BackgroundInstant messaging applications have the potential to improve and facilitate communication between hospital doctors and students, hence generating and improving learning opportunities. This study aims to demonstrate the feasibility and acceptability of instant messaging communication to supplement medical education for medical students whilst on clinical attachment.MethodsA total of 6 WhatsApp Messenger (WhatsApp Inc.) groups were created for medical students on clinical attachment. These were used to provide communication within Problem Based Learning (PBL) groups for a duration of 8 weeks. The frequency and type of communication were recorded. Students’ opinions were evaluated through a structured interview process at the end of the study period. A thematic analysis was performed on the content of the instant messaging groups and on the results of the structured interviews.ResultsAll of the participants were active in their respective messaging groups (19 students and 6 tutors). A total of 582 messages, 22 images and 19 webpage links were sent. Thematic analysis on content of the instant messaging groups identified the following themes: organisational, educational and social. Thematic analysis on the content of interviews identified themes such as the ease of use of instant messaging, benefit of instant messaging to foster understanding and learning, and the ability to access recorded discussions.ConclusionThe findings of this study illustrate a method by which communication within PBL groups can be facilitated by the use of instant messaging. The results indicate the feasibility and acceptability of WhatsApp Messenger in supplementing PBL teaching for medical students, and provides a framework for studies to investigate use amongst larger cohorts of students.

BackgroundAbout one third of patients prescribed blood pressure or lipid-lowering drugs for the prevention of coronary heart disease and stroke do not take their medication as prescribed. We conducted a randomized trial to evaluate text messaging as a means of improving adherence to cardiovascular disease preventive treatment.Methods303 patients taking blood pressure and/or lipid-lowering medications were randomly assigned to being sent text messages (Text group, 151) or not being sent them (No text group, 152). Texts were sent daily for 2 weeks, alternate days for 2 weeks and weekly thereafter for 22 weeks (6 months overall), using an automated computer programme. Patients were asked to respond on whether they had taken their medication, whether the text reminded them to do so if they had forgotten, and if they had not taken their medication to determine if there was a reason for not doing so. At 6 months, use of medication was assessed.ResultsTwo patients were lost to follow-up, providing data on 301 for analysis. In the No text group 38/151 (25%) took less than 80% of the prescribed regimen (ie. stopped medication completely or took it on fewer than 22 of the last 28 days of follow-up) compared to 14/150 patients (9%) in the Text group – an improvement in adherence affecting 16 per 100 patients (95% CI 7 to 24), p<0.001. The texts reminded 98/151 patients (65%) to take medication on at least one occasion and lead to 20/151 (13%) who stopped taking medication because of concern over efficacy or side-effects, resuming treatment.ConclusionsIn patients taking blood pressure or lipid-lowering treatment for the prevention of cardiovascular disease, text messaging improved medication adherence compared with no text messaging.Trial RegistrationControlled-Trials.com ISRCTN74757601

Introduction Novel oral anticoagulants (NOACs) are becoming increasingly more prevalent as a preventative measure for venous thromboembolism and stroke prevention in atrial fibrillation (AF)1. NOACs are considered non inferior to Vitamin K antagonists (VKAs) in terms of efficacy and clinical trial evidence has suggested lower rates of complications with the use of NOACs2. There is limited published literature on the complication rates of NOAC use in the district general hospital setting. In this retrospective study, the bleeding rates amongst patients on oral anticoagulants in a district general hospital in the United Kingdom were established. Methods All patients prescribed a NOAC (Rivaroxaban, dabigatran or apixaban) or a VKA at the Princess Alexandra Hospital, a district general hospital in Harlow, United Kingdom, between 01/01/2015 and 31/12/2015 were identified from hospital pharmacy records. Electronic patient hospital records of these individuals were reviewed to identify indication for anticoagulation and any subsequent bleeding complications after initiating therapy as classified according to ICD-10 up until 31st of June 2016. Results A total of 521 patients were prescribed a NOAC. 283 patients were prescribed Rivaroxaban, 217 patients Apixaban and 21 patients were prescribed Dabigatran. 969 patients were prescribed a VKA. From 1st of January 2015 to June 31st 2016, 5.9% of NOAC patients suffered a bleed requiring a hospital visit during this time, versus 7.1% patients on a VKA. Amongst patients prescribed a NOAC, common causes of bleeding included GI haemorrhage (34.5%), epistaxis (38.0%), haemoptysis (13.8%). Amongst patients prescribed a VKA, common causes of bleeding included gastrointestinal bleeding (57.0%), epistaxis (25.2%), haemoptysis (11.9%). Rates of cerebral haemorrhage were low in both groups (0.77% of patients prescribed a NOAC and 0.61% of patients prescribed a VKA). Conclusion This data illustrates real-world experience of bleeding rates requiring hospital admission of patients on NOACs and VKA. The data suggests a lower bleeding complication rate amongst a district general hospital patient population taking NOAC compared to VKA, in keeping with previously published data. References 1. Beyer-Westendorf J, Förster K, Pannach S, Ebertz F, Gelbricht V, Thieme C, Michalski F, Köhler C, Werth S, Sahin K, Tittl L. Rates, management, and outcome of rivaroxaban bleeding in daily care: results from the Dresden NOAC registry. Blood. 2014 Aug 7;124(6):955-62. 2. Chai-Adisaksopha C, Crowther M, Isayama T, Lim W. The impact of bleeding complications in patients receiving target-specific oral anticoagulants: a systematic review and meta-analysis. Blood. 2014 Oct 9;124(15):2450-8. Disclosures No relevant conflicts of interest to declare.

Regular exercise provides many health benefits. Participation in sport is one enjoyable way of achieving this desirable objective and should be encouraged. Sports participation is also, unfortunately, associated with an increased risk of injury. The growing popularity of winter sports means that patients are more likely to present in primary care with injuries following a winter break. This article aims to cover the most common winter sports injuries of the upper limb seen in the community and considers their assessment, investigation and management.

Background: Stroke is the most common cause of adult disability and the second most common cause of death in London, United Kingdom. Social deprivation has been demonstrated to be an important risk factor for stroke. It is unclear whether individuals from a lower socioeconomic background suffer more severe strokes. In this study we aim to investigate the relationship between social deprivation and stroke severity at presentation to hospital. Method: Data was prospectively collected on all patients presenting to a London tertiary stroke centre between 1 st February 2014 and 1 st March 2017. Stroke severity on presentation to the emergency department was measured by the National Institute of Health Stroke Scale (NIHSS). This data was linked using the patient’s zip code to the UK government’s published index of multiple deprivation decile (IMDD) - 1 st decile being most deprived, 10 th decile being least deprived. Univariate and multivariate regression analyses were performed to evaluate the association between social deprivation and stroke severity. Results: Data was available for all 2514 patients that presented between 1 st February 2014 and 1 st March 2017. The median IMDD was 3. There was an association with an increase in IMDD and increasing age at presentation (p<0.05 OR 1.48), decreasing prevalence of hypertension (p<0.05 OR 0.93) and decreasing prevalence of diabetes (p<0.05 OR 0.88). Adjusting for patient characteristics and time from onset of symptoms to presentation to hospital, there was an association with an increase in IMDD and lower NIHSS at presentation to hospital (p<0.05 OR 0.76). Conclusion: The patients that presented to our hospital during this study were more likely to be from a deprived area. Despite being younger, patients from more deprived areas were observed to have higher rates of hypertension and diabetes compared with patients from less deprived areas, and this should be the subject of targeted intervention in primary care. In our analyses, deprivation was associated with a more severe clinical presentation of stroke. This finding may contribute to worse outcomes following stroke in patients from more deprived areas, and the factors underlying this relationship should be investigated further.