BackgroundThere is currently conflicting evidence surrounding the effects of obesity on postoperative outcomes. Previous studies have found obesity to be associated with adverse events, but others have found no association. The aim of this study was to determine whether increasing body mass index (BMI) is an independent risk factor for development of major postoperative complications.MethodsThis was a multicentre prospective cohort study across the UK and Republic of Ireland. Consecutive patients undergoing elective or emergency gastrointestinal surgery over a 4‐month interval (October–December 2014) were eligible for inclusion. The primary outcome was the 30‐day major complication rate (Clavien–Dindo grade III–V). BMI was grouped according to the World Health Organization classification. Multilevel logistic regression models were used to adjust for patient, operative and hospital‐level effects, creating odds ratios (ORs) and 95 per cent confidence intervals (c.i.).ResultsOf 7965 patients, 2545 (32·0 per cent) were of normal weight, 2673 (33·6 per cent) were overweight and 2747 (34·5 per cent) were obese. Overall, 4925 (61·8 per cent) underwent elective and 3038 (38·1 per cent) emergency operations. The 30‐day major complication rate was 11·4 per cent (908 of 7965). In adjusted models, a significant interaction was found between BMI and diagnosis, with an association seen between BMI and major complications for patients with malignancy (overweight: OR 1·59, 95 per cent c.i. 1·12 to 2·29, P = 0·008; obese: OR 1·91, 1·31 to 2·83, P = 0·002; compared with normal weight) but not benign disease (overweight: OR 0·89, 0·71 to 1·12, P = 0·329; obese: OR 0·84, 0·66 to 1·06, P = 0·147).ConclusionOverweight and obese patients undergoing surgery for gastrointestinal malignancy are at increased risk of major postoperative complications compared with those of normal weight.

BackgroundCritical appraisal is an important skill for clinicians of the future which medical students often have limited opportunities to develop. This study aimed to evaluate whether a national journal club session could improve medical students’ confidence with critical appraisal.Methods98 medical students attended a critical appraisal lecture and supervised journal article discussions. Junior doctor mentors supported students to submit discussion points as a letter-to-the-editor. An online cross-sectional survey was administered before and after the conference.Results74 students responded, reporting increased confidence with critically appraising research articles (median score 2 vs 4, p<0.01) and increased understanding of why critical appraisal was important to their careers (median score 3 vs 5, p<0.01).DiscussionThis is the first study to demonstrate that a single national journal club session can significantly improve UK medical students’ confidence with the critical appraisal process. These opportunities are valued by medical students.

Medical education follows the clinical drive toward patient-centered care and, therefore, puts strong emphasis on the development of empathy by medical students. It has, however, been found that there is a decline in empathy throughout a student’s education. Students’ participation in role-play as the doctor has been proved to improve patient care in a clinical capacity. Here, it is proposed that patient role-play can enhance patient care holistically, by enhancing key communication skills and student’s empathy.

IntroductionSevere acute respiratory syndrome coronavirus-2 (SARS-CoV-2) or COVID-19, constitutes a public health emergency of international concern. The virus has spread globally through aerosol and contact transmission since the discovery of the SARS-CoV-2 in December 2019 in Wuhan, China. 1 As of 8 October 2020, 36,002,827 cases of COVID-19 have been reported worldwide, including 1,049,810 deaths. 2 The majority of early reported cases had the common symptoms of fever, dry cough and dyspnoea, as well as less common symptoms of headache, myalgia and sputum production. Computerised tomography (CT) scans showed bilateral lung opacities in almost all patients. 3 A meta-analysis of risk factors of critical COVID-19 patients showed that patients with dyspnoea were more likely to deteriorate into a critical condition than those who presented with fever only. There was an increased risk among the elderly (especially males over 65 years) and patients with comorbidities, such as diabetes, hypertension, cardiovascular and respiratory disease. 4 The assessment of dyspnoea is therefore an essential part of managing patients presenting with suspected COVID-19.The pandemic has placed increasing strain on scarce healthcare resources such as hospital beds and clinician time. This has been due to both increased demand and the need for stringent infection control procedures. As a result, many countries have relied on primary care systems to reduce the fl ow of patients through hospital emergency departments.A large amount of community-based diagnosis and triage of COVID-19 is currently being performed by video and telephone consultation. This has presented clinicians with a new challenge in risk-stratifying patients with shortness of breath. Dyspnoea is a diverse symptom and can be present in those who are critically ill but also in the worried well. Objective modes of assessment are required to differentiate these patient groups.The transformation of primary care from face-to-face to remote consultations has been aided by technology such as

Inconsistencies in the availability and quality of pain service provision have been noted nationally, as have lengthy waiting times for appointments and lack of awareness of the Pain Clinic role. The 2013 NHS England report stated that specialist pain services must offer multispecialty and multidisciplinary pain clinics. This national survey of multidisciplinary pain service provision in the United Kingdom and Ireland provides a snapshot of pain service provision in order to review and highlight what variations exist in multidisciplinary team (MDT) provision and working patterns. A common perception among clinicians is that financial pressures have led to alternate ways of staff utilisation with variable degrees of success. The survey included 143 pain clinics, focusing principally on MDT working patterns, MDT composition and adoption of the extended role. The results identified that the majority of Pain Clinics utilise the MDT approach. However, provision of critical components such as regular MDT meetings is highly variable as is the composition of the MDT itself and also working patterns of the individual clinicians. The survey reports the successful use of the extended roles for specialist nurses in follow up clinics. In contrast, the survey highlights that a large proportion of clinicians surveyed have reservations about both the effectiveness and the safety of utilising specialist nurses in the extended role to see new referrals of complex pain patients to pain clinics. This survey underlines the essential requirement for incorporation of greater MDT working locally and nationally and allocation of appropriate resources to facilitate this.