Vasodilators and vasoactive substances for idiopathic sudden sensorineural hearing loss.

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BackgroundNecrotising fasciitis (NF) is a severe, devastating soft tissue infection characterised by rapidly progressing tissue necrosis. This rare condition has a high mortality rate and poses diagnostic and management challenges to the clinician. There is usually a history of trauma, which maybe trivial. Some of the premorbid conditions associated with NF are diabetes and or immunocompromised state. It requires prompt recognition and early treatment with intravenous antibiotics and extensive surgical debridement.Case presentationWe describe a 74-year-old lady who presented to our emergency department following 3 days’ history of watery diarrhoea and feeling generally unwell.She had signs of severe sepsis and was started on broad-spectrum intravenous antibiotics and fluids for sepsis with unknown source. She was found to have an area of blackish discolouration on her thigh which was suspected as necrotising fasciitis (NF) and referred to the surgeons. She had no history of trauma or significant comorbidity. She underwent surgical exploration and debridement within few hours of arrival into the emergency department and subsequent further debridement with above-knee amputation of the affected limb.She eventually died after about 48 h of hospital stay despite an early diagnosis and prompt surgical debridement and a multidisciplinary approach.ConclusionsNecrotising fasciitis has been previously reported in literature but we would like to highlight through this case the importance of looking for the source of sepsis by thorough clinical examination and the need to have a high threshold of suspicion for this rare condition and urgent involvement of a surgical team for debridement.

At present there are limited resources for simulation faculty development and educators are unable to access face-to-face courses uniformly across the region. Currently available online resources lack interactive reflective activity and recorded faculty videos which leads to a less engaging and effective learner experience. We aimed to create a structured and accredited simulation faculty development course on the Bridge online platform for educators who are novice in simulation-based education using a blended learning approach by incorporating recorded faculty videos and current available resources on eLearning For Healthcare (eLFH), Scottish Simulation framework and provide a platform with links to online resources. A scoping review was conducted to review current available online resources and face to face courses across the East of England region. Faculty across the region were contacted to understand the learning objectives, outcomes, and content of their courses. A survey was sent out to Bridge users across the region to determine how best to deliver the simulation faculty development course and whether they would find a Bridge course useful. We received 158 responses of which 94% respondents were keen to develop their simulation education skills, 74% had not received any formal training, and nearly 90% wanted a blended learning course. SIMSTEPS has been developed following a detailed gap analysis and scoping review. The course has been designed incorporating the eLFH learning modules, the Scottish framework for Simulation Faculty development. It does not replace face to face teaching but gives a starting point to develop the learners’ knowledge and skills about simulation-based education which can be enhanced further in face-to-face courses or workshops. Modules have been developed on key topics relevant to simulation-based education [1] with links to videos, recorded Faculty sessions, and online educational resources. Learners are encouraged for continuing reflective practice [2] and prompted to reflect after modules. The course would be accessible to all Bridge users (Interprofessional educators) in the East of England at no cost and can be completed by them at their own pace and time. We planned meticulously to ensure the course content meets learning objectives and ensured quality assurance by independent review of the course by established and experienced faculty. Post-course evaluation by learners will be done on course completion. A blended learning course like SIM-STEPS can potentially provide an effective resource on Simulation faculty development and improve learner experience and engagement. 1. Motola I, Devine LA, Chung HS, Sullivan JE, Issenberg SB. Simulation in healthcare education: a best evidence practical guide. AMEE Guide No. 82. Medical teacher. 2013;35(10):e1511–1530. 2. Brydges R, Manzone J, Shanks D, Hatala R, Hamstra SJ, Zendejas B, Cook DA. Self‐regulated learning in simulation‐based training: a systematic review and meta‐analysis. Medical education. 2015;49(4):368–378.

Virtual Reality (VR) simulation has opened to a lot of trainees an ability to experience various clinical scenarios in a virtual space at a time and place that suits them [1]. It also gives an opportunity for deliberate practice as one can repeat the scenario as many times as one likes till proficiency is reached. Research over the years has shown most of the learning occurs during the debriefing [2] and the VR scenario gives a unique opportunity for self-debriefing or peer-peer debriefing in small groups [3]. However, in the current VR scenarios available to trainees, there is no provision of any link at the end of the scenario to access current best practice guidelines on the topic/scenario which the learner could use as part of their self-debriefing. The project aims to create wraparound learning module around the Virtual Reality clinical scenario to include a patient journey through the hospital, current guidelines, and teaching videos so that learners could conceptualize and consolidate their learning from the VR experience VR scenarios available to Foundation doctors were chosen and a review of the topic and related standard best practice guidelines were reviewed on NICE, BTS, and similar resources. We also searched for real patient stories and easy to access procedural videos related to the topic and incorporated them on the module. Wraparound learning modules were created using a blended learning approach on Bridge online platform on topics like pneumothorax and infective exacerbation of Chronic Obstructive Pulmonary Disease. More modules are being created for the benefit of the Foundation doctors across East of England. Throughout the module reflection is encouraged and the topic is aligned to the Foundation curriculum and reviewed for quality assurance. A Likert scale survey would be sent out to the trainees who have completed the modules to assess the increase in their confidence in managing a clinical case after finishing the wraparound module. The results of the pre-course and post-course levels of knowledge, skills and confidence are being analysed. Wraparound learning modules could potentially improve learners’ experience of the VR scenario and improve learning and confidence in the clinical setting. 1. Cheng A, Kolbe M, Grant V, Eller S, Hales R, Symon B, Griswold S, Eppich W. A practical guide to virtual debriefings: communities of inquiry perspective. Advances in Simulation. 2020;5(1):1–9. 2. Rudolph JW, Simon R, Dufresne RL, Raemer DB. There’s no such thing as ‘non-judgmental’ debriefing: a theory and method for debriefing with good judgment. Simul Healthcare. 2006;1(1):49–55. 3. Pottle J. Virtual reality and the transformation of medical education. Future healthcare journal. 2019;6(3):181–185.