Having benign paroxysmal positional vertigo (BPPV) puts patients at a signifi cantly higher risk of falling. It is poorly recognised and diagnosis is frequently delayed. BPPV has been studied in outpatient settings, but there have been no studies looking at the prevalence in patients admitted with falls. This study aims to establish how common BPPV is in these patients. For a 4-month period, patients admitted on an unselected medical take were screened for an admission precipitated by a fall. Patients who consented were assessed for BPPV using the Dix-Hallpike manoeuvre. Patients who tested positive were treated using the Epley manoeuvre. The assessments were carried out by specialist physiotherapists who were experienced at assessing and diagnosing patients with peripheral vestibular disorders. Out of the 111 patients initially identifi ed, 37 (33%) were considered to be appropriate and consented to be part of the study. Of these, 20 patients (54%) had a positive Dix-Hallpike manoeuvre. Of the patients included in the study, over half tested positive for BPPV. This merits further study. Potentially, there is a proportion of patients admitted with falls who have an easily treatable contributing factor that is not being identifi ed with standard practice.
This umbrella review aimed to systematically identify the peri-operative risk factors associated with post-operative cognitive dysfunction (POCD) using meta-analyses of observational studies. To date, no review has synthesised nor assessed the strength of the available evidence examining risk factors for POCD. Database searches from journal inception to December 2022 consisted of systematic reviews with meta-analyses that included observational studies examining pre-, intra- and post-operative risk factors for POCD. A total of 330 papers were initially screened. Eleven meta-analyses were included in this umbrella review, which consisted of 73 risk factors in a total population of 67,622 participants. Most pertained to pre-operative risk factors (74%) that were predominantly examined using prospective designs and in cardiac-related surgeries (71%). Overall, 31 of the 73 factors (42%) were associated with a higher risk of POCD. However, there was no convincing (class I) or highly suggestive (class II) evidence for associations between risk factors and POCD, and suggestive evidence (class III) was limited to two risk factors (pre-operative age and pre-operative diabetes). Given that the overall strength of the evidence is limited, further large-scale studies that examine risk factors across various surgery types are recommended.
The primary aim of the study was to determine whether classroom-based acute care teaching delivered by junior doctors is comparable to that by senior doctors or faculty. This study reviews student opinions of near-peer and faculty led teaching on acute medicine to explore the differences and student preferences.
Methods:This study aimed to evaluate the role of trainees as near-peer tutors in the acute medicine tutorial based setting by randomly allocating the sessions to a junior or senior doctor. Student opinions were then invited through questionnaires and focus groups.
Results:There was no statistical difference in students' perception of the level, pace and usefulness of the sessions. All teachers were approachable and enthusiastic. Students felt that senior doctors were more knowledgeable and better able to explain concepts. Students felt that all sessions were useful to their learning.
Conclusion:Students enjoyed and derived educational benefit from both types of teaching session. Students found that senior doctor-led tutorials were more beneficial to their technical medical knowledge but felt that they gained more practical advice from junior doctor-led teaching. Trainees could provide reassurance, advice and mentorship regarding their careers and role of a doctor. Students recognised the value of tutorials by junior and senior doctors and requested the inclusion of both in their undergraduate curriculum.
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