Background 5-Aminolevulic Acid guided surgery (5-ALA-GS) improves the extent of resection and progression free survival in patients with glioblastoma multiforme (GBM). Methods Single-center retrospective cohort study of adult patients with GBM who had surgical resection between 2013 and 2019, 5-ALA guided versus a non 5-ALA cohort. Primary outcome was the overall survival (OS). Secondary outcomes were extent of resection (EoR), performance status (PS), and new focal neurological deficit. Results 343 patients were included: 253 patients in 5-ALA-GS Group and 90 patients in the non-5-ALA-GS Group. The OS (17.47 versus 10.63 months, p<0.0001), post-operative PS (p<0.0001), PS at 6 months (p=0.002), new focal neurological deficit (23.3% versus 44.9%, p<0.0001) and radiological EoR (gross total resection (GTR) - 47.4% versus 22.9%, p< 0.0001) were significantly better in the 5-ALA-GS Group compared to non-5-ALA-GS Group. In multivariate analysis, use of 5-ALA (p=0.003) and MGMT promoter methylation (p=0.001) were significantly related with a better OS. In patients with radiological GTR, OS was also significantly better (p<0.0001) in the 5-ALA-GS Group compared to the non-5-ALA-GS Group. Conclusions 5-ALA guided surgery is associated with a significant improvement in the OS, PS after surgery and at six months, larger EoR, and fewer new motor deficits in patients with GBM.

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Background Medical school assessments, clinical placements and teaching have been disrupted by the COVID-19 pandemic. The ADAPT consortium was formed to document and analyse the effects of the pandemic on medical education in the United Kingdom (UK), with the aim of capturing current and future snapshots of disruption to inform trends in the future performance of cohorts graduating during COVID-19. Methods Members of the consortium were recruited from various national medical student groups to ensure representation from medical schools across the UK. The groups involved were: Faculty of Medical Leadership and Management Medical Students Group (FMLM MSG); Neurology and Neurosurgery Interest Group (NANSIG); Doctors Association UK (DAUK); Royal Society of Medicine (RSM) Student Members Group and Medical Student Investigators Collaborative (MSICo.org). In total, 29 medical schools are represented by the consortium. Our members reported teaching postponement, examination status, alternative teaching provision, elective status and UK Foundation Programme Office (UKFPO) educational performance measure (EPM) ranking criteria relevant to their medical school during a data collection window (1st April 14:00 to 2nd April 23:59). Results All 29 medical schools began postponement of teaching between the 11th and 17th of March 2020. Changes to assessments were highly variable. Final year examinations had largely been completed before the onset of COVID-19. Of 226 exam sittings between Year 1 and Year 4 across 29 schools: 93 (41%) were cancelled completely; 14 (6%) had elements cancelled; 57 (25%) moved their exam sitting online. 23 exam sittings (10%) were postponed to a future date. 36% of cohorts with cancelled exams and 74% of cohorts with online exams were granted automatic progression to the next academic year. There exist 19 cohorts at 9 medical schools where all examinations (written and practical) were initially cancelled and automatic progression was granted. Conclusions The approaches taken by medical schools have differed substantially, though there has been universal disruption to teaching and assessments. The data presented in this study represent initial responses, which are likely to evolve over time. In particular, the status of future elective cancellations and UK Foundation Programme Office (UKFPO) educational performance measure (EPM) decile calculations remains unclear. The long-term implications of the heterogeneous disruption to medical education remains an area of active research. Differences in specialty recruitment and performance on future postgraduate examinations may be affected and will be a focus of future phases of the ADAPT Study.