Abstractobjectives Urban areas are traditionally excluded from trachoma surveillance activities, but due to rapid expansion and population growth, the urban area of Brikama in The Gambia may be developing social problems that are known risk factors for trachoma. It is also a destination for many migrants who may be introducing active trachoma into the area. This study aimed to determine the prevalence and risk factors for follicular trachoma and trichiasis in Brikama.methods A community-based cross-sectional prevalence survey including 27 randomly selected households in 12 randomly selected enumeration areas (EAs) of Brikama. Selected households were offered eye examinations, and the severity of trachoma was graded according to WHO's simplified grading system. Risk factor data were collected from each household via a questionnaire.results The overall prevalence of trachomatous inflammation-follicular (TF) in children aged 1-9 years was 3.8% (95% CI 2.5-5.6), and the overall prevalence of trichiasis in adults aged ≥15 years was 0.46% (95% CI 0.17-1.14). EA prevalence of TF varied from 0% to 8.4%. The major risk factors for TF were dirty faces (P < 0.01, OR = 9.23, 95% CI 1.97-43.23), nasal discharge (P = 0.039, OR = 5.11, 95% CI 1.08-24.10) and residency in Brikama for <1 year (P = 0.047, OR = 7.78, 95% CI 1.03-59.03).conclusions Follicular trachoma can be considered to have been eliminated as a public health problem in Brikama according to WHO criteria. However, as the prevalence in some EAs is >5%, it may be prudent to include Brikama in surveillance programmes. Trichiasis remains a public health problem (>0.1%), and active case finding needs to be undertaken.

Hospital medicine in the UK is under unprecedented pressure, with increasing demand on physicians as well as challenges in recruiting new doctors into the physicianly specialties. We sought to assess the prevalence of the afternoon ward round and its effect on those undertaking them. We sampled each hospital within our postgraduate region, surveying junior doctors working on inpatient medical wards. We surveyed roughly two-thirds of eligible doctors, fi nding that 30% of juniors had some commitment, of varying frequency, to ward rounds beginning after 1.00pm. Of the doctors involved in afternoon ward rounds, the majority felt they contributed to late fi nishes, delayed discharge of patients, reduced team effi ciency and reduced job satisfaction. Just under 80% felt they were less likely to consider a career in hospital medicine as a result The afternoon ward round lives on, and we should not underestimate its effect. Low junior doctor morale coupled with high work intensity can lead to burnout as well as impairing the effectiveness of the clinical service. Clinical leaders should consider leaving this practice in the past so we can cope with the challenges of the future.

Background The ward round often represents the mainstay of doctor-patient contact during a hospital stay. They give the opportunity for the multi-disciplinary team to tailor individual patient care and improve patient safety and experience. In 2012 the Royal Colleges of Physicians and Nursing created a set of best practice principles for ward rounds. This audit aimed to compare current practice to these best practice principles. Methods A prospective audit of 45 inpatients on the Obstetric and Gynaecology wards of Walsall Manor Hospital in nine days of April 2013. Standards set out in the document “Ward Rounds in medicine – Principles for best Practice” were used as a benchmark. Results 89% (40/45) patients were reviewed by a doctor, 58% (23/40) of whom were reviewed before 10am, with 30% (12/40) being reviewed between 10:00 and 13:00. There was considerable variation between consultants as to the percentage of their patients which were reviewed (50–100%), the time of day at which the review took place and who reviewed the patient. Conclusions The majority of patients are probably being reviewed on most days of their hospital stay by a senior doctor. However there is considerable variation depending on the consultant responsible for the patients’ care. Reducing this variability may be important in improving patient experience and safety. By creating guidelines based on the best practice principles it may be possible to reduce variability and better involve members of the multidisciplinary team. It will also help define future audits and provide for meaningful national comparisons.

Objectives Accurate timekeeping in obstetrics is crucially important and has significant clinical and legal implications. Department of Health Guidelines promote a ‘bare below the elbows’ clinical dress code, emphasising the importance of other timepieces. This audit aimed to assess accuracy of timekeeping devices in the obstetric department in a busy district general hospital. Methods A radio-controlled clock synchronised with MSF radio signal was used as the comparison standard. Times displayed on clocks, cardiotocography monitors and other devices (mainly computer screens and anaesthetic monitors) in clinical obstetric areas were recorded. Times were recorded as fast or slow to the nearest minute, with the proposed standard as agreement between all devices and the control. Results In total, 65 timepieces were assessed. Just 5 of 27 clocks (19%) and 2 of 20 CTG monitors (10%) were correct. For other devices, 14 of 18 (78%) were correct, a considerably higher proportion. Overall, 32% of all devices displayed the same time as the control. On the labour ward, just 24% of timepieces were correct. Incorrect times ranged from -3 to +5 min5 minutes.