGGERING? G. Deehan*, R.W. Partridge, J.A. Davies. Edinburgh Aims: Villus morphogenesis is the process by which the luminal epithelium of the intestine changes from being a flat surface to having crypts and villi. In mammalian development, villi form in proximal bowel first and subsequently spread distally in a wave of morphogenesis. Better understanding the factors controlling the development and maintenance of villi may help guide therapies for patients suffering post-bowel resection intestinal failure. It is not known whether the propagation of villus morphogenesis occurs as a result of a proximal–distal signaling cascade, or by intrinsic factors which trigger villus growth at predetermined timepoints. An embryonic mouse tissue culture model was used to explore this. Method: Embryonic mouse small intestine was dissected at day 11.5 and cultured in a low volume of media. Four groups were established: (1) control - intestine cultured intact; (2) divided one third of the way along and reapposed at same position; (3) middle third removed (proximal third apposed to the distal third); (4) middle third reversed and re-inserted. Villus morphogenesis was assessed using brightfield microscopy, timelapse in-incubator microscopy, histology and immunohistochemistry. Results: Embryonic mouse intestine was successfully cultured in vitro for 5-7 days. During this time it elongated, commenced rhythmical peristaltic contractions and develop villi. The wave of villus morphogenesis was not affected by dissecting and reapposing in-situ. A delay was seen at the join when the middle third of the gut was removed. When the middle third was reversed, villi developed distally prior to proximally. Conclusion: Our findings suggest that villus morphogenesis occurs due to location-specific intrinsic factors, rather than a proximal to distal signalling cascade. Further work is required to quantify villus growth and explore candidate triggering factors. PATI: PATIENT ACCESSED TAILORED INFORMATION N.M. Foley*, G. Connolly, S. Tabirca, B. Maher, T. Cil, M.A. Corrigan. Cork Aims: Gaining empowerment through knowledge is a common theme among breast cancer patients. Information gathering can reduce feelings of uncertainty and produce feelings of hope and being in control. We have
developed a mobile application that is not only educational but also supports early discharge and remote monitoring of post operative patients, independent of geographical location. Methods: Developed over 6 months, the app contains patient tailored content, including information on patient specific surgery as well as general breast cancer related information. Patients update drain output and pain scores daily; information which is directly relayed to the phone of the relevant breast care nurse and surgeon. Additionally patients can communicate anonymously with other study participants through a moderated ‘whiteboard’. Direct patient video/audio education is delivered on drain and wound care, along with physiotherapy and past patients delivering frequently asked questions. Results: Adhering to eMedical developmental protocols and in partnership with NALA (national adult literacy agency) the application is now available on iPads used by participating breast cancer patients. The study is at the accrual stage with data collected on knowledge acquisition, anxiety and technology familiarity. In tandem qualitative and quantitative assessment of use of the app is also collected. Conclusions: This project reflects the initial stages in the development of online patient pathways for breast cancer care. PATI will empower patients and primary care, shifting the care paradigm away from tertiary centres and towards the community. PROGRESSION OF OPEN APPENDECTOMIES DURING ST3 R. Fernandes*, P.S. Basnyat. Ashford Aims: The purpose of the study was to assess the performance of a first year surgical registrar to perform an Appendicectomy. Duration of the operation, length of stay post-surgery, readmission, complications and analgesic requirements following surgery were evaluated. Methods: Data was collected prospectively between September 2012September 2013 on all appendicectomies done by a single surgical trainee in a District General Hospital. Results: 82 Appendicectomies (Open) were performed during the year. Intra-operative TEP blocks were given to all patients. There was no significant difference in ASA status between groups of patients in each quarter. The number of operations in each quarter was identified; 17, 22, 23 and 20 respectively. The mean duration of the operation shortened from 78 minutes in the first quarter to 41 minutes in the final quarter. The post operative length of hospital stay also shortened from a mean 1.8 days in the first quarter to 1.1 days in the final quarter. 17% of patients operated during the first quarter required opiates on day 1 post operation whilst only 5% of patients operated on in the final quarter required such analgesia. There were 3 cases of readmission. Two patients had histology of neoplasia requiring further surgery and one patient had a collection which was treated conservatively with antibiotics. Conclusions: The results show that as a trainee builds experience their performance and operative outcomes also improve. The District General Hospital setting provides good exposure and encourages performance to improve from the given caseload. This is within the current climate of the European Working Time Directive and a consequentially reduction in trainee operating time. SIGMOID VOLVULUS: SURGICAL INTERVENTION OR CONSERVATIVE MANAGEMENT? N. Heywood*, W. Chu, M. Wilkinson. Morecambe Bay Aims: Sigmoid Volvulus is the most common form of volvulus of the gastrointestinal tract and accounts for 8% of intestinal obstruction. There are no specific guidelines and non-definitive management has high recurrence rates. Our aim was to review current practice over a 5 year period. Methods: 20 patients were identified through clinical coding to have a diagnosis of sigmoid volvulus (age range 48-97 years). Each underwent restrospective review of management. Results: 14 (70%) were treated conservatively with either flatus tube insertion or flexible sigmoidoscopy. 6 (30%) underwent definitive surgical intervention (2 with primary anastomosis, 3 end colostomy, 1 loop colostomy). Mean survival in those treated conservatively (age range 76-97)
Abstracts / Annals of Medicine and Surgery 3 (2014) 47–50
incontinence. However, the significant difference in body image observed echoes findings in earlier studies. KNOWLEDGE AND ATTITUDES OF MEDICAL STUDENTS TOWARDS ORGAN DONATION AND TRANSPLANTATION K.K. Bedi*, A. Hakeem, R. Dave, K.R. Prasad, N. Ahmad. Leeds Aims: The shortage of organ donors is still a fundamental problem in the UK. Many strategies have been put forward to overcome this, one of which aims to improve awareness of organ donation and transplantation (ODT) at medical student level. This survey seeks to identify current knowledge and attitudes of medical students towards ODT. Methods: A 33-item online questionnaire was distributed to 957 medical students at the University of Leeds (October-December 2012). Results: There were 215 (22.5%) respondents. Students were aware of kidney, heart and liver transplantation (98.5%, 95.5% and 93.0%). Awareness of small intestine (39.5%) and limb (39.0%) transplants were poor. Students understood the term Brain Stem Death (BSD, 88.1%), however they lacked understanding of criteria used for BSD testing (59.2%). Despite 59.5% indicating they would feel comfortable addressing a patient's questions about ODT, 43.3% were unhappy with their current knowledge. 87.6% agree that ODT teaching should be included in the curriculum. 63.8% would select a topic of transplantation for their studentselected module. Conclusion: Students have basic understanding of ODT but they lack detailed knowledge. They accept its importance and desire further teaching to supplement their current knowledge in order to be able to truly understand the issues related to ODT. VILLUS MORPHOGENESIS DURING INTESTINAL DEVELOPMENT: A PROXIMAL-DISTAL SIGNALLING CASCADE OR INTRINSIC TRIGGERING? G. Deehan*, R.W. Partridge, J.A. Davies. Edinburgh Aims: Villus morphogenesis is the process by which the luminal epithelium of the intestine changes from being a flat surface to having crypts and villi. In mammalian development, villi form in proximal bowel first and subsequently spread distally in a wave of morphogenesis. Better understanding the factors controlling the development and maintenance of villi may help guide therapies for patients suffering post-bowel resection intestinal failure. It is not known whether the propagation of villus morphogenesis occurs as a result of a proximal–distal signaling cascade, or by intrinsic factors which trigger villus growth at predetermined timepoints. An embryonic mouse tissue culture model was used to explore this. Method: Embryonic mouse small intestine was dissected at day 11.5 and cultured in a low volume of media. Four groups were established: (1) control - intestine cultured intact; (2) divided one third of the way along and reapposed at same position; (3) middle third removed (proximal third apposed to the distal third); (4) middle third reversed and re-inserted. Villus morphogenesis was assessed using brightfield microscopy, timelapse in-incubator microscopy, histology and immunohistochemistry. Results: Embryonic mouse intestine was successfully cultured in vitro for 5-7 days. During this time it elongated, commenced rhythmical peristaltic contractions and develop villi. The wave of villus morphogenesis was not affected by dissecting and reapposing in-situ. A delay was seen at the join when the middle third of the gut was removed. When the middle third was reversed, villi developed distally prior to proximally. Conclusion: Our findings suggest that villus morphogenesis occurs due to location-specific intrinsic factors, rather than a proximal to distal signalling cascade. Further work is required to quantify villus growth and explore candidate triggering factors. PATI: PATIENT ACCESSED TAILORED INFORMATION N.M. Foley*, G. Connolly, S. Tabirca, B. Maher, T. Cil, M.A. Corrigan. Cork Aims: Gaining empowerment through knowledge is a common theme among breast cancer patients. Information gathering can reduce feelings of uncertainty and produce feelings of hope and being in control. We have
developed a mobile application that is not only educational but also supports early discharge and remote monitoring of post operative patients, independent of geographical location. Methods: Developed over 6 months, the app contains patient tailored content, including information on patient specific surgery as well as general breast cancer related information. Patients update drain output and pain scores daily; information which is directly relayed to the phone of the relevant breast care nurse and surgeon. Additionally patients can communicate anonymously with other study participants through a moderated ‘whiteboard’. Direct patient video/audio education is delivered on drain and wound care, along with physiotherapy and past patients delivering frequently asked questions. Results: Adhering to eMedical developmental protocols and in partnership with NALA (national adult literacy agency) the application is now available on iPads used by participating breast cancer patients. The study is at the accrual stage with data collected on knowledge acquisition, anxiety and technology familiarity. In tandem qualitative and quantitative assessment of use of the app is also collected. Conclusions: This project reflects the initial stages in the development of online patient pathways for breast cancer care. PATI will empower patients and primary care, shifting the care paradigm away from tertiary centres and towards the community. PROGRESSION OF OPEN APPENDECTOMIES DURING ST3 R. Fernandes*, P.S. Basnyat. Ashford Aims: The purpose of the study was to assess the performance of a first year surgical registrar to perform an Appendicectomy. Duration of the operation, length of stay post-surgery, readmission, complications and analgesic requirements following surgery were evaluated. Methods: Data was collected prospectively between September 2012September 2013 on all appendicectomies done by a single surgical trainee in a District General Hospital. Results: 82 Appendicectomies (Open) were performed during the year. Intra-operative TEP blocks were given to all patients. There was no significant difference in ASA status between groups of patients in each quarter. The number of operations in each quarter was identified; 17, 22, 23 and 20 respectively. The mean duration of the operation shortened from 78 minutes in the first quarter to 41 minutes in the final quarter. The post operative length of hospital stay also shortened from a mean 1.8 days in the first quarter to 1.1 days in the final quarter. 17% of patients operated during the first quarter required opiates on day 1 post operation whilst only 5% of patients operated on in the final quarter required such analgesia. There were 3 cases of readmission. Two patients had histology of neoplasia requiring further surgery and one patient had a collection which was treated conservatively with antibiotics. Conclusions: The results show that as a trainee builds experience their performance and operative outcomes also improve. The District General Hospital setting provides good exposure and encourages performance to improve from the given caseload. This is within the current climate of the European Working Time Directive and a consequentially reduction in trainee operating time. SIGMOID VOLVULUS: SURGICAL INTERVENTION OR CONSERVATIVE MANAGEMENT? N. Heywood*, W. Chu, M. Wilkinson. Morecambe Bay Aims: Sigmoid Volvulus is the most common form of volvulus of the gastrointestinal tract and accounts for 8% of intestinal obstruction. There are no specific guidelines and non-definitive management has high recurrence rates. Our aim was to review current practice over a 5 year period. Methods: 20 patients were identified through clinical coding to have a diagnosis of sigmoid volvulus (age range 48-97 years). Each underwent restrospective review of management. Results: 14 (70%) were treated conservatively with either flatus tube insertion or flexible sigmoidoscopy. 6 (30%) underwent definitive surgical intervention (2 with primary anastomosis, 3 end colostomy, 1 loop colostomy). Mean survival in those treated conservatively (age range 76-97)