Heterogeneity in outcome reporting limits identification of gold-standard treatments for Hirschsprung’s Disease(HD) and gastroschisis. This review aimed to identify which outcomes are currently investigated in HD and gastroschisis research so as to counter this heterogeneity through informing development of a core outcome set(COS). Two systematic reviews were conducted. Studies were eligible for inclusion if they compared surgical interventions for primary treatment of HD in review one, and gastroschisis in review two. Studies available only as abstracts were excluded from analysis of reporting transparency. Thirty-five HD studies were eligible for inclusion in the review, and 74 unique outcomes were investigated. The most commonly investigated was faecal incontinence (32 studies, 91%). Seven of the 28 assessed studies (25%) met all criteria for transparent outcome reporting. Thirty gastroschisis studies were eligible for inclusion in the review, and 62 unique outcomes were investigated. The most commonly investigated was length of stay (24 studies, 80%). None of the assessed studies met all criteria for transparent outcome reporting. This review demonstrates that heterogeneity in outcome reporting and a significant risk of reporting bias exist in HD and gastroschisis research. Development of a COS could counter these problems, and the outcome lists developed from this review could be used in that process.

Secondary prevention after coronary artery bypass graft (CABG) surgery is imperative in slowing the progression of atherosclerosis in both native and grafted vessels. Aspirin and statins remain the key medications for all patients without significant contraindications. The evidence for dual antiplatelet therapy with clopidogrel is less convincing, but there is hope for newer antiplatelet agents, such as ticagrelor. Meanwhile, β-blockers and angiotensin converting enzyme inhibitors might only offer benefits to specific sub-groups. Post-CABG patients appear to have different medication needs to the general cardiovascular patient and respond differently. In this review, we cover the drug regimens proposed by recent guidelines and the evidence behind their use. Assessing the evidence behind these recommendations, we find that there is an unmet need in some areas for robust population-specific evidence. We hope that future research will address this gap.

William Osler was the first to be credited with taking medical students out of the lecture theatre and to the bedside Could VRS provide a meaningful learning opportunity during the first wave? Could we elicit the strengths and weaknesses of virtual simulation in medical learning?We used the Oxford Medical Simulation (oxfordmedicalsimulation.com) VRS platform where the learner manages an acutely unwell patient with specified learning objectives (opting for the 2-D to make it accessible to students at home). Scenarios were grouped, accompanied by didactic learning resources and released on a weekly schedule. Data were collected with consent on the number of scenarios accessed, performance score and student feedback.The VRS course ran for 5 weeks (access extended to 11 weeks). In total, 224 students expressed an interest in accessing the VRS platform. Of the 224 students, 64 accessed the scenarios (50% first-year students). The students accessed 821 scenarios. The average score on all first attempts of scenarios was 75%; second attempts 78% and third attempts 90% (The high initial response rate suggested student interest and engagement. The low (21%) conversion rate to accessing the VRS platform may be explained by initial technical issues and the voluntary nature of the project. The quantitative data show the importance of repetition in improving learning. Participation over time may improve with incorporation into the medical school curriculum. Lower usage among the final-year medical students may be explained by volunteering and early commencement of clinical duties. This innovation reveals some strengths of VRS: basic equipment; learner-directed; improved performance and student interest. Overall, the VRS platform allowed the delivery of a rapid response to fill a gap in clinical education. The next phase of this project will be to provide live tutor-supported debrief.

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