BackgroundCurrently there is great interest in antibiotic prescribing practices in the UK, but little is known about the experiences of the increasing numbers of recent migrants (those present in the UK for >1 year but <5 years) registered at GP practices. Qualitative research has suggested that reasons for not prescribing antibiotics may not be clearly communicated to migrants.AimThis study aimed to explore the factors that shape migrants’ experiences of and attitudes to antibiotics, and to suggest ways to improve effective communication around their use.Design and settingA qualitative study on recent migrants’ health beliefs, values, and experiences in a community setting in primary care.MethodTwenty-three recent migrants were interviewed in their preferred language by trained community researchers. The research team conducted a thematic analysis, focusing on health beliefs, engaging with health services, transnational medicine, and concepts of fairness. Experiences around antibiotics were a strong emerging theme.ResultsThree reasons were identified for antibiotics seeking: first, holding an ‘infectious model’ of illness implying that antibiotics are required quickly to avoid illness becoming worse or spreading to others; second, reasoning that other medications will be less effective for people ‘used to’ antibiotics’; and third, perceiving antibiotic prescription as a sign of being taken seriously. Some participants obtained antibiotics from their country of origin or migrant networks in the UK; others changed their mind and accepted alternatives.ConclusionPrimary care professionals should aim to understand migrants’ perspectives to improve communication with patients. Further research is needed to identify different strategies needed to respond to the varying understandings of antibiotics held by migrants.

Introduction Mishandled endotracheal cuff pressure may either make ventilation difficult or cause damage to the airway. Therefore, the aim of this audit was to assess the knowledge about endotracheal cuff pressure monitoring with a manometer and manual palpation of pilot balloon among critical care providers. Methods This audit includes 150 critical care providers having experience of handling endotracheal tube (ETT) cuff at critical care area of National Institute of Cardiovascular Diseases (NICVD), Karachi from April 2017 to June 2017. Knowledge about endotracheal cuff pressure monitoring with the manometer and deleterious effects of mishandled ETT cuff was assessed using a self-reported questionnaire. Enrolled healthcare providers were asked to palpate the patient and cuff pressure was recorded and categorized. Results Out of 150 participants, 66 (44.0%) were doctors. Only 46 (30.67%) participants had prior knowledge about ETT cuff manometer and 110 (73.33%) had never used a manometer. Similarly only 42 (28.0%) had knowledge of hazardous effects of mishandled ETT cuff. Kappa coefficient of 0.155 with p=0.015 showed significant yet low agreement between participant prediction and the actual amount of air in cuff balloon. Agreement level was comparatively higher for staff as compared to doctors with a Kappa coefficient of 0.210 (p=0.018) vs. 0.133 (p=0.099). Conclusion In this study of knowledge and practice of ETT tube cuff pressure monitoring, we observed low levels of knowledge (30.67%), poor adherence to standard practice (73.33%) and were able to demonstrate poor agreement (Kappa coefficient 0.155; p=0.015) between the palpation method and cuff manometer measurements for assessing cuff pressure.

The Scottish Mathematics Support Network (SMSN) was formed in July 2008 with the aim of creating a support network for people working in Scottish universities who were involved with, or wished to be involved with, providing mathematical and/or statistical support for their students. The consensus of the SMSN is that increasingly more students need assistance with their basic mathematical and statistical skills than was the case in the past, and that consequently mathematics support is an area on which universities will need to focus on in future years. Through networking and professional development opportunities with other practitioners in the field of mathematics and statistics support, the SMSN have developed and maintained strong links with individual practitioners, and more broadly with like-minded groups such as the sigma Network and the Irish Mathematics Learning Support Network. With the provision of mathematics and statistics support becoming more prevalent in UK Higher Education institutions, it seemed timely to assess the current state of this provision in Scotland, and to compare with the rest of the British Isles. At the 2016 SMSN AGM, it was unanimously agreed that such a study should be carried out with the SMSN committee taking responsibility for conducting the research.

Duodenal lymphoma accounts for a small percentage of gastrointestinal tumors and has a very poor prognosis. The majority of patients have little or no cure with limited time of remission. Median survival is 5 to 10 years, and most patients die of lymphoma, its complications, or complications of therapy. We report a patient with lymphoma refractory to treatment with cyclophosphamide, vincristine, and prednisone, who was successfully treated with rituximab, a CD-20 monoclonal antibody.

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60-year-old woman with a family history of colon cancer and a history of adenomatous colorectal polyps underwent surveillance colonoscopy. Her last endoscopy, three years previously, had revealed two polyps and normal colonic mucosa (Panel A). Since then, increasing constipation had developed, for which the patient took a daily dose of senna, a laxative that contains anthraquinone. Endoscopy revealed diffuse dark brown and black pigmentation throughout her colon, which is consistent with the presence of melanosis coli (Panel B). Biopsies of the affected areas showed pigment in macrophages of the lamina propria, without any evidence of inflammation or cancer (Panel C).Melanosis coli is dark brown pigmentation of the colon that occurs with the use of laxatives containing anthraquinone, such as senna. It can develop within a few months of use, and it can disappear in a few months if the use of the laxative is discontinued. Anthraquinones have a direct toxic effect on the epithelial cells of the colon that results in the production of lipofuscin, the dark pigment seen in macrophages in melanosis coli (Panel C, arrow). The cecum and rectum are the most common sites of melanosis coli, but it can affect the entire large bowel. Melanosis coli is considered a benign lesion because no association with colorectal cancer has been shown.

In this paper we discuss an intervention that was introduced at the University of Glasgow in order to address problems of scheduling face to face Peer Assisted Learning (PAL) sessions in the College of Science and Engineering (CoSE). Using Facebook groups, the authors have successfully implemented a Virtual Peer Assisted Learning (VPAL) model. We begin by discussing the background to choosing VPAL as a model and Facebook groups as a method of delivery, and then set out our model in detail. We next present some recent student feedback and discuss the strengths and weaknesses of our model. We end by also commenting on the sustainability and transferability of this design.