BackgroundGood communication in healthcare between professionals and between professionals and patients is important in delivering high-quality care. Evidence of translation of technical skills taught through simulation into the clinical environment has been demonstrated, but the evidence for the impact of communication skills is less well known.ObjectivesTo identify and critically appraise the evidence for the impact of communication taught through simulation-based education (SBE) and use this evidence to suggest a model for future SBE interventions for communication skills.Study selectionMEDLINE, CINAHL, EMBASE and PsycINFO were searched for articles pertaining to communication skills taught through simulation. A content expert was consulted to suggest additional studies. 1754 studies were initially screened for eligibility, with 274 abstracts screened further. 147 full-text articles were further assessed for eligibility, with 79 of these excluded. The remaining 68 studies were reviewed and 18 studies were included in the qualitative synthesis as studies designed to show benefits beyond the simulation centre.FindingsThe 18 identified studies with an impact at a Kirkpatrick level of ≥3, are analysed; 4 looking specifically at communication between healthcare professionals and 14 looking at communication between health professionals and patients or relatives.ConclusionsThere is some evidence that the improvements in communication taught through simulation can be translated into benefits measurable beyond the simulation centre, but this evidence is limited due to the way that most of the studies are designed. We suggest a model for SBE aimed at teaching communication skills that is informed by the current evidence and takes into account the need to collect higher-level outcome data.

IntroductionLearning from simulation takes place to a large extent in debriefing; however, there is still sparse knowledge about the advantages and disadvantages of debriefing methods. 2 common forms are video-assisted and oral only debriefing. We set out to determine if there is increased knowledge acquisition for candidates undergoing video, rather than oral debriefing.MethodsSecond year doctors were randomised to a training day with oral or video feedback. Candidates underwent an emergency clinical scenario followed by feedback. The candidates completed 30 multiple choice questions related to managing common clinical emergencies presimulation and postsimulation training.ResultsThere was no significant difference in the postscore mean for the oral debriefing (128.3, SD 5.16) and video-assisted debriefing group (127.1, SD=5.96). There was significant interaction between precourse and postcourse scores with superior knowledge acquisition for candidates with lower precourse scores (p=0.008). The candidates with lowest precourse score showed significant improvement in the orally debriefed group in comparison to video debriefed group.DiscussionOur results showed that video debriefing has equivocal effect to oral debriefing. Oral debriefing provides superior knowledge acquisition to learners with lower precourse test scores.

SUMMARYThis is the first case of skull base osteomyelitis presenting with isolated bilateral hypoglossal nerve palsy reported in the literature. A 75-year-old man presented with tongue paralysis without any other cranial nerve palsy. He was otherwise well apart from recently having a high prostate-specific antigen level recorded. Investigations for malignancy or cerebrovascular insult were negative with the diagnosis of skull base osteomyelitis confirmed using CT. Following treatment with intravenous antibiotics for 6 weeks, symptoms resolved. BACKGROUND

Vasculitis is a descriptive term for a wide variety of conditions characterised by inflammation of the blood vessels that may occur as a primary process or secondary to an underlying disease. Occlusive vasculopathy is a different clinical entity characterised by skin changes and ulceration of the lower extremities because of thrombosis of the small vessels of the dermis and is usually associated with pre-thrombotic conditions. Both conditions can be confirmed or excluded by skin biopsy. We report the case of a 63-year-old woman presenting with upper and lower respiratory tract symptoms followed by a vasculitic rash on both legs. The patient underwent extensive radiological and laboratory investigations that were negative apart from positive coronavirus OC43. A biopsy of the skin was performed. Considering the clinical presentation and the investigations performed, the diagnosis of small vessel vasculopathy following coronavirus OC43 has been suggested by the authors.

Primary spontaneous upper extremity deep vein thrombosis is characterised by thrombosis within deep veins draining the upper extremity due to anatomical abnormalities of the thoracic outlet causing axillosubclavian compression and subsequent thrombosis. It is an uncommon condition that typically presents with unilateral arm swelling in a young male following vigorous upper extremity activity. The diagnosis of this condition is usually made by Doppler ultrasound, but other investigations are mandatory to exclude the secondary causes of upper extremity DVT. Different treatment options are available including anticoagulation, thrombolysis, and surgery. We report the case of a young healthy male with athletic physique who presented with pain and swelling of his dominant arm after weightlifting in the gym.