IntroductionThere is no consensus on the optimal treatment strategy for people with advanced endometrial cancer. Neoadjuvant therapies such as chemotherapy and radiotherapy have been employed to try to reduce the morbidity of surgery, improve its feasibility and/or improve functional performance in people considered unfit for primary surgery. The objective of this review is to assess whether neoadjuvant chemotherapy or radiotherapy improves health outcomes in people with advanced endometrial cancer when compared with upfront surgery.Methods and analysisThis review will consider both randomised and non-randomised studies that compare health outcomes associated with the neoadjuvant therapy and upfront surgery in advanced endometrial cancer. Potential studies for inclusion will be collated from electronic searches of OVID Medline, Embase, international trial registries and conference abstract lists. Data collection and extraction will be performed according to the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines. The methodological quality of the studies will be assessed using the Risk of Bias 2 and Risk of Bias in Non-randomised Studies of Interventions tools. If appropriate, we will perform a meta-analysis and provide summary statistics for each outcome.Ethics and disseminationEthics approval was not required for this study. Once complete, we will publish our findings in peer-reviewed publications, via conference presentations and to update relevant practice guidelines.

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Objectives To comparatively evaluate a low‐cost otoscope with a traditional device among health care workers in Malawi. Methods The study is a prospective, comparative, qualitative observational survey of health care worker's opinions using 5‐point Likert rating scales and tick box categories in a 10‐item survey questionnaire. Twenty‐five mixed cadre health care workers from the Ear, Nose, and Throat Department of the Queen Elizabeth Hospital, Blantyre in Malawi were recruited. Outcomes measures used were ease of speculum attachment, handling, insertion, stability, the quality of view, color, build, brightness, overall ease of use, and their suitability for local work. Results The low‐cost otoscope scored statistically higher in overall combined performance, as well as in the remaining four out of the nine attributes. Notably, 54.2% of users rated the low‐cost device more suitable than the traditional device for use in low‐middle income countries, 25% were equivocal, and 20.8% preferred the traditional device. Conclusion This study found the Arclight otoscope to be an appropriate and practical substitute for more expensive traditional otoscopes for the delivery of ENT services in low resource settings. Level of Evidence N/A

IntroductionThe COVID-19 pandemic affected medical students experience of clinical neurology. Outpatient clinics reverted to telephone or video consultations. We sought to assess the impact of this change via a survey of both students and consultant neurologists.MethodsAn online 14-part questionnaire using Likert scales and free text options was distributed to all Year 4 medical students and consultant neurologists via email.Results366 students received the survey and 39 responded (an 11% response rate). 41 consultants received the survey and 9 responded (a 22% response rate). 83% of consultants felt the student’s inter- action with the patient was affected by the telephone/video software. 29% of students strongly agreed and 36% agreed that technological barriers impacted their learning experience.The free text student feedback highlighted good practice. We developed best practice guidance which included use of video consultation software, student engagement and clinic debrief. This was distributed as digestible checklists for students and clinicians. The limitations of this survey are the small response rates of both consultant and student groups.ConclusionRemote consultations are likely to remain part of neurological practice. Ongoing evaluation of its effect on medical student education and specific guidance for educators is required.

Background Neoadjuvant therapy is increasingly used in the first-line setting in people with advanced endometrial cancer despite a paucity of evidence for this approach. Objective To systematically evaluate the literature in this area. Search Strategy Electronic searches of Ovid MEDLINE, Ovid Embase, Clinical trials.gov and the International clinical trials registry platform were performed for studies published between 1990 and 2021 comparing neoadjuvant therapy with upfront debulking surgery in Stage 3 or 4 endometrial cancers. Selection Criteria Studies reporting overall survival, progression free survival, adverse events and/or quality of life in those undergoing neoadjuvant therapy or upfront debulking. Data Collection and Analysis Odds ratios (OR) and log hazard ratios (HR) along with 95% confidence intervals (CI) were calculated and pooled for analysis. Risk of bias was assessed using the ROBINS-I tool. Main Results Eight non-randomised studies with a total of 50,510 patients were identified. These showed that patients undergoing primary chemotherapy had similar survival outcomes to those undergoing primary surgery (HR 1.26 (95% CI 0.95-1.69)). Fewer patients in the neoadjuvant group had surgery but those that did were less likely to be suboptimally cytoreduced (OR 0.24; 95% CI 0.21-0.28). Surgical morbidity was no different between the two approaches (OR 0.51, 95% confidence interval 0.08-3.25). However, the potential for bias in these studies is very high. Conclusion There is significant uncertainty as to whether the outcomes for those undergoing primary cytoreductive surgery or neoadjuvant chemotherapy in the presence of unresectable disease are better. Prospective reporting of outcomes is needed.